Religious backing boosts use of contraception
By Feizal Samath
December 5, 2000
Colombo - 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 program 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 organization Muhammadiyah is now distributing
the birth control pills and also helping organize 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
US-based Program 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
organizations 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 popularize 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 Organization (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 centers. A two-pill pack sells
for 100 rupees (US$1.40).
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 Behavior 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 program 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 program had to be slowed down considerably due to lack of backing
from the public and religious groups. In Mexico, a similar program 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.
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