Oxytocin: a circular based on myths is dangerous

‘Hormone’ is a Greek word meaning “to set in motion”. Hormones are complex biochemical substances secreted in small amounts by various glands located in different parts of our body, each acting on specific organs. One such gland is the Pituitary, located in the base of the brain. Among several important hormones it secretes, one is oxytocin — which is used to induce labour under the guidance of an expert doctor for conducting deliveries. Subsequently, the same hormone acts on the mother’s breast to eject milk so that she can feed her newborn.

Apart from these two well established actions — one on the uterus and the other for release of breastmilk, the hormone is notorious for its abuse and misuse, which is probably because it’s popular by its other name as the ‘love hormone’. The spectrum of abuse ranges from being promoted to women to look younger and being used in agriculture by farmers to increase the size of vegetables and to increase milk secretion in cows.

All these have no scientific basis, but the myths are so popular that oxytocin continues to be misused. So much so that the central Ministry of Health & Family Welfare issued a circular restricting “the manufacture of oxytocin formulations for domestic use to public sector only from September 1, 2018, due to complaints of misuse”.

The implication of this circular is far-reaching because as of now over a hundred drug companies are manufacturing this drug. All of them would have to stop. Only one public sector company in Bengaluru would be permitted to manufacture oxytocin. The fear is that this will create a shortage of oxytocin, which is also a life-saving drug and finds mention in the World Health Organisation’s (WHO) list of ‘Essential Medicines’ as well as the union ministry’s own list.

Restricted manufacturing will create a shortage of a life-saving drug because oxytocin is administered to prevent bleeding which may occur after the baby is delivered. Post-Partum Haemorrhage (PPH) or bleeding following delivery is a major cause of maternal deaths in India.

Nigeria and India accounted for more than a third of all global maternal deaths in 2015, though these deaths have declined recently as per the Ministry of Health & Family Welfare. But it is well-known that the single major medical cause of maternal death is PPH, because “more than 72.6% of deaths from haemorrhage were classified as postpartum haemorrhage”.

So, the availability of affordable and good quality oxytocin is extremely important from a public health angle to prevent maternal deaths. Oxytocin is also used to induce unobstructed labour, which needs monitoring by health experts and this, in turn, reduces the chance of the mother needing to undergo Caesarean section.

Use in animals

Just as it is used in humans, so also oxytocin finds use in veterinary practice, to prevent bleeding after the calf is born. Often, oxytocin is administered to the cow about an hour or so before actually milking the cow. Many think that by injecting this drug, the milk yield will increase, but in reality it does not increase milk yield, it just hastens its flow.

There is another misleading statement that is made: that when injected into the cow, its milk will contain oxytocin and is a health hazard to humans who consume it. This is an absolute myth because oxytocin does not act when taken by mouth and all standard textbooks all over the world have highlighted this aspect. For oxytocin to act, it has to be administered either by intramuscular or intravenous route. The drug does not act when administered orally, though at times it may be administered by inhalation through the nose.

The allegation that milk consumed by humans from animals that were injected with oxytocin harms humans has been propagated by none other than our honourable union cabinet minister Maneka Gandhi. She wrote in her column that “In order to get the milk, dairy owners inject them (cows) with an illegal drug called oxytocin twice a day. Oxytocin sends the animal into labour, so for two hours a day, the animal is writhing in labour pains till the milk is squeezed out of her inflamed diseased teats. Oxytocin comes into the milk and results in hormonal imbalances in humans, who get diseases like tuberculosis, cancer, blindness in children, etc”.

While one appreciates Maneka Gandhi’s campaign for animal rights and environmental issues, it is necessary to note that her quote above is misleading on multiple counts.

Firstly, oxytocin is not illegal because it finds mention in the WHO list of Essential Medicines; secondly, oxytocin will not act on the uterus unless there is pregnancy, so there is no question of sending the animal into labour; thirdly, the inflamed teats are not because of oxytocin; fourthly, there is absolutely no evidence that oxytocin produces diseases like tuberculosis, cancer or blindness. Lastly, what constitutes ‘hormonal imbalance’ is anybody’s guess.

A few health activists have approached the court and sought a stay order on the circular issued by the Ministry of Health & Family Welfare. There is some temporary relief now, and one hopes that the court will ultimately decide in favour of making oxytocin available and accessible to all mothers who are in need of it and help in saving lives.

At times, just a name is enough to make people famous. On that count, though, oxytocin seems to be in trouble just because its popular name is ‘love hormone’ and the many myths created about it. Oxytocin must be freely and widely available, but it must be used only what it is meant for.

(The writer is President, Drug Action Forum, Karnataka)