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EMERGENCY CONTRACEPTIVE PILLS - ETHICAL OR UNETHICAL

Presentation By:Ankit Verma

Shadab Ahmad

CONTENTS

Introduction Doctors’ Suggestions India in 2010 Ethical Aspects Use of Pills- Ethical or Unethical Counter Arguments Ethical Aspects on Religious Grounds Ethics involved in Advertising and

Marketing Conclusion

THE BASICS FIRST

An emergency contraceptive pill is a contraceptive method which, if used after unscheduled intimacy, may prevent pregnancy

They are called Emergency Contraceptive Pills because they are meant to be used in an emergency situation

They are not recommended as standard contraceptives

BASICS…

An Emergency Contraceptive Pill (ECP), a.k.a. the Yuzpe Regimen contains an elevated dose of oral contraceptives containing estrogen (ethinyl estradiol) and a progestin (levonorgestrel or norgestrel) is taken within 72 hours of unprotected intercourse

This method has been in use for over 20 years.

Gravol pills are often given in addition to the ECP, to reduce nausea - a common  side-effect

BASICS… Currently, the two types of pills in the

market are the I-pill from Cipla (now Piramal) and Unwanted-72 from Mankind

The hormone in these is LNG of 1.5 mg, to be taken as a single tablet

Other brands like EC2 (Zydus) or Norlevo (Win Medicare) have 0.75 mg of LNG, to be taken as two tablets 12 hours apart, which decreases vomiting

WHAT THE DOCTORS SAY

Each such tablet contains 1.5 mg of levonorgestrel, a synthetic hormone

Statutory warning : Use only in emergency situations, not as substitute for condoms or low-dose oral contraceptives. Does not prevent sexually transmitted diseases such as AIDS

Possible side-effects : Vomiting, nausea, fatigue, abdominal pain, diarrhea, dizziness, headache, early or late onset of next period and increased menstrual bleeding. Some women might suffer ectopic pregnancy

DOCTORS SAY… Effectiveness : 1. Various sources indicate that their

efficiency is 74% or more2. Some studies found them 89% effective3. The number of women who take the pills

and still become pregnant is only about 2%

4. Doctors believe that most women who take EC Pills would not have become pregnant anyway

INDIA IN 2010

The proportion of women knowing the methods of birth control like oral pills and condoms varies from about 2 percent in Meghalaya to 80 percent in Himachal Pradesh

21% pregnancies are unplanned, contributing 6.5 million induced abortions every year

A survey, Indian Adolescents – Changing Sexual Behavior, claims that teenage pregnancy has doubled between 2004 and 2009Source : Jansankhya Sthirata Kosh, http://www.jsk.gov.in/

INDIA IN 2010

65% of the girls who get pregnancy before marriage prefer to abort without letting their families know

This is not widely known that Emergency Contraceptive Pills are included in the National Family Planning Program

Source : Jansankhya Sthirata Kosh, http://www.jsk.gov.in/

TEENAGERS IN INDIA

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• 20% teens have watched porn before they reached 13

• By the time they reach 16, 50% teens have already watched porn

• About 50% of teens have kissed someone of the opposite sex

• 9 out of 10 teens think premarital sex is fineFind it plausible? At least in our opinion, it

is...

Teenagers in India

Some Good And Some Not So Good News :

The good news is that the number of medical termination of pregnancies has started to dip

The bad news, however, is that the country still records large number of MTPs

In 2008, 6.41L abortions across 12,510 institutions Highest number of such abortions- Tamil

Nadu(89,194) followed by UP Tamil Nadu has banned the sales of ECPs under

provisions of the Drugs and Cosmetics Act

Source : The Times of India, Kounteya Sinha, Thursday, 16 September 2010

EMERGENCY CONTRACEPTION - ETHICAL

ASPECTS The ethics of providing EC Pills has been

questioned by some, arguing that it acts by preventing implantation

Scientific evidence does not support this concept, but shows that EC Pills act before fertilization

Placing obstacles to the access of EC Pills is unethical as it transgresses the ethical principles of autonomy and justice

Far from inducing abortions, EC Pills reduce unwanted pregnancies and prevent abortions

ETHICAL OR UNETHICAL

The ethics related to EC Pills use can be seen from two opposite perspectives

There are those who believe that the use of EC Pills is unethical and those who believe that limiting access to EC Pills is a violation of basic ethical principles

USE OF EC PILLS - UNETHICAL

Some people question the ethics of using EC Pills arguing that its mechanism of action is prevention of implantation and that the fertilized egg is equivalent to an unborn child

Consequently, they maintain that prevention of implantation is an early abortion, which they condemn

