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<select id="email-citation-format" name="citation-format" class="action-panel-selector email-citation-format">
<option selected="selected" value="summary">Summary</option>
<option value="summary-text">Summary (text)</option>
<option value="abstract">Abstract</option>
<option value="abstract-text">Abstract (text)</option>
</select>
</div>
<div class="include-supplemental-container">
<input type="checkbox" aria-label="Include MeSH and other data" name="include-supplemental" id="email-include-supplemental" class="email-include-supplemental">
<label for="email-include-supplemental" class="email-include-supplemental-label">MeSH and other data</label>
</div>
<div class="form-field recaptcha ">
<div class="g-recaptcha" id="id-recaptcha" data-sitekey="6LfsWHMdAAAAAClKbtOpjQ2pMjgsGxvv7NdZW9uI"></div>
</div>
<div id="captcha-error-message" class="usa-input-error-message captcha-validation-message" role="alert"></div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Sending..."
data-ga-category="save_share"
data-ga-action="email"
data-ga-label="send">
Send email
</button>
<button class="action-panel-cancel"
aria-label="Close 'Email citations' panel"
ref="linksrc=close_email_panel"
aria-controls="email-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="email"
data-ga-label="cancel">
Cancel
</button>
</div>
<input type="hidden" name="email-search-details" value="" />
<input type="hidden" name="email-search-details-hash" value="0e42663a6c3bd85498fcb88798998fed7bfdc45d457db35281e41afe13cc0524" />
</form>
</div>
</div>
<div id="collections-action-panel"
class="collections-action-panel action-panel in-progress-dots-panel"
aria-hidden="true"
data-collections-open-panel-enabled="false"
data-collections-open-panel-url-hash="#open-collections-panel">
<div class="inner-wrap">
<h3 class="action-panel-heading">
Add to Collections
</h3>
<form id="collections-action-panel-form"
class="collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-existing-collections-url="/list-existing-collections/"
data-add-to-existing-collection-url="/add-to-existing-collection/"
data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/"
data-get-article-ids-by-search-url="/get-article-ids-by-search/"
data-myncbi-max-collection-name-length="100"
data-add-to-collection-max-amount="1000"
data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/">
<input type="hidden" name="csrfmiddlewaretoken" value="yZZT4DXkaVFzo4Ep3EDO6bl3sbDBlXOaPMJYHtqGKws3ivKfGXgQAjRH0flNeymu">
<div class="choice-group" role="radiogroup">
<ul class="radio-group-items">
<li>
<input type="radio"
id="collections-action-panel-new"
class="collections-new"
name="collections"
value="new"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="collections_radio_new">
<label for="collections-action-panel-new">Create a new collection</label>
</li>
<li>
<input type="radio"
id="collections-action-panel-existing"
class="collections-existing"
name="collections"
value="existing"
checked="true"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="collections_radio_existing">
<label for="collections-action-panel-existing">Add to an existing collection</label>
</li>
</ul>
</div>
<div class="controls-wrapper">
<div class="action-panel-control-wrap new-collections-controls">
<label for="collections-action-panel-add-to-new" class="action-panel-label required-field-asterisk">
Name your collection:
</label>
<input
type="text"
name="add-to-new-collection"
id="collections-action-panel-add-to-new"
class="collections-action-add-to-new"
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/"
maxlength="100"
data-ga-category="save_share"
data-ga-action="create_collection"
data-ga-label="non_favorties_collection">
<div class="collections-new-name-too-long usa-input-error-message selection-validation-message">
Name must be less than 100 characters
</div>
</div>
<div class="action-panel-control-wrap existing-collections-controls">
<label for="collections-action-panel-add-to-existing" class="action-panel-label">
Choose a collection:
</label>
<select id="collections-action-panel-add-to-existing"
class="action-panel-selector collections-action-add-to-existing"
data-ga-category="save_share"
data-ga-action="select_collection"
data-ga-label="($('#collections-action-add-to-existing').val() === 'Favorites') ? 'Favorites' : 'non_favorites_collection'">
</select>
<div class="collections-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your collection due to an error<br>
<a href="#">Please try again</a>
</div>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="add">
Add
</button>
<button class="action-panel-cancel"
aria-label="Close 'Add to Collections' panel"
ref="linksrc=close_collections_panel"
aria-controls="collections-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="collections"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="bibliography-action-panel"
class="bibliography-action-panel action-panel in-progress-dots-panel"
aria-hidden="true"
data-bibliography-open-panel-enabled="false"
data-bibliography-open-panel-url-hash="#open-bibliography-panel">
<div class="inner-wrap">
<h3 class="action-panel-heading">
Add to My Bibliography
</h3>
<form id="bibliography-action-panel-form"
class="bibliography-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-add-to-bibliography-max-amount="100"
data-add-to-bibliography-batch-size="10"
data-bibliography-delegates-url="/list-bibliography-delegates/"
data-add-to-bibliography-url="/add-to-bibliography/"
data-get-article-ids-by-search-url="/get-article-ids-by-search/"
data-mybib-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/mybibliography/">
<input type="hidden" name="csrfmiddlewaretoken" value="yZZT4DXkaVFzo4Ep3EDO6bl3sbDBlXOaPMJYHtqGKws3ivKfGXgQAjRH0flNeymu">
<div class="action-panel-control-wrap bibliographies-controls">
<div class="choice-group">
<ul class="bibliographies-action-add radio-group-items">
<li>
<input name="bibliography" id="my-bibliography" class="my-bibliography" type="radio" checked/>
<label for="my-bibliography">My Bibliography</label>
</li>
</ul>
</div>
</div>
<div class="bibliographies-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your delegates due to an error<br>
