In a new study in @CMAJ_Open, we analyzed survey data from @StatCan_eng to understand if #contraception use differed among female youth aged 15-24yrs by household income. bit.ly/2NkAYeU @cartgrac @e_nethery @wvnorman @DrLSchummers @womensresearch @CanPaedSociety /1
A more general summary of the study in the @ubcnews release here: bit.ly/2WPkGxV

Now attempting my first #tweetorial – shout out to @s_l_lake @ubcspph for this idea and her brilliant example /2
Despite Canada’s universal health insurance, we do not have universal coverage of #contraception.

More effective methods like ‘the Pill’ can cost 15-40$
per month. Condoms are usually the cheapest, around $1 each, but are less effective in real-life conditions (85%). /3
What we found: For low-income (household income <$80k/yr) female youth (15-24y), lower rates of the pill, dual methods (condoms and a second method) and more use of condoms-only or no method– when compared to high-income youth. /4
Even after controlling for other factors (like age, marital status, student status, etc), being from a low-income household was still associated with a 15% decrease for ‘the pill’ and a 30% increase in using condoms. /5
Equitable access to #contraception is something that should be a key part of Canada's health care system. Eliminating cost barriers to contraception access through #UniversalSubsidy and @pharmacare2020 would lead to improved health and lower govt costs. /6
Other interesting findings: Roughly 3 out of 20 youth were not using any method – despite saying it was important for them to avoid a pregnancy.

In Quebec, where a private or public drug plan is govt mandated, we still found an income-based difference in contraception use. /7
Injectables (DMPA) were used by 2.5% of the study group. But, DMPA was more common in the low-income group (3%) vs the high income group (1.5%). Also, the rate of DMPA use was even higher, 10%, in the northern territories. /8
We also stratified by whether youth said they had a family doctor: 18% of female youth without a family doctor were using NO contraception method compared to 12% of those youth who did have a doctor. @CanPaedSociety /9
Further research can help identify and target strategies to address all barriers to improve access the full range of contraception options for all Canadians. /10

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More from @e_nethery

Dec 8, 2021
1/ A recent analysis and commentary directly critiques our study (Nethery et al, 2021) on planned home and birth center birth in Washington State in @greenjrnl. Some thoughts after reading ajog.org/article/S0002-… in @AJOG_thegray (long thread)
2/ ‘An immutable truth’ could have also been titled “The vast majority of US home births were ‘low risk'; Low-risk home births had better outcomes than high risk home births”. And, let's improve hospital-based care + access to hospital-midwives for high risk people.
3/ They studied 'high risk' v. 'low risk' home births using US birth certificate data.
Read 28 tweets
Dec 7, 2021
@ObMD @DrLSchummers @greenjrnl @NACPM @ACNMmidwives @BirthPlaceLab @wamidwives @ob_coap @Canadamidwives @TheUpliftLab 1/ Our study aim was NOT to compare ‘high-risk’ to ‘low-risk’ home birth.
Others have studied this: e.g. a w/ a US ITT cohort designed for place of birth research (Bovbjerg, 2017. Birth) and the UK Birthplace Study (Li, 2015. BJOG).
2/ Saying “[high risk people] have no place in planned home births” in my mind, is akin to ‘telling people what to do with their bodies’ - and not useful in promoting safe, respectful maternity care.
3/ We can strongly and clearly recommend hospital birth with specific risks, but ‘telling women/birthing people what to do with their bodies’ is patriarchical - as is forced pregnancy.
Read 10 tweets
Dec 4, 2021
@ObMD @greenjrnl @NACPM @ACNMmidwives @BirthPlaceLab @wamidwives @DrLSchummers @ob_coap @Canadamidwives Thank you. We encourage people to read our paper. We studied births attended by members of a state-wide professional midwifery association in Washington State and within local standards and guidelines for planned community birth. journals.lww.com/greenjournal/f…
@ObMD @greenjrnl @NACPM @ACNMmidwives @BirthPlaceLab @wamidwives @DrLSchummers @ob_coap @Canadamidwives a/ Discussion: "We focused this study on pregnancies meeting eligibility guidelines for community birth, similar to those in countries with well-integrated midwifery. Greater availability of ACOG-supported practices such as trial of labor after cesarean, vaginal twin and
@ObMD @greenjrnl @NACPM @ACNMmidwives @BirthPlaceLab @wamidwives @DrLSchummers @ob_coap @Canadamidwives b/ vaginal breech may reduce the likelihood of pregnant people choosing planned home birth outside of guidelines. Notably, planned births outside guidelines were infrequent (7%) in our study and no more common than the 7% reported in planned homebirths in the UK Birthplace study
Read 6 tweets

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