The best birth control – IUDs, implants or condoms? In Hong Kong 80 per cent of couples rely on man using condoms, even though doctors say alternatives better
- Hong Kong has the second highest prevalence of male condom use behind only Japan
- Women are more receptive to other, more effective contraceptive types once they have had a proper consultation with a doctor
We’ve been spending a lot more time at home, but it’s unlikely to result in a coronavirus baby boom. As concerns about employment and the economy grow, couples are delaying expanding their families and as a result, many are exploring their contraceptive options.
A 2019 report by the United Nations Department of Economic and Social Affairs that examined contraceptive methods in 195 countries found Hong Kong has the second highest prevalence of male condom use (32 per cent), behind only Japan (35 per cent).
Why are condoms so popular? Lo says it’s because they’re inexpensive, easy to obtain and have no side-effects, unlike the pill and IUDs, which can be expensive and require a trip to the doctor.
Dr Joyce Lai, a general practitioner at a clinic in Central, Hong Kong, says that the condom – or “barrier method” – is popular because it requires no medical intervention. “A lot of my patients just don’t like the concept of medication – it’s as simple as that,” she says.
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A 2016 study published in the Hong Kong Medical Journal that examined attitudes to the pill among Hong Kong women found fear of side-effects was the major reason cited by women who had stopped taking or had never tried the pill.
Interestingly, the researchers also found a lack of access to consultation services can exacerbate women’s concerns about side-effects. There is no evidence that the pill – which is available over the counter – causes weight gain, and there’s very low risk of serious side-effects such as blood clots or cervical cancer.
Research also shows that long acting reversible contraceptives (Larcs) – that is, IUDs and implants – are a lot more popular when women receive thorough contraceptive counselling. In the Contraceptive Choice Project, a landmark US study of more than 9,000 women that provided free contraception and counselling to women aged 14 to 45, 67 per cent of participants chose Larcs and only 9 per cent chose the pill.
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Larcs are supported by health professionals because they are the most effective form of contraception. They are more than 99 per cent effective at preventing pregnancy, compared to 91 per cent for the pill – and 82 per cent for male condoms. Because Larcs are inserted by a medical professional, there’s no risk of user failure. They can be used by women who have given birth as well as those who haven’t.
“I do promote inserting an IUD, especially among women who’ve had difficulty with compliance, either by the male partner, or they travel frequently and taking a pill can be difficult,” says Lai.
It might sound like having an IUD inserted can be uncomfortable, but for Sarah, who prefers not to use her real name, the process was quick and painless. “I’d built myself up because I was so worried about it, but my doctor was talking to me and I didn’t even notice it was happening,” she says. “The whole thing was over so quickly.”
“For me, it’s better than being on a contraceptive pill,” she says. “I’ve had it for two years, and in three years’ time I think I’ll be quite happy to have another one.”
But that’s not to say every couple should ditch condoms in favour of an IUD or the pill, says Lai. “It’s so personal and there’s no one method that’s better than another,” she says. “It’s really important for people to do their research and have counselling to understand which form of contraception is most appropriate for them to use.”
Comparing 6 contraceptives
Implant
- The most effective and reliable method available (greater than 99 per cent)
- A soft piece of plastic that’s inserted under the skin of the arm, containing a hormone (a progestogen) similar to a progesterone – a woman’s hormone
- Lasts for three years, but can be removed at any time
IUS (intrauterine system) or hormone coil
- Greater than 99 per cent effectiveness
- Has very low levels of hormone and is used to treat heavy, painful periods
- A doctor or nurse inserts the device into the womb and it lasts up to five years
IUD or copper coil
- Greater than 99 per cent effectiveness
- Made of plastic and copper, contains no hormones, and may make periods heavier
- Put into the womb by a doctor or nurse, and lasts five to 10 years
Patch
- About 92 per cent effectiveness
- A square, sticker-like, thin plaster enables skin to absorb oestrogen and progestogen
- The patch is changed once a week
The Ring
- About 91 per cent effectiveness
- A soft plastic ring inserted into the vagina, it releases oestrogen and progestogen
- The ring is changed every three weeks, with a week off
Diaphragm or cervical cap
- About 84 per cent effectiveness
- Made of silicone, placed at the top of the vagina, to cover the neck of the womb
- Used with spermicide (a cream that kills sperm). It must be correctly positioned before sex
