Canadian women used to grind beaver testicles into moonshine to drink as birth control. Imagine stomaching such a brew, only to get pregnant anyway. So much for family planning on the frontier.
Centuries later, we have state-of-the-art birth-control pills and condoms with the tensile strength of a plastic chair. But countless women are still blindsided when they see two pink lines materialize on a pee stick. To this day, half of all pregnancies in Canada are unintended. One in four ends in abortion. By age 45, one-third of Canadian women will have terminated at least one pregnancy.
Many women are still roughing it when it comes to birth control because of health policies that limit access to contraceptives.
Canadian women have a narrower range of birth-control options than women in other developed countries, according to new guidelines from the Society of Obstetricians and Gynaecologists of Canada that are scheduled for release this fall.
Moreover, Canada does not offer universal coverage for birth control, unlike Australia, New Zealand and more than 11 European Union countries, including Britain.
In most Canadian jurisdictions, only a doctor can provide contraceptives – a policy that does not serve women in communities where physicians are scarce, experts say. And once a woman gets a prescription, she has to pay for it.
Women rely on the method they can afford. But the cheaper the contraceptive, the higher the failure rate: Out of 100 women who rely on male condoms, 15 will become pregnant within a year.
Canada's patchwork of private insurance plans and compassion programs to cover contraceptives does not go far enough to prevent unintended pregnancies, said Dr. Wendy Norman, an assistant professor at the University of British Columbia.
The copper intrauterine device (IUD) lasts five years and is more than 99-per-cent effective. But the upfront cost of $60 to $80 is high enough to put the device out of reach for many women, Norman said.
Dealing with birth control is time-consuming for women, with side effects that can range from annoying to unbearable. And consider the fact that women are paying out of pocket to reduce the burden of unintended pregnancies for all.
Government investment in contraceptive services is cost-effective, research has shown. In 2010, the U.S. government earmarked $1.9-billion (U.S.) for family planning services. For every dollar spent, the government saved $7.09 in costs associated with unintended pregnancies, according to a study published in 2014 by the Guttmacher Institute, a non-profit organization dedicated to reproductive and sexual-health research.
The return on investment "is right up there with vaccines," said Norman, who holds a five-year chair in applied public-health research into family planning, awarded by the Canadian Institutes of Health Research and the Public Health Agency of Canada.
When money is no object, women are more likely to choose effective, long-lasting contraceptives such as IUDs, according to a U.S study of more than 9,000 women published in 2014.
In Canada, however, getting an IUD can take extra legwork since many doctors are not trained to insert them. Midwives have the right skill set, but most provinces do not permit midwives to insert IUDs.
Canada can improve access to birth control by allowing health-care professionals other than doctors to provide contraceptives, Norman said.
Pilot programs in Quebec and British Columbia indicate that nurse practitioners are fully capable of helping patients choose a safe contraceptive. "Our research shows it should be very feasible for pharmacists to do the same thing," Norman said.
Pharmacists already provide emergency contraceptive pills. And in provinces including Alberta and B.C., they can swap medications and fill certain prescriptions without a doctor's request, she pointed out.
Still, it takes time to counsel women on birth control. And for many family physicians, it's easier to just write a prescription for the pill, reproductive health experts say.
But other methods available in Canada may better suit a woman's cultural background, health status and lifestyle needs, said Dr. Sheila Dunn, research director of the Family Practice Health Centre at Women's College Hospital in Toronto.
In many parts of the world, such as China and other parts of Asia, the method of choice is IUDs, not pills, Dunn pointed out. "Women need to know what is out there."
That's just a start. It's time, experts say, to expand Canadian women's access to a wide range of contraceptives.