Emergency Contraception

This article features talk of sexual violence and sexual assault. Information and referral services for victims of crime and immediate crisis support can be accessed by calling or texting 1-800-563-0808. The article also discusses abortions.

 

I have always been told not to believe everything I see on TV, but when it comes to learning about sexual health, it can be the only place some people have to learn from.

Over the summer, my roommate and I started watching Shrill. The show is a comedy based on Lindy West’s non-fiction book Shrill: Notes from a Loud Woman, which follows Annie (played by SNL star Aidy Bryant), a journalist trying to make it in Portland, Oregon while attempting to change her life without changing the size of her body.

In the first episode, Annie finds out she’s pregnant with her not-so-great boyfriend’s child. While staying calm, cool, and collected, she goes to a pharmacy to purchase a morning-after pill. That’s when she learns that the morning-after pill doesn’t work for women over a certain weight.

That was the first time I’d heard this information.

The closest thing to “the talk” I’d received was in the car with my mom during the 45-minute drive to my monthly orthodontist appointments as she tried to teach me about “the birds and the bees.” I don’t know what hurt more—knowing my mom was enjoying seeing how embarrassed and uncomfortable I was, or my mouth after having my braces tightened.

Maybe it was due to my self-consciousness blocking out all the awkward memories of being trapped in the car, but I cannot seem to remember a single thing from those drives.

Luckily, I got to hear it all over again in high school, as ninth-grade students were rounded up and sent to the auditorium to listen to an hour-long presentation about sexual health.

The school counsellors were joined by two health care workers, and they spoke on pretty much everything you would expect from a basic sex education talk. They discussed all the STIs that were out there, the different forms of birth control someone of the female sex could take, and how to put on a condom. This, of course, was accompanied by ninth-graders cracking jokes and laughing every time an illustration of a penis appeared on the screen. 

Overall, I thought the presentation was good, it taught us almost everything we needed to know to have safer sex. Of course, there are some points I believe the school missed out on teaching us about.

Sex education isn’t always a similar experience for everyone, though. 

Emma Simard-Provençal, a fourth-year Nursing student at VIU, told me that the sexual education at her high school had been useful.

“We had this one speaker [named] Carrie Isham, and she’s a very talented and knowledgeable sex ed speaker,” Simard-Provençal said. “I don’t think she does it anymore for the public schools, but there was never any kind of focus on abstinence, which is what I really appreciate, because that’s obviously not a good, proven solution.”

When Simard-Provençal attended NDSS in Nanaimo four years ago, they had a health clinic in the school which has since expanded into the Nanaimo Youth Wellness Centre at the Nanaimo Aquatic Centre.

“It was so great because they could prescribe you with contraceptives if you wanted, and that was really great for addressing certain barriers. Especially [for] kids who had limited transportation, or didn’t have that open relationship with their parents,” she said.

Since she graduated in 2018, Simard-Provençal said that a lot has changed with the sexual education program, and she has heard that a lot of people are not having the same experience as she did when it comes to sexual education.

For third-year nursing student Kate Mcgregor, her high school P.E teachers taught her sexual education curriculum. 

“We would just take a day dedicated to my gym teacher doing kind of a PowerPoint and some worksheets and stuff,” Mcgregor said. “I wouldn’t say it was bad. However, I do feel as if there does need to be more exposure to these topics at younger ages, I think especially in middle school and high school when transition and change is so prominent in that area of one’s life.”

Mcgregor believes sexual and reproductive health should be taught at a younger age so young people can have the tools and knowledge they need while going through puberty. She also thinks schools tend to leave out items that have stigmas around them.

“There is a huge stigma around talking to youth about, for instance, porn, or all the different birth control methods or abortion, and what that looks like, and supports in their communities of where they can go if they are facing some difficulties within their sexual health regime,” she said. “I feel like kids are watching it or engaging in those activities behind closed doors with not a lot of education on the matter.”

Schools tend to leave out what happens after the fact—I just had sex, what now? 

It also seems to be left out for many people receiving “the talk.” Perhaps it’s because of the controversial idea of sex, or because some contraception methods tend to be considered taboo, but it still seems to go unheard.

