As use of morning-after pills rises in India, health workers voice concerns

There are few limits on the sale of the I-pill, which is available at Kamal Jain's store in New Delhi.
There are few limits on the sale of the I-pill, which is available at Kamal Jain's store in New Delhi. (Ayesha Manocha/the Washington Post)
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By Emily Wax
Washington Post Foreign Service
Saturday, January 2, 2010

NEW DELHI -- A college-age woman, dressed in traditional Indian clothing with her hair in a long braid, nervously whispers into a phone that she needs to find an abortion clinic. The next scene of the popular Indian TV ad shows the woman and a friend peering into a dimly lit alley as a voice-over says, "It's better to take an I-pill and avoid the quandary of an abortion."

The candor of the advertisement is a sign of dramatic change in India, whose traditional society still frowns on public displays of affection. Sexual behavior is increasingly openly discussed -- and prevalent. As the nation's economic boom draws growing numbers of young people into the workforce, they are leaving the confines of family, moving to big cities and often declaring their independence through sex.

Doctors report that use of the I-pill, which can prevent pregnancy if taken within 72 hours of unprotected sex, is soaring. But they also worry that young women are misusing the pill by taking it too often or in place of contraceptives.

"In India, it's almost like girls are gulping I-pills," said Yash Bala, a gynecologist outside New Delhi. "The biggest problem with this is that girls are not concerned about whether their partner uses a condom."

Many young women report using the emergency contraceptive pills several times a month instead of using condoms, increasing the risk of contracting sexually transmitted diseases, gynecologists say. This year, dozens of ads for the I-pill, also known worldwide as the morning-after pill, have flooded Indian TV channels, highway billboards and women's magazines.

Meher Malik, a belly-dancing teacher in New Delhi, has used the I-pill twice. She said many of her friends also have used it, some of them far more often.

"They definitely want to take the pill if they think that something went wrong last night," said Malik, 21, who is single. "I think it is very apt for today's generation."

Many gynecologists and health workers say that the pills have helped women avoid abortions, which are legal in India but are often performed by untrained workers in unsanitary conditions. Health workers say the pill's availability also empowers women, who face many hurdles in the country's tradition-bound, patriarchal culture.

As many as 7 million abortions are performed in India annually, and more than 20,000 women die of botched abortions each year, according to the Mumbai-based Federation of Obstetric and Gynecological Societies of India. The group says that the number of deaths is probably higher in reality because many families and health workers are afraid to report them.

"In India, women are now getting their own identity. They want to make decisions on their own -- about financial matters, about their career and about when they have a baby," said Ajay Pal Singh, a psychiatrist. "The big difference is now they don't need to go to their family members or anyone. They can go straight to the chemist and buy the pill. It's how the pill has been marketed to women in the ads also."

Since August 2007, when the Indian pharmaceutical company Cipla launched the I-pill, which costs less than $2, about 200,000 units of the drug have been sold every month.

"Sometimes, for products, getting the timing right is critical," said Arvind Sharma, chairman of the Indian subcontinent division of the advertising firm Leo Burnett in Mumbai. "There has been change in lifestyles, there has been a lot of migration from small towns to big towns. This pill is a symbol of that change."

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