India tops the list in being the largest non-use of any method of contraception mainly because of a lack of awareness and misconception about birth control.

At a two-day Workshop on Contraception held at Bangkok between September 24-26, 2003, it was found that around 34 per cent of the urban Indian women use female contraceptives, 5 per cent opt for traditional methods of birth control, 2 per cent of the population used combined oral contraceptives, 2 per cent intra uterine devices, 3 per cent use condoms and male sterilisation is among 2 per cent of Indians.

World wide, the use of contraception is highest in Germany where 53 per cent use birth control methods, followed by France (49 per cent), United Kingdom (38 per cent) and USA (27 per cent). The maximum use of contraception is the age group between 25-35 years in the US and Europe, said Dr. Duru Shah honorary professor, obstetrics and gynaecology, Grant College and consultant, Jaslok Hospital, Mumbai in her address on Contraception: Past, Present and Future.

According to her, the concept of emergency contraception with a hormone implants and injectible contraceptives are the best option for India. Emergency Contraception (EC) was already launched all over India early this year. EC is available on a toll free line - 3970011 and is useful in preventing pregnancy in many situations like when a condom slips or breaks, a diaphragm becomes dislodged or moves out of position, when one forgets the use of contraception and have unprotected sex or missed taking the oral contraceptive pills, or forced into having sex or if one miscalculated the "fertile" days and have sex without birth control.

There are two types of emergency contraception in India today. One is the Emergency Contraceptive Pill (ECP) method referred to as the "morning after pill" that has a high dose of combined oral contraceptives (OCs) to prevent conception. The OC method is effective if used within 72 hours after unprotected intercourse. The other is the Intrauterine Device (IUD) method, which involves the insertion of an IUD into the uterus by a gynecologist, which must be inserted within a week of unprotected sex.

The latest offering in contraception world wide for women are new hormone injection called Desogestrel, implants, vaginal ring intra-uterine devices and skin patch (releases an hormone that protects for six months).

While the single rod implant is not available in India as yet, the IUD is known to cause inflammation in the uterus tract, said Dr. Shah who feels that vaginal ring could be considered as an ideal emergency option for women. Options like the skin patch on the abdomen or the luteal area has a failure rate of 1 pregnancy per 100 women.

Research suggests that women and couples want their contraception to be cent percent effective, with no side effects, and be fully reversible for pregnancy. It is the gynecologists who have to decide which contraceptive is the ideal option for each woman.

In his address on the Pill- The contents and working mechanism, Dr. Suresh Menon, vice president, Medical, Organon India said that Pill is effective convenient and safe but only 2 percent of the population used it.

There is a fear psychosis about the pill because it contains steroids but in reality there is only a one percent of steroid content is in it, informed Dr. Menon.

The controversies surrounding the pill are that it is causes blood clot in the veins, heart diseases and breast cancer caused due to the estrogen content in the pill. Although there are short term side effects like nausea, dizziness and lack of appetite but this was prevalent only among 4- 5 per cent of the women The causes of cancer, blood clot and heart disease was high among pill users who were smokers pointed out Dr. Menon as cigarette contents were contraindications for pill contents. Patients who use the pill had to screen to prevent the reactions, he added.

The future trends in contraception are evolved around the development of a new drug delivery system, increased access to a full range of options, emphasis for better compliance and widen the use of emergency contraception, said Dr. Konstantinos Papadopoulos, a contraceptive and infertility specialist from Greece, who covered the session on the latest developments in Contraception.

The contraceptive vaccines are currently undergoing global trials and in India the project was headed by Dr. S Talwar, a Delhi-based gynecologist. The inclination among medical research scientists was to go in for newer progesterone because of the diminishing side effects on users, stated Dr. Papadopoulos who added that Organon and Schering Plough were conducting clinical trials on a male pill in Edinburgh, Manchester, Germany and Finland. No details will be shared as a part of the trial policy, he stated.