Chennai’s confusion with contraceptives and abortion pills

With the advent of various methods of contraception including oral contraceptive pills, a woman who is unprepared to start a family is no longer helpless or so we thought. It may not be so in Chennai. Usually, women can use a daily pill or in case of emergencies, Emergency Contraceptive Pills. Emergency contraceptive pills (ECP), commonly known as morning-after pills, prevent pregnancy after unprotected sex. The biggest advantage of the ECP in India is to prevent unwanted pregnancies and therefore prevent termination of pregnancy under unhygienic and unsafe conditions.

Popular brands include Piramal’s i-Pill, Unwanted-72 from Mankind Pharma, EC2 by Zydus, Norlevo from Win Medicare and E-Pill by Panchsheel Organics. In the absence of contraceptives, doctors say that morning-after pills are the best alternative for a woman to avoid the strain of an abortion. Though emergency contraceptive pills were made available over the counter in 2005, it may not be so in Tamil Nadu.

In 2002, the Ministry of Health and Family Welfare made ECP available in India, following which, in 2005 ECPs were made (i.e. drugs that do not require a prescription) drugs. Ever since the legal availability of ECPs, Tamil Nadu has had a woman at the helm for more than two terms and yet the situation is bleak for women living here. I have heard from some women living here about the scarcity and difficulty they have in accessing ECPs, being public health professional, I decided to check the situation out for myself, posing as a patient who needed an ECP. I went to a select few prominent Government Hospitals around Chennai namely:

  • Kasturbai Gandhi Hospital for Women and Children in Triplicane,
  • Govt. General Hospital, Park Town,
  • Govt. General Hospital, Royapettah,
  • Govt. Hospital for women and children, Egmore
  • And Kilpauk Medical College and Hospital

I started with Kasturbai Gandhi Hospital for Women and Children in Triplicane. I went to the in-house pharmacy asking for the ECP. The pharmacists had no idea what I was talking about until I mentioned the term oral contraceptive. However, they still told me only about the 30-day regime. When the pharmacists were not of much help, I asked a few nurses if they had the Morning-After pill. I only got bewildered expressions and questions about what exactly it was that I was asking for. I further elaborated on what I meant by the morning-after pill. I asked if they had the I-pill and still got nothing. When I mentioned oral contraceptive pills again to the nurses, there was recognition. They simply said that I needed to meet the doctor and she would prescribe the 30-day strip for me. This left me dumbfounded. I had a firsthand glance into the ignorance of healthcare workers in the public hospitals. However, the government does provide condoms in the family planning section of the hospital, which was a relief, that they are making an effort at promoting safety and family planning.

I then decided to go to other government hospitals and some private pharmacies in other areas – Egmore, Teynampet and Royapettah, to check for availability of these ECPs. Each time I was told that it was either out of stock or that they do not sell it in their pharmacies. Not only did I return empty handed but, some of the pharmacists even frowned upon the fact that I was asking for it. After visiting 4 pharmacies, I had had enough. An over the counter prescription free drug, which is available even in some of the backward cities in India, is not available in its health capital.

Back in 2008-09, senior obstetrician-gynecologist Dr. Jayashree Gajaraj, President of the Obstetrics and Gynecology Society of South India was quoted in an article as saying “Three years ago, when the product was just launched in the market, we told women that there was a revolution in the offing. Today, many women are aware of the option, but they don’t have access to the pill.”

The report also talks about a rise in the number of abortions observed by the gynaecologists in the city. Government data released state-wise for the number of medical terminations of pregnancies performed in the country also seems to support this fact. Tamil Nadu seems to be the top 4 states with maximum number of medical terminations of pregnancy in the country between 2008 and 2013, although the reasons for the terminations are not known.

Dr. Anusha Aravind, practicing in the city of Chennai speaking on the issue says, “The ban on morning-after pills is very much opposed by practitioners as this leads to abortions as only option for women. The process of abortion is very stressful for women and is strongly associated with the emotion of guilt which is very hard for them to overcome.” She says it is ridiculous to confuse morning-after pills with abortion pills because an ECP is just one pill while abortion pills are four in number. She further clarifies that the ECP is the best solution for women who are not ready for the pregnancy and simply aids in a delay in ovulation. She also states that the morning-after pill doesn’t work at all stages of the ovulation cycle and is a necessity in a state where there isn’t much awareness or popularity of the female condom. The ban on these pills leads to unnecessary complications for women and is definitely putting more women at risk of unsafe and unnecessary abortions. While abortion pills bring about contractions of the uterine wall the morning-after pill does no such thing.

What is the compositional difference?

While the ECP is composed of a drug named Levonorgestrel, the pill for abortion is composed of Mifepristone in combination with misoprostol. The composition of the morning-after pill is completely different when compared to that of the abortion pill and it is baffling to see that these could actually be thought of interchangeably.

As I completed my exercise of Assessing Awareness and Availability of morning- after pills in Chennai, I concluded that the Chennai is not as inclusive as we would like it to be. On further research into the issue, I gathered that this is largely because of the misconception that an ECP is a method of abortion and not contraception. This leads me to conclude that a ban on moral grounds and confusion with abortion pills means that it is next to impossible to find emergency contraceptive pills in the city. I also know of men and women (myself included), who have no idea that such a ban exists in Tamil Nadu, maybe because they had no need for the morning-after pill.

