WHO has published new Clinical Guidelines “Responding to children and adolescents who have been sexually abused” to orient health workers in providing quality clinical care to child and adolescent survivors of sexual abuse. (Pour le moment, en anglais seulement)(Por ahora, sólo en inglés.)
The most relevant sections to emergency contraception starts on page 28, which details “pregnancy prevention and management among girls who have been sexually abused”. The existing recommendation for providing EC to women applies to girls in the following conditions: 1) those who have attained menarche and who are in the beginning stages of puberty (i.e. Tanner physical developmental stage 2 or 3), and 2) those who have been exposed to forced sex involving penile-vaginal penetration.
The document outlines: the timeframe and the diversity of EC regimens, pills (LNG, UPA, Yuzpe), and copper-IUD; the safety of the treatment, particularly compared to the potential harms in the absence of treatment; and that pregnancy testing is not required.
For details relevant to this topic, please review the following ICEC documents: Medical and Service Delivery Guidelines; EC for survivors of rape; and Questions and Answers for Decision-makers, with a brief section on adolescents and young people.
Today, the Federal Ministry of Health of Nigeria launched Nigeria’s National Guidelines for Emergency Contraception. Nigeria was one of the first countries in the world to make emergency contraception available to women;the Society for Family Health began distribution through pharmacies and drug vendors 20 years ago and important research on EC has been conducted in Nigerian universities. However, until recently, EC was not available in the public sector or procured by the government. This is now changing and these new Guidelines support and clarify the role of different sectors in providing EC to Nigerian women.
Continue reading for an outline of Nigeria’s National Guidelines on Emergency Contraception.
The Guidelines outline roles & responsibilities for various sectors and stakeholders. For example:
- That the public sector create “an enabling policy environment (including promotional efforts) to increase access to and awareness of EC”
- That the private/commercial sector and social marketing sector “support… innovation for improved demand and supply for EC”
- That donors “support NGOs and technical assistance agencies to continue to improve access to EC in Nigeria”
- Various cadres have a role for providing EC pills: physicians, pharmacists, nurses/midwives, community health workers and distributors, and non-clinical workers, regarding referral and provision for family planning needs and sexual assault response
The Guidelines outline recommendations to all stakeholders on the various priority areas. For example:
- For access: “Ensure that there is no age restriction for accessing EC as long as the person is exposed to unprotected sex”
- For awareness and promotion: “Law makers, policy makers and other stakeholders should create enabling environment for media promotion of ECP in Nigeria;” and that “indigenous languages should be used to promote EC in an integrated manner in Nigeria.”
- For procurement: “Ensure deliberations on EC as a standing item on the agenda of the regular Reproductive Health Technical Working Group Meetings.”
- For service provision: “Service protocols [should be updated] with current EC information.”
- For training: “There should be Pre- and In-service training for all service providers including CHEWs, nurses, midwives, and clinicians, in alignment with National Task Shifting Guidance.”
- “Develop a national curriculum for non-clinical health service providers on Especially PPMVs, Technicians and Law enforcement agents”
- For M&E: “EC should be captured in LMIS tools (HMIS, DCR, FP register, tally cards and RIRF)”
The American Society for Emergency Contraception (ASEC) is currently conducting a survey on EC access and pricing across the United States. Current US regulations allow levonorgestrel ECPs to be sold directly on the shelf to women and men of any age with no restrictions, yet reports from around the US found that this is not always the case.
A call for help was issued for anyone who is in the United States and is interested in helping to collect data on ECPs in their local community. All that is needed from a participant is to take a trip to a local pharmacy and answer a few questions in a google survey on how levonorgestrel EC is being sold and how much it costs.
We are interested to see the results on whether store personnel still believe that restrictions based on age or gender exist, and whether consumers need to show ID to purchase EC in the US.
If you would like to be part of this activity, you can email Kelly (email@example.com) or Jamie (firstname.lastname@example.org) to obtain the survey or with any questions you have.
PMA2020 uses mobile technology to support low cost, rapid-turnaround surveys to monitor key indicators for family planning in select countries. The PMA2020/Nigeria team recently released findings from the 2017 survey, which was conducted April to May this year.
Key family planning indicators are now available from five states (Anambra, Kaduna, Lagos, Nasarawa, Taraba) as well as nationally representative estimates. Emergency contraception is included in the question regarding which modern method contraceptive users are utilizing.
At the national level, the rate of current EC use found in round 2 data collection was 10.6% for unmarried women and 3.7% for married women. While EC rates for unmarried women are not available within the individual states during round 2, the highest rate of EC use for married women is found in Anambra at 6.9% and the lowest rate is in Lagos at 3.4%.
