PMA2020 surveys provide valuable new information on knowledge and use of emergency contraception. This issue brief analyses the levels of knowledge, use of, and access to EC in seven different African countries. Results show that knowledge of EC varies by country but that use remains low in all areas surveyed.
This section contains fact sheets, blog posts, technical statements, clinical guidelines, journal articles and publications focusing on policies and access. Several publications focus on sexual assault and humanitarian settings. For more information on specific themes, please visit the EC Issues Pages. Many of our publications are available in multiple languages.
While emergency contraceptive pills are labeled for single use, medical evidence suggests that they can safely be used multiple times in a cycle. Because ECPs work by delaying ovulation, they will not provide protection from pregnancy if unprotected intercourse occurs after ECPs have been used. Women who want to avoid pregnancy can take ECPs multiple times in each cycle with assurance that such use is safe; however, long-term or on-going methods are more effective at preventing pregnancy, and only condoms can prevent transmission of sexually transmitted infections. This fact sheet reflects the latest version of the World Health Organization’s Medical Eligibility Criteria (MEC), released in 2015.
This publication reviews new developments in emergency contraception research, including women’s weight and EC effectiveness, repeat use of EC, and the need for EC as part of comprehensive post-rape care. Clinicians can play an important role in making EC information and services available to women by providing accurate information about EC generally and the specific options that may be most effective for each woman, including levonorgestrel, ulipristal acetate and the copper IUD. Authors: Elizabeth Westley, Sarah Rich, and Hilary Lawton
This study examined knowledge and use of emergency contraception in 45 countries using population-based survey data. In every country surveyed but Colombia, fewer than 50% of women have ever heard of EC and fewer than 6% have ever used it. In general, the more educated women were or the wealthier they were, the more likely they were to have known about or used emergency contraception. Authors: Tia Palermo, Jennifer Bleck, and Elizabeth Westley
This review summarized evidence regarding current demand for on-demand oral contraception from 19 studies across 16 countries. In these studies, 9–97% of women in the analysis populations reported using the pills on demand as main method, although frequency and consistency of use varied. Reported reasons for interest in or use of this contraceptive approach included convenience, ease of remembering, ability to conceal use, lack of coital interruption, and infrequent sexual activity. Data from a variety of settings suggest that demand for an on-demand oral contraceptive may be widespread. The effectiveness of this potential method is not established, however. Authors: Elizabeth G. Raymond, Tara Shochet, Jennifer Kidwell Drake, and Elizabeth Westley
This article describes the methods of emergency contraception available in the United States, including efficacy, mode of action, safety, side effect profile, and availability. The most effective emergency contraceptive is the copper intrauterine device (IUD), followed by ulipristal acetate and levonorgestrel pills. Levonorgestrel is available for sale without restrictions, whereas ulipristal acetate is available with prescription only, and the copper IUD must be inserted by a clinician. Although EC pills have not been shown to reduce pregnancy or abortion rates at the population level, they are an important option for individual women seeking to prevent pregnancy after sex. Authors: Kelly Cleland, Elizabeth G. Raymond, Elizabeth Westley, and James Trussell
This paper reports the results of a review to synthesize the current evidence on service delivery strategies to improve access to ECP. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs. There are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models, and investment cases for ECP. Authors: Angela Dawson, Nguyen-Toan Tran, Elizabeth Westley, Viviana Mangiaterra, and Mario Festin
Donors, particularly US-based private foundations, have played a key role in making emergency contraception available around the world, but the dynamics of donor funding have not been well-documented before now. This paper analyzes data on donor funding for EC-focused programs and donor spending for EC procurement.
When no products marketed specifically for emergency contraception are available, combined oral contraceptives – regular birth control pills – can also be used as EC. This is known as the “Yuzpe” method. The Yuzpe method offers critical EC access for women without access to dedicated ECPs.
Women’s access to ECPs is significantly influenced by the availability of EC products in their country. Many dedicated products – those that are packaged and labeled for EC use specifically – exist, but are only accessible to women if at least one product is registered and/or imported in their country. The ECP Registration Status fact sheet provides an overview of ECP availability by country based on three designations – at least one product registered, no registered product but current or previously imported product, and no registered or imported product.
For women wanting to prevent pregnancy, timely access to ECPs is crucial, since the sooner they are taken, the more likely they are to be effective. Regulatory limitations on the sale of ECPs (including prescription requirements and age restrictions) impede a woman’s ability to get ECPs when she needs them. This fact sheet addresses why unrestricted, over-the-counter (OTC) access to ECPs is essential and safe for women of all ages.