With best wishes and regards,
Rekha Pande

Choosing a harmful contraceptive is no choice

Women in India, we are told, are now fortunate. Their 'basket of
contraceptive choices' has been enlarged - with the introduction of
injectables like Depo Provera and Net En. Both progestin-only hormonal
contraceptives, these injectables have a long-lasting effect, Depo Provera
for three months and Net Ne for two. One of the face of it, they seem ideal:
a shot in the arm to keep pregnancy at bay. Why is it then that women's
group are vociferously protesting against the health minister's proposal to
introduce Net En on a trial basis through 12 medical colleges around the
country ?
These injectables contraceptives have serious short-term and long-term side
effects. Yet problems such as amenorrhoea (absence of menstruation),
irregular bleeding, generalized weakness, migraine and severe abdominal
camps have been considered to be "non-serious" by pharmaceutical companies
promoting these products. But from a woman's viewpoint these side-effects
could hamper daily activities and seriously affect well-being.
While the implications of blood loss in an already anemic population are
serious, experts have point out that menstrual cycle patterns may be a
fundamental determinant of women's health status and that alterations in
menstrual function may influence many disease processes, including the
natural resistance to metastatic spread. Similarly, amenorrhoea or absence
of periods is not 'harmless', but a serious medical factor causing
endometrial atrophy, which could have a bearing on a woman's future
fertility status, which is a serious drawback in a contraceptive promoted as
a spacing method. Yet manufacturers as well as health ministry official are
choosing to play down these adverse effects and counsel woman into accepting

In addition, Depo Provera has the potential side-effect of loss of bone
density and a risk of osteoporosis  - which is of great significance in
India where bone density among women in already is already low.  Further,
the cancer risk of these contraceptives has not been adequately studies,
though studies show that an increase risk of breast cancer, especially among
younger women, cannot be ruled out. In any case, the administration of
long-acting hormonal contraceptives require the ruling out on
contra-indications like heart disease, clotting disorders, liver
dysfunction, early pregnancy, diabetes, etc. through tests which require
sophisticated equipment and diagnosis.
The appalling state of the healthcare infrastructure, the meager increases
in the budget allocations to health, bring into question the quality of care
given to the users of potentially hazardous contraceptives. The potential
for abuse of injectable contraceptives is also very high in the
target-oriented government population control programmes. There is the
possibility of the contraceptive being administered without the knowledge of
the woman. Further, given that women do have a genuine need for effective
contraception, they may "accept" the injectable if only the aspect of
convenience is highlighted. It was this gross violation of the norms of
informed consent that led women's groups in 1986 to file a petition against
the government in the Supreme Court on behalf of peasant women from AP.
Informed consent, the hallmark of the much-touted 'choice', which is
supposedly being increased by the introduction of injectables, continues to
be absent in the India health care system. Although the National Population
Policy (NPP) is committed to 'voluntary and informed choice', the policies
of several state governments violate the letter and spirit of the NPP by
proposing harsh disincentives for those with more than two children.
'Reproductive rights' cannot be asserted in isolation. Certainly women have
the right to choose but with complete awareness of the risks involved. When
'choice is guided by a population control lobby, backed by the sophisticated
marketing strategies of the pharmaceutical lobby, it should be viewed with
Source: Indian Express. 20 July, 2001.p.8

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