Planning Commission of India-Access to Health systems including AYUSH

Working Group on


“Access to Health Systems including AYUSH”
Government of India

Planning Commission
D.O. No.G-20018/3/2006-P&E

July 31, 2006

Dear


Planning Commission has constituted a Working Group on “ Access to Health Systems including AYUSH” under the chairmanship of Secretary (AYUSH). Secretary (AYUSH) in turn had constituted Sub-Groups on following five issues:


(i) AYUSH Education.

(ii) Standardization and Quality Control of AYUSH drugs.

(iii) Research & Development.

(iv) Medicinal Plants.

(v) Mainstreaming of AYUSH.


The above Sub-Groups have submitted their reports which were discussed in the meeting of the Working Group chaired by Secretary (AYUSH) recently (Minutes enclosed). On the basis of a discussion in the Working Group and the Sub-Groups the Department has formulated its 11th Five Year Plan proposals. The change in priorities and schemes in the 11th Plan are reflected in the introduction chapter. The Department proposes to scale up Plan provision for Department of AYUSH from Rs.1057.26 crore (actual expenditure of first four years of the 10th Plan and B.E. of 2006 – 2007) to Rs.2473.45 crore in 11th Plan. The Department has been very cautious and realistic in making its Plan projections and it is hoped that by improving utilization of Plan funds and the quality of Plan expenditure the Department would be able to come back to the Planning Commission for raising its Plan provision midway during the 11th Plan.


Please find enclosed herewith the proposals of the Department of AYUSH for 11th Five Year Plan for AYUSH sector which have been duly approved by Secretary (AYUSH).


I am also enclosing the copies of the reports of the 5 Sub-Groups constituted by Secretary (AYUSH) on the above mentioned five subjects. The 11th Five Year Plan proposals alongwith the 5 reports of the Sub-Groups may be treated as report of the Working Group on “Access to Health Systems including AYUSH” constituted by the Planning Commission under the chairmanship of Secretary (AYUSH)..


With regards,


Yours sincerely,



( SHIV BASANT )

Prof. N.K. Sethi,

Adviser (Health), Planning Commission,

Yojana Bhawan,New Delhi.




INTRODUCTION


Department of Indian Systems of Medicine and Homoeopathy (ISM&H) was established in 1995 and renamed as Department of Ayurveda, Yoga & Naturopathy, Siddha, Unani and Homoeopathy (AYUSH) in November, 2003. There has been a three fold increase in the Plan budget of the Department in the 10th as compared as 9th Plan, most of which was on account of scaling up of the budget provision in the last two years of the 10th Five Year Plan i.e. 2004 – 2005 and 2005 – 2006 in line with the declared policy of the Central Government to increase the budgetary provision for AYUSH sector for mainstreaming it in the national health care delivery network.


Department has utilized the increased budget provisions in the 10th Plan for raising standards of AYUSH education, upgradation of national institutes set up by the Department to lay down benchmarks for teaching, research and clinical practices of different systems. With a view to prevent the mushroom growth of sub-standard colleges, the Indian Medicine Central Council and Homoeopathic Central Council Acts were amended in 2003 to provide for prior permission of the Central Government for establishing new colleges, starting new and higher courses, increase in the admission capacity in Ayurveda, Siddha, Unani and Homoeopathy colleges. The Centrally Sponsored Schemes of Strengthening of Institutions was effectively utilized for providing assistance to Government and Government aided colleges for ensuring conformity with the minimum infrastructural standards laid down by the statutory bodies. The Department would like to develop Government, Government aided and private but not for profit AYUSH colleges to the level of Centre of Excellence by providing enhanced scale of assistance on the basis of college specific upgradation plan which will clearly outline the responsibility of the college management and the State Governments for effective utilization of central assistance to be provided in the 11th Plan for the upgradation of these colleges.


