ICEC hosting EC dissemination meeting in Nigeria

On 1 February, 2018 the International Consortium for Emergency Contraception (ICEC) hosted a meeting in Abuja, Nigeria with various stakeholders in the region, including the Federal Ministry of Health (FMOH).  The aim of this meeting is to share recent achievements and explore next steps for EC in Nigeria.

ICEC has been working in Nigeria with multiple partners since 2010 to increase access to EC, with a strategic approach focused on the policy, service delivery, awareness, provider, and community levels.  Under the current grant starting in 2014, ICEC advocated for EC to be included into Nigeria’s Essential Medicine List and provided technical assistance as Nigeria drafted their first-ever National Guidelines for Emergency Contraception.

Over the past year, there have been numerous activities by all partners to continue work in supporting these guidelines. Products that came out of this range from: client communications around EC, pharmacy detailing materials, and EC storylines inserted into radio dramas. These materials will be disseminated as we convene the FP/RH community to determine next steps for EC in Nigeria.

Prescription still needed in South Korea to access ECPs

A recent news article made the point that South Korea has emergency contraception (EC) in name only. While the article isn’t entirely accurate around side effects and other information, it makes some important points on EC access in South Korea.

During a review of their guidelines, South Korea’s Ministry of Food and Drug Safety made the decision not to update their national guidelines on emergency contraception pills (ECPs) in 2016, continuing to classify ECPs as a prescription drug available only with a doctor’s prescription.  This is in contrast to WHO’s EC factsheet, stating that ECPs are safe for over the counter access.

The ministry had concerns over possible misuse or overuse of the EC pill, citing the fear of “a socially more accepting attitude toward sexual activities expected after the pill became available over the counter”. They also cited “a lack of public knowledge and possible side effects” as a barrier to moving it to over-the-counter status.

ECPs are extremely safe, even when used repeatedly, and side effects are relatively minor, benign and easy to manage. For more detail, see  ICEC’s Clinical Guidelines, ICEC – WHO Safety statement, WHO’s Medical Eligibility Criteria for Contraceptive Use, and ICEC’s Repeated Use Factsheet.

More up-to-date information on availability of EC in South Korea can be found in our Status and Availability Database. Two regimens of LNG ECPs are available, detailed in ICEC’s  EC regimen update: a single pill of 1.5 mg, and two pills of 0.75 mg each.

Register for next ICEC Webinar on Contested Access: EC in Malta, Peru, USA and other challenging environments

Emergency contraception (EC) can be a flashpoint, and in many settings, opposition to EC access continues.  Since the 2000’s, attempts have been made to restrict access in the Philippines, Chile, Ecuador, the United States of America, Poland, Peru, Malta, Costa Rica, Honduras, Guatemala, and Spain.

This webinar will share strategies and tactics used to confront or overcome political opposition to EC at different levels of the government. Presenters from Malta, Peru and the United States will discuss their experiences with product registration and license renewal, EC provision in the public sector, and exclusion in health insurance policies.

Speakers: 

Moderator: Cristina Puig, European Consortium for Emergency Contraception.

Malta, Opposition to product registration: Dr. Lara Dimitrijevic, Director, Women’s Rights Foundation.

Peru, Opposition to EC provision in the public sector: Karen Anaya, Lawyer, Promsex.

USA, Opposition to EC in health insurance and the Affordable Care Act: Mara Gandal-Powers, Senior Counsel, National Women’s Law Center.

Date: Thursday, January 25th, 2018

Time: 10 am EST USA (Lima, Washington DC), 4 pm CET (Barcelona, La Valetta, Warsaw).

Register: http://bit.ly/2mqTe8D

Webinar: Do women have access to emergency contraception in crisis settings?

Do women have access to emergency contraception in crisis settings?

EC is a lifesaving treatment essential in reproductive health programming in all stages of a humanitarian crisis, when health systems and regular contraceptive access are disrupted and when the risk of unintended pregnancy increase, along with sexual assault and transactional sex. However, multiple barriers to access are exacerbated in crises.

This webinar will provide a global overview of EC access in crisis settings, and include findings from research projects in Africa, Asia and the Middle East, among Congolese, Syrian, and Rohingya refugee women and girl refugees.

Register via this link and join us on Friday, 12 January, 2018 at 10 a.m. Lima, New York EST (7 am Seattle, 3 pm London, 4 pm Abuja and Brussels, 6 pm Nairobi, 8:30 pm New Delhi).

Presenters include:

  • Melissa Garcia (ICEC) will present a global overview of EC in crisis settings
  • Ruth Nara (University of Ottawa, International Development Research Centre) will discuss EC findings among Congolese refugees in Uganda
  • Mona El-Mowafi (University of Ottawa, Cambridge Reproductive Health Consultants) will describe EC knowledge, attitudes and provision among Syrian refugees in Jordan
  • Angel Foster (University of Ottawa, Cambridge Reproductive Health Consultants) present EC findings from RH needs assessment with Rohingya women and girls in Malaysia

Discussant:
Sarah Rich, Women’s Refugee Commission

New ICEC webinars in the New Year

As we celebrate a new year, ICEC would like to thank all of our members, partners, and colleagues who have worked so diligently with us this past year.

