Dr Deborah Lee, Dr Fox Online Pharmacy, explores what the association between contraception and climate change is and how it can save the planet
Hand’s up, if you, like me, care about the environment?
- But what is the association between contraception and climate change?
- How does using conception save the planet?
- How can we improve the uptake and long term usage of contraception?
I’m going to explore the answers to these questions.
Read on and find out more.
Contraception and climate change
The problem with being human is that just by being alive, we use up the worlds’ resources, and at the same time, pollute the environment.
And more and more humans are arriving to join us, as the world population continues to grow in a seemingly unstoppable fashion. The current figure is around 7.7 billion, but by 2100, this is predicted to rise to 11 billion.
Population growth is the main driver for climate change. Unless we make drastic changes, we are heading for climate disaster.
The Alliance of World Scientists recently issued this stark warning –“the runaway consumption of limited resources is crippling the Earth’s life support systems and jeopardising our future.” So far, governments have done little in response.
Climate change and COVID-19
Ecologists believe that the COVID-19 pandemic is a clear indication of the toll human life is taking on the planet. The COVID-19 virus is thought to have possibly originated from bats and/or pangolins, for sale in a Chinese wet market. Why should this happen?
By destroying animals’ natural habitats, we are forcing them to share man’s environment far more closely. Add to this, the fact that climate change is resulting in warmer, wetter weather conditions, which increases viral ability to survive and replicate. As humans and animals move closer together, this encourages viruses to jump from animals to humans – so-called zoonotic spread.
Previous viral outbreaks, caused by SARS, MERS, Ebola, and measles, were also thought to have also been caused by zoonotic spread. If we don’t act now, it will only be a matter of time before we face yet another pandemic. Now is the time to change our behaviour.
Yes, we need to stop climate change – and this requires huge economic and strategic investment by governments. Yes, we want clean energy and sustainable agriculture – but these will take time. But – we can’t afford to wait.
This is where contraception comes in. Contraception is an instantly available, highly cost-effective, and so far, overlooked, tool, which we can use to help save our planet.
By limiting the world population growth, via the use of contraception, we can potentially reduce greenhouse gas emissions by an impressive 40%.
How does reducing population growth save the planet?
It’s a sobering statistic that almost half – 44% – of pregnancies are not planned. These unintended pregnancies result in either abortion, miscarriage, ectopic pregnancy, or live birth. Each of these outcomes has a huge physical, emotional, and financial cost – and a cost to the planet. If we could prevent more unplanned pregnancies, there would be so much to gain for everyone involved, and indeed for our environment.
Across the world, most of the predicted 3 billion pregnancies forecast by 2100, are in Sub-Saharan Africa and Asia. However, no country can be complacent. The carbon footprint of individuals in high-income countries, such as the US and the UK, is far higher than the carbon footprint of those living in less wealthy nations.
If contraception is the solution, why are so many women not using it?
In a persuasive 2019 paper in the British Medical Journal (BMJ), the authors made a strong case for the importance of contraception in our fight to prevent climate change. Their rationale is based on 3 simple points –
- Population growth causes climate change.
- Increasing the use of good quality contraception reduces unplanned conceptions.
- Women would use contraception more often if they could obtain it easily, and there were few side effects.
What do we know about the use of contraception in the UK?
Here are some facts about the use of contraception in the UK
Use of contraception in the UK
Contraception has been provided, free of charge, to all women in the UK, since 1974.
In 2013, 87% of women and 73.8% of men had visited at least one venue to obtain a form of contraception, according to the 2013 NATSAL-3 survey. 59.1% of women obtained contraception from their GP, 28.6% from other retail outlets such as pharmacies, and 23% from community Family Planning and GUM services.
However, this survey was conducted 7 years ago and much has changed. The recent COVID-19 pandemic has stressed NHS services across the board. Sexual health, and contraceptive service provision, was overstretched and underfunded, long before the pandemic began.
Women are currently reporting great difficulty obtaining their contraception. Marie Stopes International has predicted there will be 900,000 unplanned pregnancies as a result of this disruption to contraceptive services. UK abortion rates are already on the increase.
Women most often use contraceptive methods which are the least effective
Despite the fact there are now 15 different methods of contraception, women still most commonly choose to take the pill, or use a condom. These methods require much input from the user, and they do not provide such effective contraception as less user-dependent methods, known as the Long-Acting Reversible Contraceptive (LARC) methods – these are the IUD (copper coil), IUS (hormone coil), injection, and the implant.
