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We need to deal with teenage pregnancy

We need to deal with teenage pregnancy

A teenage pregnancy is one in which the mother’s age is less than 19 years.

The incidence of teenage births in Malaysia has varied from 14,000 to 18,000 annually since the beginning of 2010. This means an average of between 37 and 50 births daily.

By comparison, the incidence in Singapore and Hong Kong is about 20% to 30% that of Malaysia.

There are various factors that increase the likelihood of teenage pregnancies.

Data from the United Nations Children’s Fund (Unicef) Malaysia revealed that teenage pregnancies are strongly associated with poverty, with the mothers either unemployed or in lowly paid employment.

A study of pregnant teenagers at two women’s shelter homes reported lack of or poor parental supervision, with about half reporting poor communication with their parents about personal issues.

Another study in a semi-rural clinic reported that about a third of pregnant teenagers had low educational backgrounds.

Dropping out of school increases the likelihood of insufficient sexual and reproductive health knowledge, and involvement in risky sexual activity.

Various studies have reported low levels of knowledge about sexual and reproductive health, even in university students. The main source of such information were mothers in the Klang Valley and friends in Kelantan.

A study in 1998 reported that 50% of 14–15-year-olds had read pornographic materials and 44% seen pornographic images in magazines and videos.

Peer influence have been reported to have contributed significantly to teenage pregnancies.

Studies have reported that the incidence of consensual premarital sexual intercourse amongst teenagers in the Klang Valley and Negri Sembilan were 13% and 5.3% respectively, with three quarters in the former not using any form of contraception.

Teenagers are biologically not ready for pregnancy, which is reflected in health consequences.

In addition, there are social and economic consequences of teenage pregnancies.

Health consequences

Teenage pregnancy continues to remain a major cause of maternal and infant mortality, as well as inter-generational cycles of illness and poverty. They account for more than 90% of all maternal deaths globally.

Local studies report fewer antenatal care consultations at healthcare facilities, unsureness about date of delivery, maternal anaemia, preterm deliveries and perinatal complications for the newborn.

When there are fewer antenatal consultations, there are decreased opportunities to diagnose and treat maternal conditions such as anaemia; educate the mother-to-be on infant and child care; and planning for the upbringing of the baby.

About one in four teenage mothers have a preterm delivery. This exposes the baby to perinatal complications such as respiratory difficulties and infections.

In addition, the low birth weight of these babies exposes them to long-term health effects.

A study of residents in a local shelter home reported about 93% having emotional problems; 58% sleep problems; and 46% low self-esteem.

The rejection of pregnant teenagers by their families and their use of shelter homes as means to avoid embarrassment and shame exposes the mother to puerperal depression.

Rapid repeat pregnancy exposes mother and baby to further risks.

Studies of teenage pregnancies from other countries report higher risks of fits (“eclampsia”); genital tract and systemic infections; bleeding before and after delivery; frequency of operative delivery; and unsafe abortions, which contribute to maternal mortality and lasting health problems.

Teenage pregnancy, abandoned babies, young mothers, child marriages, premarital sex, contraception, sex education, Star2.com

Teenage deaths account for more than 90% of all maternal deaths globally.

Social and economic consequences

The pregnant teenager is likely to drop out of school because of the early pregnancy or marriage.

Subsequent lower educational attainment leads to fewer skills and employment opportunities, which often perpetuate poverty cycles.

It has been found that child marriage reduces future earnings.

The economic impact is that the country will lose out on the annual income that these women would have earned over their lifetimes if they did not have the teenage pregnancy.

According to police statistics, there are about 80 to 100 newborn babies found abandoned annually, with more than 50% found dead.

These numbers could be the tip of the iceberg as many may be buried or thrown away in places where their little bodies can never be found.

Going forward

The Prime Minister’s instruction to states to increase the minimum age of marriage to 18 years is a positive step.

However, more needs to be done and the measures have to be sustained. For a start, policymakers, parents and society have to acknowledge the following:

• A teenage pregnancy is most probably an unplanned pregnancy; particularly the younger the mother-to-be is.

• The young will increasingly indulge in sexual activity for biological and other reasons.

• Knowledge about sexual and reproductive health in our young is sorely lacking.

