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EC Use Rises in the United States
27 May 2010
The National Survey of Family Growth, conducted by the Centers for Disease Control and Prevention, found that use of emergency contraception in the US rose: in 2002, 4% of women reported ever having used this contraceptive method. By 2006-2008, this number had increased to 10%. A preliminary report on Use of Contraception in the United States: 2006-2008, authored by William D. Mosher, Ph.D., and Jo Jones, can be downloaded here.
Database of EC availability updated
25 May 2010
ICEC has updated its database providing information on brands of EC products available as well as local policies related to EC access in every country of the world, and can be searched by country, pill brand, or manufacturer. The database can be accessed through the "search our databases" tab on the left side of this page.
Highlights from our latest batch of updates include information on Ella, a new EC product with the active ingredient ulipristal acetate. In Venezuela, EC is now available over-the-counter. In Peru, we have added information on many additional dedicated EC products; Peru now has approximately 30 EC products registered, although not all are available. We also have a number of countries for which we have NO information available: Afghanistan, Bahrain, Bermuda, Botswana, Brunei, Chad, Costa Rica, Croatia, Djibouti, East Timor, El Salvador, Eritrea, Haiti, Iraq, Japan, Jordan, Kuwait, Laos, Malta, Mozambique, Panama, Somalia, Sudan, Swaziland, Syria, and Tanzania. We recently took a country off this list: we just learned that Iran has two locally produced EC products on the market available through both the public and private sector. In Bhutan, we don’t have information on product availability, but we learned that EC is incorporated in national youth and family planning guidelines. Do you have information on EC availability in any of these other countries? In countries where no dedicated EC product is available, woman can safely use the Yuzpe method, and the Princeton University affiliated site www.not-2-late.com provides information on which OCs suitable for EC use are available for each country.
We also endeavor to provide other information relevant to EC access, such as local policies and legal challenges, over the counter vs. prescription access, availability in the public sector, and anything else that might affect access at the local level. We just updated the database with information compiled by DKT International on EC provision by social marketing organizations. We added information from the USAID Deliver project on EC access in the public sector (data available for limited countries). We also include some demographic information, such as levels of unmet need for contraception.
Chart clarifies US product availability
10 August 2009
A chart created by Reproductive Health Technologies Project clarifies the current situation with EC products in the US. A new single-pill product is being introduced to the market, a generic product is entering the market, and the age for non-prescription access has been lowered by a year. Click here for the chart.
Strategizing about legal assaults on EC
22 July 2009
Emergency Contraception (EC) is increasingly attacked in courts in Latin America. In Peru, Chile, Brazil, Honduras, Argentina and other countries in the region, lawsuits have been filed against EC in different courts, from the state level up to constitutional courts. Ultra-conservative groups have been attacking the method at the legal level, especially now that many countries in the region have dedicated products, EC is included in the family planning rules and access to the method is relatively widespread. In some cases, other contraceptive methods (such as the IUD and oral contraceptive pills) have been included in the legal attacks.
In response, a workshop on “Strengthening capacities for the legal defense of Emergency Contraception in Central America” took place in Managua, Nicaragua, on July 16th-17th 2009. The Latin America and Caribbean Consortium for Emergency Contraception (CLAE) organized the workshop, with support from UNFPA and the Pacific Institute for Women’s Health. This workshop brought together lawyers and advocates to share lessons learned and generate strategies to respond effectively when EC is challenged in courts.
For further information on CLAE’s work in Latin America or to join CLAE’s listserv, please contact the CLAE Coordinator, Rossina Guerrero, at clae at clae dot info. If you are interested in joining a new network focused on legal challenges to EC, please contact ICEC’s Latin America specialist Cristina Puig, at cpuig at fcimail dot org.
HRA Pharma Launches ellaOne in Europe
13 July 2009
HRA Pharma announced in May 2009 that its “next generation” emergency contraceptive pill has been granted marketing authorization by the European Commission. The new product, called ellaOne, received a positive opinion from the Committee for Medicinal Products for Human Use in March. The marketing authorization now allows HRA Pharma to launch and distribute ellaOne throughout the European Union. The new drug, ulipristal acetate, has been shown to have sustained effectiveness and has been approved for use up to five days following unprotected intercourse.
One-pill product, generic to launch in US
13 July 2009
In the US, Teva Pharmaceuticals announced today that it will be launching a one-pill version of Plan B (PlanB One-Step) later this month. Like Plan B, this product will be available without a prescription; while the earlier two-pill product was available without a prescription to women 18 and older, the new product will be available without a prescription to women 17 or older. American women will now have access to single-dose levonorgestrel EC as recommended in ICEC’s 2003 Regimen Update (based on a WHO study published in 2002).
In separate news, a generic EC product (a two-pill levonorgestrel product called Next Choice) will be launched in the US by Watson Pharmaceuticals; it will be available by prescription for women 17 and under only.
Pharmas Launch Innovative EC Ads
26 June 2009
An on-line ad campaign in for Plan B in Canada uses a new “sperm font” and a sexy soundtrack to illustrate that “uh oh moment” from the perspective of an ovum. Put on your headphones for this one! The text reads “Screwed?” and then “To the Rescue.”
In the UK, Levonelle made a splash with a television advertising campaign – apparently UK’s first television campaign for a hormonal contraceptive. Featuring an upbeat pop song, a pink color scheme, and simple animation, this cheerful campaign shows a young woman waking up after a contraceptive accident (more sperm), riding a bus, and going to a pharmacy. The text reads “the condom split,” “not ready for that” and “what a relief.”
