In Case of Emergency, Maximise Profits

Flicking through articles on the BBC website, I was struck by an article about a type of emergency contraception called the E-pill, currently being marketed in Kenya. Not that it’s strange that emergency contraception should be marketed in Kenya, just that it is being marketed by Population Services International (PSI). They receive tens of millions of dollars in donor funding every year to promote safe sex so that people can protect themselves from unplanned pregnancies and sexually transmitted infections (STI), including HIV.

Emergency contraception is taken by people who haven’t used planned contraception or for whom that contraception has failed. What I find odd is that PSI should market this product without also pointing out the things that the E-pill does not protect you from. Surely this organisation is supposed to be marketing methods, not products? Is it naïve to expect them to be more concerned about broad outcomes rather than narrow indicators? These E-pills are likely to appeal to those who don’t use condoms, the very people who need to recognise the dangers of unprotected sex aside from unplanned pregnancy.

The director of PSI who is interviewed is right in pointing out that marketing contraceptive products to people does not necessarily result in them having sex, having more sex, starting to have sex earlier or having more risky forms of sex. But it is a struggle to promote safe sex as a way of avoiding several inherent dangers that sexually active people face, pregnancy being just one of them.

If young people are being exposed to STIs and HIV, unplanned pregnancy may even be the least of their worries. In fact, people who become pregnant and contract HIV at the same time will probably have their HIV status diagnosed as soon as they attend an antenatal clinic. If they don’t get pregnant, their HIV status may not be diagnosed until they eventually do get pregnant or until they become very ill. At this stage, they will probably have transmitted HIV and other STIs to other people.

One of the problems with marketing a single-issue programme as a means of protecting against HIV, such as male circumcision, is that it ignores the issue of pregnancy and, indeed, several STIs that are not prevented by it. It is senseless to sell safe sex as a means of avoiding just unplanned pregnancy or just STI or HIV infection. Family planning and safe sex marketing must involve all the issues. And PSI is supposed to be concerned with all the issues, not just one at a time.

One of the oddest aspects of this story is that it is not even permitted under Kenyan law to advertise emergency contraceptives in the first place. But because PSI is American and funded by donor funding, the whole thing is ok as far as the Kenyan government is concerned.

I agree that emergency contraception is, as claimed, preferable to botched abortions. It is preferable to unplanned pregnancies. But I think emergency contraception could appeal to the very people that PSI should be targeting: people who don’t want to use planned contraceptive methods, such as condoms.

PSI talks of making ‘the markets work for the poor’ in its mission statement and lists one of its core values as ‘[t]he power of markets and market mechanisms to contribute to sustained improvements in the lives of the poor’. Perhaps the organisation is a little too market driven to claim truly to be working for the benefits of poor people. It seems to me that the markets are working for PSI very well, thank you very much.