Department of AYUSH attaches very high priority to laying down of pharmacopoeial standards for single and compound formulations, scientific validation of herbo-metallic compounds, standardization and quality control of AYUSH drugs. It is proposed to set up a Pharmacopoeial Commission for Indian Medicine in the 11th Plan which will be housed in the newly constructed building of the Pharmacopoeial Laboratory of Indian Medicine, Ghaziabad. The basic objective is to create an independent scientific body which will undertake laying down of pharmacopoeial standards and their revision from time to time on a more permanent footing. The Centrally Sponsored Scheme of Drugs Quality Control in the 10th Plan was utilized for providing financial assistance to the State Drug Testing Laboratories and State Pharmacies. The experience has not been a happy one as inspite of provision of financial assistance, State Drugs Testing Laboratories have been functioning at a sub-optimal level due to a variety of managerial problems. Offtake under the strengthening of enforcement mechanism component has also been very poor. The Department would like to shift the emphasis in the 11th Plan from strengthening of State Drug Testing Laboratories to utilization of a vast network of NABL accredited laboratories all over the country for random testing of Ayurveda, Siddha and Unani drugs and Homoeopathic mother tinctures for ensuring quality control of AYUSH medicines. It is proposed to modify the existing drug quality control scheme to provide financial assistance to States in terms of reimbursement of expenditure incurred by them on random testing of AYUSH medicine through NABL laboratories. The Department has enforced Good Manufacturing Practices and mandatory testing of heavy metals for export of purely herbal Ayurveda, Siddha and Unani medicines. Hon’ble Members of Parliament and informed sections of the public are also pressing for mandatory testing of AYUSH medicines for domestic consumption as well which would require in-house quality control laboratories in most of the AYUSH manufacturing units. A large number of AYUSH manufacturing units fall in the small and medium scale, it is felt that without a liberal financial assistance from the Government they would not be able to purchase costly equipments like Atomic Absorption Spectrometer for testing of heavy metals, TLC/HPTLC/GLC for testing of crude drugs. Therefore, it is proposed to provide backended subsidy of Rs.50.00 lakh or 50% of the project cost whichever is less to Ayurveda, Siddha and Unani drug manufacturing units for acquisition of requisite equipments and instruments for enabling them to test their ingredients, their raw materials and finished products inhouse. The subsidy would be released only through scheduled banks on the basis of a certificate to be issued by State Licensing Authority or any NABL Laboratories to the effect that the concerned manufacturing unit has obtained the requisite equipments and has started inhouse testing of raw materials and medicines. This assistance will be provided only to those units which has an annual turnover not exceeding Rs.25.00 crore. Units whose annual turnover exceeds Rs.25.00 crore should be able to avail of soft known facilities under the Pharma Development Fund which is administered by the Department of Science & Technology. As regards the State Drug Testing laboratories for which 1st instalment of upgradation grants has been released in the 10th Plan would be eligible for 2nd and 3rd instalment in the 11th Plan on proper utilization of funds.


Mainstreaming of AYUSH is one of the key strategies under the National Rural Health Mission (NRHM) under which it is envisaged that all PHCs/CHCs would be provided AYUSH facilities under the same roof. While the AYUSH manpower would be arranged either by relocation of AYUSH doctors from existing dispensaries or from contractual hiring of AYUSH doctors under NRHM funds. The other infrastructure and supply of medicines to PHCs/CHCs would be done through the Centrally Sponsored Scheme of Hospitals and Dispensaries which has received a very good response from States in the last two years of the 10th Plan. Hence, it is proposed to substantially increase the Plan provision for this scheme to Rs.625 crore in 11th Plan. A minor modification in the scheme for providing upgradation and assistance to existing AYUSH hospitals and dispensaries is also proposed.


