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Emergency Contraception in National Essential Medicines Lists

2016
Publication type: EC Policies, Access, and Awareness
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Emergency Contraceptive Pills (ECPs) are an essential component of women’s reproductive health. They offer women an important second chance to prevent pregnancy when a regular method fails, no method was used, or sex was forced. Research over the past 30 years has shown that ECPs are safe and effective.

The most recent (April 2015) World Health Organization’s Essential Medicines List (EML) includes one form of ECP, containing levonorgestrel (LNG) as an active ingredient. While other drugs can be used for EC, only the LNG form is listed by the WHO at this time. The WHO list includes two regimen options for LNG ECPs: two tablets of 0.75 milligrams, or one tablet of 1.5 milligrams (mg). (These may also be written as 750 micrograms and 1500 micrograms (μg).) Either regimen can be used; although the two-pill regimen is labeled for the pills to be taken 12 hours apart, the current recommendation is for both pills to be taken together as a single 1.5 mg dose.

A new drug used for emergency contraception, called ulipristal acetate (UPA), is included in one country’s EML but is not included in the WHO EML at this time.

A number of countries have shared their national EMLs on the WHO website1; others have been shared via personal correspondence. Those that include ECPs are listed below, with the year of publication; two countries specify a different method of EC, based on taking a higher dose of regular oral contraceptives (called the “Yuzpe” regimen). The countries whose EMLs are available but do not include EC are also listed. However, the fact that a country does not include EC in its EMLs does not mean there is no product registered or on the market. For those countries with no EC listed in its EML, we have listed whether or not EC is available locally.

Of the 118 countries with available EMLs, 62 countries are known to list ECPs:

6 include only the 1.5 mg dose 38 include only the 0.75 mg dose  
12 include both the 1.5 and 0.75 mg doses 5 include LNG but do not specify the dose 
1 includes UPA EC
2 include the Yuzpe regimen (high dose of regular oral contraceptives as EC)

56 countries do not include ECPs. Of these, 7 do not include any contraceptives

6 National EMLs are known to include only the 1.5 mg LNG ECP regimen:

Brazil: 2010 Ghana: 2010 Sweden: 2011
Cook Islands: 2007 Peru: 2010 Tunisia: 2008

38 National EMLs are known to include only the 0.75 mg LNG ECP regimen:

Algeria: 2007 Haiti: 2012 Senegal: 2008
Armenia: 2010 Iran: 2009 Seychelles: 2010
Bhutan: 2012 Jamaica: 2008 Solomon Islands: 2010
Bolivia: 2011-2013 Kenya: 2010 South Africa: 2008
Burkina Faso: 2014 Kyrgyzstan: 2009 Sri Lanka: 2009
Cape Verde: 2009 Malawi: 2015 Sudan: 2007
Chile: 2005 Mali: 2008 Suriname: 2014
Dem. Rep. of Congo: 2010 Mexico: 2009 Thailand: 2008
Dominican Republic: 2005 Nauru: 2010 Tuvalu: 2008
Ethiopia: 2015 Nicaragua: 2009 Uganda: 2012
Fiji: 2006 Niue: 2006 Zambia: 2013
Gabon: Year unknown Paraguay: 2009 Zimbabwe: 2011
Georgia: 2007 Rwanda: 2010

12 National EMLs are known to include both the 1.5 and 0.75 mg LNG ECP regimens:

Cameroon: 2009 Laos: Year unknown Pakistan: 2007
Colombia: 2011 Moldova: 2009 Russia: Year unknown
Congo: 2013 Myanmar: 2010 St. Vincent & the Grenadines: 2010
Ecuador: 2011 Nepal: 2009 Tajikistan: 2009

5 National EMLs are known to include LNG ECPs without specifying indication or dose:

Belize: 2009-2011 China: 2007 Ukraine: 2009
Central African Rep.: 2009 Syria: 2008

2 National EMLs are known to include the Yuzpe regimen (high dose of regular oral contraceptives as EC):

Tanzania: 2013 Zimbabwe: 2011

1 National EML is known to include UPA ECPs:

Sweden: 2011

56 National EMLs are known NOT to include ECPs:

Afghanistan: 2007 Guyana: 2009-2010 Nigeria: 2010 (EC product registered)
Angola: 2008 (no contraceptives in EML; no EC product registered, but allows for import with license) Honduras: 2009-2011 North Korea: 1999, list for international agencies (no contraceptives)
Argentina: 2005 (EC product registered) India: 2011 (no contraceptives in EML, but EC product registered) Oman: 2009
Bahrain: 2009 Indonesia: 2008 (Listed as removed since 2005 edition) (EC product registered) Palau: 2006
Bangladesh: 2008 (EC product registered) Iraq: 2010 Papua New Guinea: 2002
Barbados: 2011-2012 (EC product registered) Jordan: 2009 Philippines: 2008
Botswana: 2012 (EC product registered) Kiribati: 2009 Poland: 2009 (EC product registered)
Bulgaria: 2009 (EC product registered) Lesotho: 2005 (no contraceptives in EML, but EC product registered) Serbia: 2010 (EC product registered)
Burundi: 2012 (no EC product registered, but allows for import with license) Macedonia: 2010 (no contraceptives in EML, but EC product registered) Slovakia: 2010 (EC product registered)
Cambodia: 2003 (EC product registered) Madagascar: 2008 (EC product registered) Slovenia: 2010 (EC product registered)
Chad: 2007 (no EC product registered, but allows for import with license) Malaysia: 2008 (EC product registered) Somalia: 2006 (no contraceptives in EML)
Cote d’Ivoire: Year unknown (EC product registered) Maldives: 2009 Timor Leste: 2004
Croatia: 2010 (EC product registered) Malta: 2008 Togo: 2012 (EC product registered)
Djibouti: 2007 (EC product registered) Marshall Islands: 2007 (no contraceptives in EML) Tonga: 2007
Egypt: 2006 (EC product registered) Mauritania: 2007 (EC product registered) Trinidad and Tobago: 2010 (EC product registered)
El Salvador: 2009 (EC product registered) Montenegro: 2011 (EC product registered) Uruguay: 2011 (EC product registered)
Eritrea: 2010 Morocco: 2008 (no contraceptives in EML, but EC product registered) Vanuatu: 2007
Guinea-Conakry: 2013 (EC product registered) Namibia: 2008 (EC product registered) Venezuela: 2004 (EC product registered)
Vietnam: 2008 (EC product registered) Yemen: 2007 (EC product registered)

 

 

1 World Health Organization. “National Medicines List/Formulary/Standard Treatment Guidelines.” Website: www.who.int/selection_medicines/country_lists/en/index.html.

A note on methodology: ICEC downloaded all the available EMLs from the WHO website in October 2015 and used the “find” function to search for the following key words: levonorgestrel, ulipristal acetate, norgestrel, contraception, and emergency contraception.