Contraceptive method switching in Peninsular Malaysia: ethnic differences, 1940s-1970s.

Between 1955 and 1975 total fertility in Peninsular Malaysia dropped from 6.2 to 4.2. However the change was not consistent among the 3 major ethnic groups: Malays Chinese and Indians. Data from the 1976-1977 Malaysian Family Life Survey (MFLS) were used to construct individual contraceptive histories of 1191 ever-married women and to study contraceptive method switching in a total of 7154 interpregnancy intervals for the population as a whole and by ethnic group. Contraceptive methods considered were: sterilization; pill IUD injection (referred to in this analysis simply as "pill"); condoms; safe time (includes abstinence and withdrawal) folk methods; and no method. 80% of the samples from all intervals reported "no method"; Indians had the greatest proportion (84.5%) of unprotected intervals. The most popular contraceptive method was the pill (31% for the whole population 42% for the Chinese 23% for Indians and Malays). Sterilization was highest among Indians (20.5%). Since "no method" was used in all pregnancy intervals by 47% of the sample the ever-use rate for the sample was 53% (67% for Chinese 57% for Indians 40% for Malays). Only 16.6% of ever-users reported use of more than 1 category of contraceptive method. Individual contraceptive histories were analyzed for acceptance discontinuation or change of method at each transition i.e. each pregnancy interval. 84% of all transitions represented continuation of the same method. The probability of continuation of the same method was greater the less effective the method. Most switches were from less effective to more effective methods; 92% of these were from no method to the pill. Most of the switches to less effective methods were switches to no method and switches to no method increased with increasing effectiveness of the method. The rate of new acceptances was 13.7% but the discontinuation rate was 20.3%. Only 83 couples were sterilized and most of them had previously used no method. For all ethnic groups the majority of new acceptors were pill users. New acceptance however was less common than discontinuation especially among the Indians (40%). Malays were the least likely to accept contraceptives but when they did they were very unlikely to change method. The Chinese had the highest acceptance rate the highest probability of switching methods and the highest probability of switching to a more effective method. Indians had the highest percentage of unprotected pregnancies the highest discontinuation rate and were the least likely to switch to more effective methods. Implications of these data for program policy are that there are still many nonacceptors to be reached; that the more effective methods should be promoted since most couples continue using the method with which they started; that the largest ethnic group that needs to be reached is the Indian population; and that different contraceptive methods should be available for choice.