ICMR BULLETIN VOL. 27-No.-3-MARCH-1997.pdf

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ISSN 0377-4910

emergency contraception
A woman would prefer to prevent an unwanted preg­
nancy rather than having an abortion or carrying the
pregnancy to term. No amount of legal or religious re­
strictions, social stigma or lack of access to professional
care can stop her if she decides to seek termination of an
unplanned pregnancy. Society and the health care provid­
ers should help in preventing abortions. A late abortion
is particularly distressing for both the woman and the
professionals involved in her care. In spite of this, it is
surprising that an estimated 40-60 million women seek
termination of pregnancy every year1. Unfortunately, a
large percentage of the induced abortions, particularly in
developing countries, are performed by unqualified per­
sons under unsafe conditions. As a result, the woman
faces a risk of death perhaps 100-500 times greater than
the woman who has access to a skilled operator working
in aseptic conditions. In fact, unsafe abortion is one of
the greatest neglected problems of health care in devel­
oping countries and a serious concern to women during
their reproductive lives. At least 70,000 of the approxi­
mately 580,000 maternal deaths that occur annually are
a consequence of complications of unsafe abortion pro­
cedures.

The available methods of fertility regulation are quite
safe and effective, and their use can help couples to decide
when and how often to allow pregnancy to occur. In
addition to the regular methods of contraception, there
are contraceptives available, commonly referred to as

emergency contraception, which can be used postcoitally
and provide a back-up in individuals at risk of unplanned
pregnancy. Indications for emergency contraception in­
clude unprotected intercourse, failure of barrier method,
missed oral contraceptive pills, and sexual assault.
Emergency contraception has therefore rightly been re­
ferred to as “the Casualty Department of Family Plan­
ning” as it offers a last chance, secondary method of
contraception to prevent an unplanned pregnancy2.
Increased adolescent sexual activity in recent years
has resulted in a corresponding increase in pregnancy,
childbirth and abortion, as well as increase in the sexually
transmitted diseases (STDs). How to deal with and
especially how to prevent thpse problems are major
concerns and topics of debate among parents and at all
levels of the community. The access to and appropriate
use of contraceptives including emergency contraceptives
can help prevent unwanted pregnancies and could save
the women from the agony and embarrassment of
resorting to induced abortions. Most couples are not
aware that contraception even after coitus is possible.
Surveys conducted by the International Planned
Parenthood Federation in 1994 have shown that, in South
Asia, only 20 per cent of the family planning associations
provide emergency contraceptive services, as compared
to 100 per cent in Europe. The Survey also indicated that
the women who sought emergency contraceptive services
were in the age group of 15-30 years3.

Couples in the reproductive age group need to be
educated about the available emergency contraceptives
and women have to be empowered to make and exercise
their own choice of contraceptive methods. They need to
be reminded that pregnancy during the adolescent years
can severely limit their future as well as oftheir offspring.
Infant mortality is highest among babies bom to the
young mothers. It is essential therefore to enable women
to have more control over their reproduction and to
exercise their full rights.

Recent studies have shown that if emergency contra­
ceptives are made known and are also generally available,
many women who are subjected to unprotected inter­
course, would rather use them than resort to abortion
later. For reproductive health care managers, therefore,
it is important to ensure the availability of such methods
and services.
This review provides information on the available
methods of emergency contraception, barriers to their
use, and the rising international interest to include emer­
gency contraception as a part of the reproductive health
care package and make it more widely available to the
potential users so as to prevent unwanted pregnancies and
consequently induced abortions.
Available Methods

Emergency contraception includes methods that can
be used to prevent pregnancy following an unprotected
act of sexual intercourse. The other terms frequently used
to express emergency contraception are “postcoital” con­
traception and “morning-after pills”. However, these
terms are generally misleading as they do not convey the
correct timing of use of the available methods and the
important message that emergency contraception should
not be used regularly. The term emergency contraception
dispels the fear that the user had missed the chance of
averting an unwanted pregnancy if she did not wait until
the morning-after or by having delayed the treatment
beyond the morning-after. The term emergency contra­
ception also emphasizes that such methods are for only
emergency use and not intended for regular use.
The two methods of emergency contraception which
are currently in use are: steroid hormone pills and copperreleasing intrauterine devices (Cu-IUDs)4. Among the
steroidal methods, high-dose estrogens, estrogenprogestogen combination (Yuzpe regimen), and
progestogen-only pills, are available in many countries
20

and their postcoital use can reduce substantially the
incidence of pregnancy. The use of Cu-IUDs offers a
more effective method of preventing pregnancy in
comparison to the use of hormonal methods. This method
may be useful when the woman plans to continue using
the device as a long-term method of contraception.

High-Dose Estrogens

High-doses of estrogens were the first hormonal
method, pioneered in the mid-1960s by Haspels, for
emergency use to prevent pregnancy5. The: first reported
clinical trial was done on a 13-year old rape victim who
was given 50 mg of diethylstilbestrol (DES). Subse­
quently, studies to identify the most effective and safe
estrogen and to optimize the dose and duration of treat­
ment followed. Some of the synthetic, natural and con­
jugated estrogens which have since been used are: DES
(25-50 mg/day, 4-5 days), ethinyl estradiol (2-5 mg/day,
3-5 days), and conjugated equine estrogens (30-50 mg/
day, 2-5 days). Estradiol benzoate (12.5 mg) combined
with 10 mg estradiol phenylpropionate has also been used
as an emergency contraceptive agent6.
The estrogens are generally administered in two
dosages for up to five days. Treatment, initiated within
72 hours of the unprotected intercourse, is very effective.
The pregnancy rate is generally less than one per cent
with most of the regimens.
The use of high doses of estrogens induces severe side
effects which are related to the drug load. The incidence
of nausea and vomiting is reported by over 50 per cent
and 25 perc ent, respectively, of women on the first day
oftreatment. Headache, dizziness, breast tenderness, and
irregular bleeding are also reported by some of the
women. In cases of treatment failures, about 10 per cent
of the resultant pregnancies are likely to be ectopic.
The high incidence of side effects and prolonged
duration of treatment have restricted the use of high doses
of estrogens as an emergency method of contraception.

Yuzpe Method
In the early 1970s Yuzpe showed that a single dose
of 100 mg of estrogen and 1.0 mg of dl-norgestrel
rendered the endometrium out of phase7. Since then the
use of estrogen-progestin combination, also referred to as
the Yuzpe method, is the most commonly used method of
emergency contraception. The method is simple,

relatively inexpensive and could be made readily
available as the steroids involved are available world­
wide and contraceptive delivery systems have already
been established in many countries.
Different combinations of estrogens and progestins
have been tried in various countries, however, the most
typical formulation contains 200 mg of ethinyl estradiol
and 2.0 mg of dl-norgestrel (or 1 mg of levonorgestrel)
which is given in two divided doses. The treatment is
initiated within 72 hours of the unprotected sex and the
second dose is repeated 12 hours later. When pills
containing lower doses of ethinyl estradiol and
levonorgestrel (or norgestrel) are available,
proportionately increased number of pills are taken.
Treatment should not be delayed unnecessarily as efficacy
may decline over time. However, the timing of taking the
first dose should be such that taking the second dose 12
hours later will not be inconvenient.
The failure rate of the Yuzpe method ranges from 0.2
to 2 per cent if calculated by the conventional method, ie.
the percentage of pregnancies occurring amongst treated
women irrespective of the day of coitus8. On the other
hand, in the trials that used information on the time of
coitus relative to ovulation and have compared the
number of pregnancies observed with the number
expected, it was shown that the Yuzpe regimen reduced
the chances of pregnancy by about 75 per cent9. The
lower contraceptive efficacy of the Yuzpe regimen in
comparison to the regular contraceptive methods is
because with the use of emergency contraceptive pills the
pregnancy rate is based on a one-time use, it cannot be
directly compared to failure rates of regular
contraceptives, which represent the risk of failure during
a full year of use.
The side effects of the Yuzpe regimen are comparable
to those seen after high-dose estrogen, but their incidence
is lower. Typical side effects are nausea and vomiting.
Less common side effects include breast tenderness,
abdominal pain, dizziness and headache. A recent study
has shown that in the combination regimen, the incidence
of side effects with the use of pills containing
levonoigestrel is significantly less as compared to the use
of pills containing dl-norgestrel10. Although the side
effects are uncomfortable for many women, very few
women experience serious medical problems. Similarly,
the short exposure to steroids does not appear to alter
blood clotting mechanisms. The high doses of steroids
used in the combination regimen do not increase the rate