<a href="#">Please try again</a>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore>
Add
</button>
<button class="action-panel-cancel"
aria-label="Close 'Add to bibliography' panel"
ref="linksrc=close_bibliography_panel"
aria-controls="bibliography-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="mybib"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="saved-search-action-panel" class="saved-search-action-panel action-panel " aria-hidden="true"
data-saved-search-open-panel-enabled="false"
data-saved-search-open-panel-url-hash="#open-saved-search-panel">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Your saved search
</h2>
<form id="saved-search-action-panel-form"
class="saved-search-action-panel-form action-panel-content action-form"
data-create-saved-search-url="/create-saved-search/"
data-try-search-terms-url="/try-search-term/"
data-saved-search-root-url="https://www.ncbi.nlm.nih.gov/myncbi/searches/">
<input type="hidden" name="csrfmiddlewaretoken" value="yZZT4DXkaVFzo4Ep3EDO6bl3sbDBlXOaPMJYHtqGKws3ivKfGXgQAjRH0flNeymu">
<div class="action-panel-control-wrap">
<label for="saved-search-name" class="action-panel-label saved-search-name-label required-field-asterisk">
Name of saved search:
</label>
<input maxlength="200"
type="text"
name="saved-search-name"
id="saved-search-name"
class="saved-search-name"
value=""
required
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/">
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-term" class="action-panel-label required-field-asterisk">
Search terms:
</label>
<textarea name="saved-search-term" id="saved-search-term" class="saved-search-term" required></textarea>
</div>
<div class="test-search-term-wrap">
<a href="#" class="try-search-term">Test search terms</a>
</div>
<div class="choice-group action-panel-extra-margin-top">
<span class="action-panel-label" id="fieldset-label">
Would you like email updates of new search results?
</span>
<fieldset id="saved-search-alert" aria-describedby="fieldset-label">
<legend class="usa-sr-only">Saved Search Alert Radio Buttons</legend>
<ul class="radio-group-items">
<li>
<input type="radio" id="saved-search-alert-yes" class="saved-search-alert-yes" name="saved-search-alert" value="yes" checked>
<label for="saved-search-alert-yes" class="action-panel-label">Yes</label>
</li>
<li>
<input aria-label="No radio input" type="radio" id="saved-search-alert-no" class="saved-search-alert-no" name="saved-search-alert" value="no">
<label for="saved-search-alert-no" class="action-panel-label">No</label>
</li>
</ul>
</fieldset>
</div>
<div class="alert-schedule-wrap">
<div class="action-panel-control-wrap">
<label class="action-panel-label">
Email:
</label>
<span aria-label="Email address" id="saved-search-email" class="action-panel-label"><span class="action-panel-label-bold"></span> (<a class="myncbi-account-settings" href="https://www.ncbi.nlm.nih.gov/account/settings/">change</a>)</span>
</div>
<div class="action-panel-control-wrap action-panel-extra-margin-top">
<label for="saved-search-frequency" class="action-panel-label">
Frequency:
</label>
<select id="saved-search-frequency" class="no-border-panel-selector saved-search-frequency">
<option value="monthly">Monthly</option>
<option value="weekly">Weekly</option>
<option value="daily">Daily</option>
</select>
</div>
<div class="action-panel-control-wrap saved-search-monthly-additional">
<label for="saved-search-monthly-on-day" class="action-panel-label">
Which day?
</label>
<select id="saved-search-monthly-on-day" class="no-border-panel-selector">
<option value="Sunday">The first Sunday</option>
<option value="Monday">The first Monday</option>
<option value="Tuesday">The first Tuesday</option>
<option value="Wednesday">The first Wednesday</option>
<option value="Thursday">The first Thursday</option>
<option value="Friday">The first Friday</option>
<option value="Saturday">The first Saturday</option>
<option value="day">The first day</option>
<option value="weekday">The first weekday</option>
</select>
</div>
<div class="action-panel-control-wrap saved-search-weekly-additional">
<label for="saved-search-weekly-on-day" class="action-panel-label">
Which day?
</label>
<select id="saved-search-weekly-on-day" class="no-border-panel-selector saved-search-weekly-on-day">
<option value="Sunday">Sunday</option>
<option value="Monday">Monday</option>
<option value="Tuesday">Tuesday</option>
<option value="Wednesday">Wednesday</option>
<option value="Thursday">Thursday</option>
<option value="Friday">Friday</option>
<option value="Saturday">Saturday</option>
</select>
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-report" class="action-panel-label">
Report format:
</label>
<select id="saved-search-report" class="no-border-panel-selector saved-search-report">
<option value="DocSum">Summary</option>
<option value="DocSumText">Summary (text)</option>
<option value="Abstract">Abstract</option>
<option value="AbstractText">Abstract (text)</option>
<option value="MEDLINE">PubMed</option>
</select>
</div>
<div class="action-panel-control-wrap">
<label for="saved-search-amount" class="action-panel-label">
Send at most:
</label>
<select id="saved-search-amount" class="no-border-panel-selector saved-search-amount">
<option value="1">1 item</option>
<option value="5" selected>5 items</option>
<option value="10">10 items</option>
<option value="20">20 items</option>
<option value="50">50 items</option>
<option value="100">100 items</option>
<option value="200">200 items</option>
</select>
</div>
<div>
<input type="checkbox" id="saved-search-send-if-no-result" class="saved-search-send-if-no-result" name="saved-search-send-if-no-result">
<label for="saved-search-send-if-no-result" class="action-panel-label smaller-checkbox">
Send even when there aren't any new results
</label>
</div>
<div class="action-panel-control-wrap option-text-in-email-wrap">
<label for="saved-search-email-text" class="action-panel-label">
Optional text in email:
</label>
<textarea name="saved-search-email-text"
id="saved-search-email-text"
class="saved-search-email-text"></textarea>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Saving..."
