Investigating the i-pill

Published in Rave Magazine, Nov 2008, Special edition on 'Youth'

Fear. Shame. Anger. Guilt.

These are the typical emotions one associates with an unwanted pregnancy - in a country where chastity before marriage is expected by many; where women continue to bear the brunt of an unwanted pregnancy. The availability of the emergency contraceptive has, however, transformed these feelings of pain and anguish into hope and happiness. We live in an age where options are limitless to the youth of today – and the availability of this little pink pill has spawned many choices. To choose contraception instead of abortion. To choose sexuality over morality. To choose living with hope instead of living in fear.

What is an emergency contraceptive pill?
Emergency Contraceptive Pills (also known as ECP’s or morning after pills), are drugs that prevent the ovulation or fertilization of an egg in a woman. If an egg is already fertilized, the pill may prevent it from attaching itself to the lining of the womb – thus stopping it from forming into a zygote. A pregnancy can only be established if a fertilized egg attaches itself to the womb, and this typically

happens 2-3 days after sexual intercourse.

The ECP is not the same as an abortion pill, as it does not destroy a zygote, but merely prevents it from forming. The effectiveness of emergency contraception is best when taken within 12 hours of intercourse, with 72 hours being the maximum time limit for it to work.

The ECP is also different from the regular contraceptive pill as it stops ovulation or fertilization instead of inhibiting sperm penetration. It is supposed to be ten times more potent that a regular contraceptive pill – which is why it is marketed as an ‘emergency’ contraceptive pill. It is only to be used as a last resort in the event of contraceptive failure or unprotected intercourse, to prevent pregnancy. The ECP does not act as a barrier contraceptive - meaning it cannot prevent sexually transmitted diseases.

There are non oral options for emergency contraception available, such as intrauterine methods where a device (such as the Copper T) is inserted in the uterus during the time a pregnancy is not desired. These methods are expensive and not as popular as ECP’s. The associated side effects are also higher as compared to ECP’s.

The Indian market
The emergency contraceptive pill was made an over-the counter (OTC) drug in 2005, but it was only with the advent of the popular i-pill advertisements that the public became aware of such a product. There are currently about seven ECP brands available in the Indian market, all of them sold over the counter (ECee2, Norlevo, Pill 72, Pregnon, Preventol, Unwanted 72).

The cost of Cipla's i-pill is currently Rs 82.50 and is easily available in any chemist shop. Though the oral ECP is the cheapest form of emergency contraception, the i-pill’s price may not be very inviting to a vast majority of the Indian population. The Consortium for Emergency Contraception in India states that “pricing should be kept as low as possible, to make it accessible to poorer classes, in whose case the need may be more.” Unfortunately, the i-pill does not address this.

Cipla has also set up helpline numbers to answer questions about the i-pill. The numbers are 1800-22-9898 and 022-3200 0055 and are operational 7 days a week. The operators are only available between 9.30 am and 6 pm. This means that any queries that occur the night before or the morning after, need to wait.

Cipla also has an exclusive website for the i-pill ( with an exhaustive FAQ list. Strangely, it took me many minutes and the combination of several keywords to find this website via google. There is also no mention of the i-pill on the Cipla wikipedia entry. There are however, blogs and webzines that have information and opinions on the product.

Wonder drug or wicked drug?
The common side effects associated with an ECP or a birth-control pill include nausea, vomiting, abdominal pain and headaches. Cipla’s i-pill also warns users of “chances of unexpected vaginal bleeding, but this is not dangerous and should clear up by the time you have your next period.” A medical check-up is not required for consuming the i-pill (unless you have a serious health ailment) and the i-pill claims to have no long-term or serious side effects. All these factors are expected in a drug that is easily available without medical prescription.

While some doctors say the i-pill is harmless, there are others who advise consultation prior to the consumption of the pill. Contraceptive pills, in general, are known to be infamous for causing ovarian cancer and other hormonal problems, and the i-pill’s side effects cannot be ignored. There are some doctors who state that the i-pill can cause complications such as menstrual irregularities and abdominal pain. Over-use could also lead to infertility among women.

