Laura Wershler is Executive Director of Sexual Health Access Alberta. Recently she wrote a critical response for the re:Cycling blog to a study published in the British Medical Journal which reported that 'Women in the UK who have ever used oral contraceptives are less likely to die from any cause, including all cancers and heart disease, compared with never users.' She has previously served on the board for the Planned Parenthood Federation of Canada (now the Canadian Federation for Sexual Health) and is a self-described opponent of menstrual suppression through hormonal birth control and advocate of body literacy. In this two-part interview, she discusses the gaps she sees in Planned Parenthood services and the rising interest in non-hormonal methods. What is Sexual Health Access Alberta and what is your role? We used to be called Planned Parenthood Alberta and as such we are an adamantly pro-choice organization that promotes reproductive choice and sexual health and wellness. Many organizations in Canada have changed their name from Planned Parenthood because our work has expanded to include a much broader range of sexual health issues. Our goal at Sexual Health Access Alberta is to facilitate access to sexual health and reproductive information and services. I bring with me a commitment to the issues of body literacy and truly informed choice for young women, and as Executive Director of the organization I have worked on areas relating to those issues. In recent years I have advocated that sexual health organizations pay attention to an emerging need and desire amongst young women for support to effectively and confidently use non-hormonal methods of birth control. I am an outspoken opponent of menstrual suppression with hormonal birth control, and that is probably unique for organizations involved in the Planned Parenthood family. I am opposed to the consideration of it as just another choice. Would you see Planned Parenthood as generally more supportive of hormonal birth control over other birth control or merely pro-choice in its outlook on contraceptive methods? I think there is concern with suggesting there may be problematic issues with menstrual suppression -- whether in the way women are encouraged to consider this, or our readiness to understand it as just another option -- and this concern comes out of a fear of having our pro-choice values challenged. It is very difficult for a pro-choice organization to say there are problems associated with menstrual suppression through long-term hormonal birth control use. But women do need access to information, services and support for a broad range of reproductive choices throughout their lives and we are absolutely not paying enough attention to non-hormonal methods. We are not working on the information, service or programming needs of women looking to use non-hormonal methods. In fact, in many ways we are discouraging women from feeling comfortable using those methods because we are not offering enough support to them. Ultimately our inability to present the downside of hormonal contraception and champion the growing research on the benefits of healthy, continuous ovulation comes from a belief that our pro-choice stance will be questioned. Do you feel due to time and money limitations sexual health organizations see hormonal birth control as the most effective and easiest method of preventing unwanted pregnancies and that this is their main goal? Absolutely. When I ask colleagues why there is a reluctance to promote non-hormonal methods of birth control, such as good barriers and fertility awareness, the answer is always, 'But we deal with teenagers who are having sex in the bathrooms at school, young women who don't have control over their sexuality.' And I wonder if they are listening to themselves. If we are concerned that young women are not having a say in when and where they have sex then we should be looking into that seriously. Sexual health clinics do see a lot of teenagers and they are concerned with preventing unintended pregnancy, and that is valid and appropriate, but at the same time we don't just serve teenagers, we also serve young women who are looking for alternatives. What about the women who can't use hormonal contraception because of blood pressure problems or their own bad reaction to the drug? Or the women who won't use hormonal contraceptives and just refuse? Or the women who don't want to? We are not serving their needs and I can state that categorically. I have been working in this area for 20 years and there is no well-thought out, well-delivered assistance. An article posted on the Macleans website at the end of 2009 reported on a decline in the number of women using the Pill in Canada, can you comment on that? The message from many, many young women is clear, they are not finding support in choosing non-hormonal birth control methods. There is an emerging trend of young women, as the article says, 'ditching the Pill for good' and many are doing it without fanfare. There's a belief that the number of women who think this way is very small, but that's not true, it is larger than we see. But there are few forums, like your blog, where they can share opinions or acknowledge each other.The oddest comment I have heard from a young woman at one of my talks is - 'My boyfriend's mother would be horrified if she thought I was going off the Pill!' I want to know, are women making a choice because it is the one they are comfortable with? Or is it because they have been led to think it is the only effective, responsible choice? Women are seen as irresponsible when they are not taking the Pill. That's not choice, and that is not respecting the needs of patients at sexual health clinics. Let's not forget -- the Pill does not fix what is wrong with you, it does not make you healthier, it doesn't manage a disease -- the Pill induces infertility for a positive, appropriate goal, but at the same time I worry the only definition for a 'healthy young woman' for some of the people who serve their needs is 'no unintended pregnancy' and whatever else happens to young women is not important. So, the young women who are concerned about the way they feel, their libido, or about their IBS or their bone loss (all issues linked to the Pill) - they have the right to be listened to. Say a woman has read the study about how Pill use increases artery plaque by 20% and,considering her family history, she chooses not to take the Pill, or a woman is an athlete and she knows research shows the Pill diminishes her ability to build strong muscles and so chooses not to use it - these women need support and they need validation of their concerns. Have you seen in your work a recent rise in interest in non-hormonal birth control methods and an increased rejection of hormonal birth control? Yes and I think the rise in interest is coupled with the rise in interest in holistic health care and organic ways of living, as well as the environmental movement. I believe if you took 200 women aged 30 to 35 and asked their opinions about their experiences with hormonal birth control you would find a lot more displeasure than we might expect. A lot of women use these methods grudgingly, they use them because they have been encouraged to. And just because they use it it doesn't mean their experience has been positive or that they don't wish to know about other methods. We have got so used to this easy 'fast-food' approach to birth control -- take a pill, put in a ring, slap on a patch -- that we are not recognizing that if we want to look at alternatives it will require a certain analysis and introspective look at our sexual lives. It will require a different mindset. It won't be about 24/7 availability for sex whether you feel like having it or not. It will be more about considering how our sexual choices fit into our lives. If a woman decides to stay fertile, she'll have to ask: 'What do I need to know? How will this change the decisions I make? How will this change how I engage sexually? And that's slow contraception. We need to recognize this, and decide to put some dollars into going there and working on how the mindset needs to change in order for young women to be successful in using non-hormonal methods. Making the transition from hormonal to non-hormonal birth control is not easy. There is a lack of a framework, no blueprint, for how to make that change. All women at some point will have to make that transition and there are no services to help them with this.