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World Contraception Day: As more women opt for morning-after pills, doctors urge caution

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Among other things, frequent use is believed to cause nausea, abdominal pain, weight gain, and a complicated conception later.

New Delhi: The morning-after pill has emerged as the contraceptive of choice for Indian women, with government data suggesting that sales had doubled to two million pills between 2008-9 and 2015-16.

It’s cheap, it’s convenient, and it’s seen as a godsend by women who have partners who shun contraceptives (more on this later), and wish to avoid accidental pregnancies.

Among the urban young, meanwhile, it is seen as an important tool that has aided women’s sexual liberation.

As World Contraception Day was marked Wednesday, doctors championed the effectiveness of the pill, but added a note of caution by advising against their indiscriminate use.

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The pills first came to India in 2006. Their possible side-effects remain a subject of debate worldwide, but doctors suggest that overuse can prove harmful for women.

Among other things, frequent use is believed to cause nausea, abdominal pain, weight gain, and a complicated conception later.

One extremely serious complication, said Dr Sonia Naik of Max Smart Super Speciality Hospital in Delhi’s Saket, is ectopic pregnancy.

Ectopic pregnancy is one where the foetus develops outside the uterus, typically in the fallopian tube, and may endanger the mother’s life.

“Women often take these over-the-counter pills in haste,” said the obstetrician and gynaecologist, “It often leads to complications.”

‘I often get complaints’

Dr Poonam Khera, a senior consultant in obstetrics and gynaecology at BLK Super Specialty Hospital, echoed Naik.

“Most of my patients are aware of emergency pills, especially the unmarried girls,” she said.

“I frequently get patients who complain of complications after having emergency pills. They often lack knowledge about whether it was required or not in their situation,” she added.

According to her, it is OK to take the pills 2-3 times a year, but no more.

“Complications include abnormal uterine bleeding, hormonal imbalance. In some cases, excessive bleeding can lead to anaemia,” she added.

“A rare but serious complication is ectopic pregnancy,” Khera said.

Asked how this may happen, she said the ova or egg is released from the fallopian tube. The effects of the pill, she added, may cause the egg to get stuck in the tube leading to the abnormal or ectopic pregnancy.

Dr Nozer Sheriar, secretary general at the Federation of Gynaecologists and Obstetrician Societies of India (FOGSI), also advised against regular use.

“I personally think emergency pills have a great role to play even if they are not 100 per cent effective,” he said.

“It is extremely safe but should not be used regularly. It can disrupt the menstrual cycle,” Sheriar told The Print.

He said the rise in use of emergency pills showed that India had failed to give couples reliable contraception. “There is no speciality with respect to contraceptive counselling in the country,” he added. “Young people need access to birth control.”

Onus on women

The morning-after pill is just one of several contraceptive measures on offer these days, and awareness about these is part of a larger government programme to encourage family planning and check India’s population.

For example, there’s the intrauterine contraceptive device (IUCD), a small coil-like, often T-shaped device inserted into a woman’s uterus.

Last year, the government started offering two free contraceptives for women – an injectable drug called ‘Antara’ that’s effective for three months, and a pill, ‘Chayya’, said to be effective for a week.

However, according to an IndiaSpend report from February last year, abortions remain on the rise in the country with men ever more reluctant to use contraceptives.

Several men believe condoms take a toll on their sexual experience, with few enthusiastic about vasectomy too. According to the IndiaSpend report, between 2008 and 2016, the use of condoms in India fell by 52 per cent and vasectomies by 73 per cent.

This suggests the onus is increasingly on women to prevent accidental pregnancies, a fact probably leading them to use oral contraception more often. After all, the alternative is an abortion.

A study in health journal The Lancet stated that while an estimated 15.6 million abortions were carried out in India in 2015, the ministry of health and welfare listed the figure for 2014-15 as only 701,415.

As many as 78 per cent of the abortions, the study suggested, were undertaken outside a health facility, thus putting thousands of women in the hands of quacks.

Importance of male contraception

Experts ThePrint approached reiterated that there was an ever greater need to promote male contraceptives, adding that this line of approach had the added benefit of preventing sexually transmitted diseases.

“Besides vasectomy and condoms, advances in oral and injectable, hormonal and non-hormonal delivery systems have opened a new arena in male contraception,” said Dr Sonal Kumta, the head of obstretrics and gynaecology at Fortis Hospital Mulund in Mumbai.

“Over the last few years, a number of testosterone and progesterone (hormonal) formulations have become available, including long-acting injections, implants,” she added.

Also read: Abortion has been legal in India since 1971 but it is still not a woman’s right

“Here, hormone is administered in part to block the process of sperm production and maturation, but it also maintains sexual drive and muscle mass. In recent trials, overall efficacy was found to be approximately 95 per cent, with the median time of reversibility and complete recovery to fertility being 3-4months,” she added.

Naik, however, advised against these measures, saying they were yet at an experimental stage. Even so, she reiterated the need to emphasise the need for greater use of contraception by men.

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