By DR LUCAS LUK TIEN WEE
Shocked you got pregnant? You might have the wrong idea about your fertility or the contraceptive method you are using. — AFP
During the initial introduction of lockdowns and working from home (WFH), there arose wry speculation that the increase in “idle time” spent in close proximity would inadvertently lead to couples indulging in more sensual rendezvous, resulting in a “Coronial Boom” (i.e. a boom in babies born during the Covid-19 pandemic).
However, with the prolonged socioeconomic consequences of the pandemic, the converse is likely to be true.
There exists a logical and intuitive correlation between catastrophe and birth rates.
Minor catastrophes, such as a night of temporary electrical blackout or a minor weather warning, may trigger idle bodies to explore romantic pursuits, culminating in small birth spikes nine months later.
However, major catastrophes, especially those that disrupt normal livelihoods and gravely impact the economy, have instead rather consistently reflected a decline in birth rates nine months after the sentinel event.
Recent epidemics such as the 2002 SARS (severe acute respiratory syndrome) outbreak in Hong Kong and the 2015 Zika outbreak in Brazil, have both reflected this short term depression of birth rates, or a “pregnancy pause”.
Covid-19 continues to permeate almost every facet of our daily lives, despite unprecedented global measures undertaken to “flatten the curve”. The constant donning of face masks, physical distancing and daily constraints under the various movement control orders (MCOs) are part of the new norm we have all grown accustomed to.
In the midst of this pandemic, many couples are considering delaying conception until the spread and threat of Covid-19 is deemed to be under control. Conceiving and raising an additional child is a commitment many can scarce afford to undertake at present.
Yet, are these couples actively planning against unplanned pregnancies?
Far too often, unsuspecting couples appear genuinely confounded when pregnancies quite naturally arise as a consequence of unprotected sexual intercourse.
To ensure that every child is wanted, couples should plan their families with the aid of contraception. — 123rf.com
Here are the top eight conception myths in the form of the question “How can I get pregnant if…”:
It should come as no surprise to most that a single sexual encounter is indeed sufficient for a woman to conceive.
Yet, in a local survey conducted in 2015, one in three female adolescents seemed bewildered by this fact.
Although fertility does decline with age, women can continue to conceive until menopause, which is the cessation of periods for more than a year. In Malaysia, the average age of menopause is around 51.
However, many Malaysian women stop practising contraception in their 40s, erroneously believing that they are no longer fertile.
Breastfeeding is an effective method of contraception (known as the Lactation Amenorrhoea Method) during the first six months after delivery, if a woman is exclusively breastfeeding and has not had periods after delivery.
Should any of these three conditions not be met, a woman can conceive even while breastfeeding.
Coitus interruptus, or withdrawal, remains a rather popular choice of contraception in Malaysia with one in 10 couples practising it.
Yet, the chances of conception with this method are significant.
In a virile male, a single drop of pre-ejaculate contains many active sperm, with conception only requiring one healthy, motile sperm to unite with the woman’s egg. Besides, during the throes of passion, enforcing a premature withdrawal can prove to be a monumental task.
This is another common contraceptive choice amongst Malaysians.
However, about one in four women using this method will conceive every year. It is likely that many who purport to be on this form of contraception are not practising it appropriately.
Before relying on the rhythm method, a woman must first chart her menstrual cycles for a period of at least three months.
Then, to calculate her fertile period, 10 days must be subtracted from the longest cycle (the interval between the first day of one period to the first day of the next) and 20 days from the shortest cycle.
For example, let us say that Ms A’s cycles lasted 32 days, 28 days and 27 days in September, October and November respectively.
Subtracting 10 from the longest cycle of 32 days results in 22, while subtracting 20 from the shortest cycle of 27 days results in seven.
This means that days seven to 22 of Ms A’s menses are her “fertile days”, during which unprotected sexual intercourse carries a high chance of pregnancy.
In women with regular cycles, minimal pregnancy risks are associated with sexual intercourse on non-fertile days.
However, it is important to note that emotional stress and physical ailments can affect menstrual cycles and one blip is all it takes to fall pregnant.
Sperm have been documented to survive for a week or longer in a woman and to be resilient to menstrual flow.
