A Pill At Will

Contraception needs to be addressed urgently, for efforts undertaken so far have met with little success. Although the couple protection rate went up from 22.8 per cent in 1981 to 46.5 in March, 1996, the growth rate has remained at a high 2.14 per cent, mainly because the people who go in for sterilisation already have three or more children. It8217;s imperative to give effective contraceptive coverage to young couples with less than two children. That8217;s where the pill comes in, as it is the most safe spacing device, with lesser side-effects than any other form of conception.

Pills are as safe for adolescents as for adults and come with many health benefits, apart from the most obvious one of preventing conception. They make the menstrual cycle regular, prevent ovarian and uterine cancers, help prevent pregnancies outside the uterus and protect against pelvic inflammatory diseases. Still, of the 7 crore women who use it worldwide, only 23 lakh are from India, with intra-uterine devices IUD remaining the most popular method of spacing. This, when pills can be bought at the neighbourhood chemist and is distributed free by family planning services across the country.

8220;The pill is available everywhere only theoretically,8221; says Ranjit Roychaudhury, Professor, Emeritus, National Institute of Immunology. 8220;Women are often too embarrassed to go and ask for the pill at a dispensary or a health centre. What we should be looking at is an aggressive form of social marketing where the pill is delivered to their homes8221;.

Deepika Deka, Additional Professor, Department of Gynaecolgy and Obstetrics, All India Institute of Medical Sciences, agrees only partially: 8220;There is no embarrassment involved, for these women have to ask the doctor for a tubectomy or IUD, too. What makes Copper-T score over the pill is that once it is inserted, a woman can carry on with her work, but a pill has to be taken every day. Give them a pill which has to be taken once a month and see how popular it will be8221;!

A step in this direction is the non-steroidal and non-hormonal pill developed by the Central Drug Research Institute, Lucknow, which needs to be taken only twice a week for three months, and then once a week as long as contraception is desired. This pill is virually free from even the usual mild side-effects and is marketed under the brand name Saheli.

But social marketing remains a good option, with experiments by the Indian Council of Medical Research in Uttar Pradesh and by the Population Foundation of India in Jaipur showing that women were more willing to listen to their neighbourhood vaid or ayurvedic practitioner than the counsellor at the health centre. 8220;Rural women are naturally suspicious of things developed outside the country,8221; points out Roychaudhury. 8220;They have asked me on many occasions whether there were any herbal remedies for contraception.8221; Adding to the fear of the pill is the strong women8217;s lobby of NGOs and do-gooders who are deeply suspicious of the pill themselves. 8220;They need to be educated by unbiased people about the advantages, because they sometimes make whole villages go off the pill,8221; points out Roychaudhury.

8220;It8217;s fear of cancer that keeps most women away from the pill,8221; says Deka. 8220;The pill does not cause cancer, but the ones distributed by the government 8212; Mala-D and Mala-N 8212; still cannot be given to those with a history of diabetes, jaundice or high blood pressure.8221; More sophisticated are the branded pills being marketed by private companies 8212; Novelom, Femilom and Triqilar, to name a few. 8220;These have such low doses of the benign hormones that they do not affect the lipid profile at all, which makes them completely safe for even those women who suffer from high blood pressure, obesity and high blood sugar,8221; says Deka.

But if the pill is so safe, then why aren8217;t women buying this argument? Mild symptoms like nausea, headache and breast-tenderness may be reported by pill users initially, but this should not give rise to worry. But a visit to the doctor becomes necessary if menstruation does not occur in two cycles while taking the pill, there is severe abdominal or chest pain, swelling and pain in the legs, migraines or giddiness.

Pills should not be taken in the case of:

8220;But the side-effects are small compared to the 100 percent effectiveness of the pill,8221; says Roychaudhury. Voices like his need to be heard urgently, for counselling remains the most effective tool to make women in India see the virtues of the pill.