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Controversial Issues in EC Introduction : A Debate

Will free availability of EC reduce regular contraceptive use?

– Dr Vatsla Dadhwal, AIIMS- Dr M M Misro, NIHFW

We 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.

Easy 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.

Some patients 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.

I 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.


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