of spontaneous abortion if treatment foils and they are
ineffective after implantation has occurred. No
teratogenic effects have been reported after ‘occasional’
postcoital use of combination regimen. The percentage of
ectopic pregnancies among the failures is higher than
among a normal pregnant population. It is therefore
essential to rule out the possibility of ectopic pregnancy
in all cases of failures of emergency contraceptive pill
users.

Emergency contraceptive pills should not be given to
a woman who has a confirmed pregnancy, primarily
because there will be no effect. According to the most
recent guidelines from the World Health Organization
(WHO), there are no other known medical
contraindications to the use of emergency contraceptive
pills. The dose of hormones used in the combined
estrogen-progestin regimen of emergency contraception
is relatively small and the pills are used for a short time,
so the usual contraindications associated with use of
combined oral contraceptives for regular contraception
do not apply. If an estrogen-free preparation is desired,
an option is to give 750 mg of levonorgestrel within 72
hours of intercourse, followed by a second dose 12 hours
later.
i
Proprietary preparation of the estrogen-progestogen
combination are now licensed for emergency
contraception in the United Kingdom, Germany, Norway,
Finland, Sweden, Switzerland, New Zealand and
Hungary11. However, several brands of combined oral
contraceptives contain the same hormones as used in the
combination regimen but the doses are lower resulting in
women using these brands having to take a greater
number of pills.

Progestogen-only Pill

Levonorgestrel (0.75 mg) tablets are available in
several countries for occasional contraceptive use. Its
contraceptive action is probably due to the combined
effects on pituitary-ovarian function, endometrium and
on cervical secretion12. Studies carried out in the early
1970s showed that the frequent postcoital use of
levonorgestrel was associated with a high incidence of
cycle disturbances. However, subsequent studies showed
that when used as an ‘occasional9 method of postcoital
contraception, the menstrual irregularities with
levonorgestrel were much less. The initial report
evaluating the contraceptive efficacy of levonorgestrel in
21

emergency contraception provided very encouraging
results. Treatment with a single 0.6 mg dose, given
within 12 hours after unprotected intercourse, had a
pregnancy rate of 3 per cent in 205 treated women13.
A prospective randomized trial compared the effec­
tiveness and side effects of two tablets of levonorgestrel,
each taken 12 hours apart, with those of the Yuzpe
regimen among women requesting emergency contracep­
tion within 48 hours of unprotected intercourse14. A total
of 424 subjects were recruited into the Yuzpe group and
410 subjects into the levonorgestrel group. The contra­
ceptive efficacy of levonorgestrel was similar to that of
the Yuzpe regimen. The failure rates were 2.6 per cent
and 2.4 per cent, respectively. With both treatments,
pregnancy rates tended to be slightly lower among women
who initiated treatment within 24 hours after intercourse
than among those who began between 24 and 48 hours.

The side effects like nausea, vomiting and breast
tenderness with this method were similar to but less
frequent than those found with the Yuzpe regimen. The
trial is being replicated in a multinational study spon­
sored by the WHO. If the fmdings are confirmed,
levonorgestrel could represent an improvement over cur­
rently available methods of emergency contraception12.
Copper-IUDs

Use of Cu-IUD as a method for emergency contra­
ception was introduced in late 1970s by Lippes and co­
workers15. The contraceptive effectiveness of IUDs, when
used in emergency contraception, is primarily due to their
ability to prevent implantation which is attributed to
endometrial changes resulting from the presence of the
device and the copper ions, and possibly a direct
embryotoxic action of copper.

The emergency use of a Cu-IUD is a highly effective
method to prevent pregnancy, the failure rate is probably
no higher than 0.1 per cent16. Additional advantages of
this method include its longer time frame for administra­
tion, ie. it can be inserted up to 5 days after intercourse
or up to 48-72 hours later than hormonal methods. The
longer time span is because of the ability of an IUD to
prevent implantation. It also has the additional advantage
of providing contraceptive protection for many years.
Postcoital IUD insertion is particularly useful when the
hormonal methods are no longer effective.

22

Some of the disadvantages of the IUD for emergency
contraception are: (i) it may be difficult to insert
particularly in young and nulliparous women; (ii) some
abdominal discomfort may occur; (iii) risk of infection,
particularly in cases of multiple sexual partners and of
rape; and (iv) in some cases relatively long-term
contraceptive protection may not be desired.

The service delivery implications raised by the
method, however, may be challenging, particularly in
some developing countries. In general, there has been a
gradual decrease in the age at first sexual encounter as
a result of which many young and nulliparous women
require emergency contraception. For such a population,
IUD may not be the first choice for emergency contracep­
tion.
Potential Future Methods

The requirements of an ideal emergency contracep­
tive are: high effectiveness, free of side effects and men­
strual disturbances, longer sex-treatment interval, easily
administrable form, preferably single administration, and
affordable. The currently available methods do not meet
all the requirements of an ideal emergency contraceptive.
However, it should not discourage prospective clients to
use the available methods to avert unwanted pregnancy.
The side effects of emergency contraceptive methods
generally subside within 24 hours and therefore may not
carry the same weight as with regular methods of
contraceptionas. Moreover emergency contraceptives
may be needed only once in a lifetime. Nevertheless, there
is an urgent need for new and better methods of emer­
gency contraception. The hormonal methods which are
being investigated include an antiprogestin mifepristone
and a progestogen danazol.

Antiprogestogens

Progesterone is indispensable for the establishment
and maintenance of pregnancy. Its major physiological
role is to prepare the uterus for implantation of the
fertilized ovum and then to nurture it for its development.
Progesterone also has a direct role in the intra-ovarian
regulation of folliculogenesis and ovulation as well as
transport of fertilized egg through the Fallopian tubes17.
Thus, any substance interfering with the synthesis, secre­
tion or peripheral actions of progesterone would have
antifertility effects.

Mifepristone (RU 486) is a potent progesterone an­
tagonist which blocks the action of progesterone both at
the endometrial and pituitary levels. Treatment with
mifepristone either in the early or mid-luteal phase of the
menstrual cycle invariably disrupts follicular develop­
ment18. The preovulatory rise in serum levels of estradiol
and luteinizing hormone is either attenuated or completely
blocked and ovulation is arrested. On the other hand,
treatment with mifepristone during the early luteal phase,
impairs endometrial development and prevents implanta­
tion19. The properties of mifepristone to arrest ovulation
as well as prevent implantation make it an ideal candidate
for emergency contraception.

appeared to be equally effective and prevented about 9U
per cent of the pregnancies which would have occurred
without treatment. These studies need to be extended to
determine whether the treatment would still be effective
in women presenting with a delay of up to five or six days
after unprotected intercourse and also to determine as to
how often mifepristone or related antigestagen could be
used in one cycle without causing disturbances in the
menstrual cycle rhythms. Studies are being also planned
to compare low doses of mifepristone with both the Yuzpe
regimen and the levonorgestrel treatment to assess advan­
tages and disadvantages of these methods of emergency
contraception.

