Old Family Planning Fraud in New Bottle

TOI reports that Govt. has announced 'Incentive' scheme to spur acceptance of Vasectomy operation. Those who undergo Vasectomy operation will be paid Rs. 1200/-,'Motivator' will receive Rs 150/- and even surgeon will be paid incentive. Govt. hopes that this will help make Vasectomy more acceptable. Of course women undergoing Tubectomy operation will also be paid similar amount as incentive.
This news brought memory of those good(?) old days when Vasectomy had pride of Place in Family Planning Program. During Emergency Scion of Gandhi family and heir apparent Sanjay had taken up Vasectomy as part of his 5 point program. Teachers,Govt. officials, Police and all those who were in power were given Vasectomy operation targets and they HAD to fulfill the target. Result of this misplaced zeal was forced Vasectomies. Police and other Govt. functionaries rounded up people and forced them to undergo Vasectomy,even those who were not eligible for operation.Surgeons aware of this state of affairs simply gave incision on Scrotal skin and did not Tie/cut the Vas. Ofcourse he was paid off to do this.Incentive money was shared by the staff of Family Planning Dept. I remember people arriving by train from U.P./Bihar etc were rounded off and forced to undergo Vasectomy at V.T. station. After emergency was lifted, Vasectomy program was severely criticized and was held responsible for defeat of Indira Gandhi.
As Vasectomy operation virtually disappeared from the scene, incentive program was introduced. But by this time FP staff had learned the trick. As a person who had worked in the dept. then, I can confidently say that more than 95% of the cases done between 1980 -86 were fake cases.we used to call then as 'D' cases. Everyone including driver/cleaner of the Mobile Vasectomy Van of BMC had share of this loot. In city like Mumbai, Patient could never be traced if address given was in slum. Each center had a team of 'Motivators' who would bring patients for Vasectomy. Everyday 5-6 cases were done. Same people would come again n again for operation and all forms were duly filled and money distributed.Biggest problem was to give names to the patient.Here Marathi newspapers would come handy and Names were lifted from Navakal,Sakal etc. Injections,syringes,Gauze, Cotton and other material was pilfered. There was scramble to get posting at centers doing cases and on Mobile Vasectomy Vans. Vasectomy operation figures improved dramatically. There were cases which were not eligible for Vasectomy, age more than 40 yrs or spouse had undergone tubectomy etc. but those were the days of Dr. Datta Samant led Mill Strike. Many Striking Mill worker opted to get operated to get Rs. 800/-as incentive money.In 1983 this was good amount. Unemployed youth,migrant workers, teenage streetchildren were lured by Motivators to undergo Vasectomy operation. Obviously this FP program couldn't make any dent in burgeonig population. When in 1986 ,incentive program was stopped, number of Vasectomies dropped precipitously and now it is just few thousand cases.
Fate of this program is not going to be different.Crores of Rupees ,badly needed to provide Health care to poor will be diverted and siphoned off. May be this is a pay off to political party worker in Pre Election year. As it is even Female Tubectomy program is not picking up. There should be rethink on Permanant Method like Tubectomy/Vasectomy. Their acceptance is very low these days. Couples prefer to use Temporary methods like Condoms,IUCD or Pill and Emergency contraceptive pill. In case of failure Medical Termination is preferred.This new incentive scheme is invitation to fraud and new generation of FP worker will be initiated into this fraud and will stop promoting temporary methods as well. ---PK

E Pill-Emergency Contraceptive pill

I am really pissed off with the TV advertisement of Cipla's Emergency Contraceptive pill. Don't get me wrong. I have no cultural or moral objection to this advertisement. On the contrary I feel its very very effective advertisement, and there lies the problem. Since the airing of these films I have had patients who had used these pills and were pregnant. There are girls who are sexually active and want to use this pill as contraceptive method. Now this pill is meant to be 'Emergency' contraceptive and one should not have emergency every month or 3-4 times in a month. Inadequate knowledge, easy availability in Chemist shop without prescription and lack of supervision by medical personnel can result in complications. If one is Sexually active on regular basis then Regular,more effective Contraceptive methods under Medical supervision should be preferred.
First of all , it's Emergency contraceptive pill, so it should be used only in an Emergency.That means that if you suspect that contraceptive method used by you may not work( Condom broke or slipped off or semen entered the Vagina. or you missed to take the pill or safe period was calculated wrongly. In the case of Rape it should be routinely given.) It is not as effective in Preventing Pregnancy as regular contraceptive methods like Condoms, Birth Control Pills or IUCD-Copper T. Its no more effective than 70-80% ( There is no good Clinical data for this as well). It contains Hormone Estrogen and Progesterone and will alter Hormone Balance and period can be delayed. multiple use may make period irregular. Besides there are side effects like Nausea and Vomiting, Venous Thrombosis etc. Though these side effects are not usually serious.
Finally my pet grouse. E-Pill does not protect from Sexually Transmitted Diseases like Candida and other infections, Herpes and fatal HIV and Hepatitis B & C. This is more dangerous then Pregnancy! Most effective Emergency Contraceptive is to Carry good quality Condom in your purse and ask the Man to use it properly if he wants Sex. If he refuses then walk out for your own good.