Canadian Contraception Consensus (Part 1 of 4)

Abstract

The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Chapter 1: Contraception in Canada Summary Statements 1. Canadian women spend a significant portion of their lives at risk of an unintended pregnancy. (II-2) 2. Effective contraceptive methods are underutilized in Canada, particularly among vulnerable populations. (II-2) 3. Long-acting reversible contraceptive methods, including contraceptive implants and intrauterine contraception (copper-releasing and levonorgestrel-releasing devices/systems), are the most effective reversible contraceptive methods and have the highest continuation rates. (II-1) 4. Canada currently does not collect reliable data to determine the use of contraceptive methods, abortion rates, and the prevalence of unintended pregnancy among reproductive-age women. (II-2) 5. A universal subsidy for contraceptive methods as provided by many of Canada's peer nations and a few Canadian provinces may produce health system cost-savings. (II-2) 6. Health Canada approval processes for contraceptives have been less efficient than those of other drug approval agencies and Health Canada processes for other classes of pharmaceuticals. (II-2) 7. It is feasible and safe for contraceptives and family planning services to be provided by appropriately trained allied health professionals such as midwives, registered nurses, nurse practitioners, and pharmacists. (II-2) Recommendations 1. Contraceptive counselling should include a discussion of typical use failure rates and the importance of using the contraceptive method consistently and correctly in order to avoid pregnancy. (II-2A) 2. Women seeking contraception should be counselled on the wide range of effective methods of contraception available, including long-acting reversible contraceptive methods (LARCs). LARCs are the most effective methods of reversible contraception, have high continuation rates, and should be considered when presenting contraceptive options to any woman of reproductive age. (II-2A) 3. Family planning counselling should include counselling on the decline of fertility associated with increasing female age. (III-A) 4. Health policy supporting a universal contraception subsidy and strategies to promote the uptake of highly effective methods as cost-saving measures that improve health and health equity should be considered by Canadian health decision makers. (III-B) 5. Canadian health jurisdictions should consider expanding the scope of practice of other trained professionals such as nurses, nurse practitioners, midwives, and pharmacists and promoting task-sharing in family planning. (II-2B) 6. The Canadian Community Health Survey should include adequate reproductive health indicators in order for health care providers and policy makers to make appropriate decisions regarding reproductive health policies and services in Canada. (III-B) 7. Health Canada processes and policies should be reviewed to ensure a wide range of modern contrace...

The not so over-the-counter status of emergency contraception in Ontario: A mixed methods study with pharmacists

“…Our findings further confirm that pharmacists have operationalized this label change in different ways. Black and Guilbert (2015) recently issued recommendations to address this issue, and our results suggest that the dissemination of evidence-based guidelines about the relationship between efficacy and weight, and a reminder to pharmacists that as an OTC product all people should be able to purchase the medication, is a priority.…”

Introducing a “same day referral” program for post-coital IUD insertion in Ontario: A mixed-methods study with pharmacists

“…E panding access to emergency contraception in Canada has long been identi ed as a priority among reproductive health and rights stakeholders [8,11,20]. urther, in recent years there has been a plethora of efforts in North merica to e pand access to long-acting, reversible contraception [21 23].…”

“…Methods of long-acting reversible contraception (LARC), including the hormonal intrauterine device (IUD), the Copper-T IUD, and implants, are safe and extremely effective at preventing pregnancies for 3-10 years [2]. In addition, the post-coital insertion of the Copper-T IUD is the most effective method of emergency contraception (EC) [3][4][5]. Insertion of the IUD within 7 days of unprotected or under-protected sexual intercourse represents an important option for women who not only want to prevent pregnancy after a specific event but also desire highly effective, ongoing contraception [5,6].…”

“…Indeed, a study conducted in Ontario found that a limited number of family medicine residents felt adequately prepared to perform an IUD insertion [9]. Although overarching trends suggest that the use of the IUD, in general, is increasing, use of the IUD as EC is minimal [4].…”

Some Hormonal Contraceptives, Hormone-Related Reproductive Breast Cancer Risk Factors Among Women in Port Harcourt: A Case-Control Study.

“…Findings on the role of hormonal contraceptives on breast cancer have not been consistent (Black et al, 2004). Using combined oral contraceptive pills as a prototype, earlier study did not find any association with breast cancer (CDC & NICHHD, 1986;Black et al, 2004); however, a collaborative group (CGHFBC, 1996) found a significant association though not when the pills have been stopped for more than 10years.…”