LARC methods are ‘fit and forget’ methods which give over 99% contraceptive reliability for 3-5 years or more, without the user having to do much at all.
The most effective contraceptive methods are either LARC methods or sterilisation. However, the NATSAL survey showed only 1 in 5 women are using these methods.
Sexual health specialists across the UK have been trying to encourage more women to use LARC methods because they have so much to commend them. LARC uptake has increased in the under 25’s, however, LARC methods are suitable for all age groups, including older women.
What’s going wrong with contraception?
This is a very good question. Why do some women choose not to use contraception and leave such a momentous decision as getting pregnant, to chance? There are many reasons women either choose not to use or give up on their contraception.
Women are often dissatisfied with contraception
For example, in the CHOICE study, a prospective American study, 5,087 women were offered their choice of contraception free of charge for 3 years. At 12-months, LARC continuation rates were good at 86%, but only 55% were still taking the contraceptive pill. Although 80% were satisfied with an IUD, only 54% were satisfied with their pill – and the pill is still the first choice contraceptive option for most women.
Reasons for dissatisfaction with the pill are usually due to concerns about side effects such as headaches, breast tenderness, mood swings, weight gain, and also because women have difficulty remembering to take it.
If there are pill side effects, one option is to change to a different pill, or try a different method. The worst thing to do is stop the pill and not go back to the clinic. With 15 different methods, there is something out there for everyone. And many of these methods offer non-contraceptive benefits – such as less heavy painful periods, improved acne, and improvements in PMT, for example.
Being unaware of the difference in the failure rate of contraception with typical and perfect use
Women are often told the pill is 99% reliable, however, this is the failure rate if you take your pill perfectly all the time. For most women, it’s pretty impossible not to make mistakes taking a pill when they have to take it reliably every day. This means that the failure rate of the pill resulting from typical use, is much higher – generally around 9%.
The average pill user needs to understand that the typical use failure rate of the pill is around 30-times higher than it is for those who manage to take the pill perfectly.
LARC methods are ‘fit and forget’ methods, which need very little input on the part of the user. Once the IUD/IUS or implant has been fitted and is working, they continue to work with over 99% reliability. In contrast to the pill, there is almost no difference with LARC methods between the failure rates from typical and perfect use.
Feelings and emotions get in the way of contraception
Focus studies have shown that feelings play a huge part in when and how women choose to use contraception. In one study, 151 women were asked their reasons for not using contraception. At the time of the study, 56% of participants were not currently using contraception, and ‘being in love’ was the second most common reason. The most common reason was just not being prepared in advance.
Other studies have shown that although contraception use may be good at the start of a relationship, it starts to tail off as the relationship progresses and feelings of love and trust develop.
I would just comment that an unplanned pregnancy can easily wreck a relationship! Somehow, it’s important to keep a perspective and control fertility until both partners are ready for parenthood.
Women want to please their partners
Women often want to please their partners. They worry that using a condom may reduce their partner’s erection, that he might feel their coil threads with his penis, or that hormones might reduce their own libido, or cause side effects such as bleeding or vaginal dryness, which could spoil the sexual experience.
In truth, there is much to say to reassure women on all these issues –
Condoms and erections – There are many factors which can affect a man’s ability to stay erect when he applies a condom – including using the wrong size of condom, applying it too early, and using the wrong technique. Penis sleeves can actually help men get better erections. If he has erectile dysfunction he should see a doctor – there is much that can be done to help.
Men and IUD threads – Doctors who regularly fit IUD’s, (myself included) will tell you that it’s rare for men to say they can feel an IUD thread with their penis. If they do, the threads can be trimmed very short to get rid of the problem.
Hormones and libido – Many factors other than just contraceptive hormones, affect sexual desire.
Although free testosterone levels are lowered in women on the combined pill, most female pill users do not find this has a negative effect on their libido. There seems to be a small group of women who are particularly sensitive to these effects, and who need an alternative option. However, for most women, this low libido on the pill is not usually a problem.
Contraception and periods – Here’s the good news – the combined pill, patch and ring can all be used continuously, to get rid of monthly periods, and improve cycle control. This is called extended use and is safe and effective. Many users of LARC methods have no periods, or occasional light bleeds only.
Contraception is not a major cause of vaginal dryness – Vaginal dryness is an uncommon side effect of the pill. There are many factors, that have nothing to do with contraceptive hormones, which affect vaginal lubrication during sex.
