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Issue–1 Dedicated Method of Choice for Emergency Contraception in India

1.1 Women have the right to control or manage their own sexuality and fertility.

1.2 There is a genuinely-felt need for Emergency Contraception in India to prevent a large number of unplanned pregnancies, and to bring down the incidence of abortions and unwanted pregnancies with the availability of EC as a ‘back-up’ method.

1.3 Emergency Contraception is indicated as a back-up method in the following situations:

(a) Problem during contraceptive usage e.g. ruptured or slipped condom, misplaced intra-uterine device, displaced diaphragm or forgotten pill.

(b) Unprotected intercourse due to failure to use a contraceptive, miscalculation of safe period or inappropriate coitus interruptus.

(c) Incorrect or inconsistent use of a regular contraceptive

(d) Accidental intercourse due to rape, assault or sexual coercion.

1.4 Emergency Contraceptive Pill availability as a ‘back-up’ will increase confidence of users spacing contraception and increase their acceptability.

1.5 Combined Oral Contraceptive Pill is already available in India but it is not recommended as an ideal Emergency Contraceptive Pill. Levonorgestrel needs to be introduced as the dedicated method of choice.

1.6 Safety is an important issue even when the method is only for occasional use. Thus it is better to start a programme with a better method, and even if some wait is required in making Levonorgestrel available, it is worthwhile in the interest of women’s health.

1.7 ECP should be made available as soon as possible as a two-pill pack, each tablet containing 0.75mg Levonorgestrel :

(a) The packing should include instructions on one-time use, method of use, side-effects, efficacy, action to be taken in case of failure, need for regular contraception and no protection from sexually transmitted infections/AIDS.

(b) Packaging should be made as non-embarrassing as possible, so that people do not shy away from use.

(c) Anti-emetic is not required in the packet; woman just needs to be counselled about the potential side-effects

(d) Pricing should be kept as low as possible, to make it accessible to poorer classes, in whose case the need may be more.

1.8 Training manuals for intra-uterine device and oral pills should mention their potential use as Emergency Contraception including details of counselling in such situations.

1.9 Mifepristone should be introduced only at a later date, when more research has been done on its potential as Emergency Contraception and safety profile.


Issue–2 Pre-introduction IEC and Media Campaigns for Public Awareness

2.1 A strategy to build support of opinion leaders and policy-makers for the cause of Emergency Contraception is the key to overall acceptance of this method.

2.2 The available method should be publicized through meetings, workshops, group discussions, family planning counselling, and through print and electronic media to create awareness about Emergency Contraception.

2.3 The selection of IEC messages should be appropriate and relevant to national and local set up.

2.4 Awareness campaigns to educate providers and users should be initiated at all levels and in different community-settings.

2.5 Women, women’s groups and organizations, NGOs, professional bodies, specialists, all need to be involved equally in awareness campaigns.

2.6 IEC initiative should remove gender bias and encourage women empowerment and male participation. Men need to be involved and encouraged to take greater responsibility for reproductive health and adoption of regular contraception.

2.7 Concerted actions such as a telephone hotline, a country-specific website, published material, advertising on popular media, all are needed to improve the knowledge about EC.

2.8 IEC should also emphasize that Emergency Contraception is not as effective as regular use of contraception. Moreover, undesirable side-effects are also more common after Emergency Contraception than during regular contraception use.

2.9 Emergency Contraception is to be promoted only as a ‘back-up’ method when regular methods are not used, used incorrectly or fail for other reasons.

Issue–3 Training of Healthcare Providers for Emergency Contraception services

3.1 Multiple-level training is required involving all healthcare providers.

3.2 It is important to involve all professional organizations and train the trainers first, who could then train others.

3.4 International standard training modules can be adapted to suit the Indian context.

3.5 The training curriculum needs to be more problem-oriented than theoretical.

3.6 A standard training kit with slide-show to be prepared for standardized training throughout India.

3.7 Lecture on Emergency Contraception to be included in Medical, Nursing and Pharmacy college curriculum.

3.8 Periodic refresher training needs to be built into existing RCH training.

Issue–4 Ideal Approach to Introduction and Distribution of Emergency Contraception to the Masses

4.1 Currently, the service delivery to reduce accidental pregnancies should focus on the target groups.

4.2 All doctors prescribing spacing contraception should counsel women about role of Emergency Contraception in preventing accidental pregnancies.

4.3 Important route for supplying Emergency Contraception is through the established Family Planning Clinic network down to the community level.

4.4 Alternative sources for supply are required when routine clinic services are not available.

4.5 Involvement of NGOs in distributing EC pills particularly to rural masses and urban slums can be helpful.

4.6 It was considered that the method should be publicized widely, but should be available only through the service-providers or on prescription.

4.7 In the current Indian scenario, Emergency Contraception pill should not be available over the counter; this may be considered a possibility a few years later, only when widespread awareness gets created.

Issue–5 Client Information and Counselling for Safe Usage of emergency Contraception

5.1 Appropriate counselling is a must for safe and effective use of emergency Contraception.

5.2 Written consent is not required.

5.3 Only contra-indication for Emergency Contraception use is pregnancy, which should be excluded.

5.4 Proper information about the Emergency Contraception should be provided to the client in a format that she can understand, along with the tablets.

5.5 No protection from sexually transmitted infections/AIDS as well as any subsequent sexual exposure should be clearly told to the client.

5.6 Client should be informed about the potential side-effects and how to cope with them.

5.7 Risk of failure should always be explained and the client asked to report if menstruation does not start within one week of the expected period.

5.8 In case pregnancy continuation is desired, she should be informed about no adverse effect of Emergency Contraception on pregnancy.

Issue–6 National Monitoring of the Programme

6.1 Monitoring is essential to find out about efficacy and misuse of services.

6.2 Monitoring will help in setting priorities based on assessment of need and acceptability to women.

6.3 Monitoring the factors which facilitate or inhibit programme success through feedback from all levels will help in making appropriate modifications in the programme.

6.4 The client monitoring form should be kept as simple as possible. The provider should be able to help the woman fill out the form and return it to the monitoring cell.

6.5 This monitoring form will provide useful information about frequency of EC use in various locations, as well as review women’s health parameters.

6.6 There is need for a National Monitoring Cell consisting of members from the health ministry, scientific advisors, demography experts and statisticians.

6.7 Data should be reviewed every six months and the programme should be modified accordingly.

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