This World Contraception Day, Marie Stopes International Cambodia urges donors, partners and the global community to ensure women have continued access to contraception throughout the COVID-19 global pandemic.
Currently, across the globe, there are 214 million women with an unmet need for contraception and this is only increasing. During COVID-19, an estimated of 1.4 million women globally lost access to its family planning services alone.
In Cambodia the global pandemic has lead to loss of employment; the hardest hit sectors including tourism, manufacturing exports, and construction. 12 percent of garment and footwear factories, where most employees are women, have halted operations since mid-April 2020 affecting close to 100,000 workers. The return of many of these women to rural provinces may put them out of reach of, or unable to afford, essential contraception services.
For younger women, accessing contraceptive advice and services can be especially challenging. As a result, large numbers of young women do not have the information they need about sex and how to prevent a pregnancy. 12.3% of pregnancies among 15-24 years old are unintended. Access to non-judgmental youth friendly contraceptive information and services is essential to meet the needs of these groups.
Family planning changes lives, giving every woman the freedom to choose her own future. Improving access would result in millions more girls being able to complete their education, enter the workforce, and having the power to make decisions about their own lives and futures.
Call to action
Marie Stopes International Cambodia is therefore urging local health authorities, donors and health sector partners to work together to maintain or increase their current support for access to sexual and reproductive healthcare services and to prioritise this in their COVID-19 responses, to ensure women and girls have timely access to essential services when needed most.
Amy Williamson, MSIC Country Director, said,
“It is so important for information on contraception and proper reproductive health counselling to be accessible by all those who need it – and it costs only around 3 cents per day to protect a young woman from an unintended pregnancy for one year, giving her the chance to finish her education or even saving her life.”
As providers of family planning services, clients usually relay to us their misconceptions about modern contraceptive methods, namely IUDs (intrauterine devices) and implants. Hence, this time, this particular blog aims to shut down all the misinformation about IUDs and implants and to state the great importance of IUDs and implants. In fact, LARCs (Long-acting reversible contraceptives) are recognized by WHO (World Health Organization) as the most efficient methods to prevent unwanted pregnancy.
What are LARCs (Long-acting reversible contraceptives)?
Just like the name suggests, LARCs are methods of contraception that can be removed and lasts for a long time. They consist of IUDs (Intrauterine devices) and implants. Depending on the brand, IUDs can last up to 10 years and implants usually lasts for 3 to 5 years.
Debunking myths about LARCs
The reality is 12.5% of women in 2012 expressed an unmet need for contraception (CDHS, 2014). Even though modern contraceptive methods have become more widely used in recent years, LARCs remain lower than short-term contraceptive methods such as pills or injectables. On the other hand, women’s access to highly effective LARCs are still limited. A 2015 UNFPA review of sexual reproductive health of young people in Asia and the Pacific mentioned myths and misconception about modern contraceptive methods contribute to the preference of traditional contraceptive over modern contraceptive (UNFPA,2015).
IUDs do not cause abortion: These small devices do not terminate pregnancy. Their mechanism of action is to prevent a fertilization from happening because copper induce the production of some substances in the body that is toxic to sperm and ova. They DO NOT have the ability to abort a fetus.
IUDs do not cause infertility: There have been numerous researches done that show that there was no causative correlation between infertility and IUDs. Two studies showed that there were no significant differences in pregnancy rates between women who reported use of IUDS and women who had never had IUDs:
A 2001 study of women seeking treatment for primary infertility without tubal occlusion, women seeking treatment for primary infertility with tubal occlusion, and primigravida pregnant women.
Another one is a prospective cohort IUD study in Norway, women who had their copper IUDs removed to become pregnant versus those who had them removed for complications had no difference in pregnancy rates. 
Pain with LARCs: Contrary to popular beliefs, having an IUDs placed isn’t excruciatingly painful. There’s only a little cramping or low-level pain when the IUD is being put, but the pain/cramping continues to decrease after you put them in and women usually feel fine afterwards. They are not crippling pain that cause any kind of significant discomfort. On the other hand, studies have actually reported Mirena (IUDs) and Implanon (Implants) being an effective management for pain in women with Endometriosis.
IUDs and Implants do not cause cancer: In fact, studies have suggested that copper and hormone-containing IUDs may have a protective effect against endometrial cancer and cervical cancer.
Why they are the most efficient at preventing pregnancy?
The sexually active population, especially the younger sexually active population are mostly ignorant about the choices that they have in regards to contraception. With over 50 percent of the population being under the age of 24 and the age of sexually active people gets younger and younger, addressing the need for the best contraception methods is vital.
Long-acting reversible contraceptives are important in that regard because they are cost-effective in the long run versus having to buy oral contraceptives or getting injectables every month. They also have a high pregnancy protection rate than any other contraception method and lower risk of discontinuation since they do not have to take pills regularly or remember to get injections.