• Knowledge and access to contraception have never been reported to increase sexual activity among the young.

• Criminalising the unfortunate end result of human biology cannot stop the natural order of things.

• The government, parents, teachers, and society have to be proactive and not reactive.

As such, there is a need to:

• Implement comprehensive sexual and reproductive health education in all schools.

This means the provision of explicit knowledge about human reproduction and contraception and skills to manage human biology.

• Provide easy and non-judgmental access to contraception to teenagers who are sexually active, including emergency contraception.

• Provide easy and non-judgmental access to antenatal care and delivery.

• Provide social support and acceptance of teenage mothers, particularly single mothers.

• Soften society’s view about teenage and single motherhood.

Some of these measures can be implemented immediately, while others will take time to take effect. However, if there is a will, the time frame can be shortened.

People who have no sympathy for pregnant teenagers would do well to remember not to judge others.

Every teenage pregnancy, particularly if the baby is abandoned, reflects society’s failure to take care of its most vulnerable.

If Malaysia is to be a developed nation, it can and must provide comprehensive sexual and reproductive care for all women, particularly teenagers.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
How contraception is related to universal health coverage

How contraception is related to universal health coverage

“Reproductive health implies that people are able to have a responsible, satisfying and safe sex life, and that they have the capability to reproduce and the freedom to decide if, when and how often to do so.

“Implicit in this are the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth, and provide couples with the best chance of having a healthy infant.” (World Health Organization)

The provision of information about sexuality and reproduction has been perceived by many that it encourages sexual activity.

However, this is not supported by evidence. Good quality reproductive health education does not lead to earlier or increased sexual activity.

When the young are well informed about sexual responsibility and contraception, evidence shows that it leads to decreased teenage pregnancies, abortions and sexually transmitted infections.

Sexual activity and pregnancy

Pregnancy can result if any sperm is deposited inside the vagina or spilled on the vulva.

A female can get pregnant if she has had her first period, even if she is aged 12 or less; it is the first time she has sexual intercourse; does not have intercourse often; has intercourse during her period; does not have an orgasm; is not fully breastfeeding; douches (washes the vagina with fluid or other materials) after intercourse; or the penis is withdrawn before ejaculation (coitus interruptus); and irrespective of the position during intercourse.

Limited knowledge

Young Malaysians have limited knowledge about sexual and reproductive health.

For example, one out of 10 and 42 out of 100 thought that douching and coitus interruptus respectively were effective contraceptive methods; 51 out of 100 did not know pregnancy could occur during the period; and one out of four thought contraception was “not required so long as there’s mutual trust between partners”.

“More than half of the sexually active said that their first sex was unexpected or unplanned.”

Unsurprisingly, Malaysia has a relatively low contraceptive prevalence rate of 55.6% in 2010 and 52.6% in 1990.

Malaysia’s unmet need for contraception was 17% in 2010 and 18.6% in 1990.

By comparison, the contraceptive prevalence rates for all developing countries were 62.0% in 2010 and 51.8% in 1990, and the unmet need 12.8% in 2010 and 16.5% in 1990.

Making the right choice

Choices are made throughout life.

A baby brings joy to parents who are prepared to provide the love and care needed.

However, an unintended or unwanted pregnancy brings problems and sorrow to the parents, particularly the young women.

There are about 18,000 teenage pregnancies annually in Malaysia, i.e. about 50 every day. Over a thousand newborns were reportedly dumped in the past decade, i.e. two every week with more than half found dead.

Advising adolescents and young people not to have sexual intercourse is obviously insufficient without concomitant information about contraception.

The provision of access to voluntary contraception is not only crucial to the improvement of reproductive health outcomes, but also has positive associations with improved health, schooling and economic outcomes.

There are various contraceptive methods available with different methods for individuals at different times in their lives.

To make a voluntary informed choice, the information provided should include the correct use of the method, how it works, its effectiveness, common side effects if any, health benefits and risks, return to fertility on discontinuation, signs and symptoms that will require medical attention, and information about sexually-transmitted infections (STIs).

Certain methods are usually not recommended for adolescents and young people, e.g.  sterilisation, intra-uterine contraceptive device (IUCD), withdrawal and fertility awareness methods.