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="save">
Save
</button>
<button class="action-panel-cancel"
aria-label="Close 'Your saved search' panel"
ref="linksrc=close_saved_search_panel"
aria-controls="saved-search-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="citation-manager-action-panel" class="citation-manager-action-panel action-panel" aria-hidden="true">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Create a file for external citation management software
</h2>
<form id="citation-manager-action-panel-form"
class="action-panel-content action-form"
action="/results-export-ids/"
data-by-search-action="/results-export-search-data/"
data-by-ids-action="/results-export-ids/"
method="post"
data-by-search-method="post"
data-by-ids-method="post">
<input type="hidden" name="csrfmiddlewaretoken" value="yZZT4DXkaVFzo4Ep3EDO6bl3sbDBlXOaPMJYHtqGKws3ivKfGXgQAjRH0flNeymu">
<input name="results-format" type="hidden" value="pubmed"/>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Sending..."
data-ga-category="save_share"
data-ga-action="citation_manager"
data-ga-label="save">
Create file
</button>
<button class="action-panel-cancel"
aria-label="Close 'Send citations to citation manager' panel"
ref="linksrc=close_citation_manager_panel"
aria-controls="citation-manager-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="citation_manager"
data-ga-label="cancel">
Cancel
</button>
</div>
</form>
</div>
</div>
<div id="rss-action-panel" class="rss-action-panel action-panel " aria-hidden="true">
<div class="inner-wrap">
<h2 class="action-panel-heading">
Your RSS Feed
</h2>
<form id="rss-action-panel-form"
class="rss-action-panel-form action-panel-content action-form"
data-create-rss-feed-url="/create-rss-feed-url/"
data-search-form-term-value="">
<input type="hidden" name="csrfmiddlewaretoken" value="yZZT4DXkaVFzo4Ep3EDO6bl3sbDBlXOaPMJYHtqGKws3ivKfGXgQAjRH0flNeymu">
<div class="action-panel-control-wrap">
<label for="rss-name" class="action-panel-label required-field-asterisk">
Name of RSS Feed:
</label>
<input maxlength="200"
placeholder="Name"
type="text"
name="rss-name"
id="rss-name"
class="rss-name"
value=''
required
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/">
</div>
<div class="rss-limit-wrap">
<div class="action-panel-control-wrap action-panel-extra-margin-top">
<label for="rss-limit" class="action-panel-label">
Number of items displayed:
</label>
<select id="rss-limit" class="no-border-panel-selector rss-limit">
<option value="5">5</option>
<option value="10">10</option>
<option value="15" selected="selected">15</option>
<option value="20">20</option>
<option value="50">50</option>
<option value="100">100</option>
</select>
</div>
</div>
<div class="action-panel-actions">
<button class="action-panel-submit"
type="submit"
data-loading-label="Creating..."
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="save">
Create RSS
</button>
<button class="action-panel-cancel"
aria-label="Close 'Your RSS' panel"
ref="linksrc=close_rss_panel"
aria-controls="rss-action-panel"
aria-expanded="false"
data-ga-category="save_share"
data-ga-action="alert"
data-ga-label="cancel">
Cancel
</button>
</div>
<div class="action-panel-control-wrap rss-link-copy-wrap">
<label for="rss-link" class="usa-sr-only">RSS Link</label>
<input placeholder="Your RSS Feed Link" type="text" name="rss-link" id="rss-link" class="rss-link" title="RSS Link">
<button
type="button"
disabled
class="rss-link-copy-button disabled"
data-ga-category="save_share"
data-ga-action="rss"
data-ga-label="copy">
Copy
</button>
</div>
</form>
</div>
</div>
</div>
</div>
<div class="article-page" id="article-page" data-article-pmid="26606712">
<aside class="page-sidebar">
<div class="inner-wrap">
<div class="full-text-links">
<div class="full-view">
<h3 class="title">
Full text links
</h3>
<div class="full-text-links-list">
<a class="link-item
dialog-focus"
href="https://linkinghub.elsevier.com/retrieve/pii/S1701-2163(16)30033-0"
target="_blank"
rel="noopener"
ref="linksrc=fulltextorjournal_fulltext&amp;is_pmc=False&amp;PrId=3048&amp;itool=Abstract-def&amp;log$=linkouticon&amp;uid=26606712&amp;db=pubmed&amp;nlmid=101126664"
title="See full text options at Elsevier Science"
data-ga-category="full_text"
data-ga-action="Elsevier Science"
data-ga-label="26606712"
><img src="https://cdn.ncbi.nlm.nih.gov/corehtml/query/egifs/https:--linkinghub.elsevier.com-ihub-images-PubMedLink.gif" alt="Elsevier Science full text link"><span class="text">
Elsevier Science
</span></a>
</div>
</div>
<div class="short-view">
<a href="#" class="full-text-links-button full-text-links-dialog-trigger">
Full text links
</a>
</div>
</div>
<div class="actions-buttons sidebar"><h3 class="title">Actions</h3><div class="inner-wrap"><button class="citation-button citation-dialog-trigger"
aria-label="Open dialog with citation text in different styles"
data-ga-category="save_share"
data-ga-action="cite"
data-ga-label="open"
data-all-citations-url="/26606712/citations/"
data-citation-style="nlm"
data-pubmed-format-link="/26606712/export/"><span class="button-label">Cite</span></button><link type="text/css" href="ncbi-overlay-block/src/overlay-block.css"><div class="collections-button-container" data-article-id="26606712" data-article-db="pubmed"><button class="collections-button collections-dialog-trigger"
aria-label="Save article in MyNCBI collections."
