Emergency Contraception will prevent unwanted pregnancy and thus reduce the morbidity and mortality related to unsafe abortion. This will improve the reproductive health of women. Hence Emergency Contraception can play an important role in National Family Welfare programme of India. But for this, strategies need to be formulated keeping in mind the ethical aspects.

Important ethical issues:

It is unethical that emergency contraception service is not always accessible to women who need it. The important ethical issues are :

• Service-providers may be unware of Emergency Contraception due to lack of training.

• Existence of such contraception after unprotected coitus is not always known to public.

• There are dilemmas about the different modalities. Yuzpe method is available and cheap whereas, levonorgestrel which is more effective than Yuzpe method, is not available in India. So, there is an ethical dilemma: which product is to be used? Should we wait till we get levonorgestrel which is a little more effective, or should we compromise?

• It is sad that misconception about EC prevails among both service-providers and clients. Women may have reservations using EC, thinking that the product is an abortifacient.

• Emergency Contraceptives are for emergency situations. Repeated use of EC instead of regular contraception for birth control may result in adverse health problems.

• Client is upset if there is pregnancy even after emergency contraception. This demands ethical consideration and pre-counselling.

• Main ethical issues are related to regulation and monitoring of Emergency Contraception.

Measures to resolve some of the ethical dilemmas:

• Assessment of client needs.

• Training of service providers : Information should include indications of EC, recommended dosage, mode of action, efficacy, side-effects, precautions.

• Friendly and co-operative attitude of providers caring for client’s privacy and dignity.

• During counselling, it must be stressed that:

- it is not an abortifacient.

- it is not an alternative to regular contraception.

- it is effective for that particular coitus only.

- it does not protect from HIV/AIDS/STI.

- there are some side-effects such as nausea, vomiting, abdominal pain, breast tenderness, irregular vaginal bleeding.

- failure rate is about 2%. If the period is delayed, she should see the service-provider for possible pregnancy.

Conclusion

Emergency Contraception is an essential armament in family welfare programs in special circumstances. But ethical issues are to be given due consideration and all measures taken for proper introduction of Emergency Contraception.

Role of counselling is immense, because counselling can help the woman resolve her conflict and dilemmas, as well as advice about regular contraception.

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