Emergency contraceptives | A pill in time

But in spite of the formation of the International Consortium for Emergency Contraception in 1996, only a handful of countries have a tested emergency contraception (EC) product on their chemists’ shelves. While 140 countries have permission from their governments, only 44 have emergency contraceptives available over the counter. The good news is, India is one of them.

The morning-after pill gained legitimacy after efforts by national and international organizations succeeded in helping build consensus on its safety and efficacy. The ministry of health and family welfare introduced it in the Reproductive and Child Health (RCH) programme 2002.

The initiative has since gained momentum with radio and television spots addressing the anxiety of those who have had an unprotected sexual encounter and fear they might get pregnant. All they have to do is go to the nearest chemist and ask for Cipla’s i-Pill or Pill 72 that costs Rs83 and Rs47, respectively, follow the instructions on a detailed manual or even ask the friendly chemist before popping the first pill and sleeping easy.

As the only way to prevent pregnancy after unprotected sex, and endorsed by World Health Organization (WHO) and the US Food and Drug Administration, it is considered vital in empowering women.

Interestingly, the advertisements currently running on radio and television feature married couples in an attempt to be politically correct, whereas, in reality, the morning-after pill is being used mainly by adolescents and, according to gynaecologists, rather indiscriminately. Umesh Arya of Preet Medicos and General Stores in Delhi’s Khan Market says the sale of i-Pill has gone up four times since the ad campaign started. Up to 80% of buyers are women in the age group of 18-25. This trend is precisely what worries Sonia Naik, attending consultant, obstetrics and gynaecology, at the Sitaram Bhartia Hospital in New Delhi. She says: “The worrying thing is not that bulk buyers are from the metros or are unmarried, but the fact that they are violating its very purpose and relevance. By treating it as routine medication and not as an option for an emergency, many young girls are having it as frequently as three-four times during their menstrual cycle. Given the heavy dosage of hormones (oestrogen) in them, this could then lead to irregular periods and heavy bleeding."

Decreasing age of menarche and increasing age of marriage have created a wider window of time for premarital sex and pregnancies. Studies have found a delay of about one year on average between the start of sexual activity and the first use of contraception. This has been a matter of concern for those working in the area of HIV/AIDS. With young people being at a high risk of infection, their plea has been to bring greater acceptance to condoms, especially because the first sexual encounter of most young people tends to be unprotected.

While EC does not protect against sexually transmitted infections and HIV, it still has brought down the rate of abortions by as much as 50% in China (WHO 2001). Of the 11% decrease in abortions in the US between 1994 and 2000, an estimated 43% was attributed to EC use.

The inability of women to negotiate safe sex—either because of cultural norms or lack of power within the relationship—has not only made them more prone to infection but also vulnerable to the prospect of being saddled with an unwanted pregnancy. While the medical fraternity insists that for spacing children or stalling pregnancy a more reliable barrier method is to be opted for (the intrauterine device, injectable contraception or even the condom), the emergency pill does give women a fair chance of averting pregnancy.

Like most contraceptives, the efficacy of the morning-after pill, say gynaecologists, is not 100%. The failure rate could be anywhere between 5% and 15%. It is recommended that those who have used it wait for their next menstrual cycle which could get delayed by a few days and, failing which, go for a pregnancy test.

So while opponents argue on the easy access of EC leading to promiscuity, liberals feel that it is a tool that has to be used with sufficient awareness and knowledge. That is the key, maintains Dr Naik, who finds that although the number of women calling her up randomly or walking into the clinic wanting to know about the pill has gone up in the last few years, awareness levels are still very low.

Shireen Jejeebhoy, senior associate, population council, is emphatic about schools and colleges updating their sex education lessons but more importantly, for parents to be far more involved in their children’s lives, setting up clear communication and review mechanisms that can help them determine their child’s mental and physical health.

Meanwhile, a warning on the outer jacket of the pill, clearly indicating that EC is to be used only after a rare encounter of unprotected sex, would not be misplaced. For, though it may be an effective form of contraception, it is not a substitute for it.

Two Sides Of The Pill

Pluses

• Can be self-administered

• Does not need a prescription

• Prevents unintended pregnancy

• Brings down maternal mortality

• Reduces complications in reproductive health

• Eliminates dependence on unsafe abortions

• Empowers women by giving them the option of deciding when not to conceive

Minuses

• Does not protect against sexually- transmitted infections or HIV/AIDS

• Has a failure rate of 5-15%

• Tends to be misused (frequent consumption)

• Access may still be an issue, with a lot of chemists not stocking it

• Frequent use could lead to irregular menstrual cycle and heavy bleeding

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