Induced abortion is the most health-threatening choice of ‘family-planning’,
especially for women at the beginning of their reproductive life. It is estimated
that the maternal death toll due to unsafe abortions, mainly in the developing
countries, is approximately 200,000 each year. A large number of pregnancies are
unwanted and half of them are due to contraceptive failure or misuse, (yet, access
to safe and reliable Emergency Contraception is not available or utilized). Knowledge
and attitude of women about EC across different countries has been highly variable
as is evident from numerous studies conducted over the last few years. While women
in the developed countries were aware of EC, those from the developing countries
showed little knowledge. Even those who had heard of EC showed incomplete knowledge
as regards timing, source and methods available.
Few baseline surveys and studies conducted in India have revealed an extremely
poor awareness of prospective users about Emergency Contraception (2-10% in most
studies). These studies also highlighted incomplete knowledge about EC amongst
healthcare providers, including doctors and nursing staff. Insufficient information,
negligence and poor education are the main causes for under-utilization of the
currently available EC methods. Therefore, the provision of detailed information
and intensive education of both providers and users remains a very important issue
during the pre-introduction phase for safe implementation of EC.
Most women in India following an accidental undesired sexual exposure and not
wanting to conceive do not even know that unwanted pregnancy can still be avoided;
they just wait with anxiety, for the period to come. A very focussed awareness
campaign is required to educate men and women about such possibility as well as
to emphasize the need for regular contraception.
The spread of television and radio, the rise of independent press and increasing
literacy rates offer new opportunities to communicate information and knowledge
on EC to the community. Not only does media reach people earlier and better, it
also gets the attention of policy-makers who follow the media closely.
Questions to be Answered
The group needed to decide on:
A. Who will be the target audience for
pre-introduction IEC campaigns?
B. What will be the methodology?
C. What will
be the modalities for
- building support from
- utilizing the professional
- obtaining support from policy-makers
of the Group
group deliberating on this issue based their recommendations on the assumptions
that, simultaneously, there is :
of a dedicated product
• EC is launched nationwide
• Service delivery is available
Unless these are ensured, all IEC efforts are going to be wasteful.
A. The target audience for IEC campaigns.
The Group identified the following target audience
groups for IEC and awareness campaigns:
I Clients/ Beneficiaries
Women seeking family planning advice or undergoing MTP.
(ii) Users of barrier or other spacing methods.
(iii) Women and their husbands in reproductive age group wanting to space children
but using contraceptives erratically.
girls and boys.
(v) Victims of sexual assault.
II Healthcare/ service providers
(i) Medical practitioners including general practitioners,
government doctors, registered medical practitioners and practitioners of Indian
systems of medicine
(ii) Paramedicals including
nurses, pharmacists, anganwari workers, auxillary nurse midwives, primary health
centre staff, NGOs, women’s groups etc.
Police and staff at remand homes, orphanages, missions etc.
III Opinion makers and advocacy groups
(i) Religious leaders
(ii) Gram panchayats
(iii) School teachers
(vi) Planning Commission
of IEC and awareness campaigns
Group recommended that the message for IEC should be very clear and include its
role in preventing unplanned pregnancies i.e. the contraceptive emergencies. Where
and how it is available and whom to consult?
Various methods available for IEC were listed for the groups consideration. For
reaching the masses, the Group divided the methods in two parts :
out to rural people
The methods proposed are
- IEC by health providers
- street play / folk media
- wall writings /
hoardings / posters
- radio / television
- news papers / magazines
- pamphlets / brochures
- health melas
- word of mouth
- local community groups, Mahila
- NGOs/ field workers
II Reaching out to urban people
methods proposed are :
- telephone hotline
- radio – FM
- public lectures / seminars / symposia / group discussions
- NGOs / field workers working in
- youth centres
- perfect health melas
Though there is a considerable
overlap, but some methods are more specific based on the community setting.
Details of methods suggested are as follows :
• Public lectures/seminars : Lack of knowledge
and awareness on EC use and availability can be improved through lectures given
by family planning doctors, social workers etc. They should give factual, frank,
fair and friendly guidelines citing experience of patients who have taken EC.
• Group discussions : at schools to target adolescents
and parents as a part of health education, in Mahila Mandals, Anganwaries, Youth
Centres, Health Melas etc.