In the US, Court Faults Age Restrictions on EC Access
24 March 2009
In most of the world, EC is available without a prescription and without age restrictions. A number of studies show that EC is safe for young women and does not lead to decreased condom use or changes in sexual behavior. However, attempts to reduce age barriers to EC access in the US have been long and arduous. Read RHTP’s timeline of this process here. A Citizen Petition was filed by the Center for Reproductive Rights with Association of Reproductive Health Professionals and a number of other ICEC and ASEC member organizations in 2001; the Center for Reproductive Rights, with other organizations, filed a lawsuit in 2005. Three applications for a change in status were filed by Duramed, the drug’s distributor: the first asked to make EC available without a prescription for women of all ages, the second requested non-prescription access for women 16 and older, and after that was rejected, a third application was submitted for women 17 and older. The FDA commissioner accepted the third application but made the decision to limit non-prescription access to women 18 and older.
On March 23, 2009, the courts issued a ruling on the lawsuit. The judge’s decision reviews the history of the attempts to make EC available without prescription in the US and states that “(t)he FDA repeatedly and unreasonably delayed issuing a decision on Plan B for suspect reasons.” The decision goes on to state that “FDA upper management, including the Commissioner, wrested control over the decision-making on Plan B from staff that normally would issue the final decision on an over-the-counter switch application; the FDA’s denial of non-prescription access without age restriction went against the recommendation of a committee of experts it had empanelled to advise it on Plan B; and the Commissioner – at the behest of political actors – decided to deny non-prescription access to women 16 and younger before FDA scientific review staff had completed their reviews.” The FDA has been invited to review its decisions regarding OTC access and ordered to provide OTC access to 17 year old women within 30 days. Read the full ruling here.
EC access has improved since FDA approval of behind-the-counter status for those 18 and older, according to results of a recently published survey carried out in Boston, Atlanta and Philadelphia. The surveys, carried out in 2005 and again in 2007, aimed to assess whether pharmacies could provide Plan B within 24 hours, and if not, why. The number of pharmacies unable to provide Plan B within the 24 hour time period fell appreciably, from 22% down to 8% between the 2005 and 2007 surveys; the rates of pharmacist refusals halved from 4% to 2%. The results also showed that in 2007 large pharmacy chains were more likely to stock Plan B (only 3% could not provide it within 24 hours), and there was a significant variation in cost (from $18-80, mean cost of $43).
The two surveys had a high response rate (75% in 2005 and 82% in 2007), but were focused on large metropolitan areas, which may limit whether the results are generalizable to smaller cities and rural areas. The variation in cost implies that women might do well to compare prices between different pharmacies; having a prescription (even for those over 18) could reduce out-of-pocket costs.
Excerpted from:
Gee RE et al. Behind-the-counter status and availability of emergency contraception. Am J Obstet Gynecol 2008 Nov; 199:478.e1. (http://dx.doi.org/10.1016/j.ajog.2008.04.032)
Youth Survey Reports on EC Use in Seven European Countries
05 March 2009
Of 24 countries included in the analysis of the 2002 Health Behavior in School-aged Children (HBSC) survey, seven provided EC as a response option: Finland, Flemish Belgium, France, Hungary, Scotland, Sweden, and Wales. The large cross-national survey of contraceptive use by 33,943 sexually active 15-year-old students, as analyzed by Godeau et al and presented in the Archives of Pediatric and Adolescent Medicine, offered a unique opportunity to examine contraceptive use amongst adolescents across countries and regions, and demonstrated broad differences. The survey noted widespread contraceptive usage. Overall 82.3% of sexually active students reported using a condom and/or the birth control pill during most recent sexual intercourse, the majority of respondents relying on condoms alone (58.1%). Nonetheless, the proportion unprotected was 13.2% and if the poorly protected group is included, this figure rises to 16.7%.
In countries where the EC response option was provided, 8.2% of students reported use– ranging from 2.9% in Finland to 14.2% in France. (The relatively high rates of EC use in France may be attributable to its OTC status since 1999, and availability through school nurses since 2001.) Of the relatively small percentage of adolescents who did not use condoms or pills during their most recent intercourse, 10.1% reported having used EC (7.2% in Scotland and 15.8% in France). In fact, youth who used no method were not significantly more likely to use EC (10.1% of them did) than users of pills and condoms (8.2%). The majority of EC use, therefore, was preceded by the use of another contraceptive method—what might be termed a “belt and suspenders” approach to birth control.
Excerpted from:
Godeau E, Nic Gabhainn S, Vignes C, Ross J, Boyce W, Todd J. Contraceptive use by 15-year-old students at their last sexual intercourse: results from 24 countries. Arch Pediatr Adolesc Med. 2008;162(1):66-73.
PSI Expands Access to EC in Rajasthan, India
19 February 2009
A Population Services International (PSI) program (funded by William and Flora Hewlett Foundation) successfully expanded access to and use of EC in the state of Rajasthan in India. The program focused on 500 slums in four towns, accounting for 61% of the total city slum population of the state. It achieved increases in the percent of women reporting having ever used EC and the percent of EC users reporting bridging to a regular method of birth control. PSI is continuing its work to ensure availability of EC in Rajasthan by launching its own EC brand, “Emergency Goli.” Click here to access the full report.
CLAE, the Latin American Regional Consortium for EC, partners with www.Not-2-Late.com
23 February 2009
The Latin America Consortium for Emergency Contraception (CLAE) is now
partnered with the Emergency Contraception Website, www.not-2-late.com. This pioneering website was founded in 1994 by Princeton University's James Trussell and is now co-managed by Princeton’s Office of Population Research and the Association of Reproductive Health Professionals. The site offers comprehensive information about emergency contraception in English, Spanish, French and Arabic. The site receives 125,000 hits each month as well as more than 1,100 queries each year from women and men around the world. Each of these queries is personally answered. Now, Spanish-speaking enquirers will receive prompt answers from a psychologist and midwife at PROMSEX, a Peru-based NGO that is the current host organization for CLAE. This partnership means faster responses and frees up resources that were previously used for translation.
