As of 2005, almost one of every five babies in the Cree communities was born to teenage mothers aged 15 to 19. The numbers speak volumes about the lack of birth control being used in the communities despite its widespread availability.

According to Martine Drolet, RN and Program Officer for Sexual and Mental Health in the Public Health Department of the James Bay Cree Territory, when it comes to birth control, “Most Crees don’t take anything, they just ‘pull out.’ People think that when you pull out you won’t ejaculate inside. But, they forget that there is also pre-ejaculatory fluid that is full of spermatozoid so with this contact you can get pregnant.”

For as much as contraception is available through the North’s clinics, the system under which it is distributed is dramatically different from the rest of the province where anyone can go to the doctor or pharmacy of their choice to obtain whatever they want anonymously. The selection of contraceptives, products and medical services is limited in the North. The following is an overview of what kinds of birth control are available in the communities, what is not and who should use what according to their needs.

Condoms

According to Drolet, condoms are widely available at community clinics, wellness centres, some band offices, through school nurses and through community health representatives.

“Condoms are a good method if you use them correctly,” she said. “We are not sure if everyone is using them correctly or at the right moment.” Drolet emphasized the necessity of avoiding any penetration before putting a condom on.

Though their accessibility might be advantageous, on the down side some do find that condoms can interfere with their sexual experience. As well, the co-operation of the male partner is needed and then there are those who are allergic to latex.

As the condoms that are distributed within the Cree communities do not come in large packages where instructions and diagrams are provided, Drolet says that the Cree Health Board has instead installed pictograms where condoms are distributed to explain their use. “Also when the 15-year-olds come in for their booster shots we take this time to teach the teenagers how to use a condom. We talk about sexuality and protection,” said Drolet.

Female condoms are available in most pharmacies throughout Quebec but they are not available in the Cree communities. The female condom is a polyurethane pouch with rings at both ends that prevent the sperm from being deposited in the vagina. It is advantageous in the sense that it provides slightly more coverage of the vulva, thus adding extra protection against disease transmission but they are not as widely used as the male version. Should there be interest in this particular product, the CHB could make it more available within the communities.

Oral contraceptives

Birth control pills are synthetic compounds that mimic the effects of female hormones estrogen and/or progesterone, preventing the release of an egg from the ovaries. As some women experienced difficulty taking the original forms of the pill, which contained both hormones, there are now prescriptions available on the market that contain only one of the hormones.

The pill is ideal for most women as it is easy to use, does not interfere with sexual activity and can have added health benefits (it reduces the risk of endometrial and ovarian cancers, decreases menstrual flow and even reduces acne). The down side of the pill is that it needs to be taken every day without fail and it increases the risk for blood clots, heart attacks and strokes, particularly in women who smoke and are over the age of 35.

Depo Provera Injections

Depo Provera is another form of hormonal therapy that prevents pregnancy. It is a synthetic progestin serum that is injected into the muscular region of the arm every three months.

Drolet said the injections are a common alternative to contraceptive pills in the Cree communities. A team from the CHB comes four times a year to the clinic to dispense it. Patients may even receive reminder calls. “We can make a check list and call them in advance to make sure that they don’t forget, especially for the youth,” said Drolet. “So, it’s a good contraception that has been used for 35 years.” One possible side effect is slight weight gain.

Depo Provera is ideal for those who do not want to have to worry about taking the pill daily and it’s a great alternative for those who are intolerant to estrogen.

Depo Provera can be disadvantageous in the sense that it may take up to 18 months to be able to conceive a pregnancy after the method has been stopped and it can cause irregular bleeding. Women who have experienced unexplained vaginal bleeding, liver disease, heart attacks, strokes, breast cancer or blood clots should not take this medication.

The Contraceptive Patch or Evra

Evra is a transdermal patch or sticker that can be applied to various different parts of the body and it delivers a steady dose of progestin and estrogen through the skin. The patch needs to be replaced once a week for three weeks out of the month but is not needed during the week that a woman menstruates.

It’s not recommended for women who weigh more than 98 kilograms because it can increase the risk of a blood clot in the brain.

“It is not, however, very effective with the youth because they tend to forget it,” said Drolet.

What is ideal about the patch is that it is easy to use and it also does not interrupt sexual activity. The patch functions similarly to oral contraceptives and it has similar benefits though it can fall off though it is designed to be durable and last through things like bathing and heavy activity. It can also cause breast tenderness and local skin reactions. The contraindications for this drug are similar to oral contraceptives.

IUDs or Intrauterine Devices

An IUD is a small, T-shaped, wire device that contains copper wire. The device kills sperm and it changes the environment in the uterus, creating difficulty for a fertilized egg to implant. Levonorgestrel-releasing IUDs release a synthetic hormone to thicken the cervical mucus and thins out the uterine lining. Women who are deemed good candidates by their physicians can have this device implanted by their doctors.

IUDs are ideal for women who want a long-term but reversible form of birth control as it can last from five to eight years and its effects stop immediately after a doctor removes it. They are not, however, recommended for women who have STIs, who have multiple partners or who have metal allergies. Some maintenance is required with this form of birth control, as patients need to check if the device is still in place after each menstrual cycle. IUDs can also randomly fall out.

