Plenty, But not Enough
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.
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