How To Build A Singaporean Woman: Share The Duty Of Birth Control

“How To Build A Singaporean Woman” is a Her World original docuseries which highlights the social and cultural issues that women in Singapore face, and asks: what does it mean to be a Singaporean woman today? In the sixth and final episode, “Share The Duty Of Birth Control”, obstetrician and gynaecologist Dr. Shilla Mariah Yussof and the CEO of Dear Doc and Duly Shruti Dwevedi discuss their experiences and expertise on birth control, and why men need to do their part in sharing the burden of it.

Understanding birth control

“When doctors tend to prescribe these medications to young girls, the mothers are often quite scandalised,” says Shruti. “They’re like, ‘Why are you giving my daughter like birth control pills?’”

This is a perception that Dr. Shilla seeks to correct. “People don’t see birth control pills as hormonal medicines, which is actually what they are,” she says. “They have a lot of applications beyond contraception.”

“As you reach adolescence, hormones don’t affect your growth. If anything, it could regulate your periods and prevent long term or future fertility problems,” Dr. Shilla clarifies.

Birth control has come a long way from the past. “Since it was developed in the 1960s [...], a lot of different generation pills and combinations and formulations have come about over the years”, says Shruti.

That storied history, however, does not necessarily mean it is widely used today. 

“A lot of times when we ask women what prevented them from actually continuing birth control use, two topics always come up: One was cost, because birth control is something they have to use regularly. And the second was counselling,” notes Shruti. “We get questions very often around supplements: ‘Can I take this medication along with birth control?’ or even just taking Panadol along with birth control.”

Regularly using birth control pills takes a financial toll. “The daily oral contraceptive pill would range from $20 to $40 a month, and that can add up,” says Dr. Shilla. But the alternative of having an unplanned baby is way more expensive.

Debunking birth control myths

“A lot of times women are not sure [...] if this is normal or if this is something they should be worried about, so women then tend to just get worried and then just stop [birth control]”, says Shruti.

A chief concern many women have is the lack of certainty around religion and birth control. One example would be whether women can pray while wearing a birth control patch.

“We actually had to really address that topic very specifically that it’s okay to be praying,” says Shruti. She notes that removing the patch during prayer, then reapplying it reduces the efficacy of the patch. 

These aren’t the only topics where information amongst the general population on birth control has been lacking.

“On a forum, we actually brought doctors as well as media to actually have those open conversations to address a lot of these myths and misconceptions,” says Shruti. The situation is still challenging, with surveys showing that 60% of Singaporean women were not familiar with the various birth control options on the market.

“In Singapore, we happen to be in a system where we do require consultations to get any kind of hormonal or birth control pill, including emergency contraceptive pills,” says Shruti. “The implication that has for women is that they have a very short period of window of time  when they can actually use that medication. And in that time if they have to make an appointment and consult a doctor, a lot of time is lost. Considering that the awareness around how to take these medicines is already quite low, a lot of women then tend to miss these windows and run into the risk of having an unintended pregnancy.” For many who are unprepared to be parents, that then means abortions – in 2020, there were over 4000 abortions performed on Singaporean women.

Contraception for men

“Contraceptive methods have just been, you know, involving women,” notes Shruti. “There’s very little that exists for men.”

“I feel probably the reason why there hasn’t been any advances on that  is because medicine has generally and historically been dominated by men,” speculates Dr. Shilla. “I feel that with more women in the medical field we probably will come up with things that do improve women’s health because it is up to us to help ourselves right? 

“We have contraception pills for women, the IUD, the contraception patch, contraception injections,” lists Dr. Shilla. “But what do we have for men? Condoms?” 

That said, as Dr. Shilla notes, there are changes on the horizon. “Recently, they have come up with a male pill but it’s still in the pre-clinical stages, so fingers crossed.”

While there might be a lack of temporary contraceptive methods for men, there is the option for men to get a vasectomy – but there can still be an aversion amongst some men towards taking it up. “When I was training in the West, people would jump at having vasectomies because they did not want to have any more kids or unintended kids,” says Dr. Shilla. “But in Asia, it’s a little bit more different. I think in Asian culture, it’s just not seen to be masculine. They think that it will affect your erection and sex drive – which is totally not true.”

This aversion can lead to women being forced to take up more of the duty of birth control. “I had a pregnant lady who was on her fourth caesarean section. [...] There was a lot of scarring and we couldn’t go ahead with doing the permanent tube ligation,” Dr. Shilla recalls. “After the surgery, we looked through the other contraception options. We suggested that her husband get a vasectomy – a simple, minor surgery –but he did not want to have any part in it.”

The responsibility falls on both partners

Currently, the responsibility for birth control tends to be skewed towards women. “The risk of having an unintended pregnancy, especially in a set-up where the partners are not married, is much higher for women. Therefore, they have a much higher incentive to actually take care of that,” says Shruti.

Incentives aside, it is also how women are socialised into taking more responsibility in the household, and very often in relationships too. “It just happens that the responsibility of contraception or birth control also then just automatically falls on them first.” This is a notion Shruti wants to dispel. “It is a joint and financial responsibility for both partners involved.” 

She argues it does not have to be hard. “It’s really like supporting her could be something as simple as making sure that, let’s say, the pills are available.”

Finding what is right for yourself

When it comes to birth control and gynaecology needs, Shruti feels that “the challenge is really around whether they feel comfortable [seeking help].” She cites how young women fear judgement for being sexually active, which constrains their ability to access healthcare. 

Technological aids, like teleconsults, can help. “Women feel very comfortable because they are in a place where they feel very safe. They’re able to have a very private one-on-one conversation with the doctor and really open up,” says Shruti.

Increasing access comes hand-in-hand with changing the culture around seeking help for female health. “It’s not just about seeking help when you’re unhealthy, but also seeking help when you’re healthy,” says Dr. Shilla. 

She does see an improvement in the number of women stepping forward to get the help they need. “With Instagram, TikTok, sometimes when we’re silent sufferers who [comes across] someone else talking about it, [you think] maybe I should go and seek help too.” 

Transcription and article: Saw Yone Yone