The need for in-situ conservation and promotion of ex-situ of medicinal plants cannot be over emphasized. On the basis of the recommendations of the Task Force of Planning Commission the National Medicinal Plants Board (NMPB) was set up in the 10th Plan which is still grappling with infrastructural constraints. However, the National Medicinal Plants Board has been able to provide a strong impetus to medicinal plants sector through promotional and contractual farming schemes. Keeping in view the vast experience and constraints in the implementation of these two schemes, it is now proposed that the promotional and conservation scheme of the NMPB would be continued as Central Sector Scheme while the contractual farming scheme should be converted into a Centrally Sponsored Scheme for better monitoring and implementation by the State Medicinal Plants Board (SMPB). It has been felt that the States have not strengthened their Medicinal Plants Board as NMPB has been directly implementing the contractual farming scheme as a Central Sector Scheme. Conversion of this into Centrally Sponsored Scheme will provide the right impetus to the States to strengthen their SMPBs for better planning, implementation and monitoring of the contractual farming scheme which has a huge potential of generation of additional employment and income to the farmers through crop diversification. The Central Sector Scheme of the NMPB will concentrate on conservation/regeneration through joint forest management committees in forest areas, establishment of Gene Bank and community herbal gardens, etc. Whereas the Centrally Sponsored Scheme would encourage cultivation by farmers and provision of post harvest management and marketing support by State Medicinal Plants Boards and other State agencies in collaboration with National Medicinal Plants Board. Accordingly it is proposed to scale up the plan financing of the NMPB from approximately Rs.134.64 crore to Rs.465 crore in the 11th Plan.


AYUSH research councils have done a lot of research based on survey of medicinal plants and observatory clinical trials. Department has been emphasizing on focused, protocol based and peer reviewed research in a specified time frame and with specified outcomes. The major hindrance in the working of the AYUSH research councils has been non-implementation of the flexible complimentary scheme made applicable to other scientific institutions for in-situ Assured Career Progression as a result of which AYUSH councils are not able to attract talent. This matter has been taken up with the Department of Personnel & Training and Ministry of Finance on a number of occasions without much success. It is hope that the Sixth Pay Commission on the anvil will be able to address this anomaly. Another area of weaken of the AYUSH research councils has been lack of adequate equipments and good laboratories for standardization and quality control work. The Department has now entrusted the Pharmacopoeial work to the AYUSH research councils so that laying down of pharmacopoeial standards and SOPs can be attended to on a sustained basis in a scientific environment. Keeping in view the requirements for upgradation of various peripheral units of the research councils, it is proposed to scale up the Plan provisions** of Central Council for Research in Ayurveda and Siddha (CCRAS) from Rs.54.37 crore to Rs.100.00 crore in 11th Plan, for Central Council for Research in Unani Medicine (CCRUM) from Rs.59.45 crore to Rs.90.00 crore and for Central Council for Research in Homoeopathy (CCRH) from Rs.37.39 crore to Rs.77.50 crore.


** Plan Provision indicates actual Plan expenditure of that 1st four years of 10th Plan and Budget Estimates of 2006-07.

Suitable scaling up of Plan outlays for other Central Sector Schemes of the Department, namely, IEC and International Exchange is also proposed. The proposal for setting up of a National Ayurveda Hospital in Delhi and North-Eastern Institute of Ayurveda and Homoeopathy was conceived in the 10th Plan. Land has also been acquired for the National Ayurveda Hospital in Delhi and detailed project reports for these projects are being revised keeping in view the advice received from Expenditure Finance Committee. A Plan provision of Rs.75.00 crore for National Ayurveda Hospital in Delhi and another Rs.75.00 crore from out of that 10% NE corpus for North-Eastern Institute of Ayurveda and Homoeopathy is proposed in the 11th Plan.


