Shreya Pal, 25, doesn’t think twice before popping an emergency contraceptive pill. “Well, I really can’t be bothered about side effects when there is an emergency.” And how often do such emergencies arise? At most about twice a week, she reveals after much prodding.

Pal is not the only one using emergency contraceptive pills, or morning after pills, as they are called, as a regular mode of contraception. In the past few years, there has been a dramatic increase in the number of people using such pills. Most are not aware of the potential side effects of these pills and are swayed by advertisements that promise painless deliverance from unplanned pregnancy.

With doctors and gynaecologists expressing concern about the rampant misuse of emergency contraceptive pills, many state drug control offices had wanted them to become prescribed drugs instead of over the counter (OTC) medication as they now are.

“Early this month, the Drug Controller General of India’s office ruled that the morning after pill would continue as an OTC medicine. But we will try our best to make it a prescribed one,” says Dr Sajal Roy Chowdhury, director, Drugs Control, West Bengal. “Most of these pills contain hormones 10 times more than the stipulated dosage for chemical contraceptives. So it is best that such pills are prescribed. Otherwise, users will be affected in the long run,” he explains.

Dr Tirthankar Chaudhury, an endocrinologist at Apollo Gleneagles, Calcutta, has proof that Dr Roy Chowdhury’s fears are not unfounded. “Of late, I have been getting cases of young girls complaining of menstrual problems after sustained use of emergency contraceptive pills. Its high dosage of hormones causes side effects like disruption in the normal menstrual cycle, water retention and unpredicted pain. The high hormone content of these pills makes it necessary that their use be regulated,” he says.

Says Anupriya Roy, second-year student of a media college in Mumbai, “The OTC contraceptive pills do contain a warning that they are not to be used as regular contraception but only in times of emergency. Even after such a warning, if an individual pops such pills indiscriminately, then it is her choice.”

“One needs to understand that levonorgestrel, a synthetic progesterone used in most of these pills, can cause damage,” says Joydeep Sarkar, joint secretary, All India Chemist and Distributor Federation, Calcutta. “Keeping them as OTC medicine means that they are easily available to buyers. This is dangerous as many a time a consumer might take the pill without knowing the attendant dangers.” He adds that he knows of several cases where patients have complained of excessive bleeding within a few hours of popping a morning after pill. The advertisements, however, mention no side effects. Worse, they imply that the pill is 100 per cent effective.

“Most pills have a failure rate,” says Dr T. Biju Singh, a gynaecologist associated with the Bhagirathi Neotia Woman and Child Care Centre, Calcutta. “They are 95 per cent effective if taken within 24 hours of intercourse, 85 per cent if taken within 25-48 hours; 58 per cent if taken after 49 but before 72 hours. So the failure rate increases with time but this is often not advertised. Also, if the pill is taken in mid-menstrual cycle, the chances of it being ineffective is very high.”

Manufacturers clarify that the fact that the pill might sometimes fail and its side effects are listed not only in the literature provided with the medication but also on the company website. Says Ramesh Chandra, general manager of Mankind Pharma which manufactures the morning after pill Unwanted 72, “The advertisements are not misleading and we do have the side effects listed in a booklet within the pill box.”

“It’s the advertisements that make consumers think of the emergency contraceptive pill as a great blessing. The average consumer keeps on using it blithely till the side effects become obvious and she has to seek medical help,” says Dr Singh.

“I find the advertisements for these pills completely misleading,” says 28-year-old Neha Singh, who had a bad scare when she used an emergency contraceptive recently. “I hadn’t read the fine print, so when I started suffering from lethargy, breast tenderness and my periods were delayed — all typical signs of a pregnancy — I didn’t realise that they were side effects. In fact, I thought that the pill had failed. The ads should at least mention the possible side effects and educate consumers about the correct use of the morning after pill.”

Taking into account the number of complaints received, the Drug Technical Advisory Board (DTAB) has set up an expert committee to decide how these pills should be advertised and what changes are necessary in the advertisements currently on air to make them more acceptable.

Most manufacturers have welcomed the move. “We are waiting for the committee to come up with guidelines for the advertisements being aired. The necessary changes will be made and some kind of warning added in the days to come,” says Chandra.

Of course, even if the ads are made more informative, and even if these pills continue to remain available over the counter, it is up to the consumer to make sure that she knows exactly what kind of side effects emergency contraceptive pills might have.

(Names of pill users have been changed on request)