Staff attitudes toward providing advance provision of EC
13 November 2008
A study published in the September 2008 issue of Perspectives on Sexual and Reproductive Health shed light on service deliver realities involved in advance provision of EC in publicly funded clinics in the U.S. Results suggest that clinical staff had highly favorable attitudes toward EC and advance provision, but frequently did not offer EC to patients who were medically eligible. Reasons for this discrepancy include staff perceptions of patients’ reproductive lifestyle (women who used an effective regular method were frequently not offered EC) and clinical logistics. Findings suggest that staff thought that most patients would refuse EC because they relied on their main method, when in reality nearly all patients said they would consider using EC if they had unprotected sex.
IAWG annual meeting
03 November 2008
The Interagency Working Group on Reproductive Health in Crises (formerly Refugee Settings) is holding its annual meeting this week in Cairo. Two ICEC member organizations – the Women’s Commission for Refugee Women and Children, and Ibis Reproductive Health – are participating in the meeting. Sarah Chynoweth of the Women’s Commission helped us navigate the agenda process and made sure that EC was included in the agenda, and Angel Foster of Ibis is presenting on Emergency Contraceptives in Displaced Settings as part of the Special Topics and Emerging Issues panel.
EC has been included in the work of the Interagency Group from its inception; most importantly, it is included in the Interagency Field Manual and is part of the Minimum Initial Service Package (MISP). However, there continues to be the need for a special focus on EC as surveys indicate that women in refugee camps and other crisis situations usually do not have access to EC. You can learn more about the Interagency Group at www.iawg.net and about EC in crises settings generally in the EC issues section of the ICEC website, at www.cecinfo.org/issues/crises/htm.
Mainstreaming EC, Compton Foundation initative and report
22 October 2008
In 2002 the Compton Foundation launched a major initiative to increase awareness of and access to emergency contraception worldwide, with an emphasis on US, Latin American and African efforts. Compton was an early and steady supporter of ICEC and provided extensive support for the regional consortia. Funds were committed over six years with the goal of increasing awareness and access to EC globally. As a result of this initiative, in 2008, EC is considered an integral part of high quality reproductive health care, and awareness and availability has expanded worldwide. More information about this initiative, its success in mainstreaming EC, and the work that remains to secure access to EC for low income women everywhere can be found in the report, Mainstreaming Emergency Contraception: A report on the Compton Foundation’s Emergency Contraception Initiative 2002-2007.
FIGO Endorses ICEC Statement on EC's Mechanism of Action
16 October 2008
The International Federation of Gynecology and Obstetrics (FIGO) joined ICEC in releasing a new statement on the mechanism of action of emergency contraceptive pills (ECPs). The statement focuses on levonorgestrel-alone ECPs, which are available in most countries of the world. It concludes that the pills work primarily and perhaps only by delaying or interrupting ovulation. There is limited evidence for an effect on sperm function, and no evidence for an effect on the endometrium. This means that ECPs cannot prevent a fertilized egg from implanting in the uterus. They also do not harm an existing pregnancy.
The statement was developed by an international panel of experts, and is based on a comprehensive review of the most recent studies. It is available in English on the Policy Statements page; more languages will be available shortly.
10 years of EC in the Spanish province of Cantabria
28 August 2008
Prior to the introduction of EC, the province of Cantabria in Spain had one of the country's highest rates of unwanted pregnancy, legal abortion, and adolescent pregnancy. In order to reduce these indicators several strategic steps were taken. Educational sessions were held for individuals working in the school system, including teachers, parents, and teenagers in order to widen the scope of information about EC. Social networks were engaged to make their services known to populations vulnerable to unwanted pregnancies. EC was disseminated by local media. Additionally, EC service delivery was facilitated at the local health centers. Following these steps, population-based data indicates that, EC use increased steadily, the number of legal abortions decreased, and the number of adolescent pregnancies declined.
EC access in Brazil: old barriers and new access strategies
15 July 2008
A recent study in Brazil compared two strategies of access to EC and their relationship to the use of EC and regular use of contraceptives. Women age 18 to 49 who attended reproductive health clinics from six Brazilian towns were recruited. These women were randomly placed into either a group getting information about EC or in a group getting information and advanced supply of EC. The study found that the advance supply group tended to use EC more often, sooner after unprotected sexual intercourse, and experienced an increase in regular use of contraceptives compared to the group of women who just received information. This study concluded that advance deliver improved access to and use of EC, and did not reduce the regular use of other contraceptives.
ICEC Hosting a Panel on EC at the RAISE Conference
16 June 2008
This week, ICEC members are taking part in a panel on EC in humanitarian response to crises, being held in Kampala, Uganda. The panel, convened by ICEC, will feature Jill Keesbury, the coordinator of ECafrique, the regional EC consortium, along with ICEC Steering Committee member Angel Foster of Ibis Reproductive Health. Panelists will present on EC in crises generally, as well as focused information on EC in Kenya, Palestine, and the Thai/Burma border. Please visit the RAISE website for the full conference program and visit our EC in Crisis Issues Page (see Issues on the left hand side of this site) for more information.
Postinor 2 registration upheld in Colombia
12 June 2008
After a six year long process, on June 5th, 2008, the State Council of Colombia announced the ruling on the suit to reverse the registration of Postinor 2. The motion was based on the alleged abortifacient mechanism of action of levonorgestrel emergency contraception (EC). The registration was given to PROFAMILIA (the member association of IPPF in Colombia) by INVIMA, the Colombian drug regulatory agency. PROFAMILIA and INVIMA both contested, the suit with support from different organizations as well as private citizens, stating that scientific evidence points to the lack of any post-fertilization effect. The State Council also consulted the Colombian Institute of Forensic Medicine which stated that there is no scientific evidence to indicate that levonorgestrel EC causes any direct damage to the human embryo. On this evidence, the suit was denied, and Postinor 2 will stay on the drug register in Colombia.
EC availability in Canada
02 June 2008
On May 14, 2008, the Canadian National Association of Pharmacy Regulatory Authorities (NAPRA) accepted an expert recommendation to change the status of emergency contraception, allowing it to be sold in a self-selection area of the pharmacy, close to the dispensary where consultation by a pharmacist is available. In accordance with its By-laws, NAPRA has now provided a 30-day period for comment or submissions respecting any objective, science-based evidence to warrant a different category for this drug. Provinces continue to determine conditions of sale for drugs to the public either by reference to the NAPRA system or through their own process, subject to any federal restrictions.
