A pharmacist displays two brands of
over-the-counter contraceptives available at Phnom Penh pharmacies yesterday.
Pha Lina
The
greatest obstacle to increased contraception use in Cambodia isn’t the price of
birth control or the social stigma around using it, a new study has found, it
is fear of side effects.
What’s
more, this fear may arise from the many disparate medical systems operating
simultaneously in Cambodia, the study’s authors claim.
Released
this month by China Pharmaceutical University’s School of International
Pharmaceutical Business, the study, titled Explanation of Contraception and
Unmet Need for Family Planning, found that many sexually active Cambodian women
who professed a desire to avoid pregnancy weren’t using birth control.
What’s
more, many highly educated women are using traditional methods of birth
control, such as the withdrawal method, rather than modern methods like birth
control pills, the study found.
About 40
per cent of women surveyed cited health concerns and fear of side effects as the
primary reason behind their decision not to use contraception, the study, based
on 10 years of data from the Cambodian Demographic and Health surveys, found.
Meanwhile, close to 47 per cent of women cited infrequent sex, lack of
fertility, or a desire to get pregnant as the reasons behind their decision.
While a
fear of side effects is considered a common reason for women in developing
countries to avoid contraception, the study determined that pluralistic medical
systems – referring to Cambodia’s mix of private clinics, public health
providers and traditional healers – and a lack of trust in the Cambodian health
system at large could be contributing to the problem.
“Fear of
side effects, stemming from both contraceptive experiences and notions of health
and the body was found to be the greatest obstacle to the use of modern
contraceptives,” the study reads. “This related more broadly to the pluralistic
medical systems operating simultaneously and the varying levels of
medicalization and trust in both bio-medicine and the Cambodian health system.”
In that
context, behaviour that appears counter-intuitive becomes more understandable,
the authors determined. Still, other experts say a lack of information about
potential side effects is likely behind the trend.
While
awareness about birth control methods is growing among Cambodian women, that
doesn’t necessarily mean women have complete information about the side effects
of each method, said Ashish Bajracharya, country representative at the
Population Council, a research organisation that focuses on family planning.
“I don’t
think the parallel system is the cause, but I think parallel systems lead to
less information,” Bajracharya said.
“It would
make sense that women are getting mixed messages, especially when there is an
unregulated market, but I don’t know if there is any empirical data that
objectively proves that,” he added.
Health
experts argue that women need comprehensive health counselling in order to have
accurate information about birth control methods. In Cambodia, opinions about
birth control are often formed through rumour alone, health workers say.
“If there
are side effects for one woman, the whole village knows about it,” said Lyn
Huy, a program manager at Action for Health. “So what is really needed is
counselling to dispel myths.”
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