They also suggest that the i-pill should also ideally be used by women between the age of 25 and 45, and only as an emergency measure. But there are a number of teenagers who consume the pill as a regular contraceptive, without knowing its detrimental effects. Many young women feel they can do without other forms of contraception, without realizing the dangers of STD’s or hormonal imbalance. The i-pill comes in a box that warns users about it not preventing sexually transmitted diseases, but states nothing about age group or how often it can be used. A health warning comes inside the packet about the adverse effects of the pill – in fine print that is quite likely to be ignored by distressed women who are rushing to prevent their pregnancies.

The power of communication
There is no doubt that Cipla’s aggressive marketing strategy ensured it became the number one ECP brand name in everyone’s mind. Advertising not only helps to popularize a product, but shapes opinions of it as well.

Cipla played it safe by targeting its first set of advertisements at married couples. You had a newly married couple, a middle aged couple, and a young couple (with their wedding rings as prominent as the product itself) in the television advertisements. Even though the ads captured the sensitivity of the issue of unwanted pregnancy, there are mixed opinions in they way they handled it. Vineet Kumar, a software professional says, “the ads capture the anxieties of the couple very well and help allay the fears of unwanted pregnancy.” While Sandhya Rao, a knowledge manager says, “Why is it the woman's onus to ensure there are no "repercussions" to what both participants "enjoyed"?”

The newer television ads are more in-your-face and also include the unmarried woman.
One ad in particular, has a salwar clad, bindi wearing girl as the worried protagonist. This shatters the myth that only ‘skirt wearing party going’ girls engage in sexual activities. The new ad campaign focuses on the advantage of prevention over cure – the tagline being “Because prevention is better than abortion. Isn’t it?

The other ad shows a woman getting a call at about 2 a.m. from a distressed friend/relative who has engaged in unprotected sex. She advises the woman in distress to take the i-pill as a precaution, to stop a pregnancy from happening, instead of waiting for an abortion. What struck me about this ad, was the ease with which they brushed the topic of unprotected sex. The NACO is going the extra mile with its condom ads and ring tone, but this ad seems to do just the opposite. No doubt the purpose of the i-pill is to prevent unwanted pregnancies, but the ad could have spoken of a case of failed contraception as against no contraception, and driven home the point that the i-pill does not prevent venereal diseases. This is particularly interesting, since Cipla is one of the largest manufacturers of antiretroviral drugs (that fight HIV/AIDS).

The i-pill ads also do nothing in educating the public about the side effects caused due to misuse of the product. Ashwini Rao, a finance professional says “The company should realise that they are selling a serious product, and should come with a warning that these pills are to be taken in an emergency situation only.” (Addendum: Mint magazine has written an article on how these ads have come under the govt.scanner)

‘Getting back to life’
The sexuality of the modern Indian is no longer something to be embarrassed or ashamed of – but something to acknowledge. The i-pill is therefore not just a pill, but a reflection of the way the youth thinks. The message that prevention is better than cure appeals to many – and has left us with a useful and perhaps life-changing choice. A woman no longer has to undergo pregnancy, motherhood or a forced marriage in the event things do not go as planned.

The i-pill is definitely a better choice over abortion – in a country where approximately 20,000 women die annually due to unsafe abortions. It is also a great option in the event of forced intercourse or rape. While it cannot erase the trauma of rape, it can at least eliminate the possibility of childbirth.

The i-pill is perhaps a welcoming sign of the changing times,but the grey areas cannot be ignored. The availability of the pill as an OTC drug tends to encourage over-consumption of the product, posing serious health risks. And like regular contraceptives, there is no guarantee that the ECP is 100% foolproof. The only way to know if it has worked is if a woman’s period resumes. Till then, she has to wait and watch and worry.

Whether the i-pill encourages sexual irresponsibility or not is also debatable. Back in the 70’s, a typical response to “main tere bacche ki maa banne wali hoon” (I'm going to be the mother of you child) would have been that of anger and blame. With the i-pill, one may not hear such statements anymore, but one might get to see a new breed of pill-popping PYT's who enjoy sexual freedom at the cost of their health. We still have a long way to go before male hormonal contraceptives are available in the market. Till then, birth control continues to be a woman's responsibility.

For the youth, such an option is available – but do more options liberate us or confuse us?

(All images have been taken from the internet)