Research Article
Contraceptive Use: Patterns and Preferences among New Acceptors in Malaysia,
1990 to 2018
Nor AzahSamat1, Noor Azlin Muhammad Sapri2, AdzmelMahmud3, Noorazrin Abdul Rajak4, Nurakmal Ahmad Mustaffa5
1,2Department of Mathematics, Faculty of Science and Mathematics, UniversitiPendidikan Sultan Idris35900
TanjongMalim, Perak, Malaysia
3,4Population and Family Research Division, National Population and Family Development Board,
50350Kuala Lumpur, Malaysia
5School of Quantitative Sciences, Universiti Utara Malaysia, 06010 Sintok, Kedah, Malaysia
1norazah@fsmt.upsi.edu.my, 2azlin@lppkn.gov.my, 3adzmel@lppkn.gov.my, 4noorazrin@fsmt.upsi.edu.my
Article History: Received: 10 November 2020; Revised: 12 January 2021; Accepted: 27 January 2021; Published online: 05 April 2021
Abstract: Family planning is one of the important aspects in the Sustainable Development Goals (SDG's) in Goal 3 on
Health and Goal 5 on Gender Equality and Women’s Empowerment. Family planning is the basic need and women’s right to pregnancy, to get optimal health. The use of contraceptive enables women to attain their desired number of children and determine the gap of pregnancies towards the improvement of the families’ well-being of. The aim of this paperisto describe the patterns and preferences of contraceptive use among new acceptors attending a family planning clinic at National Population and Family Development Board (NPFDB) in sixteenstates in Malaysia. The data analysis includes the new acceptors of contraception use among married women aged 15 to 49 years old, who attended a family planning clinic at NPFDB for the year 1990 to 2018. There are various types of contraceptive methods considered: contraceptive pills, Intrauterine Contraceptive Device (IUD), condom, hormone injection, implant, sterilization, rhythm and others. Results of the analysis show that contraceptive pills and sterilization have continued to be the most preferred contraceptive methods among new acceptors at NPFDB clinic, with decreasing pattern from 1990 to 2018.While the use of implant, hormone injection and condom has increased steadily since 2004. The state of Perak has the highest number of new acceptors in most years, whilethe federal territory of Labuan has the lowest number of acceptors in most years within 29 years from 1990 to 2018. In addition, the most popular contraceptive method among women for all states in Malaysia in most years from 1990 to 2018 is contraceptive pills, which is preferred in ten states: Kelantan (83%), Kuala Lumpur (72%), Labuan (40%), Negeri Sembilan (86%), Pahang (66%), Perlis (45%), Pulau Pinang (35%), Sabah (60%), Selangor (69%), and Terengganu (76%). While sterilization is the most popular in four states: Johor (62%), Kedah (59%), Melaka (52%), and Perak (66%). Finally, hormone injection is the most popular method in Putrajaya (100%), and condom is the most popular in Sarawak (40%).As a conclusion, this study has found that although the use of contraceptive pillsisdecreasing, it still becomes the most popular among new acceptors in most of the states in Malaysia since 1990. However, the decreasing pattern of new acceptors for all types of contraceptive methods becomes our concern. Future research should therefore,concentrate on the investigation of the reduction number of new acceptors at NPFDB clinic. This is important to make sure the demands of contraceptive can be met and NPFDB clinics couldprovide better services towards better quality of life and better families’ well-being.
Keywords:Contraceptive use, family planning, contraceptive method, family planning pattern
1. Introduction
The use of contraceptive enables couples and people to understand their fundamental rights to freely and responsibly decide whether, when, and how many children to have. The increasing use of contraceptive methods has led not only to changes in health results such as decreased maternal mortality and infant mortality (World Health Organization, 2019; Chola et. al 2015; Arthur et. al, 2012), but also to changes in education and financial results, particularly for women (Sonia, 2018; Zeynep et. al, 2017; Karen et. al, 2015; Gustavo et. al, 2005).
There are various types of contraceptive methods. These include the natural methods (fertility awareness based method, basal body temperature, cervical mucus method, combination method, Lactation Amenorrhoea method), barrier methods (condom, cervical cap, diaphragm), hormonal (tablet, implant, injection), Intrauterine contraceptive device (IUCD), and permanent methods (NPFDB, 2019).
