In 2009, a group of undergraduate collegians made a student film, 'Pill and I'. This 28-minute film traces the path emergency contraception has taken since it was first introduced in India. 'Pill and I' shows the interplay of powerful forces that look at women’s bodies as a battleground for the market. Through reconstructed stories, the film focuses on four student protagonists, three women and one man. The young women share their experiences of using the emergency contraceptive pills (ECPs) regularly, and how this has affected them and their bodies. The male protagonist, on the other hand, even though fully aware of the harmful effects of their repeated use on his girlfriend, does not demonstrate any inclination to use the condom instead.
The film reflects on issues of women’s sexual health and the omnipresence of oral emergency contraceptive pill advertisements, showing, as the synopsis says that “there is lack of awareness about when to consume the pill, contraindications, regimen, side effects and other possible implications. Through candid confessions by users and implications of abuse debated by professionals, the film questions each player’s accountability: the individual, the corporate and the state”.
The film directors asked an official from the Drug Controller General’s of India (DCGI) office for reports about the negative impact of the use of the pill. Vrishnika Singh, one of the directors, revealed that it was shocking to hear from the official that the DCGI had received no reports of this kind. When they interviewed an executive of one of the firms manufacturing ECPs about the lack of responsible advertising, he shrugged the question off saying that while the pill was a “double-edged sword”, it was necessary. Significantly, he was not ready to accept the company’s accountability in providing complete and accurate information to users.
The stories that the film portrays are not imaginary ones, but real-life experiences of young women who are friends and classmates of the five student directors. The unsettling part of 'Pill and I' is that these experiences are not just Delhi-centric. A male student felt that the visibility of the I-Pill on television ensures instant recall for the youth, and its easy availability over the counter made it the first contraceptive choice for them. Another young woman clarified that since there was no mention of the number of times one could safely use the pill, young users did not hesitate to use it regularly.
Kalpana Mehta, a senior women’s rights and health activist, opines, “We have always been against the social marketing of contraceptives because it does nothing to prevent abortions or unwanted births, but subjects women to all kinds of risk. Of course, in certain situations it may benefit some women, like victims of sexual assault … For the government, it is fine as long as women do not have babies.”
In many parts of the world, and especially in the Indian sub-continent, women can very rarely make decisions about which contraceptive to use, when, how many times, and until what age they should use them. They are seldom able to weigh their options, see which one would suit them the best and then, actually go out and get it. Limited availability of product information comes in the way of their making an informed choice about their own reproductive needs. The wide range of contraceptives (like the Copper-T, cervical cap, the contraceptive pill as well as female sterilisation) being offered to women by the market could probably be because they are easier targets. Indian men normally prefer that women do “whatever is necessary” to ensure the right family size as well as provide protection against sexual diseases - and the Indian state seems to back them up.
A report brought out in 2000 by the World Health Organisation’s South-East Asian Regional Office (SEARO), places the contraceptive prevalence rate (CPR) for married women in India at 48.3%. National Family Health Survey-3 (NFHS-3) data indicate that the predominant form of contraception for women is female sterilisation (37.3%), while male sterilisation is a shockingly low 1.0%. The pill and IUD usage for women is 4.8%; while condom usage for men is 5.2%. NFHS-3 statistics do not show contraceptive usage among sexually active unmarried women, so the figures may, at best, be taken as indicative of behaviour patterns of contraceptive use among women.
The controversy around ICs and implants arose in the late 1980’s and early 1990’s. Determined health activists and women’s activists ensured that they were not put into use. However, more than 15 years later, another contraceptive crisis-in-the-making emerged. In August 2007, Cipla Ltd introduced the I-Pill, while Mankind Pharmaceuticals unleashed Unwanted-72 in the market. This was followed by an advertisement blitzkrieg. The ads reiterated that the ECP was useful following unprotected sex, as an emergency contraceptive to prevent pregnancy. The emergency nature of its use has somehow got submerged in the static of it being so accessible “over-the-counter”.
Neither in the publicity nor in the information doled out by the companies, are the contraindications and long-term side effects of the drug mentioned. So potential users have no written information about the risk of cancer or infertility, due to prolonged use of the ECP. On the contrary, the Cipla website
uses the word “safe” several times, saying in no uncertain terms, that the I-Pill has “no long-term or serious side effects”. Nowhere does this website, or the insert in the Unwanted-72 box, mention that the ECP can be used only once a menstrual cycle, i.e. about once a month. The fact that the ECP poses risks of cancer as well as infertility is not even discussed. Dr. Mohan Rao, Professor, Centre of Social Medicine and Community Health, Jawaharlal Nehru University, New Delhi, feels that, “The publicity being generated is a good thing if people get to know that it is an emergency contraceptive and not a routine one. But it is also ill-informed in that other safe contraceptives are not being mentioned at all; condoms are out of it.”
The din created by the medical fraternity and activists about the unethical marketing by pharmaceutical manufacturers resulted in the Union Health Ministry considering a ban on the advertising of ECPs. The move was made on the grounds that the commercials do not conform to the law governing advertisements for drugs under the Drugs and Magic Remedies (Objectionable Advertisements) Act, 1954.
The two main players in the market have currently stopped airing their ads. But some tough questions need to be asked: Why did the aggressive marketing of the ECPs by the pharmaceutical companies not include correct and complete information on health hazards to women?
Why was the implied focus of the advertising on only married women as sexually active (and therefore at risk of getting pregnant), once more leaving out the (not quantified) population of sexually active unmarried women. And what are pharma companies marketing ECPs doing to ensure that messages reach single women about potential risks to their bodies and lives?
While the Drug Controller General of India did pull the ads off the air in late 2009, why did they allow the companies to air them for about two years, without necessary regulations?
Finally, what is the state doing now to ensure that correct messages about the safety concerns of ECPs reach all women users, including those who have no access to the Internet or 1-800 numbers?
The answers to these questions will help consumers understand just how concerned the state is about the health status of its women citizens.