About this Guide • Cultural Safety and Humility • Patient Choice • Shared Decision-Making • Background
The FNHA stands alongside First Nations women. Coerced sterilization and informed consent for contraception is an ongoing concern and we are working with our health system partners to ensure First Nations women's rights and wishes are honoured and respected.
About this Guide
Informed Consent for Contraception is a shared decision-making guide that can be used in conversations with a patient about methods of birth control. Its purpose is to help prevent decisions about contraception being made in an acute setting (that is, just before, during or after giving birth) and to ensure the patient's voice is heard and understood.
The guide includes a form can be used a checklist for ensuring that consent to a contraception method is informed and has been given freely and prior to the acute setting. Note: This form cannot be used in place of surgical or procedural consent. Surgeries and procedures require a separate consent form as well.
For Health Care Providers
This manual is a resource for health care providers to ensure they are providing patients with the opportunity for free prior and informed consent when making decisions about contraception and reproductive health.
In a healthcare provider–patient relationship, the patient's interests always come first. Cultural humility and safety must be the backbone of care, and care must be provided in a way suitable to and in line with the patient's wishes.
The quality of the care provided will be measured not just by medical skill but by communication. Communication with the patient must be culturally safe (respectful and non-racist). It must also allow the patient time to think about everything in order to make their own decisions, which may require multiple visits.
When it comes to birth control, it is the patient's choice, and the patient's choice alone, which method of birth control they want or whether to use birth control at all.
Where the patient is a part of a group that has been discriminated against, such as First Nations, Métis and Inuit people, the requirements of consent are even greater.
Replacement decision-making (healthcare providers or others making decisions for patients), is illegal with respect to methods of birth control. Seeking consent for any form of birth control (including tubal ligation) while a patient is in the peripartum period (just before, during and after giving birth) is medically negligent and unethical.
The healthcare provider must explain the risks and benefits of the birth control method chosen to the patient before the patient goes into labour and delivery. The patient must be given time to consider their options and genuine desires before this period. This is called shared decision-making over time.
Consent cannot be obtained when a patient is under pressure, is under the influence of pain medications or sedation, or has suffered a traumatic delivery.
A patient may withdraw consent at any time.
The coerced sterilization of Indigenous women, both permanent and by long-acting birth-control interventions, is an issue of ongoing concern.
In response to this concern, the Office of the FNHA Chief Medical Officer, in consultation with Senator Yvonne Boyer and Perinatal Services BC created this shared decision-making guide to informed consent for contraception.
The FNHA would like to thank Senator Boyer, Perinatal Services BC, the project team and community members and reviewers for their contributions to the development of this guide.
Office of the Chief Medical Officer