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_button"
data-collections-open-dialog-enabled="false"
data-collections-open-dialog-url="https://account.ncbi.nlm.nih.gov/?back_url=https%3A%2F%2Fpubmed.ncbi.nlm.nih.gov%2F26606712%2F%23open-collections-dialog"
data-in-collections="false"><span class="button-label">Collections</span></button><div class="overlay" role="dialog"><div id="collections-action-dialog"
class="dialog collections-dialog"
aria-hidden="true"><div class="title">Add to Collections</div><div class="collections-action-panel action-panel"><form id="collections-action-dialog-form"
class="collections-action-panel-form action-panel-content action-form action-panel-smaller-selectors"
data-existing-collections-url="/list-existing-collections/"
data-add-to-existing-collection-url="/add-to-existing-collection/"
data-create-and-add-to-new-collection-url="/create-and-add-to-new-collection/"
data-myncbi-max-collection-name-length="100"
data-collections-root-url="https://www.ncbi.nlm.nih.gov/myncbi/collections/"><input type="hidden" name="csrfmiddlewaretoken" value="yZZT4DXkaVFzo4Ep3EDO6bl3sbDBlXOaPMJYHtqGKws3ivKfGXgQAjRH0flNeymu"><div class="choice-group" role="radiogroup"><ul class="radio-group-items"><li><input type="radio"
id="collections-action-dialog-new"
class="collections-new"
name="collections"
value="new"
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_radio_new"><label for="collections-action-dialog-new">Create a new collection</label></li><li><input type="radio"
id="collections-action-dialog-existing"
class="collections-existing"
name="collections"
value="existing"
checked="true"
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="collections_radio_existing"><label for="collections-action-dialog-existing">Add to an existing collection</label></li></ul></div><div class="controls-wrapper"><div class="action-panel-control-wrap new-collections-controls"><label for="collections-action-dialog-add-to-new" class="action-panel-label required-field-asterisk">
Name your collection:
</label><input
type="text"
name="add-to-new-collection"
id="collections-action-dialog-add-to-new"
class="collections-action-add-to-new"
pattern="[^&quot;&amp;=&lt;&gt;\/]*" title="The following characters are not allowed in the Name field: &quot;&amp;=&lt;&gt;/"
maxlength="100"
data-ga-category="collections_button"
data-ga-action="create_collection"
data-ga-label="non_favorties_collection"><div class="collections-new-name-too-long usa-input-error-message selection-validation-message">
Name must be less than 100 characters
</div></div><div class="action-panel-control-wrap existing-collections-controls"><label for="collections-action-dialog-add-to-existing" class="action-panel-label">
Choose a collection:
</label><select id="collections-action-dialog-add-to-existing"
class="action-panel-selector collections-action-add-to-existing"
data-ga-category="collections_button"
data-ga-action="select_collection"
data-ga-label="($('.collections-action-add-to-existing').val() === 'Favorites') ? 'Favorites' : 'non_favorites_collection'"></select><div class="collections-retry-load-on-error usa-input-error-message selection-validation-message">
Unable to load your collection due to an error<br><a href="#">Please try again</a></div></div></div><div class="action-panel-actions"><button class="action-panel-submit"
type="submit"
data-loading-label="Adding..."
data-pinger-ignore
data-ga-category="collections_button"
data-ga-action="click"
data-ga-label="add">
Add
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<h1 class="heading-title">
Canadian Contraception Consensus (Part 1 of 4)
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Canadian Contraception Consensus (Part 1 of 4)
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French]
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Objective:
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To provide guidelines for health care providers on the use of contraceptive methods to prevent pregnancy and on the promotion of healthy sexuality.
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Outcomes:
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Guidance for Canadian practitioners on overall effectiveness, mechanism of action, indications, contraindications, non-contraceptive benefits, side effects and risks, and initiation of cited contraceptive methods; family planning in the context of sexual health and general well-being; contraceptive counselling methods; and access to, and availability of, cited contraceptive methods in Canada.
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Evidence:
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Published literature was retrieved through searches of Medline and The Cochrane Database from January 1994 to January 2015 using appropriate controlled vocabulary (e.g., contraception, sexuality, sexual health) and key words (e.g., contraception, family planning, hormonal contraception, emergency contraception). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies published in English from January 1994 to January 2015. Searches were updated on a regular basis and incorporated in the guideline to June 2015. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies.
