Canadian women have fewer options than their counterparts abroad when it comes to birth control choices. Creative Commons photo by Flickr user vociferous.

Sitting up on the examination table, I can hear my sterile paper gown crinkling with every movement. The gynecologist sits a few feet away, looking up at me, and I feel like a stage performer as I explain the reason for my visit. “I’ve tried and hated almost every type of hormonal birth control,” I tell her. “I want to know about non-hormonal options.” She nods when I reveal I’m in a long-term, monogamous relationship; she tenses up when I say I’m interested in an IUD or a diaphragm.

My request was uncommon. Hormonal contraception is the unequivocal norm for most young Canadian women, and research for other options is virtually non-existent in this country. Birth control is low on the health agenda, and this oversight is putting Canadian women at risk.

In the last decade, I’ve sampled nearly ten kinds of hormonal contraception. By the age of 19, I had tried five different types of oral contraceptive. Puberty came with a prescription for the pill to help control heavy periods. In university, hormonal contraception threw me into an emotional frenzy. Going from the pill to the Depo-Provera injection to the Nuva Ring, I experienced symptoms that included an obsession with my weight, loss of my sex drive and intense mood swings. As a responsible young adult in long-term relationship, I was a good candidate for a vaginal barrier method or an intrauterine device (IUD), but I was unaware of those options and they were never mentioned. Campus physicians continued to advocate hormonal methods, convinced they could find “the right match.” Still, my body was completely uncooperative. I assumed I was the problem.

My latest attempt, a consultation with a gyno, earned me a prescription for a diaphragm. After trying more than a dozen pharmacies, I discovered that diaphragms are nearly non-existent in Canada. A call to the manufacturer revealed that in 2010, less than 100 devices were distributed across the country.

Finally turning online, research led me to the FemCap, a highly recommended new version of the cervical cap. An American product, it’s said to be comfortable, reusable, purchasable online and most importantly, hormone-free. I included the recommended organic spermicide with my order, because it’s not available in Canadian pharmacies.

When my gadget came in the mail, my boyfriend and I watched the unintentionally hilarious instructional video, which features a real vagina and animated sperm whose mission to fertilize is thwarted by the FemCap. To be sure, I ran the device by my family doctor. She’d never even heard of it, but she was enthusiastic. After giving it her seal of approval, she asked to keep the instructional pamphlets I brought in.

Advancement in non-hormonal birth control is not a popular field of research and statistics show Canadians are particularly unaware. The United Nations’ 2009 report on contraceptive use says the world’s most popular form of reversible birth control is the IUD. This is the method of choice for 14 per cent of the world’s women. While the report shows the pill is the most popular option for most developed countries, on the global scale only nine per cent of women rely on it. In Canada, one in every five women uses oral contraceptives. The condom is second in popularity with 15 per cent, followed by traditional techniques like the rhythm method at nine per cent. The IUD and vaginal barrier methods (including the diaphragm and the FemCap) are each used by only one per cent of women. In contrast, a whopping 13.5 per cent of European women report using an IUD and 14 per cent rely on natural family planning.

So why are Canadian women so dependent on hormones?

Cindy Weeds, the coordinator of women’s programming at Planned Parenthood Toronto, explains that North American women have normalized the consumption of hormonal birth control. “Often we see women who come in and all they know about is the pill,” she says. Whether this is the cause or the effect of the current contraceptive landscape is difficult to say. Proliferation of hormonal methods is cyclical: as these contraceptives become more accepted, the industry becomes more profitable and advertising increases. This ensures the products stay on the radar and gain approval, re-launching the cycle. “Certain kinds of pills are really heavily marketed, particularly to young women,” says Weeds.

One of the consequences of this consumption cycle is a decrease in demand for non-hormonal products, reducing their supply and leading to a dearth of available information.

Fear of pregnancy is also a consideration. The pill boasts a 99.9 per cent rate of effectiveness, while the diaphragm has a failure rate between four and eight per cent, a margin of error too risky for many.

In Canada, advancements in the study of contraception are not a priority: little research is done to develop any new methods of birth control, let alone non-hormonal alternatives. Since 2008, the Canadian Institute of Health Research has spent $916,226 on birth control-related research, none devoted to new developments. In contrast, research devoted to pregnancy and conception received more than $20 million in funding, 22 times the amount allocated to birth control. And for example, while $14,000 was given to a British Columbia conference focused on sexual health education, $20,000 was allocated to finance events honouring the oral contraceptive’s 50th anniversary.

Women will often accept the side-effects of hormonal birth control because their fear of conceiving is so great. But, as Amy Sedgwick, owner of Toronto sex and health store the Red Tent Sisters, says, “there’s really no other comparable situation where millions of healthy people are taking a daily drug.” Numerous studies warn of the effects of hormonal contraception. The pill is said to impair muscle gain and increase women’s risk of heart attack, stroke and cervical cancer. Studies have also shown that women who use hormonal contraception are more susceptible to mood disorders and sexual dysfunction, and prolonged use of Depo-Provera, the hormonal injection, has been linked to bone-density loss.

