Moving Over the Contraceptive

As the Indian woman becomes more aware and vocal about her health, are pharma companies gearing up to meet her aspirations? For instance, India’s OTC women’s health market has huge potential, but growth is slow as companies figure their way beyond the tried and tested, trying to win over women reluctant to voice their needs. Of late, a savvy few companies are breaking through into this under-served territory By Shalini Gupta

Even as the US debates the inclusion of the oral contraceptive pill as an Over The Counter (OTC) product, OTC products for women globally have taken a huge leap. Gone are the days when they began and ended with contraception. Today they span across menstrual cycle regulators, anti-fibronoytics, haematinics, anti-fungal, nutrition supplements etc. Women are getting more discerning and aware about their health needs. Companies too are not shy of expanding their offerings in this segment as they come up with newer products or even acquire another company to add value to their basket. Like Mylan Laboratories, which, recently signed a definitive agreement to acquire certain female health care businesses from Famy Care, a specialty women’s health-care company with global leadership in generic oral contraceptive products (OCPs) for $750 million in cash plus additional contingent payments of up to $50 million.

Huge potential, slow growth

However, the women’s health market in India is at a very nascent stage and captures 32 per cent (valued at $662 million) sales of the total Indian OTC market which is estimated at $2 billion, says Sangeeta Barde, Managing Partner, Sorento Health. She further adds that the market for prescription medicines for women stands at around Rs 5200 crores (AWACS Nov 2014) growing at a rate of nine per cent. This mainly comprises gynaecologicals, hormones and urology products used by women. Data from IMS Health pegs the market at Rs 4,927 crores as of MAT (Moving Annual Total) December 2014. Figures are in a flux since OTC as a category remains undefined and within that what constitutes women’s health is expanding as well, however, there is no denying that it is growing.

HLL Lifecare is credited with the launch of Saheli (Ormeloxifene), the world’s only non hormonal contraceptive pill (with one week dosage) which has been empowering Indian women for the past 25 years in taking the decision to space their family. The company also launched Novex DS (Ormeloxifene 60mg Tablets) an effective Dysfunctional Uterine Management pill with 90 per cent efficacy that occupies 70 per cent of the market share in its category. No wonder then that their women’s health division has registered a growth of 35 per cent over last year. The ethical subdivision of it consists of contraceptives viz., Oral Contraceptive Pills (OCPs), Intra Uterine Contraceptive Devices (IUCD), injectables contraceptives, emergency contraceptives and hormone releasing intra uterine systems like Emily. The other categories include, ovulation inducers, anti emetics, ante natal’s, menstrual cycle regulators, anti fibronoytics, MTP Pills, haematinics, anti spasmodic, anti fungal, DUB management pills, nutrition supplements, galactagogue, pregnancy test kits and sanitary napkins.

The institution business team of WHD focusses on the needs of State and Central Governments and has facilitated large scale supply of iron and folic acid tablets and sanitary napkins to Tamil Nadu, Karnataka, Maharashtra, AP, UP and Bihar to the tune of more than 300 million each. “Products which cater to everyday needs and are specifically positioned for women can drive significant volumes. Among women, decision of consuming supplements is need and evidence-based. Hence, creating awareness regarding preventive health and showcasing brand differentiation will create the desired impact,” chips in M Ayyyapan, Chairman and Managing Director, HLL.

The past few few years have seen several brands catering to women’s health rise to the top. “Revital Woman, Calcium Sandoz Woman and Supractiv Complete Woman have significant potential, but need aggressive brand building to make an impact. Some of the major introductions have also been in the area of birth control category like i-pill and Unwanted-72,” observes Barde.

Even though the women’s health market is nascent, data from IMS Health reveals positive findings. Talking on the same, Amit Mookim, Head of South Asia Consulting at IMS Health, elaborates, “There were around 861 New Introductions (NI) in the last five years in this segment as of December 2014. Over the last two years, NIs in gynaecology segment contributed Rs 323 crores to overall Indian pharmaceutical market. 70 per cent of the NIs came from haematinics, gonadotrophins and antiprogestogens categories with haematinics alone contributing one-third.”

Scope for improvement

Mookim notes the increase in consumption of haematinics and hormones due to changing lifestyles as one of the major drivers of growth alongwith increasing health awareness and rising disposable income especially in metro and Class I regions. He also observes that health supplements market has steadily grown over the years triggered by the iron and folic acid supplementation initiative under the national RMNCH+A programme. HLL which is setting up generic pharmacy outlets in the entire state of Karnataka sees an increase in the healthcare spend by the government to leverage greater opportunity.

Growth in medical infrastructure, changing lifestyles resulting in higher incidence of lifestyle diseases, greater penetration in rural markets, and a nascent, yet fast growing health insurance industry will fuel the growth in future, adds Ayyyapan.