Studies conducted under the aegis of the WHO have
confirmed the potential value of mifepristone as an
emergency contraceptive. In two clinical trials, one com­
paring mifepristone with Yuzpe regimen20 and the other
mifepristone with Yuzpe regimen and danazol21,
mifepristone was found to be the most effective. No
pregnancy was observed among the 597 women (402 at
one centre and 195 at the other) who were exposed to the
risk of pregnancy and were given a single dose of 600 mg
mifepristone within 72 hours of unprotected intercourse.
Analysis of the data from the centre where 195 women
were enrolled showed that at least 72 women had had
intercourse within three days after ovulation. On the other
hand, among 589 women who received the Yuzpe regimen
nine pregnancies occurred (pregnancy rate: 1.5%), and
among 193 women treated with danazol nine pregnancies
occurred (pregnancy rate: 4.7%). In addition, the women
who used mifepristone reported less nausea and vomiting
and fewer other side effects than did those receiving the
Yuzpe regimen. The incidence of nausea and vomiting
was slightly less in women treated with danazol in com­
parison to those treated with mifepristone. In 42 per cent
women treated with mifepristone, the menstrual cycle
length was prolonged by three or more days, compared
to 13 per cent in women treated with Yuzpe regimen. The
prolongation of menstrual cycle length could be due to the
extension of the follicular phase resulting in delayed
ovulation.

Danazol

To assess the efficacy and side effects of lower doses
of mifepristone in emergency contraception, WHO has
carried out a multicentre study, involving 11 centres which
recruited 1717 women, evaluating three doses, 600 mg,
50 mg and 10 mg22. It was estimated that among these
women some 10 per cent would have become pregnant
without treatment. According to interim results all doses

Danazol is a progestogen with antigonadotrophic ac­
tivities. It also prevents implantation by rendering the
endometrium out of phase. The use of danazol for emer­
gency contraception has been found to be more effective
as compared to the Yuzpe regimen23. Among the 990
women who were treated with 800 mg danazol (two doses
of 400 mg at 12 hour interval) within 72 hours of the
unprotected intercourse, only 17 pregnancies occurred
(pregnancy rate: 1.7%). Increase in the dose of danazol
further reduced the pregnancy rate. Among the 730
women treated with 1200 mg dose (3 doses of 400 mg
each at 12 hour interval) only 6 pregnancies occurred
(pregnancy rate: 0.8%). In this study, the pregnancy rate
among the 407 women treated with the Yuzpe regimen
was 2.2 per cent (9 pregnancies). The incidence of side
effects such as nausea, vomiting and breast tenderness
was also less in women treated with danazol in comnarison to those treated with Yuzpe regimen.

A more recent study, however, failed to confirm these
findings21. The pregnancy rate in the danazol treated
group (600 mg given twice, 12 hours apart) was 4.7 per
cent, which was nearly the same as the number expected
with no treatment. This study questions the usefulness
of danazol in emergency contraception and suggests a
need for further research to determine its potential as
emergency contraceptive agent. Danazol is
contraindicated in women with undiagnosed or abnormal
bleeding, impaired liver, kidney or heart function, or
porphyria, epilepsy or migraine.
The development of better methods for emergency
contraception is therefore a challenging task and requires
collaboration between investigators and organizations
active in the field.

23

Potential Users

A woman who would like to avert a pregnancy but
gets exposed to unprotected sex is likely to use emer­
gency contraception rather than resorting to abortion
later on. All women in the reproductive age would
therefore prefer to have access to this secondary method
of contraception, even before they may need it. Decrease
in the age at the first sexual encounter, and increased
demand for abortion by young girls indicate that adoles­
cents are the most vulnerable population in greatest need
for contraceptives and contraceptive services.
In India, about 275 million people (approximately
30% of the total population) are between the ages of JO24 years, of which 90 million are between 15-19 years24.
Only 19 per cent of the married women between 15-24
years of age use any form of contraception. As a result,
17 per cent ofteenagers start childbearing25. These young
Indian adolescents seem to contribute substantially to the
estimated 1-4.4 million abortions induced on adolescent
women in developing countries each year. They are the
potential users of emergency contraception.
There are no realistic estimates on the use of.emergency contraception in India. Nearly all the data related
to sexuality, use of emergency contraception and attitude
to take chances comes from the more developed coun­
tries. In a survey conducted in the United Kingdom, on
167 pregnant women aged 13-19 years, it was observed
that only 12 per cent of the pregnancies were planned, 73
per cent were unplanned and in another 15 per cent the
teen was equivocal at the time of conception about pre­
venting pregnancy26. Many of the teenage couples do not
use contraception during their first sexual experience.
They do not plan ahead or think about possible conse­
quences, such as unintended pregnancies and STDs.
They need to be informed of the available options to
prevent pregnancy and provided with reliable contracep'tives and contraceptive services.

Another possible reason to provide emergency con­
traception is the increasing use of condom by young
couples, particularly by those with multiple partners. In
the United Kingdom, a survey conducted by the Office
of Population Censuses and Surveys in 1993 showed that
after the Health Education Authority began warning the
people about the acquired immunodeficiency syndrome
(AIDS) the teenagers switched their main method of
contraception from the pill to the condom27. Since the
failure rates with condom or the barrier methods are, in
24

general, relatively higher, the women will require a sec­
ondary method of contraception in the event of breakage
or slippage of the barrier method.

Pregnancy complications and maternal and infant
mortality are also common among adolescents. Infants
bom to adolescent mothers are at higher risk of low birth
weight, prematurity and stillbirth. Teenage pregnancy is
a result of lack of knowledge about family planning, lack
of access to contraception, and lack of reproductive
health services, as well as sociocultural factors. It is
important therefore that besides health education, in­
creased emergency contraceptive services, including
emergency contraception, are made available to all
women particularly young couples.
Expanding Access to Emergency Contraception

Despite the facts that emergency contraceptives have
been available for almost 20 years and are safe and
effective to prevent substantial number of unwanted preg­
nancies, they have remained “the world’s best contracep­
tive secret”. Non-availability of registered products for
emergency contraception, lack of awareness among
women and health care providers that contraception fol­
lowing intercourse is feasible, and service-related factors
hamper accessibility and wider use of emergency contra­
ceptives. The misconceptions such as that emergency
contraception is an abortion, and its use promotes irre­
sponsibility and a promiscuous life-style particularly
among adolescents also contribute to underutilization of
emergency contraception to prevent unintended pregnan­
cies. Some of the barriers to the availability and use of
emergency contraception and what needs to be done to
expand access to emergency contraception are discussed
below.

Product Availability
In India, no pharmaceutical company is marketing
emeigency contraceptive pills or Cu-IUDs specifically
packaged or labelled for use for emergency contracep­
tion. Though oral contraceptive pills are officially avail­
able for regular contraceptive use, their use as emergency
contraceptive drugs has not been included in the National
Family Welfare Programme. Even in the developed coun­
tries, where the contraceptive prevalence rate is relatively
high, not many pharmaceutical companies have been
marketing emergency contraceptives.