The Department has showed in the last two years of the 10th Plan that it has the capacity to plan for and utilize higher Plan allocation in priority areas of strengthening of AYUSH institutions, standardization and quality control of AYUSH medicines, mainstreaming of AYUSH in national health care delivery network and focussed research for meeting national health goals. Keeping in view the enhanced Plan provisions a second post of Joint Secretary was sanctioned in the Department for strengthening planning, coordination and monitoring of various Central Sector and Centrally Sponsored Schemes. The posts of Directors, CCRUM/CCRAS/CCRH and the posts of Director of National Institutes were upgraded in the last two years of the 10th Plan and the proposal to upgrade the post of Director, PLIM to the Joint Secretary level is on the anvil. Due to sustained efforts, the Department has been able to find regular Directors for its research councils and autonomous institutions and fill up such vacancies timely. The Department of AYUSH has been maintaining a constant dialogue with all the stakeholders including the AYUSH industry. Successful launching of the Golden Triangle research initiative in collaboration with the ICMR, CSIR and creation of Traditional Knowledge Digital Library (TKDL) for defensive protection of ASU classical formulations from misappropriation are indicative of the fact that the Department of AYUSH has been providing effective leadership and momentum to the scientific validation and mainstreaming of AYUSH systems in the national health care delivery network. Keeping in view the tremendous potential of these systems for better health care for Indian citizens and for obtaining a better share of the world herbal market, these systems need to be supported by a quantum jump in Plan funding of the various Central Sector and Centrally Sponsored Schemes of the Department of AYUSH. Accordingly, it is proposed to scale up Plan provision for Department of AYUSH from Rs.1057.26 crore in the 10th Plan to Rs.2486.45 crore in the 11th Plan. The Department has been very cautious and realistic in making its Plan projections for 11th Plan and it is hoped that by improving utilization of Plan funds and the quality of Plan expenditure the Department would be able to come back to the Planning Commission for raising its Plan provision midway during the 11th Plan.


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Fibromyalgia

People with the condition can experience unbearable pain


Fibromyalgia is a condition which causes widespread pain and severe fatigue.
It cannot be treated, and people with the condition have to find ways of managing their symptoms.

What is fibromyalgia? The term combines "fibro" - which means fibrous, with "my" - muscles and "algia" - pain.

It is a collection of symptoms, rather than a specific disease.

As well as pain and fatigue, it can cause headaches or migraines, irritable bowel syndrome and can affect sleep.

Although other conditions, such as chronic fatigue syndrome, can lead to similar symptoms, fibromyalgia is defined as widespread pain for at least three months which is experienced in at least 11 specified points around the body.

If people are severely affected, it can limit their ability to work or have an active social life.

What causes the syndrome?

It appears that it is usually triggered by some kind of trauma, such as a car accident, a viral infection or an operation, although some cases develop without any obvious trigger.

Researchers are still investigating the actual cause of fibromyalgia.
However, scientists have suggested a deficiency in levels of the brain chemical serotonin, which helps deliver messages between cells in the brain.

This can lead to a problem in the way the brain processes messages about pain, meaning people feel pain where others might experience a slight ache or stiffness.

Are there treatments available?

Many people are offered drugs normally used to treat depression. Given at much lower doses, this class of drugs, called tricyclics, blunt pain messages to the brain.

Others use over-the-counter pain-relief medications, or receive treatment at a pain clinic.

Understanding how to relieve symptoms is crucial, experts say.

The Fibromyalgia Association recommends using relaxation techniques.
It also says that heat, from hot water bottles, baths or showers or even soaking hands and feet for a few minutes can relieve overnight symptoms.

Stretching and aerobic exercise can also help.
The association says the most important thing is for people to listen to their bodies, and to slow down when they need to.

Nutrional facts about Salt

Bread is a major source of salt


Campaigners say it is important for people to cut the amount of salt they eat in their diet.Too much salt is linked to high blood pressure, which is turn can increase the risk of heart attacks and strokes.

The government watchdog the Food Standards Agency announced targets for reducing salt in a range of food products in 2006.

Why do we need salt?

Salt is a commonly occuring mineral, the technical name of which is sodium chloride. It is the sodium part of salt that is important. The body needs a certain amount of sodium to function properly.

Sodium helps to maintain the concentration of body fluids at correct levels. It also plays a central role in the transmission of electrical impulses in the nerves, and helps cells to take up nutrients.

Why is too much salt bad?