“Women of today are more economically independent thus increasing their purchasing ability which in turn influences their consumption decisions. They enjoy an active and diverse role in the family, increasingly digitally involved, talking and interacting with physicians and friends, take active interest in their health and lifestyle,” reiterates Barde outlining the women consumer. While product opportunities lie across a woman’s life cycle spanning adolescence, reproductive age and post menopause, most of the products target the reproductive stage. Barde thinks that sexual health category in women is a very interesting space, although it is a very hush-hush topic. Feminine intimate care, like vaginal wash, prescriptions to OTC switches of some of the potential products, innovations in formulations, dosage, formats etc present other viable opportunities.

Mulling on the white spaces that currently do not address women’s needs directly through the OTC route, Ayyyapan notes, “None of the iron supplements are promoted OTC, despite the glaring necessity. Analgesics present an interesting opportunity, considering studies that report that women are more sensitive to intense pain than men (Source: Journal of Pain, January 2012). Vaginal yeast infections (VYI) treatments too are still largely prescription-driven or based on home remedies. Introducing effective products in convenient and non-messy formats will drive OTC consumption. With the launch of vaginal wash and anion-based sanitary napkins catching up, mild herbal remedies, that can relax the tense muscles and nerves and keep anxiety levels low, would be much welcome by many women.”

These areas can open doors to marketers who are looking for new avenues of growth. Besides, catering to these needs can create first mover advantage, he adds. The vitamin and nutritional category seems to have evolved but there is still a long way to go. Same applies to the feminine intimate care products, however, the change will only come when women talk on this subject more comfortably.

Addressing unmet needs

Companies have for long been operating in predictable categories, but some are diving into unchartered waters, given the huge opportunity it represents. HLL Pharma plans to achieve Rs 1600 crores by 2020 in which WHD Ethical business will contribute Rs 100 crores. The company’s R&D team will be developing osteoporosis as a new indication for Ormeloxifene, projected to revolutionise the treatment modality. Bone mineral density is a major problem in Indian women nearing menopausal age with 20 per cent of them suffering from osteoporosis, for which there is no effective medication apart from calcium supplements. It is also focusing its energy to develop an effective and affordable prophylaxis for breast cancer which accounts for 25 to 31 per cent of all cancers in women in metros.

Barde stresses further, “The area of reproductive health especially in PMS relief, sexual dysfunction in women, painful intercourse due to menopause, menopausal health, should be explored to market these brands OTC in India. With OTC feminine intimate care opening up in a big way internationally, products such as Lactacyd, Clean & Dry intimate wash and 18 (vaginal tightening cream) have entered the Indian market. There is a need to create awareness among women about the need for such products, as their intimate needs are largely unspoken. Women’s needs such in urinary incontinence and UTI prevention are largely underserved and require serious attention.”

Innovative marketing and R&D

Piramal Healthcare has used offbeat marketing to reach out to its women consumers. More than two thirds of the company’s portfolio is generated from – skin care and intimate space targeting females and it hopes to increase this to 50 per cent in the next five years. Elaborates Kedar Rajadnye, President and Chief Operating Officer – Consumer Products, Piramal Enterprises, “We developed an application for women wanting to conceive to track their periods, advertised in female washrooms of movie theatres to educate consumers about the intimate categories and created awareness about misconceptions in the emergency contraception space through twitter campaigns.”

The company’s i-sure brand which detects the two most fertile days of a women and helps her conceive faster, has been priced at Rs 100 since its launch, to avoid women spending more time at the cash counter. 10 lakh CDs were distributed across one lakh pharmacy outlets in India to create awareness about ovulation and educate women about their fertility. Supractive, a multivitamin supplement was designed differentlyby the R&D team, since the calcium and iron receptors in the body are similar.

HLL has been instrumental in breaking new ground. Its hormone releasing intra uterine device – Emily released in FY 2013-14 has created a buzz amongst the gynaecological fraternity, because of the easier insertion mechanism. It works as a contraceptive for five years and is mostly used by the doctors to control heavy menstrual bleeding. Uncontrolled heavy menstrual bleeding can even lead to removal of uterus. The company tied up with Kottakal Arya Vaidya for an ayurvedic medicine to increase breast milk secretion for nursing mothers called Lactohil which contains 23 natural herbs.

The women’s health category is poised for a revolution, and why should it not. The US FDA has recognised female sexual health as a top 20 focus area to address unmet needs. With more companies researching and developing novel products for women’s health needs, empowerment is not far.

It is time for holistic empowerment, one that is just not centered around education and financial inclusion, but focusses on the most important aspect, the health of women, for the health of a nation depends on it.

[email protected]