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Introduction to Emergency Contraception
and The Status of Global Access
2013 International Conference on Family Planning
Addis Ababa, November 12, 2013
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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
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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.
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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.
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ECPs are registered in most countries
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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
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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.
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Most women in developing countries do
not know about EC
Source: Demographic and Health Surveys
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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.
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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
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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.
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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?