COUNTER ARGUMENTS

This ethical objection of the use of EC Pills is not valid, as it is based on the false premise that the mechanism of action consists prevention of implantation

This incorrect concept stems from the supposition that synthetic hormones used for EC Pills would alter the characteristics of the endometrium in such a way that it would interfere with implantation

But all mechanism of action studies have shown that EC Pills interfere with the ovulatory process

ARGUMENTS CONTINUED…

EC Pills either inhibit or delay ovulation beyond the period of sperm survival in the woman’s body

The primary problem is that old textbooks on contraception state that interference with implantation is one of the mechanisms of action of the EC Pill

But now, there is sufficient scientific evidence for pre-fertilization effects of emergency contraception

USE OF EC PILLS - ETHICAL

Placing barriers to the use of pills is a transgression of the ethical principles of respect to the autonomy

EC pill is a very effective instrument for the prevention of unwanted pregnancy, and consequently of induced abortion

If the pills are used as they are meant to be, far from ‘inducing abortion’, it can be a very important instrument to improve the health and well-being of women

The pills are again very helpful in the cases of forced sex or when the health conditions of woman are not good enough to have a baby

COUNTER ARGUMENTS Social conservatives oppose all forms of

abortion on absolutist grounds, allowing only rare exceptions where the life of the mother is truly at stake

Some people argue that easy access to EC Pills would stimulate women, particularly adolescent girls, to promiscuity and abuse of sexual freedom

Earlier, due to ethical issues and social stigma attached to getting pregnant before marriage, girls used to avoid unprotected intercourse but now even teenagers think it is easy and casual to consume a pill and prevent pregnancy

ON RELIGIOUS GROUNDS Religions vary widely in their views of the ethics of

birth control The Roman Catholic Church accepts only Natural

Family Planning and only for serious reasons, while Protestants maintain a wide range of views from allowing none to very lenient

In Islam, contraceptives are allowed if they do not threaten health, although their use is discouraged by some

Hindus may use both natural and artificial contraceptives, however they are against any contraceptive method which works after fertilization

A common Buddhist view of birth control is that preventing conception is ethically acceptable, while intervening after conception has occurred or may have occurred is not

LIES, SEX AUR DHOKHA Quoting what was told to

Spiderman "With great power comes great responsibility“, marketers should also be fully aware of the responsibility which comes along with yielding such a powerful force on consumers

The fact that they have been made into OTC (over the counter) drugs by which it means that they can be sold without a doctor's prescription and companies can directly communicate to consumers is one reason which has led to the issue

ab ham hain tension free

DHOKHA CONTINUES… Morning-after-pills are

emergency contraceptives but the way they are being presented in the advertisements, more and more women in the age group of 16 to 35 are falling prey to them• The ads give false hope of a ‘tension-free’ sex-

life, claiming that ECP is 100 percent effective with no side-effects• They do not mention that ECP should be used only for emergencies, thus leading to misuse and complications

Abortion say accha hai pregnancy ko rokna

CONCLUSION Creation of awareness about ECP should be the

government’s responsibility, and not just that of pharma firms’

Ethical guidelines should be laid out by the Indian Council of Medical Research and made binding on the firms

A conference in India indicated that ECP could make a major impact at reducing country's millions of legal and illegal abortions each year

It should be allowed only in the case of danger to life of the pregnant woman, grave injury to mental or physical health of the woman, pregnancy caused by rape, risk of child being born with severe physical/mental handicaps or failure of any contraceptive device or method

CONCLUSION CONT… Although there is general agreement that

emergency contraception protects against unwanted pregnancy, the magnitude of the protective effect continue to be a matter of debate

This debate may well never be concluded because, to settle the question, a randomized trial would have to be conducted comparing pregnancy rates in treated and placebo groups

But.. This would be unethical

REFERENCES Alcorn R. Does the birth control pill cause abortions? 3rd edition.

Eternal Perspectives Ministries. Gresham, OR. 1998. (http://www.epm.org/bcp.html /)

Kahlenborn C. How the pill and other contraceptives work. Can a Christian take the Pill? ? Life Advocate 1997;12(7). (http://mttu.com/Advocate/7_97/feature.htm/)

Facts about family planning. Health brochure series. American Academy of Natural Family Planning. St. Louis. 1999. (http://www.aanfp.org/fpfacts.htm/)

Birth control pills: contraceptive or abortifacient? American Life League. Stafford, VA. 1999. (http://www.all.org/issues/pillab.htm/)

http://ec.princeton.edu/questions/dedicated.html http://www.religioustolerance.org/abo_emer0.htm http://www.tehelka.com/story_main46.asp?

filename=Ne140810Proscons.asp http://www.jsk.gov.in/family_planning_method.asp/

Thank You!!