Truth about Injectable Contraceptives

Injectable contraceptives, the latest to be promoted by the government for effective birth spacing is causing menstrual chaos apart from causing osteoporosis, weight and metabolic changes and cancer.

The hazardous character of injectable contraceptives has made them controversial all over the world, including in the countries of their origin in the West. Injectable contraceptives such as Net-En (Norethisterone Enanthate), DMPA or Depo Provera (Depot Medroxyprogesterone Acetate) and Cyclofem, which consists of DMPA, are promoted as highly effective birth spacing methods. Pushing a method that allows for spacing between children is high on the agenda of the government because it is one of the quickest ways to bring down birth rates in a context where fertility is highly valued, men are unwilling to use contraception and methods like sterilization are resorted to only after children have been born. But in the haste to push forward the agenda of population control and one may add, the interest of the pharmaceutical companies, the government consistently overlooks the dangers these drugs pose to women.

"Women who undergo injectable contraceptive undergo menstrual irregularities set off by the drug was its chief disadvantage," says gynocologist, Dr.Firoz Sonawalla from Mumbai. Larger doses of hormones are there in injectable contraceptives than the daily birth control pills. "Injectable contraceptives lead to disappearance of menstruation period for up to one year," adds Dr Sonawalla. Another consideration associated with injectables is the loss of bone mass. Injectables have the effect on the calcium stored in bones. The concentration of the calcium in bones decreases especially during the first year of use. The loss of the calcium from bones causes decrease in bone mass. And although the process is reversible and bone mass normally increases after discontinuation of use there are still some long term concerns of a temporary loss of bone mass. Such women are said to have a higher risk for osteoporosis later in their lives.

 Given that these hormonal injectable contraceptives are a highly invasive spacing method with known side affects, their safe administration requires continuous medical screening and supervision. And such health monitoring facilities are a far cry for the main targets of family planning policies- the masses of poor, rural, illiterate and disadvantaged women. "The ethics of promoting such a contraceptive that could have consequences for these women, in a country with very poor public health system, is far from established. Furthermore, this method of contraception has the potential for abuse by providers and other agencies having control over women's lives and bodies," says sociologist, Dr. Nandini Sardesai.

"The possibility of abuse becomes obvious by the manner in which the clinical trials are conducted by the state. While informed consent is a must for conducting such trials for any such drugs, permission is hardly ever sought," adds Dr Sardesai. Other side effects, not associated with menstrual period and bleeding, include dizziness, nervousness, headaches, change in skin color and rash. There might be severe mood swings from very good mood to depression. Women can experience breast tenderness and hair loss. Facial and body hair may increase or decrease. Some women may gain more weight.

"With injectable contraceptives there is an increased risk of breast and cervical cancer. So those with a family history of breast and cervical cancer should use other methods of birth control. Injectable contraceptives may also lead to total infertility," says Dr. Ambarish Warty, general physician with Bombay Hospital.

Indian women need safe contraceptives, which is reversible and effective. "Effective barrier methods that do not interfere with the entire body system are the condom, diaphragm and cervical cap. Some of these have the additional advantage of being re-usable. These contraceptives are much cheaper as compared to the injectable contraceptives.