Family planning involves deciding when the right time to have children is, spacing the pregnancy and what is the appropriate number of children for a couple to have. To carry out family planning, the couple cannot shy away from the topic of contraception. 

Contraception, commonly known as birth control, is the deliberate use of any natural or artificial methods to prevent pregnancy as a result of sexual intercourse. Unfortunately, Malaysia still has a long way to go. 17.6% of married women have unmet needs, i.e. those who are sexually active still do not use any method of contraception. In contrast, our neighbouring countries seem to do better than us -- Indonesia has 12.1%; Singapore has 10.9% whilst Thailand only has 5.7%. 

Ensuring access for all people to their preferred contraceptive methods advances several human rights including the right to life and liberty, freedom of opinion and expression and the right to work and education, as well as bringing significant health and other benefits. 

Use of contraception prevents pregnancy-related health risks for women, especially for:

• Adolescent girls (younger than 20 years old)

• When births are separated by less than two years, which the chance of the baby dying is 45% higher than it is when births are 2-3 years and 60% higher than it is when births are four or more years apart

• When the woman has certain illness that may affect both the woman’s and baby’s well-being

•  When the couple does not have the intention to have a child

Available methods of contraception

Thanks to modern medicine, there are various types of contraception available today -- each with different effectiveness, application method and costs.

Image credit: Trussell J, Aiken ARA, Micks E, Guthrie KA. Efficacy, safety, and personal considerations. In: Hatcher RA, Nelson AL, Trussell J, Cwiak C, Cason P, Policar MS, Edelman A, Aiken ARA, Marrazzo J, Kowal D, eds. Contraceptive technology. 21st ed. New York, NY: Ayer Company Publishers, Inc., 2018.

Traditionally, couples practice contraception through means of withdrawal, fertility awareness-based methods and abstinence. However, these methods have higher failure rates than modern methods, especially if the couple failed to practise them perfectly. 

Modern methods have a better success rate of contraception. Examples of modern methods are pill, sterilization, condom and implants. 

The Ministry of Women, Family and Community Development reported that taking contraception pills is the most common family planning practice among married women in Malaysia, followed by tubal ligation/occlusion and condoms. You can find out more information about individual contraception methods here.

How do I know which contraceptive method is suitable for me?

To identify the most suitable contraception method for you, it would be useful to consult your healthcare provider. Your healthcare provider would evaluate the most suitable contraceptive method for you based on several important factors, such as your age, body weight, health condition, personal preference, and your lifestyle factors (such as whether you smoke or not). 

The following questions can help you decide which method is most suitable for you. You can ponder them before seeing your doctor. Some of them may require the insights from your healthcare provider:

• How effective are the different methods? (Refer to the infographic above)

• Can you make contraception part of your daily routine? For instance, do you believe that you are able to remember taking a birth control pill everyday for 3 weeks as diligently as possible?

• Or would you prefer a method that you don’t have to remember everyday?

• Are you comfortable inserting contraceptives into your vagina? 

• Do you mind if your periods change? Some of the birth control pills may affect your periods.

• Do you smoke? 

• Are you overweight? 

• What if you can't use hormonal contraceptives? 

• What if you can't use contraceptives that contain oestrogen? 

• Are you taking medicines for other conditions? 

• Do you want to get pregnant in the near future?

• Does my insurance cover the cost of contraception? If not, will I be able to afford it?

Source: https://www.nhsinform.scot/healthy-living/contraception/getting-started/things-to-consider-when-choosing-contraception

Partner also has a very important role in giving support to ensure women receive effective family planning. Encourage your partner to participate in the conversations surrounding family planning. 

Make sure you’re not pregnant before starting any contraception

Before starting on contraception, you have to make sure that you are not pregnant. A women is not pregnant if she has no symptoms and sign of pregnancy and meet the criteria as below :

• Within the first 7 days after normal menses

• Within the first 7 days post abortion or miscarriage

• Within 4 weeks postpartum for non-lactating mother

• Given birth within the last 4 months for breastfeeding mother and not yet had a menstrual period.

• Has not had sexual intercourse since her last menses or last childbirth.

If you are not sure, you can:

• have urine pregnancy test done or

• wait until your next menstrual period (condom or spermicidal can be used while waiting for next menses)

Different contraceptive methods may require different time to start. Talk to a healthcare provider to know when’s the best time to start your preferred contraception.

