The definition of emergency

Pallavi Barnwal
Wednesday, 18 April 2018

I-pill, widely advertised as an emergency contraceptive pill is being used by many young girls as an alternative to regular contraception, thanks to poor awareness levels and taboos

One thing all women dread is an unwanted pregnancy which has a delirious impact on the biological and psychological state of a female. The prospect of getting an abortion (medicinal or surgical) is nerve-racking. And thus the discovery of the I-pill seems like a blessing. But is it?

Study indicates that there are a lot of myths about birth control pills, leading to their no or lesser use. The usage of birth control pills in the rest of the world is 35 per cent, while in India it is a meagre three per cent. Most women think that the 21-pill regime will lead to hormonal problems, increase in body weight, acne, and facial hair. A single dose of I-pill seems much safer to take than two dozen birth control pills. Most women link the dosage to the tablet size, but they do not know that the dosage of Levonorgestrel used in I-pill (1.5 mg) is 50 times higher than that present in single birth control pill. Which means in one go you are popping in 50 pills.

I-pill, Unwanted 72 is an emergency contraceptive pill. But couples have taken to it as a regular, routine measure. What they don’t understand is that it is called emergency for a reason. An emergency is when you are using a regular method of contraception and it has failed, like condom slippage, condom breakage, IUD expel, a forgotten dose of regular pill, or a sexual assault. It is like calling the cops, calling a fire brigade. You don’t do that every month.

I-pill increases the likelihood of unprotected sex behaviour among couples. Further, persuasive attempts by men to encourage women to use I-pill is also found as men feel it’s easier for women to use the I-pill than men using a condom. For women who are not in monogamous relations, it exposes them to sexually transmitted fatal infections like HIV, Syphilis, HBsAg, Gonorrhea. Dr Divya Sudarshan, gynaecologist, obstetrician, and sexologist, Hyderabad states, “If you are not using a condom, it is as good as sleeping with every person your partner has slept with before.”

I-pill can lead to ectopic pregnancies, which is life threatening and needs surgical intervention. Here is how it happens. The fertilisation takes place in the tube and after that pregnancy moves and falls into the uterus. So, when I-pill cannot stop fertilisation, it reduces the tubal motility and hence the embryo gets implanted in the tube which can lead to tubal rupture.

These days, some school girls are sexually active too. Since there is a taboo associated with pre-marital, underage sex, these girls have no one to seek advice from. They cannot talk to their parents, or the doctor. So the only information they get is from the internet which is hardly reliable.

The marketing information provided is not complete with regard to the use of I-pill. A survey of 50 chemist shops indicated that in only 28 per cent shops, birth control pills sell more than I-pill. There is also a wider advertisement of I-pill compared to a birth control pill.

Dr Sudarshan says, “Nobody has ever used it, the way it has been used in India. There are studies in China which state that plan B is not effective because Chinese women tend to be fertile. That’s the reason why India and China top the population chart. It is not that we have higher sex prevalence than the rest of the world. It is called fecundity of a nation, the capacity to get pregnant. So we have to be smarter about managing it.”

One of the reasons for the misuse of pill is also its affordability. An emergency contraceptive pill in the US will cost you anywhere between USD 75 to 60. In UK it costs you around 25 pounds. In India it costs you Rs 80-150. “Abroad, they never use the trade name of a product. They will say ‘a progesterone only pill’, ‘a levonorgestrel pill’. But here we say I-pill. Now the patient has registered I-pill in their mind and they will just google it,” she adds.

Dr Anjali Kumar, director, Gynecology & Obstetrics, Artemis Hospital, Gurgaon, says that the biggest side effect of the emergency pill is the failure of it, which means a woman can still get pregnant. Emergency contraceptive pills have a much higher failure rate in a clinical scenario (20-30 per cent) than condom which is 3-4 per cent.

The solution is in education. “It’s high time sex education is taught in schools and colleges. There should be an open discussion with an expert. Talking about contraception is not a licence to have random sex. Contraception is important, and I feel essential information is necessary,” says Dr Meenakshi Ahuja, director, Obstetrics & Gynecology, Fortis La Femme, Delhi.

It is very important to spread sexual health and contraceptive awareness among all youth from the time they enter puberty. Education, before a doctor, must start at home from the mother, then at the school. Girls need to be explained in a very mature, responsible, non-judgemental manner that it is okay to talk about these issues.

(Pallavi Barnwal is a single mother, writer and 
a social change champion, Startup Leadership Program (SLP) fellow)

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