Various methods of contraception: The truth about unplanned pregnancy

People in society often view “unplanned pregnancy” as something that shouldn’t happen. Why don’t they know how to use contraception? Because it’s not difficult to use, it should focus more on prevention when having sex. Solving the problem with abortion is not something to support. But this issue is like a two-sided coin because women who can’t have an abortion and can’t raise a child end up abandoning the child, which is always present in society. What are the reasons behind their actions? What causes ineffective prevention or lack of prevention?

On November 15, the RSA volunteer medical network reported finding a baby’s body in a box in front of a rental house in Nakhon Ratchasima province. A letter was attached in the box, stating that they couldn’t afford to raise the child. It is believed the baby suffocated and died. In such cases, would it have been better to have an abortion in the first 1-2 months of an unplanned pregnancy?

On November 6, in Chatuchak district, Bangkok, a newborn was found abandoned in front of a house in an alley, wrapped in a black T-shirt and covered with a gray-red sweater. The baby was in good health.

On October 19, in Pluak Daeng district, Rayong province, a baby was found in a bag left beside a garbage pit. Villagers found the baby, and it was safe.

On October 8, in Sam Khok district, Pathum Thani province, construction workers found a baby wet from the rain, abandoned and left crying. Police suspect a teenager with an unplanned pregnancy secretly gave birth in the workers’ bathroom. The baby was taken to the hospital and was safe.

However, in 2015, a study report titled “Abandoned Children: A Problem Society Must Heal” by Nitcha Buranasingh stated that the main reason for child abandonment is the lack of readiness to raise a child due to misunderstandings about family life, financial status, the need to continue education, and unwanted pregnancies. Family problems such as violence, divorce, and disabled children also contribute. The impact of child abandonment creates a burden on society to care for them and affects the children, leading to delayed development and low self-esteem, resulting in inappropriate behavior.

Uncle Doctor will tell the truth about contraception that leads to “surprise” pregnancies.
Uncle Doctor calls it “Preventive Practice Models” as follows:

1. Carelessness A 19-year-old student and her same-age boyfriend have sex without much contraception because they think that since they have regular periods, they won’t get pregnant easily. It turns out she is 21 weeks pregnant.
2. Fearful and Hesitant A 20-year-old student experiences pain when her boyfriend wears a condom, so he ejaculates outside. Sometimes he accidentally ejaculates inside, and sometimes the condom breaks, so she takes an emergency contraceptive pill 12 hours apart. The result is pregnancy.
3. Negligence Due to Intoxication An 8-week and 3-day pregnant student has a 65-year-old boyfriend but accidentally has sex with another man. She says, “I was drunk, and he was too, so we didn’t use protection.”
4. Taking Two Types of Birth Control Pills A 20-year-old woman with one child is 5 weeks pregnant with a new boyfriend and then breaks up. She uses emergency contraception followed by monthly birth control pills.
5. Inconsistent Pill Use A 19-year-old student becomes pregnant due to inconsistent monthly pill use, taking it for one month and stopping for two. She says the pharmacy advised that continuous use is not good for health and that one pack can cover 1-2 months. During the break, she had unprotected sex or used withdrawal.
6. Fear of Birth Control Affecting the Child A 22-year-old woman is 6 weeks pregnant. Her boyfriend believes that both monthly and emergency birth control pills have negative effects on having children, based on internet information suggesting infertility or unhealthy children, causing internal problems. So, they use withdrawal.
7. Second Withdrawal Failure A 19-year-old woman married to a 45-year-old husband believes that her age and the possibility of her having another man in the future make her husband reluctant to let her take birth control pills due to fear of infertility. They use withdrawal for a year, confident in its effectiveness. After the second intercourse, she is now 11 weeks pregnant.
8. Fear of Condoms Causing Cervical Cancer A 25-year-old student has been with her boyfriend for 3 months. She has been sexually active since 18, always using condoms and never getting pregnant. She read an article suggesting that condoms cause cervical cancer, leading her to question if it contributes to the high cervical cancer rates today. So, she lets her boyfriend use withdrawal, resulting in pregnancy.
9. Never Forgetting to Take Birth Control A 43-year-old woman has been taking birth control every night since getting married a year ago, following the pill pack order. She believes she never forgets and never stops taking it. Now, with a new foreign boyfriend aged 65, she is 12 weeks and 6 days pregnant.
10. Long-Distance Relationship A 33-year-old woman is 9 weeks and 3 days pregnant because she didn’t use contraception. She had an ovarian cyst surgery years ago, and her boyfriend works in another province, visiting infrequently, so she thought pregnancy was unlikely.
11. Forgot to Take Birth Control for 2 Days A 31-year-old woman is 6 weeks pregnant. She is afraid of injections and needles and heard that one must have a child before getting birth control injections. She went to another province without her pills, missing 2 days, which was over 10 days after her period. She had unprotected sex with her boyfriend once, took emergency contraception the next morning, but still got pregnant. She is surprised she got pregnant.
12. Disbelief in Pregnancy from Withdrawal A 37-year-old woman with 2 children has a new boyfriend after separating from her husband. She is afraid to buy condoms, claiming that 7-Eleven and pharmacies are crowded, so they use withdrawal. When she says she’s pregnant, her boyfriend asks, “How can you have a child? He doesn’t believe it.”
13. Two Days of Sex but Only One Set of Emergency Pills A 37-year-old woman with 3 children, the youngest being 1 year old, has a boyfriend working away, visiting once a week. They use condoms to prevent pregnancy during sex, but the last time they ran out of condoms, so they had unprotected sex. After the first time, she took the first emergency pill the next evening, then had sex again that night. At 5 a.m., she took the second emergency pill, resulting in pregnancy.
14. Forgot to Take Birth Control for 3 Days and Took All 3 Missed Pills A 44-year-old woman with 2 children previously gave birth to large babies weighing 4.2 and 3.9 kilograms. The doctor said she was at risk for diabetes and needed regular blood tests. After giving birth, she had a 3-month birth control injection but had an allergic reaction, so she has been taking low-hormone birth control pills for 10 years. Fortunately, her weight hasn’t increased, her blood pressure is normal, and diabetes is not affected. Recently, she often forgets to take her pills. In October, she forgot to take pills 10, 11, and 12, and her boyfriend had unprotected sex. She remembered on the day she was supposed to take pill 13, so she took the 3 missed pills at once in the evening and took pill 13 before bed. In November, her period didn’t come, and she found out she was 5 weeks pregnant.