If there has been sexual contact without contraceptive use or the contraceptive method failed, there are emergency contraception methods that can be used.

There is no perfect contraceptive method. All methods have a failure rate.

There are two types of contraceptive failure, i.e. user failure and method failure.

User failure refers to pregnancy occurring because of incorrect use or non-use of a contraceptive method.

Method failure refers to pregnancy occurring despite the contraceptive method being used correctly and consistently, or fitted correctly.

The effectiveness of a contraceptive method depends on the individual’s age, the frequency of sexual intercourse and whether the instructions are followed.

If 100 sexually-active women do not use any contraception, about 85 will get pregnant in a year.

The contraceptive failure rates in daily life are higher than that reported from clinical trials because of user failure. As such, one cannot extrapolate the failure rates in clinical trials, in which usage is more likely to be correct and consistent, to that in common daily usage.

With the exception of male and/or female sterilisation, the various contraceptive methods do not result in irreversible changes in fertility. The return to fertility is immediate with all methods, except for progestogen injections.

Anyone is exposed to STIs, including HIV/AIDS, if he or she has more than one partner or their partner has other partners. In such circumstances, there is a need to prevent pregnancy and STI.

Whenever there is a possibility of STI, the advice is to have dual protection, either through the simultaneous use of condoms with other contraceptive methods, or the consistent and correct use of condoms alone for the prevention of pregnancy and transmission of STI.

A healthy sexual relationship requires both partners to be responsible.

The questions each couple has to address include whether a pregnancy is wanted or unwanted, whether there is access to contraception if a pregnancy is unwanted and whether protection against STI is necessary.

Universal health coverage (UHC) is the core of the health-related targets of the Sustainable Development Goals which Malaysia has signed on.

Lack of coverage for sexual and reproductive health would cost women and girls their future with negative impacts on UHC and economic growth.

As health is a human right, access to quality sexual and reproductive health services, which includes contraception, should not depend on age, gender, race, financial standing or place of residence.

The contraceptive prevalence rate in Malaysia has stagnated since 1990 and is lower than the rate for all developing countries, with the unmet need for contraception higher than the rate for all developing countries.

The question is whether there are any policies and strategies to reduce the unmet need for contraception in Malaysia in the quest for UHC.

In short, it is always better to make a choice and not take a chance.

Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
The first app to get approved as birth control in Europe has now been green-lit in the US, despite controversy

The first app to get approved as birth control in Europe has now been green-lit in the US, despite controversy

Natural Cycles founders Elina Berglund Raoul Schewitzl

Natural Cycles founders Elina Berglund Raoul Schewitzl
Natural Cycles
  • Birth-control app Natural Cycles has been approved by the US Food and Drug Administration – the first app to be approved for contraception in North America.
  • The app uses an algorithm to tell women when they have the highest and lowest chances of getting pregnant, but it ultimately relies on men and women changing their behavior.
  • The app recently came under fire in Sweden when 37 women reported getting pregnant while using it.

A birth-control app called Natural Cycles has been approved by the US Food and Drug Administration, marking the first time an app has been approved for contraception in North America.

Designed by physicist couple Elina Berglund and Raoul Scherwitzl, the app doesn’t involve a pill and contains no medication. It works by giving heterosexual couples recommendations about when to avoid sex or use protection, based on a woman’s daily temperature measurements and the regularity of her period.

“Consumers are increasingly using digital health technologies to inform their everyday health decisions, and this new app can provide an effective method of contraception if it’s used carefully and correctly,” Terri Cornelison, assistant director for women’s health at the FDA’s Center for Devices, said in a statement. “But women should know that no form of contraception works perfectly, so an unplanned pregnancy could still result from correct usage of this device.”

Natural Cycles only helps prevent pregnancy if people using it behave in the way it prescribes. The app also recently gained regulatory approval in Europe – the first app to do so there as well – but it came under fire in Sweden several months later when 37 women reported getting pregnant while using it.

Those pregnancies ignited a small controversy about how the app works and what it can – and can’t – do. But Scherwitzl told Business Insider in January that he was not surprised women had become pregnant.

