- The government is set to introduce injectable contraceptives for women in district hospitals, in accordance with a decision taken last year. ABANTIKA GHOSH explains the new entrant in the basket of family planning choices for Indian women.
What are injectable contraceptives?
- Deoxymedroxy progesterone acetate (DMPA) is an injectable drug that prevents pregnancy by stopping ovulation, which is the release of an egg from the ovary. It does this by blocking the rush of Luteinising Hormone (LH) that causes ovulation. Without ovulation, the egg and sperm cannot meet to form a zygote, whose possible implantation makes a woman pregnant. The drug also makes the processes of fertilisation and implantation more difficult. There are other injectable contraceptives such as Norethindrone enanthate (NET-EN), and monthly injections of combined Estrogen and Progestin, which are not yet available in India.
For how long is DMPA effective?
- Each shot can prevent pregnancy for three months. A 150 g dose of DMPA is administered intra-muscularly every three months. It can be started at any time during the menstrual cycle, but it is usually more effective if started within the first five days. It can be started as early as six weeks after childbirth and can also be given to a lactating mother. However, if a woman wants to get pregnant after having been on DMPA for some time, it can take up to 8-9 months from the last shot to do so.
Where will the injectable contraceptive be available?
- Minister of State for Health and Family Welfare Anupriya Patel told Lok Sabha last week that injectable contraceptives will first be available in medical colleges and then, in a phased manner, in district hospitals. At a later stage, they will be available in sub-district hospitals, community health centres and primary health centres. The injections will be available free at all government health centres and hospitals. Various brands of the injection are available for between Rs 50 and Rs 230 in the market.
What side effects does DMPA have?
- While injectable contraceptives are preferred because of the duration for which it is effective, the flexibility that it allows — a couple of weeks’ delay in a follow-up injection does not usually result in an unplanned pregnancy — and the fact that it is not related to coitus, the primary side effect is change in menstrual bleeding patterns, acne, weight gain and depression. One of the great advantages of DMPA is that it prevents ectopic pregnancies, endometrial cancer and uterine fibroids.
Are there conditions in which DMPA cannot be used?
- Lactating mothers who have had a delivery less than six weeks earlier cannot receive DMPA, nor can women with a history of breast cancer. It is also contraindicated if there is a history of ischaemic heart disease, severe hypertension, diabetes for more than 20 years that has led to damage to vision, kidneys or nervous sytem, and if there is a complaint of deep vein thrombosis or pulmonary embolism. Patients of viral hepatitis of severe cirrhosis or those with liver tumours, whether benign or malignant, cannot be injected with DMPA.
When did India decide to include DMPA in its contraceptive basket?
- In August last year, the Drug Technical Advisory Board of the Drug Controller General of India recommended that India should provide the option of DMPA in its family planning programme to widen the basket of contraceptive choices for women. The programme currently relies heavily on spacing methods such as condoms, intrauterine contraceptive devices and birth control pills, apart from male and female sterilisation.
What is the big picture on sterilisation in India?
- Women constitute 98% of the sterilised population in India, even though the procedure is less complicated for men. Of the total 41,41,502 sterilisations done in India in 2015-16 under government programmes, 40,61,462 were tubectomies. In 2014-15, out of a total 40,30,409 sterilisations, 39,52,043 were tubectomies and, in 2013-14, the corresponding numbers were 43,03,568 and 42,13,172. A host of factors, including the common misconception that sterilisation makes men “weak”, is held responsible for the discrepancy.
What has been done at the policy level to address this skew?
- India discontinued the practice of setting targets for sterilisation in 2000 to reduce chances of forced procedures. However, there is still something called the ‘expected level of achievement’ which activists say is really targets by another name. There is also a serious dearth of male health workers, which means that messages meant to reach men are effectively not being delivered. According to the Rural Health Statistics, 2015, the number of male health workers that are required is 1,53,655 — a little less than three times the number that are actually available, which is 55,657.