Medical barriers to emergency contraception: a cross-sectional survey of doctors in North India

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In 2005, India passed legislation allowing over-the-counter sales of emergency contraceptive pills (ECPs), such as at this chemist shop located in New Delhi. Awareness and use of ECPs, however, remain low in the country.

TABLE 1. Facts About Levonorgestrel-Based Emergency Contraception

Characteristic	Fact
Dose and regimen	1.5 mg taken at one time, within 120 hours of unprotected sex, is the best approach.
Mechanism of action	Preventing/delaying/disrupting ovulation.
	Possibly thickening cervical mucus.
	Does not prevent implantation based on best evidence.
	Does not disrupt established pregnancy.
Effectiveness	52%–94% reduction in what risk of pregnancy would have been; better if taken sooner after unprotected sex.
Medical eligibility	Should not be taken if the woman has a confirmed pregnancy (because no need to take), although best evidence indicates it would not harm fetus.
Medical eligibility	Otherwise, no medical restrictions, including age.
Side effects	Minimal and not harmful (for example, possible mild nausea, menstrual changes).
Repeat use	Regular repeat use not recommended because of relatively poor effectiveness over time and possible side effects such as menstrual irregularity. However, repeat use poses no known health risks.

TABLE 2. Knowledge and Attitudes About ECPs Among Surveyed Doctors in North India (N = 83)

Knowledge and Attitudes	Percentage
Knowledge of Mechanism of Action^a
Inhibits ovulation^b	23
Prevents implantation	96
Induces abortion	1
Attitudes About Expanding Access^a
Oppose OTC provision	67
Oppose provision by CHWs	53
Oppose provision as prophylactic	42
Recommend age restriction	84
Women Using ECPs Are More Likely To^a:
Engage in premarital sex	53
Engage in promiscuity/have more sex partners	75
Participate in risky sex behavior	18
Not use other family planning methods	33
Have sexually transmitted infections	26

Abbreviations: CHWs, community health workers; ECPs, emergency contraceptive pills; OTC, over-the-counter.
↵a Multiple responses were possible.
↵b Correct response.

TABLE 3. Attitudes of Surveyed Doctors About Appropriate Use of ECPs (N = 83)

Situation/Characteristic of User	Percentage
Married woman	80
Infrequent/unpredictable sex	61
Contraceptive failure	12
Unprotected sex	41
Rape or sexual coercion	27
Living in refugee/conflict settings	7
Multiple responses were possible.