Sexual and Reproductive Health Awareness Week 2016: Reproductive Wisdom

2/12/2016

By Rachel Bach, MDP

As Indigenous women, part of living the vision of "healthy, self-determining and vibrant BC First Nations children, families and communities" is recognizing our sexual and reproductive health rights and self-determination over, and respect for, our bodies. Every one of us has the right to enjoy a mutually satisfying and safe relationship that is not only free from coercion and violence but also free from fear of health concerns or unintended pregnancy.

Birth control is an essential part of sexual and reproductive health and is about more than just preventing pregnancies. Birth control is about supporting women to plan and space pregnancies as desired. It is about recognizing Indigenous women's rights to choose to have a child, or not have a child, without negative, or even dangerous, consequences. Birth control is about meeting women where they are at in their lives and empowering decision-making.

Birth control is all about finding the right method for you; if you don't like one, you can always try another. These days there are many options available and a lot of them are funded through FNHA Heath Benefits, find out more online at www.fnha.ca/benefits. Did you know that in Canada, almost half of pregnancies are unintended? And nearly half of unintended pregnancies end in abortion. Even though abortion stories are not shared readily, nearly one in three women in Canada has had an abortion in her lifetime. Little is known about the number of Indigenous women seeking abortions. What we do know is that women living in rural and remote locations, women living with the burdens of poverty, single working mothers, sexual assault victims, and women with mental wellness and substance use challenges are more likely to experience difficulties accessing contraceptives, have unintended pregnancies and are over-represented among those seeking abortions.

There are three options available to women: parenting, adoption and abortion. Each option will have its challenges. Deciding what to do about an unintended pregnancy is an important process and may be difficult for some people. Emotions, education, work and resources (money and time) could all play a part in decision-making. Some people will discuss their options with their partners or a trusted friend or family member, while others will make their decisions alone. Some may consult with a counsellor, nurse, doctor or traditional healer or call one of the numbers below as part of the decision-making journey. At the end of this issue of Spirit find a list of resources throughout the province you can access to discuss your path forward.

What is most important is that you respect and honour yourself – honour yourself for what you have been through and for being present to make this decision. Only you know what is best for you and your body. Trust that you will make the right decision for you and then respect and honour your decision, whatever it may be. As Indigenous women, it is important to know about our options and to share this information with each other. The information and resources about birth control and pregnancy options listed below are available to support you on your wellness journey.

Birth Control Options

HORMONAL METHODS

Birth Control Pills, the Patch, Nuvaring, Depo-Provera

These methods use hormones to prevent ovulation, thicken the cervical mucus so it is more difficult for sperm to enter the uterus and thin the lining of the uterus so it is less likely a fertilized egg could attach to it. Each method varies in the way in which hormones enter the body – birth control pills are taken orally every day, the patch is applied directly to the skin and replaced weekly, the Nuvaring is inserted in the vagina and replaced monthly, and Depo-Provera is administered via injection every three months. Hormonal methods are very effective at preventing pregnancy. They each have their pros and cons, including costs, side effects and level of commitment. Not every method will be a good fit for everyone. Hormonal methods do not, however, offer protection from sexually transmitted infections (STIs). A physician's prescription for birth control must be filled at a pharmacy in order to be reimbursed through Health Benefits.

BARRIER METHODS

Condoms (external or internal; often referred to as 'male' and 'female'), spermicides (foam, film, gel, sponge), diaphragm, cervical cap

These methods are used each time you have sex and stop sperm from reaching the egg. Most of these methods are available over the counter. Be sure to read the instructions before using one of these methods.

INTRAUTERINE DEVICE (IUD)

Copper and Hormonal (Mirena and Jaydess)

This small T-shaped device is inserted into the uterus by a doctor and can stay in place for up to five years. The copper IUD stops sperm from fertilizing an egg and prevents implantation. The hormonal IUD option releases low levels of hormones and acts similarly to other hormonal methods mentioned above. They are very effective methods of birth control. IUDs do not protect against STIs.

