Population Council Research that makes a difference

2011 International Conference on Family Planning
29 November–2 December 2011

Abstract

"Emergency contraceptive pills in India: Trends and operational challenges"
M.E. Khan

Background
ECPs were introduced into India’s national family planning program in 2001 and gained over the counter status in 2005. Since then ECP use has increased significantly in urban areas, but is still relatively unknown in rural areas. During 2006–2009 EC products were aggressively promoted by private sector pharmaceutical firms, triggering controversy in Indian media, focusing on two issues: that EC access leads to increased pre-marital sex among adolescents and that many are using it repeatedly as family planning method leading to complications. Data shows that ECPs are safe, even used repeatedly, but there is no data available to support or reject the other media claims.

Methods
Two data sets were analyzed. First, retail audit firms provided details of sales of the drug by state, rural-urban sales, and data for 15 large cities, for 2008, 2009, and 2010. The second data set consisted of surveys of 68 primary health care facilities located in two districts of Uttar Pradesh, including interviews of 120 provides (52 doctors and 68 nurses) to assess their knowledge and attitudes toward ECP.

Results
Data show that 34 brands of ECP are manufactured and sold in India. In 2008 the total sale was 4.6 million, increasing to 15.2 million in three years. The sale of ECP in rural areas (4.8 million) is around 31.8 percent of the total sales in India. An analysis by metro cities shows that highest sales of ECP was in Delhi (34.6 %), followed by Mumbai (21.5%). In Chennai, where the state government of Tamil Nadu is opposed to EC, sales were less than one percent. The findings of the facility survey shows that most health care providers were aware of ECPs (both doctors and nurses/midwives) but further questions revealed a number of misperceptions about the method (e.g. it causes abortion, it cannot be used during breast-feeding, etc.), indicating a need for further education and orientation of health care providers. The method was available in only 21 percent of the facilities on the date of visit.

Conclusion
The two data sets taken together clearly indicate that while use of ECP is increasing fast in urban India, access and use vary across the country depending on state government support; there are significant myths and misconception about ECP both in the media and among health care workers.

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Diane Rubino: drubino@popcouncil.org; +1 212 339 0617