“We give red and green days and clear recommendations on which days to abstain and which days we consider the risk of pregnancy to be negligible,” he said.

The problem with saying ‘as effective as the pill using only math’

brooke lark 194254

Unsplash/Brooke Lark

Natural Cycles was initially portrayed by multiple news outlets – including Business Insider – as being “as effective as the pill using only math.”

When is used properly, Natural Cycles may be comparable in effectiveness to the pill. But that doesn’t always happen, as the controversy in Sweden revealed.

So the problem with these types of statements is that the app relies on couples to change their behavior and either not have sex or use protection based on the app’s recommendations.

“Just like with the pill, you have scenarios where women take the pill everyday” and it’s as reliable as possible, Scherwitzl said, and then there are “scenarios where they don’t take it every day” and the reliability decreases.

How Natural Cycles compares with simply using a calendar

natural cycles app

Natural Cycles/Facebook

Natural Cycles’ approach puts it in a larger category of birth control known as fertility awareness, which is similar to the calendar-based approach people have used for decades.

The company’s founders published a study on the app’s effectiveness in the European Journal of Contraception and Reproductive Health Care in 2016. The research involved 4,000 women between the ages of 18 and 45, and the results showed that out of every 100 women who used the app in a “typical” way for a year (meaning certain common slip-ups were accounted for), seven of them got pregnant.

That rate is and significantly lower than the traditional calendar method, which has an average fail rate of 24%, according to the CDC.

The “typical use” scenario for the pill leads to about nine out of 100 women getting pregnant within a year, so the study suggests Natural Cycles is on par with an oral contraceptive. But the app still leads to more pregnancies than would be seen among people using injectable birth control or an IUD. The typical use fail rate for an IUD is 0.2-0.8%, or less than one out of 100 women getting pregnant each year.

Apps can ‘provide encouragement,’ but still have key limitations

As far as the women who got pregnant while using the Natural Cycles app are concerned, the same European study found that more than half of them had unprotected sex with men on the days when the app advised against it. Those instances are evidence of a longstanding human reality: behavioral control is difficult, especially when it comes to sex, and not a guaranteed way to prevent pregnancy.

“While smartphone apps may provide encouragement, they can’t stop [men and women] from … sex altogether,” Susan Walker, a professor of sexual health at Anglia Ruskin University, wrote in an article for The Conversation.

A handful of other factors can also get in the way of the app working correctly, including having multiple sex partners and having a partner who is not equally committed to birth control.

So if you’re planning on using the app – or one of the dozens like it that have not been approved as medical devices – experts say you should have a predictable sex schedule, regular periods, be willing to check your temperature every day, and have the ability to abstain from sexual activity on consecutive days every month.

If you can do all that, the app could work for you.

“In the end, what we want to do is add a new method of contraception that women can choose from without side effects,” Scherwitzl said. “I think there are many women who this will be great for.”

Doctors have warned an emerging STI could become an antibiotic-resistant superbug

Doctors have warned an emerging STI could become an antibiotic-resistant superbug

  • About 2% of the population have an STI called Mycoplasma genitalium.
  • It has similar symptoms to chlamydia, but it is more resistant to antibiotics.
  • Doctors have warned it could become a superbug if not treated properly.

It’s not a great time to be having unprotected sex. Cases of syphilis are on the rise, there’s something called super-gonorrhea going around, and according to BASHH, there’s a new STI you can catch.

What makes it even worse is that doctors have warned the new infection could become a superbug – like MRSA – if it isn’t treated properly.

The bacteria is called Mycoplasma genitalium (MG), and it causes similar symptoms to chlamydia, such as painful urination. It often has no symptoms at all, but if left untreated, it can lead to pelvic inflammatory disease, and ultimately infertility in women.

An estimated 2% of people are infected in the UK, so The British Association of Sexual Health and HIV (BASHH) has released new guidelines about how to treat and diagnose MG.

MG can be treated with a five-day course of antibiotics, but it is increasingly becoming more resistant to different antibiotic drugs. This is made worse by the fact MG is often misdiagnosed, and can go untreated.

