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Emergency Contraceptive Pills: The misunderstood savior for Pakistan?

http://www.huffingtonpost.com/farahnaz-zahidi/emergency-contraceptive-p_b_9123750.html

02/01/2016 01:07 pm ET | Updated 10 hours ago

  • Farahnaz Zahidi Writer, editor, media trainer and communications expert.

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It does not work by means of abortion, has no effect on future fertility, does not increase risk of diseases like cancer or stroke, and will not harm a fetus or cause birth defects if a woman already happens to be pregnant. Yet, while the conventional 21 to 28 day contraceptive pill has found a degree of acceptance in Pakistan and most developing countries, the ECP (Emergency Contraceptive Pill) continues to be shadowed by myths.

Most people still confuse it for something that terminates a potential pregnancy, and thus confuse it with abortion. The facts could not be further from the truth. It is ironic that in Pakistan a lot of people avoid the ECP thinking that it translates into an abortion. Out of the 2.4 million unwanted pregnancies in Pakistan in 2002, some 900,000 were terminated by induced abortions (Studies in Family Planning 2007). These unsafe abortions that often claim the woman’s life due to resulting complications can be avoided with the use of an ECP.
This method of contraception can be used after unprotected sex when another form of contraception is unavailable or has failed. It can be used to prevent pregnancy for up to 120 hours (five days) after. Again, it acts as a preemptive measure, and does not cause abortions. The sooner it is taken, the better is the efficacy.

Why choose ECPs in Pakistan?
In Pakistan, it is available over the counter and unlike many other countries where it is a pricey contraceptive choice, it is economical. And it is safe. What is needed, then, is a more aware understanding about this excellent option.

As concerned world leaders, philanthropists, media persons and health care persons came together for the fourth International Conference on Family Planningheld in Bali, Indonesia, from 25 to 28 January, 2016, the ECP was discussed in depth. For the world’s sixth most populous nation even if the registered number of Pakistani citizens is considered, which stands at 199,085,847 in July 2015, as per the CIA Fact book, understanding contraceptive methods is vital.

In Pakistan, many organizations and pharmaceuticals, including Green Star andMarie Stopes facilitate the availability of and understanding about the ECPs. A section on emergency contraception in the Manual of National Standards for Family Planning Services, a document developed by the Family Advancement for Life and Health (FALAH) project, includes the EC and related policy. While the document recognizes that there is a lack of awareness among health care providers regarding ECPs, it also mentions certain stipulations about when it should be used and who should prescribe or dispense it. The possibility of it being used without misconception or difficulty, then, depends on how aware both the users and the health care providers are.

Representatives of the International Consortium for Emergency Contraception (ICEC) shed light on the subject during the ICFP. In over 140 countries women can buy emergency contraception and the ECP is readily available over the counter in 60 countries including Pakistan.


When the ECP is the best choice – in rape and other cases

While using a regular, ongoing method is recommended as the most effective way to prevent a pregnancy, in certain cases the ECP is the better choice. In cases of rape, it makes perfect sense. In 2013, the 57th Session of the United Nations Commission on the Status of Women stated that all Member States must require first responders to include EC provision in post-rape care. The ECP, thus, needs to be included as a regular post-rape treatment.

But the usage of the ECP should not be limited to cases of rape. It is also ideal in cases where the couple may not have regular sexual activity.

Most importantly, it bails out the couple, and especially the woman, in case of an “accident”. If she decides that this might not be the best time to have a child, the pill empowers her to use that discretion.

It is a safe, economical and effective method of contraception. It has very few side-effects and can be used more than once with the consultation of a doctor but should not be used as a regular contraceptive. To gain maximum benefits, people need to know more about what is often called the morning after pill. Above all, it need not be discussed in hushed tones. Contraception is a careful choice and Pakistanis need to make informed decisions regarding FP. Better to be more informed about the ECP and be safe than sorry.

Would a ‘male pill’ revolutionise birth control in Pakistan?

