The choice for family planning may get a boost as the government is considering removing the ban on injectable contraceptives. These monthly, bi-monthly and sometimes once-in-three-month injections for women containing synthetic hormones ? progesterone or oestrogen ? are a convenient alternative to other contraceptives such as birth control pills, intrauterine devices and condoms, even though the journey of?introducing injectable contraceptives (ICs)?in various regulated markets, including US, has been scarred with own set of controversies.
Cyclofem, NET-EN and Depo-Provera are some of the popular brands in this category.?ICs may catch the imagination of the Indian mainstream if a pilot project designed by the Indian Council of Medical Research (ICMR) succeeds. According to officials, ICMR has plans to introduce ICs through district hospitals and clinics run by NGOs in a study, which in turn could act as a precursor to introducing injectables through the official family planning programme. If that materialises, it could be a lucrative area for domestic pharma companies. Leading drug firm Sun Pharma has already sought permission to manufacture and market a form of IC suspension from the Drug Controller General of India (DCGI), according to sources.
Currently, 56% of married Indian women in the age group of 15-45 years use some form of contraception, with birth control pill emerging as the most-preferred contraceptive.
?According to a rough estimate, 50% of our clintele who opt for contraception use birth control pills, 30% must be preferring condoms, 20% going in for intrauterine devices and the rest for natural or other means,? says Dr Anuradha Kapoor, head of obstetrics, New Delhi-based Max Super Speciality Hospital.
Kapoor added that ICs are fairly common in West Asia and neighbouring countries, like Pakistan and Bangladesh, as is evident from the experience of medical tourists that Max gets.
However, gynaecologists such as Kapoor and Dr Archana Dhawan Bajaj of Nurture clinic vouch that awareness among Indian women about injectables as a contraception option is already very high. The proportion of women in India who knew about injectables shot up from 19% in 1993 to 52% in 2006, according to the National Family Health Survey (NFHS).
However, expert opinion on whether injectables would?find wide acceptance in India, once the current ban on such products is lifted, differ. Kapoor believes that it will be a hit in India considering its easy-to-comply ? once in a month or once in two months ? schedule.
?Once the notions of long-term effects of such products causing cancer is dispelled effectively and we start prescribing it, surely the product would find many takers for the sheer convenience it offers over other options?. Bajaj however doesn?t fully agree. ?While people from lower economic strata may adopt it, women from middle and upper class may not warm up to it. For the educated woman today, every such fertility control decision making starts with surfing the Net. And these products have been full of controversies. Also, it plays havoc with the cyclicity of menses and is marked by a fairly high failure rate, all of which may deter urban women from picking it up over others,? said Bajaj. However, she feels that the women from lower economic strata, who are averse to using IUDs, may lap it up for the sake of convenience.
Eminent demographer D Kothari votes for including ICs in the official family planning programme, specially so that ? the bottom of the pyramid? can benefit.
NFHS data show that every fifth birth in the country is unplanned or unintended. Roughly, two-third of the unintended pregnancies result from non-use of contraceptives, and around one-third of unintended pregnancies result from the ineffective use of contraceptives.
?The data show that women belonging to low-economic strata have more children than they actually want. The data also indicate that the level of unwanted fertility decreases sharply among women from the lowest economic strata to the women in the wealthiest strata from 1.5 children per woman to 0.3 children per woman.?It means total fertility would drop substantially if their unwanted fertility could be eliminated. And here modern contraceptive methods, especially, effective spacing methods such as ICs could?play an important role,? notes?Kothari.