“This is not curing the infection and is causing antimicrobial resistance in MG patients,” Paddy Horner, a consultant senior lecturer in sexual health at Bristol University and one of the authors of the new guidelines, told the BBC. “If practices do not change and the tests are not used, MG has the potential to become a superbug within a decade, resistant to standard antibiotics.”

Like any STI, the best way to prevent MG is by using condoms. Even if you have a regular partner, it’s best to get tested at least once a year.

“The new BASHH guideline on MG is a positive step forward to improving testing and diagnosis,” said Helen Fifer, a consultant microbiologist at Public Health England.

“If you have symptoms of an STI, we recommend you get tested at your local sexual health clinic. Everyone can protect themselves from STIs by consistently and correctly using condoms with new and casual partners.”

A new study suggests a popular birth control pill might not cause depression after all — but it’s not that simple

A new study suggests a popular birth control pill might not cause depression after all — but it’s not that simple

Simone van der Koelen / Unsplash
  • A new review of 30 years of research has concluded that progestin contraceptives do not cause depression.
  • This contradicts a large study from Denmark that found women had a 34% increased risk of depression by taking that pill.
  • There is still research to be done in the area, as there are still unanswered questions.
  • The researchers said the aim of the study was to put women’s minds at ease and to tell them to continue using hormonal contraception if it works for them.

The leaflet inside a packet of contraceptive pills lists side effects women might experience, including breast pain, migraines or headaches, stomach problems, and acne. It also says you might experience changes in mood, and depression.

For years women have been telling anecdotes, such as this story in The Debrief, about how they feel their personalities changed after going on the pill. Some of them experience serious mental health problems, which they believe is directly caused by taking hormonal contraception.

The scientific evidence was shaky until 2016 when a massive study of over one million people in Denmark found that women taking the combined pill, which contains oestrogen and progestin (progesterone), were 23% more likely to be diagnosed with depression than women who didn’t take any pills.

Those on progestin-only pills, also called the mini pill, were 34% more likely to be diagnosed with depression.

Women who had suffered from mental health problems, such as Holly Grigg-Spall in the Guardian, felt like their worries about the pill had been validated. There was finally scientific research that backed up what a large proportion of women had been saying all along.

However, as the NHS states on its website, this type of study can provide possible explanations for the use of contraception and the increase in depression, but it cannot say outright that one causes the other. Due to the inability of scientific studies to cover every possible variable, all the researchers can conclude is that it is possible.

A new study, published in the journal Contraception, complicates things even further. It is an analysis of 26 studies over 30 years of research, and the conclusion is that progestin pills aren’t linked to women developing depression at any age.

“Depression is a concern for a lot of women when they’re starting hormonal contraception, particularly when they’re using specific types that have progesterone,” said Brett Worly, an obstetrician-gynecologist at Ohio State Wexner Medical Center and lead author of the study, in a statement. “Based on our findings, this side effect shouldn’t be a concern for most women, and they should feel comfortable knowing they’re making a safe choice.”

Even for women at high risk, such as those already diagnosed with depression, there was no evidence being on progestin pills made them worse.

“Adolescents and pregnant moms will sometimes have a higher risk of depression, not necessarily because of the medicine they’re taking, but because they have that risk to start with,” Worly said. “For those patients, it’s important that they have a good relationship with their health care provider so they can get the appropriate screening done – regardless of the medications they’re on.”

The new study looked at large areas and included women with varying access to healthcare. The researchers believe this makes their findings more widely reliable than the Danish study.

However, none of the papers in the review were randomly controlled trials – meaning participants probably knew what they were taking. This can cause biases and women reporting incorrect symptoms, particularly if they had read a lot about hormonal contraception before. There were a few papers in the review that found a link between progestin and depression, but the evidence wasn’t strong enough to influence the final conclusion.

Worly admits this shouldn’t be the end of the conversation on contraception. He said patients have valid concerns about their mental health, and they should continue to talk to their doctors about the best option for them.

Ultimately, the aim of the research was to put women’s minds at ease, and to say that progestin pills are an effective and safe form of contraception for many people – so keep using them.

“We live in a media-savvy age where if one or a few people have severe side effects, all of a sudden, that gets amplified to every single person,” Worly said. “The biggest misconception is that birth control leads to depression. For most patients that’s just not the case.”

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