Last year, a 20-year-old approached a top city gynaecologist for help to terminate an unwanted pregnancy. The patient, a college student, said her partner had refused to use a condom, and she didn’t want to get onto oral contraceptive pills because she feared they’d lead to weight gain, and affect her chances of pregnancy later. Her choice of contraception was the emergency pill which she’d pop each time she had sex. Sometimes, she admitted, she’d take as many as six pills a month. Over the next few months, she experienced severe menstrual irregularity, weight gain, mood swings and water retention. She also developed polycystic ovarian syndrome (PCOS). On one occasion, the pill didn’t do its job, hence the trip to the gynaec.
She isn’t alone. Mumbai gynaecologists say city teenagers and youth are reckless and illequipped with information.
Data made public by the Brihanmumbai Municipal Corporation’s health department recently revealed that over 30,000 abortions were conducted across public and private hospitals between 2013-14, up by 10 per cent in the last seven years. While a percentage of this can be attributed to gender selection, doctors stress a large number are due to inappropriate use or complete lack of contraception.
Dr Sheetal Sabherwal, who runs the Tulip’s Women’s Healthcare Centre in Khar (W), says 60 per cent of her patients who seek abortion haven’t used a contraceptive, while 40 per cent tried and failed. This is common even among married couples, with 60 per cent reporting an accidental pregnancy due to improper use of contraception. Putting the high-risk category in the 18-26 age group, she says, “Youth rely on information from friends and media. Rarely do they speak to qualified doctors. Even the middle and upper classes are ignorant about contraception.”
Battling the myths
Half the battle, doctors say, can be won if myths surrounding contraception are busted. “Men carry doubt and prejudice regarding contraception. They believe condoms reduce sexual pleasure, and interrupt the act,” says Dr Uddhav Raj Dudhedia, gynaecological, endoscopic and oncosurgeon. The only methods of contraception available to men are condoms, sterilisation or withdrawal before ejaculation. “Sterilisation, although absolutely safe and permanent, will lead to impotency since it involves surgery of reproductive organs, men think,” Sabherwal adds.
Dr Kiran Coelho, consultant gynaecologist at Lilavati Hospital, adds that taboos associated with sex are also to blame. “Single people, especially women, find it difficult to get their hands on contraceptives since they are embarrassed or afraid to ask for information.” Quoting a 2012 study on contraception practices in India, Dudhedia says, it was found that 52.4 per cent women were aware of contraceptive methods but only 32.2 per cent adopted them.
Only in emergency
Often finding themselves caught in the “heat of the moment”, couples forget to take contraceptive measures. Last year, a Mirror reader wrote in to resident sexpert Dr Mahinder Watsa saying:
‘I had unprotected sex with my girlfriend. In the heat of the moment, I popped an I-pill instead of her. Can it cause complications for me?’
This was preceded by a query in 2012: ‘I am 21 years old and my girlfriend is 20. We used to have unprotected sex twice a week, sometimes thrice. Every time we had sex, I gave her an emergency contraceptive. For the last month, she has been getting her period every week. What is the problem?’
Doctors point out that despite disclaimers in the emergency pill ads, users aren’t paying heed to the fact that they must be used, as their name suggests, only in an emergency. They are a lastminute and one-time solution.
Emergency pills contain high doses of hormones, which once inside the body, work to prevent the sperm from doing its job. They disrupt the lining of the uterus to prevent the fertilised egg from growing, and thicken the cervical mucus to stop the egg from forming, depending on which time of the menstrual period the tablet was taken. Since sperm take a maximum of 72 hours to travel from the vaginal opening to the egg, the pill must be taken within 72 hours of intercourse, to be effective.
Repeated use of the emergency pill, warns Coelho, causes hormonal imbalance in the body leading to menstrual irregularity, weight gain, mood swings, water retention and in severe cases PCOS.
Not just about babies
While the oral contraceptive is a calculated protection against unwanted pregnancy, safe sex is not merely about delaying pregnancy. Dr Sanjay Pandey, a consultant uro-andrologist at Kokilaben Dhirubhai Ambani Hospital, points out that contraception is a preventive healthcare tool. “I often treat patients for sexually transmitted diseases (a result of unprotected sex with multiple partners) and urinary tract infection. Constant exposure to emergency contraceptives takes a toll on the body’s immunity,” he adds.
A condom, he says, acts as a barrier against blood, semen and vaginal fluids — which carry viruses bearing STDs — from passing from one partner to the other.
In the absence of any formal sex education in schools and colleges, experts agree that urban Indians should have access to discreet medical professionals who offer authentic advice. “Gynaecologist consultations can be introduced in educational institutions, and the dangers of over-the-counter medication must be spelt out,” says Sabherwal.
Choose your contraceptive
You have a choice, says Dr Coelho, and here’s how to pick what suits you best:
1. Safe and no side effects 2. Effective (2 to 6 failure rate) 3. Protects against STDs
Safe, effective, minimal side effects. Spermicides are available in the form of gels and tablets and can be bought from a chemist. They must be inserted into the vagina 10-15 minutes before sex. They contain a chemical that kills sperm and immobilises them before they are able to swim into the uterus. To be effective, the spermicide must be placed deep in the vagina, close to the cervix.
1. Extremely effective (0.1% failure rate) 2. Have minimal side effects. 3. Can be used by young women for a long period. 4. Protect against benign breast disease, ovarian and uterine cancer. Research has been conducted on this subject. Two to three years of continuous use reduces the risk of the above cancers. 5. Regulates cycles, reduces PMS & period pain and heavy bleeding. 6. No effect on future fertility. 7. Downside is that it does not protect against STDs.
In the form of injections, implants, vaginal rings (a small, soft plastic ring that once placed inside the vagina releases oestrogen and progestogen which prevents ovulation, makes it difficult for sperm to get to an egg and thins the womb lining so it’s less likely that an egg will implant there) and intra-uterine device. The side effects are the same as oral contraceptives. In case of vaginal rings and IUDs, the hormones are locally absorbed so this reduces side effects.