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BIRTH CONTROL

Using a reliable method of birth control poses challenges for street-involved youth because addressing their most basic needs of life often takes priority over preventing pregnancy. Also, many youth may not have the knowledge, money and transportation to access appropriate health care (Elliot, 2013). Others want to become pregnant because they see it as a way to get off of the streets (Lokanc-Diluzio, 2014).

REILLY’S STORY…

 

There are so many birth control choices. I don’t even know where to begin. My boyfriend says it’s up to me. I’m happy using condoms, but I don’t always have them when I need them. Besides, he doesn’t like them at all. I know that the birth control pill is the most effective method, but I’m not good at remembering to take them and they cost too much. Maybe I don’t need to worry about birth control because I haven’t got pregnant yet. I probably can’t get pregnant anyway.

In a 2014 study of British Columbian street-involved and homeless females ages 12 to 19, during their last sexual intercourse (Smith et al., 2015):

made no effort to prevent pregnancy0%
used condoms0%
used withdrawal0%
used birth control pills0%
used Depo Provera0%
used another method prescribed by a doctor (e.g. birth control patch/ring, IUD)0%
used emergency contraception0%
were not sure what method they used0%

 

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Youth who identify as being sexually or gender diverse (lesbian, gay, bisexual, transgender) are also at risk for unintended pregnancy.


 

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Not all sexually active youth wish to avoid pregnancy and not all youth pregnancies are unintended. Along with providing non-judgemental information and access to contraception, supporting youth in developing personal values regarding sexuality, identifying life goals, and understanding the realities of pregnancy and parenting, allows youth to make decisions that work best for them.

RISK FACTORS FOR UNINTENDED PREGNANCY

Any person who is sexually active and not correctly and consistently using birth control is at risk for pregnancy and STIs.

Risk factors for unintended pregnancy include:

 

  • Age of less than 30 years old.
  • Frequent intercourse.
  • Lifestyle (e.g., street involvement) or sexual patterns that make correct and consistent use of birth control difficult.
  • Known use of alcohol and/or other substances.
  • Previous contraceptive failure.

For more information on pregnancy, click here.


 

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In one year, 85% of women will get pregnant if having unprotected sex (Hatcher et al., 2011). Access for youth to no-cost birth control and prescriptions can be found at Alberta Health Services Sexual and Reproductive Health Clinics. For information on community resources, click here.

WHAT IS BIRTH CONTROL?

Birth control is also known as contraception and refers to methods used to prevent a pregnancy. Contraception works by either preventing the fertilization of egg by the sperm, or preventing the fertilized egg (embryo) from implanting in the uterus.

66%

youth

According to the 2009/2010 Canadian Community Health Survey, 66% of youth aged 15-24 had sexual intercourse at least one time (Rotermann, 2012).

99%

street-involved youth

Whereas in a 2010 Edmonton study of street-involved youth, 98.5% of youth ages 15-24, had sexual intercourse at least once (Alberta Health Services, 2011).

TYPES OF BIRTH CONTROL

Methods of contraception are sometimes divided into categories including natural family planning, hormonal, barrier, spermicidal and other methods.

Natural family planning

This is a type of birth control that does not use any drugs or devices. Types of natural family planning methods include abstinence, withdrawal, and fertility awareness based (FAB) methods.

 

Abstinence means different things to different people.  It is often referred to as being 100% safe; meaning that it completely eliminates the risk of unintended pregnancy and sexually transmitted infections (STIs). This is only true if abstinence is interpreted to mean no intimate sexual contact with another person, such as contact with vaginal or seminal fluid, any contact with the anal or genital area or intimate skin to skin contact.  Pregnancy can occur without intercourse if sperm is ejaculated near the entrance of the vagina. Abstinence may not be seen as an option for all youth given their life circumstances.

 

Withdrawal (“pulling out”) is when the penis is pulled out of the vagina before ejaculation. With typical use, this is about 73% effective at preventing pregnancy. This method is not recommended if unintended pregnancy would be a problem and emergency contraception should be considered.


 

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Birth control methods can be used safely for a long time. There is no need to take a break from birth control. Females can get pregnant right away after stopping most types of birth control. The birth control injection (Depo Provera) may delay return to fertility.

Hormonal methods

Hormonal methods are the most effective type of birth control. They contain hormones that are similar to a female’s natural hormones.

 

Some methods of birth control are combined hormonal contraception which means they contain both estrogen and progesterone. The way the combined hormones work is by preventing ovulation. If a person does not release an egg, they cannot get pregnant.

 

Examples of combined hormonal birth control methods include the birth control pill, the contraceptive patch and the vaginal ring.

Some hormonal methods contain only one hormone called progesterone. This type of contraception is often referred to as progesterone only hormonal contraception.

 

The way that progesterone only contraception works is that progesterone thickens the cervical mucus to help prevent sperm from getting into the uterus, changing the lining of the uterus which helps prevent a fertilized egg (embryo) from implanting, and it changes the movement of the ovum (egg) inside the fallopian tube to help prevent the egg and sperm from meeting. Progesterone only contraception may or may not prevent ovulation.

 

Examples of progesterone only contraception include Depo-Provera injections (“the shot”), progesterone only pills (“mini pill”), Mirena and Jaydess IUD.