Scaling up EC in South Asia
21 May 2008
Results from EC scale-up efforts in several South Asian countries showed that a majority of users (70-80%) had a regular/full-time method of family planning that was continued after use of emergency contraception pills. EC was most often accessed after women experienced method failure or mistakes in using their regular method. Most EC users only used it one time within the study period. The research also showed that advance provision of EC lead to greater utilization (75% of those women reporting episodes of unprotected sex) than EC provided on-demand (47%) and that EC use presented the opportunity to bridge women to other modern and effective methods of family planning. In both Bangladesh and India, women who used EC were more likely to start or continue using an on-going contraceptive method. In addition, mid-level medical personnel were found to be able to provide EC safely and effectively. More information about this effort to scale up EC in South Asia can be found at the Population Council website.
Russian-language EC update now available
21 May 2008
Ipas has released a four-page Russian-language brochure for European clinicians, providing comprehensive information about EC. This brochure addresses EC effectiveness, guidelines for use, potential side effects and availability throughout Europe. This publication can be found at the Ipas website and on our East Europe, NIS & Balkan Region page.
EC Under Threat in Honduras
25 April 2008
In Honduras, a Congresswoman connected to Opus Dei has submitted a bill to the Congress to ban the promotion, sale, and use of emergency contraceptive pills, including both dedicated EC products and the oral contraceptive pills used for Yuzpe.
The CLAE Coordinator, Rossina Guerrero, is following the situation and is in close contact with organizations from Honduras like Centro de Derechos de Mujeres de Honduras and CLADEM. The women’s and the SRHR movements in Honduras are not very strong and CLAE is endeavoring to be supportive of the few local organizations that are working on these important topics.
EC ban in Chile rouses thousands to demonstrate
23 April 2008
On Tuesday, April 22 2008, approximately 10,000 people marched in Santiago Chile to protest the decision of the Constitutional Court to ban free distribution of EC at government health centers. Additionally, about 80% of public health workers walked off their jobs to protest the high court ruling.
The decision of the court was formalized on Friday, April 18 2008, and put an end to a program started by President Michelle Bachelet, the first female president of the socially conservative country and a former pediatrician, aimed at making contraception more widely available to low-income women. This decision can not be appealed.
The court ruling did not ban sales of the drug in private pharmacies, where it costs about $25. Bachelet's administration has commented that having EC available only in the private sector is discriminatory against poor women. Read more in the International Herald Tribune or visit the CLAE website for detailed information in Spanish.
DHS: EC knowledge low in developing countries
16 April 2008
A new report, Contraceptive Trends in Developing Countries, examined trends and differentials in key family planning indicators in 35 developing counties. Results of this study indicate that knowledge of contraception is almost universal in most countries, yet knowledge of EC, despite increases over time, remains considerably lower.
The percentage of currently married women who reported knowing about EC was substantially lower than the percent of women who reported knowing about other modern contraceptive methods, such as condoms and pills. Knowledge about EC was especially low in sub-Saharan Africa. Knowledge of EC among married women ranged from a low of only four percent in Mauritania and six percent in Mali and Madagascar, up to 29% of women in Ghana. While still low, women in Latin American and the Caribbean countries were more likely to report knowing about EC; for instance, 35% of married women in Colombia knew about EC. This report highlights the need to raise awareness about EC as a component of family planning and reproductive health in developing countries. ICEC commends the organizations conducting DHS for gathering this important data.
EC debate in Italy continues
16 April 2008
In the Tuscan city of Pisa, two women were recently denied access to EC by physicians. In the first case, a young woman who went to a public health clinic the day before Easter Sunday found a notice on the door stating, “This office does not prescribe the so-called morning-after pill.” A few days later, another woman was declined a prescription by a doctor on emergency duty at a nearby Pisa hospital. This is not the first time that women have experienced difficulties in obtaining EC in the area.
Because EC requires a prescription in Italy, physicians play a vital role in ensuring its access. The two recent cases of denied access to EC in Pisa will be investigated by local health officials and public prosecutors in the up-coming weeks. The two doctors were questioned by the local health manager responsible for both the clinic and the hospital. Tuscany's regional councilor for health, Enrico Rossi, said on Wednesday that access to the morning-after pill was a woman's right and that doctors were obliged to ensure it was respected. He urged regional health managers to make sure that their staff were aware of their obligation to provide a prescription if requested.
EC closer to over-the-counter status in Canada
16 April 2008
Paladin Labs Inc. announced on April 15 that the National Drug Scheduling Advisory Committee (NDSAC) has recommended Paladin's application to move Plan B(r) from Behind-the-Counter status to full Over-the-Counter (OTC) status to the National Association of Pharmacy Regulatory Authorities (NAPRA). Currently, Canadian women need to request EC from a pharmacist. If the change is accepted, women would be able to purchase Plan B(r) just like any other OTC product.
EC is more effective the earlier it is taken, so fewer barriers to access can improve women’s ability to use EC in a more timely and effective way. Plan B(r) meets requirements for OTC availability: it is safe, easy to use, and has no contra-indications. Moreover, the package instructions have been shown to be easy for women to understand and follow.
ICEC recommends that EC should be made available without a prescription. Many leading Canadian health organizations, including the Society of Obstetricians and Gynecologists of Canada, the Canadian Federation of Medical Women and the Canadian Association for Adolescent Health, are supportive of making Plan B(r) available on pharmacy shelves as an OTC drug (Schedule III) as it is a safe and effective emergency method to prevent unintended pregnancy.
Brazilian government dispenses EC and condoms during Carnival
19 March 2008
ECPs were distributed at public clinics in the city of Recife throughout the four days of frenzied partying of Carnival. Similarly, in Sao Paolo during 2007, the Brazilian government distributed ECPs in the city metro stations and cut the price of birth control by 90 percent at pharmacies.