The awareness of reproductive health would prevent the disability of babies as a result of pregnancy and birth too early or late. Family planning is the basic need and women’s right to pregnancy and to get optimal health. Among the factors contributing to the reduction of the mortality ratio are the wide range of professional health services as well as quality family planning and service information. Family planning is also a key factor in reducing poverty and improving the well-being of families. The convenience of reproductive health, including
family planning, is the main target of a new agenda for Sustainable Development Goals for the period of 2015 to 2030.
Many studies on contraceptive use patterns have been conductedpreviously(Koop et al., 2017; Tolefac et al., 2018; Abdulrahman et al.,2019; Fowler et al., 2019). In Malaysia, the studies on contraceptive use are scarce (Manaf, Ismail and Latif, 2012; Frances Shiely and Mohammed SyafiekSaifuddin, 2013). Therefore, this paper aims to study the patterns and the preferences of contraceptive use among new acceptorsin Malaysia for the period of 29 years from 1990 to 2018,forall 16 states in Malaysia.
2. Methodology
The methodology usedin this study is based on descriptive analysis to identifythepatterns of contraceptive use and in determining the most popular contraceptive methods among women in Malaysia. It is important to study the patterns of the contraceptive use so that further action cans be taken by the authorities to improve family well-being in Malaysia.
Firstly, overall,the use of contraceptive family planning methods according to years 1990 to 2018 is analysed using a time series graph in order to study the pattern. Then, the data of contraceptive use is analysed annually for all sixteen states to determine the most popular method for each state over time, and the findings are presented in tables. Here, the most popular method is referring to the use of contraceptive methods that have the highest frequencies among other methods.
In Malaysia, family planning data is gathered from the National Family Planning Programme consists of four different sources: Ministry of Health (MOH), National Population and Family Development Board (NPFDB), Federation of Reproduction Health Associations Malaysia (FRHAM) and Army. However, in this study, the data used is only focusing on data provided by NPFDB which includes the data for women aged 15 -49 years old who are attending NPFDB clinic in all 16 states in Malaysia, from 1990 to 2018. Here, all the sixteen states are included: Johor, Kedah, Malacca, Perak, Kelantan, Kuala Lumpur, Labuan, Negeri Sembilan, Pahang, Perlis, Penang, Sabah, Selangor, Terengganu, Putrajaya, and Sarawak. In this paper, the federal territories of Putrajaya, Kuala Lumpur and Labuan are called states throughout the paperto facilitate discussion.
Furthermore, in this study, various family planning methods are analysed: contraceptive pills, Intrauterine Contraceptive Device (IUD), condom, hormone injection, implant, sterilization, rhythm and others. The following are the definitionsforeach method (NPFDB, 2014).
Contraceptive pills
Contraceptive pills refers to pills containing artificial hormones, either a combination of oestrogen and progesterone, or progesterone only. It acts to prevent the production of eggs (ovum), which causes the cervix to become thick and thick, thus preventing the sperm to enter the womb. It should be taken on a regular basis. Intrauterine Contraceptive Device (IUD)
Intrauterine Contraceptive Device (IUD) is a small ‘T’ plastic device inserted into the uterus to prevent pregnancy. There is a small rope in the uterus that extends out to the top of the vagina and can be felt by women. It contains iron or hormone and can last for a long time (3-5 years or more).
Condom
Condom is a thin sheath made of rubber wrapped around a tight penis before intercourse. It acts to prevent the sperm from entering the vagina and into the womb.
Hormone Injection
Hormone Injection is the injection of hormone (progestin) into the muscle every two to three months. It will be injected into the woman’s arms or buttocks. These hormones prevent ovulation, attach to mucus/mucus in the uterus and thin the lining of the uterus.
Implant
Implant is a tool of the size of a trunk containing hormone (progestin), which is inserted under the skin on the side of the upper arm. It releases small amounts of hormones for 3 years to prevent fertilization, tighten mucus/mucus in the uterus and thin the lining of the uterus.
Sterilization
Sterilization is a permanent family planning method. There are female sterilization and male sterilization (vasectomy). For female sterilization, this method is performed through a small operation on women, in which both fallopian channels are tied or clamped to prevent the fertilization of the egg and sperm.
Women who have undergone this surgery will not have the opportunity to become pregnant again.Whilstmale sterilization is done through a small operation on the male, in which both vas deferens are cut and bonded to prevent the flow of sperm out of the epidermis.
Rhythm
Rhythm method is also called the calendar method or the calendar rhythm method, a form of natural family planning. This method can prevent pregnancy by avoiding intercourse during the fertile time of a woman. The fertile period of a woman is from the 8thto 19thmenstrual period with menstrual cycles within 26 to 32 days.
