Contraception: Options for Young Women

Scenario

Sarah, 16, and her boyfriend Mike, 17, have recently become sexually active. They have been using condoms that Mike got from her older brother. However, Sarah sometimes gets nervous that they may break.  Sarah has been thinking about it and has decided she would like to start taking some other form of birth control in order to protect herself from getting pregnant. 


Sarah’s parents don’t know she is sexually active and she wants to find out what forms of birth control she can start taking without needing her parents’ consent. She has heard about different contraceptives like the birth control pill or NuvaRing from her friends, but she has no idea whether or not she can get them if she is not 18 years old. 


Eventually she plans on talking to her parents, but she is not ready yet and for the time being she just wants to make sure she is protected.

Information

There is no specific age requirement for accessing birth control. Instead, this is governed by the Ontario Health Care Consent Act, which says that health practitioners (including doctors) can provide treatment (including medication) to patients as long as that patient is "able to understand the information that is relevant to making a decision about the treatment...as the case may be, and able to appreciate the reasonably foreseeable consequences of a decision or lack of decision." (See s. 4 of the Act).  


If a young person is not capable of understanding info around certain health care decisions, then in most cases it is their parent or guardian who must consent to the treatment. 


In this scenario, Sarah does not need permission from her parents to obtain birth control. Most 16 year-olds, including Sarah, are able to understand the information and issues around birth control and thus they don't need their parents' consent before a doctor can prescribe it.  However, it is important that Sarah's doctor give her complete information about the pros and cons of taking various forms of birth control, including the risks, benefits and potential side effects.  This will put Sarah in a position where she can give her "informed consent", which is what is required under the law.  (See s. 11 of the Act. ) 


In circumstances where youth feel comfortable and safe talking to their parents or another trusted adult about issues around sexuality, then it may be worth considering whether to discuss contraception issues and questions with them.  


For more on your health care rights, check out this JFCY pamphlet.


Sarah can get a prescription for birth control from her health care provider, from a sexual health clinic, or (if she is in Toronto) from Planned Parenthood Toronto’s Health Services. If Sarah does not have OHIP it is still possible for her to get a prescription from Planned Parenthood Toronto’s Health Services.


Forms of Contraception

While JFCY is not an expert on medical matters or sexual health, we have compiled the following is a list of available birth control options. You will need to discuss them with your health care provider.

Birth Control pills

What is it? 
Pills that contain hormones a woman takes for either 21 or 28 days to prevent pregnancy. 


How does it work?

• Contains hormones that stop the egg from being released every month
• Makes cervical mucus thicker to stop sperm from getting to the uterus

Where can you get it? 
A woman gets a prescription from her doctor or a clinic 


Condom (for women) 

What is it? 
A plastic pouch worn inside the vagina 

How does it work?

• A woman inserts it before intercourse
• Catches semen which contains sperm

Where can you get it? 
Drugstores and some clinics 


Spermicides (sponge, foam, gel, contraceptive film) 

What is it? 
Sperm-killing chemicals, usually nonoxynol-9 

Spermicides do not protect against Sexually Transmitted Infections 

How does it work?

• Placed in the vagina before intercourse
• Spermicide is released which kills sperm

Where can you get it? 
Drugstores and clinics 

Depo-Provera 

What is it? 
A hormone injection given every three months 

How does it work?

• Hormone makes cervical mucus thicker
• May stop eggs from leaving the ovary

Where can you get it? 
From some doctors and some clinics 

Depo-Provera does not protect against Sexually Transmitted Infections. 
Use condoms every time. 


Fertility Awareness Method 

What is it? 
A combination of natural methods of birth control 

How does it work?

• A woman keeps a record of her menstrual cycle
• She looks for signs that she is close to ovulation (releasing an egg)
• She and her partner do not have sex around the time of ovulation
• The Fertility Awareness Method can be used to make other methods more effective because a woman knows when she is fertile and can use a second method e.g. condoms

Where can you get it? 
A woman can take a course to learn how to use this method effectively 

Emergency Contraception 

What is it?

• Methods used if a condom breaks, if there is unprotected sex, or in the case of a sexual assault
• Two methods to choose from are the Emergency Contraceptive Pill or the Intra-Uterine Device

Emergency Contraceptive Pill 

What is it? 
Pills containing hormones 

How does it work?

• Usually stops sperm from meeting the egg
• Also works by stopping the embryo from attaching to the uterus
• Should be taken as soon as possible after unprotected sex
• Can be taken up to five days after unprotected sex

Where can you get it? 
Clinics and some doctors. It is available without a doctor's prescription at drugstores in Ontario. 

The Patch 

What is it? 
The patch is attached to the skin and delivers hormones into the bloodstream. It is changed once a week for three weeks each month. During the fourth patch-free week, the woman gets her period. 

How does it work?

• Contains hormones that stop the egg from being released every month
• Makes cervical mucus thicker to stop sperm from getting to the uterus

Where can you get it? 
A woman gets a prescription from her doctor or a clinic 

Nuvaring® 

What is it? 
A soft, flexible ring inserted in the vagina. It delivers hormones into the bloodstream. It is inserted for 21 days and removed for 7 days. A new one is inserted at the end of the 7-day break. 

