Births in control, but at mothers’ cost?

KARACHI – Depo-provera, a birth control injection that is said to last for three months, is still being pushed upon unsuspecting women in Karachi despite known hazards of long-term use. According to the WHO, long-term use of the drug causes a loss in bone mineral density – an issue that led the Federal Drug Administration (FDA) in the US to apply the ‘black box’ warning (the highest that is applied to drugs short of banning them altogether) to Depo-Provera.
Despite these issues, not only is usage of this drug on the rise in Karachi, it is also recommended by government-funded organisations such as ‘Sabz Sitara’ (Green Star). Almost every Depo-Provera user that Pakistan Today spoke to said that she opted for it because of ‘the convenience factor’.
“With birth-control pills, there are issues if I forget to take even one. I have a family to look after and often forget to take my own medication. With Depo-Provera, however, I can be in peace for almost 13 weeks,” Sameera, a housemaid who had come to a Sabz Sitara outlet in Karachi, said. Other women at the clinic concurred. None of them had been told about long-term side-effects by professional who administered the injection.
“There are no such side-effects, or we would have known,” a nurse at a private organisation said. “Depo-Provera is the most convenient birth-control method for both, working women and housewives. Even if there are side-effects, they probably manifest only after a decade or so of use. I don’t think anyone uses birth control for that long.” She could not clarify where she had got the ‘decade or so’ hypotheses or the fact that women do not use birth control ‘for that long’.
Her ‘analysis’ is erroneous: according to studies that were conducted by Depo-Provera manufacturers as well as several organisations, such as the National Institutes of Health (NIH) in the US, adults and teenagers who used Depo-Provera for at least two years were more likely to experience loss of bone density than women using non-hormonal methods. “We want to take birth control issues into our own hands,” a group of women who had come for Depo-Provera shots to a private, NGO-subsidised clinic, said.
“Our husbands don’t like using condoms, and forcing them leads to a row. We’d rather not deal with that unpleasantness; but we don’t want to have any more children in the near future either. Birth-control pills require a lot of discipline. Depo-Provera is our best option. It is not because of cost – there’s no difference: an injection which lasts three months costs us Rs30. A one-month pack of birth-control pills costs Rs10. If there were side-effects to Depo-Provera, the people here would have told us.”
A major problem, meanwhile, is that most women who come to these clinics hail from the low-income strata – sections already at higher risk of Osteoporosis due to insufficient nutrition. That fact that giving them a drug that is known to increase loss of bone density puts them at even greater risk of osteoporotic fractures, should have been looked into by the authorities concerned. All is not gloom, however, and any side-effects that have been caused due to long-term use of Depo-Provera can be reversed, at least in part.
Studies conducted by the NIH in the US show that bone loss is “at least partially reversed” in women who stop using Depo-Provera. That, meanwhile, would require an immediate ban on the product – something that, according to sources in the health department, is not on the cards, primarily because authorities concerned are not aware of even known side-effects of the drug.