Others
In this paper other methodsreferto withdrawal, diaphragm, lactational amenorrhea, hormone patch, vaginal ring, and traditional methods.
3. Results and Analysis
Figure 1 shows the total number of new acceptors of contraceptive according to various types of contraceptive methods among women aged 15 to 49 years old, who are attending NPFDB clinic from 1990 to 2018.
Figure 1. Number of New Acceptors of Contraceptive use by Family Planning Methods, 1990 – 2018 It can be seen from Figure 1 that contraceptive pills and sterilization continued to be the most preferred contraceptive methods among new acceptors at NPFDB clinic from 1998 to 2018. The number of contraceptive use has declined steeply for all family planning methods for most of the years.However, there has been notable increases in acceptance of the implant, hormone injection and condom from the year 2004 onwards. Among all sixteen states in Malaysia, the state of Perak has the highest number of new acceptors in most years, while the state of Labuan has the lowest number of acceptors in most years within 29 years from 1990 to 2018.
0 2000 4000 6000 8000 10000 12000 14000 16000
Next, Table 1 depicts the most popular family planning methods among married women who attended a family planning clinic at NPFDB for all sixteen states in Malaysia for the period of 29 years, from 1990 to 2018. It reveals that different types of methods are used by the new acceptors over time.
Table 1.Preferences of Family Planning Methods for each state in Malaysia, 1990 – 2018
Year Johor Kedah Kelantan Kuala
Lumpur Labuan Melaka N. Sembilan Pahang 1990 Pill (59%) Pill (64%) Pill (74%) Pill (53%) - Sterilization (62%) Pill (68%) Pill (47%) 1991 Pill (62%) Pill (56%) Pill (66%) Pill (55%) - Sterilization (50%) Pill (59%) Pill (41%) 1992 Pill (63%) Pill (58%) Pill (60%) Pill (58%) - Sterilization (49%) Pill (59%) Pill (40%) 1993 Pill (66%) Pill (54%) Pill (55%) Pill (60%) - Sterilization (49%) Pill (55%) Pill (36%) 1994 Pill (51%) Sterilization (40%) Pill (56%) Pill (57%) - Sterilization (53%) Pill (68%) Pill (43%) 1995 Sterilization (44%) Sterilization (49%) Pill (42%) Pill (53%) - Sterilization (64%) Pill (68%) Pill (35%) 1996 Sterilization (58%) Sterilization (45%) Pill (45%) Pill (51%) - Sterilization (72%) Pill (72%) Pill (36%) 1997 Sterilization (60%) Sterilization (52%) Pill (41%) Pill (49%) - Sterilization (66%) Pill (69%) Pill (40%) 1998 Sterilization (60%) Sterilization (55%) Pill (41%) Pill (50%) - Sterilization (78%) Pill (70%) Pill (48%) 1999 Sterilization (50%) Sterilization (56%) Pill (39%) Pill (47%) - Sterilization (90%) Pill (57%) Pill (47%) 2000 Sterilization (56%) Sterilization (66%) Pill (36%) Pill (46%) - Sterilization (90%) Pill (62%) Pill (57%) 2001 Sterilization (54%) Sterilization (70%) Pill (39%) Pill (39%) - Sterilization (92%) Pill (55%) Pill (63%) 2002 Sterilization (60%) Sterilization (67%) Pill (32%) Pill (42%) - IUD (69%) Pill (61%) Pill (59%) 2003 Sterilization (43%) Sterilization (64%) Pill (41%) Pill (34%) - IUD (79%) Pill (52) Pill (61) 2004 Sterilization (41%) Sterilization 68%) Pill (38%) Pill (28%) - Condom (35%) Pill (55%) Pill (58%) 2005 Sterilization (39%) Sterilization (65%) Pill (50%) Pill (27%) - Pill (40%) Pill (29%) Pill (48%) 2006 Sterilization (46%) Sterilization (63%) Pill (47%) Pill (27%) - Pill (37%) Others (35%) Pill (30%) 2007 Sterilization (50%) Sterilization (52%) Pill (52%) Pill (30%) - Pill (37%) Pill (34%) Pill (31%) 2008 Sterilization (47%) Sterilization (53%) Pill (43%) Pill (25%) - Pill (33%) Pill (35%) Pill (29%) 2009 Sterilization (55%) Sterilization (53%) Pill (44%) Pill (25%) Pill (50%) Pill (37%) Pill (37%) Sterilization (44%) 2010 Sterilization (42%) Pill (31%) Pill (33%) Condom (21%) Pill (39%) Sterilization (36%) Pill (32%) Sterilization (35%) 2011 Sterilization (38%) Sterilization (26%) Pill (36%) Injection (27%) Pill (41%) Sterilization (36%) Pill (31%) Sterilization (27%) 2012 Sterilization (30%) Pill (27%) Pill (44%) Injection (21%) Condom (40%) Sterilization (42%) Implant (30%) Sterilization (25%) 2013 Condom (23%) Condom (27%) Pill (28%) Injection (26%) Implant (39%) Implant (41%) Implant (28%) Condom (28%) 2014 Pill (22%) Implant (37%) Implant (45%) Implant (26%) Implant (39%) Implant (58%) Implant (35%) Condom (60%) 2015 Pill (26%) Condom (33%) Implant (41%) Pill (23%) Injection (41%) Implant (35%) Pill (26%) Condom (76%)
