New Delhi: Advertising and broadcast firms may be cheering the ad blitz by makers of emergency contraceptive pills, popularly known as morning after pills, but India’s drugs regulator is beginning to take a dim view of this because of potential overuse and misuse.
The Drug Controller General of India (DCGI) is considering converting these over-the-counter (OTC) emergency contraceptives (ECs) into prescription drugs.
If this happens, these drugs can no longer be advertised.
The proposal is to be discussed at the next meeting of the Drug Technical Advisory Board, which will also consult with the department of family welfare. The date for the meeting has not yet been fixed.
Wrong message? Ads for Cipla’s I-pill and Mankind Pharma’s Unwanted-72 contraceptives. The advertising council is finding it difficult to take a call on ads for morning after pills as the government endorses family planning on the one hand, but doesn’t like the way such advertisements are being received by the audience.
DCGI has already written to the two companies, Cipla Ltd and Mankind Pharma Ltd, that have been advertising their morning after pills I-pill and Unwanted-72, respectively, and is awaiting their response.
“There are ethical concerns over these ads and we have received a number of complaints. In India, there is not enough awareness on emergency contraceptives, so the situation needs to be tackled carefully. In most countries emergency contraceptives are sold OTC but this may not be feasible for us,” said drug controller general Surinder Singh.
Some gynaecologists say the advertisements present morning after pills not as emergency contraceptives but as a way to have unprotected sex without worrying about getting pregnant. “Abortion say accha hai pregnancy ko rokna (it is better to stop a pregnancy than have an abortion),” says the I-pill ad, while the Unwanted-72 advertisement ends with the line “ab ham hain tension free” (we are now tension free).
Listen to an interview with Dr. Ranjana Sharma of Fortis La Femme about whether emergency contraceptives should be prescription based
Following complaints, the Advertising Standards Council of India (ASCI), an industry body that deals with complaints against ads, has decided to study these ads.
The council is yet to take a call on the ads because, as one of its officers put it, the issue isn’t an easy one. The government endorses family planning on the one hand, but doesn’t like the way ads for morning after pills are being received by the audience, said Alan Collaco, secretary general, ASCI. “The issue is more legal than moral.”
Until four years ago, morning after pills were sold as prescription drugs in India. In September 2005, then health minister Anbumani Ramadoss announced that in order to “empower women to be able to avoid pregnancy in such situations as unprotected sexual exposure, contraceptive accident or forced sex”, the government would allow over the counter sales of such drugs.
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While advertising commenced soon after, it is only recently that the tempo was stepped up. The companies declined to share the size of the advertising budget. “Brands like I-pill and Unwanted-72 are not per-year brands, which means they don’t advertise consistently every year like most regular advertisers do. With a marketing budget of approximately Rs15-20 crore for this year alone, they have invested in high-value, high-reach shows to create maximum awareness of their product,” said a senior executive from a media buying agency who did not want to be named as he is involved in the media buying.
An executive at Cipla maintains that the ads are appropriate and do not suggest that morning after pills be used instead of condoms or other preventive measures.
This information is also on the packs, said Amar Lulla, joint managing director, Cipla. He added that helplines set up by the company to speak to users of morning after pills clearly spell out that that the condom should be the primary prophylactic because sexually transmitted diseases cannot be prevented by the use of morning after pills.
“The World Health Organization says that emergency contraceptives should be publicized as much as possible. It is being suggested as an emergency should there be an accident. Instead of talking about our ads, I would suggest that the DCGI and health ministry make an ad and take the initiative to create awareness,” said Lulla. “Let them counter it with responsible communication. What is stopping them?”
Even countries that allow sale of morning after pills over the counter usually monitor sales to minors. The US, for instance, requires girls under the age of 17 who buy these pills to provide a prescription.
Ranjana Sharma, a gynaecologist at Fortis La Femme, a unit of Fortis Hospitals, said the ads send out the wrong message to girls who end up thinking that if they take ECs then they can have intercourse whenever they want without any protection. “And they keep taking it several times a month, making their menstrual cycle very irregular.”
And the pills themselves aren’t as effective as regular contraceptives, she added. “We just don’t approve of these ads. We get patients who are under the impression that this (EC) is the best contraceptive. The way they advertise is as if this is the answer to contraception.”
Studies show that day after pills are 95% effective if taken within 24 hours of sexual intercourse, 85% if taken within 25-48 hours and only 58% if taken after 49 but before 72 hours.
“Therefore, the importance of follow-up for three weeks must be clearly explained to the users. During this period, barrier method (condoms) must be used and if the menstrual period does not start, then the possibility of ectopic pregnancy (a pregnancy that is outside the uterus) or toxicity to the foetus needs to be assessed. None of this essential safety and efficacy information is included in the high-pitched advertising blitz to promote the sale of the pill,” said C.M. Gulhati, editor Monthly Index of Medical Specialities, a medical journal.
Sharma said that while ideally morning after pills should be sold over the counter since they are meant for emergencies, the absence of sex education and counselling in India means that they are better sold as prescription drugs now.
“Currently, girls just see the ad and take the pill when they want to. But if they had to consult a doctor first, we could be able to advise them on whether the drug will suit them, screen them for infections, know their sexual behaviour and discuss a whole lot of health issues with them before they can take the pill,” she added.
Sharma said that in cases where the use of the pill is not advisable, doctors will be able to offer an alternative such as the Copper-T, which can also be used as an emergency contraceptive.
But Lulla argued that in some cases girls may not want to go to a doctor. “Also, by the time she reaches the doctor, it may be too late.”
I-pill’s advertising agency Network Advertising Pvt. Ltd declined to comment, but Mankind’s advertising agency, Prachaar Communications Pvt. Ltd found nothing objectionable about what was conveyed.
“We followed the brief given by the company, which was to create awareness on the pill, and I don’t think the ad conveys any other message,” said Dhaval Vyas, manager of the Unwanted-72 account.
An advertising executive said it was wrong to blame the advertisements.
“I dont see anything wrong with the ads,” said Piyush Pandey, executive chairman, Ogilvy and Mather, South Asia.
“Do car ads tell you how many wires there are in a car? I don’t think television ads should have to give such details on how and when to take the pill. I think people are savvy enough to know or go to the doctor for consultation.”