If you are worried about confidentiality, you can get IUDs and implants at Marie Stopes International Clinics all over Cambodia with an affordable price and comprehensive counselling. If you’re interested, you may try our online counselling service that advises you on the best contraceptive for you right now: http://app.mariestopes.org.kh/en/
Watch this video to know more about IUD: https://www.facebook.com/watch/?v=716250388934314
If you have any questions about LARCs such as implants, IUDs or any other contraception methods, consult with @MarieStopesKH now: ✓ Send a Facebook message ✓ Every day from 7 am to 5 pm ✓ 012 999 002 or 098 999 102 ✓ Send a message via LINE, Viber, WhatsApp, WeChat 093 24 08 23 ✓ www.mariestopes.org.kh/contactus
Cambodia: identifying actions for scaling up long-acting reversible contraceptives. World Health Organization Regional Office for the Western Pacific; 2017. License: CC BY-NC-SA 3.0 IGO.
Bajracharya, A., Veasnakiry, L., Rathavy, T., & Bellows, B. (2016). Increasing Uptake of Long-Acting Reversible Contraceptives in Cambodia Through a Voucher Program: Evidence from a Difference-in-Differences Analysis. Global Health: Science and Practice, 4(Supplement 2), S109-S121. doi: 10.9745/ghsp-d-16-00083
Russo, J., Miller, E., & Gold, M. (2013). Myths and Misconceptions About Long-Acting Reversible Contraception (LARC). Journal of Adolescent Health, 52(4), S14-S21. doi: 10.1016/j.jadohealth.2013.02.003
Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. New Engl J Med 2001; 345:561e7
Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility –Follow-up after participation in a randomized clinical trial. Contraception 2007; 75:88e92
When people talk about birth control methods, one of the most well-know amongst them is a hormonal contraception method known as oral contraceptive pills. A comprehensive study on women who use modern contraceptive by the Ministry of Health in 2010 found that, the pill was the most popular among all the modern contraceptive methods. However, some women are still unsure about how to correctly use the pill and when they should take them. We will guide you through some simple steps on how to take the pills correctly and prevent unwanted pregnancy.
There are two main types of oral contraceptive pills: combination pills which contains both estrogen and progesterone, and the other one is progestin-only pills which only contains progesterone.
In this blog post, we will be focusing on the more popular type of OCPs (oral contraceptive pills) in Cambodia, which is the combination pills.
How to take OCPs
Most combination pills come in a 28-day pack or a 21-day pack. When you buy oral contraceptives, they generally have instructions on the package on how you should take them, but they usually follow the following instructions.
For a 28-day pack, you usually have to take them for 28 days straight without a break. There are 21 active pills and 7 inactive or reminder pills. You must start another pack right away on day 29. Therefore, you have to buy them before you run out! Take care to know that you might bleed when you’re taking these reminder pills, but no worries, you’ll still be protected from unwanted pregnancy while you are taking reminder pills. Microgynon ED is a 28-day pack OCPs that is currently available for purchase in Cambodia.
For a 21-day pack, there are 21 pills in them. You have to take them for 21 days straight, then no pills are taken for the next 7 days in the 28-day menstrual cycle. Women usually bleed during those 7 days, but you won’t get pregnant during those bleeding days if you have sexual intercourse. Start another pack right away after having taken no pills for 7 days in order to stay protected against pregnancy. These are the most common types of pills. Yasmin is a 21-day pack oral contraceptive pills.
Where to buy them
Pharmacies usually charge a slightly higher price for contraceptive pills than organizations like Marie Stopes. You can get birth control pills like OK, Diane, and Yasmin, Floris 35, and Desolon at Marie Stopes International Clinics at an affordable price.
If you have any questions about oral contraceptive pills or any other kind of contraceptive methods, consult with @MarieStopesKH now: ✓ Send a Facebook message ✓ Every day from 7 am to 5 pm ✓ 012 999 002 or 098 999 102 ✓ Send a message via LINE, Viber, WhatsApp, WeChat 093 24 08 23 ✓ www.mariestopes.org.kh/contactus
We have discussed some interesting things so far involving a wide range of topic from post-partum menstruation to how to discuss with your partner about abortion.
Today we’ll be exploring another important topic. In contraception talk, we will be focusing on one of the first techniques of family planning known as The Withdrawal Method.
Weighing the benefits and failures
So, what is the withdrawal method? It’s the act of withdrawal of the penis before ejaculation as to prevent the sperm in the semen from entering the vaginal lumen.
Today, although this traditional method of contraception is still widely used with 5% of users worldwide, it’s nothing compared to female sterilization (24%) and male condom (21%).