ECP distribution is a part of the Brazilian government’s move to put issues of reproductive health in the social mainstream. The government’s contraceptive plan during the Carnival included ECP distribution and giving out 19.5 million condoms. The supportive role of the Brazilian government to ensure access to reproductive health resources, despite open opposition from the Catholic Church, sets the country apart from many other nations in the region.
The uncertain future of EC in Chile
19 March 2008
In 2006, the Chilean Ministry of Health (MoH) launched the National Guidelines on Fertility Regulation, including the free provision of EC to women and adolescents older than 14 without parental consent. The following year, a group of opposition members of parliament appealed these regulations in the Constitutional Court. This appeal aimed to prohibit EC, other contraceptive methods, and the provision of information and contraceptives to adolescents without parental consent. In November 2007, the Court listened to the arguments and now the judges must come to a decision.
If the judges rule in favor of the lawsuit, it would be a severe step back in public health and human rights for women, adolescents and couples in Chile. Such a decision would limit the rights of those who are most vulnerable because an adverse sentence on these MoH guidelines, would only affect service and contraceptive access in public health centers.
ICEC will share news as soon as the court reaches it decision.
EC access through pharmacies and clinical settings
19 March 2008
A study published in the March 2008 issue of Contraception compared the provision of emergency contraception pills (ECPs) through pharmacies and clinical settings. This study aimed to determine whether aspects of client satisfaction and subsequent sexual health outcomes differed when ECPs was accessed at one setting from another.
A recent study in South London surveyed women 4 months after accessing ECPs. Seventy percent of women who went to a pharmacy and 43.9% who went to a clinical service obtained ECPs within 24 hours. A greater proportion of women accessing ECPs at a clinical setting felt at least quite comfortable asking for ECPs, compared to those who went to a pharmacy. Those who obtained ECPs from a clinic also felt significantly better informed about both ECPs and their future contraceptive options, compared to the women who went to a pharmacy.
This study suggests that pharmacies are associated with more rapid access to ECPs whereas client satisfaction was greater among women accessing EC in a clinical setting.
Researchers Outline Challenges of Testing EC Effectiveness against a Placebo
12 February 2008
The best way to measure the absolute efficacy of any treatment is with a placebo-controlled randomized trial. In an efficacy trial of emergency contraceptive pills (ECPs), women who had recently had unprotected intercourse would be assigned to take either the active drug or a placebo, and the proportion of women subsequently becoming pregnant in the two groups would be compared. Such a study has never been done for ECPs; rather, pregnancy rates found in EC trials are compared with separate data sets of expected pregnancy rates.
A paper by Elizabeth Raymond et. al. in the February 2008 issue of Contraception determined that there would be substantial challenges in identifying eligible participants for a placebo-controlled randomized trial. These challenges would make such a trial time consuming and expensive. In addition, since the effectiveness of ECPs has already been proven in other types of studies, there would be ethical challenges to testing ECPs against a placebo. Given this, the "gold standard" of a placebo-controlled randomized trial may not be a realistic goal for ECPs.
What do Jamaican and Barbadian Health Care Providers Say About EC?
11 February 2008
A survey of Barbadian and Jamaican health care providers and pharmacists in 2005-2006 revealed that nearly all respondents had heard of EC and that a large majority had provided the method. The study, published by Eileen Yam et. al. in the December 2007 issue of International Family Planning Perspectives, also found that about half had refused to dispense EC on occasion for medical and safety concerns or due to limited supply, and misinformation was rampant. Only one in five providers knew that the method could be safely used as often as needed, and few knew that it was still somewhat effective if taken within 120 hours of unprotected sexual intercourse. Half of all providers believed that its use encourages sexual risk-taking and leads to increased STI transmission. Nonetheless, most respondents believed the method was necessary to reduce rates of unintended pregnancy and were willing to dispense it to rape victims, women who had experienced condom failure and women who had not used a contraceptive.
The authors concluded that future educational efforts among Jamaican and Barbadian health care providers and pharmacists should emphasize the safety of emergency contraceptive pills, encouraging increased availability of the method. The study findings also suggest a need to clarify misconceptions about the impact of EC on sexual-behavior.
In The US, States Ensure Access To And Information On EC
January 2008
In 2007, several states in the U.S., including Connecticut, Oregon, and Colorado, passed laws that require all hospitals, including those associated with the Catholic Church, to inform sexual assault survivors about emergency contraception (EC).
EC Gel May Provide a New Method to Prevent Pregnancy
January 2008
In the August 2007 issue of Contraception, Vivian Brache et. al. reported on the effects of adding levonorgestrel (the primary ingredient in ECPs) to Carraguard vaginal gel. The gel was administered in a single dose at different stages of follicle development of the ovulatory process. Carraguard is being studied for HIV prevention. The findings of this study suggest that a “single vaginal administration of 0.75mg levonorgestrel in Carraguard gel in the late follicular phase is effective for interfering with the ovulatory process.” Thus, it may be a potential candidate for ‘dual protection,’ offering both pregnancy and HIV prevention.
Chile Government Ensures EC Availability
January 2008
In an on-going debate over access to emergency contraception (EC) in Chile, the Deputy Health Minister, Lidia Amarales, warned pharmacy owners that the government would close pharmacies refusing to fill prescriptions. This was a result of several major pharmacy chains failing to sell EC in recent weeks. These pharmacies argued that they were not able to fill prescriptions because they could not buy stocks locally. In response the government imported stock in the pills, fined the pharmacies 34 million pesos (USD$68,000), and warned that refusing to provide pills would result in closure.
The sale of EC has been highly controversial in Chile and has been challenged repeatedly in the courts by conservative and religious groups. One of the pharmacy chains, Salcobrand, said the government’s actions were a violation of its freedom of opinion about the pill. More specifically, the company stated that not selling EC was a form of ‘conscientious objection.’