In coi nines, like India, where preparations of emer­
gency con aceptives are not available, if the available
oral contraceptive pill is to be used as an emergency
contraceptive, the whole packet has to be opened to
provide the desired dose. This would create logistic prob­
lems in dispensing and audit. Moreover, some practitio­
ners may not be willing to prescribe the use of oral
contraceptives for a non-approved indication, thus ham­
pering wider availability and use of emergency contra­
ception.

It is essential that emergency contraception is in­
cluded in the family welfare programme and appropriate
products and services are made available for that pur­
pose. This should attract the pharmaceutical industry to
market preparations for emergency contraception. There
should not be any legal restrictions in marketing emer­
gency contraception as the available methods prevent
pregnancy rather than producing miscarriage. Moreover,
the available emergency contraceptive pills and Cu-IUDs
have been found to be effective and safe.

User’s Perspectives and Awareness
Awareness that contraception is possible even after
coitus is an important requirement for the use of emer­
gency contr ception. Lack of awareness as well as pre­
cise information about emergency contraception are some
of the major barriers to the use of emergency contracep­
tion. The potential users of emergency contraception may
have heard of emergency contraception but may not be
aware that the hormonal methods of emergency contra­
ception is simply a larger dose of the steroids which are
used in regular oral contraceptives and their use is safe
and effective; emergency contraception is not an abortion
and the medication is not taken for termination of preg­
nancy; and the hormonal methods have to be used within
72 hours and the Cu-IUD within five days of the unpro­
tected intercourse. It is also important for the potential
user to know how to obtain emergency contraception in
a timely fashion.

In India, a survey of 1125 urban and 575 rural
women in the reproductive age group showed that only
8 and 3 per cent of the women in the two groups, respec­
tively, knew about emergency contraception28. Even in
countries where overall contraceptive prevalence rate is
high, knowledge about emergency contraception is rather
low. In the United Kingdom, for example, where emer­
gency contraceptives have been available for almost 12

years, 24 per cent of the population surveyed had no
knowledge of the existence of the emergency contracep­
tion, and only 10 per cent knew that the method had to
be used within 72 hours of the unprotected intercourse.
Similarly, knowledge that IUD can also be used for
emergency contraception was much less as compared to
emergency contraceptive pill. In New Zealand, a survey
among 200 women seeking .pregnancy termination
showed that 38 per cent had not heard of the emergency
contraception and 41 per cent did not know where to
obtain it29. Similarly, a survey conducted in Princeton
University, showed that many students confused pills
dispensed for emergency contraceptive use with the
abortifacient mifepristone30.

Failure to use emergency contraception is not always
a matter of ignorance”. In a recent study from the United
Kingdom amongst 167 pregnant teenagers (aged 13-19
years) requesting pregnancy termination or having their
first antenatal visit, 135 girls had heard of emergency
contraception but 119 did not obtain it. In just over twothirds of these 119 teenagers, the girl was aware that she
was at risk of pregnancy but ‘took a chance’ rather than
obtain emergency contraception26. Clearly, counselling
about the risk of unplanned pregnancy following unpro­
tected intercourse must be given greater emphasis in sex
education, family planning counselling, etc.
The main reason underlying lack of awareness of the
available methods and the willingness to use the methods
of emergency contraception is, of course, the failure of
family planning services and providers and of the educa­
tional system to give information about emergency con­
traceptives to potential users.

A comprehensive survey of the knowledge or aware­
ness of emergency contraception in the general popula­
tion is very essential. It should then be followed by a welldesigned and intensive information, education and com­
munication campaign among the potential users. The
available methods should be publicized through meet­
ings, workshops and group discussions, during counsel­
ling for family planning, and through media such as radio
and television to create awareness about emergency con­
traception. The pharmaceutical companies should, in
addition to manufacturing and marketing the drugs, share
responsibility in increasing awareness among the poten­
tial users and the providers. In addition, contraceptive
clinics for teenagers need to be established which can
provide services and counselling for all methods of fer-

25

tility regulation. The latest scientific findings regarding
the advantages and disadvantages of the available contra­
ceptive methods need to be brought to their attention.
However, it may be emphasized that it is the woman
who has to take the final decision whether she would like
to have easy access to the product and the services. The
providers, the pharmaceutical companies and the govern­
ment are generally ambivalent towards the provision and
use of emergency contraception. In the USA, a coalition
of women’s health advocates and professional associa­
tions in health fields organized a successful campaign to
encourage governmental regulatory changes that would
promote greater access to emergency contraceptive ser­
vices.

Provider’s Perspectives and Awareness

Another obstacle to wider use of emergency contra­
ception is continued ignorance of the available methods
among a large population of the health care providers. In
India, a random survey of 342 gynaecologists revealed
that only 30 per cent had some awareness about the
available options28. Similarly, a survey conducted in New
Zealand showed that 62 per cent of the women who
reported for termination of pregnancy indicated that they
would have used emergency contraception if their physi­
cian had provided them with a postcoital pill to have had
on hand for use after unprotected intercourse, and 57 per
cent said they would have purchased such a pill if it were
available over the counter at pharmacies29. A survey
determining the knowledge, attitude and prescribing prac­
tices concerning emergency contraception amongst rural
and urban general, practitioners (GPs) from New South
Wales, Australia, indicated that a substantial number of
practitioners did not have adequate information about
emeigency contraception31. Amongst those who had some
knowledge about emergency contraception, 58 per cent of
urban GPs and 52 per cent of rural GPs prescribed the
Yuzpe regimen, and some prescribed regimens which had
not been adequately studied. Moreover, almost 30 per
cent of the urban and rural GPs did not include informa­
tion about emergency contraception in routine contracep­
tive counselling. In addition, the survey results suggested
that some doctors may not provide information or pre­
scribe emergency contraception, probably because of
moral or religious objections.
These findings suggest that the general practitioners
and other health care providers need to be informed and
trained about the emergency contraception, indications

26

for emergency contraception, management of a request
for contraception and followup.

In a country like India, where the doctor-patient ratio
is very low, the gynaecologists alone may not be adequate
in numbers to counsel on emergency contraception. It
may be appropriate to involve other health professionals
and if need be educate them about the use of the available
methods. This may help in extending services for emer­
gency contraception. The non-governmental organiza­
tions (NGOs) can provide significant help in promoting
emergency contraception. NGOs can also help in training
doctors. Prescription requirement also poses an obstacle
to some potential users, which need to be overcome
ideally by making the emergency contraceptive pills avail­
able off the shelf. In some of the developed countries, the
barrier of prescription is overcome by providing 24-hour
telephone referrals to nearby sources of emergency contraceptives. Similar facilities need to be established in
India.
Improved Services
Where to get an emergency contraception is another
essential requirement for its timely use. Many women
may know or have heard of emergency contraception but
may not know how to access it within 72 hours of its need.
In many countries emergency contraception can be ob­
tained only on prescription, which is not easy to get
within 72 hours of unprotected intercourse particularly
over the weekends. Moreover, many young couples may
feel embarrassed to talk to the doctors and may therefore
prefer to take a chance. Some poor women may even lack
access to a family planning provider.

Making these methods widely and easily available
could have a significant impact upon reducing the inci­
dence of unintended pregnancies. It is essential therefore
to make these methods widely available. Emergency
contraception would probably be less effective if pre­
scription was made essential. In some countries such as
the United Kingdom, New Zealand and Norway, the
possibility of making it available over-the-counter from
pharmacists is currently under discussion11. Another ap­
proach, taken in China, is to give barrier method users
emergency contraceptive pills prophylactically for back­
up use in case of mishap with the barrier method.

