Temporal trends in contraceptive use in British Columbia, Canada between 2001 and 2021: A descriptive analysis

This study reports trends in reversible and permanent contraceptive use among females aged 15-44 in British Columbia (BC), Canada, from 2001 to 2021.

Using a retrospective, population-based design, we analyzed data from BC Pharmanet, healthcare visits, and hospital records for females (as registered by the provincial insurance program), aged 15-44 in BC. Contraceptive options included short-acting reversible contraceptives (combined oral contraceptives [COC], progestin-only pills, vaginal rings, transdermal contraceptives), long-acting reversible contraceptives (levonorgestrel intrauterine devices [LNG-IUD], copper intrauterine devices), and permanent contraception (tubal ligation, bilateral salpingectomy). We measured IUD use in incident (number of insertions per year) and prevalent use (number of estimated users per year).

From 2001 to 2021, the incident and prevalent use of the LNG-IUD in women aged 15-44 living in BC increased from 0.0% to 1.9%, and from 0.0% to 11.7%. The incidence of COC use decreased from 20.5% to 14.4%. Tubal ligation incidence declined from 0.4% to 0.0%, and bilateral salpingectomy incidence increased from 0.0% to 0.2%. Overall, these permanent contraception methods decreased from 0.4% to 0.3%. Younger age groups increasingly opted for LNG-IUDs, as illustrated by a median age decrease from 33.3 to 30.1 from 2001 to 2021.

We observed pronounced shifts away from the use of COC towards the LNG-IUD, which was larger in younger age groups. Despite a pronounced move away from tubal ligation and toward bilateral salpingectomy for permanent contraception, there were fewer seeking permanent contraception.

In British Columbia from 2001 to 2021, contraceptive use shifted away from short-acting reversible methods toward long-acting reversible methods, suggesting a change to more effective methods for reducing unintended pregnancies. While bilateral salpingectomy rates increased and tubal ligation rates decreased (reflecting the recommendations to perform bilateral salpingectomy for ovarian cancer risk reduction), female permanent contraception rates decreased overall.