DOH: Injectables preferred method of contraception

Contraceptive pills were the subject of much debate during deliberations on the Reproductive Health bill, which the bicameral conference committee approved on Wednesday. Senate Majority Floor Leader Vicente Sotto III blamed contraceptive pills for the death of his son, saying his wife had gotten pregnant despite being on the pill. Senator Pia Cayetano, co-sponsor of the RH bill, responded that there is no proven link between the use of contraceptives and the condition of babies born with illnesses or disabilities. But the RH bill promotes the use of both natural and artificial methods of birth control, with the latter going beyond the often mentioned pills and condoms. According to Usecrectary Ted Herbosa of the Department of Health, injectables are the most in-demand method of contraception at their health centers. "Hinihingi ito ng karamihan ng kababaihan. Kasi yung pills iniinom yun everyday. So kapag nakalligtaan 'yung pills kagaya nga doon sa debate sa Senado, may ilang senador na hindi maganda ang experience sa pills, kasi puwede mo talaga,makaligtaan at pag nakaligtaan magmimintis yung method na 'yun," he said in an interview on GMA News TV's News to Go on December,19. The 2008 National Demographic and Health Survey (NDHS) conducted by the National Statistics Office revealed that,"the pill and injectables are more popular among younger women, whereas older women tend to use long-term methods,such as female sterilization and IUD." The survey also said that calendar/rhythm/periodic abstinence was popular among older women (age 40-44), while withdrawal was popular among women age 20-34 years old. Herbosa explained that unlike pills, that must be taken daily, injectable hormones prevent pregnancy for as long as three months. "Convenient siya kasi once every three months ka lang magpupunta sa health center hindi kagaya ng pag naubos na yung pills mo every month babalik ka para humingi na naman ng bagong pack for the next month," he said. There are two types of injectable contraceptives, progestin-only injectables (which prevent pregnancy for three months),and combined injectables (which are administered once a month). According to an article on the World Health Organization's Reproductive Health Library, compared with progestogen-only injectables, combination injectable contraceptives are associated with more regular bleeding patterns, lower risk of amenorrhea, and less likelihood of infrequent menstruation. Combined injectable contraceptives, which contain two hormones, a progestiv and an estrogen, were developed to address troublesome side effects of progestin-only formulations, according to a review of combination injectable contraceptives, also available on the online library. "More women using combined injectables had normal bleeding than women using progestin-only injectables like ’depo.’Also, fewer women using combined injectables stopped using them because of bleeding reasons than progestin-only users. However, users of combined injectables were more likely to stop using them overall and to stop for other medical reasons. Many factors can affect whether women keep using the method, including whether the women liked it," the review said. Among the generic brands of injectable contraceptives are Depo-Provera and Lyndavel. Injectable contraceptives cost around 200 pesos per dose. Choosing the method Apart from injectables, women may also opt for implantable hormones, which are placed underneath the skin and are effective for up to two years. "Hindi na sila babalik sa health center for two years at kung gusto na nilang mabuntis, aalisin lang yung device," he said. On the other hand, condoms are less favored despite being made available at health centers, Herbosa said. "Alam niyo,naman ang mga kalalakihan, parang ayaw daw nilang maligo na nakakapote," he said, adding that there is also a need to change certain mindsets. As one sexually active teenager told GMA News Online, her current sex partner does not like to use condoms because,"walang kwenta kung gagamit nito." "Kung minsan ang nagsusuffer doon ang ating mga kababaihan, kasi nabubuntis sila na unwanted," Herbosa said. In the Philippines, 19.3 percent of married women had unmet needs for family planning as of 2011. In 2008, the actual fertility or birth rate in a woman's lifetime was 3.3, while the target fertility was 2.8 births, translating to a 0.5 difference in actual vs. wanted births. Herbosa said that with the RH bill, women will be able to choose which method to use, whether they prefer natural,methods such as abstinence or the calendar method, or contraceptives such as pills or injectibles. "Puwedeng mapili na,ng mga kababaihan kung ano ang bagay o sang ayon sa kagustuhan nila. Kasi hindi naman pinipilit na injectible sa lahat. Kung ano ang gusto, kunwari gusto nila ng natural, andiyan ang pamamaraan na natural. Abstinence, huwag magtalik, hindinaman mabubuntis, o gumamit ng mga method na mabibilang mo kung kailan safe at hindi safe," he said. He said the DOH can instruct couples on natural family planning, as well as offer contraceptives including condoms, pills, injectables, implantables, tubal ligation, and non-scalpel vasectomy. Herbosa said the RH bill is expected to help lower the maternal mortality rate in the country. He noted that pregnant,women must have at least four antenatal visits, which many of the poor cannot do because of lack of services at the health centers, or lack of funds to get to the health center. "Dito sa batas na ito, dapat magkaroon sila ng prenatal care, breastfeeding sa bagong panganak, at bakuna," he said. He noted that while the DOH has already been implementing its family and reproductive health program, there is still a lack of information and access to family planning methods, particularly in areas where the local government refuses commodities or modern family planning methods from the DOH. "Karamihan ang impormasyon ay hindi napopondohan, at kagaya ng mga nakaraang administrasyon na pabor sa gusto ng ibang paniniwala na natural ang gamitin, hindi nabibigyan ng emphasis ang mga programa na ito. Kaya maraming kababaihan na mahihirap na nakakausap namin ay gusto nilang matutunan yung iba't ibang pamamaraan ng pagplano ng pamilya," he said. — Carmela G. Lapeña/DVM/HS, GMA News