Deep invasion

But will Indian women be safe using Depo Provera?

By Seema Kalra
Published: Thursday 30 June 1994

IF HEALTH is indeed wealth... then we Indians are going to get richer. Very soon: announces the advertisement for Depo Provera (DP) in a national daily -- the same Depo Provera (depomedroxyprogesterone) that has been around for more than 25 years, getting into one controversy or the other ever since its development. The safety of the drug has been repeatedly questioned, especially when used as a long-acting injectable contraceptive.

Preliminary trials of DP on beagle dogs and rhesus monkeys showed an increase in breast nodules and breast cancer. In 1974, the US Food and Drug Authority (FDA) allowed the use of DP for "restrictive use" by women with a history of contraceptive failure. The drug was banned in 1978 in the US after 3 Congressional hearings, which was lifted a couple of years back. Even during the ban, Upjohn, the manufacturer of the contraceptive, exported DP to countries like Thailand, Sri Lanka and New Zealand.

Recently, there have been serious allegations of bribery against Upjohn. In a submission to the US Securities and Exchange Commission, Upjohn admitted that it had paid $2,710,000 to employees of foreign governments to ensure sales to government agencies. Hardly the right credentials to promise better health care for Indians. Apart from the FDA approval, there seems little reason for the Indian government to approve the use of DP in the country.
...And side-effects be damned The government's only priority seems to push the birth rate down. It fells that the greater the availability of drugs, the better it will be. But the uncomfortable truth remains that these invasive contraceptives are still to be proved safe from side-effects like anaemia, amenorrhoea, diabetes, depression, weight loss or gain and negative effect on the foetus.

It seems we have not learnt any lessons from the experience of NET-EN, the case against which is still pending in the Supreme Court and from the dismal trials of Norplant. Now, with the commercial availability of DP, the question that immediately arises is: why are these drugs being pushed into the Indian market despite doubts about their safety? Is it to give the Indian women "a choice"? But choice or informed consent is impossible by just stating an effect. For instance, you can stop at telling the user that the drug may cause amenorrhoea, neglecting to elaborate that such a condition can lead to infertility.

Informed consent makes sense if the women are educated enough to ask questions. But if these kind of drugs are introduced into the family planning programme, it could be one of the most disastrous of steps, especially when our public health care system is completely ill-equipped to regularly monitor the effects of the drugs over a significant period.

Moreover, these invasive contraceptives are effective for anywhere between 2 months to 5 years, which means that the women are at the mercy of the drug and have to bear its effects till it goes out of the blood system. And if the contraceptive fails, the drug can affect the unborn child. Under these circumstances, women have "no choice" but to live with the drug.

There is no denying the fact that women need contraceptives, but it does not mean that they should be administered drugs with dubious safety records. Moreover, aggressive marketing of contraceptives is unlikely to control population growth. It's time that health planners looked for more effective options than to parrot the Western concept of birth control.

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