In the USA, a toll-free service has been established
which provides callers with information about emergency
contraceptive methods available in the USA as well as the

Mh

names, telephone numbers, and locations of three provid­
ers located nearest to them. The hotline is completely
confidential, fully automated, and available 24 hours a
day.

contraceptive pills are not effective after the pregnancy
is established. Therefore, even in countries where abor­
tion is not legal, it should be quite ethical to provide
emergency methods of contraception.

In India also, confidential access to emergency con­
traception should be provided through the most practical
delivery systems so that people in need of the method can
obtain it without delay. Possible avenues of distribution
could be pharmacies, family planning clinics, private
practitioners, vending machines, and casulty departments
of all hospitals and nursing homes. There is also a need
to actively advertise the availability of emergency contra­
ception and that health personnel should inform women
about it during visits. Hospitals and general practitioners'
should provide personalized advice about emergency
contraception to the users of barrier methods for contra­
ception. They should also display conspicuous, welldesigned, information, and accurate materials for the
public in the waiting rooms. Providing women with leaf­
lets about taking the contraceptive pill correctly and
emergency contraception appears to improve significantly
their extent of such knowledge. The drug industry should
also participate in creating awareness among the poten­
tial users about the emergency contraception and in bring­
ing to their attention the emergency contraceptive poten­
tial of existing products. Increased knowledge about the
available methods and their proper use might reduce the
number of unplanned pregnancies.

Another concern raised about emergency contracep­
tion has been that when easily available this would be
used routinely in lieu of a barrier method, or even the men
may pressurize a woman into unprotected sex. These
concerns are due to the lack of awareness about the
contraceptive effectiveness of the available methods of
emergency contraception. The available hormonal meth­
ods of emergency contraception are not as effective as
regular hormonal methods and should therefore not be
used as a substitute for regular contraceptives.

Ethical Considerations
The three major issues which raise ethical consider­
ations are emergency contraception might be viewed as
tantamount to abortion; promotes, irresponsibility and
promiscuous life-styles; and is targeted mainly at unmar­
ried adolescents32.

Data from a survey conducted by the International
Planned Parenthood Federation (IPPF) amongst its affili­
ate members indicate that several family planning
programmes do not provide emergency contraception be­
cause of the mistaken belief that its mode of action is an
abortifacient one. For the similar reasons, some women
with religious or philosophical objections may be hesitant
to use emergency contraception. The health care provid­
ers and women with such concepts need intensive coun­
selling. They need to be explained that emergency con­
traceptives act by way of either preventing ovulation,
fertilization or implantation. These methods do not ter­
minate an established pregnancy. In fact, emergency

The availability of emergency methods of contracep­
tion should also not be viewed as promotion of adolescent
sexuality and premarital sex33. If the emergency contra­
ceptives were not available, one should consider the
consequences when a woman using regular contraception
had a contraceptive accident either because the method
was not used correctly or the method failed such as when
a condom breaks, or a diaphragm or IUD becomes dis­
lodged; when woman is forced to have sex against her
will; and when men and women fail to plan ahead.

Similarly, access to emergency contraceptives for
adolescents is not an attempt to undermine parental au­
thority and community morals. The demographic and
health surveys point to increasing numbers of teenage
pregnancies and induced abortions. Moreover, infant
mortality is known to be very high among babies born to
the young mothers. Pregnancy at a young age may se­
verely affect a woman's entire future. Preventing an
adolescent pregnancy should be viewed highly ethical.
Some health care providers have shown concern that
access to postcoital contraception will encourage women
to stop using a regular contraceptive method. Studies,
however, show that this is not the case. Only 8 .per cent
of women seek repeat use of emergency contraception.
Use of the method in this situation may actually serve as
an entry point for patients to obtain emergency contracep­
tion and to start a regular, reliable method.

In all of these circumstances-'the ethical course of
action is to use emergency contraception to prevent an
unplanned pregnancy rather than getting a pregnancy
terminated. It may be highly unethical to withhold the
benefits of a technology that is less dangerous than either

27

carrying an unwanted pregnancy to term or undergoing
an abortion. In addition, it is equally important to provide
to adolescents sex education and education about repro­
ductive physiology, contraceptive practices, and STDs
including AIDS.

partners, jointly with the four developing countries
(Kenya, Indonesia, Mexico and Sri Lanka), will design,
implement and evaluate introduction strategies, which
will then be replicated to other developing countries. The
introduction strategies will be tailored tp suit the repro­
ductive health needs of individual countries.

Consortium for Emergency Contraception

In addition to the efforts by the Consortium partners,
other international agencies have also initiated
programmes to bring emergency contraception into the
mainstream of reproductive health care. IPPF has issued
substantially liberalized guidelines designed to make
emergency contraceptive pills more easily accessible
through “the most practical delivery systems” and to
remove virtually all contraindications for their use35. The
Advisory Committee of the US Food and Drugs Admin­
istration has declared the Yuzpe method safe and effective
and urged its wider availability. This action should facilitate approval of a dedicated product in the USA, and may
be in other countries. National publicity campaigns have
been launched in many countries to educate women and
providers about emergency contraception.

A conference on emergency contraception held in
Bellagio in April 1995 highlighted the facts that the use
of available methods of emergency contraception can
help avert an unwanted pregnancy and consequently an
induced abortion34. The participants also emphasized that
this potential of emergency contraceptives has not been
exploited to the full advantage of the women and, there­
fore, recommended that the government and the NGOs
should ensure that women everywhere have access to
these safe and effective ways to prevent unwanted preg­
nancy. The participants called upon family planning
providers to include emergency contraception in all fam­
ily planning programmes and on all national essential
drug lists, a recommendation which was acted upon by
the WHO Expert Committee on the use of Essential
Drugs, within a few months of the meeting.
In response to the need for increased access to emer­
gency contraception, seven international agencies, com­
mitted to expand the availability of all safe and effective
methods of fertility regulation including emergency con­
traception, formed a Consortium35. These organizations
are the Concept Foundation, IPPF, the Pacific Institute
for Women’s Health, Pathfinder International,.the Popu­
lation Council, the Programme for Appropriate Technol­
ogy in Health; and WHO. The Consortium’s goal is to
identify, through model introductions and operation re­
search, the specific “best practices” needed to broaden
access to hormonal emergency contraceptives while en­
suring their safe and appropriate use. The Consortium's
proposed five-year programme of work comprises
(i) Establishment of partnership with private industry to
market a product for use for emergency contraception and
to publicize the product and create awareness among the
potential users. The Consortium has decided to promote
the use of progestogen-only pill (two tablets containing
0.75 mg each of levonorgestrel) as its use may have fewer
side effects as compared to the estrogen-progestin com­
bination pills, (ii) Introduction of emergency contracep­
tion in the developing countries. Initially the Consortium

28

The scope for introducing emergency contraception
in India is wide. Steps need to be taken to remove the
barriers to the introduction and use of emergency contra­
ception. Strategies need to be formulated which can cre­
ate awareness about the methods and expand availability.
An assessment of potential users information and service
needs, regulatory requirements, and service delivery ca­
pabilities can provide useful information about the need
for emergency contraception as well as help guide the
development of an introductory plan.
Conclusions

