Emergency Contraceptives - Ethical or Unethical
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Transcript of Emergency Contraceptives - Ethical or Unethical
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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
Sou
rce :
Th
e T
imes
of
Ind
ia,
ZE
EN
IA F
BA
RIA
, Ju
l 3
, 2
01
0
• 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!!