In adults, when levels of sodium are too high, the body retains too much water and the volume of bodily fluids increases.

Many scientists, although not all, believe this process is linked to high blood pressure, or hypertension, which in turn is linked to a greater risk of coronary heart disease and stroke.

With high levels of fluid circulating through the brain there is a greater chance that weaknesses in the brain's blood vessels are exposed, and that they may burst, causing a stroke.

Similarly, a greater volume of fluid passing through the heart can place additional strain on the organ, increasing the possibility of coronary disease.

However, there are many potential causes of hypertension and coronary heart disease, and some scientists deny that salt plays any significant role at all.

An adult will be able to remove salt from the body through the kidneys into the urine.

However, very young babies do not have the capacity to process large quantities of salt as the kidneys are not yet developed.

If they are given adult food with a higher salt content before they are at least four months old, excess sodium can accumulate in the body, causing kidney, liver and brain damage, and in very occasional cases, death.

It is recommended that babies are given only milk, whether breast or formula, for the first four months of life.

Baby foods are supposed to contain lower levels of salt, and it is recommended that if adult foods are to be given, unprocessed foods should be used, and no salt added.

How much salt should we eat?

The government recommends that adults should eat 6g of salt a day. However, the average intake of salt is between 9g and 10g a day.

Experts estimate that if average consumption was cut to 6g a day it would prevent 70,000 heart attacks and strokes a year.

The main sources of salt in the diet are processed foods and salt added during cooking or at the table. Meat and meat products, and bread can also be high in salt.

Processed foods are thought to account for around 75% of the average person's salt intake.

However, research published in The Lancet medical journal suggested that most people could not tell the difference between loaves with markedly different salt content.

Salt is added to processed foods to aid preservation and to improve taste. Sodium is present in additives such as monosodium glutamate and sodium bicarbonate.

Small amounts of sodium can be found naturally in some foods such as eggs and fish.

The salt we sprinkle on our food from cellar accounts for only 10%-15% of our intake.

What action has the Food Standards Agency taken?
It drew up targets for the food industry to cut the salt content of a range of 85 products.

The aim was that if the targets were enforced, the average daily intake of salt would fall to the recommended level of 6g.

However, the targets were voluntary, and campaigners said they were not set at a sufficiently tough level. They argued that even if followed by the food industry they would result in an average daily intake of 8g, rather than 6g.

Professor Graham MacGregor, of Cash (Consensus Action on Salt and Health), said that would mean an extra 30,000 more strokes and heart attacks a year in the UK - 15,000 of which would be fatal.

What should we do?

Dr Wynnie Chan, a nutrition scientist for the British Nurtrition Foundation, says that everybody should look to reduce the amount of salt in their diet.

"It would have a significant effect on those people who need to reduce their salt levels because they are susceptible to hypertension, but it would also do no harm for the whole population to reduce its salt intake," she said.

Dr Chan said there were four main ways to reduce salt intake:


*Stop adding table salt to food once it is served

*Choose items with a reduced sodium content

*Carefully monitor the salt content of processed food

*Eat more fruit and vegetables - they contain potassium which balances the effect of salt on the body

Reading food labels can be confusing as they often give the sodium, rather than the salt content of food. To calculate the amount of salt in a product, multiply the sodium content by two-and-a-half times.

Motor neurone disease

Motor neurone disease is a progressive fatal condition that causes muscle wastage.
It is most common among people aged 50 to 70, and tends to affect men slightly more than women.

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What is motor neurone disease?

Motor Neurone Disease (MND) is a group of related diseases affecting the motor neurones in the brain and spinal cord.Motor neurones are the nerve cells along which the brain sends instructions, in the form of electrical impulses, to the muscles.

Degeneration of these cells leads to weakness and wasting of muscles.Some groups of muscles are more affected than others.

What are the symptoms?

The symptoms are usually first apparent in the arms or legs. Initially, they tend to be mild, and can include stumbling and difficulty holding objects.

