Last month, the government announced its intention to introduce an injectable contraceptive for women into the national family planning programme, in disregard of the many opposing voices.
As per news reports, the Union health ministry hopes to add the Depot Medroxyprogesterone Acetate-based injectable contraceptive to its kitty of free-of-cost birth control services such as female sterilisation, intrauterine device, condoms, male sterilisation and pills. The government decision overlooks a number of concerns.
In the shambles of our public health services, which are stricken by budget cuts and resource crunch, offering a controversial form of birth control to poor women in mofussil towns and villages that lack basic health services is both dangerous and wasteful.
Besides, the injectable drug, better known by its brand name Depo-Provera, is not without risks.
Adverse health effects
A progesterone-based hormonal contraceptive, Depo-Provera suppresses ovulation for three-month intervals. Its intra-muscular shot is associated with a number of adverse health effects, including menstrual irregularities (such as bleeding or spotting), abdominal pain, weight gain, dizziness, headache, nervousness and loss of libido. Apart from this, it is also associated with an elevated risk of breast cancer, and an increased risk of HIV acquisition. The drug's American manufacturer, Pfizer Inc., has had to place a black box warning on Depo-Provera’s label cautioning about “significant bone mineral density loss”.
The World Health Organization’s 2012 technical statement on hormonal contraception and HIV recommended that “because of the inconclusive nature of the body of evidence on possible increased risk of HIV acquisition, women using progestogen-only injectable contraception should be strongly advised to also always use condoms, male or female, and other HIV preventive measures”.
The same year, an Indian study published by the non-profit Population Council found that “Following discontinuation of injectable contraceptive use, about three in ten women switched immediately to another contraceptive method, a similar proportion switched to another method (including those who switched back to injectable contraceptives) after a gap of one to three months…” Although the report recommends Depo, it notes that “…more than four in five women who adopted injectable contraceptives had experienced at least one side effect, largely menstrual disturbances or backache, weakness and weight gain”.
Opposition from many groups
The Indian government’s attempt to introduce the drug is not new, nor is the opposition to it from health and women’s groups. As far back as on February 16, 1995, at a meeting of India’s top advisory body on health, the Drug Technical Advisory Body, it was decided that “Depo-Provera is not recommended for inclusion in the Family Planning Programme”. Members agreed for continued private marketing of Depo-Provera injection, but rejected its inclusion in the Family Planning Programme.
Dr NH Antia, one of the members of the advisory body during that period, argued against DMPA's inclusion, saying that “the target-based approach of the government program may lead public health personnel to impose DMPA on women without checking for contra indications and without explaining properly other possible hazards including permanent sterility. The health of the DMPA user has to be monitored to watch for the array of disturbing side effects of DMPA. The Indian public health system is too inadequate, inefficient and indifferent to do this work properly”. All these reasons hold good even today, yet the Drug Technical Advisory Body has approved DMPA.
Till there is substantive research that establishes the safety of the drug, we believe it would be wrong to subject women across the country to the drug. Besides, the drug reinforces entrenched gender roles where women are responsible for contraception, not men. Given women’s experiences of the drug as well as the sorry state of our healthcare services, the decision to introduce DMPA in the family planning programme could be ill-advised. Before it does any harm, the government should review its decision.
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As per news reports, the Union health ministry hopes to add the Depot Medroxyprogesterone Acetate-based injectable contraceptive to its kitty of free-of-cost birth control services such as female sterilisation, intrauterine device, condoms, male sterilisation and pills. The government decision overlooks a number of concerns.
In the shambles of our public health services, which are stricken by budget cuts and resource crunch, offering a controversial form of birth control to poor women in mofussil towns and villages that lack basic health services is both dangerous and wasteful.
Besides, the injectable drug, better known by its brand name Depo-Provera, is not without risks.
Adverse health effects
A progesterone-based hormonal contraceptive, Depo-Provera suppresses ovulation for three-month intervals. Its intra-muscular shot is associated with a number of adverse health effects, including menstrual irregularities (such as bleeding or spotting), abdominal pain, weight gain, dizziness, headache, nervousness and loss of libido. Apart from this, it is also associated with an elevated risk of breast cancer, and an increased risk of HIV acquisition. The drug's American manufacturer, Pfizer Inc., has had to place a black box warning on Depo-Provera’s label cautioning about “significant bone mineral density loss”.
The World Health Organization’s 2012 technical statement on hormonal contraception and HIV recommended that “because of the inconclusive nature of the body of evidence on possible increased risk of HIV acquisition, women using progestogen-only injectable contraception should be strongly advised to also always use condoms, male or female, and other HIV preventive measures”.
The same year, an Indian study published by the non-profit Population Council found that “Following discontinuation of injectable contraceptive use, about three in ten women switched immediately to another contraceptive method, a similar proportion switched to another method (including those who switched back to injectable contraceptives) after a gap of one to three months…” Although the report recommends Depo, it notes that “…more than four in five women who adopted injectable contraceptives had experienced at least one side effect, largely menstrual disturbances or backache, weakness and weight gain”.
Opposition from many groups
The Indian government’s attempt to introduce the drug is not new, nor is the opposition to it from health and women’s groups. As far back as on February 16, 1995, at a meeting of India’s top advisory body on health, the Drug Technical Advisory Body, it was decided that “Depo-Provera is not recommended for inclusion in the Family Planning Programme”. Members agreed for continued private marketing of Depo-Provera injection, but rejected its inclusion in the Family Planning Programme.
Dr NH Antia, one of the members of the advisory body during that period, argued against DMPA's inclusion, saying that “the target-based approach of the government program may lead public health personnel to impose DMPA on women without checking for contra indications and without explaining properly other possible hazards including permanent sterility. The health of the DMPA user has to be monitored to watch for the array of disturbing side effects of DMPA. The Indian public health system is too inadequate, inefficient and indifferent to do this work properly”. All these reasons hold good even today, yet the Drug Technical Advisory Body has approved DMPA.
Till there is substantive research that establishes the safety of the drug, we believe it would be wrong to subject women across the country to the drug. Besides, the drug reinforces entrenched gender roles where women are responsible for contraception, not men. Given women’s experiences of the drug as well as the sorry state of our healthcare services, the decision to introduce DMPA in the family planning programme could be ill-advised. Before it does any harm, the government should review its decision.