Introduction to Emergency Contraception and The Status of ... · Introduction to Emergency Contraception and The Status of Global Access 2013 International Conference on Family Planning

Introduction to Emergency Contraception

and The Status of Global Access

2013 International Conference on Family Planning

Addis Ababa, November 12, 2013

Emergency Contraception: What is it?

– Can be taken AFTER sex to PREVENT pregnancy

– Includes pills and the Copper T IUD

– The most common pill is levonorgestrel, a common hormone used in many birth control pills.

– Very safe

– Does not cause an abortion

Emergency Contraception: Some History

– In the 1970s it was discovered that high doses of

normal oral hormonal contraception could be taken AFTER sex to PREVENT pregnancy

– Mechanism of action was unclear at that time. – Dedicated EC products were available in a few

European countries. – First integrated into global policies during Balkans

crisis – Mid-1990s a WHO multi-center trial found that

levonorgestrel alone without estrogen was as effective and caused fewer side effects.

– Now a number of manufacturers produce an LNG EC product.

Initial Introduction

– EC was piloted in four developing countries: Indonesia, Kenya, Mexico, Sri Lanka.

–Core set of clinical, training and client materials was produced.

–Consortium was established.

–Other partners joined and EC was introduced in more countries.

ECPs are registered in most countries

Global Policies Support EC

• WHO Essential Medicines List

• WHO Guidelines for Sexual Assault

• Normative documents on family planning (USAID, WHO, FIGO, country-level professional associations)

• Donor purchasing systems (UNFPA, USAID)

BUT

• MISSING from WHO Task Shifting Guidelines

EC Provision Varies by Sector

• 74% of countries have a product registered in the commercial sector.

• More than half of developing countries surveyed report that they include EC in their public sector programs.

• Around a third of social marketing family planning programs offer an EC product.

Most women in developing countries do

not know about EC

Source: Demographic and Health Surveys

EC inclusion in family planning and post-rape care guidelines varies

– Increasingly, EC is included in family planning guidelines.

– It is not clear that services are always in line with such guidelines.

Only half of countries include EC in their Essential Medicines Lists

This has implications for:

• Integration of EC with other programs

• Equitable access

• Post-rape care

Women too often need a prescription to access EC

Access to EC can be classified as:

1. Over the counter or on the shelf

2. Behind the counter – can be provided by a pharmacist upon consultation

3. Prescription-only - requires a consultation with a health provider and often a second trip to a pharmacy to have the prescription filled.

Next Steps

• EC is a neglected commodity receiving focus from the United Nations Commission on Life Saving Commodities for Women and Children.

• Great potential for full access – products are fairly widely available but programming and knowledge are lagging.

• Do we have an “innovation pile-up” in family planning?