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The quality of the evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care (Table). Chapter 1: Contraception in Canada Summary Statements 1. Canadian women spend a significant portion of their lives at risk of an unintended pregnancy. (II-2) 2. Effective contraceptive methods are underutilized in Canada, particularly among vulnerable populations. (II-2) 3. Long-acting reversible contraceptive methods, including contraceptive implants and intrauterine contraception (copper-releasing and levonorgestrel-releasing devices/systems), are the most effective reversible contraceptive methods and have the highest continuation rates. (II-1) 4. Canada currently does not collect reliable data to determine the use of contraceptive methods, abortion rates, and the prevalence of unintended pregnancy among reproductive-age women. (II-2) 5. A universal subsidy for contraceptive methods as provided by many of Canada's peer nations and a few Canadian provinces may produce health system cost-savings. (II-2) 6. Health Canada approval processes for contraceptives have been less efficient than those of other drug approval agencies and Health Canada processes for other classes of pharmaceuticals. (II-2) 7. It is feasible and safe for contraceptives and family planning services to be provided by appropriately trained allied health professionals such as midwives, registered nurses, nurse practitioners, and pharmacists. (II-2) Recommendations 1. Contraceptive counselling should include a discussion of typical use failure rates and the importance of using the contraceptive method consistently and correctly in order to avoid pregnancy. (II-2A) 2. Women seeking contraception should be counselled on the wide range of effective methods of contraception available, including long-acting reversible contraceptive methods (LARCs). LARCs are the most effective methods of reversible contraception, have high continuation rates, and should be considered when presenting contraceptive options to any woman of reproductive age. (II-2A) 3. Family planning counselling should include counselling on the decline of fertility associated with increasing female age. (III-A) 4. Health policy supporting a universal contraception subsidy and strategies to promote the uptake of highly effective methods as cost-saving measures that improve health and health equity should be considered by Canadian health decision makers. (III-B) 5. Canadian health jurisdictions should consider expanding the scope of practice of other trained professionals such as nurses, nurse practitioners, midwives, and pharmacists and promoting task-sharing in family planning. (II-2B) 6. The Canadian Community Health Survey should include adequate reproductive health indicators in order for health care providers and policy makers to make appropriate decisions regarding reproductive health policies and services in Canada. (III-B) 7. Health Canada processes and policies should be reviewed to ensure a wide range of modern contraceptive methods are available to Canadian women. (III-B) Chapter 2: Contraceptive Care and Access Summary Statements 8. Although there are many contraceptive options in Canada, only a narrow range of contraceptive methods are commonly used by those of reproductive age. (II-3) 9. Condom use decreases with longer relationship tenure and when the sexual partner is considered to be the main partner, likely due to a lower perceived risk of sexually transmitted infection in that relationship. Condom use may also decrease markedly as an unintended consequence when an effective non-barrier method, such as hormonal contraception or intrauterine contraception, is initiated. (II-3) 10. Family planning counselling provides a natural segue into screening for concerns about sexual function or intimate partner violence. (III) 11. Well-informed and well-motivated individuals who have developed skills to practise safer sex behaviours are more likely to use contraceptive and safer sex methods effectively and consistently. (II-2) Recommendations 8. Comprehensive family planning services, including abortion services, should be accessible to all Canadians regardless of geographic location. These services should be confidential, non-judgemental, and respectful of individuals' privacy and cultural contexts. (III-A) 9. A contraceptive visit should include history taking, screening for contraindications, dispensing or prescribing a method of contraception, and exploring contraceptive choice and adherence in the broader context of the individual's sexual behaviour, reproductive health risk, social circumstances, and relevant belief systems. (III-B) 10. Health care providers should provide practical information on the wide range of contraceptive options and their potential non-contraceptive benefits and assist women and their partners in determining the best user-method fit. (III-B) 11. Health care providers should assist women and men in developing the skills necessary to negotiate the use of contraception and the correct and consistent use of a chosen method. (III-B) 12. Contraceptive care should include discussion and management of the risk of sexually transmitted infection, including appropriate recommendations for condom use and dual protection, STI screening, post-exposure prophylaxis, and Hepatitis B and human papillomavirus vaccination. (III-B) 13. Health care providers should emphasize the use of condoms not only for protection against sexually transmitted infection, but also as a back-up method when adherence to a hormonal contraceptive may be suboptimal. (I-A) 14. Health care providers should be aware of current media controversies in reproductive health and acquire relevant evidence-based information that can be briefly and directly communicated to their patients. (III-B) 15. Referral resources for intimate partner violence, sexually transmitted infections, sexual dysfunction, induced abortion services, and child protection services should be available to help clinicians provide contraceptive care in the broader context of women's health. (III-B) Chapter 3: Emergency Contraception Summary Statements 12. The copper intrauterine device is the most effective method of emergency contraception. (II-2) 13. A copper intrauterine device can be used for emergency contraception up to 7 days after unprotected intercourse provided that pregnancy has been ruled out and there are no other contraindications to its insertion. (II-2) 14. Levonorgestrel emergency contraception is effective up to 5 days (120 hours) after intercourse; its effectiveness decreases as the time between unprotected intercourse and ingestion increases. (II-2) 15. Ulipristal acetate for emergency contraception is more effective than levonorgestrel emergency contraception up to 5 days after unprotected intercourse. This difference in effectiveness is more pronounced as the time from unprotected intercourse increases, especially after 72 hours. (I) 16. Hormonal emergency contraception (levonorgestrel emergency contraception and ulipristal acetate for emergency contraception) is not effective if taken on the day of ovulation or after ovulation. (II-2) 17. Levonorgestrel emergency contraception may be less effective in women with a body mass index &gt; 25 kg/m2 and ulipristal acetate for emergency contraception may be less effective in women with a body mass index &gt; 35 kg/m2. However, hormonal emergency contraception may still retain some effectiveness regardless of a woman's body weight or body mass index. (II-2) 18. Hormonal emergency contraception is associated with higher failure rates when women continue to have subsequent unprotected intercourse. (II-2) 19. Hormonal contraception can be initiated the day of or the day following the use of levonorgestrel emergency contraception, with back-up contraception used for the first 7 days. (III) 20. Hormonal contraception can be initiated 5 days following the use of ulipristal acetate for emergency contraception, with back-up contraception used for the first 14 days. (III) Recommendations 16. All emergency contraception should be initiated as soon as possible after unprotected intercourse. (II-2A) 17. Women should be informed that the copper intrauterine device (IUD) is the most effective method of emergency contraception and can be used by any woman with no contraindications to IUD use. (II-3A) 18.
