Thursday, January 27, 2011

Who Controls Your Birth Control?

Originally published in the Montreal Gazette on January 18, 2011.



If you're reading this and you know my Greek mother-in-law, please don't translate.


I still use birth control.


We'll save the reasons why for another time. The point is, I don't want babies right now. I also don't want to be on the pill. I never liked the idea of putting hormones into my body that aren't supposed to be there, or tricking it into doing things it doesn't do naturally. After trying it for the second time and seeing how quickly my emotions rebelled, I went to my doctor and got fitted for a diaphragm. And that was the end of that story.


Until a year later, when I tried to renew my prescription. That's when I was told:


They don't make diaphragms anymore.


It was the strangest feeling. Living in this country, and growing up with a sex ed curriculum that included the diaphragm, I simply took for granted that whichever form I chose to use would be available to me. My doctor did point out that I was his only patient who still used a diaphragm - I think the word "granola" might have jokingly come up - but he also called it the "healthiest form of birth control" for the reasons I've already stated. So he made a few calls, and it was confirmed: Janssen-Ortho had stopped manufacturing the diaphragm, due, they claimed, to lack of demand.


I understand that the lowly diaphragm isn't as popular as the pill. It's more complicated and, unless used perfectly, not as reliable. (If used perfectly, the failure rate of a diaphragm is four to eight per cent, whereas the failure rate for hormonal methods runs between 0.1 and 0.3 per cent.) But surely there were other women with the same concerns as me? What about those who couldn't take hormones for medical reasons? And where does lack of demand figure in when things like tanning oil and TaB are still on the shelves?


I did some research and found a U.K. company called Westons that sold the Ortho diaphragm online. It cost $25 including shipping -about half of what I'd paid for my first one -and all was once again well until this year, when I learned that Westons had stopped carrying the Ortho diaphragm, too.


Desperate, I called one of the larger Pharmaprix in Montreal.


"I'm looking for a diaphragm," I said.


"How do you spell that?" the pharmacist asked. "Does that come in pill form?"


I called a Jean Coutu, who told me they could order a brand of diaphragm called the Cooper Surgical Milex for $98 plus taxes. I asked if that included spermicide, which my last pharmacy diaphragm had. No, the pharmacist told me. Spermicide is no longer available.


I found a Yahoo group for women who use, or are considering using, barrier methods of birth control, and when I mentioned I wanted to write this article, dozens of stories flooded in. One American woman was told by her doctor that cervical caps - which work similarly to the diaphragm and are available for purchase online - are illegal in the U.S. A woman in Australia had to order spermicide from Canada. One woman in Ontario was completely unable to obtain a diaphragm from Shoppers Drug Mart, and another had such difficulty getting either a diaphragm or cervical cap that she's resorted to using the rhythm method and withdrawal combined with condoms on her fertile days.

"I'd probably be ridiculed by health-care professionals," she says, "but I feel more comfortable taking the risk of possibly needing an abortion than injecting my body with hormones that make me act like a completely different person and whose long-term side effects nobody can say for sure."


That may be an extreme example, but it still points to a very large problem: An important and long-standing form of birth control may be in the process of going extinct. And lack of demand can very easily feed itself. Could it be a vicious circle? If the pharma companies no longer sell something, won't that lead sex educators to stop including it in their curriculum?


I asked Amanda Unruh, a member of the Sexual Health Network of Quebec who also runs the Shag Shop at McGill, if the diaphragm is still part of the sex ed curriculum in this province.


"On a basic level, yes," Unruh said.  "But whether teachers impart that basic information to students is another story."


Dara Maker, a family physician at Women's College Hospital in Toronto who works at the Bay Centre for Birth Control, talked to me about what's going on in Ontario.


"Young people are being taught about the diaphragm," Maker said, "but a lot of reason for lack of demand is it's not being advertised, and there's less people talking about it. Young women will talk about contraception with friends, and if you have less users, you have less women generally sharing information. In that way, it is a vicious circle."


Both agreed that the demand being down probably has a lot to do with more hormonal methods coming on the market in the last 10 years, which are more efficient and "safer"-at least when it comes to failure rates. And the Shag Shop started selling the Cooper Surgical Milex in November, for $60. The shop is located in the McGill health clinic, where doctors are available to do fittings.


Had there been much interest in the diaphragm?


"We do get a lot of people asking about hormonal contraceptives but saying they're not comfortable," says Unruh, "or younger women who have been on a hormonal method and it hasn't been for them. Most people go to the hormonal method first because that seems to be the social norm. But people are asking more and more about the diaphragm and the female condom. I think it'll balance out over time."


By the time I found out about the Shag Shop, I'd already learned, through the Yahoo group, that another brand still available through Westons fit the same way as the now defunct Ortho diaphragm. Spermicide is available through a site called Ladytobaby.com, which also retails cervical caps.


Let's hope that these companies continue to offer alternatives to hormonal birth control. Because as much as I love my mother-in-law, I also love my right to choose what goes into my body. And that's a right the drug companies shouldn't have.


The McGill Shag Shop is located in Suite 3300 in the Brown Building, 3600 McTavish St. 
Or call them at 514-398-2087. They sell spermicide, too.


Ladytobaby.com sells cervical caps, a natural (Nonoxynol-9 free) spermicide, and fertility and ovulation monitors.


Westons.com sells the Reflexions flat spring diaphragm for about $15, plus shipping. You'll have to get fitted by your doctor before ordering.


For information and discussion about diaphragms and cervical caps, go to http://groups.yahoo.com/group/DiaphragmsAndCaps.

6 comments:

  1. Hi Natalie. Thanks so much for this post. I was shocked when I went to the pharmacy and she didn't have a diaphragm to give me! I'm so sad that those of us who don't want to take pills are running out of options. I'm so relieved I can get one I'm thinking of ordering 2. thanks again!

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  2. Do it! Or go to McGill if you're in Montreal. Glad I could help!

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  3. I used to use the Today sponge but it too has disappeared from the market.

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  4. Hi Natalie!

    I am so lucky to have found your blog by google search.

    This was absolutely helpful especially finding legitimate online websites selling these at a more affordable prices. I have been unlucky fulfilling my prescription from 3 of Toronto East area's Shoppers Drug Mart.

    Thank you for posting this. Many will definitely benefit from this!

    More power and all the best,
    Elisha - royalsapphire7@yahoo.ca

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  5. Thanks Elisha. I'm so glad it helped you find something. Amazing that you couldn't even find one in Toronto. Spread the word!

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  6. Hi Natalie, great write up.

    Something as important as having our own chosen method of contraception readily available to us should almost be a right, we all know that's not the case and we do have to jump through hoops.

    With all the money spent on trying to reduce unwanted pregnancies you have to wonder where the logic is. In Australia and New Zealand I've heard that diaphragms and spermicide are no longer licensed so you can't even import them!

    I got my diaphragm from buydiaphragms.com and the last time I looked they had 4 types of diaphragm, cervical caps and 2 spermicides :)

    Hope this helps!

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