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Journalism of Courage
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Of the 50 million conceptions that take place in the country every year, 13 million end up being aborted. No wonder India accounts for almost a fifth of the abortions that take place worldwide. And that’s not all. WHO figures say unsafe abortions account for the death of over 80,000 women, besides causing debilitating illnesses for many more.
If you think these figures are worrying, there’s more. “About 75 per cent of pregnancies that take place in our country are unplanned, but 25 per cent of the women still go ahead with them because they don’t want to go in for an abortion for whatever reason,” points out Dr Suneeta Mittal, Professor, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), and the India representative at the WHO project on emergency contraception.
Mittals says the ignorance and misconceptions about contraception are staggering. “Most people, especially women, are either too embarrassed to ask for contraceptives or think that pregnancy is something that cannot happen to them,” she says. Quite a few who do know about the importance of using contraceptives often end up not using them because they fear side-effects. And those who do use contraceptives, don’t do it properly, leading to unwanted pregnancies.
Morning-after pills to tackle post-coital contraception have not caught on in the country. Their use is simple enough. Called Yuzpe Regimen of emergency contraception, the use of the `morning-after pills’ is based on a modified method of combined oral contraceptive pills which contain an oestrogen and a progestogen. All you need to do is take two of your oral contraceptive pills in the morning and another two 12 hours later. If it is a 30 microgram pill like Mala-T or Mala-D, take four tablets in both doses.
Developed in the ’80s, this method has a failure rate of 3.2 per cent. But there’s some more good news when it comes to post-coital contraception. The Who study — which involved 21 centres across the globe and 1,998 women — found a safer method of emergency contraception involving the use of levonorgestrel. This is effective even when treatment is started 72 hours after unprotected sex.
Says Mittal: “It gives women more time to get oral contraceptive pills and is especially useful for rape victims, who are too traumatised immediately after to give any thought to contraception. And by the time the formalities are through, they have to deal with the trauma of an unwanted child.” In both cases, it was found that the earlier the treatment was started, the more effective it was.
When treatment was started within 24 hours, 95 per cent pregnancies were prevented using the levonorgestrel method, as compared to the 77 per cent using the Yuzpe Method. After 48 hours, however, levonorgestrel, was found to be more effective in preventing pregnancies in 60 per cent of the cases as compared to 38 per cent of the Yuzpe Method.
“Not only is this method completely safe but the single-dose administration of the full medication makes adopting it easier. What’s more, the levonorgestrel regimen is better tolerated and more effective than the hormonal emergency contraception currently in use,” says Mittal. Yuzpe regimen may cause mild nausea in about 50 per cent of women, whereas only 25 per cent of women using the levonorgestrel method report it. While vomiting was reported in about 22.4 per cent of women using the Yuzpe regimen, it occurred in only 6 per cent of those taking levonorgestrel.
While condoms remain the most popular method of contraception in India, Copper-T is the most popular method among women. Oral contraception has not caught on, probably because many women fear side-effects or find taking a pill daily too cumbersome. “Contraception coverage in our country is very poor, and if this new pill is marketed aggressively, it will save many women the physical and mental trauma of resorting to abortion,” says Mittal.
The new levonorgestrel pill will be available over-the-counter in the country next year and is expected to be priced at a low Rs 2. And given its low failure rate — percentage of women who conceive in spite of taking treatment — is a low 1.1 per cent, women have a lot to look forward to.
