Health Dilemmas of 2010

By HARSHA CHAWLA

# 1 THE i- pill

The Product: Available over the counter, emergency contraceptive pills such as the i- pill or UNWANTED- 72 are useful after an episode of unprotected sex. They are intended specifically for an emergency, should be taken as early as possible after unprotected sex and don't work after 72 hours. India sells about 8.2 emergency contraceptive pills every year.

The Controversy: The first controversy arose when an NGO Krupa Prolifers filed a petition early this year to bar over the counter sales of the i- pill, claiming it was being misused by women to induce abortions.

Issues of morality were also raised. Cipla's defence against the i- pill being labelled an 'abortion pill' was that life didn't begin at the time of fertilisation (which is when the pill acts) but only later during implantation. The second controversy involved the Drug Controller General which banned advertising for all emergency contraceptives in January 2010, following concerns raised by activist groups that such ads promote the use of emergency pills as a regular contraceptive and that women are popping them on a regular basis after unprotected sex.

Ground Reality: The morning after pill is an 'emergency' contraceptive, and makes it much less likely that you will get pregnant if it is taken within the first 48 hours after an episode of unprotected sex. It should not be used in place of a regular contraceptive as it certainly isn't as effective. Nor does it offer protection against sexually transmitted infections such as HIV. Emergency contraceptives are not the same as abortion pills, as they work before the pregnancy begins, not after it has taken place.

Current Status: The pills are available over the counter and adverts are back on air.

Our take

In an imperfect world, sex isn't always consensual and pregnancies are often unintended.

Emergency contraception is essential in certain circumstances, and
anyone buying this pill should have information on how to take it ( not
more than twice a month), its side effects and the difference between
this, oral contraceptives and the abortion pill.

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# 2 HPV VACCINE

The Product: Human papillomavirus (HPV) vaccines namely Gardasil and Cervarix have received FDA approval after testing on thousands of females.

When the injection is given to a woman, pre- puberty, this is supposed to confer protection against cervical cancer, the second- leading cause of cancer deaths in developing countries.

The vaccine prevents cancer that develops as a result of infections from two strains of HPV ( 16 and 18), responsible for 70 per cent of cervical cancer.

The Controversy: FDA approval and clinical trials on thousands of women haven't rescued the HPV vaccine from controversies on its adverse side effects and misleading marketing campaigns. A few months back the central government halted the pilot project to vaccinate 30, 000 young girls in poor regions of Andhra Pradesh and Gujarat after 4 deaths were reported after the administration of the vaccine. Also, one of the manufacturers of the vaccine GlaxoSmithKline was accused for misleading advertising by claiming its vaccine was a foolproof method of prevention against cervical cancer.

Ground Reality: Cervical cancer is the most common cancer among women in India. Those in rural areas are more vulnerable to it as they live in unhygienic conditions, lack access to contraceptive and undergo unsafe abortions, and have lowered immunity.

Though HPV virus is one of the causes of cervical cancer, just getting vaccinated against it isn't enough. " The vaccine protects you from two strains of HPV. However, there are about 20 more high risk viruses for which this vaccine doesn't work," says Dr S K Das, gynaecological oncologist, Action Cancer Hospital. The vaccine offers protection only for five years and women would need booster doses.

Current Status: The interim report by the four member committee said that the deaths of four girls in the state of Andhra Pradesh are ' most probably unrelated to the vaccine'. The report says that the trial conducted by the NGO PATH didn't flout any guidelines as accused by CPI( M) member Brinda Karat.

Our take

Women with daughters should ensure they get a HPV vaccination on time.

In addition, they should provide sex education to their girls; educate
them about HPV and also how they can reduce their chances of acquiring
this by using protection.

Women above 30 should ensure that they get a pap smear every five years.

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# 3 DEPO-PROVERA

The Product: Like the birthcontrol pill, the injectable contraceptive Depo- Provera works by disrupting the female hormonal cycle that normally leads to ovulation. The injectable is a synthetic version of the hormone progesterone, similar to one of the two main ingredients of the birth control pill. It does not, however, contain estrogen, and therefore does not seem to share the most serious drawbacks of the Pill.

The Controversy: Though Depo- Provera made its way into the country fifteen years ago and has been available in the private sector, the proposal to introduce it on a large scale in public sector was withdrawn at that time due to the protests of women's groups. Recently, it made the news again, as the health ministry are reconsidering making it part of the nationwide family planning programme. A few weeks back CPI( M) member Brinda Karat wrote to the health minister expressing her concerns over this proposed move. She, along with other women's groups, alleges that this is a damaging and invasive hormonal contraceptive.

Ground Reality: Every contraceptive has side effects, be it the pill, IUD or injectable.

Depo-Provera causes changes in the bleeding pattern of usersthese include cessation of the menses as well as random episodes of bleeding during the month. But these can be kept in check. "A person can die of an insulin shot but not from an injectable contraceptive," says Dr Jyoti Vajpayee, special health advisor, Population Services International.

Depo-Provera was approved by the US FDA in 1992 after much controversy.

Today this and other injectable contraceptives are used by women in over 90 countries, and could eventually be a blessing for women in rural India who often die in repeated childbirth or due to unsafe abortion. "If community health centres in India can equip themselves to do safe deliveries then providing injectables is easy enough," says P S Chandrashekar, consultant, reproductive health.

Current Status: It has still not been introduced into the public health system.

Our take

Women should be provided as many contraceptive options as possible including the injectable.

This offers them the opportunity to make an informed choice. An
effective and functional healthcare system is essential for both the
delivery and follow- up of injectables, so their use is best confined to
urban areas.

*************************************

Reproduced From Mail Today. Copyright 2010. MTNPL. All rights reserved.

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