ICEC comments: EC necessary after rape
October 14, 2007
The ICEC Coordinator published an letter in the New York Times today, in response to news coverage of the horrific epidemic of rape in the Congo. EC must be offered to all victims of sexual assault, no matter where they live, giving them an important "second chance" to prevent pregnancy, the letter stated.
To the Editor:
While the situation in Congo is extreme in its brutality and pervasiveness, the sickening fact is that rape has been widely used as a tool of war (most notably in Kosovo, Rwanda and Darfur) and is all too common in our own communities. Pregnancy can be a second trauma for rape victims, but its risk can be greatly reduced by prompt use of emergency contraception. Yet women are often denied emergency contraception after rape.
It was estimated that during the 1990s, only one-fifth of women being treated for rape in United States emergency rooms were offered emergency contraception, and Catholic hospitals in many states are still withholding this contraceptive method from women in their care. Anecdotal evidence suggests that women in many developing-country settings face similar difficulties accessing this safe “second chance” to prevent pregnancy.
Until we consistently provide emergency contraception in emergency rooms (including those in Catholic hospitals) and in refugee camps around the world, we are failing women during a time of desperate need.
Elizabeth Westley
New York, Oct. 7, 2007
ICEC Panel at Women Deliver
October 2007
ICEC is coordinating a panel at Women Deliver, a landmark global conference that will focus on creating political will to save the lives and improve the health of women, mothers and newborns around the world.
The panel will take place on Friday, October 19th, 12:30 pm – 1:30 pm, in room SG13. It be moderated by Elizabeth Westley, the ICEC Coordinator, and will feature presentations from Latin America and the Arab World, as well a presentation on new approaches to distributing EC.
PRESENTERS
Lester Chinery, Managing Director, ICON, International Planned Parenthood Federation (IPPF), United Kingdom Getting Emergency Contraceptive into Women’s Hands: New Approaches to Introducing Emergency Contraception with Local Partners
Angel M. Foster, DPhil, MD, AM; Associate, Ibis Reproductive Health, United States of America Building the Case for Expanding EC Access in the Arab World
Angela Heimburger, MPH; Americas Researcher, Women’s Rights Division, Human Rights Watch, United States of America Access Under Threat: The Politics of EC in Latin America
Veronica Schiapacasse, Licensed Midwife, MPH; Executive Director, Prosalud Foundation, Chile Challenges to EC Access in Latin America: Service Delivery and Policy Issues
ICEC Panel at Global Health Council
22 May 2007
Over the past 10 years, ICEC and its member organizations have amassed a wealth of experience and developed diverse strategies to expand access to this important contraceptive method. Four ICEC members will take part on a panel on expanding access to EC at the Global Health Council's Annual Conference. This panel describes partnerships that respond to sexual assault (Zambia), establish supply networks (East and Central Africa), advocate for policy change (the Caribbean), and work broadly at the national level (Mexico). Please join us on May 31st, 2007, at the Omni Shoreham Hotel in Washington DC (conference registration required).
EC Again Challenged in Chile, Other Contraceptive Methods at Risk
13 April 2007
In an on-going battle over access to EC in Chile, a group of parliamentarians opposed to the Bachelet government has submitted a third petition to the Constitutional Court. This petition focuses specifically on blocking implementation of new national norms for fertility regulation of the Ministry of Health. This time, they are requesting that the court not only prohibit EC, but also copper IUDs, levonorgestrel-releasing IUDs, and all oral contraceptives that contain levonorgestrel. The petition centers on the assertion that these contraceptive methods have an abortifacient effect. Abortion is prohibited under Chile’s constitution. The petition also requests the prohibition of counseling to youth under 18 years of age without parents' consent, asserting that such counseling would harm the right and preferential duty of parents to educate their children. Once the Constitutional Court issues a decision, there is no possibility of appeal. The decision to remove most contraceptive methods from the public health system would prove disastrous for Chile’s women, especially those who are most poor and vulnerable.
Awareness of Hormonal Emergency Contraception among Kuwaitis
07 March 2007
Virtually no data exist on knowledge and use of EC in the Arab world. Three recent papers investigated awareness and perceptions of hormonal emergency contraception among married women outpatients in a maternity hospital, married women within a Kuwaiti extended family and their social contacts, and among retail pharmacists in Kuwait, using a self-administered questionnaire in all studies.
These papers are especially significant, explains Angel Foster, the EC Coordinator for the Arab World Regional Network, since "the research conducted by this team makes an important contribution to the small but growing body of research on emergency contraception in the Arab world. As few studies have examined attitudes toward and knowledge of EC in the region, these articles have the potential to serve as a valuable resource for researchers and advocates working to increase access to EC both in the Gulf and in the region as a whole.”
The above articles were authored by Douglas E. Ball, Najlaa Marafie, and Eman Abahussain.
ICON distributes EC in Chile
07 March 2007
Optinor, the emergency contraception (EC) pill distributed by ICON, arrived in Chile this week, becoming the only EC product currently available in Chile. ICON, the wholly-owned subsidiary of IPPF, worked with a generic manufacturer to produce Optinor, a high-quality, low-cost EC pill, to respond to the global need for more affordable and accessible EC.
In recent months, political debate surrounding access to EC in Chile has intensified, culminating in a ruling which allowed the no-cost provision of EC through public health services to women and girls aged fourteen and over. However, with other brands withdrawn from the market, access to EC was limited until the arrival of Optinor. Formal registration of the product is underway. Until then, Asociación Chilena de Protección de la Familia, (APROFA), the International Planned Parenthood Federation (IPPF) Member Association in Chile, has received an emergency resolution from the ISP (Public Sanitary Institution) to distribute Optinor as of this week. APROFA has acquired 10,000 boxes of Optinor to meet the initial demand for EC and to ensure access to EC.