Published: November 18, 2012

As Pakistan’s population time bomb ticks, contraceptive pills for men might become a game-changer. DESIGN: SAMRA AAMIR

KARACHI: 

With the world’s sixth largest population, and growing faster than the top five, Pakistan needs to drastically rethink contraception and family planning.

Until now, conception has largely been a man’s decision in a patriarchal society like Pakistan’s, but usage of contraceptives, when allowed by men, has largely been a woman’s responsibility.

That dynamic, however, may soon be turned on its head by the advent of the ‘male pill.’

The ticking bomb

The country’s headcount ticked past 180 million on World Population Day, July 11, 2012, according to the Population Census Organisation of the Government of Pakistan, and is expected to reach 300 million by 2050.

Fertility rates have been halved to 3.42 births per woman, from historic highs of 6.6 all the way up to the mid 1970s, but contraception usage is restricted.

Only 30% of married Pakistani women, however, use any form of contraception, according to the Pakistan Demographic and Health Survey, 2007. The percentage of men who use contraceptives is much lower.

That may simply be because of the variety of contraceptive options available to women – from pills and coils to injectables and rings – compared to only one accessible option for men, condoms. Even for that there is a lot of resistance. Vasectomy, for its invasiveness and non-reversibility, is not a popular option. In Pakistan, attitudes are also influenced by Islamic teachings that discourage permanent methods of contraception.

“According to Shariah [law] contraception is allowed if there is a genuine reason. But the methods allowed should be temporary and reversible and should not harm the user’s health. The reason should not be ‘who will feed them’,” said Mufti Shah Tafazzul Ali of Darul-uloom Karachi.

A contraceptive for men that is safe, non-invasive and with reversible effects may sound too good to be true, but is already in the making.

Herbal pill

While both allopathic and herbal versions of an oral male contraceptive are currently under research, the closest to hit the shelves is the pill from Indonesia.

Made from the shrub justicia gendarussa, which is found mostly in the Papua Island, the pill “disturbs the enzyme system of spermatozoa and affects its function,” according to Professor Bambang Prajogo, who started research on the world’s first non-hormonal contraceptive pill for males in 1987 at the Airlangga University in Surabaya, Indonesia.

In simpler words, the active ingredient from the herb weakens the sperm, disabling it from penetrating an ovum. The pill’s effect, meanwhile, is not permanent. According to findings of Dr Dyan Pramesti from Airlangga University, who held clinical trials, men were fertile again just two months after they stopped taking the pill.

The pill has been tested on mice for years, and has shown to be safe, effective and with few side effects, Professor Prajogo had said in an interview to PBS in July 2011. Clinical trials on humans had already started by then and, according to Prajogo, had shown “impressive results.”

The Gendarussa pill is ready to hit the Indonesian market in 2013, but will have to be approved by the World Health Organisation before it will be widely available elsewhere. Right now, a small-scale herbal medicine company called Naturoz has started the pill’s production. Once approved by international health authorities, it can easily be exported to Pakistan.

Under research

The latest news of an allopathic male pill has come out of Baylor College of Medicine in Houston, Texas.

Researchers discovered a compound, JQ1, that produces a rapid and reversible decrease in sperm count in mice.

According to a report from August 2012, the compound penetrates a boundary in the cells of the male testes and shuts off sperm development. The result is non-hormonal birth control that researchers said is entirely reversible. The research, however, is preliminary and clinical trials have yet to begin.

Revolutionising family planning

The idea of a male pill is being hailed by women’s groups, receptive males, and family planning advocates. The male pill would not only broaden the choice in contraceptives, but also change social attitudes towards family planning.

“Men being supportive, and involved in the choice, of a contraceptive method is the way forward. It would signal a behavioural change as currently men are generally a barrier to family planning,” said Dr Rehana Ahmed, a director at Greenstar Social Marketing, Pakistan and senior international health adviser to several NGOs.

“But behavioural change requires a process – pre-contemplation, then contemplation phase, and finally action. It is a slow process,” Dr Ahmed added.

Published in The Express Tribune, November 18th, 2012.

http://tribune.com.pk/story/467472/rethinking-contraception-would-a-male-pill-revolutionise-birth-control-in-pakistan/