In July last year, Tamil Nadu’s Health Minister Ma Subramanian claimed that Emergency Contraceptive Pills (ECPs) were available to the public, free of cost, at government hospitals. TNM decided to fact-check this claim and filed an RTI in September, seeking details about the availability of ECPs at public healthcare facilities in Tamil Nadu.
We received 45 responses from government general hospitals such as the Government Rajaji hospital, Madurai; speciality and multispeciality hospitals such as Omandurar and Institute of Thoracic Medicine; medical college hospitals such as Stanley Medical College Hospital, Villupuram Medical College Hospital; the Department of Health and Family Welfare, and the Drug Controller division among others. While multi-speciality and specialised hospitals dismissed the question of ECP availability as “non-applicable,” some government medical college hospitals claimed that they provided ECPs with a prescription. The responses that we received from Chennai’s healthcare facilities and the Directorate of Health and Family Welfare were contradictory and confusing.
Between December 19 and 22, TNM visited five government hospitals in Chennai seeking ECPs. Without disclosing that we were reporters, we visited some of the biggest public healthcare facilities and tried to corroborate their RTI responses with the ground realities.
The Rajiv Gandhi Government General Hospital (RGGGH), one of the city's biggest public healthcare facilities, did not even reply to our RTI query. TNM’s reporters visited the facility where a doctor simply dismissed us. “You will not be able to find ECPs in the pharmacies here because there is no gynaecology department. Go to the Institute of Obstetrics and Gynaecology in Egmore,” she said. The fact that a hospital of RGGGH’s stature neither has a gynaecology wing nor stocks ECPs despite the pills being listed in the National List of Essential Medicines (NLEM), is baffling. According to the NLEM, levonorgestrel contraceptive pills are supposed to be stocked in all primary, secondary and tertiary health centres. Levonorgestrel is the active pharmaceutical ingredient and is a synthetic progesterone known as progestin. Most ECPs available in India including those supplied by the Union government are levonorgestrel-based.
TNM’s next stop was the Institute of Obstetrics and Gynaecology, which had previously responded to TNM’s RTI query saying that the hospital “does not provide ECPs for public purchase.” At the hospital, the reporters had to shuttle between multiple buildings for 30 minutes after which we were instructed to try the outpatient (OP) ward of the Family Planning Department. But as OP hours (between 8 am and 12 noon) had ended, we were told to visit the next day. It’s to be noted that ECPs are effective only if they are taken within a window of 48 to 72 hours after having sex.
The following morning, the supervisor outside the Family Planning OP inquired about the reporters’ marital status. Upon learning that we were unmarried, she said, “I don’t think you can get it here, but you can try.” The supervisor then directed the reporters to a nurse, who wanted to know if the reporters wanted to go for an abortion. After TNM’s reporters explained that ECPs were not abortion pills, the nurse who was visibly uncomfortable told the reporters to approach the senior doctors. Inside the room, three senior women doctors were equally taken aback after learning that the reporters were seeking ECPs as single women. One of them asked the other, “Enna ma’am ithu?” (what is this ma’am?) with an expression of disgust. She redirected the reporters back to the gynaecology OP and asked them to “try” to get a prescription. “You might get the pills at the pharmacy here [Family Planning Department] with that prescription,” she added. Even after this ordeal, the reporters were turned away empty-handed.
Located two kilometres away from the Institute of Obstetrics and Gynaecology is the Omandurar Multi Speciality Hospital in Chepauk. This sprawling facility also does not stock ECPs. The RTI response reads, “As there are no pertaining departments, ECPs are not available in this hospital’s pharmacy.” Similar to RGGGH, the reporters found that the Omandurar hospital's pharmacy, in line with their RTI response, does not have the pills considered ‘essential’ under the NELM.
From Chepauk, TNM reporters headed to North Chennai’s Stanley Government Medical Hospital, which caters mainly to densely populated areas such as Royapuram, Washermanpet, Vyasarpadi and Pulianthope. The RTI response from Stanley said that ECPs are not provided to the public. At the hospital, the reporters visited two of the pharmacies — the 24x7 general pharmacy and the pharmacy in the multi-speciality wing — but to no avail. A doctor advised the reporters to try in private pharmacies and insisted that ECPs would not be available at the gynaecology department either.
TNM visited the Government Kasturba Gandhi Hospital on December 22, which was one of the few government hospitals that claimed to have stocks of ECPs in their RTI response. However, it was not easy to access ECPs at this facility either. After repeatedly asking us about our marital status, making us shuttle between multiple departments and buildings, dehumanising us, and even handing us the wrong pills at one point, the reporters finally managed to obtain ECPs.
Meanwhile, the Department of Family Welfare claimed through an RTI that ECPs can be purchased by the general public from the drug warehouses in Tamil Nadu. However, when TNM approached the Tamil Nadu Medical Services Corporation Limited (TNMSC) District Drug Warehouse in Chennai’s Anna Nagar, the pharmacist pointed out that no individual can purchase or procure any drug from the warehouse even if they arrive with a prescription. Additionally, they said that they do not receive stocks of ECPs.
Speaking to TNM, the director of drugs control, Tamil Nadu, Vijaylakshmi, referred to the Drugs & Cosmetics Act, 1945, to say that ECPs in India are Schedule H drugs – meaning prescription only. While the Act doesn’t make a direct reference to ECPs, it does list all progesterone-based substances under Schedule H. But this doesn’t change the fact that ECPs are easily and widely available over-the-counter across the country. The unavailability of ECPs remains a problem peculiar to Tamil Nadu.
Vijaylakshmi said, “As long as you have a prescription, you should be able to get the pills in any pharmacy.” When TNM pointed out that our ground report in Chennai from July 2022, based on visits to 23 private pharmacies in the city had given contrary results, the director insisted that her department had sent repeated instructions to pharmacies to stock the pills and to provide them to anyone who approaches them with a prescription. Regarding the lack of ECP stocks in public healthcare facilities, she replied that the issue came under the purview of the Directorate of Public Health (DPH).
Selvavinayagam, the Director of Public Health, said that the matter had been escalated to the Drugs Control Department after TNM published a ground report from Kasturba Hospital on December 27, 2022. From public health facilities to officials, no one has been able to provide concrete answers regarding the difficulties in accessing ECPs.