There is a large natural variation in natural vaginal secretion. When questioned, some women say in fact, they would prefer sex to be ‘drier.’
Other forms of contraception, such as the condom, also need to be used with a vaginal lubricant. Of note, the vaginal ring has been associated with an increase in vaginal secretions.
Women prefer sex to be spontaneous
Women often say in research studies, that they did not use contraception because sex was spontaneous, and contraception had not been thought about in advance. But many women would like a method that was in place and working so they can have sex when they want and know they are protected.
In one study, when 574 women attending for abortion were asked, twice as many (65%) said they would prefer a method they did not have to use at the time of having sex.
Women especially dislike contraception which interferes with the spontaneity of sex, such as condoms, cervical caps and diaphragms, or withdrawal.
Many methods of contraception can be used in advance, so they are up and running for the moment you decide to have sex. These include the pill, the patch, the vaginal ring, the injection, the coil, and the implant.
Other research has found that using safe contraception, such as an IUD or an implant, can be a ‘turn-on’ It can increase sexual disinhibition, and can lead to enhanced sexual enjoyment. Some women report they cannot really ‘let go’ unless they know their contraception is secure.
Some women feel ambivalent about pregnancy
We tend to assume that a woman would make an active decision when the time is right to try to conceive a child. However, research suggests this is far from true.
Some may feel they want to have a child at some point anyway and when it happens, it happens. In one American study, up to 50% of those surveyed said they would be prepared to stop using contraception because they wanted a child in the next 3 years.
For others, the fact they could become pregnant by non-use of contraception, adds to their sexual arousal.
Studies have also reported that many women experience a range of pleasurable emotions when they find they are pregnant, even if the pregnancy was not intended.
However, many women may not realise that pregnancy outcomes are much improved when they plan their pregnancy in advance.
Planning a pregnancy results in better pregnancy outcomes for mother and baby
The RCOG has recently published (December 2019) an evidence-based life-course strategy – ‘Better for Women’ – stressing the need to care for women across their lifetime, as they pass through the reproductive years and on to menopause and older age. In this comprehensive and forward-thinking document, they stress the need to plan pregnancies, to improve the health outcomes of both mother and baby. They cite the benefits of planning a pregnancy.
Unplanned pregnancies, although they often become very much wanted pregnancies, overall, have worse outcomes, with more obstetric complications. These babies are more often premature, low birth-weight, tend to have more mental health issues, lower intelligence testing, and lower levels of cognitive testing at the age of 4 years.
The RCOG stress the need for all women to have good contraceptive care, and good pre-conception care – to make an active choice when they want to become pregnant. Many of the risks of pregnancy and childbirth can be reduced or prevented by planning ahead.
Many health and lifestyle factors can be changed before deciding to become pregnant and give a pregnancy a better chance of the best outcome.
- Smoking is a major cause of miscarriage, stillbirth, and birth defects.
- The UK has one of the highest rates in the world for women drinking in pregnancy.
- Being overweight or obese increases virtually all your pregnancy risks and those of your baby: miscarriage, stillbirth, diabetes in pregnancy, pre-eclampsia, Caesarean section, blood loss, wound infections, and mental health issues. (RCOG 2019)
Women are worried about serious risks from using contraception
There are always risks with any decisions you make in life. It’s reassuring to know that contraception has been extensively researched and found to be incredibly safe.
The combined pill, for example, has now been in existence for more than 50 years, and its safety is well established. As the years have passed, the types of hormones in the pill have been modified, and the dose of hormones has been reduced dramatically, such that some women now take the same amount of hormone over a week, as they used to take in one day!
The risk of a fit, healthy non-smoking your women, aged 16-34, dying from taking a combined pill has been calculated to be 1 in 1,667,000. This is similar to the chance of being struck by lightening – a 1 in 2 000 000 risk!
The risk of venous thromboembolism – VTE – (a blood clot) on the pill is believed to be 9.1 per 10,000 users per year. The risk of VTE is however three times higher in pregnancy – with a VTE risk of 30 per 10,000. Most women happily embark on a pregnancy without giving a second thought to the risk of having a thrombosis in pregnancy. Thrombosis is serious, but treatable, with a mortality of less than 1%.
