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 them. 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 caution. ---------------------------------------------------------------- Source: Indian Express. 20 July, 2001.p.8 This is GainsNet, the mailing list of the UN-INSTRAW-GAINS Network Members. To reply to the GainsNet group, click on "reply all" To reply to an individual, click on "reply" To unsubscribe from GainsNet, send an email to [EMAIL PROTECTED] with the word "unsubscribe" in the subject line