Emergency contraceptives are methods that can be
used to prevent pregnancy following unprotected act of
sexual intercourse. The two methods which are currently
available in many countries are steroid hormone pills^nd
copper-releasing intrauterine devices (Cu-IUDs). Among
the steroidal methods estrogen-progestogen combination
(Yuzpe regimen) and progestogen-only pills are safe and
effective as only about 2 per cent of the women who take
these pills within 72 hours of the unprotected intercourse
get pregnant. The use of Cu-IUDs offers a more effective
method of preventing pregnancy in comparison to the use
of hormonal methods, and the device can be inserted up
to 120 hours after the unprotected sex. This method is

particularly usefill for women seeking long-lasting con­
traceptive protection. Despite the facts that emergency
contraceptives are safe and effective to prevent substan­
tial number of unwanted pregnancies, their use has been
restricted due to the non-availability of registered prod­
ucts for emergency contraception, lack of awareness
among women and health care providers that contracep­
tion following intercourse is feasible, and service-related
factors. Family planning and reproductive health care
providers should make emergency contraception a part of
the reproductive health care package and make it more
widely available. In addition, community and religious
leaders, policy-makers and programme managers,
women’s health advocates, and the public at large should
be apprised that emergency contraception is not an abor­
tion,. and its use is not meant to promote irresponsibility
and a promiscuous life-style particularly among adoles­
cents but instead is a method to reduce the chances of
unintended pregnancies and consequently induced abor­
tions. It must also be emphasized that emergency con­
traception should be reserved for emergency situations
only and not to be used as a substitute for regular con­
traception. Better awareness about contraceptives in­
cluding emergency contraceptives and their appropriate
usage should help prevent the need for abortion. Further
research also needs to be done to develop more effective
methods, as well as on innovative service delivery ap­
proaches.

Diczfalusy and M. Bygdeman. Serono Publications, Raven
Press, New York, 36:29, 1987.

7.

Yuzpe, A.A. Emergency postcoital contraception. In: Post-Co­
ital, Once-a-Month and Menses-Inducing Agents in the Control
ofFemale Fertility. Proceedings of Joint ICMR-WHO Sympo­
sium held at Bangalore. Eds. B.N. Saxena, S. Mokkapati and
G.S. Toteja. Indian Council of Medical Research, New Delhi,
p. 149, 1985.

8.

Van Look, P.F.A. and von Hertzen, H. Emergency contracep­
tion. Br Med Bull 49: 158,1993

9.

Trussell, J. and Stewart, F. The effectiveness of postcoital
hormonal contraception. Fam Plann Perspect 24:262,1992.

10.

Sanchez-Borrego, R. and Balasch, J. Ethinyl estradiol plus dlnorgestrel or levonorgestrel in the Yuzpe method for postcoital
contraception: Results of an observational study. Hum Reprod
27:2449,1996.

11.

Van Look, P.F.A. and Buckshee, K. Barriers to the use of
emergency contraception. In: Emergency Contraception. Eds:
C.P. Puri and P.F.A. Van Look. The Federation of Obstetrics
and Gynaecological Societies of India, Mumbai, p 14, 1996.

12.

von Hertzen, H. and Van Look, P.F.A. Research on new meth­
ods of emergency contraception. Int Fam Plann Perspect 22:
62,1996.

13.

Hoffmann, K.O.K. Postcoital contraception: Experiences with
ethinyl estradiol/norgestrel and levonorgestrel only. In: Fertil­
ity and Sterility. Eds. R.F. Harrison, J. Bonnar and W.
Thompson. MTP Press, Lancaster, U.K. p 311, 1984.

14.

Ho, P.C. and Kwan, M.S.W. A prospective randomized com­
parison of levonorgestrel with the Yuzpe regimen in postcoital
contraception. Hum Reprod 8: 389, 1993.

15.

Lippes, J., Malik, T. and Tatum, H.J. Tire postcoital copper-T.
Adv Plann Parenth 11:24,1976.

16.

van Santen, M.R. What is the role of the IUD in emergency
contraception? In: Fertility Control Reviews. Ed. S.R. Killick
4(2): 20, 1995.

17.

Puri, C.P. Antiprogestins: Useful investigative tools and novel
contraceptives. Curr Sci 68:40H, 1995.

18.

Puri, C.P. and Van Look, P.F.A. Editorial. In: Emergency Con­
traception. Eds: C.P. Puri and P.F.A. Van Look. The Federation
of Obstetrics and Gynaecological Societies of India, Mumbai.
p2, 1996.

Puri, C.P. and Van Look, P.F.A. Newly developed competitive
progesterone antagonists for fertility control. Front Harm Res
19:127,1991.

19.

Senanayake, P. Emergency contraception: The International
Planned Parenthood Federation’s experience. Int Fam Plann
Perspect 22: 69, 1996.

Gemzell-Danielsson, K., Swahn, M.L., Svalander, P. and
Bygdeman, M. Early luteal phase treatment with mifepristone
(RU 486) for fertility regulation. Hum Reprod 8: 870, 1993.

20.

Shah, R. and Puri, C.P. Available methods of emergency con­
traception. In: Emergency Contraception. Eds: C.P. Puri and
P.F.A. Van Look. The Federation of Obstetrics and
Gynaecological Societies of India, Mumbai, p 5,1996.

Glasier, A., Thong, K.J., Dewar, M., Mackie, M. and Baird,
D.T. Mifepristone (RU 486) compared with high dose estrogen
and progestogen for emergency postcoital contraception. N Eng
J Med 327: 1041, 1992.

21.

5.

Haspels, A.A. Emergency contraception: A review. Contracep­
tion 50: 101,1994.

Webb, A.M.C., Russell, J. and Elstein, M. Comparison of
Yuzpe regimen, danazol and mifepristone (RU 486) in oral
postcoital contraception. BrMedJ 305: 927, 1992.

22.

6.

Van Look, P.F.A. Postcoital contraception: A cover-up story.
In: Fertility Regulation Today and Tomorrow. Eds. E.

von Hertzen, H. Emergency contraception: Potential future
methods. In: Emergency Contraception. Eds: C.P. Puri and
P.F.A. Van Look. The Federation of Obstetrics and
Gynaecological Societies of India, Mumbai, p 8,1996.

References
1.

2.

3.

4.

Fathalla, M.F. Reproductive health in the world: Two decades
of progress and the challenge ahead, hi: Reproductive Health:
A Key to a Brighter Future. Eds. J. Khanna, P.F.A. Van Look
and P.D. Griffin. World Health Organization, Geneva, p 3,
1995.

29
LIBRARY
> oA
P<
ANO
>H
"
documentation
f

o

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Zuliani, G., Colombo, U.F. and Molla, R. Hormonal postcoital
contraception with an ethinyl estradiol-norgestrel combination
and two danazol regimens. Eur J Obstet Gynecol Reprod Biol
37:253, 1990.

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Weisberg, E., Fraser, LS., Carrick, S.E. and Wilde, F.M.
Emergency contraception. General practitioner knowledge, atti­
tudes and practices in New South Wales. Med J Aust 162: 136,
1995.

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The World’s Youth 1994. Population Reference Burea, Wash­
ington, D.C., USA, 1994.

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India: Women and Children in Focus. Data from the National
Family Health Survey, 1992-1993. International Institute for
Population Sciences, Deonar, Mumbai, 1996

Using emergency contraceptive pills (ECPs}-A prototype ECP
training curriculum. In: Consortium for Emergency Contracep­
tion. Consortium Coordinator. S.L. Camp, Welcome, MD,
USA. 1996.

33.

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Pearson, V.A.H., Owen, M.R., Phillips, D.R., Pereira Gray,
D.J. and Marshal, M.N. Pregnant teenager’s knowledge and
use of emergency contraception. BrMedJ 310: 1644, 1995.

Joshi, J. Legal ethical and regulatory aspects in introduction of
emergency contraception In: Emergency Contraception. Eds:
C.P. Puri and P.F.A. Van Look. The Federation of Obstetrics
and Gynaecological Societies of India, Mumbai, p 15,1996.

