As the government intensifies the implementation of its family planning program in the next four years, much more needs to be done to educate Filipinos about the importance of reproductive health and to correct the misconceptions about modern contraception.
Despite the availability and accessibility of different types of contraceptive methods, accelerating the acceptance and utilization is still hindered by misconceptions and lack of knowledge on modern contraception.
“Following the launch of the first World Contraception Day Philippines in 2018, we want to continue the conversation to empower and educate Filipino women and couples to make informed choices about their reproductive and sexual health,” said JunIl Kim, Country Division Head, Bayer Pharmaceuticals.
Among the types of modern contraceptives, the pill, Intrauterine System (IUS), female sterilization, contraceptive patch and injection are the most effective types of interventions with ~99% efficacy, when administered correctly and used with 100% accuracy. However, male condom, fertility awareness trackers and withdrawal method remain to be the most commonly used with approximately 72-82% efficacy. [i]
Earlier, the government has announced the implementation of an intensified family planning program nationwide targeting 11.3 million women over the next four years. This is to increase the usage of contraceptives among Filipinos from 40 percent to 65 percent.
Via Antonio, actress and comedian, talked about her own experiences in pursuit of better reproductive and physical health, “In this day and age, reproductive health remains to be a taboo topic, even among women. Many are using contraception for various reasons yet no one is openly talking about it. The stigma on birth control is alive.”
Dr. Amity Casurao-Trono, Obstetrician and Gynecologist at St. Luke’s Medical Center Q.C and Rizal Medical Center, shed light on the myths and misconceptions about modern contraceptives during her “Pillowtalk” session held in Makati City.
In 2018, an estimated 25.8% or 7.1 million Filipinas aged 15-49, are using modern contraception, an increase of 1.2 million since 2012.
Oral contraceptives or the pill remains to be one of the most effective and preferred form of modern contraception among Filipinas because they are convenient, non-invasive and reversible. It comes in two types — the combined oral contraceptive (COC) pill, which contains both progestin and estrogen hormones and the Mini Pill or progestin-only pill (POP).
Progestin is the main contraceptive ingredient that prevents ovulation, thins out the uterine lining and thickens cervical mucus such that sperm cannot pass through. Ethinyl estradiol, the synthetic female hormone, stabilizes the endometrium and enhances the action of progestin.
Dr. Casurao-Trono clarified and put sense into the most prevalent myths about the use of COCs.
Pills do not cause birth defects: No adverse effects were observed when COCs were accidentally taken during early pregnancy. Past COC use is not associated with an increase in spontaneous abortions.[iii]
Pills do not increase cancer risk: Studies have not established strong and direct links between breast cancer and pill usage. In fact, the risk of cancer lowered with COC use. It reduces risks for certain cancers such as ovarian cancer (~40% lower), endometrial cancer (~50% lower) and colorectal cancer (~20% lower)[iv]. However, it does not protect from sexually transmitted diseases.
Pills do not make you infertile: 21% of women get pregnant after one month of stopping taking COCs and 79% get pregnant after one year of stopping.
Pills, depending on the formulation and indication, also treat a variety of hormone-related conditions and imbalances such as hyperandrogenism, premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD), a severe and debilitating form of PMS. Over 88% of women receiving COCs report no adverse effects.
Aside from preventing unintended pregnancies, selected COC pills offer added benefits beyond contraception such as reducing estrogen-related fluid retention and bloating because of its anti-mineralocorticoid property. It regulates hormonal problems such as acne, facial hair and hair loss due to its anti-androgenic quality. Some COC pills also come in a 24/4 regimen that promotes user compliance. Despite its additional benefits, OB-GYNs highly recommend women to go on a healthy diet and take regular exercise to achieve the desired results.
Like any other medication, it comes with some common side effects such as nausea, breast tenderness and headache, which are tolerable.
Some contraindications to taking the pills are presence or history of Deep Vein Thrombosis, Pulmonary Embolism, Myocardial Infarction, Ischemic stroke, Transient ischemic attack, angina, Severe liver disease, DM with vascular disease, Migraine with aura, Breast cancer, Undiagnosed vaginal bleeding, known or suspected pregnancy, smokers > 35 y/o, severe lipid disease and uncontrolled hypertension.
Dr. Casurao-Trono reiterates that, “It’s time for women to take a more active stance in taking control of their reproductive and sexual health. We should be able to normalize these discussions, without the fear of being shamed or embarrassed.”
[iii] The Global Library of Women’s Medicine. Contraception and congenital malformations
[iv] 1Hannaford et al. BMJ 2007; 2 Beral et al. Lancet 2008; 3 Ness et al. Am J Epidemiol 2000; 4 Tworoger et al. Am J Epidemiol 2007; 5 The Cancer and Steroid Hormone Study of the CDC and the National Institute of Child Health and Human Development. JAMA 1987; 6 Kaufman et al. N Engl J Med 1980; 7 Hulka et al. JAMA 1982; 8 Jick et al. Obstet Gynecol 1993; 9 Vessey & Painter. Br J Cancer 2006; 10 Appleby et al. Lancet 2007; 11 Bosetti et al. Hum Reprod Update 2009; 12Fernandez et al. Br J Cancer 2001
[v] Shulman & Westhoff. Dialogues in Contraception 2006; 2 Barnhart et al. Fertil Steril 2009; 3 Cronin et al. Obstet Gynecol 2009
[vi]1US FDA 2004; 2Endrikat et al. Contraception 1997; 3Hernádi et al. Contraception 2009; 4Hite et al. Eur J Contracept Reprod Health Care 1999; 5Kaunitz et al. Contraception 1999; 6Palacios et al. \\ J Obstet Gynecol Reprod Biol 2010; 7 Parsey & Pong. Contraception 2000
[vii] 1Thorneycroft IH. New Pills/new progestins. In Shoupe D, ed. Contraception. In Diamond MP, De Cherney AH, eds. Infertility and Reproductive Medicine Clinics of North America, 2000;
[viii]Fritz, M and Speroff, L. Clinical Gynecological Endocrinology and infertility, 8th ed
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