Contraception, where have we been and where are we going prepared by Dr.Laxmi Shrikhande a leading Gynaecologist and Fertility expert in Nagpur

1. • Chairperson Elect ICOG –Indian College of OB/GY
• National Corresponding Editor-Journal of OB/GY of India JOGI
• National Corresponding Secretary Association of Medical Women, India
• Founder Patron & President –ISOPARB Vidarbha Chapter
• Chairperson-IMS Education Committee 2021-23
• President-Association of Medical Women, Nagpur AMWN 2021-24
• Nagpur Ratan Award @ hands of Union Minister Shri Nitinji Gadkari
• Received Bharat excellence Award for women’s health
• Received Mehroo Dara Hansotia Best Committee Award for her work as
Chairperson HIV/AIDS Committee, FOGSI 2007-2009
• Received appreciation letter from Maharashtra Government for her work in the
field of SAVE THE GIRL CHILD
• Senior Vice President FOGSI 2012
• President Menopause Society, Nagpur 2016-18
• President Nagpur OB/GY Society 2005-06
• Delivered 11 orations and 450 guest lectures
• Publications-Thirty National & Eleven International
• Sensitized 2 lakh boys and girls on adolescent health issues
Dr. Laxmi Shrikhande
MBBS; MD(OB/GY);
FICOG; FICMU; FICMCH
Medical Director-
Shrikhande Fertility Clinic
Nagpur, Maharashtra

2. Contraception- Where have
we been and
where are we going?
Dr Laxmi Shrikhande
Consultant –Shrikhande Hospital & Research Centre
Pvt Ltd
Nagpur

3. Population Projection – India & Global
India accounts for 17% of world’s population
By 2050 : expected population :
India : 1.63 Billion
World’s population 9.3 billion
(16% in 2050 will be over 65 – more would be over 85 yrs)
• Population increase due to
 lack of contraception
 Decline in infant mortality
 Increase in life expectancy.

4. SDGs and the World Population
• The goals are laudable but cannot be achieved with an ever increasing
population.
• To survive and thrive; the denominator i.e. the population need to be stable.
Contraception is the need of the hour
Global : Unmet need
225 million women in the reproductive age group who want contraception.
80 million unwanted pregnancies

5. 15.6 Million Abortions Occur
Annually in India
The Lancet Global Health—was conducted jointly by researchers at the International Institute for Population Sciences (IIPS), Mumbai; the
Population Council, New Delhi; and the New York–based Guttmacher Institute. 2017

6. Current use of family planning methods (among
married women of reproductive age)
India (%)
Total unmet need 9.4
Any modern method use 56.5
Female sterilization 37.9
Male sterilisation 0.3
IUD/PPIUCD 2.1
Pill 5.1
Condom 9.5
Injectables 0.6
Source: National Family Health Survey (NFHS-5) 2019-20. Ministry of Health & Family Welfare, Government of India
• Unmet need : 9.4 %, indicating that 1 in 10 women want to space or limit births, are not able to do so
• Undue burden of family planning on women, the focus continues to be on female sterilization.
• Adoption of spacing methods and male participation remain low.

7. Female
Sterilisation ,
37.9%
Male
Sterilisation ,
0.3%
IUD/PPIUD,
2.1%
Pills , 5.1%
Condom,
9.5%
Injectables ,
0.6%
India
Source: National Family Health Survey (NFHS-5) 2019-20. Ministry of Health & Family Welfare, Government of India

10. Snapshot- New Contraceptives

11. Injectable Contraceptive MPA (Antara Program)
Long-acting reversible contraceptive (LARC)
• 4th most prevalent contraceptive
• Currently 42 million women worldwide use MPA as a method of choice
• Developed in 1954 by the Upjohn Company for treatment of
endometriosis and habitual or threatened abortions
• Since 1960, licensed to be used as Contraceptive
• USFDA in Feb 1992 approved DMPA as a contraceptive
• Currently approved for use in more than 130 countries
(WHO: Family Planning: A Global Handbook for Providers)

12. Two New Progestin-only contraceptives introduced in India
DMPA –SC (Sayana Press)
Subcutaneous injectables
Subdermal Progesterone Implants

13. Both are injectable Medroxy Progesterone Acetate for 3 monthly use

14. DMPA-SC Self injection Way forward …
Client self-
injection under
supervision at
PHC (two visits)
Self-injection
independently at home
for two doses
Client returns to healthcare
facility after six months for
check up and DMPA-SC re-
supply
DMPA-SC can be self –Administered- Improve autonomy
Cost effectiveness : travel, service provision
Improved continuation rates
DMPA SC
injection
admistered by
Healthcare
provider

15. Progesterone Implants

16. Implants - LARC
 Implanon NXT (Nexplanon): 1-rod
 effective for 3 years
 68 mg of Etonorgestrel
 bio-equivalent to Implanon but has an
addition of barium sulphate that makes it
radio-opaque.
Jadelle: 2-rod
effective for 5 years
Levonogestrel 75 mg
Progestin-filled small flexible rod
Inserted under the skin of the Inner upper arm

17. Emergency contraception
 Ulipristal acetate
( progesterone receptor modulator)
 Single dose 30mg within 120 hours
 The UPA EC regimen is slightly more
effective than LNG as shown by a
meta-analysis (n = 3242) of two
randomised controlled comparative
trials
 UPA may be more effective than
LNG for women who are obese.
 Cu-IUD
 Inserted within 120 hours
 Large systematic review of 42 studies
showed that Cu‐IUD is the most
effective EC with failure rates of
<0.1%.
Levonorgestrel 1.5 mg single dose ?
Although for use within 72 hours, there is evidence that efficacy may be maintained up to 96 hours post UPSI
Piaggio G, Kapp N, von Hertzen H. Effect on pregnancy rates of the delay in the administration of levonorgestrel for emergency contraception: a combined
analysis of four WHO trials. Contraception 2011;84:35–9
Cheng L, Che Y, Gulmezoglu AM. Interventions for emergency contraception. Cochrane Database Syst Rev 2012;8:CD001324

18. Other newer routes of administration of combined
hormonal contraception
Vaginal rings Contraceptive Patch
Monthly combined
Injectable

19. Women are Dying Every Day…
• Every 15 minute……., somewhere in India, a woman dies in
pregnancy or childbirth
-One – Third of these deaths could be avoided if women
who wanted effective contraception had access to it

20. Questions

21. My World of sharing happiness!
Shrikhande Fertility Clinic
Ph- 91 8805577600
shrikhandedrlaxmi@gmail.com

22. The more you give, the more you will get.
Then life will become a sheer dance of love.
H. H. Sri. Sri. Ravishankar
The Art of Living
Thank you