ONLYFOR AN EMERGENCY
Quick-fix pills may seem like the 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.
ABITTER PILLTO 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 nonprescription,
ONLYFOR AN
EMERGENCY
Quick-fix pills may seem like the answer to unwanted
pregnancies but frequent usage can be dangerous
SOCIETY CONTRACEPTIVES
By Aditi Pai and Sonali Acharjee
48 INDIA TODAY ◆ April 15, 2013
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 NOTGUARANTEED
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.
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