Ground Report: Pros And Cons Of The Move To Launch Monthly Contraceptive Shot

An expert group in the Health Ministry has approved a contraceptive shot that can be given every month to women wanting to avoid unwanted pregnancy. The injectable shot is a fixed dose combination (FDC) of synthetic oestrogen, progesterone, medroxyprogesterone 25 mg and estradiol cypionate 5 mg injection.

In August 1989, a combination of oestrogen and progesterone was banned by the central government. But last year, an expert group headed by the Indian Council of Medical Research (ICMR) Director-General Dr Soumya Swaminathan, daughter of eminent agricultural scientists Dr M S Swaminathan, recommended to the Drug Controller General of India to remove the ban on combined contraceptive that had oestrogen and progesterone. The objective was to make the contraceptive commercially available.

In March this year, the Directorate General of Health Services set up a sub-panel headed by Dr Nilima Kshirsagar, national chair in clinical pharmacology at ICMR, to examine if the Centre could lift the ban on the contraceptive, popularly known as Cyclofem.

The Drugs Technical Advisory Board at is meeting on 29 November took up the issue of lifting the ban. A note circulated for the meeting said that Kshirsagar panel had concluded that the injectable FDC was safe and efficient.

The FDC has been approved for marketing, and is in use in several countries, while the contraceptive has been included in the list of essential medicines by the World Health Organisation last year.

Since the FDC has never been sold in the country, it was decided to treat it as a new drug according to the provisions of the Drugs and Cosmetics Rules, 1945. On its part, the board had examined the report and agreed to accept the Kshirsagar panel recommendation.

However, the move has led to some uneasiness among those working in the women’s health and family welfare sectors. An expert, working in the sector not wishing to be identified, expressed concern that the responsibility of family planning was again being thrust on women, instead of roping in men too.

A women’s consortium in Minnesota, US, vehemently criticises making birth control methods exclusive for women. It says that women are more likely to pay for these birth control solutions as they are not cheap, pointing out that women earn less than men.

In addition, the consortium says that such birth control methods have side effects, especially leading to nausea and weight gain. Adopting birth control methods also attract certain social stigma in some communities, and women often are forced to face the wrath.

An expert in family welfare says that these issues are often not the focal point since the government’s objective is to control population. In India, the men are taken into confidence on these birth control measures, though things are totally different in the case of commercial sex workers (CSW).

The expert also points out at the National Family Health Survey 2018 that indicates female sterilisation is still the most popular contraceptive method. This has paid dividends right from the beginning when the Indian government introduced family planning.

Critics of the contraceptive shot point out that it has side effects such as irregular menstrual periods - longer or shorter, loss of such periods, headaches, breast pain and weight gain.

Advocating Reproductive Choices (ARV) national task force - a coalition of organisations and individuals working in sexual and reproductive health - on expanding contraceptive choices says that 66 per cent to 82 per cent women have continued to use Cyclofem. While 7 per cent of the users discontinued due to bleeding abnormalities, 2 per cent stopped due to missed periods.

ARV had conducted clinical trials, which proved to be totally effective. The trials also showed that 89 per cent of women who took the contraceptive became pregnant when they wanted to go in for a child. The trials also showed that 60 per cent of the users found it to be a better contraceptive alternative.

Studies elsewhere in countries like Mexico have also showed Cyclofem to be acceptable, safe and successful. The Mexico study showed that the contraceptive method is highly effective, a reason why the Indian government is looking at this option.

However, there is another area of concern that seems to be left unaddressed or unattended by the authorities. This is exposing women to the risk of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) besides sexually transmitted diseases (STDs).

Critics of the contraceptive shot say that this could discourage or lead to disuse of condoms by men, thus putting women at the risk of HIV/AIDS or STDs, in case they have multiple partners.

The National Family Health Survey 2018 reported that in 2017 only 48 per cent of the men who confessed of having paid sex, used condoms. According to the study, at least 72 per cent of those in the 15-19 age group had high-risk sex with 10 per cent of them having multiple partners.

The survey showed that HIV prevalence among women and men in 15-49 age groups decreased between 2005-06 and 2015-16 from 0.28 per cent to 0.24 per cent.

However, the decline is due to a decrease in HIV prevalence among men, from 0.36 per cent to 0.25 per cent while among women it was up a tad 0.23 per cent from 0.22 per cent.

Professor Janet P Hapgood, a professor of molecular and cell biology at University of Cape Town, South Africa, in an interview to Women’s Health said necessary precautions have to be taken against HIV and other STDs, which has to be interpreted as condom use.

Shelving the use of condom by someone because he/she was using another contraceptive method is no guarantee to be free from HIV/AIDS risk. Hapgood says: “No contraceptive method protects from contracting HIV.”

However, this issue doesn’t seem to have caught the eye of officials and administrators. The family welfare expert says that before introducing the contraceptive shot, the government could well carry out a campaign on risk-free sex through use of condoms.