Is overpromotion of emergency contraceptives misdirecting youth away from condom culture?

Sir, News papers, magazines or electronic media, now-adays we see almost everywhere the advertisements of emergency contraceptives. Among the general public, these emergency contraceptive pills are promoted as the remedy to the tension of pregnancy if sexual exposure was unprotected. Although the intention of the drug companies and government agencies may be right and justified, but unrestricted access to emergency contraception in advance may act as a psychological pull for youngsters to have sexual contact without employing the usual contraceptive measures.


Is overpromotion
of emergency contraceptives misdirecting youth away from condom culture?
Sir, News papers, magazines or electronic media, now-adays we see almost everywhere the advertisements of emergency contraceptives. Among the general public, these emergency contraceptive pills are promoted as the remedy to the tension of pregnancy if sexual exposure was unprotected. Although the intention of the drug companies and government agencies may be right and justified, but unrestricted access to emergency contraception in advance may act as a psychological pull for youngsters to have sexual contact without employing the usual contraceptive measures.
We performed a simple questionnaire-based analysis of 250 sexually active males, aged 21-35 years, for 6 months, from September 2008 to March 2009, in Mangalore city. The main reason to have only the male group in our study is that our society is mainly male dominant and that they still have the upper hand during intercourse over their female better-half. We found that the most common mode of contraceptive measure was condom followed by coitus interruptus. During the last 6 months of their sexual life, they had used emergency contraceptive pills on an average of eight times per male. But, in only 1.2 times per male, these pills were actually used after a forgotten unprotected intercourse and during the remainder of the times, they had convinced their partner to use emergency contraceptive pills later and intentionally had sex without any protection. The most common reason advocated for unprotected intercourse was to have complete and uninterventional sexual pleasure. Surprisingly, we found that not every time our study group males had to convince their partner for emergency contraceptive pills later. On an average of three times per male during 6 months, their female partner volunteered to have unprotected intercourse. In our study, 76 males had multiple sex partners and 29 males had visited professional sex workers. One hundred and forty-three males were concerned of only their sexual pleasure and were not much aware of possible sexually transmitted diseases that can occur during unprotected intercourse, especially among the high-risk males like multiple sex partners and those visiting professional sex workers.
Among the 208 males who have made their partner use the emergency contraceptive pills, it was found that they were keen to use this contraceptive measure routinely irrespective of knowing the fact that it is an emergency pill and not a regular one. Weaver et al. [1] also concluded that with an unrestricted access of these pills, some women may substitute emergency contraception for their usual contraceptive methods. We have not measured the contraceptive failure rate as it was not the objective of our study.
Increased access to emergency contraceptive pills has surely enhanced its use, but the existing literature is unable to justify and also creates confusion regarding the usefulness of these emergency contraceptive pills in reducing the unintended pregnancy rates. [2][3][4] We still do not have evidence-based research of a possible increased rate of sexually transmitted diseases like human immunodeficiency virus, hepatitis B and many more diseases with the overuse of emergency contraceptives. [5] Further research is needed to explain this finding and to define the best ways to use emergency contraception to produce a public health benefit.

Control of STIs and HIV: The male reproductive and sexual health context -The paradigms
Sir, The concern about male reproductive and sexual health and, concomitantly, the health of their sexual partners is set in the context of rapid spread of human immunodeficiency virus (HIV) and increasing rate of sexually transmitted infections (STIs) in India. In the context of HIV prevention, a reduction in the prevalence of other STIs can help in decreasing the rate of transmission of HIV.
In the present scenario, men, in general, do not feel comfortable seeking services from family planning clinics and young people, in particular, often feel embarrassed. [1] Men's reproductive health needs include a wide range of services such as family planning, treatment and prevention of STI/HIV, infertility, sexual problems and others. Men need clinics and staff that provide confidential and non-judgmental care. [2] Also, to increase the male participation in reproductive and sexual health, the primary focus should be on strategies to "encourage and enable men to take responsibility for their sexual and reproductive behavior and their social and familial roles." The time is now ripe to determine and address men's sexual health needs if they are expected to participate fully as responsible partners in improving and protecting their own and their partner's sexual and reproductive health. [3] Under the Research and Intervention in Sexual Health: Theory to Action (RISHTA) project at the International Institute for Population Sciences, a male health clinic was established in one of the three experimental communities. RISHTA interventions successfully demonstrated the strategies of effective community health education programmes and also the efficacy of engaging Ayurveda, Unani, Siddha , Homeopathy and Allopathic providers in HIV/STI risk reduction among men. [4] PROFAMILIA in Colombia offers men their own all-male clinic located in a different building from the regular clinics, and also has found the number of male clients increasing at its regular clinics when staffs are trained to be sensitive to men's unique needs. [1] In rural Bangladesh, reproductive health services for men were successfully integrated into formerly female-focused services without compromising the quality of care. The addition of services for men increased utilization of clinical services by both men and women. [5] The Talking about Reproductive and Sexual Health Issues telephone helpline based in New Delhi receives the majority of its calls from young men. On subsequent calls, male clients reported delaying penetrative sex, masturbating instead of visiting a commercial sex worker and adopting other less risky sexual practice. [1] The choice of the paradigm in a community will depend on the pattern of utilization of health services by males, type of services already existing and the resources available. The exclusive male health clinic model poses a challenge of intensive resource requirement for establishment and maintenance. Being in the era of integrated health programmes, a similar model shall thus be a practicable choice.