Birth control and pregnancy options
When speaking to traditional Elders knowledgeable about reproductive health matters, repeatedly they would refer to a woman knowing which herbs and methods to use “to make her period come.” This was seen as a woman taking care of herself and doing what was necessary.
Be sure to read Part 1 before working on this unit. See these other units for more issues related to birth control and pregnancy options:
Unit 2 – Educating Children and Youth About Sexuality
Unit 4 – Youth Sexuality and Sexual Health
Unit 5 – Teen Pregnancy
Unit 17 – HIV/AIDS and Other Sexually Transmitted Infections
Before the induction of modern medicine, the Kokums (Grandmothers) were the keepers of the knowledge of herbal medicines, including medicines for birth control. They were the midwives in the community and had knowledge of the whole gamut of medicines to cure any illness in their families. The knowledge for many of these medicines was easily shared from First Nations to the Metis.
Metis writer from Ontario
Traditionally and still today, Aboriginal people thought of having and raising children as a natural part of life, a sacred trust and a part of the circle of life. However, even in previous times, women took measures to delay having children (until other children were older or to plan births for safe times and places). Today, while some First Nations, Inuit and Metis people believe getting pregnant should be left up to the Creator, others want to decide if and when they will have children. Young people especially want to delay pregnancy to a time when we are ready to parent and are able to give our children the best start in life. People who want to choose to get pregnant want complete information and services the birth control methods, and access to abortion, adoption and parenting help that will let us make these decisions for our own good, and that of our families, communities and nations.
Fear of pregnancy can rob couples of the joy sex is able to give them. Sex without birth control will likely lead to pregnancy: research shows that 25 percent of young women who have intercourse without using some method of birth control will become pregnant within one month, and 85 percent will become pregnant within one year.’ Everyone who is sexually active needs to practise “safer sex” (i.e., preventing pregnancy and sexually transmitted infections).
For the same reasons discussed in other units, these matters are not always easy to talk about. Different people have different values. Youth may be afraid to talk to their parents, and don’t always have the skills to talk about and then act on birth control decisions with their sexual partners. There may be a lack of confidential and non-judgmental information and counselling in a community. Small and isolated communities may lack services and birth control supplies. These are all barriers to pregnancy planning and choice that communities have to try to overcome.
Preventing and Dealing with Unintended Pregnancy
Good Sex Education
Informed decisions about pregnancy start with good sexuality education because women and men need to know how their bodies work and how pregnancy comes about. Even more importantly, they will be better able to make decisions and carry them out if they feel good about their sexuality, can talk openly about sex, have good self-esteem and can choose good relationships. Parents, grandparents and other adults can help by providing healthy sexuality education, by talking openly with children and youth, and by guiding youth while respecting their decisions.
Pilot coordinator Barb says:
What advice would I give to others working in sexual health education? Never give up. Those working in sexual health services often feel isolated. There is not another topic more sensitive than sex and sexuality. What is encouraging is that when people feel safe to discuss sexuality openly, honestly and respectively, incredible discussions and learning can take place.
Barb McWatters, Planned Parenthood Regina, Regina, Saskatchewan
Information and Services for Youth
Youth want and need to make their own decisions about sexual activity, pregnancy and parenting – whether this be to delay sexual involvement, use a method of birth control or get pregnant. Parents and educators can help by encouraging youth to actively decide if they are ready for sex, what makes a good relationship, and what having a child is really like. Service providers need to provide accurate information to youth, and make sure that sexually active teens have access to methods that prevent pregnancy and sexually transmitted infections. Youth need help selecting a birth control method that will work for them (depending on their lifestyle, level of responsibility, nature of their sexual encounters, etc.) and help “negotiating” safer sex with their partners. As with other youth programs, peer education (youth talking to youth) and youth-directed services have the greatest chance of success.
In my community, the doctors are very discriminating. I wanted to go on the pill when I was 14. I went into the doctor’s office, and I knew that I needed parental consent But I was just going in to talk about it. And the doctor said, “Well you shouldn’t be having sex anyway.” Then I went in with my mom. But if my mom wasn’t with me I knew I wouldn’t be able to get it because I was under 16. And you couldn’t get condoms in the school. You’d have to go into the drug store and that is pretty intimidating, especially in a small town because you know everyone who works there. So unless the guys had them, the girls didn’t go out and buy them.
Youth from northern British Columbia
Men and women can practise many different kinds of birth planning, and should talk with one another to choose the way that is best for them. Also, up-to-date information is important, since methods are changing all the time. Individuals and couples who want to postpone or prevent pregnancy should talk to a health care provider or a Planned Parenthood counsellor. As a service provider, you can learn more about birth control methods and pregnancy planning, refer your clients to your local health clinic for this information, or contact the closest Planned Parenthood office (there is a list at the back of the Sourcebook).
