Before a baby comes along

Here's a question newly married women often hear from parents, family and friends: "When are you starting a family?"

Universiti Malaya Medical Centre department of obstetric and gynaecology senior consultant Professor Dr Jamiyah Hassan says motherhood is for those who are prepared - mentally and physically.

"Pregnancy is natural, but giving birth is risky because it can be fatal. Women need to be sure that they are in the best of health to reduce any risk in pregnancy and childbirth. The couple must also be financially ready to raise a child," says Dr Jamiyah.

"Women should exercise their reproductive rights without being afraid of what society says. It is important for women to know that they have the right to choose and everybody should respect that," she adds. Family planning, Dr Jamiyah says, means making an informed choice about the right time to start a family.

"A newborn child has to be provided for," adds Dr Jamiyah.

But there is concern, among some religions, that family planning is considered a sin. Dr Jamiyah understands this anxiety but for Muslims, she says, many women have interpreted family planning wrongly. "There is a fatwa (legal pronouncement) that family planning is considered harus (no sanction if performed or otherwise) on the premise that it does not stop procreation.

Family planning is practised in Islam with the aim that women need to be healthy to take care of the husband and children. Permanent contraception is, however, haram."

If a couple has too many children, they may not be able to provide for them adequately and this can lead to social problems, broken families and marital disharmony.

Men taking charge

Men taking charge

Mention family planning and contraceptive methods come to mind. But men also practise contraception by using condoms, practising coitus interruptus and undergoing vasectomy. But there are other ways.

"Researchers have been studying male birth control pills or injectable forms of it using either synthetic testosterone on its own or together with synthetic progesterone. But it will take a few years before it is available to the masses," says Dr Jamiyah.

There is also contraceptive "gel" that works by injection into the vas deferens (ducts which carry the sperm before ejaculation) to stop the transfer of sperm. But this, too, is still not widely available and practised.

"Most men know of condoms and vasectomy but not so much on other types of contraception. We need to increase this awareness so they know that it is not only women who are responsible for contraceptive measures. One of the reasons why men don't care much about contraception is because they don't get pregnant.

"Contraception is the responsibility of both men and women," she says firmly.

If men are not familiar with the types of contraception available, they should at least resort to condoms.

"Vasectomy is permanent, making it less popular. Condoms can prevent pregnancy and protect against sexually transmitted diseases (STD). But if not used properly, the failure rate maybe high," says Dr Jamiyah.

Choose well

Choose well

A recent survey by the National Population and Family Development Board has indicated that the average marriage age among Malaysians will be 33 by 2015.

This means pregnancy will be delayed. Some women may not get married.

There is concern that this phenomenon will result in a decline in fertility rate. "All women have maternal instincts, but they can exercise their reproductive right," says Dr Jamiyah. "Being childless is all right, it's your reproductive right."

Dr Jamiyah advises women to choose contraceptives after consulting with their gynaecologists. If a woman is a chronic smoker and overweight, oral contraceptive pills may not be safe. Other options are combined oral contraceptive pills, intrauterine contraceptive device, intrauterine contraceptive system with hormones, injectables and implants.

"These methods do not protect women against STDs, only condoms do." Combined hormonal contraceptives have other advantages such as protection against ovarian and endometrial cancer, reduction of acne and improvement of symptoms of premenstrual syndrome," says Dr Jamiyah, adding that exclusive breastfeeding is also known to be a contraceptive.

The latest contraceptive method for women is Implanon. With this method, an implant is inserted on the medial side of a woman's arm. Implanon is a 4cm inert rod made of ethyl vinyl acetate and contains etonogestrel, a hormone that will be released in the woman's body for three years upon implantation.

This method has an efficacy level of 0.05 per cent, making it better than oral contraceptive pill. "The upfront cost for Implanon may be expensive but it saves money in the long run. This form of contraception is suitable for women who do not like the regime of taking pills, those who can't take estrogen or are obese," says Dr Jamiyah.

Perils of unwanted pregnancy

Perils of unwanted pregnancy

There is a danger if a pregnancy is not welcomed by a woman. "An unwanted pregnancy can emotionally affect a woman if she is not ready. She may not take good care of herself during pregnancy and is more exposed to other risks. It may also disrupt marital harmony because the pregnancy itself is a strain on the body.

"If her mind and soul is not in it, she will not be able to handle it well. This can also lead to postnatal depression," warns Dr Jamiyah.

Women should also be able to enjoy sexual intercourse without the expectation of pregnancy. "Husband and wife have to communicate about sex without any inhibition. It is not easy for some people to do this because of their upbringing, religious and cultural background, but we need to raise this awareness. A lot of problems can be solved by communication between couples," says Dr Jamiyah.

That said, couples with or without children can still be happy in their marriages. "Children may make a woman or man happy but there are happy couples who are childless and are still very happy," says the mother of three.

It is also not fair to have children to have them look after their parents in their old age. "We should prepare for old age without having to depend on our children. We choose to have children and therefore it is our responsibility to provide for them without asking for anything in return.

"That is the reason why we should have family planning. We can never be sure our children will have the capacity to take care of us during our old age.

"My father is almost 78 and he is independent and provides for both himself and my stepmother. He is working full-time six days a week and drives more than 100km daily for his job. He believes that old people need to be effective and productive.

Dr Jamiyah's aim is to create comprehensive understanding of family planning.

"I have talked to my children about sexual and reproductive health since primary school."

Pregnancy fact file

Pregnancy fact file

• Pre-existing diseases such as heart diseases, systemic lupus erythematosus or kidney diseases may get worse during pregnancy.

• Folic acid reduces the risk of fetal abnormality like neural tube defect such as anencephaly (absence of a large part of brain and skull).

• The best time for women to have a child is between the age of 25 and 35 as the risk of pregnancy complication is the smallest during this period.

• Young women aged 20 years and below face a bigger risk if they get pregnant. Their pelvis are still growing so they have a higher chance of carrying smaller babies, having anaemia or hypertension as well as having a higher incidence of operative deliveries.