are gathered here for the Consortium on National consensus for Emergency Contraception
with an aim to make the drug freely available and to include it in the National
Family Welfare Programme. But, I want to convey an important message that free
availability of EC will reduce the regular contraceptive use.
Emergency Contraception as the name implies is for use only in emergency situations.
These are condom tear, rape etc. To ensure this, Emergency Contraception (EC)
should not be freely available as over the counter, but only after consultation
with a registered medical practitioner.
availability will lead to omission of contact with a doctor who, while prescribing
proper use of EC, would also counsel the patient for regular contraceptive use.
Free availability will lead to increased or repeated use, this would lead to decrease
in regular contraceptive use.
who are not regular users of regular contraception will find an easy way out with
easy availability of EC. Why should a woman pop a pill everyday or use condoms
which require motivation from the male partner ? Taking 4 pills after an act may
be simpler for her! Taking EC without proper counselling and repeated misuse will
expose a woman to high doses of hormones and higher failure rates.
Easy availability with wide publicity that there are no contra-indications to
use of EC except pregnancy and no significant side-effects, will lure patients
to use EC on a regular basis decreasing the use of regular contraception. The
higher failure rates with EC may discourage the patient from using regular oral
contraceptive pills also.
Repeated misuse of
EC will result in a higher failure rate and more side-effects. This will indirectly
make it unpopular. Hence, it is my plea that EC should not be easily available
but only in certain emergency situations under the guidance of a doctor.
will be speaking against the topic “availability
of EC will reduce the use of regular contraceptives”. We have to review the topic
under two aspects viz apprehension and fact. First let us look at the facts
l In India, the contraceptive prevalence rate
is low, about 48%.
l Awareness of the contraceptives
available is low, forget about the efficacy.
l Awareness of EC is non-existent if we ask the general public.
Availability of ECs would, in fact, increase the use of regular contraceptives,
as ECs are nothing but altered and higher doses of regular contraceptives. We
should educate women about the EC use of Copper IUDs. The window period of this
can be still better, upto 5-7 days. So it is a fantastic EC and it has got a very
good efficacy rate. Also, EC has no different role to play; it just plays a crucial
emergency role. It has been proved by studies in different countries that availability
of EC would, in fact, increase the use of regular contraceptives. In Sri Lanka,
a limited study was done on increase in use of EC. It resulted in the increase
of faith in regular contraceptives when they know these are the ECs which can
be taken in emergency cases. It has led to more acceptance.
The side-effects are undesirable but there are some positive points. It is the
general psyche that if there is nausea and vomiting, then the drug is strong and
effective. So, if the woman gets nausea and vomiting, then it is a positive point
and she is sure that she is going to get her periods. The other thing is that
nausea and vomiting with EC will restrict its use for emergency only.
Before I conclude, I would like to tell you a story. There was once a conflict
of ego between the two Gods – the God Shani and the Goddess Laxmi. They tried
to test and find out the views of a Brahmin. They asked him, ‘What do you think,
who is more respected and who is more liked, the Shani or the Laxmi?’ Then the
poor Brahmin said, “Madam and Sir please give me one hour”. After one hour, when
the God and Goddess came back, the Brahmin replied to Shani that “God, you are
definitely respected but people like you when you leave them”. Then he turned
to Laxmi and said “Madam you are definitely liked the most but people do not like
you when you leave them”.
Now about EC, I must
say that we have taken since 1996, about 4 years, and I do not know how much longer
we will take to make it available for our women. We have to come out and consider
the views of the users, the providers, the industry and we also have to consider
the advocacy groups’ views. Our priorities should be very clear.
ECPs should be made available in the form of kits. We should remove any misconception
at both provider and user levels. Improve the IEC. This would result in increased
preferential acceptance, not only for Ec but overall contraceptive prevalence
rate among couples, youth and other groups.