HEALTH: Religious Backing Boosts Use of Contraception

By Feizal Samath Reprint | | Print |

Feizal Samath

COLOMBO, Dec 4 2000 (IPS) - Efforts to promote emergency contraception pills in Indonesia met unexpected success when a major Islamic group in the world’s fourth most populous nation agreed to stock these in its clinics.

This became possible, those in charge of the programme said, after they cited sections of the Koran to make the point that this was not against the teachings of Islam.

This is an example of how efforts to address social concerns can help boost the understanding and acceptance of the use of contraceptives, the promoters of emergency contraception pills told an international meeting of family planning experts here in late November.

Thus, the Indonesian religious organisation Muhammadiyah is now distributing the birth control pills and also helping organise seminars and spread awareness of emergency contraception.

The group’s support was crucial in getting the pill Postinor-2 registered with Indonesian health authorities, said Don Douglas, Indonesia director of the U.S.-based Programme for Appropriate Technology in Health.

Approval by the Islamic Religious Leaders Council in Indonesia is essential for contraceptive registration. “We have developed a key relationship with some Islamic organisations in endorsing EC (emergency contraception),” he said.

According to Biran Affandi, professor of gynaecology at Jakarta University, there are some 3.5 million unwanted pregnancies every year in Indonesia. “How wonderful it would be if emergency contraceptives methods could prevent this,” he told the conference here in the Sri Lankan capital.

Efforts to popularise Postinor-2 in Mexico too have involved overcoming resistance from religious leaders, said participants at the meeting of birth control experts from India, Pakistan, Nepal, Sri Lanka and Thailand.

Representatives of the World Health Organisation (WHO) and the London-based International Planned Parenthood Federation (IPPF) were also present to learn how Postinor-2 was successfully introduced in Indonesia and Sri Lanka.

Also known as the ‘morning after pill’, Postinor-2 can prevent an unwanted pregnancy if taken within 72 hours after the failure of a regular contraceptive method.

A global coalition of international family planning groups, together with the WHO, is trying to promote the pill in developing nations, beginning with Sri Lanka, Indonesia, Kenya and Mexico.

Daya Abeywickrema, executive director of Sri Lanka’s Family Planning Association, said the demand for Postinor-2 is growing in the country since its introduction three years ago. Some 20,000 packets were sold in the first year, 80,000 packets are expected to be sold this year and 100,000 next year.

According to Harsha Seneviratne, head of the gynaecology department of the University of Colombo, the success of the emergency contraceptive pill is a good example of effective social marketing.

The pill is freely available in about 1,000 Sri Lankan drug stores and health centres. A two-pill pack sells for 100 rupees (1.40 U.S. dollars).

Before launching the product, the promoters commissioned a survey of more than 300 people which found them concerned that the pill would encourage sex among young people and cause infertility.

Two years later, the results of another survey showed that some these concerns had lessened. “There was great relief, particularly among women who were able to prevent unwanted pregnancies and also that it did not affect cultural and religious values,” said Janaki Bamunusinghe of Market Behaviour Lanka Ltd, which carried out the two surveys.

In Indonesia, Postinor-2 is still not sold in the open market, but is distributed by special clinics run by its promoters.

Twelve Indonesian Planned Parenthood Association clinics in six provinces took part when the programme to promote its use was introduced in 1997. Women’s groups are now also being involved to spread awareness about it.

Pramilla Senanayake, assistant director-general of IPPF, said that while Sri Lanka and Indonesia have shown some success in the Postinor-2 project, there was much more opposition to emergency contraception methods in Kenya and Mexico.

The Kenyan programme had to be slowed down considerably due to lack of backing from the public and religious groups. In Mexico, a similar programme was met with initial opposition from religious and conservative groups.

The Mexican government approved Postinor-2 for use a year ago, but it is still not sold in the market. According to a conference document, “political and religious sensitivities often challenge proponents of family planning services and legislation in Mexico.”

Reproductive health workers were at first reluctant to promote emergency contraception in Mexico, even though the country has a high level of unwanted pregnancies and complications caused by illegal abortion.

However, an educational campaign using the mass media is changing attitudes. Demand is also being generated through innovative marketing methods. Thus, condom packs now carry stickers with telephone numbers of emergency contraception service providers. Information is also being provided at popular music shows.

As a result, emergency contraception, “once a very sensitive topic — is now considered an important aspect of standard reproductive health care,” adds the document. Postinor-2 is expected to be available in the Mexican market shortly.

Kenya approved the pill for use in April 1997 and it is freely available in family planning clinics and chemist shops at less than one dollar for a pack.

But last year, the Kenyan Ministry of Health asked Postinor-2 promoters to put off a major conference of health experts, pharmacists and government officials due to a debate generated by an unrelated abortion controversy.