• Monday, August 17, 2015 - 05:30

  In a world where attention spans flicker like a cursor, romance is reduced to a roulette. Blender, Tinder, Grindr gamify intimacy into a casino for quickies. People are matched by math not the flutter of the heart. We swipe for sex at scale, and manage its `side-effects’ with the dangerous morning-after pill. But risky ain’t sexy when it comes to deeper biology. By way of contraceptives, Indian women are spoilt for choice, be it pills, gels, injections or implants. Why then are so many of them popping the morning-after pill? Recent data from Euromonitor International, a UK-based market intelligence firm, says the market for emergency contraceptives soared to Rs. 667 Crore between 2009 and 2014, a jump of 88%, making India the world’s third-highest consumer of emergency contraceptive pills, after the United States and China. India, the report says, is among the fastest-growing markets for these contraceptives. Since 2005, popular brands of emergency contraceptive pills (ECP) like iPill and Unwanted 72, are being sold OTC (Over-The-Counter) across India, barring Tamil Nadu. The Centre approved the sale of a two-pack pill of 0.75 mg, a dosage widely regarded as safe, and approved by the WHO. However, Tamil Nadu later backtracked following pressure from the police, women's commissions and NGOs, who argued that the sale would promote free sex. Their widespread popularity, gynecologists say, is not surprising. For one, they are marketed as cool, easy to use and private. “I come across far too many women who use only emergency contraception”, says Dr Vijaya Sherbet, senior gynaecologist at Bengaluru’s Columbia Asia Hospital. “Easy access, OTC availability, casual sex and presumed safety are factors that promote its use”. The impression that ECPs are safe to use is misleading and dangerous, warn experts. “They are supposed to be taken only in an emergency but I find a lot of people pay no heed”, says Mumbai-based gynaecologist Dr. Nitin Narvekar. “When women come to me complaining of irregular menses or difficulty in conceiving, they don’t even mention that they use ECPs regularly. I find that a lot of married couples use it frequently. There are many safe birth control methods like Intra Uterine Devices (IUDs) and oral contraceptive pills that women can use, but there are myths that they cause weight gain or mothers-in-law forbid their use”. Regular use of ECPs, on the other hand, disrupts hormonal patterns if used at the wrong time in the menstrual cycle. “ECPs contain progesterone, a hormone that makes the inner uterine lining shed itself. In my experience, the most common feature in young women who report to the emergency room with tubal pregnancies is a history of ECP use’’, adds Dr. Sherbet. “Women using ECP should seek help if their periods are delayed or irregular”. However, there is little awareness of these side effects, and women continue to use them indiscriminately. A major reason for their popularity, experts say, lies in the conservative attitude towards sex in India. “Sexual behaviour may be changing, but talking about sex is still mired in morality issues, sadly, even among health care professionals”, says a Chennai-based gynecologist who did not wish to be identified. Mumbai-based media professional Reena*, 25, concurs. “I went for a general health checkup about a year ago and the gynaecologist asked me if I was married. When I said I was single, she just assumed that I wasn't sexually active. And yes, I would definitely avoid going to a gynaecologist in my neighbourhood. And because I dread the looks I would get if I discuss contraception with a doctor, I have left it entirely to my partner”. According to a 2014 study titled Emergency Contraception - Potential for Women’s Health, there are 210 million pregnancies annually worldwide, of which 46 million end in induced abortions and 20 million in unsafe abortions. Ninety-five per cent of these abortions occur in developing countries, while 13% of the women die from unsafe abortions. This indicates a significant unmet need for contraception. Where termination of unwanted pregnancies are a threat to women’s lives, emergency contraception has emerged an easy alternative for women whose contraception has failed or who have had unprotected sex. However, going the way of Tamil Nadu is not the correct approach, say experts.  Instead, “there is an urgent need to promote meaningful public discourse on safe sex and contraception, coupled with access to answers on questions relating to sexuality”, says Dr. Sherbet.