So, women can indeed conceive during “period sex”.
Users of hormonal contraception should discuss with their healthcare provider regarding the appropriate guidelines for missing a pill.
One missed pill can potentially result in pregnancy.
Starting the pill, switching over to other methods of contraception and taking hormonal pills concurrently with other medications are also topics to discuss with your healthcare provider.
Unfortunately, no contraceptive method is infallible, save abstinence.
The responsibility for contraception is often unfairly left to women. — AFP
Contraceptive use in Malaysia ranks amongst the lowest in South-East Asia.
Only half of sexually-active Malaysian women practise any form of contraception and a mere three in 10 utilise modern contraception.
The fact that at least 20,000 teenage pregnancies and an estimated 100,000 abortions occur annually in Malaysia truly make for harrowing statistics.
In fact, the actual numbers are likely to be higher, as many conceal these occurrences for fear of social stigma.
Even more stunning perhaps, are the revelations of a nationwide survey published in 2018, stating that almost half of married mothers, especially those from lower income households, had not intended on falling pregnant.
During these difficult economic times, the B40 group are hard hit and many cannot afford to welcome another child.
With such a wide array of effective, modern contraceptive methods to choose from (see infographic below), why are so many Malaysians still shunning them?
Albert Einstein has been quoted as saying: “If I had an hour to solve a problem, I’d spend 55 minutes thinking about the problem and five minutes thinking about solutions.”
So, identifying the problem is key to solving it.
Malaysia remains a conservative society and the public discussion of sex is still deemed taboo by many.
Alas, sex education in our local schools barely skim the surface of basic biology for the most part. Educators themselves have expressed discomfort in discussing sex with their students.
The sheer number of unplanned pregnancies, amongst married and unmarried couples alike, clearly allude to the unmet needs of sex education in Malaysia.
Yet, there are longstanding concerns that exposing curious young minds to sex will only further stoke the raging hormones of youth, hence propagating more premarital sex and teenage pregnancies.
It is high time we openly acknowledge the pink elephant in the room: regardless of race, religion and social class, premarital sex occurs and many teenagers are in fact already sexually active.
Rather than propagate violence, the learning of martial arts has been well-known to cultivate one’s patience, discipline and self-restraint. Similarly, sex education in schools does not necessarily equate to an increase in premarital sex.
Instead, introducing a comprehensive sex education, focusing not merely on the act of sexual intercourse, but also highlighting the consequences of unplanned pregnancies, may well serve to have youths think twice before engaging in unbridled sexual gratification.
A more responsible attitude towards sexual pursuits can thus be nurtured.
Malaysia has earned plaudits for our initial containment of Covid-19. Identifying the spread of Covid-19 to be a threat to our community, our government acted decisively in establishing considerably drastic measures to limit physical interaction.
There was much initial disgruntlement, but swiftly shutting our borders and establishing the MCO in March (2020), has undoubtedly proven to be a wise move in protecting our citizens.
Teaching children about sex is more likely to instill responsible behaviour, rather than encouraging sexual activity. – TNS
Where family pregnancy is concerned, it is strikingly apparent that the level of contraceptive knowledge and awareness amongst many Malaysians is inadequate in preventing unplanned pregnancies.
Many exhibit pre-conceived prejudices against the use of modern contraception.
Most men still seem to have an entrenched notion that contraception remains the responsibility of the fairer sex.
Clearly, the sexual health knowledge amongst Malaysians is not quite adequate.
Empowering our populace through comprehensive sex education in schools will go a long way in shaping positive attitudes and behaviour regarding contraceptive usage.
There will be resistance, but similar to our fight against Covid-19, only with concerted efforts by our authorities, can we appropriately address the issue of unplanned pregnancies.
Whilst we await regulatory efforts to provide for more comprehensive sexual education of our next generation, the onus lies on every sexually-active couple in our midst to engage in appropriate contraception and family planning.
Arrange a consultation with a doctor if necessary.
Each individual is unique, and the Internet, well-intentioned friends or family are not the best sources of advice.
Unless you are ready to expand your family, practice contraception. (Contraception Table Attached)
Let every “coronial” be a wanted child.