Weakness and wasting in the muscles supplying the face and throat can also lead to problems with speech and difficulty chewing and swallowing.

In the advanced stages of the disease, a patient may become almost totally immobile. The rate of progression of the disease, however, varies enormously from patient to patient.

On average the disease takes three to four years to run its course.

Some surveys indicate that 50% of MND patients may be living three years after diagnosis, 10% after 10 years and some live for more than 20 years.

There are no remissions but people may experience a "plateau" lasting weeks or months while no deterioration occurs.

MND usually has no impact at all on intellect or memory.

The disease also has no impact on the five senses of sight, hearing, taste, smell and sensation.The bowels and bladder are not affected by the disease, but diet and exercise should be carefully monitored.

What causes MND?
The cause of the disease remains a mystery.

How is it diagnosed?

The disease is often difficult to diagnose.

It may be necessary to review patients for some time before diagnosis becomes relatively certain.

A GP may suspect the neurological problem, but confirmation of the diagnosis by a neurologist is necessary.

A range of tests are needed to rule out other conditions.

Often an Electromyograph (EMG) is used, in which a needle is inserted into various muscles to measure their electrical activity. Sometimes a muscle biopsy will be carried out so that a small sample of muscle can be examined under a microscope.

Can it be treated?

At present there is no cure.

However, a great deal can be done to improve the comfort and well being of people who have MND.

Watchdog warns over apricot seeds

Some claim apricot seeds can cure cancer.Apricot stones sold for health benefits could be fatal in high doses, the food safety watchdog has warned.

Apricot kernels are thought to contain high levels of vitamin B17, which is described as an immune system booster and even sold as a cancer treatment. But the Food Standards Agency said they also produce cyanide and can be poisonous in high doses.

It is now recommending that people consume no more than two bitter apricot kernels in a single day.

An FSA spokesman said there were reports from overseas of "very serious health effects" being associated with the consumption of 20 to 30 kernels in a short period of time.

He added: "They could be potentially lethal in high enough doses."

If simply eating apricot seeds could cure cancer, no one would be more delighted than us

Cancer Research UK
Natural food retailer Julian Graves was selling packs with a recommended daily dose of 10 kernels and has since pulled them from its shelves.

It said it had begun selling the apricot kernels due to customer demand and would do so again with a revised recommended dosage if the food watchdog gave it permission.

The seeds however are also available through specialist websites.

Cancer Research UK says of vitamin B17: "According to claims made on the Internet, this substance found in apricot pips is a highly active compound that can cure cancer.

"Unfortunately this is simply not true. The whole reason for the existence of Cancer Research UK is to find cures for cancers.

"If simply eating apricot seeds could cure cancer, no one would be more delighted than us."

Food chemicals 'may harm humans'

Scientists are divided over whether the chemicals can be harmful
Low levels of man-made chemicals in basic foods such as brown bread, butter and milk could combine to harm humans, a conservation charity has warned. WWF-UK said scientific tests link the chemicals to hormonal changes, cancers and immune deficiencies.

Dutch research suggests low levels of the chemicals are found in food from the environment or packaging.

However, some scientists have questioned whether the small quantities involved present a danger to health.

We should not be complacent about the presence of these chemicals in foods and should keep trying to reduce the levels

Professor Alan Boobis, of Imperial College London

The Dutch scientists found low levels of pesticides, flame retardants, non-stick chemicals, artificial musks used to scent products and phthalate chemical compounds used in plastics were present in food.

Further research at the London School of Pharmacy suggests low doses can work together to produce a significant combination.

Tests on animals and human cells show they might be a factor in various serious medical conditions.

Paul King, director of campaigns for WWF-UK, said: "While each item of food we tested is probably safe to eat on its own, taken together over long periods of time the food we eat contributes significantly to our body burden of chemicals."

The organisation is now calling for strict controls on the use of chemicals to be introduced by the European Parliament.

'Balanced view'

But Professor Alan Boobis, of Imperial College London, is among a number of toxicologists who have played down the research.

