Pill Bug

Each such tablet contains 1,500 mcg of levonorgestrel, a synthetic hormone.

• Statutory warning: Use only in emergency situations, not as substitute for condoms or low-dose oral contraceptives. Does not prevent sexually transmitted diseases such as AIDS.
• Possible side-effects: Vomiting, nausea, fatigue, abdominal pain, diarrhoea, dizziness, headache, breast tenderness, early or late onset of next period, increased menstrual bleeding and vaginal haemorrhage. Some women might suffer ectopic pregnancy.
• Failure Rate: 95% effective if taken within 24 hours of intercourse, 85% if taken within 25-48 hours; 58% if taken after 49 but before 72 hours. If used mid-menstrual cycle, one in every 20 women is likely to conceive.
• Precaution: Use barrier methods such as condoms for three weeks. If period does not start, then the possibility of ectopic pregnancy or toxicity to the foetus needs to be assessed.

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Avantika’s mother, like many others, was perhaps influenced by the recent spate of TV advertisements for emergency contraceptive pills. “The fact that these pills are readily available in a chemist’s store and that you don’t need a prescription to buy them,” says Avantika, “is a sure sign that we’re finally becoming a progressive society.” Sales are another marker of this increased permissiveness. For the year ending June 2009, ACNielsen valued the emergency contraceptive segment at Rs 77 crore with a 245 per cent growth in volume. Figures provided by the Pharmaceutical Wholesalers Association show that stockists of these pills estimate a 63 per cent growth in value. For the year ending August 2009, the association says that Cipla’s i-pill cornered a whopping 65 per cent marketshare, grossing Rs 42 crore, while Mankind Pharma’s Unwanted 72 raked in Rs 27 crore.

Perhaps encouraged by the success of the emergency pills, the Drug Technical Advisory Board in its November 9 meeting decided they will continue to be sold over the counter. The board, however, asked for an expert committee to be set up to determine how best these pills should be advertised.

This decision could perhaps offer some solace to the growing number of individuals—including gynaecologists and physicians—who are raising voices of alarm at the indiscriminate blitz of ads on TV for such pills.

The ad for Cipla’s i-pill, for instance, shows a young girl terrified at the thought of entering an abortion clinic. TV spots grabbed by Mankind Pharma’s Unwanted 72 have Bigg Boss contestants Tanaaz and Bakhtiyar Irani claiming to be “tension free” after using the contraceptive.

The constant advertising bombardment, detractors argue, is convincing the youth that the emergency contraceptive pill can be used as a substitute for condoms, that pregnancy and not sexually transmitted diseases should be their main worry, and that these morning-after pills have no side-effects.

“What makes these ads particularly alarming,” says gynaecologist and obstetrician Dr Tripat Choudhary, is that “they appear to be a panacea for all ills”. She cites the example of a young patient who had taken three morning-after pills over the last one-and-a half months and was still pregnant. “Why don’t these ads also say that these pills have a high failure rate?” asks the senior consultant at Fortis La Femme. Calling for a ban on all such advertisements, she says it’s the Indian mother who should ensure that “her daughter has access to regular methods of contraception such as The Pill (Combined Oral Contraceptive Pill) and doesn’t have to rely on drugs that could have very severe side-effects”.

That the emergency pill is not entirely foolproof, Dipti Sharma (name changed), a second-year student at Delhi University, learned the hard way. Also lured by the TV ads for morning-after pills, she bought herself a couple the night she decided to end her virginity. The decision not to use a condom was a premeditated one. “I took a pill within 12 hours of the event,” says Dipti. However, her worst fears started coming alive when she did not have her period on time. Embarrassed to go to a doctor, Dipti bought herself some home pregnancy tests, and was temporarily relieved to find that her worries were unfounded. “But I could only breathe easy after I started to menstruate. I was four days late, and I’m usually never late.” Chastised by the experience, Dipti says, “I know all’s well that ends well, but I’d say that if you’re doing it for the first time, spare yourself the agony and use a condom.”

A condom is exactly what Nayanika Basu’s (name changed) boyfriend wanted to avoid. “He said I could just pop a morning-after pill,” says the media professional. “Suddenly the onus of contraception shifted on to me. I ended up taking four pills a month, sending my menstrual cycle into an irreversible flux. I was bleeding when I shouldn’t have been, and vomiting often.” Nayanika finally ended her relationship a few weeks ago. “It wasn’t the only reason,” she says, “but I think my decision not to take the pills had a role to play in our break-up.”

“The easy availability of such drugs provides men the ready excuse not to use a condom,” says Sunita Menon, director (education) of human rights organisation Breakthrough. But then, she adds, “it is also a matter of people’s perception. A woman could just as easily feel liberated and able to take charge for once. The pill can be helpful, especially when she’s been a victim of forcible sex.”

An argument Cipla’s joint MD Amar Lulla too echoes in defence of the i-pill. “Every woman,” he says, “has the moral and legal right to avoid an unplanned pregnancy. Having realised that the uptake of emergency contraceptive pills was very low since its introduction in 2002, the government, through the Directorate General of Health Services, permitted us to advertise the i-pill in March 2007.”

What is needed, however, says Sunita Menon, is “the creation of greater awareness”. Lulla says their ads clearly communicate that the i-pill is to be used only as an emergency measure and not as a substitute for regular contraception. “The lady in one of our ads,” he says, “very clearly expresses her concern and angst when she asks the caller, ‘Koi protection bina (without any protection)?’.” Cipla also has an emergency helpline and a dedicated website to answer FAQs. Mankind Pharma points to the extensive leaflet it hands out with the Unwanted 72 pack.

The next time you get swayed by the emergency pill ad, do ensure your morning-after cure-all doesn’t turn into a day-after nightmare.