The five main methods of planning pregnancies are: hormonal methods; barrier methods; surgical methods; a device that works inside the uterus; and natural methods. Some methods are short term and others long term, some require a doctor’s visit and/or a prescription, others are available from a health clinic or pharmacy. Some methods are more effective than others, but there can be side effects.
Hormonal methods include many different kinds of birth control pills, injections and implants that go under the skin. Barrier methods include male and female condoms, the contraceptive sponge, the diaphragm and spermicides. Different intrauterine devices (or IUDs) are placed in the uterus. Surgical methods are tubal ligation for the woman and vasectomy for the man. Natural methods include not having any sexual contact, not having intercourse and planning intercourse for the safer times of a woman’s fertility cycle.
Within traditional societies and languages, there is no word that equals abortion. The word itself is very harsh and impersonal. When speaking to traditional Elders knowledgeable about reproductive health matters, repeatedly they would refer to a woman knowing which herbs and methods to use “to make her period come.” This was seen as a woman taking care of herself and doing what was necessary. Oftentimes women would turn to the women within her society that were keepers of those herbs, medicines and techniques for assistance.
A woman can get pregnant even if she is using birth control, or she may not be able to practise safer sex because she fears her partner or she has been using drugs or alcohol. She (and her partner) have several options if the pregnancy was unintended:
she/they can prevent the pregnancy through the use of emergency contraception (“the morning after pill” within three to five days of unprotected sex)
she can decide to have an abortion to end the pregnancy
she/they can choose to place the baby up for adoption after the birth
she/they can choose to raise the child with help from community services and others
Women and their partners deserve a great deal of support and help in making this difficult and life-changing choice. While not everyone agrees with morning-after contraception or abortion, women in Canada have a right to these health services. Counsellors and health care providers have a responsibility to provide non-judgmental information, support and referrals to women no matter which option they choose.
Print and Web-Based Materials
Beyond the Basics: A Sourcebook on Sexual and Reproductive Health Education, Planned Parenthood Federation of Canada, Ottawa, 2001.
Birth Control Handbook, Montreal Health Press, Montreal, Millennium Edition, 2000. Info Sex Net Bulletin (E-mail bulletin), Planned Parenthood Federation of Canada. Available at: www.ppfc.ca.
“Safer Sex,” What the HEALTH! A Literacy and Health Resource for Youth, Canadian Public Health Association, Ottawa, 2000. Sex Sense: Canadian Contraceptive Guide, Society of Obstetricians and Gynaecologists of Canada, Ottawa, 2000.
Sexuality in the Circle of Life, Quebec Native Women, Montreal, 1998.
Audio-Visual Resources, Multimedia and Games
Legends sxwexwxiy’am: The Story of Siwash Rock, Full Regalia, Omni Film and the National Film Board of Canada (available from the NFB), 1999. Contemporary retelling of Coast Salish myth. Faced with unemployment and the unplanned pregnancy of his girlfriend, a young man finds making the right choices isn’t easy. 24 minutes; available in English.
Useful Internet Sites
Canadian Abortion Rights Action League www.caral.ca
Go Ask Alice! www.goaskalice.columbia.edu
The Hope Clinic for Women Ltd. Publications – www.hopeclinic.com/publications.htm
Planned Parenthood Federation of America – www.planned parenthood.org
Planned Parenthood Federation of Canada – www.ppfc.ca
Sexual and Reproductive Health Promotion Unit, Health Canada www.hc-sc.gc.ca/hppb/srh/
Sexuality/Reproduction and Aboriginal Peoples Sections, Canadian Health Network – www.canadian-health-network.ca
Sexualityandu.ca (Society of Obstetricians and Gynaecologists of Canada) www.sexualityandu. ca
Sample Tools from Existing Resources
The following pages in this unit are taken from existing resources. For a complete list of these and other materials, see Resource Information at the end of the Sourcebook. Birth Control at a Glance, the Hope Clinic for Women Ltd. – intended for service providers, this birth control chart summarizes many common birth control methods. Emergency Contraception: Preventing Pregnancy After You Have Had Sex Canadian Paediatric Society – a plain language fact sheet on contraception after unprotected intercourse.
Dealing with an Unintended Pregnancy, Planned Parenthood Federation of Canada – a group exercise for youth to look at the issues and choices involved in an unintended pregnancy. As these issues can be hard for some people to address, the group leader should be prepared for both strong feelings and conflicting opinions.
Pregnancy and Pregnancy Options, Planned Parenthood Federation of Canada – an information sheet for service providers and individuals that explores the different options available for an unintended pregnancy.
Abortion and Miscarriage, Nechi Training, Research and Health Promotions Institute an individual or group exercise that can help women to explore feelings connected with abortion or miscarriage. (Make sure you provide a supportive and caring environment for this work.)
Emergency contraception: Preventing pregnancy after you have had sex
You can become pregnant if you have unprotected intercourse even just once! Maybe you tried to protect yourself but the condom broke. Perhaps you were taking birth control pills but missed two or more of them, or you usually get a birth control shot every three months but missed your last shot. Or you thought that if your boyfriend didn’t ejaculate inside you, you couldn’t get pregnant. Possibly in the heat of the moment, you just didn’t think about birth control. Maybe you were sexually assaulted.