Women with medical conditions need specific advice about their choice of contraception. This is why doctors and nurses working in the field of contraceptive care, have evidence-based guidelines to follow to help a woman choose the best and safest method. Women with medical conditions are often also likely to have increased risks if they were to have an unplanned pregnancy. Contraception is almost always going to be less risky, if it is carefully chosen, than an unplanned pregnancy.
Women are still worried contraception is not reversible
Women are often frightened that using contraception will affect their future fertility. However, they need to be completely reassured this is not the case.
A 2018 meta-analysis and review studied fertility rates in women after discontinuing a range of different contraceptive methods. They found the overall pregnancy rate within 12-months of stopping using their method, of 83.1%. This was similar for users of hormonal contraception and the intrauterine device (IUD).
In the first year of trying to get pregnant, it is known that around 15% of couples will be unsuccessful.
However, it’s worrying that some women are still harbouring thoughts that contraception might affect their fertility permanently. One research study of young women in Brazil reported that they sometimes choose a pill or a method they perceive as ‘weaker’ on purpose, so as not to have such a dramatic effect on their reproduction. They also liked having a few days off of their pill ‘to give their body a rest.’
This is paradoxical. Contraception is contraception precisely because it is reversible every time! (This does not include sterilisation). If you think about it, you only need to miss a few pills to get pregnant. That shows how quickly modern contraception can be reversed! To ask for contraception, then use the least effective method and miss pills on purpose defeats the reason for taking it in the first place.
Women still worry about delay in the return of their period after stopping the pill. What can happen is that women start their periods in their teens, and quickly go on the pill to try and reduce painful heavy periods, which it does very effectively. Many years later, now in their twenties, they come off the pill for some reason and may not immediately see the return of their periods. They then blame the pill for this. In fact, this is nothing to do with the pill. Other conditions such as polycystic ovarian syndrome PCOS, for example, are common, and this is associated with infrequent or absent periods. The pill is a very good treatment for PCOS, and it is only when it is stopped the diagnosis becomes apparent. There are other causes too, such as being underweight, eating disorders, or people who take excessive exercise.
Women need to feel confident that their contraception is completely reversible and take their pill or use their method 100% correctly. If not, they can easily end up with an unplanned pregnancy.
Some women say contraception is not natural
Some women argue contraception is not natural. Do we really want to go back to Victorian times, where most women had 12 or 13 children in a lifetime? Contraception has given women their lives back. It is not stopping women getting pregnant, it is just giving them an option to choose when they want to become pregnant and space their families.
If women want to be natural, there are natural methods of family planning.
Using contraception also has many non-contraceptive benefits. A good example is that using combined hormonal contraception – the pill, the patch, or the vaginal ring – often treat heavy painful periods, and can be effective for example, in the treatment of endometriosis.
Many women have difficulty obtaining contraception
Contraceptive services are some of the most cost-effective services to run and have been shown to save the country huge amounts of money. In an old 1995 study, McGuire and Hughes calculated that in 1991, Family Planning services had saved the NHS £2.5 billion per year. If the costs of the unintended pregnancies they had prevented were added to the equation, including social costs, these services had saved £25 billion! I wonder what the savings would be if this study was repeated now.
We need to dispel myths about contraception – for example, contraception does not make you put on weight
There are so many myths about contraception. The most common is that the pill can make you put on weight. A Cochrane data review in 2011 included 49 studies of users of combined hormonal contraception. These studies were difficult to compare but the authors said they found no evidence of any major effect of hormonal contraception on excess weight gain.
A subsequent 2016 Cochrane study looking at weight and progestogen-only methods also found no evidence of increased weight gain.
Read more about debunking contraceptive myths.
It had never occurred to me that using contraception could be so fundamental to help save the planet. Now I can see that it certainly can. The next issue to understand why women have such trouble choosing and using contraception. How can we help them?
Women need access to good quality information. They need help to make the best decision and support while they are using that method. Also, their contraceptive needs will change across their reproductive lifetime.
Its vitally important women have access to GP services and sexual health clinics where staff are suitably trained and have the time and expertise to help them.
At this time during the pandemic, when we all need to take care of ourselves, prioritise NHS resources like never before, and save the planet, isn’t it time for all of us to work together to help achieve this?
We all need to be concerned about the planet. One way we can help – is to be responsible about contraception. It’s time for us all to take action – today.
If you need help with contraception –
- Sexwise – Which method of contraception is right for me?
- Sexwise – Long-Acting Reversible Contraception
- National Sexual Health Helpline, Public Health England Telephone 0300 123 7123