Rising Use of Emergency Contraceptives Raises Alarm

By Manipadma Jena

NEW DELHI, May 21, 2010 (IPS) - When Sunita Sanyal (last name changed) complained of intense headache and vomiting, her mother presumed it was just pre-examination jitters. After all, Sunita’s business management finals were just a week away.

At the doctor’s clinic, however, the startling truth came out: Sunita, 25, had been taking emergency contraceptive pills (ECPs), often as many as eight times a month – a high overdose – or after every tryst with her boyfriend.

Reproductive health communications expert Usha Rai recalls the case of a 12-year-old in Patna in eastern Bihar State, who was repeatedly abused by her brother-in-law and made to take several doses of ECPs. The girl was already five months pregnant when she underwent medical or surgical abortion.

New Delhi-based health activist Jaya Velankar says, "the rampant and unscientific use, over-the-counter sales and misleading advertisements on emergency contraceptives like iPill and Unwanted-72 have raised huge health concerns for young women (taking these pills)."

The latter is known to prevent an unwanted pregnancy provided it is taken within 72 hours of unprotected sex.

"Over the past year iPills and Unwanted-72 have been moving fast," says Aurobind Das, owner of Mahashakti Medicines store in a posh locality in Bhubaneswar city in eastern Orissa state. These are mostly purchased by young male college students, apparently for their girlfriends, usually as often as twice a week, he says.

Das says he usually explains to these young men the danger of taking an overdose of ECPs and advises them to buy regular oral contraceptives instead. "They just shrug it off and say if there are side effects, the girl will handle that," says the chemist.

Kalpana Mehta of Saheli’ (translated as ‘a woman’s friend’), a nationwide non-governmental organisation based in this capital, describes emergency contraceptives as "fraudulent products."

She explains: "Since oral contraceptives like ‘Mala-D’ are made available by the government freely and widely in India, there is no need for a dedicated product that is costly and out of reach for most, at 80 to 100 (Indian) rupees or around 2 U.S. dollars for a single dose."

Five years ago, India included the promotion of ECPs in its national health programme. The government specifically allowed the distribution of these pills through its social marketing campaigns.

ECPs, also known as ‘curb abortion’ and ‘morning-after’ pills, contain high concentrations of hormones, usually levonorgestrel or estrogen. They have about eight to 10 times more estrogens compared to a regular contraceptive pill and thus are known to pose serious health risks to women, especially when taken in high doses.

A two-pill dose taken within 72 hours of unprotected sex – the second pill taken 12 hours after the first – disrupts the uterus lining, thereby suppressing or delaying ovulation and averts pregnancy, says Dr Sarojini Sarangi, professor of obstetrics and gynaecology at the Sriram Chandra Bhanj (SCB) Medical College in Cuttack, the foremost government-funded university hospital in Orissa.

"One dose within one menstrual cycle can be tolerated, but women take three to five ECP doses in one menstrual cycle, which interfere with the fertilisation process," says Dr Sarangi. "Often patients come to me in their second or third month of pregnancy, mistakenly thinking a missed menstrual cycle is due to the ECP pills."

Adds Dr Sujata Kar, a gynaecologist and owner of an upmarket clinic in Bhubaneswar: "Indians are a pill-happy people. Women conveniently forget the ‘emergency’ prefix in the ECP and use it as an easy means of contraception."

"If high doses are continuously taken over the medium and long term, conception ability could be impaired," warns Dr Sarangi. Other potential side effects are migraine and pelvic inflammatory disease.

"In developed countries, chemists warn buyers to look out for blood clotting and ectopic pregnancies, but not in low-knowledge India," says Mehta of the NGO Saheli. Such abnormal pregnancies, which develop outside a woman’s uterus, arise from reproductive or contraceptive failure.

Since unwanted and unplanned pregnancies are common in this south Asian country of more than a billion people, there is a high incidence of abortions.

Of the 6.4 million abortions performed in India in 2002 and 2003, 56 percent, or 3.6 million, were unsafe, according to a 2004 study by the Mumbai-based Centre for Equity into Health and Allied Themes and Healthwatch Trust.

Almost 20 percent of patients seeking abortion are unmarried, says Dr Kar. In some clinics in Patna, the percentage of such women is even higher, half of them from rural areas.

Many come for abortion in their school uniforms, writes journalist Usha Rai on the incidence of abortion in Bihar in an unpublished 2009 study titled "Rural Women Continue to Opt for ‘Clean Up’".

India legalised abortion in 1971 through the passage of the Medical Termination of Pregnancy Medical Termination of Pregnancy, which stipulated certain conditions for its execution.

Women in general are forced to bear more children than they desire, in part because of the phenomenon of son preference, which has deep cultural roots in India, or because men generally refuse contraception, says Dr Saraswati Swain, a retired professor of obstetrics and gynecology who has worked with grassroots communities.

Used right, ECP is an empowering tool allowing women more control over their reproductive lives, says Dr Kar. Therefore, they need to be made available over the counter, doctors say.

Yet, awareness of the dangers of excessive and indiscriminate use of ECPs must be stepped up significantly, says Velankar, the health activist. And this necessarily extends to consumers, particularly youth, and even drug store owners.


Source: IPS

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