During the sex education presentation at my high school, they did briefly speak about Plan B, which is an emergency contraceptive (morning-after pill) that can be used when you have had unprotected sex or when another form of birth control might have failed. Plan B can be taken up to 72 hours after unprotected sex in order to prevent pregnancy. If taken within 24 hours, it’s 95 percent effective. The efficacy rate drops to around 61 percent by the 72 hour mark.

Plan B sounds like an easy solution to protect yourself in a pinch, but after watching Shrill, it seems that Plan B isn’t actually as simple as it’s been made out to be.

The short answer is that Plan B may be less effective if you weigh 155 pounds or more, or have a BMI of 30 or higher, says Planned Parenthood, an American organization that offers reproductive health care, sex education, and information.

Plan B is something people can take because of a mishap, or because they were sexually assaulted. Morning-after pills provide the taker peace of mind, knowing that it significantly lowers their risk of becoming pregnant.

There are many individual and private reasons someone may not want to become pregnant, and if someone is unable to take Plan B, or it may not work effectively for them, there are a couple of other options.

Sex & U is an organization by the Society of Obstetricians and Gynaecologists of Canada (SOGC), which is a professional health association. SOGC is Canada’s leading authority on sexual and reproductive health.

On their website, Sex & U says that there are currently two types of emergency contraception available in Canada: the morning-after pill and an intrauterine device (IUD).

If an individual is unable to take Plan B due to their weight, there is another option for a morning-after pill called ella, an oral pill that lowers your chances of getting pregnant by 85 percent if taken within 5 days after unprotected sex. Ella works for people who weigh 155 pounds or more, but it may not be as effective if the person weighs 195 pounds or more.

The second option is a non-hormonal (copper) IUD. An IUD is a birth control method that sits inside a person’s uterus. There are two types of IUDs: non-hormonal and hormonal.

In cases where emergency contraception is needed, a non-hormonal IUD can be used to prevent pregnancy after unprotected sex. If inserted within 5 days, the efficacy rate is 99.99 percent. These IUDs can also be used for around seven years. However, a non-hormonal IUD is recommended as a last resort as they can cause severe cramping and bleeding during menstruation.

Both ella and the IUD can be effective for up to five days following unprotected sex (the sooner, the more effective), whereas Plan B is most effective within just three days. For many people working or studying full time, it might not be easy to obtain the emergency contraceptives within the effective time.

According to Planned Parenthood, Plan B is usually the easiest to get as “anyone can buy it over-the-counter without a prescription at most drugstores, pharmacies, and superstores no matter your age or gender.” In contrast, ella can be difficult to get your hands on as a prescription is required, which means having to make a doctor’s appointment, or waiting at a walk-in clinic within the five day time period.

The copper IUD can also be difficult to get within the five effective days, since you’d need to make an appointment for a nurse or doctor to insert it. The actual insertion normally only takes 5 to 15 minutes, but getting an appointment in time can be a challenge and the procedure itself can be uncomfortable or even painful.

To make matters worse, emergency contraception is not cheap and can be a struggle for many people to afford. Plan B and ella are nearly identical in price, sitting around $50 per pill. A non-hormonal IUD costs more, ranging around $100, but the price can sometimes be covered by extended health plans.

In Nanaimo, there are several places to obtain emergency contraception:

Women’s Vita Medical Clinic on Dufferin Crescent has many services for sexual and reproductive health. They provide STI testing, cervical cancer screening, breast cancer screening, prenatal care, labour and delivery support, and abortions.

Vancouver Island Women’s Clinic (VIWC) is a specialty clinic that offers a range of services. They are an inclusive clinic, and their services are available to patients of all sexual orientations and gender identities. Their services include STI and cervical cancer screenings, providing assistance in the management of miscarriage, abortions, and contraception—including emergency contraception.

Nanaimo Options for Sexual Health Clinic provides sexual and reproductive health services for all ages, gender, and orientations. It provides low-cost birth control, STI care, Pap screening, pregnancy testing, and pregnancy options counselling. There are no service fees for BC clients with the Medical Services Plan (MSP) health coverage, not including birth control products. The clinic has recently moved from its downtown location to a new location on Dufferin Crescent near the Nanaimo Regional General Hospital.

