Why Women’s Groups Oppose Injectables

Saheli along with other women’s groups, and health groups protested against the introduction of Net-En in the open market as we thought it goes against the Supreme Court judgement in this case. Our protest letter with many signatories was released to the Press.

29.10.04

PRESS RELEASE

We view with concern the workshop in Manesar (27-29 Oct 04), organized and co-ordinated by Parivar Seva Sanstha (a National level NGO), in collaboration with Government of India, UNFPA and Packard Foundation through Population Foundation of India to “expand choices of contraception” by the introduction of hormonal injectable contraceptives, which are hazardous to women’s health.

In order to meet unrealistic population control targets and as part of the liberalisation policies, the Indian authorities have in the past few years relaxed drug regulations in order to expedite the introduction of long acting, invasive, hazardous contraceptives into India. Unchecked over-the-counter sales, ill-informed doctors and inadequate Post Marketing Studies are the harsh realities of this strategy which is poised to subject millions of Indian women to long-acting hormonal contraceptives such as the injectables (Net En and Depo Provera) that is likely to cause irreversible damage to their own and their progeny's health.

We oppose hormonal long-acting contraceptives for the following reasons:

1. There is enough scientific evidence to show that hormonal injectable contraceptives like Depo Provera and Net En are hazardous for women under any circumstances. The risks (including risk of thromboembolism, osteoporosis and cancer) far outweigh the benefits of convenience of administration and use. The risks include:

· climacteric-like syndrome (pre-mature menopause)

· irreversible atrophy of the ovaries and endometrium leading to permanent sterility

· deaths due to spontaneous formation of clots inside blood vessels (thrombo-embolism)

· two fold increase in acquiring HIV infection from an infected partner as well as increased transmission from an infected woman to a non-infected partner

· ten-fold increase in the birth of a Down Syndrome baby

· increased chances of death in children born to women-users

· increase in the risk of breast cancer, cervical cancer including carcinoma-in-situ

· return of fertility after discontinuation of the drug has not been established

· unanswered questions regarding the health of babies born after cessation of the drug.

2. The public health system is ill-equipped to administer injectables. In the Supreme Court case against the injectable NET En filed by Saheli and other women’s groups decided in 2000, the government’s admission that mass use of Net En in the FP programme is not advisable is a recognition of the potential risks and need for close monitoring and follow up.

NGOs and private practitioners are currently out of the ambit of all mechanisms of accountability. To date, the Government of India has not evolved any definitive standards for NGOs in the health service sector – in terms of care, follow up or accountability. Hence, our core concerns on women’s health and safety remain unaddressed. The Post Marketing Surveillance (PMS) on the injectable Depo Provera, done in place of Phase IV trials, was conducted by Upjohn, the pharmaceutical company which directly stands to profit from the results of the research. This raises serious doubts regarding the “scientific objectivity” of the data collected and its analysis. The PMS did not study potential hazards like bone-loss, cancer risk or effect on future progeny.

4. Women's "choices" are not enhanced by adding yet another hazardous contraceptive to the "basket" of options. With a coercive population policy, based on the “two-child” norm, the potential of misuse of injectables, given their ease of administration, is immense.

5. Who gains? There are an estimated 40 million potential users of spacing methods in India – a potential market for injectables larger than the entire population of Switzerland, Norway, Sweden, and Australia put together. Is it any wonder that the manufacturers of Depo Provera (Pfizer) and Net En (Schering) are anxious to take over the Indian market?

In a memorandum endorsed by women’s groups and health groups all over the country, we have urged Shri A Ramadoss, Minister for Health and Family Welfare, to consider these issues very seriously before considering any proposals that recommend the inclusion of injectable contraceptives in the National Family Planning Programme, or widening their spread through NGOs. We have urged him to reject the interests of private profit and work instead, to formulate a policy that ensures overall good for the health of women and their progeny.

Sarojini NB (Sama)

Laxmi Murthy (Saheli)

Brinda Karat (AIDWA)

Amit Sengupta (Delhi Science Forum)