Quick-fix pills may seem like answer to unwanted pregnancies but frequent usage can be dangerous .
On a night out at her favourite Bandra pub in Mumbai, Shilpi Madan shoves her credit card, iPhone and i-pill into her large brown bag “for some unrestricted fun”. For the 23-year-old interior designer, the i-pill is God’s gift to girls who just want to have fun-minus the fear. A few drinks down, she doesn’t need to worry about the man carrying a condom. Her escape from unwanted pregnancy is in her own hands now. “Most of the time one does not plan to have sex, it just happens. With the pill, it’s just so easy. Even if you don’t have one on you, you have 72 hours to buy it from the chemist,” says Madan.
Across urban India, young women are enjoying the freedom to “get back to life”-as the i-pill advertising campaign urges-with emergency contraceptive pills. Easy to access and affordable, these over-the-counter pills promise freedom from unwanted pregnancies and young women are popping them with glee. “The boom began around 2006 ever since it started being advertised. I see at least 10 new users of the pill every month with even teenage girls using it,” says Kiran Coelho, head of the Department of Gynaecology, Lilavati Hospital, Mumbai.
The popularity of the pill shows in its numbers. The National Family Health Survey for 2010-11 states that over 83 million women use emergency contraceptives as opposed to 16 million users of male condoms. Some call it the effect of the high octane advertising that hails the pill as panacea for problems such as ruptured condom and irregular birth control doses. Others view it as a symbol of women’s empowerment that gives the girl control over a probable pregnancy.
A Bitter Pill to Swallow
An emergency contraceptive is not a one-stop shop for unwanted pregnancies. Doctors warn of side effects, which range from nausea and vomiting to abdominal pain and weight gain. And more importantly, in case of repeated and rampant use, the pill can lead to complications in conception later as it alters hormonal patterns. “It is being widely abused, with some women taking up to 10 a month,” says Coelho. She has treated girls as young as 16 for its side effects. The pill, she says, can even “precipitate the polycystic ovary syndrome (an endocrine disorder in women) with unchecked use”.
Another major downside of the pill is that it offers no protection from sexually transmitted diseases (STD). “Cases of herpes, HIV and hepatitis have increased over the past few years because people are increasingly replacing the condom with the pill,” says Shubhada Khandeparkar, honorary head of Department of Gynaecology and Obstetrics at Mumbai’s Bhabha Hospital. The widespread use of the pill can also cause human papillomavirus-a virus that can be transmitted through sexual contact and cause warts, or cervical cancer. “The pill shouldn’t be taken more than twice a month,” warns Khandeparkar.
Experts blame the pill boom on a change in the social fabric. “With the influence of western culture and values, young people view casual sex as a normal activity, making the pill a powerful tool in a woman’s hands,” explains Mumbai sociologist Sudha Desai, who is doing an independent study on the sociological aspects of the emergency pill. Coelho agrees with Desai. “Earlier, we had to take a girl behind the curtain and ask if she was sexually active. Now, mothers come and ask for contraception knowing fully well that their young daughters have sexual relations,” she says.
The pill boom took off when non-prescription, over-the-counter access to Progestogen-only emergency pills was approved in 2005, making it easily available. Rampant advertising by pharma companies added to the glamour of the pill. “Earlier, two doses were required. But the single pill became very convenient for women, who could just buy it from the local medical store,” says Suneeta Mittal, gynaecologist, Fortis, Gurgaon.
Success not Guaranteed
Emergency contraceptive pills contain levonorgestrel, a progestogen which helps prevent the implantation of the egg in the uterus and avoid the beginning of pregnancy. It can stop an egg from being released from the ovary; if the egg has been released, the pill may prevent the sperm from fertilising it and in cases where the egg is already fertilised, it may prevent the egg from attaching itself to the lining of the womb. “It causes severe disruption of the lining of the uterus, and makes the uterus hostile to a pregnancy. The method, however, is not entirely foolproof even if the pill is taken within the stipulated 72 hours after unprotected intercourse. Failure rates vary between 20 and 25 per cent,” says Coelho.
The rules governing the use of the pill vary across the world. If in the United Kingdom, the Levonelle One Step-a single-dose progestin-only treatment-can be sold over the counter to anyone over the age of 16, in the US, emergency contraception is available without prescription to men and women over 18. Some countries are stricter. In China, the pills are sold over the counter but most pharmacies record the details of the customer; in Germany, it is available by prescription only. In Norway, a two-dose treatment is available over the counter to all ages.
Promote or Condemn?
Experts say emergency contraceptive pills are here to stay, notwithstanding the pitfalls, sparking a debate between its advocates and critics. Stating the serious side effects of the pill, senior advocate M.P. Raju appeared in the Supreme Court in 2010 as counsel for Krupa Prolifiers, a charitable foundation from Kerala. They filed a PIL against i-pill stating that the product violated the Medical Termination of Pregnancy Act, 1971. However, the court did not entertain the petition and the pill is still readily available at pharmacies across the country. “Unlike contraceptives which are preventive (they terminate chances of fertilisation), emergency contraceptives are abortive (they take effect after fertilisation) and a distinction needs to be made between the usage, purchase and labelling of the two,” says Raju.
Renu Addlakha, deputy director and professor, Centre for Women’s Development Studies, Delhi, blames changing social norms and perceptions for the lack of opposition to easy availability of the pill. “There is no open discussion about the effects and usage of emergency contraceptives,” she says. Medical practitioners, however, differ, stating that the pill is essential in birth control especially in cases of unplanned or forced sex. Khandeparkar, a strong advocate of population control, believes that the pill should be available over the counter, but with a cautionary note about its side effects.
With virtually no public opposition or open dialogue on emergency contraceptives, easy over-the-counter availability and introduction of new brands, emergency contraceptives, for now, are increasingly the pills of choice for young, urban India.