2016 Injection (25%) Implant (20%) Implant (38%) Implant (45%) Implant (38%) Others (33%) Pill (23%) Condom (59%) 2017 Pill (25%) Implant (20%) Implant (56%) Implant (40%) Pill (50%) Pill (39%) Pill (23%) Condom (38%) 2018 Implant (33% ) Condom (30%) Implant (52%) Implant (48%) Implant (33%) Pill (29%) Pill (24%) Implant (43% ) Table 1 (continue).Preferences of Family Planning Methods for each state in Malaysia, 1990 – 2018.
Year Perak Perlis Pulau
Pinang
Putrajaya Sabah Sarawak Selangor Terengganu
1990 Pill (62%) Pill (56%) Pill (53%) - - - Pill (61%) Pill (70%) 1991 Pill (60%) Pill (59%) Pill (53%) - - - Pill (67%) Pill (66%) 1992 Pill (58%) Pill (65%) Pill (54%) - - - Pill (73%) Pill (57%) 1993 Pill (60%) Pill (65%) Pill (49%) - - - Pill (73%) Pill (52%) 1994 Pill (55%) Pill (44%) Pill (40%) - - - Pill (73%) Pill (50%) 1995 Sterilization (46%) Pill (40%) Pill (39%) - - - Pill (59%) Pill (53%) 1996 Sterilization (45%) Pill (39%) Pill (35%) - - - Pill (51%) Pill (54%) 1997 Sterilization (45%) Sterilization (43%) Sterilization (38%) - - - Sterilization (45%) Pill (55%) 1998 Sterilization (48%) Pill (45%) Sterilization (40%) - - - Pill (43%) Pill (58%) 1999 Sterilization (44%) Sterilization (48%) Sterilization (33%) - - - Sterilization (47%) Pill (59%) 2000 Sterilization (46%) Pill (46%) Sterilization (42%) - - - Pill (49%) Pill (60%) 2001 Sterilization (54%) Sterilization (42%) Sterilization (44%) - - - Pill (50%) Pill (59%) 2002 Sterilization (60%) Sterilization (45%) Sterilization (39%) - - - Pill (53%) Pill (52%) 2003 Sterilization (54%) Sterilization (33%) Pill (33%) - - - Pill (49%) Pill (61%) 2004 Sterilization (56%) Pill (35%) Pill (29%) - - - Pill (46%) Pill (74%) 2005 Sterilization (52%) Pill (28%) Pill (28%) - - - Pill (52%) Pill (82%) 2006 Sterilization (43%) Injection (36%) Condom (52%) - - - Pill (47%) Pill (85%) 2007 Sterilization (47%) Injection (49%) Condom (61%) - - - Pill (55%) Pill (82%) 2008 Sterilization (53%) Injection (35%) Condom (63%) - - - Pill (51%) Pill (71%) 2009 Sterilization (57%) Injection (35%) Condom (51%) - Condom (38%) Injection (50%) Pill (39%) Pill (64%) 2010 Sterilization (61%) Sterilization (39%) Condom (40%) - Pill (48%) Injection (60%) Pill (35%) Pill (58%) 2011 Sterilization (50%) Sterilization (40%) Condom (38%) - Pill (53%) Pill (47%) Pill (32%) Pill (48%) 2012 Sterilization (48%) Sterilization (31%) Condom (40%) Injection (57%) Sterilization (61%) Sterilization (77%) Implant (34%) Implant (38%) 2013 Sterilization (28%) Implant (50%) Condom (56%) Injection (65%) Pill (36%) Implant (51%) Implant (45%) Implant (56%)
(31%) (60%) (37%) (66%) (31%) (56%) (55%) (78%) 2015 Condom (29%) Implant (47%) Condom (33%) Injection (57%) Pill (50%) Condom (54%) Implant (41%) Implant (65%) 2016 Condom (62%) Implant (39%) Others (40%) Injection (45%) Condom (44%) Condom (69%) Implant (48%) Implant (50%) 2017 Condom (56%) Pill (62%) Others (37%) Injection (45%) Condom (36%) Condom (52%) Implant (50%) Implant (52%) 2018 Condom (38%) Pill (52%) Others (59%) Injection (38%) Pill (32%) Condom (31%) Implant (45%) Implant (66%) Firstly, for the first 10 years (1990 to 1999), contraceptive pills and sterilization were the most popular family planning methods chosen by the new acceptors in all sixteen states in Malaysia. However, it can be clearly seen that contraceptive pillswerecontinuously the only and the most preferred method compared to sterilization in most states, including Kelantan, Kuala Lumpur, Negeri Sembilan, Pahang and Terengganu.
