Lacking experience ,i know only what i read,as you can see injectable contraceptives are quiet popular ,in some ppl. who sre busy,& unable to regiment there lives to routine to remember taking pills evry day .
The right to choose
Usha Rai
After the tremendous setback suffered by the country’s family planning programme during the emergency, the government has been extremely cautious about every step taken on the population stabilisation front.
That is why we did not even have a population policy till last year. Though one of the first countries to launch a national family planning programme in the Fifties, the contraceptive choice is still limited to the condom, the oral pill, the IUCD (intra-uterine contraceptive device). Sterilisation is an option only for those who have completed their family.
Smaller developing countries like Indonesia and Bangladesh, despite their stricter Muslim regimen, have been more progressive and offer implants and injectables among the array of contraceptive choices. In India, women’s groups have made such a hue and cry about them that the government has steered clear of introducing them in its welfare services.
Recently, the Supreme Court set aside a writ petition against the use of the injectable net en (Norsiterat) and there is hope it may be introduced soon. But like a scalded cat the government is still being extremely cautious. After a spate of meetings with the Indian Council of Medical Research and the All India Institute of Medical Sciences, the government has decided to involve 12 medical colleges in a pilot study of net en.
While it is true that in a country where basic health facilities are lacking, it is difficult to push the injectables, which requires monitoring and counselling of those using them, with India’s population having crossed a billion, can the government just sit back twiddling its thumbs? Should it not play a more proactive role?
More and more women are resorting to abortions when they find they are pregnant. It is estimated that 11 million abortions occur in India annually killing 20,000 women. Modern technologies like ultrasound are being used in small towns and villages to determine the sex of the unborn child and get rid of it if it is female. So why are we being so queasy about the latest technologies and contraceptives to have spacing between children? Is it not better than foeticide?
While the government is still edging along cautiously on injectables, several private doctors and NGOs like DKT in Mumbai, Janani in Patna and the Family Planning Association of India are marketing and prescribing injectables. Just one NGO has motivated 50,000 women in Maharashtra, Gujarat, Madhya Pradesh, Andhra Pradesh, Uttar Pradesh and the North-east to try out the injectables. In Mumbai, the Muslim women opt for injectables to prevent conception rather than resort to sterilisation.
DKT is marketing injectables in Mumbai for over five years. Others have tried it and rejected it because it did not agree with them. The important thing is they had a choice. Yasmin Sheikh, 28, mother of two, who has been on net en for five years is a remarkably confident woman. Yasmin, who lives in Park Side, Vikroli West, has induced other young women in her locality to opt for injectables.
Just seven or eight years when her mother died, she had to stop attending the madrasa to look after her younger brother. Married at 15, for two years she was on the pill. At 18, she had her son. After that she had two abortions. She had a daughter five years after her son. Ever since, on the advice of her family doctor, she has been on injectables. Earlier, she was thin and had heavy bleeding. Now she is 50 kg and her periods are regular. Yasmin has the support of her husband and family elders.
Asked why she did not go in for sterilisation if her family was complete, Yasmin said no one in her family had undergone a sterilisation and they did not approve of one. Asked how long she would be on injectables, she replied, “As long as I can tolerate them. If I go in for sterilisation, it will be with the concurrence of my family.”
Nirmala, 35, and mother of four, has been on net en for two years now. Sterilisation is taboo in her house too. Soon after being put on net en, Nirmala said her periods were irregular, her stomach felt distended and she had a stomachache. She bled for a whole month but could do nothing about it because she was in the village. On her return to Mumbai, her doctor gave her medicine to ease the pain and control the bleeding. Nirmala has decided to continue with the injectable till a better contraceptive is available. She prefers injectables to pills, which have to be taken every day.
Rita Gupta, 23, was not as upbeat about the injectable as Yasmin. Mother of one child after a caesarian operation, Rita had an induced abortion to avert a second child. She had three shots of net en in six months. Initially, she had heavy bleeding and the chronic pain in her back had increased. With medicines the heavy bleeding has been arrested but the back pain persists.
Sanjeevani Gawde, 28, has been on injectables since 1995, within two months of its introduction in Mumbai. She saw the DKT poster at her doctor’s clinic, inquired about the product, then went in for it. According to Sujata, DKT’s social worker for the Vikroli area, Sanjeevani, had only one child when she went in for the injectables. After two years on the injectable, she stopped it to see if her fertility had been affected. She got pregnant, had a clean up job, and went back to the injectable. Sanjeevani is a remarkable women because she personally tested the contraceptive.
Behrampada is a predominantly Muslim area of Bandra, and families live cheek by jowl. Seven doctors in the area dispense injectables along with other contraceptives. Injectables have been introduced and women were in their second and third doses of net en when this correspondent met them. Praveen Abdul Salam Sheikh, 25, mother of a boy and girl aged five and three, however, had six doses of net en. Except for amenorrhoea (stoppage of periods), she found the injectable quite suitable. She was thinking of delaying her next shot of net en but the social worker asked her to get in touch with her doctor. Praveen’s daughter was only six months when she got pregnant. Earlier, she was on pills but had problems.
Praveen’s neighbour was stopped by her mother-in-law from using the injectables when she had ‘spotting’. Spotting is a side-effect of injectables and even if it is negligible women stop using the contraceptive because they cannot do pooja or namaz when they have spotting. Counselling women that spotting is different from menstruation does encourage some women to continue with the contraceptive. There were five other Muslim women from Behrampada (between 20 to 30) who were on net en.
The side-effects of injectables are intermittent. In 25 per cent cases, there is amenorrhoea. There are more chances of amenorrhoea in depo provera, which is a quarterly injectable than in net en, a bi-monthly injectable. The women tend to worry that they have got pregnant when they have amenorrohoea. Counselling is vital at this stage or the women give up injectables, says Sanjay Mehta, who runs a nursing home in Ghatkopar and offers women who have had babies a choice of IUCD, the pill and the injectables. He has been selling depo provera for less than a year.
Though DKT has been supplying net en at a subsidised rate of Rs 50 a shot, doctors charge Rs 100 a shot. For subsequent consultations they charge Rs 20 a visit. The price of depo is Rs 100 a shot. Fifty per cent of the women drop out because, coming from a poor section of society, they find the price too high. Their husbands earn Rs 2,000 to Rs 3,000 a month. They prefer Mala D, which costs just Rs 2 a month. If the injectables were cheaper, there would be greater acceptability; for if a woman on the pill misses a single dose she gets pregnant and has to go in for medical termination of pregnancy. Injectables are a surer method of staving off conception.
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