After a fight spanning years by activists to make emergency contraceptive pills accessible in Tamil Nadu, a status check by TNM across 23 pharmacies in Chennai found that little has changed.

A picture of a woman holding an iPill emergency contraceptive. There's an open first aid box in front of her. Image for representation.
Delve Reproductive Health Tuesday, July 05, 2022 - 12:25

“We don’t stock those pills here. They are banned.” At the Apollo Pharmacy in Adyar’s Shastri Nagar in Chennai, the cheerful young woman was growing increasingly reticent. Her discomfort had stemmed from our request for an emergency contraceptive pill (ECP), on which there is no official ban in Tamil Nadu. “But we don’t stock them,” she said. “We just tell customers to go to the doctor.”

A status check by TNM across 23 pharmacies in Chennai found that 22 of them did not stock emergency contraceptive pills; one first promised to get us an ECP with a prescription, but later said they weren’t able to source the medicine. Our requests for ECPs were consistently met with the same response from pharmacists — evasion and plain discomfort. TNM visited pharmacies in Shastri Nagar, Raja Annamalai Puram, T Nagar, Anna Nagar and Nungambakkam among other areas. Every pharmacist who refused to give us the pills cited reasons rooted in misinformation, about both the nature of the pills and their legality.

At eight pharmacies in Shastri Nagar and Besant Nagar alone, TNM was told that they had a policy of not stocking up on emergency contraceptive pills. All except one were under the impression that ECPs were banned in the state, and usually directed customers to seek a doctor’s advice. One private pharmacy, situated opposite the Adyar Public Health Care Centre, said they would place an order if a customer came with a prescription. But the pills only work within a narrow window of 72 hours, we pointed out. “We usually try to get them by the next afternoon,” the pharmacist said.

The person in-charge of the MedPlus Pharmacy, located in Anna Nagar, vouched that those who need to buy iPills or any kind of ECP have to get a doctor’s prescription. “Big pharmacy retail shops like us don’t store such pills in Chennai. You can check with the local pharmacies, they might have them,” he said.

At an Apollo Pharmacy in Raja Annamalai Puram, TNM was told that only pharmacies attached to hospitals had the licence to sell such pills. “We don't have any stock. It is impossible for retail medical shops to have such pills. ECPs were easily available five years ago. But after the ban, we stopped buying them.”

But it would seem pharmacies attached to hospitals are not dependable in this regard either. TNM visited one of them, the pharmacy attached to the Venkataeswara Hospital in Nandanam, only to find that ECPs were unavailable here as well, even with a prescription.

An older man working at the Apollo Pharmacy in Shastri Nagar, where TNM was earlier told by a young woman that they do not stock ECPs, said that at least one person walks into the pharmacy asking for iPills or other brands of ECPs every week.  

The pharmacist at a small state-run pharmacy in Besant Nagar told TNM that they only stored generic medicines, not branded ones. When it comes to ECPs though, even government-manufactured pills are not in stock. “These pills have a very short shelf life of just a year. It is not profitable to us,” they said. The responses from pharmacies in Saidapet, T Nagar, Aminjikarai and Anna Nagar were all similar. “We don’t even sell Dolo 650 [generically, paracetamol] without prescription,” claimed the senior pharmacist at Sitthi Vinayagar Medicals in Anna Nagar. “If the customer doesn't have a prescription for ECPs, we advise them to go to a doctor. Only doctors have access to such pills.”

At a Saidapet pharmacy named Sugam, we were told that even if we brought a prescription for ECPs, they would have to submit that to the supplier along with our personal information, including an ID proof, in order to sell the medicine. “We also have to maintain bills because our pharmacy association necessitates that. All of this is too much trouble, so we don’t stock any,” they said.

A pharmacy in Besant Nagar had told TNM that they would source ECPs for us if we gave them a prescription and our personal details, but was unable to follow through. “We will place an order with the distributor and get it by 2 pm tomorrow,” they had said. But when we approached them after two days with a prescription, they were unable to source any. After making some unsuccessful calls to distributors, they said that their pharmacy association was instructed by the Drug Control Department around two-three years ago to not sell the pills without a prescription. Even distributors had stopped stocking them after that, they said.

