India Bans Sterilization Drug
Filed at 12:06 p.m. ESTJanuary 10, 1999
By The Associated Press
CALCUTTA, India (AP) -- Most everyone agrees India's biggest problem is its population, which has soared from 350 million a half century ago to nearly 1 billion today.
So some Indian doctors were baffled, even angered, when the government banned quinacrine, an inexpensive anti-malarial drug that has been used for two decades in a non-surgical method of female sterilization.
Quinacrine's advocates praise it as accessible to even the poorest of women in rural India. Opponents criticize it for just that reason, contending a method that the World Health Organization says could cause cancer is being used on Third World guinea pigs.
Women's rights activists fueled the campaign that in August led India's government to outlaw the import, manufacture, sale and distribution of contraceptive pellets made of quinacrine.
When quinacrine is inserted in the uterus in pellet form, it irreversibly scars the fallopian tubes and prevents pregnancies.
The procedure is performed without anesthesia and can be painful. Side effects include abnormal menstrual bleeding, backaches, fever, abdominal pain and headaches. In addition, tests have found that under some conditions quinacrine could be linked to cancer.
Quinacrine is not approved for use in the United States. Nearly all major family-planning organizations, many foreign governments and the World Health Organization oppose its use for sterilization.
Indian doctors who have performed quinacrine sterilizations said the ban has more to do with politics than medicine. A large part of the controversy around its use has arisen because the drug is exported to Asian countries free of cost by two American doctors who have links to anti-immigrant groups in the United States.
Quinacrine ``should first be used on white women in the First World,'' said Dr. Mohan Rao, professor for social medicine and community health at New Delhi's Jawaharlal Nehru University, his rhetoric underlining how bitter the debate has become.
Many poor Indian women have opted for quinacrine sterilization because it does not force them to stop working, and it allows them to keep the decision from husbands who may not want them to stop having children.
``In their lives, quality has little meaning. Simple access to health care is all they can hope for,'' said C.M. Pramanik, who has performed more than 500 such operations in rural Bengal.
Protima Das, 45, was sterilized 15 years ago by Pramanik, a practitioner with a degree in alternative medicine. Homeopathy and other traditional medicines are popular in rural India, where many people are suspicious of Western medicine and surgery.
``I think it has served me well,'' said Das, a soft-spoken mother of three who lives in a sleepy village a few hours drive outside Calcutta.
She says it was recommended by her doctor, who said it was trouble-free and inexpensive. She does not recall being warned of possible health hazards.
Das is a perfect example of how poor, uneducated women can be misled about medical treatment, women's groups say. The method is so simple that people like Pramanik, who are not doctors, can perform it even though they may not be able to give women advice about possible consequences.
But doctors who have used the drug for years say it should be allowed -- unless it is proved unsafe -- because it is at times the only option for poor working women looking for cheap, noninvasive sterilization. The ban announced in August means there can be no trials in India to either prove the method is safe or confirm it is dangerous.
Four years ago, two Indian researchers, Dr. Anita Sabbarwal and Dr. Maya Sood, reportedly found quinacrine sterilization to be safe. But today, because of the controversy, they refuse to discuss their findings.
``If the drug causes cancer, I don't want to promote it,'' said Dr. J.K. Jain, a surgeon who has lobbied the government to allow the use of quinacrine and has distributed the drug to thousands of doctors and health workers across northern and eastern India.
``But pregnancy itself is a killer,'' he added. ``If the drug has so much potential to improve the lives of women in the reproductive age, it should be allowed.''
More than 500,000 women, mostly from the poor South Asian subcontinent, die every year from complications arising from childbirth. Health facilities are less than rudimentary, with federal spending on health in India averaging about 30 cents a person.
Sterilization itself has been an explosive issue in India. The country's first attempt at mass population control ended a failure in the mid-1970s under the direction of Sanjay Gandhi, son of then-Prime Minster Indira Gandhi. The younger Gandhi was accused of forcing people to be sterilized and setting up programs under which people were sterilized without their knowledge.
Since then, India has had a more cautious approach -- critics say too cautious. Government officials favor educating people about the benefits of smaller families and offering incentives, such as a one-time cash reward, to persuade people to limit families. The new methods have found limited success in largely traditional India, where women are encouraged to have many children, especially sons.