Presidential Decree in Chile Allows EC Distribution to Minors
31 January 2007
On January 29th, Chile's President, Michelle Bachelet, signed a decree allowing a plan announced last year to move forward. This is the most recent step in a political and legal battle between Bachelet's government and conservative forces in Chile. On September 2, 2006, the Chilean government issued new norms for public hospitals and clinics, specifying that women and girls 14 and over can obtain birth control, including emergency contraception, free of cost from public health centers. Under the norms, girls 14 and over are to be able to obtain birth control without parental authorization. The measure, announced by the Health Minister, is aimed at reducing Chile's high rates of adolescent pregnancy. On September 13, a court issued a temporary injunction on the free distribution of EC and on distribution to minors, pending lawsuits. On September 21, an appeals court overturned the injunction, allowing the government's plan to go forward. However, two weeks ago, the Constitutional Court ruled that the health minister did not have the power to implement the new norms, and distribution was again halted. Before the new norms were introduced, EC was available in pharmacies with a prescription for a cost of about $20, and was available free only in cases of rape.
At its November 2006 meeting, IPPF’s International Medical Advisory Panel (IMAP) discussed the recent claim that, despite making emergency contraception more widely available, the UK and other countries have experienced no reduction in the rates of abortion or unintended pregnancy. This Comment responds to the claim by reviewing the existing evidence and concludes that emergency contraception remains an important option. The Comment concludes by upholding the existing IMAP Statement on Emergency Contraception and that no change in current guidance is warranted.
EC Training Manual for South East Asia
December 13 2006
The Population Council and partners have produced a training manual and accompanying PowerPoint presentation for South East Asia, based on experiences gained in introducing EC in Bangladesh. It aims to provide trainers with appropriate knowledge and skills on emergency contraceptive pills in a one-day curriculum, after which they will be equipped to train service providers and workers on emergency contraceptive pills. Clinicians and program managers who wish to provide emergency contraception services or become acquainted with the method also will benefit from this manual. In addition, the manual provides details about service delivery and counseling guidelines.
Clinical Trials of new EC Compound Launched in US
December 8 2006
HRA Pharma announced on December 7th, 2006, that Phase III clinical trials have been launched to study the effectiveness of a new EC compound, CDB-2914, which will be known as Ella. The trials will be conducted in the United States, at 16 Planned Parenthood Clinics. The study will be conducted in 2007 and will recruit over 1000 women.
Results of a successful double-blind comparison of CDB-2914, a progesterone receptor modulator, versus levonorgestrel for emergency contraception were published by Creinin et al in the November 2006 issue of Obstetrics & Gynecology. This study concluded that "CDB-2914 is at least as effective as levonorgestrel in preventing pregnancies after unprotected intercourse and has a similar side effect profile."
Australian Study Finds EC Knowledge Low
December 2006
In November, Helen Calabretto of the University of South Australia presented the results of a study she conducted to assess knowledge and awareness of EC among young people in Australia.
Dr. Calabretto surveyed more than 600 male and female university students, and found that 75% believed that the pill must be taken the "morning after" - even though it is effective for as long as five days after unprotected intercourse. Fully half were not aware that EC does not cause an abortion, and only 35% knew that it is available directly from a pharmacist, even though a dedicated EC product has been available directly from a pharmacist since January 2002 - almost five years. "This study showed that women knew very little and the men knew even less," said Dr. Calabretto, who had recently returned to Australia from the ICEC Annual Meeting in New York. "That means people are missing opportunities to use it."
To counter low rates of knowledge and use, Dr. Calabretto recommended that EC be advertised directly to the public. She also suggested that the federal government consider offering the $40 pill free to teens under 18. "It is quite negligent to talk to young people about condoms and then not to talk to them about emergency contraception, especially when inexperienced users are the most prone to condom mishaps."
IPPF Launches New EC Pill at ICEC Annual Meeting
October 2006
The International Planned Parenthood Federation (IPPF) launched Optinor, its own dedicated Emergency Contraceptive (EC) product, at the annual International Consortium for Emergency Contraception (ICEC) meeting held on October 5th in New York.
Lester Chinery, Managing Director of the IPPF subsidiary ICON, informed ICEC members that the response from IPPF service providers had been overwhelmingly positive, with 66 of IPPF’s Member Associations expressing interest in providing Optinor. Optinor will be made available for public, social marketing and commercial programs in collaboration with IPPF Member Associations and other national partners.
George Griffith, Executive Director of the Barbados Family Planning Association, said he was pleased that women in the Caribbean would now have access to dedicated EC which would be made widely available in Barbados for any and all women who required it.
Non-prescription EC approved in the US for women 18 and over
24 August 2006
The US FDA announced on August 24, 2006 that it has approved the application for non-prescription sales of EC for women 18 and over. See the FDA’s press release here. The product will be made available through licensed pharmacies to women who show proof of age. The Kaiser Women’s Daily Health Report (accessible through our EC in the News page) provides details about the approval process, which has hinged on age. ICEC supports non-prescription access to EC; visit our Policy Statement on Improving Access to Emergency Contraception (available in English, Spanish, French and Russian) for details of our official position.
EC News from Kaiser updated daily
17 August 2006
Visitors to the ICEC website can view all EC news from Kaiser sources on our "EC in the News" page, within the media center. Stories are updated automatically as they are posted by Kaiser. ICEC thanks the Kaiser Foundation for allowing us to syndicate their news service.
Legal Challenges to EC in Ecuador
May 2006
In Ecuador, women's access to EC was, until recently, assured. The Ecuadorian Political Constitution (1998) includes sexual and reproductive rights; EC is listed as a family planning method in the Ministry of Public Health's Reproductive Health program; and as of 2002, EC was included in the protocol of assistance to victims of sexual violence.
