Promotion of EC in India needs a careful planning
and creation of infrastructure for its implementation. In this group discussion,
our focus is mainly on the distribution channels and supply systems, which are
most appropriate for our country. One obvious route of supplying EC is through
the established family planning clinic network down to the community level, where
the infrastructure for client-counselling, evaluation and provision of contraception
In some places, it has been
suggested that doctors prescribing pills and barrier methods should consider providing
a supply of EC at the same time. A study from Scotland reported that 47% of women
who had been provided EC supplies, used EC at least once, whereas only 27% of
those who were asked to report to the doctor did so. Moreover 98% of women in
the first group used EC correctly, and were not more likely to use EC and had
fewer unintended pregnancies than the second group. from this study, it was concluded
that making EC available does no harm and may reduce the risk of unwanted pregnancy.
Questions to be Answered
A. What should be the distribution channels?
B. Who should be providing the EC?
C. How should
it be made available?
of the Group
Group needed to focus on the various available options and make recommendations
on establishing and strengthening the distribution and supply network.
The Group considered several distribution channels including :
I Clinical outlets (dispensary/PHC/subcentre, OPD/emergency ward in hospitals
and nursing homes, workplace, FP clinic, study place, youth advisory centres etc.).
II Provision by doctors in Government and private hospitals, ANMs, pharmacy, chemists,
NGOs, anganwari workers, school/college teachers, counsellors etc.
III Community-based supply or marketing (social or commercial).
The Group Suggested :
• Introduction in a phased,
systematic, planned manner
• A dedicated product
to be made available before introduction of the method to the masses. Starting
with available COC pills will confuse the grassroot workers with multiple products
and dosage regimens.
• While waiting for dedicated
product (LNG), focussed awareness campaigns and training of providers to start
• Identify centres in all regions
including medical colleges, district hospitals, private hospitals and centres
with existing family planning services including NGOs for starting the programme.
Initially, restrict the programme to these identified centres and all should follow
a uniform protocol.
• General practitioners,
indigenous system practitioners, schools, colleges, work place, pharmacies to
be included only during the second phase after the baseline data are obtained.
• After proper training, education and publicity, the drug
can be made available through pharmacies on ‘Prescription only’ as social/commercial
• Expert Forum agreed with the observations made
by the discussion Group. It was felt that distribution channels should be decided
after taking into consideration the Indian scenario and having representation
from all corners of India.
• Providing EC with
a supply of condoms was debated but was not favoured by most, but counselling
about EC by doctors prescribing pills or barriers was considered mandatory.
Mentioning about EC on other contraceptive packets was also considered.
• The issue of providing EC without prescription as well as
making it available in college health services was considered, but was not accepted
since, at present, the awareness is very limited, and chances of misuse are more
if proper counselling is not done.
• The need
to include Emergency Contraception services in supply centres was expressed, to
take care of odd time consultations. Alternative sources of provision are required
when routine clinic services are not available e.g. on week-ends and holidays.
• Rape victims are a very important group for EC use. In the
Indian scenario, these women are often brought to the casualty. EC services and
sensitization of personnel dealing with such cases are important. Another important
group of potential users is young women who are just beginning their sexual lives,
when intercourse is often unplanned and unprotected. Keeping this in mind, it
has been recommended that distribution of EC be extended to adolescent sex clinics
and college health services, but appropriateness of this in the Indian scenario
was not considered, till baseline data on adolescent sexual behaviour were available.
• Providing EC through family planning channels should ensure
adequate counselling and instructions to the client, proper consent, explaining
the side-effects and measures to reduce them, assessment to exclude contra-indications
and advice to return for evaluation if she missed her period.
The supply of EC over the counter without prescription was considered, as most
young girls may feel too shy to avail themselves of the services otherwise. However,
the majority did not approve it, as the opportunity for counselling and follow-up
is not available. A slow step-wise introduction of EC and distribution through
service providers is a better option.
2.4.1 Currently, the service delivery to reduce accidental pregnancies should
focus on the target groups.
2.4.2 All doctors prescribing spacing contraception
should counsel women about the role of EC in preventing accidental pregnancies.
2.4.3 Important route for supplying EC is through the established Family Planning
Clinic network down to the community level.
2.4.4 Alternative sources for
supply are required when routine clinic services are not available.
Involvement of NGOs in distributing EC pills particularly to rural masses and
urban slums can be helpful.
2.4.6 The method should be publicized widely,
but should be available only through the service- providers or on prescription.
2.4.7 In the current Indian scenario, EC pill should not be available over the
counter; this may be considered a possibility a few years later, when widespread
awareness gets created.