Daily or monthly? Choosing contraceptive pills in Cambodia

Is the Chinese monthly pill a popular form of contraception in Cambodia?  What are its side effects?  The Royal University of Phnom Penh and Marie Stopes International carried out a study of women using the pill and the drug sellers who provide it in a rural part of Prey Veng province to discover their attitudes to the pill, which is not sanctioned by the Cambodian government.  Information was gathered from three groups of women who use either the daily or the monthly pill and from one group of drug sellers.  The study found women chose the monthly pill despite its possible side effects because it was convenient and reliable.

Cambodia has had three decades of civil war and until the 1990s its policies were pro-birth.  Maternal mortality is high; nine out of every 1 000 women die in childbirth.  90 per cent of births take place at home and abortion, while allowed, is unsafe.  The monthly pill is a single pill which, after the first two doses, is taken once a month.  It contains a much higher dosage of progesterone and oestrogen than a whole packet of combined pills and the only country to have approved its use is China.  Abortion is recommended for pregnancies conceived while on this pill.  However it has become increasingly popular in Laos and Cambodia.

Cambodian women have not in the past felt happy about using hormonal contraceptives.  They believe a strong regular flow of blood is essential for good health.  However the demand for birth spacing and the belief that hormonal methods are reliable are overcoming initial fears.  Now, up to 20 per cent of women are using modern methods of family planning.  The injectable contraceptive Depo Provera is the most commonly reported method.

The study found that:

• women preferred the monthly pill to the daily pill, saying it was easier to remember to take a pill just once a month
• only a few knew that the pill should be taken on the same date each month. Most took the pill too frequently (every 15-20 days)
• none of the drug sellers knew how to administer the pill correctly
• side effects were similar to those experienced by users of the daily pill, such as dizziness and headaches
• some women said that taking the pill while breast feeding caused breast growth in their babies and signs of menstruation in female babies. These side effects stopped when the mother stopped taking the pill

Despite the side effects, women are prepared to use the monthly contraceptive pill because they believe it works, it is convenient and readily available in local drug stores.  The report recommends that:

• women who are breastfeeding should be encouraged to used alternative methods of contraception
• information (currently in Chinese) on how to take the pills must be improved
• drug sellers should be able to instruct women clearly how to use the pill and to advise them about the possible side effects
• drug sellers should work closely with health centres and refer women who have problems caused by the contraception.

Source(s):
‘User perceptions of the monthly (Chinese) pill in Cambodia’, Marie Stopes International working paper two, by S. Siskhom and C. Chantha, February 2002 Full document.

Funded by: United Nations Population Fund

id21 Research Highlight: 2 June 2003

Further Information:
Marie Stopes International
153-157 Cleveland Street
London 
W1T 6QW
UK

Tel: 44 (0)20 7574 7400
Fax: 44 (0)20 7574 7417
Contact the contributor: msi@stopes.org.uk

Marie Stopes International

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