According to several media reports that surfaced earlier this month, an expert panel of the Central Drugs Standard Control Organisation (CDSCO) has been deliberating making hormonal contraceptive pills – currently available over the counter (including emergency contraceptive pills, popularly known as morning-after pills) – accessible only via a prescription by a doctor.
The rationale behind this potential ban is that uncontrolled and 'irrational' use of morning-after pills may lead to health complications for women.
Although an official from the CDSCO clarified last week that no such recommendation is on the horizon and emphasised that there won't be any changes in the sales and distribution of the emergency contraceptive pills, the news had already stirred concern and sparked debates among Indians regarding the safety of the pills and the ethical implications of the move.
Are Emergency Contraceptives Safe?
In India, various chemical formulations like Mifepristone, Levonorgestrel, and Ulipristal can serve as morning-after pills, but only Levonorgestrel is approved for over-the-counter sales.
This pill, available under popular brand names such as I-pill and Unwanted 72, contains a dosage of 1.5 mg of Levonorgestrel. When taken within 72 hours post-intercourse, it can prevent approximately 89 percent of pregnancies.
The side effects associated with Levonorgestrel are generally mild, including nausea, vomiting, and minor bleeding. The drug has a half-life of 20-60 hours, meaning it is completely eliminated from the body within five days to two weeks, with no lingering effects.
Current evidence does not suggest that repeated use of this pill leads to accumulation in the body or an increased side effect profile.
Only isolated case reports link emergency contraceptive pills to blood clots, but there is no established correlation between progesterone-only emergency pills and clot formation.
Moreover, while menstrual irregularities may occur in about 15 percent of users, they usually resolve in the next cycle without intervention.
The only absolute contraindication for Levonorgestrel is confirmed pregnancy.
However, even when taken by women who later discovered they were pregnant, the pill posed no risks to either the mother or the fetus.
The World Health Organization (WHO) considers it one of the safest contraceptive methods and has even approved its use among breastfeeding women.
Despite being designated for emergency use, there is concern that some individuals may use morning-after pills regularly.
This apprehension was echoed by the Tamil Nadu government during the 62nd Drugs Consultative Committee meeting in 2023, which led to the suggestion to ban over-the-counter sales.
Banning Over-The-Counter Emergency Contraceptives Could Increase Maternal Mortality
WHO guidelines indicate that Levonorgestrel-based contraception is safe for repeated use by all women, although it may not be the ideal choice. In fact, the WHO advocates for the over-the-counter availability of emergency contraceptive pills, with 112 countries permitting such sales, indicating a global trend toward access.
In India, data from the Guttmacher Institute shows that from 2015 to 2019, nearly 48.5 million pregnancies occurred annually, with 44 percent being unintended.
Of these unintended pregnancies, 77 percent ended in abortion, contributing to approximately 80,000 maternal deaths each year due to unsafe procedures.
The burden of unsafe abortions is significant, with a 2019 study in the British Medical Journal indicating that unwanted abortions result in an average of eight deaths per day, disproportionately affecting marginalised women.
Many who seek abortion care report experiences fraught with stigma and disrespect. Accessible emergency contraception could prevent unwanted pregnancies and, consequently, unsafe abortions that endanger women's lives.
Thus, banning over-the-counter emergency contraceptives could exacerbate maternal mortality rates in India by leading to more unintended pregnancies and unsafe abortions. This prohibition might also fuel demand for black-market alternatives, which lack regulation and quality control, potentially resulting in substandard or counterfeit products.
'A Matter of Privacy and Autonomy'
Additionally, easy access to emergency contraceptives allows women from various socioeconomic backgrounds to obtain necessary contraceptive care while preserving their autonomy and privacy.
In a country where the burden of contraception often falls on women, as indicated by the National Family Health Survey (NFHS-5), a ban would eliminate one of their last options for preventing unwanted pregnancies.
It appears that speculation, rather than scientific evidence, is driving the proposed policy change.
If doubts persist regarding the misuse of emergency contraceptives, comprehensive studies should be conducted to assess their impact in India before implementing an over-the-counter ban.
Instead of restricting access, India should prioritise educating both the public and healthcare professionals about the proper use and safety of emergency contraceptives, empowering women to make informed choices regarding their reproductive health.
Rather than resorting to bans and restrictions that lack scientific backing, the focus should be on promoting health and sexuality education. The data available can guide better decision-making regarding reproductive health access.
(Pooja Tripathi is a writer, public health specialist, and spokesperson for the Indian National Congress. This is an opinion piece, and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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