Doctors hail Govt. decision to market controversial abortion pill

Doctors hail Govt. decision to market controversial abortion pill
SREELATHA MENON

NEW DELHI, NOV 3: The medical fraternity in the country has welcomed the Government's decision to market the abortion pill RU-486 in India but has warned that the pill could prove to be dangerous if its use is not strictly regulated.

The Indian Council of Medical Research recently recommended marketing of the drug under strict medical supervision after the Union Ministry of Health and Family Welfare sought its opinion on the drug.

The drug, which has been in use in many European countries, was granted approval in the US only last month after a decade-long resistance to it by anti-abortion activists.

While the US Food and Drug Administration has clamped strict regulations on its use, norms on its use and marketing are yet to be announced in India. The pill has sparked off a major controversy in the country with women activists such as Brinda Karat protesting against it. They say unregulated and unmonitored use of the drug could lead to dangerous side-effects.

But according to Banu Gupta, gynaecologist in the Capital's Holy Family Hospital, such panic is unnecessary. "All one must ensure is that it is introduced with strict regulations," she said. It also requires public education.

The pill, she says, is effective in inducing abortion only in the first seven weeks of pregnancy and can be used only in a normal pregnancy and never in a tubal or any other abnormal pregnancy.

``The pill has to be taken with prostaglandin, and hence only an informed doctor can adminster it. Besides in some rare cases, it may not lead to complete abortion and the patient may require surgical removal of foetus. It may also in some cases lead to excessive bleeding requiring transfusion.'' FDA regulations make three visits to the doctor mandatory for taking the pill. The first to get counselling and three RU 486 or Mifoprex as it is known there; the second to take two tablets of a drug called Misoprostol which induces contractions; and the third for a follow up after 12 days.

According to Dr Alka Kripalini, the All India Institute of Medical Sciences, where a ten-year clinical trial of the drug was carried out, there is no reason why its use cannot be regulated. ``Why condemn a useful and safe drug because we are not willing to use it properly,'' she asks.

``Even cars can be misused but we do not ban cars,'' she says. She says that the pill was found to be 90 per cent effective in ICMR's studies involving hundreds of women at Safdarjung Hospital and AIIMS. ``It is a useful drug and is needed,'' she says.``With the pill you can avoid surgery in 90 per cent of abortion cases (normal pregnancies upto seven weeks),'' she says.

Hormonal action by the pill causes bleeding for two to three days till the foetus is expelled, she says, but excessive bleeding is rare. In such cases transfusion is a must and patients must have access to it. Those who administer the pill should also be aware of such complications, she says. Citing views expressed by doctors from the UK at a meeting of the Royal College of Gynaecologists in Chandigarh, Dr Urvashi Jha, gynaecologist in Apollo Hospital says that they had found it safe to let the patient take the pill on an out-patient basis. ``There is no reason why we should delay the pill. It will suffice to educate our doctors and the public as to who should give the pill and how the medicine should be administered.

As for misuse of the drug, she says, all drugs can be misused. ''Why pick on this drug?'' It has advantages and disadvantages but can prove very useful as it is like normal abortion and avoids anaesthesia.