However, the trend in Cambodia looks a little different compared to world statistics. In 2014, Cambodia DHS conducted a survey on contraception use in Cambodia. The survey found that withdrawal was the second most used contraception method (27.9%) only being beaten by oral contraceptives (31.9%). This means that a lot of people still prefer this traditional contraception method to others, which is why it is important for sexual partners to understand what choices are available to them and whether this method is what’s best for them.
Let’s start by talking about the good. Naturally, the withdrawal method has virtually zero ill effects on health since it is only reliant upon the withdrawal of the penis from the vaginal lumen before ejaculation. Compared to other methods of contraception, it’s true that they incur relatively lower risks. However, this method does not prevent against STIs like condom does.
The downside to the withdrawal method is that the pregnancy prevention rate is lower than other non-traditional methods. The success rate is only about 78%. For one, pre-cum or the pre-ejaculate might contain sperm that is viable to impregnate. Secondly, even if the semen lands on the vulva, it’s not impossible for the sperm to swim to the vaginal opening. Last but not least, you need a lot of self-control to withdraw the penis on time.
What emergency contraception options are available?
There are two notable emergency contraception methods that you can get when the withdrawal method fails, or when other contraceptive methods fall short (e.g. condom breaking…, etc.).
Emergency contraceptive pills are oral contraceptives with a slightly higher dose of hormone that can be used within 120 hours (5 days) or 72 hours (3 days) depending on the brand of the ECPs. It’s important to note that the earlier you take the ECPs, the more effective it will be. However, it’s recommended that you only use ECPs sporadically and not as the main contraceptive method if you’re sexually active.
Copper IUD is not well known in Cambodia as an emergency contraception option, but it’s important to know that it is, by far, the best emergency contraception method there is. It can prevent pregnancy up to 99.9% if they are placed within 5 days of unprotected intercourse. An important point to note is, if you are sexually active, this is the better contraception method than ECPs.
Destroying myths about ECPs
There are many odd things that were said about ECPs and contraception methods in general. The most popular one was that ECPs will cause infertility in women – This is absolutely UNTRUE. They also do not cause birth defects. The true function of ECPs is to delay ovulation, they do not cause abortion or disrupt an existing pregnancy.
You must be aware that you have to take ECPs after every sexual intercourse in order to prevent pregnancy, their effect is to delay ovulation after intercourse, you cannot use them to prevent FUTURE sexual acts. To simply put it, they are not effective if taken before sex. This is why long-term contraception method is recommended, rather than taking ECPs every time you have intercourse. Although, it must be noted that it is completely safe for you to take ECPs frequently, even during the same menstrual cycle.
However, they do come with some side effects such as slight bleeding, irregular period, abdominal pain, nausea, or dizziness. But the side effects are not harmful and generally resolve within 24 hours.
If you wish to purchase emergency contraceptive pills outside of pharmacies or you wish to get copper IUD, you can get these services with confidentiality at Marie Stopes clinics all over the country.
If you have any questions about the withdrawal method, emergency contraception and other contraceptive methods, consult with @MarieStopesKH now: ✓ Send a Facebook message ✓ Every day from 7 am to 5 pm ✓ 012 999 002 or 098 999 102 ✓ Send a message via LINE, Viber, WhatsApp, WeChat 093 24 08 23 ✓ www.mariestopes.org.kh/contactus
New parents can be quite anxious when it comes to pregnancy
Before birth, parents worry about whether their children
will come out okay – whether mothers can hold out well during the strenuous delivery;
and then, AFTER birth, parents worry about little things like, why isn’t my
milk coming? why does my milk taste weird (yes, they sometimes do ask that)?
and one of those questions is: why don’t I menstruate even after childbirth?
Marie Stopes got you covered!
Little did you know, these little things MOST of the time
are attributed to normal physiological function of your body post-partum.
Why am I not menstruating after childbirth?
Menstruation is a phenomenon that suggests you can ovulate.
Ovulating, in most cases, means that you will be able to conceive a child. While
you have that little bundle of joy in your womb, your baby is actually sleeping
in a sac that grows from your endometrium. Your placenta keeps secreting progesterone,
which suppresses ovulation.
After child birth, some of that progesterone persists for
some time, and your endometrium needs time to regenerate and heal. In women who
breastfeed, the hormone Prolactin suppresses the ovulation. I know this is hard
to understand; hence, this is all you need to remember: your period will
definitely come back if you have a normal pregnancy and no other existing conditions!
When will it return?
Mothers who do not breastfeed will have their period return
to normal in 6 weeks. Ovulation generally occurs before your period, which usually
comes back on the 40th day post-partum. Mothers who breastfeed in
most cases have their period much later than non-breastfeeding mothers. It can
vary from 3-6 months to 9 months, depends on how regular you breastfeed. Since
ovulation can start again at any given moment, you will be able conceive again
very soon after your pregnancy, which is not a very healthy option.
