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UBC Theses and Dissertations

Hormonal contraceptive use in Canada : levels, trends, and determinants among reproductive-aged women in British Columbia Maginley, Katharine Suzanne


BACKGROUND: Despite widespread use of contraception worldwide, Canadian research on hormonal contraceptive trends is limited. This thesis aims to address this knowledge gap through an investigation of the levels, trends, and determinants of: (1) hormonal contraceptive use in British Columbia (BC) (Study 1), and (2) the use of cyproterone acetate and ethinyl estradiol (CPA-EE), an acne drug that is also known to be prescribed as an oral contraceptive (OC) despite safety concerns (Study 2). METHODS: This thesis consists of two retrospective analyses of de-identified administrative datasets containing health care, pharmaceutical, and sociodemographic information for residents of BC between 2006–2013, inclusive. Study 1 examined incident and prevalent hormonal contraceptive use in a cohort of reproductive-aged women (15–49 years). Study 2 measured incident off-label use of CPA-EE in women aged 15–34. In both studies, logistic regression was used to model relationships between contraceptive use and sociodemographic factors. RESULTS: Study 1 revealed (1) stable prevalence, but declining incidence of overall hormonal contraceptive use, (2) declining rates of OC use, (3) increased rates of hormonal intrauterine device (IUD) use, and (4) decreased odds of hormonal contraceptive use among Chinese and South Asian women. Despite a decline in use, OCs remained the most popular method, accounting for more than 80% of all hormonal contraceptive use. In Study 2, incident use of CPA-EE declined throughout the study period. South Asian women and women with older physicians (65+) were more likely to receive a potentially inappropriate CPA-EE prescription. CONCLUSION: This thesis contributes to a sparse body of literature on hormonal contraceptive use in Canada. While rates of OC use are declining, hormonal IUD use is increasingly widespread, particularly among younger women. Chinese and South Asian women are less likely to be prescribed OCs and may therefore be at greater risk for unintended pregnancy, although this warrants further investigation, as does the influence of provider characteristics on off-label prescribing patterns.

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