Doctors Divided on Ring's Appeal
6, March 2010
By Malathy Iyer
The new female contraceptive–the vaginal ring–keeps introducing estrogen and progesterone into the blood through the vaginal lining to prevent ovulation.
Dr Rekha Daver, who heads the gynaecology department of the state–run JJ Group of Hospitals, said, "The ring is too expensive to be accessible to the majority who need contraceptives." The ring was introduced in India in November 2009 and costs a little less than Rs 800.
However, some doctors feel it is the contraceptive for the modern Indian women. Dr Mandakini Parihar, who has a clinic in Chembur and teaches at K J Somaiyya Medical School, Sion, said, "The most effective way of stabilising the population is to have womancentric contraceptive choices. While women in our country prefer tubectomy (in the public sector) and pills (in the private sector), the ring offers a choice of low–hormone dosage with few side–effects."
Parihar said that over 20 women who visited her clinic in the past three months have converted to the ring. "They are happy with the freedom it offers vis–a–vis the contraceptive pill," she said.
However, a senior doctor wondered if Indian women "who don't favour tampons would use a foreign object".
Sreeraj Roy, of the multinational MSD, which launched the ring worlwide, said that pre–launch market research in India revealed potential. "Women found the idea of once–a–month use attractive. While some doctors told us they were worried about Indian women favouring a vaginal insertion, we found that modern Indian women seemed comfortable with it."
According to Dr Urvashi Jha, of Max Healthcare, Delhi, "Twenty years back, the Indian woman would be scared, but not any more. We helped many women use it the first time and thereafter they were comfortable with it."
Dr Duru Shah, who has a clinic at Kemp's Corner, said that hormonal contraceptives have traditionally not been favoured by Indian women. "They are still guided by talk of the early pill, which had high doses of hormones and were feared to have caused uterine cancer," said Shah.
Indeed, the three National Family Health Surveys (NFHS) done in the last decade revealed that Indian women still depend on sterilisation. Over 38% chose sterilisation while only 3% depended on pills.
Daver said, "The market is flooded with contraceptives that have different delivery systems. It depends on what the woman is comfortable with." She said the ring is a new version of the original pill. "It works on the same principle. But it is too expensive to get popular," she added.
Beyond The Pill
Latest Contraceptive | Vaginal birth control ring USP | Can be inserted just once a month, unlike the pill, which needs to be taken daily
The flexible, transparent ring disperses hormones throughout the ring's core. They get absorbed through the vaginal lining into the bloodstream. Like the pill, they inhibit ovulation
Self–administration | In clinical trials in the West, 96% of women reported that the ring was easy to insert and 98% said it was easy to remove
Low estrogen exposure | It delivers hormones slowly and steadily, unlike the pill, which has a higher dosage of hormones
Fewer side–effects | As it is not taken orally, women don't suffer from nausea, bloating or tenderness in the breasts, which are associated with pills
Women with these conditions shouldn't use the rings
History of heart attack or stroke | History of blood clots in legs, lungs or eyes | History of blood clots in deep veins of legs | Chest pain | Severe high blood–pressure | Diabetes with complications of the kidneys, eyes, nerves or blood vessels | Headaches with neurological symptoms | Known or suspected breast cancer or cancer of the lining of the uterus, cervix, or vagina (now or in the past)