He said: "We should not be complacent about the presence of these chemicals in foods and should keep trying to reduce the levels.

"But we should also maintain a balanced view about whether these trace amounts represent a risk to the consumer and I don't believe that at these levels they represent a significant threat to human health"

And toxicologist Professor John Henry, of St Mary's Medical School, London, said WWF-UK was well intentioned but it had not demonstrated that the chemicals cause harm.

The Food Standards Agency and the chemical industry said levels of individual chemicals are not harmful but they are looking into how they add up in people's diets.

Steve Elliott, chief executive of the Chemical Industry Association, added the public should not be "overly concerned".

"I think there is a significant among of work that needs to be done to look at the additive effect in terms of how one substance might react with another and the ultimate product of that reaction."

Courtessy:BBC Health-Medical Notes

Hairspray linked to "Birth defect"

Hairspray exposure was linked to a condition called hypospadias
Boys born to women exposed to hairspray in the workplace may have a higher risk of being born with a genital defect.

Imperial College London scientists talked to women who had babies with hypospadias, where the urinary tract is found away from the penis.

They reported that hairspray exposure more than doubled the risk.

The study in the journal Environmental Health Perspectives, said it was too early to say for certain that hairspray was the cause.

Pregnant women will need to make their own choices about whether or not to avoid these kind of exposures

Professor Paul Elliott
Imperial College London

The incidence of hypospadias has risen sharply in recent decades, and some experts have pointed the finger of suspicion at chemicals called phthalates, found in some plastics, including those found in hairspray.

Phthalates have the ability to disrupt hormones, and have been banned in toys in the EU for some years.

Certain phthalates have also been banned from hairsprays and other cosmetic products since January 2005.

However, no study has found a convincing link between women exposed to them and problems in their children.

The latest study looks not at personal use of hairsprays, but at their use, potentially in higher doses, by workers such as hairdressers and beauty therapists.

A total of 471 women whose babies had been born with hypospadias were interviewed, as were a similar number of women with unaffected children.

The women gave birth in 1997 and 1998 and were interviewed between 2000 and 2003.

Roughly double the number of women in the "hypospadias" group revealed that they had been exposed to hairspray through their job compared with those with unaffected babies.

No proof

However, Professor Paul Elliott, who led the study, said that the finding did not prove that hairspray - or any phthalates it contained - was the cause of this.

He said: "Women shouldn't be alarmed. This study adds a bit more evidence to the general picture about these chemicals, but more research will be needed to demonstrate that the link exists.

"Pregnant women will need to make their own choices about whether or not to avoid these kind of exposures."

Professor Andreas Kortenkamp, the head of the Centre for Toxicology at the School of Pharmacy, University of London, said that it was "important research"

He said that the UK government should consider taking the approach used by the Danish authorities, which has issued advice to women about the evidence linking phthalates to health problems.

He said: "I don't think we can continue to leave women alone to make decisions about these things - they need a bit of guidance, to know where these chemicals are.

"Certainly, if this was the mother of my children who was pregnant, I would strongly advise her to stay away from these."

Leap of faith

Professor Richard Sharpe, from Edinburgh University, said it was a "big leap of faith" to conclude phthalates were to blame for birth defects.

He said research had shown phthalates could suppress production of the male sex hormone testosterone - which plays a role in penis development - in some animals, but evidence that it had the same effect in humans was inconclusive.

"My advice has long been that women who are planning a pregnancy should avoid (or at least minimise) use of cosmetics, body creams/lotions etc, especially in the first three months of pregnancy.

"This is not because we know that the ingredients can do harm to the baby, but because it can only do good for the baby to avoid unnecessary chemical exposures."

Another finding of the study provides further backing of the government's recommendation that pregnant women should take extra folate to prevent similar defects to hypospadias, which arise early in pregnancy.

Women who took folic acid in the first three months of pregnancy were a third less likely to have a baby with hypospadias, according to the study.