Emergency contraception

Emergency contraception can prevent pregnancy after unprotected sex or if the contraception you have used has failed – for example, a condom has split or you have missed a birth control pill.

There are 2 types of emergency contraception:

• the emergency contraceptive pill, a.k.a the "morning after" pill. They contain high doses of progesterone hormone that intends to stop or delay the release of an egg (ovulation), thereby preventing it from fertilising by sperm and stop pregnancy from happening. In Malaysia, you can find these “morning after” pills in any pharmacy or from a GP. The common brands are Postinor 2^®, Escapelle^® and Ella^®. Check with the pharmacist on the best way to take them and potential side effects associated with its use.

• the intrauterine device (IUD or coil). The IUD is a small, T-shaped plastic and copper device that's put into your womb (uterus) by a doctor or nurse. It releases either copper or hormone to stop the egg implanting in your womb or being fertilised by sperm. See a doctor if you would like to get an IUD inserted into your body.

Image credit:https://www.mims.com/singapore/drug/info/postinor-2?type=full

Image credit: https://uhs.umich.edu/contraception-iud

Some important facts about emergency contraception:

• You need to take the emergency contraceptive pill within 3 days (Postinor 2® and Escapelle® ) or 5 days (Ella®) of unprotected sex for it to be effective – the sooner you take it, the more effective it'll be.

• The IUD can be fitted up to 5 days after unprotected sex, or up to 5 days after the earliest time you could have ovulated, for it to be effective.

• The IUD is more effective than the contraceptive pill at preventing pregnancy – less than 1% of women who use the IUD get pregnant.

• The emergency contraceptive pill can make your next period earlier, later or more painful than usual.

• If you're sick (vomit) within 2-3 hours of taking an emergency pill, go to your healthcare provider, as you'll need to take another dose or have an IUD fitted.

• If you use the IUD as emergency contraception, it can be left in and used as your regular contraceptive method.

• If you use the IUD as a regular method of contraception, it can make your periods longer, heavier or more painful.

• You may feel some discomfort when the IUD is put in, but painkillers can help.

• There are no serious side effects of using emergency contraception.

• Emergency contraception doesn't cause an abortion.

• Emergency pills may not be suitable to be taken together with a certain medications. Inform your healthcare provider what medicines you're taking, and they can advise you if they're safe to take with the emergency contraceptive pill.

Source: https://www.nhs.uk/conditions/contraception/emergency-contraception/#:~:text=Emergency%20contraception%20can%20prevent%20pregnancy,the%20%22morning%20after%22%20pill)

How about sexually-transmitted diseases (STD)?

If you are sexually active, not only you need to protect yourself from unwanted pregnancy but also sexually transmitted diseases (STD) and HIV. Among the various contraceptive methods, only a condom can prevent the transmission of STD and HIV during a sexual intercourse. Even if you or your partner is using another type of birth control, agree to use a condom EVERY TIME you have sexual intercourse to reduce the risk to both of you for HIV and most other STDs. Birth control (such as the pill, patch, ring, implant, shot, or an IUD) provides highly effective pregnancy prevention, but it does not protect you from HIV and other STDs.

Get professional consultation

You can approach any GP or family doctor you know to kickstart a conversation about family planning. The Ministry of Women, Family and Community Development also sets up Klinik Nur Sejahtera in various states in Malaysia to provide reproductive education, family planning and menopause consultations for the general public. You can find the nearest Klinik Nur Sejahtera here. 

Image credit: http://layanlah.blogspot.com/2017/07/senarai-klinik-nur-sejahtera-lppkn.html

If you have any questions related to family planning, birth control, emergency contraception and STD, do not hesitate to chat with our online doctor on Doc2Us® app and web chat!

Download Doc2Us^® app on IOS app store, Google Play Store and Huawei App Gallery today. To chat with a doctor on desktop, go to https://web.doc2us.com/login

References:

1. MyHealth - Family Planning. http://www.myhealth.gov.my/en/family-planning/

2. MyHealth - Contraception http://www.myhealth.gov.my/en/contraception/

3. CDC - Contraception https://www.cdc.gov/reproductivehealth/contraception/index.htm#Resources-for-consumers

Written by

Ms Joyce Toh