Chennai: Bharathy Singaravel, a reporter for the Indian digital news platform The News Minute, was hunting for emergency contraceptive pills in the metropolitan city of Chennai, India, through the harsh June summer. The city infamously has poor access to the pills, and Singaravel’s status check aimed to uncover if there was any progress. There wasn’t, she told Missing Perspectives

Half-a-world away, around the same time, the US Supreme Court overturned Roe vs. Wade, a decision which reversed American people’s right to abortion. Many Indians were quick to compare Indian abortion laws with the US, pointing to the former as a shining example of what should be. In India, women can seek abortion up to 20 weeks, and even 24 weeks under special circumstances. 

Against this backdrop, Singaravel reported that over 22 pharmacies refused to provide her with over-the-counter emergency contraceptive pills in Chennai. Only one tried to source the pills, but in vain. 

Pharmacists gave Singaravel conflicting reasons as to why the pills weren’t easily available. She found out that one reason was policy flip-flops in the southern Indian state of Tamil Nadu, of which Chennai is the capital; only 3% of some cities in Tamil Nadu stocked the pill as per a survey in 2020. But another reason was the lack of knowledge and attitudes of people towards emergency contraceptives. 

“They (the pharmacists) were awkward and judgmental,” she said. To them, Singaravel didn’t “look married.” It made them uncomfortable to sell contraceptives to someone they presumed was single, thus sexually inactive. “There is derision towards the pill, and for people who come in asking for it. There’s contempt.”

From “it's banned” to “it is an abortion pill”, she heard many misinformed views. None of this was true. 

In 2003, India included emergency contraceptive pills as part of its family planning programme. Data from the country’s National Family Health Survey in 2005, showed only a third of women surveyed were aware of emergency contraceptive pills, and just 1% used it. A lot has changed, the latest round of survey, revealed. By 2019-2021, more than half of married people knew of emergency contraception methods, but the use of such pills remained less than 1%. 

The demand for the pills has increased in India, and between 2008 and 2012 sales grew four times from 4.9 million to 16.4 million. But just 18 metro cities contributed about 29% of sales, and accessibility in small towns and rural areas–where over 60% of India lives–remains poor. While the government procures the pills to be distributed through health facilities and to people’s doorstep through accredited social health activists (ASHAs), the awareness in rural areas remains poorer in comparison to urban areas.

“There’s a problem with awareness and attitude,” explained Dr Ankita Abhay, a medical activity manager at Umeed Ki Kiran (UKK), a New Delhi-based clinic for survivors of sexual and gender-based violence run by Médecins sans Frontières. Availability of pills is definitely subjective to the local status of the healthcare system and awareness of the pills in an area, she explained. 

Advocates note that lack of availability of emergency contraceptives lead to unwanted pregnancies and abortions at a later stage, putting more women in harms way. Despite Indian laws allowing access medical termination of pregnancies, nearly 67% abortions in India are unsafe. Unsafe abortions are the biggest cause of maternal mortality in India; killing nearly 8 women every day. 

However, there’s scope for misuse or overuse of the pills, experts said. 

“[I work] with the survivors of sexual and gender-based violence, and sometimes I feel it might be misused,” Abhay pointed out. A majority of India’s gender-based violence cases are unreported; and marital rape is still not recognized and treated. 

Abhay’s statement in part echoed the concerns of the wider medical fraternity, which believes that overuse of the pills can adversely impact women’s health. 

Dr Sylvia Karpagam, an independent public health researcher and scientist, said while there is a felt need for the pills, she would advise against regular use. She said that the focus should be on avoiding unprotected sex, reducing risk taking behaviours, and encouraging other forms of birth control. 

Both Karpagam and Abhay warned against side effects and health impacts that can arise from unchecked consumption. 

However, these concerns need to be addressed alongside making the pills available–without the stigma–for those in need. 

Singaravel’s work has revealed how sourcing the pills can be traumatising. She interviewed over a dozen people, and none of them found it easy to buy it over-the-counter.

“They clearly had a horrible time finding the pills. There were a lot more horror stories that came in, than I could put in the article. No one has had a pleasant experience.”