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Part 2:  Sexual and Reproductive Health Issues of Concern to Aboriginal People


Adults:
Unit 8 — Birth Control and Pregnancy Options

Be sure to read Part 1 before working on this unit. See these other units for more issues related to birth control and pregnancy options:

Unit 2 — Educating Children and Youth About Sexuality
Unit 4 — Youth Sexuality and Sexual Health
Unit 5 — Teen Pregnancy
Unit 17 — HIV/AIDS and Other Sexually Transmitted Infections


Introduction

Before the induction of modern medicine, the Kokums (Grandmothers) were the keepers of the knowledge of herbal medicines, including medicines for birth control. They were the midwives in the community and had knowledge of the whole gamut of medicines to cure any illness in their families. The knowledge for many of these medicines was easily shared from First Nations to the Métis.
Métis writer from Ontario


Traditionally and still today, Aboriginal people thought of having and raising children as a natural part of life, a sacred trust and a part of the circle of life. However, even in previous times, women took measures to delay having children (until other children were older or to plan births for safe times and places). Today, while some First Nations, Inuit and Métis people believe getting pregnant should be left up to the Creator, others want to decide if and when they will have children. Young people especially want to delay pregnancy to a time when we are ready to parent and are able to give our children the best start in life. People who want to choose to get pregnant want complete information and services — the birth control methods, and access to abortion, adoption and parenting help that will let us make these decisions for our own good, and that of our families, communities and nations.

Fear of pregnancy can rob couples of the joy sex is able to give them. Sex without birth control will likely lead to pregnancy: research shows that 25 percent of young women who have intercourse without using some method of birth control will become pregnant within one month, and 85 percent will become pregnant within one year.1(click here for footnote)   Everyone who is sexually active needs to practise "safer sex" (i.e., preventing pregnancy and sexually transmitted infections).

For the same reasons discussed in other units, these matters are not always easy to talk about. Different people have different values. Youth may be afraid to talk to their parents, and don’t always have the skills to talk about and then act on birth control decisions with their sexual partners. There may be a lack of confidential and non-judgmental information and counselling in a community. Small and isolated communities may lack services and birth control supplies. These are all barriers to pregnancy planning and choice that communities have to try to overcome.


Preventing and Dealing with Unintended Pregnancy

Good Sex Education

Informed decisions about pregnancy start with good sexuality education because women and men need to know how their bodies work and how pregnancy comes about. Even more importantly, they will be better able to make decisions and carry them out if they feel good about their sexuality, can talk openly about sex, have good self-esteem and can choose good relationships. Parents, grandparents and other adults can help by providing healthy sexuality education, by talking openly with children and youth, and by guiding youth while respecting their decisions.


Pilot coordinator Barb says:
What advice would I give to others working in sexual health education? Never give up. Those working in sexual health services often feel isolated. There is not another topic more sensitive than sex and sexuality. What is encouraging is that when people feel safe to discuss sexuality openly, honestly and respectively, incredible discussions and learning can take place.
Barb McWatters, Planned Parenthood Regina, Regina, Saskatchewan



Parental Consent and Contraception

According to Canadian law, there is no minimum age to prescribe contraception, and youth are under no legal obligation to inform their parents that they are being prescribed or are using contraception. Clinical staff is also under no legal obligation to report contraceptive use to parents. In fact, reporting contraceptive use would breach patient confidentiality.


Information and Services for Youth

Youth want and need to make their own decisions about sexual activity, pregnancy and parenting — whether this be to delay sexual involvement, use a method of birth control or get pregnant. Parents and educators can help by encouraging youth to actively decide if they are ready for sex, what makes a good relationship, and what having a child is really like. Service providers need to provide accurate information to youth, and make sure that sexually active teens have access to methods that prevent pregnancy and sexually transmitted infections. Youth need help selecting a birth control method that will work for them (depending on their lifestyle, level of responsibility, nature of their sexual encounters, etc.) and help "negotiating" safer sex with their partners. As with other youth programs, peer education (youth talking to youth) and youth-directed services have the greatest chance of success.


Birth Control

In my community, the doctors are very discriminating. I wanted to go on the pill when I was 14. I went into the doctor’s office, and I knew that I needed parental consent. But I was just going in to talk about it. And the doctor said, "Well you shouldn’t be having sex anyway." Then I went in with my mom. But if my mom wasn’t with me I knew I wouldn’t be able to get it because I was under 16. And you couldn’t get condoms in the school. You’d have to go into the drug store and that is pretty intimidating, especially in a small town because you know everyone who works there. So unless the guys had them, the girls didn’t go out and buy them.
Youth from northern British Columbia


Men and women can practise many different kinds of birth planning, and should talk with one another to choose the way that is best for them. Also, up-to-date information is important, since methods are changing all the time. Individuals and couples who want to postpone or prevent pregnancy should talk to a health care provider or a Planned Parenthood counsellor. As a service provider, you can learn more about birth control methods and pregnancy planning, refer your clients to your local health clinic for this information, or contact the closest Planned Parenthood office (there is a list at the back of the Sourcebook).

The five main methods of planning pregnancies are: hormonal methods; barrier methods; surgical methods; a device that works inside the uterus; and natural methods. Some methods are short term and others long term, some require a doctor’s visit and/or a prescription, others are available from a health clinic or pharmacy. Some methods are more effective than others, but there can be side effects.

Hormonal methods include many different kinds of birth control pills, injections and implants that go under the skin. Barrier methods include male and female condoms, the contraceptive sponge, the diaphragm and spermicides. Different intrauterine devices (or IUDs) are placed in the uterus. Surgical methods are tubal ligation for the woman and vasectomy for the man. Natural methods include not having any sexual contact, not having intercourse and planning intercourse for the safer times of a woman’s fertility cycle.


Pregnancy Options


 Within traditional societies and languages, there is no word that equals abortion. The word itself is very harsh and impersonal. When speaking to traditional Elders knowledgeable about reproductive health matters, repeatedly they would refer to a woman knowing which herbs and methods to use "to make her period come." This was seen as a woman taking care of herself and doing what was necessary. Oftentimes women would turn to the women within her society that were keepers of those herbs, medicines and techniques for assistance.2 (click here for footnote)


A woman can get pregnant even if she is using birth control, or she may not be able to practise safer sex because she fears her partner or she has been using drugs or alcohol. She (and her partner) have several options if the pregnancy was unintended:

  • she/they can prevent the pregnancy through the use of emergency contraception ("the morning after pill" within three to five days of unprotected sex)
  • she can decide to have an abortion to end the pregnancy
  • she/they can choose to place the baby up for adoption after the birth
  • she/they can choose to raise the child with help from community services and others

Women and their partners deserve a great deal of support and help in making this difficult and life-changing choice. While not everyone agrees with morning-after contraception or abortion, women in Canada have a right to these health services. Counsellors and health care providers have a responsibility to provide non-judgmental information, support and referrals to women no matter which option they choose.

 

The print version of the Sourcebook also contains information on print, web-based and audio-visual resources, and sample materials on birth control and pregnancy options.

 

1  Sex Sense: Canadian Contraceptive Guide, Society of Obstetricians and Gynaecologists of Canada, Ottawa, 2000, p. 11.  (back to paragraph)

2  Indigenous Women’s Reproductive Rights and Pro-choice Page, Native American Women’s Health Education Resource Center, Lake Andes, South Dakota, 2000. Available at: www.nativeshop.org/pro-choice.html   (back to paragraph)

 
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