Various contraceptive methods that Uncle Doctor mentioned, Uncle Doctor suggests “changing the mindset” as follows:

1. Not Using Contraception is Not Worth It In one year, there is an 85% risk of pregnancy or 6 out of 7 cases, even if sex is infrequent, contraception is necessary.
2. Wear Condoms Correctly Every Time Otherwise, there is a 14% chance of pregnancy or 1 in 6 cases in one year due to incorrect use, delayed application, slipping, breaking, or leaking. Therefore, wear it correctly, with the right size, not too big or small, not used for more than 30 minutes, not too rough. If it hurts, use additional lubricant like KY jelly or glycerin, which contains silicone as a solvent.
3. Wearing Condoms Prevents Sexually Transmitted Diseases and protects against HPV, which causes cervical cancer.
4. Take Emergency Contraception Only When Necessary and As Soon As Possible Because it cannot compare to other better methods. Although it can be used within 5 days after unprotected sex or failure of other methods, it won’t prevent pregnancy if ovulation has already occurred. Therefore, the effectiveness varies from 52% to 94%, so it shouldn’t be used frequently. Taking it sooner is more effective within 72 hours after sex, and taking 2 pills at once is better than waiting 12 hours between pills.
5. Be Cautious of Pregnancy After Taking Emergency Contraception, Wait for Menstruation This case has a high risk of pregnancy: if no contraception was used, rape occurred, the condom broke or slipped, 2 or more birth control pills were missed, the 3-month injection was late by more than 4 weeks, the 1-month injection was late by more than 7 days, and withdrawal failed. Pregnancy can be confirmed when menstruation occurs, and even if pregnant, it won’t cause birth defects.
6. Taking One Set of Emergency Contraception (2 Pills) Only Affects That Instance of Sex If sex occurs again, a new set should be taken.
7. Taking Birth Control Pills is Highly Safe Monthly birth control pills can be used safely for many years without needing periodic breaks. They prevent pregnancy only when taken consistently and won’t prevent pregnancy after stopping. After stopping, pregnancy can occur quickly, and menstruation will return to normal. The pills don’t cause harm or birth defects. Birth control pills can be used by women of all ages without fear of breast cancer, and most women won’t gain or lose weight from taking them. The chance of pregnancy is 6-8 per 100 women in one year or 1 in 17, but if used correctly, it’s 1 in 1,000 in one year.
8. When Forgetting to Take Birth Control, Know How to Take It Correctly If one pill is missed, take it immediately and continue with the remaining pills as usual. If 2 or more pills are missed in the first 14 pills, take the most recent missed pill immediately and continue with the remaining pills as usual, and use condoms for 7 days. If 2 or more pills are missed from pills 15-21, take 1 pill immediately and continue with the remaining pills until pill 21, and use condoms for 7 days, then start a new pack, discarding the last 7 placebo pills (in a 28-pill pack).
9. Withdrawal Should Be the Last Resort It is not recommended because millions of sperm are released with pre-ejaculate during sex. Controlling oneself to withdraw before ejaculation or knowing when ejaculation will occur is not possible, leading to a 22-27% chance of pregnancy. Women should know it’s extremely risky, so don’t make it convenient and easy, but women will get pregnant. Therefore, don’t trust it, and the pregnancy rate may be high if the man has premature ejaculation or little experience. If you want to please your partner, women should take or inject or implant birth control, which has a very low chance of pregnancy, 0.1-0.3%.
10. Withdrawal Followed by Emergency Contraception is Very Risky, Better Not Because Uncle Doctor says we should choose better methods, there’s no need to risk the future, and
11. “Abstinence is the Safest” so teenagers won’t become parents too soon.

Someone said, “The single biggest reason for unplanned pregnancy is not the inefficiency of contraceptive methods, but the fact that the couple didn’t use any contraception at all.”

With love and care, Dr. Ruangkit Sirikanchanakul, RSA Volunteer Network Coordinator