If you have had sex in the past few days, it isn’t too late to prevent a pregnancy using emergency contraception. Although sometimes called the morning after pill, emergency contraception can be used up to three days after intercourse (some doctors think it might even work up to five days after).
What are emergency contraceptive pills?
Emergency contraceptive pills (ECP) are high dose birth control pills. They aren’t 100% effective, but they do reduce the chance of getting pregnant by 75%. For example, if 100 women have unprotected intercourse once in the second or third week of their cycle (counting from the first day of their period), eight would get pregnant if they didn’t use emergency contraception but only two would become pregnant if they took emergency contraception.
What if I am already pregnant?
Emergency contraception will not make your pregnancy go away. It is not an abortion pill. However, if you find out after you have taken it that you are pregnant, don’t worry. Many women have taken estrogen and progestrone (the hormones in ECPs) in early pregnancy without harm to the fetus.
What are the side effects of emergency contraception?
The most common side effects of ECPs are nausea and vomiting. A pill to lessen the symptoms is given with the ECPs. If you throw up within an hour of taking the first dose of ECPs, you need to repeat it. Some women will have sore breasts for a few days, and others have complained about headaches. These problems are much less common.
How do I take it?
You will be given three pills (two are emergency contraception, one is antinausea) to take immediately, and three pills to take 12 h later. If you will be unable to take them in 12 h, you can delay your first dose so that you can take the second dose 12 h later. For instance, if it is 10 o’clock at night, and at 10 tomorrow morning you will be in math class, you can wait until midnight to take the first pills and take the next ones at lunchtime. The second dose of pills is very important.
* Do not drive or drink any alcohol for the next 24 h after the second set of pills. The medication that you take to prevent nausea may make you feel drowsy.
* Do not take any extra birth control pills. They will not decrease your chance of getting pregnant and will likely increase nausea and vomiting.
When will I get my period?
Some women get their period a few days after taking emergency contraception. Others have it when they are expecting their next period or even a bit later. If you haven’t started a period within three weeks of taking the ECPs, you should have a pregnancy test.
How long will emergency contraception protect me?
Do not count on emergency contraception to protect you if you have unprotected intercourse again. You should use condoms and spermicide if you are going to have intercourse. Talk to your doctor about starting a reliable form of birth control.
Why not just use emergency contraception each time I have sex?
Emergency contraception is not as good at preventing pregnancy`as other methods of birth control such as birth control pills taken regularly or birth control shots. In addition, you should be using condoms to prevent sexually transmitted diseases like AIDS.
Where can I find more information?
Your paediatrician, family doctor or local public health department will have more information about this. On the Internet, you can try Qpr_.princeton.edu/ec/ or read the Canadian Paediatric Society position statement on emergency contraception at www.cps.calen lish__statements/AM/AM98-01.htm,
Source: Developed by the CPS Adolescent Medicine Committee. Published in Paediatrics & Child Health, September/October 1998.
This information should not be used as a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.
Canadian Paediatric_Socity, 2204 Walkley Road, Suite 100, Ottawa, Ontario K I G 4G8
Phone: 613-526-9397, fax: 613-526-3332
Abortion and Miscarriage
Some of your regret and pain may be around children who were never born, that you may have lost through natural or planned abortion. You may never have had an opportunity to examine and express what this was like for you. This section provides an opportunity for you to do this. It does not make judgments for you or about your decision(s).
I experienced abortion or miscarriage(s). List your pregnancies and which ones ended in miscarriage or a planned abortion.
This is what I believe about miscarriage…
This is what I believe about abortion …
What messages have you received about abortion? The experience of a miscarriage or abortion is a form of loss. Some women are deeply affected by it. Even when abortion has been a choice, many women still feel regret and emotional and physical pain. This can be linked to the choice itself and the experience surrounding it. Others are comfortable with their decision. (your choice is not being judged). It is probably one of the most personal and complex decisions a woman can make. Did you make the decision with the input of the father (or someone else) or alone? Describe the experience. What happened? Who was there (or not there)? What was said? How were you affected by the entire experience? If you have experienced miscarriage or abortion you may wish to write a letter to the spirit of the child who wasn’t carried to term. Some things you may want to say: How you felt about the experience: What your life was like at the time. What you believe about the situation. What the loss was like for you.
Other messages you want to deliver.
1 Sex Sense: Canadian Contraceptive Guide, Society of Obstetricians and Gynaecologists of Canada, Ottawa, 2000, p. 11.
2 Indigenous Women’s Reproductive Rights and Prochoice Page, Native American Women’s Health Education Resource Center, Lake Andes, South Dakota, 2000. Available at: www.nativeshop.org/ pro-choice.html
Copyright Aboriginal Nurses Association of Canada 2002
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