From birth control to fertility, the 3 big trends in reproductive health

Dr. Danielle Martin explains how new technologies — and new ways of thinking — are changing the way we live.

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reproductive health
Illustration, Alexandra Tanner.

Whether we’re talking contraception, fertility, child-bearing or menopause, reproductive health is important to women at every age. It’s also an area of health where medical practices are constantly evolving, especially as social and economic trends transform the way women structure their lives. Here are three of the most important topics in reproductive health right now.

1. More women are waiting to have children.

In Canada, and most of the developed world, women are increasingly waiting until later in life to have babies. Many of the social trends behind this are good news: Women are pursuing higher education, entering the workforce in larger numbers and establishing professional careers at senior levels. Still, there are very real health implications associated with delaying child-bearing.

Fertility begins to decline after age 32, with a more significant decline occurring between ages 35 and 37. (According to Health Canada, 91 percent of women can get pregnant at age 30. At age 35, that number drops to 77 percent, and by age 40, it’s 53 percent.) When they do become pregnant, older women are at a greater risk for miscarriage and complications in childbirth, and their chances of having a child with a genetic disorder, such as Down syndrome, are also higher.

All of this doesn’t mean that women should have children before they’re ready or that they shouldn’t be ambitious in their careers. But it is important for women to understand the increased health risks associated with delaying child-bearing, so they can make educated decisions to help balance those risks.

2. Birth control is evolving.

Regardless of whether or when they choose to have children, most women rely on some form of birth control to help them plan their lives. In addition to newer options, such as ultra-low-dose birth control pills, we’re learning more about existing methods. We now know that the pill is much less effective in women with a higher body mass index (BMI), which is also the case with emergency contraceptives: The morning-after pill is less likely to prevent a pregnancy if a woman’s BMI is higher than 25. The most effective method of emergency contraception is actually the copper IUD (intrauterine device). If inserted up to five days after you have unprotected sex, it can prevent pregnancy and provide ongoing birth control for five years.Screen Shot 2015-05-26 at 4.46.32 PM

Although IUDs (both the copper variety and the newer, hormone-containing systems) aren’t as popular with women as birth control pills are, I am seeing a growing interest in them among my patients — they really are a safe, effective and easy method of contraception.

3. New abortion methods are on the horizon.

A third issue affecting Canadian women’s reproductive health is the potential approval of the drug mifepristone for abortion. The drug was first available in France in 1988 and is now used by women in 57 countries. If approved by Health Canada, mifepristone would be available by prescription to terminate pregnancies of up to nine weeks. Currently, most women seeking an abortion in Canada require a surgical procedure that may not be offered close to home. Having a non-surgical choice has the potential to greatly expand not only women’s access to timely abortion care but also the number of providers who feel comfortable offering women a full range of options.

More from Dr. Danielle Martin:
Why getting to know your doctor is good for your health
You may not need an annual Pap test or mammogram

Doctor. Danielle Martin, Chatelaine columnist

 

Dr. Danielle Martin is a family physician and vice-president, medical affairs and health system solutions, at Women’s College Hospital in Toronto.