However, in 2005 a claim was presented by an individual before the Ecuadorian Constitutional Court requesting the suspension of distribution of Postinor-2- Levonorgestrel 0.75, with the argument that EC challenged Ecuador's constitution. The Ministry of Health did not respond to the challenge or participate in this case. Scientific arguments and evidence presented in collaboration with women's and civil rights groups were ignored, as was a supportive letter from CLAE (the Latin America Consortium for Emergency Contraception) and support from FLASOG (the Latin American Federation of Obstetric and Gynecological Societies). Instead, in May 2006, the Constitutional Court opted to accept the arguments of the individual plaintiff, which resulted in suspension of the registration of Postinor-2 for the Ecuadorian market. Now, certain anti-contraception groups are requesting the extension of the recent resolution of the Constitutional Court to all contraceptives made available by the Ministry of Health; other methods containing levonorgestrel may be particularly at risk.
East African journalist-to-journalist seminar on reproductive health and EC
June 2006
When EC receives attention in the African media, it is frequently sensationalized and informed by anecdotal evidence, unsubstantiated claims, and conservative ideologies. In Kenya, for example, one national newspaper reported that young girls were eating EC "like chocolate." To better inform this debate, ECafrique undertook a rapid diagnostic of EC use among Nairobi women, aged 14-25. Results of the surveys determined that repeat use of EC is not widespread, and there is not an epidemic of EC abuse among adolescents as reported. (View the case study and PowerPoint presentation on the ICEC Website here). To promote more consistent and objective reporting on EC, ECafrique, in conjunction with the US-based National Press Foundation (NPF) and the Population Reference Bureau, convened a skill-building workshop in Nairobi, Kenya from June 15-18, 2006. As part of the NPF's Journalist-to-Journalist program, this seminar focused on increasing journalists' overall awareness of reproductive health issues (including EC) while at the same time improving their ability to effectively convey this information to the public. Twenty-two leading health reporters from Kenya, Ethiopia, Uganda, Tanzania, and Malawi were selected for the 4-day training, which immediately preceded the 2nd Africa Conference on Sexual Health and Rights. At the conference, participants were able to test their newly-acquired skills under the guidance of top guest editors, filing reports for their home publications and contributing to the conference newsletter. A similar activity for francophone journalists in West Africa is currently being planned.
PATH releases updated client brochure
Spring 2006
PATH announces the online availability of its updated client brochure "It's Not Too Late to Prevent Pregnancy." The brochure is provided in 14 languages (Amharic, Arabic, Cambodian, Chinese, English, French, Haitian-Creole, Korean, Laotian, Portuguese, Russian, Somali, Spanish, Vietnamese), each with culturally appropriate illustrations. The updated information includes the extended effectiveness timeframe (up to 5 days/120 hours) and the effectiveness of a single dose (one 1.5 mg instead of 2 doses of 0.75 mg each) of the levonorgestrel-only regimen. The brochures can be downloaded on this site as 8.5 x 11 PDFs- for the A4 size brochures, visit PATH's EC Publications site.
IPPF/WHR update: EC and advocacy in the Caribbean
July 2006
International Planned Parenthood Federation, Western Hemisphere Region (IPPF/WHR) is currently working on a regional advocacy campaign to increase access to emergency contraception in the Caribbean. Member Associations in Barbados, St. Lucia and Trinidad and Tobago are working with IPPF/WHR to create comprehensive advocacy campaigns for national political change in relation to the provision of Emergency Contraception. The IPPF/WHR team conducted a political mapping exercise in each country, identifying all of the key political players and stakeholders to ensure that the most strategic advocacy efforts are made within each country context. Each country has an individual campaign that they will implement to improve access to EC. Some of the hoped-for results include having the Ministry of Health place EC on the national drug formulary so that all government centres offer EC by the end of the project and ensuring that EC is a part of the national rape victim treatment protocol.
Consortium member FHI publishes new report on EC and adolescents
February 2006
Family Health International has published a new working paper titled Adolescents and Emergency Contraceptive Pills in Developing Countries, available here to download.
EC launched in Indonesia by Consortium member DKT International
December 2005
DKT International launched Gideon Richter's Postinor 2 in December 2005 and will be making this available through their national distribution network. DKT will include EC in future training and outreach to midwives, pharmacists, and doctors (more than 5,000 midwives have been trained in the last 2-3 years) and will develop educational materials in Bahasa, Indonesia. There are an estimated 2 million abortions each year in Indonesia; DKT International hopes the availability of EC can help reduce these numbers.
ECafrique reports EC now available in five regions of Ethiopia
Winter 2005
The Ministry of Health, Ethiopian Society of Obstetricians and Gynecologists (ESOG), ECafrique (the African Consortium for EC), and the Concept Foundation continue to work towards mainstreaming EC services into the public and non-governmental sectors. Doctors and nurses have been trained and service provision is underway in the country's five main regions: Addis Ababa, Amhara, Tigray, Oromia, and SNNPR.
This project supports incorporating EC into the pre-training curriculum of nursing, medical and community health students at each of the country's leading medical schools. Small stipends are being offered to support student research on EC. ECafrique has also developed a CD-ROM of EC-related resources for students who wish to learn more about the method, but whose access to the Internet is limited. The CD-ROM covers EC technology, service delivery guidelines, training materials, and other topics. To compliment the focus on students and their research, the project is also sponsoring guest lectures and other initiatives to exchange information on EC.
Finally, efforts are underway to secure the registration of Postinor-2 with the Ethiopian Drug Administration and Control Authority. The local pharmaceutical firm, Beker Pharmaceuticals & Medical Supplies, submitted their application for registration of the product, thereby opening up the door for future importation of Postinor 2, once current stocks are exhausted.
ECafrique surveys women in Nairobi in response to anecdotal media claims of EC abuse
December 2005
The Kenyan media reported anecdotal stories about overuse of EC by young people; although unsubstantiated, this news item nonetheless had an impact on the national policy debate. To better inform this debate, ECafrique undertook a rapid diagnostic of EC use among Nairobi women, aged 14-25. Three hundred self-administered questionnaires were administered to university and high school students, as well as to a sample of 100 out-of- school women. In addition, a series of open-ended interviews were carried out with 10 pharmacists operating throughout the city. Data is currently being analyzed.
