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Health
Plenty, But not Enough
by Kavita Devgan
When the Pill
arrived in the world market in the 1960s, birth control was
revolutionized. Since then, a variety of contraceptives - patches,
pills, injections and insertions - have appeared in the market, offering
a choice to the women who don't want to get pregnant. In fact, there is
almost a glut of female contraceptives.
In India, the market is small and slow: Most new contraceptives
(considered safer) are not available in India. Take the new hormonal
pill Yasmin - the pill has a new kind of progesterone which
prevents bloating and irritability. This pill gives shorter, lighter
periods, reduced cramps and a regular cycle. It also reduces the risk of
endometrial (the mucous membrane lining the uterus) cancer and ovarian
cysts. Its manufacturers claim that women, who so far have not done well
with other pills, are likely to respond well to this one.
But Yasmin is not available in India, although a similar pill,
Cerazette - which has only progesterone - is now freely available.
"This is a good option for women who cannot or should not use pills
containing estrogen, because of its side effects - like bloating, weight
gain, breast tenderness and nausea - or because they are
breast-feeding," says Dr Sunita Varma, Senior Consultant, Obstetrics and
Gynecology, Max Healthcare, New Delhi.
Seasonale, better known as 'the no period pill', is not available
in India yet. "Seasonale has a 91-day oral contraceptive regimen,
which gives a woman only four periods a year. Tablets containing the
active hormones are taken for 12 weeks (84 days), followed by a week of
placebo (inactive) tablets. Conventional oral contraceptive use is based
on a 28-day regimen (21 days of active tablets followed by seven days of
placebo tablets). It contains both progestin (similar to progesterone)
and estrogen, active ingredients in already approved oral
contraceptives," explains Varma. "It is also very effective in keeping
endometriosis (a chronic, painful disease which causes excessive
bleeding during periods), in check," she adds.
Dr Dolly Marya, Senior consultant, Obstetrics and Gynecology, Mohinder
Hospital, New Delhi, cautions: "Most contraceptives with progesterone
only - including Cerazette - tend to cause irregular bleeding, and later
ammenoria (cessation of periods). Women need to be counselled about all
these effects."
Increasingly, women in several countries are switching over to
contraceptive patches. These are popular among women who don't like the
Pill, or are forgetful about taking them regularly. A popular brand is
the Ortho Evra patch, also available in India. "The patch is applied on
the skin through which the hormones are absorbed," explains Marya. "But
these don't work very well in the Indian climate. Due to excessive heat,
there is abnormal loss of water from the skin, which prevents uniform
absorption of the hormone through the skin. We definitely prefer a
uniform dosage of birth control hormones," she warns.
Some experts say that the new contraceptive ring - NuvaRing - is
expected to do well in India. NuvaRing is a little ring placed
inside the vagina once a month. The ring is kept inside for three weeks
and is removed in the fourth week for menstruation to begin. A new ring
(US$ 30 per ring) is used each month.
NuvaRing, developed by Organon, Inc, is a non-biodegradable,
flexible, colorless ring made up of a polymer of ethylene vinyl acetate
and magnesium stearate (chemicals considered safe for the body). The
ring releases a certain amount of hormones every day. "The ring is
available easily in India and is a good option," says Marya. She
cautions: "The ring is suitable only for women who understand their
anatomy well and are willing to learn how to use it properly. Besides,
it is a little expensive and some women are not too comfortable wearing
it."
Interestingly, one of the earliest contraceptives to come to the Indian
market was an injectable contraceptive - Depo Provera. However,
since its arrival, it has been mired in controversies. Several women
activists in India have demanded its ban, raising concerns about its
side effects - menstrual irregularities, increased risk of breast
cancer, depression and osteoporosis.
Injectables have a different hormonal composition and are good for
feeding mothers. They are usually given in the first five weeks after
the delivery, as this doesn't alter the milk composition. These
injectables need to be taken every three months.
Despite strong objections, the Indian government has included Depo
Provera in its family planning programmes.
Women in India have also experimented with intrauterine devices (IUDs).
A recently introduced device in India is Mirena. "It's basically
like a progesterone-coated IUD that protects against pregnancy for five
years. It is a T-shaped intrauterine device, which contains a progestin
reservoir. It is inserted in the uterus where it releases small amounts
of hormone continuously for up to five years," explains Marya.
"Mirena is a suitable method for women who want an effective,
low-dose long-term contraceptive. It is particularly suitable for women
who don't want to have children for some time. In addition to its
contraceptive action, it is also suitable for treatment of excessively
heavy and painful periods. This costs about Rs 7,000 (1US$=Rs 45)," adds
Marya. According to Marya, busy women who want a one-shot solution and
are willing to pay this amount opt for this device.
Obviously, the contraceptives market in India is largely confined to
metros. Most new contraceptives are expensive and not easily available.
There is little knowledge about the long-term side-effects of some of
them. Doctors believe that once women in India become more aware of
different birth control systems, they will demand more affordable
choices.
May 7, 2006
By arrangement with
Women's Feature Service
Top
| Health
The Week of May 7, 2006
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by Rajinder Puri
Releasing Masood Azhar was a Political Decision
by MH Ahsan
Extinction of Democracies and The Irish Elk by
Gaurang Bhatt, MD
Bhutan: India's Trusted Strategic Friend and
Ally in South Asia by Dr. Subhash Kapila
What is the Solution to the Kashmir Imbroglio
by TA Ramesh
Natural Disaster: A Concern for Security by
VK Joshi
High on Grass by Chitra Balasubramaniam
Look Around You by Naira Yaqoob
An Indian Summer by Dr. Prasenjit Maiti
The Question of Truth and Yogic Practice by
Ashish Nangia
Myths in Jyotish by Rohiniranjan
The Fairy Tale Code by Kelley Bell
Make Travel Fun for your Little One by
Garima Gupta
A Passionate Cry for Human Dignity by V.
Sundaram
Never Victorious, Never Defeated A Book
Review by Amreeta Sen
Bankim's Krishna-Charita : Some Observations
by Major Gen. Shekhar Sen, VSM
VPN : An Introduction by Ruchi
Gupta
The Witty Side by Melvin Durai
O Cancer: I am a Fighter Too by Ravi Pipal
My Mother : A Cup of Wonder by Dhiraj Bhimji
Raniga
Suseela a short story by NS Murty
Divorce a short story by Vikram Karve
Naushad : End of an Era by Ramendra Kumar
Interview with Emraan Hashmi and Shiney Ahuja by
MH Ahsan
To be Single and a Mother by Karina Araos
Plenty but not
Enough by Kavita Devgan
Ayurveda as a Career by Pallavi Bhattacharya
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