For more information on family planning indicators from each state, click on the links below:
With the current largest generation of young people, there is much to celebrate on August 12, International Youth Day. In particular, there is the growing recognition that as agents of change, adolescents and young people and their organisations are essential stakeholders who contribute to inclusive, just, sustainable and peaceful societies. Crucially, advocates working on sexual and reproductive health (SRH) and reproductive rights (RR) advance access for young people in meaningful ways.
Emergency contraception (EC), and EC pills in particular, are an important contraceptive method for young people for several reasons. First of all, it is an extremely safe method for all women of reproductive age to use, including adolescents. In general, adolescents and young people may face challenges that make EC access particularly critical. Since they may be discouraged from ‘planning’ for sex, they also lack information about how to access contraceptive protection and how to use it. Method failure may also occur. Girls and young women may have greater difficulty in negotiating contraceptive use with a partner. And, unfortunately, in many parts of the world, girls and young women are vulnerable to sexual coercion.
Yet access to this very safe and important method is an issue of heated debate in almost every region of the world. This is a real challenge, founded on widespread misunderstandings about EC’s safety, suitability for young women, and effects on behaviour.
Read the 8 Top Tips for Advocates Working on Emergency Contraception created to celebrate International Youth Day.
Collecting comprehensive data around adolescent health can be challenging. PMA2020 has recently published three adolescent & young adult health briefs from Kenya, Ghana, and Ethiopia. These briefs are snapshots of key indicators among young women, ages 15-24.
You can find data on use of emergency contraception in all three of these briefs, on the second page. In all three countries, there is a very high use of EC for unmarried under the age of 25, as compared to married women under the age of 25.
Other key indicators in the briefs include: level of education, median age at key reproductive events such as first sex and first contraceptive use, and modern contraceptive prevalence rate (mCPR).
Two weeks ago, we posted a news item on the British Pregnancy Advisory Services’ (bpas) campaign, “Just Say Non,” to lower the price of EC in the UK. This successful campaign resulted in the price reduction of EC pills at British pharmacy Superdrug and supermarket chain Tesco by 50%.
Responding to the campaign, the chief pharmacist for Boots (a major UK pharmacy chain) stated “We [Boots] would not want to be accused of incentivizing inappropriate use, and provoking complaints, by significantly reducing the price of this product.”
After vocal outcry over this “sexist surcharge”, with several female parliament members expressing their support for lower prices, and the threat of a boycott, Boots is now looking for a more affordable alternative to their regularly priced EC pill brand. For more information, here are select articles covering the developing story: The Guardian, Reuters, and two BBC articles (1) (2).
To seek out emergency contraception, women must know that the option of using a contraceptive method AFTER sex exists. Need for EC is often unplanned and urgent but the time frame for use is short. Therefore, individual knowledge or awareness of emergency contraceptive pills (ECPs) is a crucial precursor to their use.
ICEC has analyzed results from the Demographic and Health Surveys (DHS) and has published a new data brief, highlighting trends on women’s knowledge of emergency contraception. Country data for the years 2008-2015 were analyzed.
In 35 countries, a majority of women do not know that EC exists: less than a quarter of women have ever heard of ECPs. At a global level, although knowledge of EC is low, knowledge within countries has increased slightly. More concentrated efforts are needed to increase awareness of ECPs.
View ICEC’s analysis more closely in this new publication: http://www.cecinfo.org/icec-publications/knowledge-emergency-contraceptive-pills-remains-low/
This week, the London Family Planning Summit is discussing efforts towards the FP2020 goals to reach 120M more women and girls with contraceptives by 2020. Emergency contraception (EC) has an important role to play in a diversified method mix, which ICEC’s Elizabeth Westley discusses in this blog post, “An ounce of “after-sex” prevention: At the FP Summit, let’s talk about emergency contraception.”
We would like to congratulate the British Pregnancy Advisory Service (bpas) for their successful UK campaign to reduce the price of LNG EC and make it available directly on shelves in pharmacies. In November of last year, they launched their campaign “Just Say Non”, which highlights the high price of EC in the UK when compared to other prices in other parts of Europe. The campaign video can be seen at this link: http://www.justsaynon.org.uk/. In the UK, LNG EC can only be obtained from behind the counter after a consultation with a pharmacist and costs up to £30. Whereas in other parts of Europe, for instance France, EC costs five times less and can be bought for only 7 Euro.
The campaign wrote to four of the top retailers in the UK asking them to review their pricing strategy of generic EC last year. Retailers continue to sell generic brands of EC at the same high price as when the first brand of EC, Levonelle, came onto the market in 2003. Two of the four retailers agreed to lower the price, and Superdrug announced last week the launch of a generic ECP for half the price of other EC on the market. This story was featured in multiple UK papers like this one: http://metro.co.uk/2017/06/28/superdrug-is-selling-the-morning-after-pill-for-half-price-6740114/