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This telegram will arrive tomorrow

Malcolm Potts, professor of population and family planning | September 29, 2013

The Poverty and Population class I co-teach emphasizes the many unnecessary and unjustified barriers that prevent women having access to the contraceptives they need.  Sometimes overcoming these barriers needs courage.

In 1974 had the privilege of working with my Thai friend Mechai Viravaidya to launch a community-based distribution of oral contraceptives and condoms. We were in Bang Lamung District, a rural area two-hour’s drive south of Bangkok. We had assembled 20 to 30 village volunteers, including schoolteachers, shopkeepers, and other local entrepreneurs. The plan was to train these family planning providers how to sell  condoms and pills, the latter for about $0 .25 a pack. The district health officer for Bang Lamung,  Dr Kom Pongkham, supported the plan. However, the day the training was scheduled  to begin, a telegram arrived from the Ministry of Public Health ordering Dr Kom to cease and desist helping Mr Mechia and Dr Potts, because it was illegal for volunteers to distribute oral contraceptives without a physician’s prescription..

Dr. Kom decided that the training should proceed saying, “In this part of Thailand telegrams can take several days to arrive. Perhaps this one will arrive tomorrow.”

The community-based distribution went ahead and it was an immediate success. Women and men could purchase contraceptives from people they knew and trusted. At that time I was the Medical Director of the International Planned Parenthood Federation in London. Working together, Mechai and I succeed in getting $250,000 to enlarged the program and in four years it reached 16, 00 villages. The Ministry of Public Health dropped its insistence on a physician’s prescription to provide the Pill and added an even larger community based distribution program of its own.

If Dr Kom had not had the courage to say the telegram would arrive the next day, oral contraceptives would have remained inaccessible to village women for several more years. Even today, in Uganda, the Pill remains notionally on prescription. Of course, any rich Ugandan women can buy oral contraceptives from any pharmacy but access for poor women remains unnecessarily restricted.

In the 1960s Thai women averaged over 7 children and the population was growing by 3.3% of year.  If such a rate – doubling every 21 years – had continued then Thailand would be a much poorer, less educated and probably more conflict ridden and much less democratic country than it is today. Fortunately, the rate of population growth was halved soon after family planning was taken into the villages. Within a decade of starting the village program 65% of eligible couples in Thailand were using some method of contraception.

Thank you Dr Kom Pogkham for ensuring that telegram took a day longer to arrive.