Chill, it’s just a pill!

CHENNAI: Contraceptive pills, though recognised as essential drugs by the State Drugs Control Department, still remain out of stock in several pharmacies in the State.

A visit to more than 15 pharmacies in the city revealed that emergency contraceptive pills are not available in most places, and pharmacists order them on a requirement basis.

Ormeloxifene finds a place in the list of more than 300 essential drugs listed by the State Health Department but remains out of stock in most pharmacies, especially in rural and sub-urban areas.

The lack of awareness and misconceptions about contraceptive pills, which are often referred to as abortion pills, lead to social and cultural taboos that are a major obstacle to women’s health. Doctors also say that contraceptive pills are not available easily to unmarried women, which only leads to the increased risk of sexually transmitted diseases, unwanted pregnancies and other complications.

Requirements

There are different types of contraception available, but oral contraceptive pills are more prevalently used.

Contraceptive methods for women can be intrauterine, oral or invasive. Other modes of contraception such as female condoms are alien to pharmacists in the city. Even if they’ve heard of it, they don’t keep stock.

The mode of contraception is decided based on a person’s medical history, family history, risk of side-effects and their health condition at the time. While the government has made different types of contraception available in primary health centres, the stigma associated with availing them from health workers or on their own is a challenge.

“The oral contraceptive pills are helpful for many reasons and not just to prevent pregnancies,” explains Dr R Premlatha, consultant obstetrician and gynaecologist. “For those struggling with irregular and painful menstrual cycles, contraceptive pills are used to manage them since it stops ovulation and regularises periods. In the case of Poly Cystic Ovarian Syndrome (PCOS), the first line treatment to regularise periods is to start a combination of these pills.”

Online pharmacies

There are hundreds of websites selling contraceptive pills, but one has to exercise caution while buying them, as the side effects can be risky. Doctors emphasise the need to understand their medical condition and/or need before taking a decision on the type of contraception to use.

“Ordering oral contraceptive pills online is not recommended because we don’t know if it works for you and how it can impact health,” warns Dr Arvind Santhosh, consultant obstetrician and gynaecologist at Government Medical College. “There’s a system to prescribe medicines based on a person’s health. Trained professionals and healthcare workers can help choose them.”

All primary health centres in TN have village nurses who maintain the family register for all families in the State. Married couples are provided with oral contraceptive pills. Mobile medical units also screen people for basic ailments and are provided with contraception.

“Nowadays, more people are sexually active before marriage and if they want to take any form of contraception, taboo surrounding that is even more. This leads to unwanted pregnancies, sexually transmitted diseases and other complication. If pregnancy occurs, due to stigma, women choose unsafe abortions. Though condoms are safe, all forms of contraception should be available too,” says Dr Arvind.

Self-medication and abortions

Doctors say that lack of access to contraceptive pills leads to an increased risk of self-medication and abortion incidences.

“It’s important to carefully monitor any woman choosing medical termination of pregnancy. We must ensure that there is no infection and other risks of complications in case a pregnancy occurs,” explains consultant gynaecologist Dr G Vinayaka. “If there is access to contraceptive pills, it’d be easier for women to prevent unwanted pregnancies. Abortion and medications that follow takes a toll on the body and affects their reproductive health in the long run.”

Unhelpful moralities

Riya Gupta, a medical student and one of the key persons working with Safe2choose, revealed that most pharmacies do not stock emergency contraceptive pills (ECPs).

Even after the issue was brought to the attention of the State Health Department, the problem persists due to an oft-quoted reason by pharmacists – ECPs are perceived as abortion bills.

“There’s no ban on ECPs, and they’re always available, as the supply is regular. However, not many pharmacies stock it because it’s not a regular drug, and the demand is low, or at least that’s what they claim,” says S Ramachandran, secretary, Druggists and Chemists Association. “When required, pharmacies arrange for the drug from the nearest warehouse, manufacturing units or medical representatives.”

Officials with the State Drug Control Department say, “The procurement of essential drugs is being done by Tamil Nadu Medical Services Corporation and other contraceptive pills are maintained in stock based on the requirement basis.”

For those struggling with irregular menstrual cycles, contraceptive pills are used to manage them since it stops ovulation and regularises periods. In the case of PCOS, the first line treatment to regularise periods is to start a combination of these pills

- Dr R Premlatha, consultant obstetrician and gynaecologist