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Anonymous. Teenagers swap pill for condom. J R Soc Health
115:140,1995.

34.

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Bhatt, R.V. Role of family planners and service providers in
emergency contraception. In: Emergency Contraception. Eds:
C.P. Puri and P.F.A. Van Look. The Federation of Obstetrics
and Gynaecological Societies of India, Mumbai, p 12,1996.

South to south cooperation in reproductive health. Consensus
statement on emergency contraception. Contraception 52: 211,
1995.

35.

Van Look, P.F.A- Making emergency contraception more
widely known and available: Rising international interest. In:
Emergency Contraception. Eds: C.P. Puri and P.F.A. Van
Look. The Federation of Obstetrics and Gynaecological Societ­
ies of India, Mumbai, p 17, 1996.

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Young, L., McCowan, L.M., Roberts, H.E. and Farquhar, C.M.
Emergency contraception-why women do not use it? N Z Med J
108: 145, 1995.

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Harper, C.C. and Ellertson, C.E. The emergency contraceptive
pill: A survey of knowledge and attitudes among students at
Princeton University. Am J Obstet Gynecol 173: 1438, 1995.

This article has been contributed by Dr. Chander P. Puri.
Deputy Director, Institute for Research in Reproduction,
Mumbai.

ABSTRACTS
Some Research Projects Completed Recently
Response of sarcoma-180 to Plumbago rosea
(chitraka), radiation and hyperthermia

Tumour growth inhibiting and radiosensitizing ef­
fects of the alcoholic root extract of Plumbago rosea,
gamma radiation and hyperthermia were studied in
experimental tumours in mice. Response to treatment
was assessed on the basis of tumour regression, volume
doubling time, growth delay and tumour free survival.
Sarcoma-180 tumours were produced in Balb/c mice by
intradermal injection of 5x105 viable sarcoma-180 cells.
Ehrlich ascites carcinomas were propagated by
intraperitpneal injection of tumour cells into young adult
Swiss albino mice.

The alcoholic root extract of P. rosea was effective
in inhibiting exponentially growing sarcoma-180 solid
tumours. A dose of 75 mg/kg intraperitoneally for 10
days was found to be safe and effective in increasing
tumour cure and growth delay. Plumbago extract (75
mg/kg) had an additive effect with hyperthermia (43° C
for 30 min) but a subadditive effect with gamma radia­
tion (10 Gy) in effecting tumour cure and long-term
survival of mice bearing sarcoma-180. Tumour cure and
30

volume doubling time and growth delay of partially
responding tumours significantly increased after com­
bined treatment of the extract, radiation and hyperthermia
above that produced by bimodality treatments.

Even where the extract individually was not very
effective as an antitumour agent, it acted as a good
radiosensitizer increasing the radiosensitivity of Ehrlich
ascites carcinomas. It produced a synergistic effect in
increasing the tumour inhibition and animal survival
from 10 to 50 per cent. The active component plumbagin,
a napthoquinone derivative from P. rosea was effective
in inhibiting the growth of Ehrlich ascites carcinoma in
mice and this effect could be enhanced by combining the
drug with radiation. A total dose of 9 mg/kg, given in
3 fractions of 3 mg/kg each, was found to be optimum
for plumbagin when used alone or as an adjuvant to
radiotherapy. Plumbagin in combination with radiation
(7.5 Gy) significantly increased the induction of micro­
nuclei in Ehrlich ascites tumour cells in vivo as com­
pared to that induced by single modality treatments. The
bimodality treatment produced synergistic increase in
micronuclei count at all time points studied (24 to 72h).

Plumbagin treatment resulted in an immediate increase
in the S-phase population of cells. Combination of
plumbagin with radiation induced reproductive death of
proliferating cells and G2-M block. The increase in
micronuclei from 24 to 72 h after combination treatment
probably reflected the delayed expression of the cyto­
genetic damage when the affected cells enter division
after G2-M block. This could contribute to the higher
tumour response and tumour free survival after combi­
nation treatment as compared to individual modality
treatments.

The study thus indicated that P rosea could be a
promising drug for human cancer therapy, it has a
remarkable radiosensitising effect and requires detailed
investigation.
F. Emerson Soloman
P. Uma Devi
Department of Radiobiology
Kasturba Medical College, Manipal
Publication
Uma Devi, P., Soloman F.E. and Sharada AC. In vivo tumour
inhibitory and radiosensitizing effects of an Indian medicinal plant,
Plumbago rosea on experimental mouse tumours. Indian J Exp
Biol 32: 523, 1994.

Flow cytometry in archival tumour material

DNA contents and cell cycle distribution were
measured in 27 routinely processed paraffin embedded
biopsy specimens of prostatic adenocarcinoma and 18
of breast carcinoma using DNA flow cytometry. The
analysis of proliferative activity, which is defined as
flow cytometric S and G2-M fractions was also carried
out to determine whether these have any independent
prognostic value or not.

Twelve of the 27 (44.4%) prostatic carcinoma and
6 of the .18 (33.3%) breast carcinoma specimens yielded
>105 cell/mni3 which were processed further for analysis
of S phase fraction (SPF) and G2-M phase fraction.

SPF was found to be between 19 and 36 per cent
in prostatic carcinoma specimens (the mean being
28.9%). Near diploid tumours had significantly higher
SPF compared to hyper-and hypo-diploid tumours.
Hypo-diploid tumours had higher G2-M fractions com­
pared to near diploid and hyper-diploid tumours. Near
diploid tumours had a higher mean S+G2-M fractions
compared to hypo- and hyper-diploid tumours. There
was a significant difference between the mean values
obtained for SPF when grade III and IV prostatic tumours
were compared. All the 6 breast carcinomas were grade
III tumours and near diploid breast carcinoma tumours
had a significantly higher mean S+G2-M fraction com­
pared to hypo-diploid tumours.
The ploidy status, SPF and S+G2-M were found to
be associated with reevaluated histological grade of
tumours. The ploidy, proliferating fractions and histo­
logical grade had individual prognostic significance. It
is concluded that there was a direct correlation between
the incidence of aneuploidy (hyperploidy) in prostatic
adenocarcinomas and Gleasons's grade. The high pro­
liferative activity was an independent predictor of high
histological grading in prostatic carcinomas. There was
no correlation between the ploidy status and histological
grade of breast carcinoma.

T.M. Valarmathi
M. Madhavan
Department of Pathology,
Dr. A.L. Mudaliar Postgraduate Institute
of Basic Medical Sciences, Chennai

ICMR NEWS
The following meetings of various technical committees/groups of the Council were held :
Meetings of the Scientific Advisory Group (SAG)/
Task Forces (TFs) held at New Delhi:

SAG of the Division, of NonCommunicable Diseases

February 26, 1997

TF on Epidemiological Study of
Child and Adolescent Psycholo­
gical / Psychiatric Disorders in
Rural and Urban Areas

March 13-14, 1997

TF on Collaborative Study on
Prevalence of RTII STD (Hos­
pital based)

March 13-14, 1997

Meetings of the Project Review Group (PRG)ZExpert
Committee:
PRG of District Nutrition Pro- February 22-23, 1997
ject for Prevention and Control
(at Allahabad)
of Micronutrients Deficiency
Disorders
31

Expert Committee on Pan
Masala

February 24, 1997
(at New Delhi)

Participation of ICMR Scientists in Scientific Events:
Dr. V.P. Sharma, Director, Malaria Research Centre,
Delhi, participated w the XXXVII Executive Committee
Meeting of the Scientific Committee on Problems of the
Environment (SCCPE) at London (February 19-21,
1997).
Dr. Kalyan Banerjee, Director, National Institute of
Virology, Pune, participated in the International Confer­
ence on Emerging Infectious Diseases in the Pacific Rim
at Bangkok (March 6-8, 1997).

