The Department of General Obstetrics & Gynaecology, KK Women’s and Children’s Hospital​ (KKH), a member of the SingHealth group, answers some frequently asked questions about contraception after pregnancy:​

1. What are the contraceptive options for women during the postpartum phase?

Mothers, who are fully breastfeeding and have not yet got their period, are protected from pregnancy in the first six months. This is known as the lactational amenorrhoea method (LAM).

Among contraceptive options are barrier methods like condoms. Breastfeeding women can also decide on hormonal methods like mini pills and injectables.

Another option is the intrauterine device (IUD), which is inserted into the womb six weeks after delivery. Oral contraceptive pills can be used if the woman chooses not to breastfeed.

Some couples choose permanent sterilisation such as female fallopian tubal ligation or male vasectomy (tying of vas deferens).

2. What is the efficacy and side effect profile of each option?

LAM has a low failure rate of 1-2 per cent. There is no side effect as this is natural.

Hormonal methods are highly effective with a failure rate of less than 1 per cent. The disadvantage of the mini pill is that it has to be taken daily and at around the same time of the day. This needs strong motivation from the woman.

Injectables are convenient and given every 3 months. However, they do cause irregular menstrual spotting which can be irritating. Some women develop depression and gain weight as well.

Oral contraceptive pills (OCP) can be used for non-breastfeeding mothers since they interfere with breast milk production. These pills can also worsen migraine in some women, and rarely, can cause deep vein thrombosis (blood clots).

The IUD is effective with a failure rate of less than 1 per cent. However, it does cause pelvic pain and infection in some women and the insertion can cause womb perforation occasionally.

The condom is less effective with a failure rate of 4 – 15 per cent. It disrupts sexual experience as condoms have to be worn before penetration and removed immediately after ejaculation. However, it is the only protection against sexual diseases.

Natural methods like rhythm and withdrawal methods are the least effective with a failure rate of 30 per cent. There is no side effect though.

Permanent sterilisation is irreversible. The failure rate of tubal ligation is 1 in 200 women while the failure of vasectomy is 1 in 2000. Besides, tubal ligation carries surgical risk and a risk of ectopic pregnancy (outside the womb) if contraception fails.

3. Any special precautions that women should take into account while choosing a contraceptive method during the post-partum stage?

When choosing a birth control method, it is always necessary to weigh up the various advantages and disadvantages. Consideration must be given to the effectiveness and the potential side effects as well as to your individual circumstances, health, age and personal/partner’s preferences.

The method you choose also depends on whether you want to have another child in a few years or have completed your family (i.e. may choose permanent methods). Besides, your decision for breastfeeding also affects your contraceptive choice.

Your doctor is an important partner in helping you choose the most suitable form of contraception, but he cannot make the decision for you. Discuss it with him/her!

4. Which is the most popular contraceptive method in Singapore?

A population survey conducted by the Obstetrical and Gynaecological Society of Singapore in 2006 found that only 47 per cent of women in the reproductive age group used any form of contraception.

Of those who used contraception, 47 per cent used condoms and 21 per cent used the withdrawal or rhythm method. Only 13 per cent tried pills or injectables. About 12 per cent chose permanent sterilisation while the remaining 7 per cent used an IUD.

5. Are there any new contraceptives available, or is a new product or device likely to be available in the near future?

The ideal contraceptive, which is 100 per cent effective with no side effect and suitable for all age groups, has yet to be discovered. We will continue to work on it!

"The New Art and Science of Pregnancy and Childbirth", a pregnancy book written by A/Prof Tan Thiam Chye, Dr. Tan Kim Teng, Dr. Tan Heng Hao​, A/Prof John Tee Chee Seng. KK Women's and Children's Hospital (KKH), a member of the SingHealth​ group.

* Available at all major book stores and Pharmacy in KKH.

​​Ref: S13