The Morning After Pill/ Ovral/ Plan B

The “morning after pill” is a combination of high-dose female hormones – estrogen and progestin – and it is generally used as an emergency back-up plan for a woman who has had unprotected intercourse or who was using a contraceptive method that failed. It must be administered within 72 hours of having unprotected intercourse and is most effective within the first 12-24 hours. Neither form of the medication is an abortive method but they are instead believed to prevent a pregnancy by slowing down the rate at which the egg travels through the fallopian tube and altering the uterine lining so that the egg, if fertilized, cannot implant and begin to develop.

There are two forms of this medication available in Quebec: Ovral and Plan B. Ovral contains both of the hormones and can cause nausea, but Plan B, a much newer drug, does not have as intense side effects. “It is available at the clinics and the hospital and we have the Ovral type most of the time,” said Drolet, though the CHB is looking to switch to Plan B soon. Unlike the rest of the province where the drug is available over the counter at any pharmacy, both forms of this medication are dispensed in the clinics within the Cree communities.

What is not available within the Cree communities but can be obtained in other regions of the province:

Diaphragms

The diaphragm is a flat ring covered by a latex dome that is inserted prior to intercourse to cover the cervix, thus preventing sperm from making contact with the egg. It is used in conjunction with spermacide to not only lubricate the device but to keep it from moving. The diaphragm needs to stay in for a minimum of eight hours after sexual activity but can not stay in longer than 24 hours.

The diaphragm needs to be inserted before sex so it won’t interrupt sexual activity but it does require planning and users of this form of birth control need to carry them around and have spermacidal gel or cream on hand. Women also need to be fitted for this product by their physicians.

Cervical Caps

Cervical caps are smaller latex caps that also cover the cervix and prevent sperm from fertilizing eggs. It is extremely similar to the diaphragm, but this device can be left in for up to 48 hours.

Spermicide

Much like insecticide, spermicide is a chemical compound that kills sperm. It comes in the form of a gel, cream, foam, film or suppository. Generally it is used in conjunction with another form of birth control as it is not as effective on its own. Spermicide needs to be inserted into the vagina prior to intercourse.

Contraceptive Sponges

The sponge is a round, single use, polyurethane foam barrier that contains spermacide and is placed deep in the vagina to absorb sperm, trapping and destroying them to prevent conception. The indications for this product are also quite similar to both the cervical cap and the diaphragm only the sponge needs to stay in for six hours after intercourse but no longer than 24 hours.

As to why these products are not available in the communities, Drolet said they are too archaic. “They are old fashioned. It’s old contraception, and they’re not that popular,” said Drolet.

Surgical Procedures

The following three procedures are available to Crees, free of charge, as they are to all Quebec residents. However, they are not available in the communities like many other medical procedures and would require an individual to leave to seek out the services where they are available.

Female Tubal Ligation

Also known as “getting your tubes tied,” a tubal ligation can be performed by a doctor. The procedure involves disconnecting the two fallopian tubes that transport the egg to the uterus. Though the procedure is not entirely irreversible, the reversals do not have a high success rate. This procedure is not as ideal for those who are younger and may desire children later on.

Male Vasectomy

A vasectomy is a surgical procedure in which the vasa deferentia are cut for the purpose of blocking the sperm from entering the ejaculatory fluid. Without sperm conception can not take place. It is a simple procedure that is not easily reversible. This is another procedure that is not generally recommended to younger men who may want children later on in life.

Abortion

Abortion is the surgical termination of a pregnancy by the removal or expulsion of an embryo from the uterus. In Canada, access to abortion services is guaranteed by the Canada Health Act and is a safe, legal procedure that is covered under Medicare. As of January 2008, due to a class-action lawsuit headed up by abortion pioneer Henry Morgentaler, all abortions in Quebec are now covered. This means that the charges previously incurred from private clinic abortions are not only covered but also those who had the procedure in a private clinic between 1999 and early 2006 can now be reimbursed for the procedure.

Any female who wishes to obtain an abortion does not need parental consent nor consent from a partner.

Abortions are available in many CLSCs, hospitals and private clinics. Almost all regions have to be represented meaning that women shouldn’t have to go very far to obtain the service.

In that the CHB was not forthcoming about the abortion services for the Cree communities, it can only be assumed that abortions are treated the same way any other surgical procedure would be since that is the law in Canada and there is a guarantee of service in place. Like any other medical procedure, a patient can inquire about obtaining the procedure through her doctor.

For those who wish to bypass the regular medical channels, the procedure is offered at over 35 different medical centres across the province and the closest to the communities are located in Val D’Or, Rouyn Noranda and Chibougamau.

To reach the family planning clinic in Val d’Or, contact the Centre hospitalier Vallée-de-1’Or at 819-825-6711 ext. 2490 The family planning clinic in Rouyn Noranda can be reached at 819-762-5599 ext. 45073

The Centre de santé de Chibougamau also has a family planning clinic that can be reached at 418-748-7658 ext. 4214 The Morgentaler Clinic in Montreal can also be reached at 514-844-4844