Diaphragms

4 Feb 01

Dr.Krishnankutty on diaphragms, 04/02/01

Hi all, (Zee, would you please print this out and send it to Janet? Many thanks!)

I think I'd better bring you into this from the beginning. A friend of ours, Janet Hastings, is a midwife from UK. She stayed with us for 3 weeks this January, and we somehow got to talking about rubber diaphragms. She was saying what a good contraceptive device this is, and also that many women are starting to also use it to contain menstrual bleeding - this, although it seems like a lot, actually only works out to a couple of ounces each month. This particularly held my interest, because the present options available in India - sanitary napkins, tampons - are expensive and eco-unfriendly for disposal. Cloth is uncomfortable, needs a lot of water to wash out, and isn't user-friendly, generally. Tampons, Janet told me, are also a common cause of infection, because women sometimes forget to take them out. This infection can have serious effects, even causing infertility.

New problems come in with the new genetically modified bt cotton entering the market - if these are used in napkins and tampons, they could make users (or vaginal bacteria) develop a resistance to streptomycin, one of the commonest antibiotics used to treat several sexually transmitted diseases...

Diaphragms are cheap, can be used for many years. They don't need to be washed with any special water or cleansing agents, just the same water we use for our other ablutions is fine - there are special anti-infection protection devices nature has in place there. Menstrual flow would need to be washed out of the diaphragm daily once (twice if its possible, but not necessary). For contraception too, they're a great device (- as a reputed and very experienced gynaecologist lists below).

Janet, Mathew and I trotted along to the local Govt. primary health centre at Yelwal, to ask about whether the diaphragm had ever been tried out, and were surpised to hear it had been, in the late 1960s, but given up since then. We racked our brains to think why, the answers are in Dr.Krishnankutty's responses to Usha, below. Anyway, we plan to follow up on this. Janet said that she'd try to see if we can get a UK co. to gift us some, and I would try to find a local doctor to help here, doing fittings, teaching how to insert them. Once we are able to get people interested in using them (if we are!!), we'd find a local manufacturer. They would probably cost only one or two rupees if made here, the doctor would need to be paid something, maybe we could find a volunteer/s, or try to tap into govt. or pvt. funded reproductive health programmes. As of now, as far as I know, they are not used in India at all.

Contraceptive devices now promoted in India are:

the condom, copper IUDs, the pill, male vasectomy, female tubectomy. Except for the first, where the woman has little say in the matter, the rest have dangerous side-effects, or are irreversible. I'd welcome feedback from any of you who can tell me anything more about this.

P.

----- Original Message -----

I just spoke to Dr. Krishnankutty. He tells me that his first posting 33 years ago was in a rural place-Pazhayannur. He sat surrounded with about 5000 odd packets of imported (from UK or Europe) diaphragms with no takers! In those days, the rural folk were quite uneducated/uneducateable about anything to do with self-insertions except the obvious! (Not his language, but it sounds good!) And this is something that needs to be taken out daily and cleaned etc. and its not possible to go to a doctor to get this done on a daily basis and the women were totally incapable of following directions. And the govt. in its wisdom had decided to try it out first in the villages!! But this is not the scene now. This is the safest method that he suggests!!

Arguments for:

1.. Its relatively simple and safe to use.

2.. It affords a simple protection against many sexually protracted diseases (this he has only read in foreign medical journals)

3.. It doesn’t have any long term effects like oral contraceptives, like breast ---(I forget the term- i think he meant cancer)

4.. Its reversible unlike sterilization.

5.. It has no harmful side effects or after effects like many IUDs.

Unlike in olden days (33 yrs back) the rural women are far more open to suggestions and can be educated on the use of it easily. (U should see how fast my rural maid has learnt to use-the mixi, the grinder, the washing machine etc) The trick as I see it is in showing them how easy it is to use, how economical , how safe and how USEFUL.

Arguments Against:

1.. Cant really think of any, except the educating bit. Long and arduous task.