NATURAL METHODS

Abstinence, Fertility Awareness, Lactational Amenorrhea, Withdrawal

These methods do not involve hormones, devices or procedures but do require cooperation of your sexual partner and typically a good awareness of your body and its natural rhythms and cycles.

EMERGENCY CONTRACEPTION

Pill (Plan B, Morning After Pill) or IUD (Copper)

The emergency contraception pill is taken orally up to five days after unprotected vaginal intercourse but is more effective the sooner you take it. It is available over the counter with no prescription at pharmacies. However, if you would like to be reimbursed for emergency contraception through FNHA, you need to obtain a prescription from a physician. The copper IUD may be used as a form of emergency contraception if inserted within 5-7 days of the sexual activity you are concerned about. Examples of when to use emergency contraception include forgetting to take birth control pills; missing a Depo-Provera injection; if a condom broke, slipped off, or leaked; when ejaculation has occurred inside the vagina while using the withdrawal method; instances of sexual assault.

Pregnancy Options

PARENTING

Continuing with the pregnancy and keeping your child Things to consider could include: role your partner would play; could you manage alone if you had to; what support do you have from family or friends; where could you go for prenatal and delivery care; are you able to support a child and yourself; where would you live during and after pregnancy; how would having a child affect your school and job plans; are you healthy; would you have a healthy child; do you feel emotionally able to parent; and if you were to choose the ideal situation for becoming a parent, what would it be?

ADOPTION

Continuing with the pregnancy and placing your child for

adoption

Things to consider could be similar to above in addition to the following: do you know your legal rights and the legal rights of adoptive parents and children and where can you find out about your rights.

ABORTION

Medical Abortion; Surgical Abortion

Abortion is a safe, legal, and funded service. Although you do not have to pay for abortion services in Canada, access across the province varies; especially for women living in rural and remote areas. A medical abortion uses pills that can be taken at home up to seven weeks from the first day of your last period. Some clinics in Vancouver are able to provide medical abortions through telemedicine to rural areas. A surgical abortion is a day procedure that can be performed up to 24 weeks, depending on the provider. There are seven abortion clinics in BC: four in the Lower Mainland, and one each in Victoria, Kelowna, and the Kootenays. At these abortion clinics, you don't need a doctor's referral - just call to make an appointment. If you can't go to one of the clinics listed above, you may obtain a referral to a doctor who performs abortions in a local hospital. If your own doctor won't refer you, or if you don't want to go to your family doctor, you can call the Pregnancy Options Line to obtain a referral, to learn more information, or to find a hospital in your area that performs abortions.

Resources:

It is important to use caution when seeking resources as some groups are opposed to contraception and abortion and may offer pregnancy counselling with the purpose to talk you out of the option of abortion. They may not have the best decision for you in mind. The following list of resources is available for you to learn more about any of the birth control options or pregnancy options and the next steps. You can also learn more about sex, sexuality, sexually transmitted infections, pap tests/pelvic exams; sexual pleasure; and so much more in a safe and non-judgmental way.

Phonelines:

Sex Sense Line: 1-800-SEX-SENSE

Free confidential sexual health referral and information service open Monday to Friday from 9:00 a.m. to 9:00 p.m. (PT). A team of registered nurses, clinical counsellors, and sex educators offer information and resources for people living in BC. You can also submit a question on the website and get a reply via email

The Access Line: 1-888-642-2725

24-hour Canada wide toll free number that provides information on reproductive and sexual health and referrals on pregnancy options.

Pregnancy Options Line: 1–888–875–3163 (toll-free) or

604–875–3163 (in the lower mainland)

Clinics:

PROVINCE-WIDE

Options for Sexual Health Clinics

604-731-4252

www.optionsforsexualhealth.org/clinic-services

*Operates 60 reproductive health clinics in BC, including satellites

and service sites

VANCOUVER