How does it work?

• Contains hormones that stop the egg from being released every month
• Makes cervical mucus thicker to stop sperm from getting to the uterus

The Nuvaring® does not protect against Sexually Transmitted Infections. 
Use condoms every time. 

Where can you get it? 
Consult your doctor

JFCY is not an expert on medical matters or sexual health.  


For more information on birth control listed above please click here

Canadian Federation for Sexual Health

If you are under age 18 in Ontario and have legal questions about your health care rights please contact a lawyer at JFCY at 416-920-1633, or toll-free at 1-866-999-5329.  

Scenario was written by Cemone Morlese, a PLE Team Member volunteer. Information written by JFCY volunteer Sarah Mehta Alexander and a JFCY staff lawyer.

Teen Pregnancy - Part One: Medical Decisions

What does the law say about a youth's right to make health-related decisions?

Kiran and her boyfriend Rick are fifteen years old and in grade ten.  They have been dating for several months and spend most of their time together.  They care about each other and trust each other very much.  A few months into their relationship, Kiran and Rick felt ready to begin having a sexually intimate relationship. 

Kiran has a lot of questions about sex and the emotions that she is feeling but she has only discussed her relationship with her peers at school.  She has not told her parents or her doctor about her sexual relationship.  She is afraid that if she tells her parents she will get in trouble.  She also believes that she cannot see a doctor without her parents’ permission and if she does see a doctor, she is afraid they will tell her parents what they have discussed.

Since Kiran has not spoken with a doctor, she is not using any methods of birth control, (such as the birth control pill) other than condoms.  Both Rick and Kiran are shy and embarrassed to buy condoms in the store, so they only use condoms when Rick asks his older brother. 

This month Kiran missed her period and thinks she might be pregnant.  She and her friend go to the pharmacy and purchase a pregnancy test.  When she takes the test she sees a positive result, indicating that she is pregnant.  Kiran is overwhelmed, scared and doesn’t know what to do next.  What are her options?  What are her rights?

There are two parts to Kiran’s decision-making about the pregnancy: medical decisions, and non-medical decisions (like adoption, involving Rick in the pregnancy, and supporting a baby).  This week’s post covers Kiran’s medical rights and decisions – part two will talk about her non-medical decisions.

Medical decisions

In Ontario, your age does not determine your ability to make decisions about medical treatment. Instead, you can make your own decisions about your health care as long as you are considered capable by your doctor or health-care provider.  Being capable means that you can understand the information that you are given about treatment as well as the consequences of your decision (such as the risks and results of the treatment).  

Your doctor might consider you capable with respect to some treatments and decisions, but incapable with respect to others, depending on how complicated or risky those treatments are.  For example, the different treatments Kiran can expect to hear about at the doctor’s office might range from a second pregnancy test to an ultrasound (a test to look at the fetus and see if it is developing healthily) to an abortion (a procedure to end the pregnancy).  All of these are treatments with different risks, so the doctor might decide that Kiran is capable of making some of those decisions and not others.  In Ontario, you are presumed to be capable of making medical decisions unless the doctor has a reason to believe that you are not capable.  Age can play a role in this decision, since the older you are, the more able you generally are to make independent decisions and understand the consequences of those decisions.  It’s always a good idea to ask the doctor before you discuss something with them, in order to make sure that the doctor will respect your rights and not tell your parents what you have said.

Since Kiran is fifteen, the doctor will probably decide that Kiran is capable of making most or all of her medical decisions.  Any decisions that Kiran makes cannot be disclosed to Kiran’s parents, unless Kiran gives her express consent.  This means that the doctor must ask Kiran before telling Kiran’s parents about her health care information, decisions, and treatment, and Kiran must tell the doctor that it is okay to tell.  Kiran would sign a “consent” form that states exactly what information the doctor may share, and who the doctor can share it with.

If the doctor decides that Kiran is incapable with respect to a certain treatment or medical decision, then the doctor will be able to disclose Kiran’s medical information to someone called a “substitute decision-maker.”  Since Kiran is under 16 and lives with her parents, this person would be one of her parents.  In this case, Kiran will be able to discuss her situation with her parents, but they will be responsible for making her health-care decisions for issues where the doctor has decided Kiran is incapable.

For more information about teen pregnancy, support, and health care options if you think you might be pregnant:

The June Callwood Centre is a multi-service centre for pregnant and parenting teens in Toronto.  Their website contains links to other resources (if you are planning to have a baby or make a decision about a pregnancy), as well as information about the resources they provide.

Rosalie Hall provides services for young women who are going to have a baby or who are new parents, including education, counseling and outreach, child care, among other programs.

Planned Parenthood Toronto provides health care and health services to youth, including on sexual and reproductive health issues, and they will provide information and pregnancy-related medical treatment, including pregnancy tests, counselling on pregnancy options, and referrals to services to help pregnant women make an informed decision regarding pregnancy.

The Ontario laws that determine who can make medical decisions and how medical information can be released are the Health Care Consent Act and the Personal Health Information Protection Act.

Scenario by JFCY Volunteer Marsha Rampersaud.  Legal information by JFCY.