INDIA: Rising Use of Emergency Contraceptives Raises Alarm

By Manipadma Jena
NEW DELHI, May 21 (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 – 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 of
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’ (meaning ‘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 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 programmes.

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
women’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, 50
percent, 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.