• Telephone hotline
: This is a very informal and educating method, found to be extremely popular
in a number of countries, as the victims of sexual accidents usually feel safer
to talk on phone.
• Internet services
: EC consortium should periodically publish a newsletter which should be available
on the internet, and which can provide sufficient information for providers and
users. Such websites should be freely available at all family planning clinics.
Some international websites already exist, but an India-specific website needs
to be created.
• Published material :
Handouts, posters and billboards for Family Planning OPDs and general OPD. Handouts/brochures
for general public seeking MTP and family planning advice. Such a material can
be also used in health camps, melas, fairs etc.
Radio : Awareness campaign can be included as part of news, features, talk
shows, interviews and panel discussions.
: Situational documentary or telefilms, small informative spots as well as weaving
into the matrix of soap operas can generate a lot of awareness. TV makes a better
impact in terms of understanding and can be successfully used even with illiterate
masses. Talk shows involving policymakers, doctors (including GPs), nurses and
community are also good sources of information. Since television relies more heavily
on events rather than sound, featuring location and pictures tells a better story.
• Newspapers/magazines : Features, articles,
editorials and advice columns can bring about periodic information, and can also
help by answering queries of the public. Again, people are less shy writing about
the problem than speaking in front of someone. Besides reporting ‘hard’ breaking
news, the newspaper coverage can target educated clients.
Street Plays : Impact on the male partner can be achieved as the will and
decision of a woman to go for EC is governed by her husband.
Word of Mouth : Clients already using EC can be instructed to tell others
about its advantage. Usually, hearing from someone who has already been benefited,
takes away the fear of unknown.
Modalities to obtain support from the community, professional bodies and policy
There is power and influence in number. Involving all stake-holders including
community leaders and professional bodies along with policy makers in a collaborative
approach for public awareness will result in better planning and more realistic
In principle, all agreed that there is a great need
for pre-introduction IEC. Unless there is awareness about the method, it cannot
be utilized. The Expert Forum accepted most of the techniques listed by the Group
discussing this issue during presentations. The following were also suggested:
• As there is a very low level of awareness across the country,
the information needs to be very clear and precise.
Announcing the availability of EC by Hon’ble Health Minister/Secretary in the
news itself will lead to nationwide awareness about the method.
• IEC has to be linked with availability. Unless the product
is simultaneously made available, all awareness campaigns are futile.
• IEC needs to be focussed depending on the product being
marketed. There is need to show the ‘pack’ on television, while talking about
the method, so that lay public is not confused about dosage etc.
• More often, women have an emergency when they have missed
a period. Thus the use of EC as a contraceptive needs to be clearly brought out.
• Before IEC, client and providers’ perspectives may need
to be evaluated. A study by Population Council revealed very different perspectives
in different populations. Thus we need campaigns to be very culturally-specific
in different areas of India. The similar campaigns may not be applicable to the
• Audio-visuals need to be made
in different languages. Due precautions need to be taken when translating anything
as the technical contents-validity and clarity should not be distorted by such
• The content and language of
messages need to be very subtle, requiring elaborate planning.
Just translating the messages in different languages will not be enough. The translation
is to be done by a subject as well as a language- expert, as the meaning may completely
change if only a literal translation is done.
There is also need to develop pictorial messages and posters for illiterate masses.
Till a dedicated product is made available, focussed
IEC and awareness campaigns are not possible.
2.2.1 A strategy to build support of opinion leaders and policy-makers for the
cause of EC is the key to overall acceptance of the method.
2.2.2 The available
method should be publicized through meetings, workshops, group discussions, family
planning counselling, and through print and electronic media to create awareness
2.2.3 The selection of IEC messages should be appropriate and
relevant to national and local set up.
2.2.4 Awareness campaigns to educate
providers and users should be initiated at all levels and in different community-settings.
2.2.5 Women, women’s groups and organizations, NGOs, professional bodies, specialists,
all, need to be involved equally in awareness compaigns.
2.2.6 IEC initiative
should remove gender bias and encourage women empowerment and male participation.
Men need to be involved and encouraged to take more responsibility for reproductive
health and adoption of regular contraception.
2.2.7 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.
IEC should also emphasize that EC is not as effective as regular use of contraception.
Moreover, undesirable side-effects are more common after EC than during regular
2.2.9 EC is to be promoted only as a "back-up” method
when regular methods are not used, used incorrectly or fail for other reasons.