Part 1: Introduction, Methodology and Demographic Characteristics of Respondents

Fertility control is a fundamental aspect of women’s health, and it is therefore important to have accurate and up-to-date information on the contraceptive knowledge, opinions and practices of women in Canada. The 1998 Canadian Contraception Study was conducted on a sample of women aged 15-44 from across Canada who were part of a panel of 60,000 households previously selected for survey research. Of 2,893 surveys mailed out, 1,599 responses were returned, a response rate of 55%. Responses were weighted to be representative by region and age within marital status, based on Canadian census data. The questionnaire asked about contraceptive practices, past, present, and future, as well as about respondents’ familiarity with and opinion of different methods of contraception. The survey also included questions about general sexual and reproductive health, including experience of sexual dysfunctions (The Canadian Journal of Human Sexuality, 1999; 8: 163-166).

Part 2: Familiarity With, Opinions About, and Use Of Contraceptive Methods Among Canadian Women

This part of the 1998 Canadian Contraception Study describes findings related to Canadian women’s familiarity with, opinions about, and use of various contraceptive methods. Familiarity was almost universal for oral contraceptives and condoms, but less than 60% of women aged 15 to 44 were familiar with the other methods. Respondents had the most positive opinions about oral contraceptives (64% of women had a "very favourable opinion"), were less positive about male sterilization (40%), condoms (37%), and female sterilization (31%) and even less so for each of the other methods cited (less than 15% in all cases). Condoms and oral contraceptives were the most widely used methods among sexually active women using contraception (44% and 43% respectively). These findings confirm the central place of oral contraceptives and condoms in the contraceptive awareness and practices of Canadian women (The Canadian Journal of Human Sexuality, 1999; 8: 167-174).

Part 3: Measures of Sexual and Reproductive Health Among Canadian Women

Women responding to the 1998 Canadian Contraception Study answered several questions about sexual and reproductive health issues. Eleven percent of respondents had never had intercourse: of those who had, 88% were coitally active during the previous six months. Premenstrual syndrome was self-diagnosed by 58% of all respondents, while 30% reported dysmenorrhea. Monthly breast self-examination was practised by 37% of respondents, with a higher reported rate among older women. Pap smears during the preceding two years were reported by 81% of sexually experienced women. Among sexual dysfunctions that were examined, the most common was diminished sexual desire, described as a problem by 39% of the total sample and by 57% of younger married women. These results show that sexual, reproductive, and women’s health problems are common among Canadian women, and that reproductive cancer screening is suboptimal (The Canadian Journal of Human Sexuality, 1999; 8:175-182).

Part 4: Oral Contraceptive Use Among Canadian Women: Practices and Opinions

The oral contraceptive (OC, or pill) is almost universally known, and very widely used, among Canadian women. The 1998 Canadian Contraception Study found that 96% of adult women were familiar with the pill as a method of contraception, and 28% were currently using it: of sexually active women using contraception, the pill was used by 43%. The findings showed that 35% of current pill users reported more than one sexual partner during the past two years, indicating considerable STD/HIV risk. Respondents thought highly of the pill, with 64% expressing a very favourable opinion of the method, and 73% of current users being very satisfied. However, despite these high levels of awareness and use, many women had misperceptions about the pill, about its safety, side effects, and use. These findings suggest that educational and clinical counselling concerning the birth control pill may need to address these misperceptions (The Canadian Journal of Human Sexuality, 1999; 8: 183-188).

Part 5: Condom Use Among Canadian Women: Practices and Opinions

Condoms are not only an effective method of contraception, they are also an effective way to reduce STD/HIV risk. Most Canadian women (91%) are aware of condoms as a method of birth control and most women (75%) have a favourable opinion of condoms. Overall, 21% of Canadian women report that condoms are their current method of contraception. Unmarried women (64%) were more likely than married women (31%) to have used condoms in the previous six months. Condom use is often inconsistent and about 25% of Canadian women carry the misperceptions that monogamy and getting to know and trust your partner eliminates the need to use condoms for STD/HIV prevention. These findings indicate a need to continue efforts to provide Canadians with effective STD/HIV prevention education.(The Canadian Journal of Human Sexuality, 1999; 8:189-194.)

