October 15, 2009

You would be really living on Mars if you still haven't come across one of those latest Ads for Emergency Contraceptive Pills. They have been put up everywhere to make sure you don't miss them. Even modes of public transport like the metros, taxis and buses have not been spared. The essence of the message is that no one, any longer, has to worry about unwanted pregnancy. It's as easy as walking to the corner drug store on your street and buying the pills.

Can the easy availability and overzealous marketing encourage sexual promiscuity?

Manipal University VC Dr Raj Warrier , a Professor of Pediatrics who has spent well over three decades in the USA is concerned  that skeptics,  some religious leaders and conservatives are quick to point out that the ads may influence the uninitiated to perceive that unwanted pregnancy is no more a major complication of promiscuity and unplanned sex. He says that "birth control has always been a contentious issue and this ‘emergency pill’ has added a new bone for the participants to chew on.”

But is a contraceptive only meant to prevent unwanted pregnancy?

Dr B Unnikrishnan, Associate Professor of Community Medicine at Kasturba Medical College, Mangalore is worried if easy availability and strong marketing of Emergency contraceptive pills could underplay the role of Condoms as contraceptives that have the added advantage of acting as barriers in preventing sexually transmitted diseases, especially like those spread by HIV (Human Immunodeficiency Virus) as in the case of AIDS or HPV (Human Papilloma Virus) in the case of Cervical Cancer. Public Health programs across the world have been advocating Condoms for some reason after all. Will the easy availability of the new pill decrease the use of condoms? The need to interrupt the sexual act and the potential to decrease the pleasure of the stolen moment are commonly quoted deterrents to the use of condoms - could this promote the acceptance of the pill in the vulnerable and high risk population?

Dr Warrier accepts that emergency contraception is a not new concept and many a remedy has been touted as the one to use over the decades or millennia. None has gained the familiarity, notoriety or wide acceptance as the Morning after pill. Can the targeted, overzealous marketing preaching the use of the easily available morning after pill change the social fabric and sexual practices of the urban socialite, the young college students or even the rural youngsters who now have easy access to TVs, cell phones and pharmacies? He explains that the forces of economics, medical knowledge and ethics are all involved in many aspects of health care and the junctions or cross roads are often difficult to negotiate. He feels education of the public, the physicians and the pharmacists would be an important factor in the appropriate use of such pills.

Do these pills may meet safety norms enough to be sold over the counter or be subjected to such massive marketing campaigns and are social concerns being thrown out of the window in what seem very possible contradictive consequences of such strong marketing- especially in metro areas? There are very high chances that in the rapidly urbanizing cosmopolitan culture, the Morning-after pill may easily be mistaken for that one-night pill.

Drug Controller takes Notice..

As reported by the Indian Express published from Delhi in the first week of October, the Drug Controller General of India (DCGI) said that a committee will be set up to examine whether Unwanted 72 and i-pill, two morning-after contraceptive pills, now sold over the counter, should be reclassified as “prescription drugs.” Unwanted 72 is made by Mankind Pharma, Cipla manufactures the i-pill. This comes after the DCGI sent a letter to the two manufacturers last month pulling them up for running TV ads it claimed were “misrepresenting abortion” and pushing the pills as a way to be “tension-free” after sex. The express added that as per norms, if these two pills are categorised as prescription drugs, they cannot be advertised. The Drug Technical Advisory Board is expected to meet on November 9 on the issue.

Late last month, News website livemint website  quoted Indian Drug Controller General Surinder Singh as saying that “There are ethical concerns over these ads and we have received a number of complaints. In India, there is not enough awareness on emergency contraceptives, so the situation needs to be tackled carefully. In most countries emergency contraceptives are sold OTC but this may not be feasible for us". The Indian Express report on the issue also hinted that the issue could take three to four months to resolve.

The story done by livemint adds that Until four years ago, morning after pills were sold as prescription drugs in India. In September 2005, then health minister Anbumani Ramadoss announced that in order to “empower women to be able to avoid pregnancy in such situations as unprotected sexual exposure, contraceptive accident or forced sex”, the government would allow over the counter sales of such drugs.