A
study has been done in collaboration with the Family Health International, Rockfeller
Foundation looking at the use of emergency contraceptive pills among women relying
on condoms as their primary contraceptive method. 200 women were enrolled after
detailed information about the study and screening for eligibility and willingness
to participate and signing a written consent.
During the 3 months of study participation they recorded details of coital acts
and condom use events. Condoms given were those provided through the National
Family Planning Programme. If condom broke, slipped during use or was not used,
they agreed to take emergency contraceptive pills within 72 hours of such an unprotected
coital act. The pills given were the Ovral tablets containing 50µg of ethinyl
estradiol and 0.25 mg levonorgestrol. The first dose of 2 tablets was followed
by another 2 tablets after 12 hours. Tablets of Phenergan were given for use if
required for nausea and vomiting. The provision
of emergency contraceptive pills was randomized to advance (group 1) and as needed
(group 2). Participants in group 1 were given the emergency contraceptive pills
at enrolment and asked to report to the clinic when they used the tablets to inform
the details and collect further advance stock. Participants in group 2 were required
to report to the clinic as early as possible after the unprotected coitus, to
collect the emergency contraceptive pills. A house visit by a social worker was
made after one week to record details of pill use.
None of the 270 women contacted for the study was aware of emergency contraceptive
methods prior to this study information. All these women were from the lower middle
socio-economic group. 192/200 participants completed the study and 8 discontinued
early (7 due to pregnancy and 1 was reluctant to continue after 1 month).
Results : Majority
(64%) of the participants were between 25-34 years of age, 61% had 10-12 years
of formal education (secondary, higher secondary), 76% were housewives and 51%
and 46% respectively had 1 and 2 living children.
Advance group had used EC more often than needed group (Tables 1 & 2).
Table 1 : EC pills used by the 2 groups
Groups
Advance Needed No.
of women who required ECPs 32 29 No. of unprotected
coital acts 47 41 No. of times ECPs not used
6 18 No. of times ECPs used correctly 26/41
23 No. of times ECP used incorrectly 15/41 0
Table
2 : Reasons for not taking EC pills as instructed
Groups
Advance needed Child
ill 1 3 Forgot instructions & reluctant
to take – 8* Confused instructions – 4
Near expected menstruation 1 2** Indifferent,
took risk – 1 Went out of city without ECPs
1 – Office and work tension, so forgot 1 –
Objection from family members 2 – * One participant
7 times ** One participant 2 times Overall
almost 50% women experienced some side-effect (Table 3).
Table 3 : Side-effects experienced by participants
with EC Intake (n=64)
Symptoms No. Nausea
– 18 Body ache – 4
Vomiting – 12 Fever – 1
Giddiness – 2 Loose motions – 2
Headache – 13 Abdominal discomfort – 2
Breast tenderness – 1 Heavy bleeding – 1
Giddiness, nausea and headache – 1 The
participants were asked to recollect the instructions given regarding ECP intake.
72% correctly said the 1st dose should be taken with in 72 hours and 83% said
the correct interval is 12 hours for the second dose, (1.5% and 4.5% could not
recollect or state the timings for the first and the second dose respectively).
61% said they would prefer advance provision while 87% preferred to get the EC
pills when needed. Based on the number of times women did not take ECP when required,
it seems better to offer the ECP in advance. On the other hand, more correct intake
was noted in needed provision group which is due to better recollection of timings
for intake, since these instructions were repeated to them, at the time of providing
the pills. It would be practical to provide women according to their preference,
but with reinforced instructions in writing, pictures or symbols or even telephonic
contacts. Various healthcare facilities should also be accessible for ECP distribution
and counselling. Conclusions
• Our small study conducted at IRR, Mumbai, has revealed that
knowledge of EC methods/pills is low, practically nil among barrier contraceptive
users and this should be increased, as these are the likely users of EC as a back-up
method. This would increase confidence in barrier methods and greater acceptance.
• Counselling for correct intake of EC pills and follow-up
after use is important, which also needs to be repeated frequently as women tend
to forget the dosage schedule and available ‘window’ for EC pill use.
• Information about EC methods, both pills and IUDs should
also be given when other contraceptives are discussed, emphasizing that it is
a back-up or ‘contraceptive first-aid’ method and not for frequent and regular
use. We need to know more about how long
the ‘window’ period of effective use of EC pills can be extended. Ethical aspects
when pregnancy occurs inspite of EC use, would be the same as for the other contraceptive
use. | 
