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.1 Others want to become pregnant because they see it as a way to get off of the streets.2

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.

Other 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.

Good to know

In one year, 85% of people with a uterus will get pregnant if having unprotected sex.3 Access for youth to no-cost birth control and safer sex supplies can be found at Alberta Health Services Sexual and Reproductive Health Clinics. For information on community resources, click here.

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 IUD is the most effective method, but it costs 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.

What is birth control?

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

Types of birth control

Methods of birth control are divided into categories including natural methods, hormonal, barrier, spermicidal and other methods.

Natural Methods

 These are types of birth control that do not use any drugs or devices but rely on behaviour. Types of natural 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

Withdrawal (“pulling out”) is when the penis is pulled out of the vagina before ejaculation. With typical use, this is about 78% effective at preventing pregnancy.4 This method is not recommended if unintended pregnancy would be a problem and emergency contraception should be considered.

For more information about natural methods: https://www.sexandu.ca/contraception/natural-methods/

Hormonal Methods

Hormonal methods are effective types 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”), hormonal IUDs such as Mirena s or Kyleena. Hormonal IUDs are also called Intrauterine Systems or IUS or Intrauterine contraceptives. 

Good to know

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

Intrauterine Contraception (IUC)

 IUCs are commonly known as IUDs.

 There are several types of IUDs including non-hormonal (which contain Copper) and hormonal (which contain a type of progestin). Hormonal IUDs are also called intrauterine systems (IUS).  These methods of birth control are long-acting and reversible and depending on the type, can last between 3 and 10 years.

Good to know

 In 2018, the Canadian Pediatric Society issued a statement recommending that IUC be considered a first-line contraceptive method for Canadian youth.5

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 condoms. For added protection against pregnancy, some barrier methods are intended for use with a spermicide.

 For more information about barrier methods, see: https://www.sexandu.ca/contraception/non-hormonal-contraception/

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. Some types of spermicidal products such as contraceptive jelly are not available in Canada.

Other methods of birth control include vasectomy, and tubal ligation.
Vasectomy and tubal ligation are sometimes referred to as sterilization, considered to be permanent and difficult to reverse.

Tip

 For help choosing a method of birth control, see   the “It’s a plan”  – birth control selection tool, found at:  https://www.sexandu.ca/contraception/its-a-plan/

Good to know

 If there has been sex without a condom or other reliable method of birth control), 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 can be used up to 7 days after unprotected sex and needs to be inserted into the uterus by a trained health care provider. 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 ECs, click here.

Birth control information

For detailed information on birth control methods, see:

How to access birth control

  • Some birth control methods can be purchased over-the-counter (e.g., 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 Alberta youth to birth control and safer sex supplies can be found at Ahs.ca/srh and resources.
  •  For youth living outside of Alberta, to find a sexual health service: https://www.actioncanadashr.org/resources/services

Birth control methods and STI protection

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

Have you ever wondered which birth control methods give the best protection from STIs?

Category Method STI Protection?
Natural Family Planning Abstinence Excellent Protection
Fertility Awareness-Based Methods No Protection
Withdrawal No Protection
Hormonal Birth Control Pill No Protection
Depo Provera No Protection
Emergency Contraception Pills No Protection
Evra Patch No Protection
Hormonal IUD No Protection
Vaginal Contraceptive Ring No Protection
Barrier Male Condom (latex or polyurethane) Good Protection
Female Condom Good Protection
Diaphragm with Spermicidal Jelly No Protection
Spermicidal Foam and Jelly No Protection
The Sponge No Protection
Vaginal Contraceptive Film No Protection
Other Copper IUD No Protection
Tubal Ligation No Protection
Vasectomy No Protection

For information on STIs, click here.

Good to know

 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.
1Elliot, A. (2013). Meeting the health care needs of street-involved youth. Paediatrics and Child Health, 18(6), 317-321.
2Lokanc-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
3Hatcher, R.A., et al. (2011). Contraceptive Technology (20th Ed.). Ardent Media: New York.
4MyHealth.Alberta.ca. (2019). Withdrawal (pulling out). Retrieved from, https://myhealth.alberta.ca/HealthTopics/sexual-reproductive-health/Pages/withdrawal.aspx
5Canadian Pediatric Society. (2019). Contraceptive care for Canadian youth. Retrieved from, https://www.cps.ca/en/documents/position/contraceptive-care