The greatest obstacle to increased contraception use in Cambodia isn’t the price of birth control or the social stigma around using it, a new study has found, it is fear of side effects.

What’s more, this fear may arise from the many disparate medical systems operating simultaneously in Cambodia, the study’s authors claim.

Released this month by China Pharmaceutical University’s School of International Pharmaceutical Business, the study, titled Explanation of Contraception and Unmet Need for Family Planning, found that many sexually active Cambodian women who professed a desire to avoid pregnancy weren’t using birth control.

What’s more, many highly educated women are using traditional methods of birth control, such as the withdrawal method, rather than modern methods like birth control pills, the study found.

About 40 per cent of women surveyed cited health concerns and fear of side effects as the primary reason behind their decision not to use contraception, the study, based on 10 years of data from the Cambodian Demographic and Health surveys, found. Meanwhile, close to 47 per cent of women cited infrequent sex, lack of fertility, or a desire to get pregnant as the reasons behind their decision.

While a fear of side effects is considered a common reason for women in developing countries to avoid contraception, the study determined that pluralistic medical systems – referring to Cambodia’s mix of private clinics, public health providers and traditional healers – and a lack of trust in the Cambodian health system at large could be contributing to the problem.

“Fear of side effects, stemming from both contraceptive experiences and notions of health and the body was found to be the greatest obstacle to the use of modern contraceptives,” the study reads. “This related more broadly to the pluralistic medical systems operating simultaneously and the varying levels of medicalization and trust in both bio-medicine and the Cambodian health system.”

In that context, behaviour that appears counter-intuitive becomes more understandable, the authors determined. Still, other experts say a lack of information about potential side effects is likely behind the trend.

While awareness about birth control methods is growing among Cambodian women, that doesn’t necessarily mean women have complete information about the side effects of each method, said Ashish Bajracharya, country representative at the Population Council, a research organisation that focuses on family planning.

“I don’t think the parallel system is the cause, but I think parallel systems lead to less information,” Bajracharya said.

“It would make sense that women are getting mixed messages, especially when there is an unregulated market, but I don’t know if there is any empirical data that objectively proves that,” he added.

Health experts argue that women need comprehensive health counselling in order to have accurate information about birth control methods. In Cambodia, opinions about birth control are often formed through rumour alone, health workers say.

“If there are side effects for one woman, the whole village knows about it,” said Lyn Huy, a program manager at Action for Health. “So what is really needed is counselling to dispel myths.”