The Pill was legalized 50 years ago, but experts say we can still improve contraceptive access

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Some myths about female birth control
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As recently as the early 1960s, contraceptives were illegal in Canada.

People still used them, according to Christabelle Sethna, a professor of women’s and gender studies at the University of Ottawa, and co-editor of an upcoming book on changes to sexuality laws in the 1969 Omnibus bill.

People were getting condoms or the relatively new birth control pill under the table from pharmacists, nurses or doctors, she said, though they were technically illegal sales. A Toronto pharmacist, Howard Fine, was convicted in 1960 for selling condoms.

While the Pill was approved for use in Canada in the early 1960s, it was only legal if its use was in the “public good,” Sethna said. So while there was a loophole and Canadians were using them, birth control pills weren’t freely available.

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“Doctors were somewhat willing to give (birth control pills) to women who were married and wanted to space the birth of their children,” she said. “They were very reluctant to give it to single women and they were extremely reluctant to give it to underage women.”

But with the passage of a bill legalizing contraception and the birth control pill in 1969, she said, things changed.

“It certainly changed relationships between women and their doctors, because you see women now going to their physicians and demanding a medication.”

It also changed the relationship between women and their fertility, she noted, as women could choose to space out their pregnancies more or to not have children at all if they wished.

“It changed women’s ability in terms of the employment market,” Sethna said. “They could have jobs, they could take up these jobs without fear of an unwanted pregnancy. They could have sex with whomever they wished to have sex without fear of an unwanted pregnancy.

“So, incredible incredible changes.”

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Are fewer women using birth control pills?

The Pill had a medical impact, too, according to Dr. Dustin Costescu, an associate professor and family planning specialist at McMaster University, and a physician at Hamilton Health Sciences.

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“Nationally and internationally, there is very good evidence that in countries where family planning services, including contraception, are legalized and readily accessible, that rates of unintended pregnancy tend to decrease,” Costescu said. “But also the medical risks of unintended pregnancy decrease.”

People might be less likely to seek prenatal care with an unintended pregnancy, he said, or more likely to deliver in unsafe conditions.

Contraception has benefitted men too, Costescu said. “Men who are less likely to have unintended children, unintended births also benefit economically from this, as well as the safety of their partners.”

And despite persisting worries that young people who are prescribed birth control will become more promiscuous, “There is no good data to show that sexual intercourse is happening any earlier now than 10 or 20 years ago,” he said. It’s actually gone up slightly, he noted, as a result of sexual education.

“We should be congratulating teenagers who are deferring initiating intercourse until they have access to birth control.”

Nowadays, he said, the top three methods of birth control in Canada are condoms, the Pill, and withdrawal. That third is problematic for a few reasons, Costescu said, “the main one being its lack of effectiveness.”

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But lately, he said, many women are moving away from the birth control pill toward longer-acting forms of contraception, like an intrauterine device, or IUD. One reason is that many women forget to take pills in their pack, so failure rates are “probably a little bit higher” than advertised, he said, and a long-acting birth control helps with that.

Other women have expressed concern about side effects of the drug and want to try different options.

Also, in the 1980s, a teenager might become sexually active and expect to have their first child in their early 20s. Now, it might be a decade or more before someone wants to have a child, he said, so they might not want a daily pill. The Canadian Paediatric Society now recommends IUDs as a first choice for teenagers.

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The Canadian Pediatric Society says IUDs should be the first-line birth control option for teens

Delaying that first child is another societal change as a result of contraception, Sethna said. “A woman can use the Pill very successfully to space out her children, the birth of her children, and possibly not have children at all if she wishes. I think that is incredible.

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“On the other hand what it means is that women who don’t have children while they’re going through extensive higher education or extensive job training may want to have children into their 40s and even in their 50s, and by then their fertility becomes an issue,” she continued.

We have invented a way to easily suspend fertility, but not an equivalent way to induce it when we want it back, she said.

And while the Pill gave women control over contraception, while earlier methods like condoms and withdrawal were men’s responsibility, she thinks it’s reinforced women’s role as “gatekeepers” of their sexuality with not just the responsibility to say no, but all the responsibility for contraception too.

“When I ask my students, ‘If there were a Pill for men, would you stop taking your own contraception or whatever it is you’re doing?’ The majority of them will say no, because you don’t trust men to take it regularly.”

And even though the Pill was legalized 50 years ago, Costescu says that there is still unequal access to birth control in Canada. Urban Canadians generally have pretty good access, he said, but people in remote areas — including remote First Nations communities — don’t have all the contraception they want. Abortion access is also still very uneven across Canada.

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One way to improve contraceptive access would be to allow non-physicians, like pharmacists, to prescribe the Pill to low-risk patients, he said.

“Certainly not every woman is going to have access to contraceptives depending on where she lives,” Sethna said. “Does she need a prescription? Does she have a doctor who is doing the right thing by her? Are there clinics that she can go to? Can she afford the contraception?

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