Sunday, 29 September 2013

Choosing contraception

OCPs and intra-uterine systems as shown here are examples of two effective contraceptives infrequently utilised by Malaysians.

OCPs and intra-uterine systems as shown here are examples of two effective contraceptives infrequently utilised by Malaysians.

The use of contraceptives is key to creating a world where every pregnancy is wanted.

WHEN you are young and in love (or in lust), it probably doesn’t seem quite romantic or spontaneous to sit down with your partner and have a chat about contraception before getting all physical.

It may be the responsible thing to do, considering that creating and dealing with another human life (i.e. a baby) is a life-changing experience, but who really thinks about that when your main goal is to please your partner and yourself?

This is of course, not to mention the potential hassle of having to deal with a sexually-transmitted disease (STD), if you or your partner should be so unlucky.

Combine that with a society that is increasingly open in practice, but still mostly caught in the traditional Asian way of perceiving sex, and what we have is a major black hole in terms of contraceptive practices.

Reflecting that are the results of a survey done by pharmaceutical company Bayer Healthcare as part of its Yes! It Takes Two campaign in conjunction with this year’s World Contraception Day.

The survey, which spoke to 216 Malaysian men and women aged 20-35, found that one in nine respondents have never discussed contraception with their partners before.

Only slightly over one-fifth of respondents reported that they had discussed the subject with their partners at the beginning of their relationship, while 18.5% revisit the topic annually.

The majority (47.2%) only discuss contraception with their partners when they run out of it.

While nearly 80% of the respondents agreed that it was the responsibility of both partners in the relationship to arrange for birth control, the fear of looking ignorant (16.7%) and the perception that it is not a subject their partner wants to discuss (22.7%) were among two of the reasons chosen for not bringing up the topic with their partners.

However, the vast majority (71.8%) stated that they do not discuss contraception with their partner because they had already previously agreed upon the type of contraceptive they would use.

Having said that, the survey also found that one-quarter of its respondents don’t use any form of contraception at all, with 6% never having even considered the matter before.

One contributing factor to this statistic is probably the difficulty people find in obtaining credible information about contraception. The survey reported that one in three people have this problem.

The top three most cited reasons for this difficulty were embarrassment in asking for information (50%), perceiving the topic as being taboo in their society (35.5%), and not having a conducive environment in school to discuss such topics (28.9%).

Other reasons include being afraid their parents or relatives would find out about their inquiries (27.6%) and not knowing where to look for such information (21.1%).

When asked who they are most comfortable discussing contraception with, the answers in descending order were: their partner (54.6%), the Internet (17.6%), their doctor (13%), their friends (8.8%) and no one, as they have never considered using contraception (6%).

Popular contraceptives

In terms of actual birth control practice, male condoms were the most popular, with half the respondents reporting that it is their current choice of contraceptive.

This was followed by no contraceptive at all (24.5%), the withdrawal method or coitus interruptus (21.8%), and the oral contraceptive pill (12.5%).

Corroborating those findings are condom brand Durex’s The Face of Global Sex 2012 report, which surveyed a minimum of 500 respondents aged 18-64 each in 37 countries, including Malaysia.

The results for our country showed that 54% of locals used condoms during their very first sexual encounter, with 57% also having used condoms at their latest sexual encounter.

The report also said that one-third of the respondents had experienced an unplanned pregnancy, while slightly over one-fifth had contracted an STD.

According to consultant obstetrician and gynaecologist Dr Lim Lei Jun, male condoms are quite a popular birth control method among the Chinese, while Malays tend to use the withdrawal method.

Male condoms are probably the most visible and easily obtained contraceptive devices, being available over-the-counter at pharmacies and convenience stores.

In addition, they serve the double duty of preventing both pregnancy and STDs.

Other contraceptives that can be obtained fairly easily at pharmacies are emergency contraceptives, also known as morning-after pills, and oral contraceptive pills (OCPs).

However, Dr Lim feels that many Malaysians misuse the morning-after pill, which is only meant to be used infrequently, for example, when a condom breaks or if a person only has sexual intercourse once every few months.

Sunway Medical Centre consultant obstetrician and gynaecologist Dr Lim Lei Jun with examples of an intrauterine system (IUS) in a model of the vagina and uterus (left) and a vaginal ring in a model of the female reproductive system, in front of her.
Dr Lim says that many Malaysians have misconceptions about hormonal contraceptives.

“They think it is a good contraceptive method, but these emergency contraceptive pills are not meant to be used on a regular basis,” she says.

She adds that those on OCPs should ideally consult a doctor before starting on the pills as they need to know the right method of taking the pills (different types have different schedules), what to do if they should miss a day or two, what to expect in terms of their menstruation (there might be changes in frequency and flow), and other relevant information.

This is also bearing in mind that 54% of the respondents in the Yes! It Takes Two campaign survey tend to forget to use contraception at all during sex.


While Dr Lim agrees with the survey results that ignorance plays a big part in contraceptive practices amongst Malaysians, she opines that it is not complete ignorance of contraceptive methods, but rather misconceptions about certain forms of birth control.

“The general perception is that pills are bad (or) anything to do with hormones is bad, not knowing that having to terminate a pregnancy and the possible consequences, like post-operative infections that can result in infertility, is worse.”

Sunway Medical Centre consultant obstetrician and gynaecologist Dr Lim Lei Jun demonstrating how to insert a vaginal ring into a model of the female reproductive system.
Dr Lim demonstrates how to insert a vaginal ring into a model of the female reproductive system. This contraceptive device releases hormones that help prevent pregnancy, and is effective for a month.

Because of this perception, many Malaysians tend to go for non-pharmacological methods of contraception, which may not always be effective.

She adds: “Most of them think that pills are bad because they make them fat, or that you can’t ever get pregnant after using them.”

Those are fallacies, she says, as the concern about gaining weight is no longer valid with the current generation of OCPs, and the vast majority of contraceptive methods are completely reversible in terms of fertility.

“Others say that their friend who used the coil (or intrauterine contraceptive device, IUCD) still got pregnant, but we are talking about different levels of risk here,” she says.

Women risk getting pregnant every time they have unprotected sex, while less than 1% of women on the coil actually get pregnant.

In fact, Dr Lim shares that certain contraceptive methods have additional benefits, aside from preventing unwanted pregnancies.

These include reducing acne outbreaks, and heavy and painful periods, as well as offering protection against endometrial and ovarian cancer.

Protecting the vulnerable

With 12 years of experience in both public and private hospitals in the Klang Valley, Dr Lim believes that many people in relationships are sexually active.

Especially during her decade in government service, Dr Lim, who is now in private practice, says: “I have to make sure that I talk to all patients, especially teenage girls who are a vulnerable group, about birth control.

“You can’t talk about moral issues with them as they will just switch off and continue to have sex anyway; what is important is to tell them how to protect themselves from pregnancy and STDs.”

She notes that the perception of being judged morally and religiously might affect sexually-active, single Malaysians, especially teenagers, from seeking the appropriate contraceptive advice from healthcare professionals.

For example, she shares that when an unmarried pregnant girl is admitted to the hospital, those involved in her care might take it upon themselves to lecture or “advise” her from a religious or moral standpoint, resulting in the patient feeling judged and stigmatised, and unlikely to seek further medical advice in the future regarding her sexual health.

At the end of the day, Dr Lim notes that contraception is essentially a life choice,

“It is very important that women are protected from two things: unwanted pregnancies and STDs – especially young girls.”

Tags / Keywords: Health , World Contraception Day , sex , contraception , STD , contraceptives


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