The need for effective contraception, especially long term, has never been greater—counselling to achieve the best contraception for every patient

Dr. Rachel SpitzerAs a primary care provider, it doubtless feels as if there are innumerable competing interests at every patient visit and that many specialties are vying for preventive health care time and opportunity – at every visit discuss smoking cessation! At every visit discuss prescribe 30 minutes a day of activity! (And now) At every visit, encourage people to be vaccinated for COVID-19! And here I am as a specialist in ObGyn coming along to remind you that every visit with a patient of reproductive age is a chance to discuss their contraceptive and family planning needs! In the coming paragraphs I will do my best to convince you of the relevance of this perspective and give you some tips and counselling points to achieve the best contraception for each patient and stress the value of Long Acting Reversible Contraceptives (LARC) for contraceptive and non-contraceptive benefits. It is known that half of all pregnancies are unplanned¹ and demand remains high for termination of pregnancy, clearly indicating that we are missing opportunities for contraception and contraception counselling on various occasions and in various settings. In particular in this past year of the COVID-19 pandemic, facing limited in person medical visits combined with social disruption, financial uncertainty for so many, increased intimate partner violence (IPV), social isolation and mental health needs, the need for effective contraception, especially long term, has never been greater. Health care and access to health care are immutable rights in the Canadian and global context and nowhere is this more crucial than around the right to reproductive health and to reproduce or to not reproduce when chosen. The Society of Obstetricians and Gynecologists of Canada (SOGC) has spoken out strongly in support of the need for prioritizing contraception and access to long term methods as an essential right at this unprecedented time.² Social activism campaigns such as Cover ContraceptiON are advocating for cost coverage of contraceptive methods at this time and are moving forward.³ It would, in fact, make most sense in times such as these, to not only preserve but expand access to LARC and all contraceptives for those in need. Contraception is a topic worth raising with any patients of reproductive age. Sometimes asking about menstrual symptoms, relationships (and safety) and sexual activity may be an entrée to review contraceptive needs or benefit of LARC for noncontraceptive reasons (such as heavy menstrual bleeding, PCOS, etc). Contraception advice is best received when there is a good rapport with the provider and when decision making is felt to be a shared experience from the patient perspective.4, 5Recent contraception literature suggests that the single best question to ask about contraception is “when do you want your next baby”6 and it has certainly been my experience in practice that this single question usually generates a clear response which can guide next steps and recommendations. Some patients will contemplate and reply that the timing is months, others might say years (in which case they will need good long term contraception) and others will loudly exclaim “Never!!!” or “Not for many, many years” in which case LARC is likely well indicated and unintended pregnancy would likely be very distressing.In contemplating LARC specifically, one should have some familiarity with the options currently available in Canada – copper IUD, hormonal IUS (Kyleena and Mirena) and the contraceptive implant (Nexplanon). There are numerous existing myths and misconceptions about contraindications to Intrauterine Contraception. Complications of insertion – perforation and expulsion of IUD/IUS – are rare in all groups (

The need for effective contraception, especially long term, has never been greater—counselling to achieve the best contraception for every patient

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