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/
This past Saturday, June 24th, the President of Poland signed a bill that will change the status of the only EC pill currently available without a prescription in the country.
Previously, both UPA and LNG EC pills in Poland were available with prescription only, until the European Medicines Agency decided that the UPA ECP (“ellaOne” brand) should be made available without a prescription throughout Europe, in 2015. Since then, ellaOne has been available without a prescription while LNG brands still required a prescription.
The recent bill counteracts the European Medicines Agency ruling; when the new law goes into effect in August 2017, it will end access to prescription-free UPA EC pills in Poland; all EC pills will again require a prescription.
ICEC and many leading organizations recommend that EC be available without a prescription; the method is completely safe for women to select and take themselves, and is more effective the sooner it is taken. Prescription requirements are onerous and can add both expense and time delays to the process of obtaining emergency contraception. Prescription requirements can be especially detrimental to survivors of sexual assault. More information can be found in this article: Poland makes emergency contraception a prescription- only drug – even for rape survivors
The World Health Organization announced on Tuesday June 6th the release of the 20th Model List of Essential Medicines (known as the “Essential Medicines List” or EML). The WHO’s list is updated every two years and provides guidance for the selection of medicines by countries and donors. Many countries have adopted the concept of “essential medicines” for their populations and issue their own EMLs, which influence which drugs are made available in health systems.
Ulipristal acetate (UPA) 30 mg was added to the newly released EML, joining levonorgestrel .75 mg (pack of 2), and levonorgestrel 1.5 mg. This inclusion is an indication that both the LNG and UPA forms of emergency contraceptive pills are now considered “essential.” UPA emergency contraception, sold under the brand name “ella” or “ellaOne” by HRA Pharma, offers women the choice of a method that may be more effective than LNG, because it works closer to ovulation (after the start of the LH surge, when LNG is no longer effective). There is also evidence that UPA may be a better choice for heavier women (those with BMI >30kg/m2) for whom LNG EC may be ineffective.
Our European Consortium listserv has seen a lot of traffic on a recent issue in Poland, and we wanted to provide our wider community with a summary of what is going on:
- Until 2015, both forms of emergency contraceptive pills were available in Poland only with a prescription from a physician. Prescriptions may not be written to those under 18 without parental consent.
- A decision was made by the European Commission in 2015 to allow ellaOne (a form of emergency contraceptive pill made with the active ingredient Ulipristal Acetate) to be sold without a prescription. In theory, this European-wide decision should apply to all members of the European Union.
- From 2015 until now, UPA EC has been available behind the counter from pharmacies for young women and girls aged 15 years and older. This means that UPA EC is available without a prescription but is not on the shelves and needs to be requested in order to purchase. The older form of ECP, LNG EC, remains available only by prescription.
- Legislators in Poland recently decided to go against the European Commission and introduced a bill to again require ellaOne be again sold with a prescription. This bill passed and has now been submitted to the President for signature.
- Misinformation about how EC works seems to be common among Polish parliamentarians who supported this bill; this factsheet from ICEC explains the difference between emergency contraception and medical abortion (also available in French and Spanish).
- The sooner emergency contraception is taken, the more effective it is. Requiring women to visit a doctor to seek a prescription before they access it will likely delay access and add cost.
Please see statements from Astra Network, Human Rights Watch and Amnesty International.
The European Consortium for Emergency Contraception (ECEC) recently made available the electronic version of the EC wheel on their website. The wheel, a counseling tool for health providers, including pharmacists, aims to strengthen the quality of EC counseling and promote women’s choice in post-coital contraception.
The EC wheel is based on WHO and the UK Faculty of Sexual and Reproductive Healthcare recommendations for EC use. The methods included are the copper IUD and levonorgestrel and ulipristal acetate EC pills. Recommendations are provided based on which method is preferable to use in a number of circumstances. Clarifications and brief recommendations on additional protection after EC use and QuickStart are included on the back of the wheel.
For more information, see the Partner Publications section of our website or visit ECEC’s website.