To some, even talking about it is a bitter "pill" to swallow, to others, the pill is a necessary evil that could prevent greater wrong doing but whatever one's stand on this, possessing a clear knowledge about this is vital for one to make an informed decision whether to take it or not.

Global Survey on Contraceptives

A global survey was conducted in almost 4,000 youths aged 15 to 24, in 18 countries encompassing the United States, Latin America, Europe and Asia Pacific. The respondents were interviewed online via a 15 minute questionnaire. Some of the findings are reported below:

• Close to one-third of the Asia Pacific interviewees feel that they are familiar with contraception options. The youth in Asia Pacific lag behind their American and European counterparts, where about 1 in every 2 claimed to be well informed of contraceptive options.
• On an average, the Asia Pacific respondents are aware of only three contraceptive methods. In comparison, youth from around the globe are aware of four contraceptive methods.
• Asia Pacific youth have indicated that the following methods are effective in preventing unplanned pregnancies:

o Condom (95%)

o The Pill (79%)

o Withdrawal (36%)

o Sex during menses (18%)

• There is a gap between the sources that the youth trust and the sources that they are most comfortable talking to with regards to contraception.

o Youth trust the advice from the following sources on contraception information:

            Doctor (63%)

            Mother (31%)

            Teacher (20%)

o However, youth feel most comfortable discussing contraception with:

            Partner (64%)

            Doctor (55%)

            Friends (50%)

o While 64% of the respondents feel most comfortable discussing contraception with their partners, only 13% of them trust the information provided by their partners.

• The respondents highlighted that the following measures will help them feel more comfortable talking about contraception:

o Better sex education in school (62%)

o Having someone they can chat with in confidence (53%)

o A change in cultural attitudes (44%)

o Access to more educational reading material (41%)

• Close to one third (30%) of the respondents know of someone close who has had an unplanned pregnancy in the recent years.

Contraception in Malaysia

In Malaysia, respondents of the online survey were aged 18-21 years. Highlights of the survey are as follows:

• Over 1 in 2 (56%) young people were not familiar with or confused about the different contraception methods available.
• Nearly 60% either did not talk about contraception or found it difficult to talk about it with their partner before they had sex for the first time.
• Around 20% have had sex with a new partner without using contraception.
• One out of 3 did not use any contraception because they did not have a contraceptive method available at the time.
• More than 20% females did not use contraception because they do not like using contraception and another over 20% females didn't use because their partner prefers not to use contraception.
• 24% of males did not use contraception because they are not at risk of pregnancy.
• 91% of young Malaysians think that condom is an effective contraceptive method.
• 69% think that oral contraceptive pill is effective in preventing pregnancy, compared to 89% of young people in Australia, where oral contraceptive pills were first introduced.
• The perceptions on trusted sources on information as well as barriers to broaching the subject with these individuals mirrored sentiments of the region. As a result, one in 5 young people in Malaysia has asked someone online for advice on contraception, higher than other countries in Asia Pacific like Australia, China, Singapore, and South Korea, which were included in the survey.
• To help increase the comfort level with the subject, 59% of young people would like someone they can consult in confidence, 57% would like better sex education in school, and 50% access to more educational reading material.

A Brief History of Oral Contraceptives

In 1950, Maragaret Sanger, founder of the American Planned Parenthood Federation, convinced biochemist Gregory Pincus of the necessity of a hormonal contraceptive. With Katherine McCormick providing financial backing, research began. Six years later, Prof Dr Gregory Pincus, his colleague, Dr Min Chuh Chang, and Dr John Rock, gynaecologist from Harvard, conducted the first trials with 60 female volunteers. In the same year, Pincus successfully carried out the first large trial with 6,000 participants in Puerto Rico and Haiti. 1n 1960, the first contraceptive pill was introduced in the United States.

What are Oral Contraceptives?

The Pill is one of the many birth control options available today. The Pill is a reversible, highly effective prescription method of birth control. It is a monthly series of pills that is taken orally.

There are mainly two types of oral contraceptive pills (OCPs):

• Combination pill - contains two female hormones (oestrogen and progestin).
• Progestin-only pill (POP) - contains only progestin.

Apart from pregnancy prevention, the latest 24/4 regimen oral contraceptive pill offer women a wide range of additional health benefits such as treatment of moderate acne, treatment of symptoms of premenstrual dysphoric disorder (PMDD) - which is a severe form of premenstrual syndrome (PMS), and regulating menstrual cycles.

Many women differ in their response to oral contraceptives depending upon their menses type (light flow, moderate flow, heavy flow), their body type (underweight, normal weight, overweight) and their ovarian hormone sensitivity (oestrogen-sensitive, androgen-sensitive, progesterone-sensitive).

When choosing an oral contraceptive, consult with your doctor to find one that's tailored to meet your individual needs.

How Does the Pill Work?

• Oral contraceptives employ synthetic hormones that mimic the properties of natural estrogens and/or progesterone to 'fool' the female reproductive system. They provide constant levels of an oestrogen and/or progestin in the blood, thus suppressing the release of two hormones that will trigger the process of ovulation.
• In addition to the inhibition of ovulation, the constant level of an oestrogen and progestin in the body causes insufficient thickening of the endometrium, which prevents attachment of the egg.
• Progestins also promote production of thick, opaque mucus, which acts as a barrier to sperm, as sperm can only pass through clear, thin mucus.
• Progestin is also thought to produce changes in the fallopian tubes that impede movement of the egg toward the uterus.
• Oestrogen and progestin may also alter the pattern of muscle contractions in the tubes and uterus. This effect may interfere with implantation.

Statistics Related to the Pill

• About 100 million women worldwide use combination oral contraceptives (COCs).
• COCs are packaged with either 21 or 24/4 pills per pack. The 21-pill pack contains only active pills and requires women to take a 7-day break between packs. The 24/4-pill pack contains 24 active pills and 4 inactive pills. These inactive pills are included to minimize the risk of women forgetting to start a new pack of pills on time after a 4-day break. The 7-day or 4-day period, when no active pills are taken, is called the 'hormone-free interval'4.
• Used properly, COCs have 99% success rate and is one of the most effective reversible forms of birth control available to women today3.
• Nine out of every 10 contraceptive users in the world rely on modern methods. In developed countries, short-acting and reversible methods including the Pill are more commonly used compared to other methods, whereas longer-acting and highly effective clinical methods such as female sterilisation or the IUD are used more frequently in the developing countries.