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<div class="abstract-content"
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<b>Objectif :</b> Fournir des lignes directrices aux fournisseurs de soins quant à lutilisation de modes de contraception pour la prévention de la grossesse et quant à la promotion dune sexualité saine. <b>Issues :</b> Orientation des praticiens canadiens en ce qui concerne lefficacité globale, le mécanisme daction, les indications, les contre-indications, les avantages nétant pas liés à la contraception, les effets indésirables, les risques et le protocole de mise en œuvre des modes de contraception abordés; planification familiale dans le contexte de la santé sexuelle et du bien-être général; méthodes de counseling en matière de contraception; et accessibilité et disponibilité des modes de contraception abordés au Canada. <b>Résultats :</b> La littérature publiée a été récupérée par lintermédiaire de recherches menées dans MEDLINE et The Cochrane Library entre janvier 1994 et janvier 2015 au moyen dun vocabulaire contrôlé (p. ex. contraception, sexuality, sexual health) et de mots clés (p. ex. contraception, family planning, hormonal contraception, emergency contraception) appropriés. Les résultats ont été restreints aux analyses systématiques, aux études observationnelles et aux essais comparatifs randomisés / essais cliniques comparatifs publiés en anglais entre janvier 1994 et janvier 2015. Les recherches ont été mises à jour de façon régulière et intégrées à la directive clinique jusquen juin 2015. La littérature grise (non publiée) a été identifiée par lintermédiaire de recherches menées dans les sites Web dorganismes sintéressant à lévaluation des technologies dans le domaine de la santé et dorganismes connexes, dans des collections de directives cliniques, dans des registres dessais cliniques et auprès de sociétés de spécialité médicale nationales et internationales. <b>Valeurs :</b> La qualité des résultats a été évaluée au moyen des critères décrits dans le rapport du Groupe détude canadien sur les soins de santé préventifs (Tableau). <b>Chapitre 1 : Contraception au Canada Déclarations sommaires</b> 1. Les Canadiennes sont exposées à des risques de grossesse non planifiée pendant une partie considérable de leur vie. (II-2) 2. Les modes efficaces de contraception sont sous-utilisés au Canada, particulièrement au sein des populations vulnérables. (II-2) 3. Les modes de contraception réversible à action prolongée, dont les implants contraceptifs et la contraception intra-utérine (dispositifs / systèmes à libération de cuivre ou de lévonorgestrel), sont les modes de contraception réversible les plus efficaces; de plus, ils comptent les taux les plus élevés de poursuite du traitement. (II-1) 4. Au Canada à lheure actuelle, nous ne recueillons pas de données fiables qui permettraient détablir le taux dutilisation des modes de contraception, le taux davortement et la prévalence des grossesses non planifiées chez les femmes en âge de procréer. (II-2) 5. Loctroi dune subvention universelle destinée aux modes de contraception, à linstar de bon nombre dautres pays et de quelques provinces canadiennes, pourrait générer des économies pour le système de santé. (II-2) 6. Dans le cas des contraceptifs, les processus dhomologation de Santé Canada ont été moins efficaces que ceux dautres organismes dhomologation, en plus dêtre moins efficaces que les processus quelle a elle-même mis en vigueur en ce qui concerne dautres catégories de produits pharmaceutiques. (II-2) 7. Loffre de contraceptifs et de services de planification familiale par des professionnels paramédicaux (tels que les sages-femmes, les infirmières autorisées, les infirmières praticiennes et les pharmaciens) ayant bénéficié dune formation adéquate est faisable et sûre. (II-2) <b>Recommandations</b> 1. Les services de counseling traitant de la contraception devraient comprendre une discussion au sujet des taux déchec liés à lutilisation typique et de limportance dutiliser régulièrement et correctement le mode de contraception choisi, de façon à éviter la grossesse. (II-2A) 2. Les services de counseling offerts aux femmes qui cherchent à se prévaloir dun mode de contraception devraient porter sur la vaste gamme des modes efficaces disponibles, y compris sur les modes de contraception réversible à action prolongée. Ces derniers sont les modes les plus efficaces de contraception réversible, comptent des taux élevés de poursuite du traitement et devraient être pris en considération, pour toutes les femmes en âge de procréer, au moment daborder avec celles-ci les options de contraception qui soffrent à elles. (II-2A) 3. Les services de counseling en matière de planification familiale devraient aborder la question du déclin de la fertilité qui est associé au vieillissement chez la femme. (III-A) 4. Les décideurs canadiens du domaine de la santé devraient envisager la mise en œuvre de politiques de santé soutenant loffre universelle dune subvention à la contraception et de stratégies visant à promouvoir ladoption de modes de contraception grandement efficaces, et ce, à titre de mesures de réduction des coûts permettant lamélioration de la santé et de léquité en matière de santé. (III-B) 5. Les territoires de compétence canadiens en matière de santé devraient envisager délargir le champ de pratique dautres professionnels