Dr. B.N. Saxena, Additional Director-General,
ICMR, participated, in the International Symposium on
Post-coital and Post-ovulatory Contraception at
Budapest (March 6-7, 1997). He also participated in a
Symposium on Safe Motherhood in India at Stockholm
(March 8-9, 1997).

Appointments :
Dr. P.K. Das took over as Director of the Vector
Control Research Centre, Pondicherry w.e.f. February
13, 1997.
Dr. H.N. Saiyed took over as Director of the National
Institute of Occupational Health, Ahmedabad w.e.f. Feb­
ruary 13, 1997.

ICMR AIDED SYMPOSIA/SEMINARS/WORKSHOPS/COURSES/CONFERENCES
Symposium/Seminar/Workshop/
Course/Conference

Date & Place

Contact Address

Symposium on Current Trends in Research on Drugs of
Herbal and Marine Origin

March 2, 1997;
(at Gandhinagar)

Prof. N.S. Parmar, Principal and Professor of
Pharmacology, K.B. Institute of Pharmaceutical
Education and Research, Gandhinagar-382023.

International Seminar on Frontiers in Surgical Pathology

March 3-5, 1997;
(at Chennai)

Dr. Malathy Madhavan, Professor and Head, Dep­
artment of Pathology, Dr. A.L. Mudaliar P.G.
Institute of Basic Medical Sciences, Chennai600113.

International Seminar on Psycho-social Issues in Health
Care with Special Emphasis on Psycho-social Oncology

March 6-8, 1997;
(at Thiruvanantapuram)

Dr. P.T. Latha, Organising Secretary of the Semi­
nar, Regional Cancer Centre, Thiruvanantapuram695011.

COUNCIL’S TRAINING PROGRAMMES FOR 1997-98
Leprosy

•

At the Central JALMA Institute for Leprosy, Agra:

•

Training Course on National Leprosy Eradication
Programme for Medical Officers (February 24March 7 and September 15-26, 1997).

Virology

Endocrinology

At the National Institute of Nutrition, Hyderabad:
•

At the National Institute of Virology, Pune:

•

Workshop on Basic Molecular Biology for Clini­
cians (December 2-11, 1997).

Annual Certificate Course on Endocrinological Tech­
niques and their Applications (August 1-September
15, 1997).

Diploma in Medical Virology (July 1997-May 1998).
Nutrition

Reproductive Biology

At the Institutefor Research in Reproduction, Mumbai:

•

Training Course on Research Methods in Clinical
Trials ofNewer Contraceptives (April 14-25,1997).

•

Workshop on Genotoxicity (August 28-29, 1997).

32

At the National Institute of Nutrition, Hyderabad:

•

M.Sc. in Applied Nutrition (June 1, 1997-February
28, 1998).

•

Postgraduate Certificate Course in Nutrition (De­
cember 1, 1997-February 28, 1998).

Laboratory Animal Technology

•

Training Course in Blood Group Serology and Blood
Bank Methodology for Blood Bank Technicians
(August 27-September 26, 1997).
Training Course in Advanced Haematology and
Immunohaematology (October 6-24, 1997).

At the National Centre for Laboratory Animal Science,
National Institute of Nutrition, Hyderabad:
•

Training Course for Laboratory Animal Technicians
(June 16-July 31, 1997).

•

•

Training Course for. Laboratory Animal Supervisors
(September 1-November 29, 1997).

Occupational Health
At the National Institute of Occupational Health,
Ahmedabad:

Haematology

•

Orientation Course on Occupational Health for In­
dustrial Medical Officers (September 30-October
11, 1997).

•

Training Course on Environmental Hygiene Practice
(November 10-14, 1997).

At the Institute of Immunohaematology, Mumbai:

•

Training Course in Transfusion Medicine for Blood
Bank Medical Officers (August 27-October 24,
1997).

ICMR PUBLICATIONS
Price (Rs.)
Nutritive Value of Indian Foods (1985), by C. Gopalan, B.V. Ramasastri and
S.C. Balasubramaniam, Revised and Updated (1989), by B.S. Narasinga Rao, K.C. Pant
and Y.G. Deosthale (Reprinted 1995)

23.00

Growth & Physical Development of Indian Infants and Children (1972, Reprinted 1989)

10.00

Studies on Weaning & Supplementary Foods (1974, Reprinted 1996)

15.00

Studies on Pre-School Children (1974, Reprinted 1984)

6.00

A Manual of Nutrition (Second Edition 1974, Reprinted 1995)

6.00

Low Cost Nutritious Supplements (Second Edition 1975, Reprinted 1994)

4.00

Menus for Low-Cost Balanced Diets and School Lunch Programmes Suitable for
North India (Second Edition 1977, Reprinted 1994)

4.50

Menus for Low-Cost Balanced Diets and School Lunch Programmes Suitable for
South India (Fourth Edition 1996)

6.00

Some Common Indian Recipes and their Nutritive Value (Fourth Edition 1977,
Reprinted 1995) by Swaran Pasricha & L.M. Rebello

10.00

Nutrition for Mother & Child (Third Edition 1978, Reprinted 1994) by P.S.
Venkatachalam & L.M. Rebello

9.00

Japanese Encephalitis in India (Revised Edition 1980)

5.00

Some Therapeutic Diets (Fourth Edition 1988, Reprinted 1995) by Swaran Pasricha

4.50

Nutrient Requirements & Recommended Dietary Allowances for
Indians (1990, Reprinted 1995)

16.00

Fruits (Second Edition 1996) by Indira Gopalan & M. Mohan Ram

20.00
33

Count What You Eat (1989, Reprinted 1994) by Swaran Pasricha

9.00

Diet & Diabetes (Second Edition 1993) by T.C. Raghuram, Swaran Pasricha & R.D. Sharma

18.00

Dietary Tips for the Elderly (1992) by Swaran Pasricha & B.V.S. Thimmayamma

3.50

Diet and Heart Disease (1994, Reprinted 1996) by Ghafborunissa and Kamala Krishnaswamy

26.00

Depressive Disease (1986) by A. Venkoba Rao

58.00

‘Medicinal Plants of India Vol.2 (1987)

136.00

*25 per cent discount allowed to individuals.
These publications are available on prepayment of cost by cheque, bank draft or postal order (bank and postal charges
will be extra) in favour of the Director-General, Indian Council of Medical Research, New Delhi. Money orders are not
acceptable. All correspondence in this regard should be addressed to the Chief, Division of Publication and Information,
Indian Council of Medical Research, Post Box No.4911, Ansari Nagar, New Delhi-110029 (India).

INDIAN COUNCIL OF MEDICAL RESEARCH

Grant-in-aid for organising Seminars/Symposia/Workshops
The Council provides partial financial assistance for organising Seminars/Symposia/Workshops.
Applications for grant of financial assistance (complete in all respects in the prescribed proforma),
will be considered only if furnished at least four months before the date,of commencement of
the Seminar/Symposium/Workshop, etc.

EDITORIAL BOARD
Dr. G.V. Satyavati

...

Chairperson

Dr. Badri N. Saxena

...

Member

Dr. Bela Shah

...

Member

Dr. N. Medappa

...

Editor

Printed and Published by Shri J.N. Mathur for the Indian Council of Medical Research, New Delhi
at the ICMR Offset Press, New Delhi-110029

R.N. 21813/71

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