CHHAYA: A contraceptive beyond family planning

Introduction of the CHHAYA pill, approved by the Government, marks a significant step in expanding contraceptive options for women, enhancing accessibility and reproductive autonomy, says Dr Ashwini Anil Kumar Sirapanasetty

The Government’s approval of new contraceptive methods, particularly the non-hormonal contraceptive pill Centchroman, marks a pivotal moment in advancing women’s reproductive health rights. Centchroman, known as “Chhaya” in public health facilities, offers women a hormone-free contraceptive option, expanding their choices and accessibility to family planning services. It is available in the market as a “SAHELI” tablet.

Who can use it?

• Can be safely used by all women once it is confirmed that they are not pregnant.
• Can be used by women of any age, including those who are unmarried or who do not have children.
• Women who had side effects with Mala-N/Mala-D can also opt for this method.
• It can be used by postpartum women who are breastfeeding as soon as they feel comfortable after delivery but before 4 weeks. Centchroman does not affect the quantity, quality and composition of breast milk.

Benefits

• It causes less bleeding during the monthly period, and also makes the interval between two menstrual cycles longer. This is beneficial for anaemic women.
• Can be adopted as postpartum (earlier than 4 weeks of delivery) or post-abortion contraception (within 7 days of completion of abortion).
• It does not impact the quality or quantity of breast milk.
• Woman can become pregnant immediately after discontinuing the method.
• Women who are not recommended to use hormonal methods can use this method.
• No interference with sexual intercourse/ pleasure.

Limitations

• It does not protect from HIV and RTI/STI.
• Every client should be screened by a trained provider before starting Centchroman, just like other oral pills.

Where can a woman get it and how it should be taken?

• It is available in all public health facilities. It is also part of the ASHA kit. However, the first dose can be provided only after proper screening at a health facility by a trained provider (doctor, CHO, SN, LHV, ANM).

The non-hormonal contraceptive comes in a strip of 8 tablets. To begin the use of Chhaya, the woman is advised to take the first pill on the first day of the period (which is the first day of bleeding) and the second pill three days later (on the 4th day of bleeding).

This pattern of days are repeated through the first 3 months. Starting from the fourth month, the pill is to be taken once a week on the first pill day and should be continued on the weekly schedule regardless of her menstrual cycle.

What in case of ‘missed pills’?

You should tell the woman that if she forgets to take the pill, she should take the missed pill as soon as she remembers that it has been missed. If she misses taking the tablet by

1-2 days (less than 7 days), she should take the missed pill as soon as she remembers and continue the normal schedule. In addition, she should use a backup method like a condom till the next period, just to ensure complete protection.

If she forgets to take pills for more than 7 days, then the current pack should be discarded, condoms should be used till she has her monthly bleeding and then she should start taking a new pack like a new user; that is, twice a week for the first 3 months followed by once a week thereafter.

Unlike traditional contraceptive pills, Centchroman does not contain hormones, making it suitable for women of all ages and reproductive stages. This inclusivity is particularly significant as it accommodates unmarried women and those without children, empowering them to take control of their reproductive decisions.

Centchroman’s safety profile further enhances its appeal. Women who have experienced adverse effects with other contraceptive methods, such as hormonal pills, can turn to Centchroman without concerns about hormonal side effects. Moreover, its compatibility with breastfeeding ensures that women can use it without compromising their lactation or the health of their newborns.

Needless to say Centchroman’s introduction reflects India’s commitment to promoting reproductive rights and gender equality. By offering women a safe, effective, and accessible contraceptive option, the government aims to empower women to make informed choices about their reproductive health. Moreover, it underscores the government’s recognition of family planning as a fundamental human right and a key driver of social and economic development.

Moving forward, continued efforts to raise awareness about Centchroman and other contraceptive options will be crucial. Comprehensive sexual and reproductive health education programs can help dispel myths and misconceptions surrounding contraception while empowering women to make informed decisions about their bodies and futures.