The Nanaimo Youth Wellness Centre is available for young people up to the age of 25 to access sexual health support along with relationship support, counselling, mental health support, and family support.

If someone was unable to access emergency contraception in time, several of the clinics also have the resources to terminate a pregnancy.

Getting an abortion is a very personal decision, and can be a very difficult one. In Canada, abortions are safe and legal, and can be accessed in hospitals and clinics across the country. In BC, they are covered for residents under the MSP. For people not covered by MSP, the procedure can cost roughly $700.

The VIWC website warns about “crisis pregnancy centres” that are actually anti-choice groups. They “pretend to help pregnant women with information and pregnancy tests,” while posing as clinics, offices and phone lines, but are really trying to frighten them into continuing with their pregnancy. Some will even say their only option is to carry it to term, which is not always true.

If you are thinking about an abortion, the National Abortion Federation has a free and confidential hotline for people seeking accurate information, confidential consultation, options counselling, and referrals. The line is open 8 am to 7 pm Monday–Friday and 8 am to 4 pm Saturday and Sunday. The hotline can be reached at 1-800-772-9100.

According to Sex & U, there are two ways to have an abortion: a medical abortion and a surgical abortion.

A medical abortion “is the use of medications that will bring about an abortion or termination of pregnancy,” says the VIWC website. It can be done within nine weeks after the first day of your last menstrual period. The procedure “stimulates bleeding at home, like a miscarriage, [meaning] blood and tissue is passed.” Strong cramping can occur. 

VIWC describes the process of a medical abortion as follows:

– On day one, you will take your first medication that will destabilize the lining of your uterus and end the pregnancy.

– Over the next 24–48 hours, you will take your second medication and you will start to bleed within 1–4 hours. During this time heavy bleeding and cramping can be expected.

– After 10–14 days of the first medication, you will return to the clinic for an ultrasound or go to a lab for bloodwork to confirm that the pregnancy has ended.

Surgical abortion is an invasive type of abortion done at the hospital, which can be performed when the pregnancy is over 14 weeks. It involves two appointments: one for the consultation and another for the procedure. 

During the consultation, you will meet with a doctor or nurse to have blood work done, as well as an ultrasound and physical examination.

The procedure takes 5–10 minutes, with a 60-minute recovery time. During the procedure, the cervix is frozen to minimize discomfort or pain. The procedure is done under sedation, so you will not be able to drive yourself home. Afterwards, you are given antibiotics to minimize the risk of infection, and an ultrasound is used to ensure completion.

I didn’t know much about abortion until I was out of high school. On an episode of Degrassi: Next Class, Lola (played by Amanda Arcuri) calmly and confidentially gets an abortion and is able to attend school the next day. 

Watching the episode, I realized abortions weren’t this super scary procedure that people made it out to be. Of course, depending on the person and their situation, abortions can still be very emotional or even traumatic.

As controversial and taboo as they can be, abortions are a form of healthcare many people need to access. They should be taught in schools along with other sexual and reproductive healthcare.

It’s ironic that, even though I’m older, I still have difficulty finding people to talk to about sexual health. For this article, I reached out to many different clinics and health care professionals. Since nurses and doctors are working at an all-time high, none of them had time to speak with me. One clinic I called referred me and my questions to a man who works at the clinic. After speaking with him for a bit, he told me he was unable to speak on the medical questions I had, such as types of emergency contraceptions, because he was a cis male and not a medical official. 

So once again, I had to turn to the internet to help me find information on the subject.

Here’s the thing: in school, they often teach youth not to have sex—or if you do, it’s “here’s how you put on a condom and hey girls, get on the pill.” But what about after that? What about waking up the next morning and realizing the condom broke, or if your birth control failed, or if you couldn’t control if the person wore a condom because you’re a survivor of sexual assault? 

These are all real problems and, sadly, it can feel like the only place to learn about them is from the television or the internet.

abortionEllaEmergency ContraceptionIUDPlan BShrill
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