formés (comme les infirmières, les infirmières praticiennes, les sages-femmes et les pharmaciens) et de promouvoir le partage des tâches en planification familiale. (II-2B) 6. LEnquête sur la santé dans les collectivités canadiennes devrait englober des indicateurs adéquats en matière de santé génésique, de façon à pouvoir permettre aux fournisseurs de soins de santé et aux décideurs de prendre des décisions opportunes à légard des politiques et des services de santé génésique au Canada. (III-B) 7. Les processus et les politiques de Santé Canada devraient être passés en revue pour que lon puisse sassurer quils ne nuisent pas indûment à loffre dune vaste gamme de modes de contraception modernes aux Canadiennes. (III-B) <b>Chapitre 2 : Soins en matière de contraception et accès à la contraception Déclarations sommaires</b> 8. Bien que le Canada compte de nombreuses options en matière de contraception, les modes de contraception couramment utilisés par les femmes en âge de procréer sont issus dune gamme restreinte. (II-3) 9. Lutilisation du condom diminue au fur et à mesure que se poursuit une relation et lorsque le partenaire sexuel est considéré comme étant le partenaire principal, probablement en raison dune baisse du risque perçu dinfections transmissibles sexuellement au sein de la relation en question. Lutilisation du condom pourrait, de façon fortuite, également connaître une baisse marquée à la suite de la mise en œuvre dun mode de contraception efficace ne faisant pas partie des méthodes de barrière (comme la contraception hormonale ou intra-utérine). (II-3) 10. Le counseling en matière de planification familiale peut naturellement mener au dépistage de la violence conjugale et des problèmes liés à la fonction sexuelle. (III) 11. Les personnes bien renseignées et bien motivées qui ont acquis les compétences nécessaires à la pratique de comportements sexuels à risques réduits sont plus susceptibles dutiliser des modes de contraception et des pratiques sexuelles à risques réduits de façon efficace et systématique. (II-2) <b>Recommandations</b> 8. Des services exhaustifs de planification familiale (y compris des services davortement) devraient être offerts à tous les Canadiens, peu importe leur emplacement géographique. Ces services devraient être confidentiels et assurer le respect de la vie privée et des contextes culturels des personnes qui les utilisent. (III-A) 9. Les consultations en matière de contraception devraient comprendre une anamnèse, un dépistage des contre-indications, loffre ou la prescription dun mode de contraception, ainsi que lexploration des choix en matière de contraception et des facteurs associés à lobservance dans le cadre élargi du comportement sexuel, des risques liés à la santé génésique, du contexte social et des croyances de la femme en question. (III-B) 10. Les fournisseurs de soins devraient offrir des renseignements pratiques sur la vaste gamme des options en matière de contraception et sur leurs avantages potentiels nétant pas liés à la contraception, en plus daider les femmes et leurs partenaires à choisir le mode de contraception étant le mieux adapté à leurs besoins. (III-B) 11. Les fournisseurs de soins devraient aider les femmes et les hommes à acquérir les compétences nécessaires à la négociation du recours à la contraception, ainsi quà lutilisation correcte et systématique du moyen de contraception choisi. (III-B) 12. Les soins en matière de contraception devraient aborder les risques de contracter des infections transmissibles sexuellement et en assurer la prise en charge; ils devraient, à ce chapitre, être fondés sur la formulation de recommandations appropriées en ce qui concerne lutilisation de condoms et dune protection double, le dépistage des infections transmissibles sexuellement, la prophylaxie post-exposition et la vaccination contre lhépatite B et le virus du papillome humain. (III-B) 13. Les fournisseurs de soins devraient souligner que lutilisation de condoms na pas seulement pour but de conférer une protection contre les infections transmissibles sexuellement, mais quelle agit également à titre de méthode dappoint lorsque lobservance envers un contraceptif hormonal pourrait être sous-optimale. (I-A) 14. Les fournisseurs de soins devraient se tenir au fait des controverses médiatiques qui font rage dans le domaine de la santé génésique et obtenir les données factuelles pertinentes qui pourront être communiquées (de façon brève et directe) à leurs patientes. (III-B) 15. Des ressources spécialisées en ce qui concerne la violence conjugale, les infections transmissibles sexuellement, le dysfonctionnement sexuel, les services davortement provoqué et les services de protection de lenfance devraient être disponibles pour aider les cliniciens à offrir des soins en matière de contraception dans le contexte élargi de la santé des femmes. (III-B) <b>Chapitre 3 : Contraception durgence Déclarations sommaires</b> 12. Le dispositif intra-utérin au cuivre constitue la méthode de contraception durgence la plus efficace. (II-2) 13. Un dispositif intra-utérin au cuivre peut être utilisé à des fins de contraception durgence jusquà sept jours à la suite dune relation sexuelle non protégée, pour autant que la présence dune grossesse ait été écartée et quil nexiste aucune autre contre-indication à son insertion. (II-2) 14. La contraception durgence au lévonorgestrel est