Birth control has been lauded as a bastion of feminist liberation and empowerment, but our dependence on hormonal methods is worrisome. As women wait longer than ever to have children, they are relying on these drugs and devices for increasing periods of time, sometimes decades. Considering the volume of research revealing frightening long-term effects, hormonal birth control should be dispensed with a plan and a well-thought-out exit strategy. Most importantly, non-hormonal alternatives should be discussed, and used, in Canada.

Hormonal birth control disconnected me from my body and made me feel uncertain about my wellbeing. Using the FemCap has kept my health and sanity intact, and disturbing instructional video aside, my partner is a big fan. Just don’t make him watch it again.

Dear Progressive Detective: I’ve heard of a new birth control pill, Seasonale, that reduces your period to four times a year instead of 12. I see the appeal, but messing with my cycle just seems like a bad idea. How safe are these kinds of contraceptives?

Extended-use hormonal contraceptives like Seasonale boost estrogen to levels that some experts link to increased risk of cancers, blood clots, and bone density loss. Yet published studies on such long-haul pills are generally not placebo-controlled, says Dr. Jerilynn C. Prior, professor of Endocrinology at the UBC Department of Medicine’s Centre for Menstrual Cycle and Ovulation Research. Prior argues such studies either use women on the standard pill as a control measure, or simply don’t bother with a control at all. Either way, those study results imply a woman on the standard pill is hormonally the same as an untreated woman—something Prior sees as grossly unscientific.

These studies have been published in respected medical journals, while concerns from experts such as Prior aren’t being taken seriously by reviewers, editors or governing bodies. “They scoffed at me when I suggested that placebo-controlled trials were necessary,” says Prior. “They got away with getting Seasonale accepted in Canada without doing placebo-controlled trials.”

What’s worse, Prior says many doctors and gynecologists rely on out-of-date trials. “The placebo-controlled trials of the birth control pill go back to when it was really a different drug. It had about five times higher estrogen doses,” she explains. “And the placebo-controlled trials were not done well by today’s standards.”

It’s not easy for the average citizen or researcher to look into the drug approval process, either. You’d have to submit an Access to Information Request form, which is limited and slow, says Anne Rochon Ford, coordinator of Women and Health Protection at York University. “We had an unbelievably long wait,” she says, “and when we did get it back it was significantly blacked out, like a prisoner’s letter.”

Ford adds post-marketing studies to monitor adverse side-effects for Seasonale aren’t being done effectively. “There’s a conflict of interest now because [Health Canada] requires pharmaceutical companies to pay for their evaluation,” says Prior. “It isn’t funded by parliament as much as it’s funded by the people it’s supposed to be regulating.” With such deeply vested interests— and such complex data—Progressive Detective asks for better research before opting for this kind of pill.

My doctor and I sat there, blankly staring at one another, wondering where we both went wrong. I was perched beside his desk, asking for a prescription refill for my birth control.

“You don’t need to ask me,” he kept saying. “Just call ahead, ask for what you’d like and come pick it up at the clinic.”

Just like that—like calling ahead to pick up pizza or Chinese take-out.

“But then who do I pay for it?” I asked. I was a Canadian living in Edinburgh on a working holiday, and my contract position didn’t offer health insurance.

“Oh my, “ he said. “Do you have to pay for your birth control in Canada?”

“Yeah…”

“[Birth control’s] a human right, love. We don’t pay for that here.”

While a percentage of the most common forms of hormonal birth control are covered by health insurance in Canada, no one I know has been able to stay pregnancy-free for, well, free.

It’s true that spending $4 per month for a pack of pills—about the average out-of-pocket price for birth control with insurance coverage—is manageable for most women.  But insurance coverage is not a given, especially in the supposedly-post-recession employment market.

When covering the debate surrounding American health care reform, Sharon Lerner, a writer with lady-blog DoubleX wrote:

“Women’s health advocates reported that some Democrats cited a fear of igniting controversy when asked to insert birth control and other preventive services for women into the minimum benefits package. What’s the controversy, exactly? It seems birth control has become a suddenly loaded political issue, a toxic sister to abortion, somehow resonant of irresponsible sex and women’s bodies.”

Can the same be said of Canada? Are we too afraid of controversy to fully-fund birth control options of all stripes?

Over the years I’ve been covered under Sun Life Financial and Blue Cross—Sun Life only covers 80 per cent of the price of pill-form contraceptives, meaning those of us who go another route are left footing the bill themselves.

The term “freedom to choose” is most often associated with abortion, but what about those of us that are just looking to find the right contraception for our bodies? I’ve often felt that young women are thrown “The Pill” as a hook-line-and-sinker form of birth control. Yep, the pill’s for you. Not so sure? Well your doctor can talk to you about other options, but good luck paying for it.

That is, if your doctor is even open to other options in the first place. Across various provinces I’ve heard accounts from friends who say their current form of contraception is simply what their doctor recommended, rather than the product of actual research or trial and error.

This is especially troubling, as recent reports have shown that Yaz, one of North America’s most prescribed forms of birth control—not to mention one of the most heavily marketed—has side effects that are much worse than previously thought.

Yaz is the perfect example of problems in the current birth control industry. Who can patients trust with their health when doctors prescribe away and undertake partnerships with pharmaceutical companies, and household budgets strangle our choices?