We would also like to include a special thank you to all those who have contributed in our recent webinar series on emergency contraception. In case you missed the last two, you can listen to the previous webinar recordings at this link . This past year our webinars discussed: data around EC knowledge and use and pricing of EC. We look forward to continuing our work in the New Year and continue sharing with everyone the great work being done around EC.

We hope to see you on our next webinar “Do women have access to emergency contraception in crisis settings? Global and local perspectives”. Register via this link and join us next year on Friday, 12 January, 2018 at 10 a.m. Lima, New York EDT (7 am Seattle, 3 pm London, 4 pm Abuja and Brussels, 6 pm Nairobi, 8:30 pm New Delhi).

Happy wishes for a prosperous new year from the ICEC team!

Webinar: Do women know about emergency contraception? Are they using it?

The question of how many women are using emergency contraception is not easily answered; data on use of EC are scarce and not easily comparable with data on use of other contraceptive methods. This makes assessing progress and impact challenging. At the same time, we do have consistent information from less developed countries on how many women are aware of emergency contraception, and these numbers are still surprisingly low.

To learn more, register here for our next webinar featuring data on EC use and awareness from PMA2020 and DHS, including an introduction from FP2020 drawing on the latest global progress report. Presenters include Alejandra Leyton of Tulane University and Jason Bremner of FP2020.

This webinar will take place on Thursday December 14th at 10 am EST (7am Pacific Standard Time, 3 pm Greenwich Mean Time, 4 pm Central European Time/West African Time, 6 pm East African Time).

New WHO Guidance on the Intersection of Systems Strengthening and Sexual Violence

On 25 November, the International Day for the Elimination of Violence against Women, and as part of the #16days of Activism to End Gender-Based Violence, WHO launched a new manual for improved quality of care to survivors of violence: Strengthening health systems to respond to women subjected to intimate partner violence or sexual violence: A manual for health managers. It is based on the WHO guidance on care for survivors of intimate partner violence and sexual violence (2013) and on the WHO health systems building blocks (2007).

The new manual highlights the importance of leadership, governance and accountability as an overarching principle and considers issues of policy change, budgeting and financing, community engagement and sectoral coordination. It addresses strengthening the healthcare workforce and improving supplies infrastructure for service delivery. The manual includes information on data, monitoring and evaluation, and scaling up. It also considers the diverse access points for survivors in need of services (pharmacies as well as facility-based) and what information needs to be provided to them.

Emergency contraception is included in the comprehensive, concrete approaches that stakeholders can take to ensure access to essential treatments throughout.

“Access to emergency contraception is a core element of the response to violence against women. Work with pharmacies to determine which formulations are available on the market and can be procured. Accordingly, determine what information about dosage and timing needs to be provided to women. Ensure that your staff have the correct information and are able to provide this information to women who need emergency contraception. You may consider developing a written policy to support best practices regarding provision of emergency contraception”

  • Policymakers can ensure that commodities for post-rape care, such as EC, are included on national essential medicines lists (see ICEC/RHSC/UNCoLSC EML Search tool).
  • Health services managers can ensure EC is on all lists and forms throughout the health system to prevent stock-outs or expirations, issues which EC pills have faced (EC is included in the related job aid). The guidance also notes the emergency reproductive health kits that are procured for humanitarian settings (Kit 3), which include ECPs.
  • Overall, stakeholders should “align the health system response with legal frameworks, including identifying and redressing procedures or policies that are barriers to access –such as requiring police reports before providing EC.”

As additional resources from ICEC, please see this fact sheet on EC for survivors of sexual assault and this blog post on barriers to access.

Register for ICEC Webinar Series

Please join ICEC for a series of webinars on various topics related to emergency contraception, hosted from November 2017 – February 2018.

We plan to offer updates and exchanges on a number of topics including clinical updates, EC in humanitarian settings, current data on knowledge and use of EC, and much more.

In addition, we will be offering webinars in both Spanish and French.

The first webinar will be on pricing. “Is EC Affordable? A Global Webinar” will be held on December 6th at 11am EST. Please register at this link.

Around the world, most women who use EC pay full market price in the
private sector. In many countries, that price is very high.

This webinar explores the issue of price of EC and will bring together
three speakers:

  • Bryan Shaw will present information on the price of EC in DR Congo,
    Ethiopia, India, Myanmar and Nigeria, the results of FPWatch, an in-depth
    audit of all private sector outlets (pharmacies and clinics).
  • Elizabeth Westley from ICEC will describe results of a global survey
    (funded by the Reproductive Health Supplies Coalition) that found that
    women are paying a high percentage of their weekly income to buy EC – with
    the highest relative prices being in Francophone Africa and Central America.
  • Clare Murphy of bpas will present an advocacy campaign, “Just Say Non
    <https://www.justsaynon.org.uk/>,” undertaken in the UK to pressure
    pharmacy chains to lower the price of EC.

This promises to be a fascinating and lively webinar – please join us at
11am US EST on December 6th (8 am Seattle, 11 am Lima, 4 pm London, 5 pm
Abuja and Brussels, 7 pm Nairobi, 9:30 pm New Delhi).

For a preview, please check out our new brief: Is emergency contraception
affordable and equitable for women in developing countries?

WHO includes EC in new guidelines on adolescent survivors of sexual abuse

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.

Launch of Nigeria’s National Guidelines for Emergency Contraception

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)”