TNM also placed orders on two medicine delivery apps---PharmEasy and Apollo 24x7. Neither required prescriptions and the orders were placed on July 1. on The PharmEasy delivery arrived a little over 12 hours later. The Apollo delivery was made only on Mobday July 4. The pills are more effective within the 72 hour window.

A Chennai resident, who requested anonymity, shared with TNM their experience of attempting to buy ECPs in the city. “Pharmacies have a lot of misconceptions about the legality of these pills. I had unsuccessfully tried to buy the pills from many stores in Triplicane, Mylapore and Royapettah. Several of them did not even know what I was referring to until I mentioned a brand name, like iPill. I did finally manage to get the pills, but that was after I contacted activist Archanaa Seker through Twitter. She sent me a list of shops, one of which had the pills in stock," they said.

Apoorva Mohan, another activist who works with Archanaa to maintain a working list of pharmacies in the city that stock ECPs, told TNM that a majority of shops on their list are located in neighbourhoods such as Anna Nagar, Adyar or Royapettah. When people reach out to them through Twitter, the activists direct them to shops from where they would likely be able to procure the pills. But as one Chennaite TNM spoke to pointed out, it seems easier to access these pills in higher-income neighbourhoods. “A friend and I were looking for ECPs and finally managed to find them at Royapettah. I wonder what is the situation in areas like Washermanpet, Keelkattalai or Chitlapakkam.”

So why do pharmacies not stock these pills?

Though they are readily available over the counter (OTC) in other parts of the country, a series of twists and turns in stance by the Drugs Control Department authorities in Tamil Nadu has led to an informal ban on ECPs in the state. There is a widespread belief among pharmacists and anti-abortion organisations such as Responsible Parents Forum, that ECPs are used for abortion. Abortion, though mired in severe stigma among several other complications, is not illegal in India. However, it is important to note that ECPs do not function as abortion pills. Instead, these pills delay or stop the release of an egg, if taken within 72 hours of unprotected sexual intercourse. They will have no impact on an already fertilised egg. This distinction, unfortunately, makes little difference to pharmacists or even the general public.

In 2005, the Directorate of Drug Control made levonorgestrel-based ECPs an over the counter drug. This was widely seen as a progressive move in favour of reproductive rights and sexual autonomy. But in 2006, Responsible Parents Forum and Satvika Samuga Sevakar Sangam, both anti-abortion organisations, protested claiming that ECPs could induce abortion and therefore should not be categorised as OTC drugs. This led to raids that amounted to ECPs worth Rs 50 lakh reportedly being seized in one instance, in turn leading to the implementation of an informal, self-imposed ban on their sale by pharmacies.

To further complicate the situation, the Directorate of Drugs Control in Tamil Nadu told Times of India in 2008 that the level of levonorgestrel in the pills had become a matter of contention between them and pharmaceutical companies. The Drugs Control Department wanted ECPs to be re-labeled as Schedule H drugs, which require a prescription because they contain levonorgestrel levels of 0.75mg, claiming that this level was fixed at 0.1mg for OTC drugs. He also said at the time that there was pressure from the police and women’s commissions objecting to “free sex”, adding “the [pills] maybe available in other places, but we have banned it because we are very strict.”

But in 2020, K Sivabalan, the then Director of Tamil Nadu Drugs Control Department, clarified to The New Indian Express that there was no ban on ECPs. “Many people are confusing contraceptive pills with abortion pills. Abortion pills should be taken only under medical supervision. Any drugs under Schedule H, H1 and X, should be sold only on prescription. But contraceptive pills like Mala D can be sold even without a sales licence,” he said.

However, when TNM reached out to G Thiyagarajan, secretary of the Tamil Nadu Chemists and Druggists Association, he alleged that they had received a verbal directive from the Drugs Control Department a few years ago, telling them not to sell ECPs without prescription. Pharmacies are only following the government’s instructions, he said.

Activists say that if this issue is ever to be resolved, the Tamil Nadu government will have to clarify in writing that there is no ban on emergency contraceptive pills, and clear the misconceptions around the nature of the pills. Pharmacies also need the assurance that they will not face harassment, so that ECPs can be available over the counter with the same ease as they are in other states.

With inputs from Nithya Pandian.

Also read: Part 2: Why emergency contraception is crucial: Chennai residents, activists explain