This could also indicate a lack of awareness regarding Emergency Contraceptive Pills. This is understandable when healthcare workers responsible for spreading awareness are themselves ignorant of such a pill. It is vital we understand that ECPs are contraceptive pills and not abortion pills. It is better , particularly with reference to unsafe and unhygienic abortions. Awareness and access to ECPs, without the stigma attached to it, similar to easy availability and access to condoms will help our women live life and make choices while keeping their self-respect and dignity!

Where is a good abortion clinic in Delhi?

If you have more doubts:

Write to us at hiddenpocketsinfo@gmail.com
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Finally I found it !

FPAI –Family Planning Association of India. Ladies!!! Have you heard about it? If yes, then I am happy for you, if no then get ready to receive an amazing information that I am going to give you. For those who are not aware of FPAI, It stands for Family Planning Association for India. They provide services on family planning and unwanted pregnancies. They have clinics around India. Few of the cities are Delhi, Agra, Ahmedabad, Bangalore, Chennai, Mumbai. Recently, I got a chance to visit the FPAI clinic in Delhi and I was amazed to see how approachable they were.

Abortion is legal under certain conditions.

First of all, let me start by saying abortion is legal in India until certain weeks. To more know about this, please check our article here.

The clinic we recommend is situated at RK Puram Sector- 4, New Delhi -110022, Opposite Capital Court, Munirka, Near HDFC Bank and Methodist Church. It is easy to locate the clinic. As I went inside the gate the surrounding of the clinic had positive vibes. The plants and trees added to the calmness. I dint feel as if I am standing in front of an abortion clinic. I went and met the Doctor who was all excited to meet us and show around the clinic. As we entered I saw the counsellor’s room. The counsellor had a huge smile on her face. I felt safe and welcomed.  We went and sat with the doctor in the examination room where the patients were examined.

“Privacy and confidentiality is the most important aspect that FPAI follows”, told the doctor.  Whoever comes to the clinic needs to just register with one’s name. This is required, to keep a count of the patients. It is not for public to examine.

Married or Unmarried women can receive abortion services.

Let it be a married women or unmarried women, the information of the patient is kept highly confidential. Nobody asks the patient uncomfortable questions like are you married or not? Where is the husband? Everybody is treated with dignity at FPAI.

As soon as one walks inside the clinic, the person is sent to the counsellor’s room. The counsellor makes sure that the person is comfortable. Privacy is given utmost important. The counsellor discusses what all happened and what can be done. Later the person is sent to the examination room and is examined by the doctor who later provides medicines or performs the operation accordingly.

For abortion or also known as Medical Termination of Pregnancy (MTP), the woman needs to fill a consent form called ‘Form C’.  Only the consent of the women is required for performing the medical termination.

For the first 4-8 weeks, doctors are willing to provide the medicines or the pills to induce abortion.

Procedures regarding Medical Abortion :

The woman is provided with a medicine kit containing mifepristone and misoprostol.  These medicines are best helpful in first 12 weeks (1st Trimester of abortion).

The doctor properly explains how to utilise these medicines as it is important to take these medicines in a proper way and under the doctor’s guidance

miso-and-mife

Procedure:

  • Day 1:One 200 mg tablet of Mifepristone is taken
  • Day 3 (between 24 to 48 hours):Misoprostol pills of 200 mcg each (total of 800 mcg) are given orally or vaginally.
  • Day 14 – 15:Person returns for a post-treatment examination to affirm that a complete end of pregnancy has happened.

The doctor would recommend to come back for an ultrasound check up after 15 days. As per the doctor if it is difficult to come back to clinic, then get an ultrasound (abdomen) done because it is important to find out if the abortion is completed and women is safe.

The doctor told me these medicines don’t have any side effects but should be always taken under the doctor’s guidance.  It is always better to see if the clinic has displayed the certificate for medical termination practice. One needs to be careful from quacks or unregistered doctors.

After 12 weeks, Doctors normally recommend Surgical abortion.

Surgical Abortion :

 

MVA (Medical Vacuum Aspiration) method  is used for surgical termination. It involves using a specially designed syringe to apply gentle suction to remove the pregnancy or pregnancy tissue from the womb. It can be done with or without local anaesthetic (you will be awake), and takes approximately 15 to 20 minutes to complete. This method is legal, less expensive and more comfortable than Dilation and curettage (which is an old method). It is also safe.

After five weeks,  a surgical procedure is your only option. If you opt for a surgical abortion, you will need to give your doctor a couple of days to make arrangements at the hospital/ clinic. The actual procedure takes only about 15-20 minutes, but you will have to stay in the hospital for four to five hours.

Is Abortion scary? I am nervous?

These are some of the questions that we have been getting in the past.

Is it safe?

Will my Girl friend treated well?

Does it hurt? 

I am unmarried. Will they provide me service?

 

Let me tell you ladies, I found FPAI very friendly and approachable. If required, kindly try utilizing this clinic. It’s friendly, non-judgemental, safe, clean and affordable. The whole facility would cost around 500 INR. Kindly utilize this amazing clinic. Try it out and refer it to the ladies around. Let us all promote safe abortion and health care around us.

We also wanted to share a story of one of our followers who felt lonely and betrayed while trying to terminate her pregnancy : http://www.hidden-pockets.com/abortion-stories-in-india/

You are not alone, we are here!

PS: “FPA India clinics may charge, what we prefer to call as a ‘partial user fee’ to the clients for seeking abortion or any other SRH service. This fee is very subsidized and helps the Association meet some running costs.  Only when the facility is not equipped to provide a particular service (for example some client may need a specialized service, or admission or higher level emergency care) are clients to other facilities.”