When considering moving abroad there are many points to consider that will impact your life in your adopted country – factors such as the language barrier, making new friends and trying new foods. But what about the less frequently remembered but often more important lifestyle factors? Things such as repeat prescriptions for medication you may regularly take at home, regular eye tests and repeat contact lens prescriptions? And equally important: access to contraception. The most readily available methods of contraception are condoms; however these don’t suit everybody for a variety of reasons ranging from latex allergies to menstrual irregularities, which necessitate other preferable methods such as the pill. Unfortunately, China is still woefully uneducated when it comes to sex education and contraceptive advice is severely lacking.

So how does a member of the fairer sex go about choosing a suitable method of contraception or biyunyao (避孕药)? Which type of pill fits into your daily routine the best? What about those containing hormones? After contacting a nurse friend of mine to discuss the options, she advised on which types of contraception are readily available and which ones are not. The results were interesting. Here we take a look at the choices of contraceptives that are available, introduce the pros and cons and offer advice on where to obtain them.

1) The Combined Pill
The combined oral contraceptive pill is commonly just called “the pill”. It contains the female hormones oestrogen and progesterone, which women produce naturally and is available in three types, so if you opt for this method you must be sure that you know which type your doctor has prescribed you: the every day pill or the 21 day pill of which there are two types.  When taken correctly, the pill is over 99% effective at preventing pregnancy.

The Monophasic 21 day pill is taken every day for 21 days and then has a seven day break before beginning the next pack.  Each pill contains the same level of hormones. Examples of this type of pill would by Microgynon, Cilest or Brevinor.

The Phasic 21 day pill – similar to the monophasic pill – is also taken every day for 21 days with a seven day break afterwards. However the crucial difference is that the pack will contain two or three different coloured sections as each section contains different levels of hormones.

The Everyday pill – as the name suggests – is taken every day. The pack contains 21 active pills and seven inactive ‘dummy’ pills, which contain no hormones and the two types are a different colour to differentiate between the two. You take one pill every day and they must be taken in the correct order: all 21 active pills together, followed by the seven dummy pills before beginning the next pack. This form of pill is especially good for women who have their seven day break and then forget to begin their next packet – having seven dummy pills ensures that you don’t forget which day you finished your last pack.

2) The Mini Pill
Also known as the Progestogen-only Pill (POP), the mini pill works in the same way as the combined pill only it does not contain oestrogen.  This is especially good for ladies who can’t take pills containing oestrogen for health reasons, such as having high blood pressure, are overweight or have had previous blood clots. When taken correctly, the pill is over 99% effective at preventing pregnancy. Each pack contains 28 pills and there are no breaks between packs, you finish one and then start the next the following day. Similar to the combined pill, there are different types:
The 3-hour mini pill, whichmust be taken within three hours of the same time each day. Examples of these types of pill would be Femulen, Micronor, Norgeston and Noriday.

The 12-hour mini pillwhich must be taken within 12 hours of the same time each day. An example of this would be Cerazette.

3) The Coil
If the idea of filling your body with synthetic hormones makes you uncomfortable, or if you’re quite forgetful and feel that remembering to take a pill every day would be inconvenient, then there are always other contraceptive methods available that remove this potential.  Having an IUD or IUS fitted means that you need never worry about contraception every day or each time you have sex.

The IUD or Intrauterine Device is a small T-shaped device that sits inside your body. This contraceptive is made of plastic and copper coil and contains no hormones.  It is fitted inside the womb by a qualified doctor and works by killing sperm since they are allergic to copper. They work for 5-10 years depending on the type fitted and are completely reversible. This means that they begin working as soon as they are fitted and you can have it removed very easily at any point and be immediately fertile again.  The IUD is more than 99% effective at preventing pregnancy. 

The IUS or Intrauterine System is also known as Mirena and works by releasing hormones into the body. Similar to the IUD, it is a small device fitted into the womb by a qualified doctor. However the main difference is that instead of copper, it works by releasing the hormone progestogen into the body. It is more than 99% effective at preventing pregnancy and works for 3-5 years depending on the type fitted.

Contraception that May Not be Available

If you are familiar with using other methods that are not mentioned above, be warned that obtaining these may be difficult in China as they are not readily available. Below are two such contraceptives that many doctors will either not be familiar with or may not have available.  Bringing these with you will also be impossible since they need to be administered by a trained medical practitioner – one into the body and one as an injection. Most local hospitals in China are unlikely to have these; a better bet would be to visit the international hospitals but even then, don’t hold out much hope.  

1) The Contraceptive Implant
This is a 4cm long tube, which is inserted into the upper arm and releases progestogen into the body. Once in place, it can work for up to three years and prevents the release of an egg each month.  The most widely used implant is Nexplanon.

2) The Contraceptive Injection
There are two types of injection – Depo-Provera and Noristerat – which  operate in a similar way to the injection by releasing the hormone progestogen into the bloodstream. The downside of this is that each injection lasts for 8-12 weeks before needing to be administered again.

Emergency Contraception

Should you find yourself in a situation where the birth control methods you have been using have failed, then obtaining emergency contraception such as the ‘morning-after pill’ isn’t too difficult. An important factor to note is that the word for birth control pills is interchangeable with the word for emergency contraception so unless your Chinese is of a high standard, taking a close confidante along with you to ensure that there are no disastrous translation errors and to make sure you get the correct medication would be prudent. According to nurse friends of mine, emergency contraception is readily available over the counter in most pharmacies as well as in the hospital. 

Visiting the Doctor

It is important to note that the above mentioned methods do not protect against sexually transmitted diseases. In order to prevent these, extra precautions in the form of condoms should also be used. Also, there may be certain side effects to consider as some methods may not be suitable if you have pre-existing medical conditions or are of a certain age.  Make sure to consult your doctor to ensure the method you prefer is suitable for you from a medical standpoint. As with any medicine, there will be certain side effects to consider – for example, the pill can increase blood pressure and cause mood swings as well as interacting negatively with certain antibiotics or medicines (including traditional Chinese medicine) whilst the IUD and IUS have a small increased risk of ectopic pregnancy and heavier periods.

The contraceptives listed in this article (not including condoms, which can be purchased anywhere including supermarkets and vending machines on the street) can mostly be obtained from a doctor in the gynaecology department of the local hospital. If not, then certainly the international hospitals will have access to a wider variety.   

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Keywords: the pill China sex education in China contraception in China