efficace jusquà cinq jours (120 heures) à la suite dune relation sexuelle non protégée; son efficacité diminue au fur et à mesure que sallonge le délai entre la relation sexuelle non protégée et son administration. (II-2) 15. La contraception durgence à lacétate dulipristal est plus efficace que celle qui fait appel au lévonorgestrel, et ce, jusquà cinq jours à la suite dune relation sexuelle non protégée. Cette différence en matière defficacité devient plus prononcée au fur et à mesure que sallonge le délai entre la relation sexuelle non protégée et ladministration, particulièrement après 72 heures. (I) 16. La contraception durgence hormonale (au lévonorgestrel ou à lacétate dulipristal) nest pas efficace lorsquelle est administrée le jour de lovulation ou par la suite. (II-2) 17. La contraception durgence au lévonorgestrel pourrait être moins efficace chez les femmes dont lindice de masse corporelle est supérieur à 25 kg/m2, tandis que la contraception durgence à lacétate dulipristal pourrait être moins efficace chez les femmes dont lindice de masse corporelle est de 35 kg/m2 ou plus. Quoi quil en soit, la contraception durgence hormonale pourrait tout de même conserver une certaine efficacité, peu importe le poids ou lindice de masse corporelle de la femme qui en fait la demande. (II-2) 18. La contraception durgence hormonale est associée à des taux déchec plus élevés lorsque les femmes qui lutilisent continuent par la suite à connaître des relations sexuelles non protégées. (II-2) 19. Une contraception hormonale peut être entamée le jour de lutilisation dune contraception durgence au lévonorgestrel, ou le jour suivant celle-ci, en sassurant de mettre en œuvre une contraception dappoint pendant les sept premiers jours. (III) 20. Une contraception hormonale peut être entamée cinq jours à la suite de lutilisation dune contraception durgence à lacétate dulipristal, en sassurant de mettre en œuvre une contraception dappoint pendant les quatorze premiers jours. (III) <b>Recommandations</b> 16. La contraception durgence, toutes méthodes confondues, devrait être mise en œuvre dès que possible à la suite dune relation sexuelle non protégée. (II-2A) 17. Les femmes devraient être avisées que le dispositif intra-utérin au cuivre constitue la méthode de contraception durgence la plus efficace et que ce dispositif peut être utilisé par toute femme qui ne présente pas de contre-indications à son utilisation. (II-3A) 18. Les fournisseurs de soins ne devraient pas déconseiller lutilisation de la contraception durgence hormonale en fonction de lindice de masse corporelle de la femme qui en fait la demande. Lutilisation dun dispositif intra-utérin au cuivre à des fins de contraception durgence devrait être recommandée pour les femmes présentant un indice de masse corporelle supérieur à 30 kg/m2 qui sollicitent une contraception durgence. En présence de conditions favorables en matière daccessibilité et de coût, la contraception durgence faisant appel à lacétate dulipristal devrait constituer loption de première intention à offrir aux femmes présentant un indice de masse corporelle de 25 kg/m2 ou plus qui préfèrent avoir recours à une contraception durgence hormonale. (II-2B) 19. Les fournisseurs de soins devraient discuter dun plan visant la mise en œuvre dune contraception continue avec les femmes qui en viennent à utiliser des pilules de contraception durgence; ils devraient également offrir des modes adéquats de contraception continue à ces femmes, lorsque celles-ci sy montrent intéressées. La contraception hormonale devrait être entamée dans les 24 heures suivant ladministration dune contraception durgence faisant appel au lévonorgestrel; de plus, une contraception dappoint (ou labstinence) devrait être mise en œuvre pendant les sept premiers jours suivant le début de lutilisation dune contraception hormonale. (III-B) Dans le cas de la contraception durgence faisant appel à lacétate dulipristal, la contraception hormonale devrait être entamée cinq jours après ladministration de la contraception durgence. Une contraception dappoint (ou labstinence) doit être mise en œuvre pendant les cinq premiers jours suivant ladministration dune contraception durgence faisant appel à lacétate dulipristal, puis pendant les 14 premiers jours suivant le début de lutilisation dune contraception hormonale. (III-B) 20. Lacétate dulipristal et le lévonorgestrel ne devraient pas être utilisés de façon concomitante à des fins de contraception durgence. (III-B) 21. Un test de grossesse devrait être mené en labsence de menstruations dans les 21 jours suivant lutilisation de pilules ou linsertion dun dispositif intra-utérin au cuivre à des fins de contraception durgence. (III-A) 22. Des services de santé devraient être élaborés pour permettre aux Canadiennes dobtenir un accès en temps opportun à toutes les méthodes efficaces de contraception durgence. (III-B).
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Keywords:
</strong>
Canada; barrier contraceptive methods; contraception; contraceptive sponge; counselling; emergency contraception; family planning; health policy; hormonal contraception; intrauterine contraception; natural family planning methods; permanent contraception; sexual health; sexuality; sexually transmitted infection (STI); spermicide; statistics; tubal ligation; vasectomy.
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