No bitter pill

By Feizal Samath

The Indonesian experience was also illustrated as a case where family planners had succeeded - to some extent - in convincing religious groups that emergency contraceptive methods are not taboo in religion and do not affect religious sensitivities.

Of four countries picked to test market emergency contraception, Indonesia and Sri Lanka have emerged as success stories to promote this globally used two-pill emergency contraceptive, which must be taken before the lapse of 72 hours after sexual intercourse to prevent pregnancy.

India, Pakistan, Nepal, Sri Lanka, Indonesia, Thailand and experts from the World Health Organisation and the London-based International Planned Parenthood Federation attended the two-day meeting to learn from the success of Sri Lanka and Indonesia in implementing emergency contraceptive programmes.

While there are various family planning and birth control methods, the most commonly-used emergency contraceptive is the Postinor-2 pill, which can be used up to three days after sex or the insertion of an intrauterine device (IUD), which is effective up to five days after sex. Planners said Postinor-2, often called the "morning after pill" has been the more popular out of the two devices. 

It is marketed in Sri Lanka by the Family Planning Association.

The need to promote emergency contraceptives emerged at a 1995 meeting in Bellagio, Italy convened by the Rockefeller Foundation where it was revealed that emergency contraception had the potential to significantly reduce the number of unwanted pregnancies in the developing world. 

A group of seven internationally recognized organizations working in the field of family planning like WHO and IPPF then formed the Consortium for Emergency Contraception with the specific task of building partnerships in developing countries and promoting emergency contraceptive pills (ECPs).

The Consortium promotes Postinor-2 as an effective ECP and provides financial support to countries to implement the ECP programme and sell it at a price that is within the reach of the middle and lower income groups. The Colombo meeting was funded by Consortium members.

While Sri Lanka's family planning programme has been a model for other developing countries, the rate of illegal abortions is at an alarming 750 per day or even more in a country with 19 million people. "It is quite a high rate and we have been pushing for abortions to be legalised but there is opposition from religious groups," said an FPA official.

Some months ago, plans by particularly women's groups to present a bill in Parliament to allow abortion at least in the case of rape or sexual assault were aborted following protests from the Buddhist, Catholic and Muslim clergy. Abortion is permitted in Sri Lanka on medical grounds and only if the mother's life is in danger. 

Daya Abeywickrema, FPA's Executive Director said the demand for Postinor-2 was growing annually. 

The programme was introduced three years ago with 20,000 packets sold in the first year. This year the demand has risen to 80,000 packets while in 2001, the demand is expected to be around 90,000 packets.

The annual demand for other contraceptives in Sri Lanka is condoms (11.8 million), birth control pills (two million packs) and injectibles (500,000 doses).

Professor Harsha Seneviratne, head of the gynaecology department of the University of Colombo, speaking as chief guest at the forum, said that Postinor-2 provided a viable option for unwanted pregnancies and also abortion.

Dr. Premila Senanayake of IPPF said there was a need to educate the public on the use of the drug and one of the target groups should be rape victims. "We should be educating police personnel and those manning police desks where rape victims make their first complaints. The police could be told to suggest the drug to rape victims which would considerably lessen their trauma and not make them social outcasts." 

Sri Lankan studies show that not a single rape victim has used Postinor-2 and prevented an unwanted pregnancy. 

Experts said the pill, freely available in about 1,000 Sri Lankan drug stores and health centres, would not dislodge an established pregnancy or cause an abortion.

A Sri Lankan survey among 327 respondents, funded by the Consortium before the product was launched, showed that people were concerned that the use of ECPs would promote undesirable sex, raise cultural and social stigmas, induce sexual intercourse among the younger generation, lead to infertility and result in zero population.

Two years later, when another survey was taken to find the impact of ECPs, some of these concerns had lessened. "There was great relief particularly among women who were able to prevent unwanted pregnancies and also that it did not affect cultural and religious values," said Janaki Bamunusinghe, director at Market Behaviour Lanka Ltd. which carried out the two surveys.

She said that respondents, among whom were ordinary men and women, felt this could also lower the suicide rate amongst women who are desperate to do anything when faced with an unwanted pregnancy.

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