This article contains mention of self-harm and suicidal ideation.
The first time Kelsha Wong visited a youth clinic, she was 15 years old, scared and alone.
“I felt super uncomfortable,” recounted Wong, who is currently doing a real estate trading services program at the Sauder School of Business. “I wish I had somebody who I [was] comfortable to go with.”
Wong didn’t feel comfortable discussing sexual health with the adults in her life, including family members and school counsellors. She didn’t even feel comfortable asking her closest friends. So instead she turned to strangers.
For students like Wong, free youth clinics can be a lifesaver for accessible sexual health care, but the support they receive from the often-overextended staff can either make or break their experience. When sexual health care overlaps into mental health care, it becomes even more important.
“I think the most difficult part about accessing this sort of care is just the stigma around it,” Wong said. She finds that although the general public are becoming more open about sexual health, many people are still not yet comfortable discussing and navigating their own.
Over time, she found herself feeling more at ease. The clinic provided a confidential space for Wong to ask the questions she wasn’t ready to ask anyone else — about getting on birth control for the first time, and navigating its notoriously variable side effects.
Youth clinics are an essential service
There are many Youth Clinics across Metro Vancouver, including three in the Vancouver area including the East Van, Boulevard and Knight Street Youth Clinics. The services are available for people between the ages of 12 to 24 and include free or low-cost birth control options, emergency contraceptive pills, pregnancy testing and STI testing and treatments. These services are also offered to registered UBC students by UBC Student Health Services.
Access to sexual health services — like contraceptives and STI and pregnancy tests — through youth clinics were invaluable for Wong as she explored her sexuality.
Ciara Norton, a fourth-year environment and sustainability student, does not feel as comfortable accessing campus resources due to privacy concerns so off-campus youth clinics are still critical for her sexual health care access.
Both Wong and Norton have been able to access birth control through their respective clinics. Contraceptives come in various forms, including intrauterine devices (IUDs), implants, contraceptive patches, rings, diaphragms and condoms.
Wong considered many forms of birth control, and happily settled on birth control patches. Meanwhile, Norton had a much bleaker experience with her now-removed Nexplanon implant.
The emotional toll of contraceptives
Norton was “severely concerned” about the potential mental health impacts of going on birth control, but she felt that her concerns were dismissed by sexual health care providers. She felt like birth control was pushed onto her. Eventually, she opted to receive an implant after a recommendation from a friend.
Then, when she wanted to take it out, the youth clinic who gave her the implant told her that she would have to wait months for a removal appointment.
“My whole life was falling apart,” said Norton.
In the meantime, her depression continued to chip away at her life. She didn’t know what to do. Her confidence dropped. Her libido went down. Her relationship with her sexuality soured. And, for the first time in her life, Norton began experiencing suicidal thoughts and practicing self-harm.
The link between birth control and depression is a complex issue. A critical review of academic literature found that many studies had inconsistent methodologies, making it difficult to compare findings and establish firm evidence about the relationship between birth control and depression. However, a number of studies note a correlation between birth control and antidepressant use, as noted in a 2016 Danish study of over a thousand women. But, effects also might vary based on the type of birth control.
Despite her insistence on removal, the youth clinic where Norton received her implant required her to book an initial consultation appointment first. Even before her removal date had been set, Norton said she was already being pressured to pick a follow up contraceptive.
“I felt like they were just really trying to give women the opportunity to not have to deal with the burdens of having a kid too young — which I think in the greater picture is more impactful, more important — but it was a horrible experience for me.”
Eventually, Norton was able to book an appointment at a clinic in Abbotsford. Once removed, she was able to return to a healthier mental state. Her self-confidence increased and her libido returned.
Bridging sexual and mental health care
Looking back, Norton wished she had accessed some form of mental health counselling while she had her implant. Although that is a service that many youth clinics as well as UBC Wellness offer, she did not take advantage of it.
“I don’t see contraceptives as being bad for mental health,” said Norton. “I am seeing them as having the ability to influence mental health and I think that it’s just undervalued when people are looking for reproductive health care.”
Although she is no longer on birth control, Norton stays safe by accessing other sexual health resources such as physical protection. She also has experience using emergency contraceptives such as Plan B.
Wong said that throughout the years, she’s spent hundreds of dollars on Plan B and pregnancy tests and wished that she leveraged cost-efficient resources. Youth clinics and the UBC Wellness Centre are free.
“If you’re going to be [sexually] active, which is totally your choice,” said Wong. “Take these steps to ensure your sexual health.”
Sometimes, those steps include prioritizing mental health in sexual health discussions and seeking counselling in conjunction with other sexual healthcare services.
For now, Norton is sticking to other forms of sexual health care resources but she hasn’t crossed off contraceptives quite yet. They’re still on the table, just as long as her health care providers are able to have a good, long chat about what it would mean for both her brain and her body.
The UBC Wellness Centre Sexual Health Shop products also include low-cost condoms and pregnancy tests. Students can also redeem up to 80 per cent of eligible prescription drugs, including oral contraceptives, under the AMS/GSS Health and Dental Plan when visiting campus pharmacies. UBC Counselling Services also offers both virtual and in–person appointments as well as drop-in sessions, with up to $1,250 covered by the AMS/GSS Health and Dental Plan annually.