With the advent of various methods of contraception including oral contraceptive pills, a woman who is unprepared to start a family is no longer helpless or so we thought. It may not be so in Chennai. Usually, women can use a daily pill or in case of emergencies, Emergency Contraceptive Pills. Emergency contraceptive pills (ECP), commonly known as morning-after pills, prevent pregnancy after unprotected sex. The biggest advantage of the ECP in India is to prevent unwanted pregnancies and therefore prevent termination of pregnancy under unhygienic and unsafe conditions.
Popular brands include Piramal’s i-Pill, Unwanted-72 from Mankind Pharma, EC2 by Zydus, Norlevo from Win Medicare and E-Pill by Panchsheel Organics. In the absence of contraceptives, doctors say that morning-after pills are the best alternative for a woman to avoid the strain of an abortion. Though emergency contraceptive pills were made available over the counter in 2005, it may not be so in Tamil Nadu.
In 2002, the Ministry of Health and Family Welfare made ECP available in India, following which, in 2005 ECPs were made (i.e. drugs that do not require a prescription) drugs. Ever since the legal availability of ECPs, Tamil Nadu has had a woman at the helm for more than two terms and yet the situation is bleak for women living here. I have heard from some women living here about the scarcity and difficulty they have in accessing ECPs, being public health professional, I decided to check the situation out for myself, posing as a patient who needed an ECP. I went to a select few prominent Government Hospitals around Chennai namely:
- Kasturbai Gandhi Hospital for Women and Children in Triplicane,
- Govt. General Hospital, Park Town,
- Govt. General Hospital, Royapettah,
- Govt. Hospital for women and children, Egmore
- And Kilpauk Medical College and Hospital
I started with Kasturbai Gandhi Hospital for Women and Children in Triplicane. I went to the in-house pharmacy asking for the ECP. The pharmacists had no idea what I was talking about until I mentioned the term oral contraceptive. However, they still told me only about the 30-day regime. When the pharmacists were not of much help, I asked a few nurses if they had the Morning-After pill. I only got bewildered expressions and questions about what exactly it was that I was asking for. I further elaborated on what I meant by the morning-after pill. I asked if they had the I-pill and still got nothing. When I mentioned oral contraceptive pills again to the nurses, there was recognition. They simply said that I needed to meet the doctor and she would prescribe the 30-day strip for me. This left me dumbfounded. I had a firsthand glance into the ignorance of healthcare workers in the public hospitals. However, the government does provide condoms in the family planning section of the hospital, which was a relief, that they are making an effort at promoting safety and family planning.
I then decided to go to other government hospitals and some private pharmacies in other areas – Egmore, Teynampet and Royapettah, to check for availability of these ECPs. Each time I was told that it was either out of stock or that they do not sell it in their pharmacies. Not only did I return empty handed but, some of the pharmacists even frowned upon the fact that I was asking for it. After visiting 4 pharmacies, I had had enough. An over the counter prescription free drug, which is available even in some of the backward cities in India, is not available in its health capital.
Back in 2008-09, senior obstetrician-gynecologist Dr. Jayashree Gajaraj, President of the Obstetrics and Gynecology Society of South India was quoted in an article as saying “Three years ago, when the product was just launched in the market, we told women that there was a revolution in the offing. Today, many women are aware of the option, but they don’t have access to the pill.”
The report also talks about a rise in the number of abortions observed by the gynaecologists in the city. Government data released state-wise for the number of medical terminations of pregnancies performed in the country also seems to support this fact. Tamil Nadu seems to be the top 4 states with maximum number of medical terminations of pregnancy in the country between 2008 and 2013, although the reasons for the terminations are not known.
Dr. Anusha Aravind, practicing in the city of Chennai speaking on the issue says, “The ban on morning-after pills is very much opposed by practitioners as this leads to abortions as only option for women. The process of abortion is very stressful for women and is strongly associated with the emotion of guilt which is very hard for them to overcome.” She says it is ridiculous to confuse morning-after pills with abortion pills because an ECP is just one pill while abortion pills are four in number. She further clarifies that the ECP is the best solution for women who are not ready for the pregnancy and simply aids in a delay in ovulation. She also states that the morning-after pill doesn’t work at all stages of the ovulation cycle and is a necessity in a state where there isn’t much awareness or popularity of the female condom. The ban on these pills leads to unnecessary complications for women and is definitely putting more women at risk of unsafe and unnecessary abortions. While abortion pills bring about contractions of the uterine wall the morning-after pill does no such thing.
What is the compositional difference?
While the ECP is composed of a drug named Levonorgestrel, the pill for abortion is composed of Mifepristone in combination with misoprostol. The composition of the morning-after pill is completely different when compared to that of the abortion pill and it is baffling to see that these could actually be thought of interchangeably.
As I completed my exercise of Assessing Awareness and Availability of morning- after pills in Chennai, I concluded that the Chennai is not as inclusive as we would like it to be. On further research into the issue, I gathered that this is largely because of the misconception that an ECP is a method of abortion and not contraception. This leads me to conclude that a ban on moral grounds and confusion with abortion pills means that it is next to impossible to find emergency contraceptive pills in the city. I also know of men and women (myself included), who have no idea that such a ban exists in Tamil Nadu, maybe because they had no need for the morning-after pill.
This could also indicate a lack of awareness regarding Emergency Contraceptive Pills. This is understandable when healthcare workers responsible for spreading awareness are themselves ignorant of such a pill. It is vital we understand that ECPs are contraceptive pills and not abortion pills. It is better , particularly with reference to unsafe and unhygienic abortions. Awareness and access to ECPs, without the stigma attached to it, similar to easy availability and access to condoms will help our women live life and make choices while keeping their self-respect and dignity!