Nitin Jugran Bahuguna

NEW DELHI, Jul 17 2008 (IPS) – With unintended pregnancies and unsafe abortions continuing to be a serious problem in India, some doctors have begun advocating use of the emergency contraceptive (EC) pill as a possible solution, though conditions in India are regarded far from conducive.

A doctor explains use of the morning after pill . Such services are inaccessible to most Indians. Credit: Nitin Jugran Bahuguna/IPS

Introduced in the Indian market last year as a prescription drug the level of awareness about EC pill is still abysmally low with only one in 100 women having any understanding of how it works, says Dr. Narendra Malhotra, president of the Federation of Obstetrics and Gynaecological Societies of India (FOGSI).

Emergency contraception is a unique method of contraception, which can prevent pregnancy in almost 90 percent of females, after unprotected sex, Malhotra explains. It gives them an opportunity to escape from the clutches of unwanted pregnancy and unsafe abortion which have a bearing on high maternal mortality rates in this part of the world.

Problems in India start with the fact that prescription drugs, including the EC pill, are readily available to users in this country s poorly regulated pharmaceutical retail business. Many women, including adolescent girls, have been known to buy and use the EC pill indiscriminately.

Typically, users of the morning-after-pill confuse it with the abortion pill that is to be taken after a woman misses her periods, said Malhotra.

When Sushma, 23, a newly married woman, missed her periods she decided to try out the I-Pill widely advertised on television and in a well-known women s magazine. After repeated use of the pill failed to restore her periods she consulted Malhotra who, after an ultrasound scan, found she was six weeks pregnant. Sushma (second name suppressed) had to undergo an MTP (medical termination of pregnancy) as the overdose of EC pills she took could have harmed the foetus, explained the doctor. The advertisements may not correctly spread awareness, he observed.
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EC pills contain a hormone called levonorgestrel which is highly efficient and has minimal side effects. It has the same ingredients found in several birth control pills, the difference being that EC contains a larger dose of levonorgestrel and when taken immediately after an unprotected sexual act minimises chances of pregnancy.

Hormonal contraceptives have had a controversial record in India so far. Injectibles such as Depo Provera (Depo Medroxy Progesterone Acetate), although listed by the World Health Organisation (WHO) as a safe, effective and convenient form of contraception, particularly for lactating and estrogen-sensitive women, have even proved disastrous in villages and remote areas, owing to poor follow-up medical services.

Meanwhile, maternal health in India remains a critical issue with only 34 percent of births attended by skilled help. India spends a mere 0.9 percent of GDP on health and the MMR (maternal mortality rate) in the country is about 400 per100,000 births, says FOGSI, the largest organisation of gynecologists in the world and the largest professional body in India with 23,000 members in 192 cities.

Research, states FOGSI, shows that 78 percent of the pregnancies in India are unplanned and at least 25 percent are unwanted. This unfortunately leads to abortions, numbering approximately 11 (eleven) million a year, half of which are unsafe and are associated with high morbidity and mortality.

In a bid to reduce the number of unintended pregnancies in India FOGSI, in collaboration with the Family Planning Association of India (FPAI), has launched an awareness campaign on the EC pill that is expected to cover every Indian state.

As per clinical trials, EC pills can prevent pregnancy by up to 89 percent if taken as early as possible and not later than 72 hours after unprotected sexual intercourse, says Dr. Mandakini Parihar, a former president of FOGSI. It can be used when a condom breaks, if a diaphragm or cervical cap slips out of place during intercourse, after a sexual assault or whenever unprotected intercourse occurs.

But Parihar too cautions that the EC pill cannot be a substitute for regular oral or injectible contraceptives and should only be used in emergency as the name suggests. Long-term use or overuse can cause irregular menstrual cycles and side effects like nausea and vomiting, she said.

The important pre-requisite here, emphasises Dr. J. B. Babbar of FPAI, is to educate women about the right use of EC pill so that this method is not resorted to on a regular basis but used strictly under emergency situations.

What is needed is for everyone to realise that there is no contraceptive that is ideal for every woman all the time, Parihar observes. According to a woman s need and requirements, the type and choice of contraceptive also changes, and it s only right that we give her this choice, she said.