The same goes for women who have just had an abortion or
miscarriage. Please take care to know that even though you did not carry your
pregnancy to term, you can still get pregnant again very easily, and using contraception
as soon as you can after your pregnancy will decrease the risk immensely.
Why is having short-spaced pregnancy unhealthy?
Babies who are conceived again less than 12 months after the
mother’s previous pregnancy has an increased risk of preterm birth, low birth
weight, still birth, and neonatal death. Therefore, mothers should wait at
least 12 months before trying for another pregnancy. This does not mean that
you can’t engage in sexual intercourse.
What you should do is use contraception, and use it promptly
MARIE STOPES! CAN YOU RECOMMEND A CONTRACEPTIVE METHOD?
Many of you might have had negative thoughts about using
certain contraceptive methods right after child birth.
For a lot of reasons, combined hormonal pills are not recommended
for women who have just had their birth less than the period of 21 days. During
those 21 days after childbirth, women have an increased risk of thromboembolism.
The best and safest methods are long term contraceptive methods,
such as IUD and implant. They can be put immediately after childbirth, or
within the recommended period of 21 days, and you can be protected from a
potential unhealthy pregnancy.
So, do not despair, your period will definitely come back. And
if you want to have another healthy pregnancy and baby, it is in your favor to
wait using safe and reliable contraceptive methods. After all, patience is
Jackson, E., & Glasier, A. (2011). Return of
Ovulation and Menses in Postpartum Nonlactating Women. Obstetrics & Gynecology, 117(3), 657–662. doi: 10.1097/aog.0b013e31820ce18c
FSRH Guidline: Contraception After Pregnancy (January
If you have any questions about menstruation, sexual
health or contraception, consult with @MarieStopesKH now:
✓ Send a Facebook message
✓ Every day from 7 am to 5 pm
✓ 012 999 002 or 098 999 102
✓ Send a message via LINE,
Viber, WhatsApp, WeChat 093 24 08 23
Marie Stopes International Cambodia worked with public sector providers to bring high quality services on sexual and reproductive health.
Under the Partnering to Save Lives (PSL) project, Marie Stopes aimed to strengthen quality services – including contraception and safe abortion, through clinical improvement and support to public providers by providing:
The PSL project worked with frontline health service providers and a range of other partners in the provinces. The work of PSL aimed to increase demand and reduce barriers to access to health care, and quality of health care services with particular attention to most vulnerable groups including impoverished women, ethnic communities, garment factory workers and women with disabilities. Since its start in August 2013, PSL has supported all seven components of the MoH’s 2016-2020 Fast Track Initiative Road Map to Reduce Maternal and Newborn Mortality (FTIRM): emergency obstetric and newborn care, skilled birth attendance, newborn care, family planning, safe abortion (through training and quality improvement), behaviour change communication, and removing financial barriers.
To save the lives of women and newborn children in Cambodia by improving quality, access and utilisation of reproductive, maternal and neonatal health (RMNH) services through a partnership approach in line with the objectives of the Ministry of Health’s revised Fast Track Initiative Roadmap for Reducing Maternal and Newborn Mortality 2016 to 2020.
Under PSL, Marie Stopes focused on provision of services in the under-served northeast (NE) provinces of Kratie, Mondul Kiri, Ratanak Kiri and Stung Treng and supported capacity development for family planning services and safe abortion in an additional 19 provinces across the country. Marie Stopes also worked to improve access to RMNH information and services for vulnerable young women working in 13 garment factories in Phnom Penh and Kandal activities included:
Comprehensive abortion care (CAC) training, and quality improvement processes in 13 provinces
Long term-family planning (implant and IUD) and permanent methods (Vasectomy and tubal ligation) services through training and quality improvement processes in 20 provinces
Providing capacity building to midwives via the Midwifery Coordination Alliance Teams (MCATs). Watch video.
Quality improvement in garment factory infirmaries in Phnom Penh and Kandal through training and coaching for service providers, quality assessments and action plans for improvement.
Engagement with service providers and factory managers to procure equipment and supplies and improve clinical spaces. Watch video.
Strengthened referral systems via the referral directory containing details of RMNH service providers, locations and price lists
Improved linkages with local authorities and stakeholders
Supported reducing financial barriers to access health services by implementing financial schemes that meet the varying health service needs of the target population
Developed training curriculum and materials and Information Education and Communication
Developed a program-wide learning agenda, supporting evidence based research
Partnering to Save Lives (PSL) is a partnership between the Cambodian Ministry of Health (MoH), the Australian Government, CARE, Marie Stopes International Cambodia and Save the Children.
PSL aims to save the lives of women and newborns in Cambodia through improved quality, access and utilisation of reproductive, maternal and neonatal health (RMNH) services, with particular attention to most vulnerable groups including impoverished women, ethnic communities, garment factory workers and women with disabilities.