Then, for the next 10 years (2000 to 2009), pills and sterilization were still the most popular methods, but with the new popular methods in some states which were hormone injection and condom. IUD was the most popular method in 2002 in Melaka, whilst condom was the most popular method in 2004, also in Melaka. Other methodswerethe most popular methods in 2006 in Negeri Sembilan, and injection was the most popular method in 2009 in Sarawak.
Furthermore, for the next 9 years (2010 to 2018), implant appeared to be the most popular method in 2012 in Negeri Sembilan, Selangor, and Terengganu.
In addition, women in several states continuously preferred the same methods for several years. For instance, injection continuously was the most popular method for seven years in Putrajaya from 2012 until 2018. While, implant was continuously the most popular method for seven years in Selangor and Terengganu from 2012 to 2018.
Condom seemedto be the most popular method in Perak from 2014 to 2018, sterilization from 1995 to 2013, and contraceptive pills from 1990 to 1994. In Kelantan, contraceptive pillswere continuously the most popular method from 1990 to 2013, and implant from 2014 to 2018.
Overall, the most popular and preferred contraceptive method among women for all states in Malaysia in most years from 1990 to 2018 were pills in ten states including Kelantan (83%), Kuala Lumpur (72%), Labuan (40%), Negeri Sembilan (86%), Pahang (66%), Perlis (45%), Pulau Pinang (35%), Sabah (60%), Selangor (69%), and Terengganu (76%). While sterilizationwas the most popular in four states: Johor (62%), Kedah (59%), Melaka (52%), and Perak (66%).Finally, hormone injectionwasthe most popular method in Putrajaya (100%), and condomwas the most popular in Sarawak (40%).
4. Conclusion and Future Research
Contraception is important to prevent unintended pregnancy. Planning for a child will help women in avoiding social, health, and financial problems. There are various family planning methods available at the NPFDB clinic. Women can choose to use whatever method suits them based on doctors’ advices and their personal needs. In this study, from 1990 to 2018, the patterns of contraceptive use for these various types of family planning methods changed over time. In general, it is found that the patterns of family planning use among women decreased in the first 13 years (1990 to 2002) for all types of family planning methods, especially pills and sterilization. However, there was a slight increase in the use of implants and condoms in 2003 onwards. The distribution of the preferred family planning methods by states showed that contraceptive pills and sterilization were the most popular methods in the first 20 years (1990 to 2009) in all states of Malaysia. However, this pattern changed for the last 9 years (2010 to 2018) when implant, condom and injection became amongst the most popular methods to be used compared to contraceptive pills and sterilization. The changes might be because of the effectiveness of the methods itself. The location of NPFDB clinic may also contribute to the changes of pattern, in which either the clinic located in rural or urban area. In addition, it might also because of the effects of the family planning campaigns or changes of policy by NPFDB. Furthermore, it might also due to the availability of contraception provided by NPFDB clinic. Therefore, further studies are suggested to investigate these, so that the demands of contraceptive can be met and NPFDB clinics could provide better services which subsequently will improve better well-being of families.This also includes further studies of
contraceptive use among women using statistical transmission models as proposed by Samat and Percy (2012), to make this contraceptive use more understandable.
5. Acknowledgments
The authors acknowledge UniversitiPendidikan Sultan Idris for their financial support in respect of this study. References
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