Barrier methods

 

Barrier methods are methods that work by blocking sperm from getting inside the uterus. Examples of barrier methods of birth control are diaphragms and male and female condoms. For added protection some barrier methods are intended for use with a spermicide.

Spermicidal methods

 

Spermicidal methods are products that are inserted into the vagina or contraceptive device (e.g., diaphragm) prior to insertion into the vagina that help to kill sperm. The active ingredient for spermicidal products in Canada is nonoxynol-9 (N-9). Spermicidal products can come in several forms like foam, film, suppositories and creams.

Other methods

 

Other methods of birth control include the Copper IUD, vasectomy, and tubal ligation. Vasectomy and tubal ligation are sometimes referred to as sterilization and are not reversible.


 

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If there has been unprotected sex in the last five days using emergency contraception (EC) can help prevent pregnancy. There are three methods of EC: two types emergency contraceptive pills (ECPs); and Copper IUD.

 

The ECP works best if taken within first 24 hours but can be used up to 5 days. Levonorgestrel ECPs can be bought at a pharmacy without a prescription, or found at many family doctors, walk in clinics or Alberta Health Services Sexual and Reproductive Health Clinics. For information on community resources, click here. A newer type of ECP, ulipristal acetate is also available by prescription. The Copper IUD needs to be inserted into the uterus by a trained health care professional. Youth should be encouraged to call their local clinic to see if this if offered.

 

A person should do a pregnancy test if their period does not come within three weeks of using EC, or if the period is much lighter than normal. For more information on ECPs, click here.


 

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For help choosing a method of birth control, see choosing wisely – birth control selection tool

 

To learn about how effective birth control methods are at preventing pregnancy, see Contraceptive Comparative Chart

HOW TO ACCESS BIRTH CONTROL

Some birth control methods can be purchased over-the-counter (e.g., male or female condoms, emergency contraception pill, spermicidal foam).

 

Other methods require a prescription (e.g., birth control pill, patch, ring, IUD). Some methods require insertion or fitting by a healthcare provider (e.g., IUD and diaphragms).

 

Access for youth to no-cost birth control and prescriptions can be found at Alberta Health Services Sexual and Reproductive Health Clinics. For information on community resources, click here.

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BIRTH CONTROL METHODS AND STI PROTECTION

Youth need to know that not all methods of contraception provide protection against STIs. Using male condoms, female condoms, and dental dams correctly and consistently reduce the risk of STIs.

Birth Control Methods and STI Protection

CategoryMethodSTI Protection?
Natural Family PlanningAbstinenceExcellent Protection
Fertility Awareness-Based MethodsNo Protection
WithdrawalNo Protection
HormonalBirth Control PillNo Protection
Depo ProveraNo Protection
Emergency Contraception PillsNo Protection
Evra PatchNo Protection
Hormonal IUDNo Protection
Vaginal Contraceptive RingNo Protection
BarrierMale Condom (latex or polyurethane)Good Protection
Female CondomGood Protection
Diaphragm with Spermicidal JellyNo Protection
SpermicidalFoam and JellyNo Protection
The SpongeNo Protection
Vaginal Contraceptive FilmNo Protection
OtherCopper IUDNo Protection
Tubal LigationNo Protection
VasectomyNo Protection

For information on STIs, click here.


 

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Frequent use of spermicides (two or more times daily) can cause tissue irritation which may increase the risk for sexually transmitted infections and HIV.

KEY MESSAGES FOR BIRTH CONTROL

When speaking to youth about their birth control options, it is important to mention these key messages:

 

  • What matters most is correct and consistent use of the birth control method. Often this is based on age and where one is in their life (e.g., taking a pill everyday may be hard for those with unstable living conditions).
  • No method is 100% effective at preventing pregnancy.
  • Dual protection or the use of two methods (e.g., hormonal contraception and a condom) at the same time dramatically lowers the risk of unintended pregnancy and STIs.
  • Methods of birth control that protect a person for a long time and do not require daily or coital adherence tend to be associated with lower pregnancy rates. Long acting methods of birth control include IUDs and the birth control injection.
  • Emergency contraception (EC) provides a last chance to prevent pregnancy after unprotected sex.

REFERENCES

Alberta Health Services. (2011). E-SYS. Enhanced street youth surveillance Edmonton site results (1999-2010). Edmonton AB: Communicable Disease Control, Alberta Health Services.

 

Elliot, A. (2013). Meeting the health care needs of street-involved youth. Paediatrics and Child Health, 18(6), 317-321.

 

Hatcher, R.A., et al. (2011). Contraceptive Technology (20th Ed.). Ardent Media: New York.

 

Lokanc-Diluzio, W. (2014). A mixed methods study of service provider capacity development to protect and promote the sexual and reproductive health of street-involved youth: An evaluation of two training approaches. (Doctoral dissertation). Available from http://hdl.handle.net/11023/1507

 

Smith, A., Stewart, D., Poon, C., Peled, M., Saewyc, E., and McCreary Centre Society. (2015). Our communities, our youth: The health of homeless and street-involved youth in BC. Vancouver, BC: McCreary Centre Society.

 

Rotermann, M. (2012). Sexual behaviour and condom use of 15- to 24-year-olds in 2003 and 2009/2010. Health Reports, 23(1).