Part 6: Sterilization Among Canadian Women and Their Partners: Practices and Opinions

Two-thirds of the women in the 1998 Canadian Contraception Study are familiar with sterilization as a method of birth control, and they generally think highly of this method. Among women who have been sterilized or whose partners have undergone vasectomy, rates of satisfaction are very high. The rate of sterilization, 23% overall, includes 10% of women who have had the operation, and 14% of their partners. The increasing use of male sterilization is appropriate, given the low morbidity attached to this procedure. This operation should continue to increase in prevalence, as 75% of women who have decided on future sterilization wish their partner to have the operation.(The Canadian Journal of Human Sexuality, 1999; 8: 195-198.)

Part 7: Contraceptive Attitudes and Practices of Canadian Women in Their Later Reproductive Years

This part of the 1998 Canadian Contraception Study examines the contraceptive attitudes and practices of women in their later reproductive years. Women aged 35 to 44 years made up 36% of the sample, and their responses to many questions indicated that they constitute a distinct group worthy of particular attention. Women in their later reproductive years were more aware of permanent contraceptive choices than were younger women, and they had more positive opinions of sterilization, and tended to use this method more than did younger women. In addition, they reported lower rates of several types of sexual dysfunction, compared with younger women (The Canadian Journal of Human Sexuality, 1999; 8: 199-202).

Part 8: Changes in Contraceptive Use Among Canadian Women

The 1998 Canadian Contraception Study asked a series of questions about the changes that women had made, or were planning to make, in their contraceptive choices. Current OC users were most likely to have used either condoms (42%) or no method (37%) prior to OC use. This suggests that many current OC users were new users of contraception. Currently sterilized women (or women whose partners had been sterilized) were most likely to have previously used either the pill (42%) or condoms (26%). Current users of any method were generally content with their present choices, with only 9% planning a change in the next six months. However, the long span of a woman’s need for contraception means that most will change methods several times. Counsellors, educators, and clinicians must be aware of these changes, the reasons behind them, and of the methods appropriate to the different needs of women across the reproductive years (The Canadian Journal of Human Sexuality, 1999; 8: 203-206).

Part 9: Fifteen-Year Canadian Contraception Trends

Since 1984, four national surveys have examined Canadian women’s contraceptive practices. The Canadian Fertility Study, and the three Canadian Contraception Studies (conducted in 1993, 1995, and 1998) allow analysis of trends in contraception across a fifteen-year time span. Except for oral contraceptives and condoms, familiarity with most methods of birth control has dropped consistently and significantly among women surveyed over the fifteen-year time period. The most significant change in contraceptive method use has been in female sterilization, which has declined from 24% of current contraceptive use among Canadian women in 1984, to 10% in 1998. The oral contraceptive has become, and remains, the most widely used method, currently used by 28% of Canadian women surveyed (The Canadian Journal of Human Sexuality, 1999; 8: 207-212).

Part 10: Clinical and Educational Implications of the 1998 Canadian Contraception Study

The 1998 Canadian Contraception Study surveyed a representative sample of Canadian women on their contraceptive practices and attitudes as well as on a range of reproductive and sexual health matters. This part of the report summarizes some of the key clinical and educational implications that emerged from the study. The findings suggest that clinicians need to increase their efforts to help women become aware of their contraceptive options, educate women about the safety and health benefits of oral contraception, remind women of the importance of cancer screening and preventive behaviour, ask women about sexual/reproductive health concerns, and promote consistent contraceptive and safer sex behaviours (The Canadian Journal of Human Sexuality, 1999; 8: 213-216).