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.
In February 2017, ICEC’s Senior Technical Officer Melissa Garcia attended the stakeholders’ workshop in Abuja, hosted by the Federal Ministry of Health, to develop a National Guideline for EC in Nigeria. In this video interview conducted by the Association for Reproductive and Family Health, Melissa explains this process and why it is a particularly opportune moment for EC in Nigeria. In Nigeria, EC pills have been available for over 20 years in the private and social marketing sectors, and they will soon become available in the public sector for the first time.
Together for Girls, along with partners PAHO, WHO, UN Women, Women Deliver, Save the Children USA, Care International, Child Helpline International, Jhpiego, SafeTrek, BD, and Cummins & Partners have developed new Every Hour Matters campaign resources.
The Every Hour Matters campaign aims to increase awareness about the critical importance of quickly accessing post-rape care. The resources are available here in English, Spanish, French, and Swahili. Included among the resources is “Every Hour Matters After Rape,” an infographic on emergency contraception and post-exposure prophylaxis; “A Call for Post-Rape Care;” “What National Leaders Need to Know about Post-Rape Care;” “Key Considerations for Creating a National Post-Rape Care Campaign;” and “Resources for Post-Rape Care.” Please visit the Partner Publications section of our website for more information in English, and click here for the resources in French.
Melissa Garcia of ICEC and Sarah Rich of the Women’s Refugee Commission co-authored a blog post on the Sexual Violence Research Initiative’s website about EC and post-rape care, which can be read here. EC has particularly critical relevance for post-rape care since it can reduce the risk of pregnancy following unprotected sex, including forced sex, but it is not systematically provided to survivors, which violates their human rights. The blog piece discusses the most crucial barriers to EC access for sexual violence survivors, including policy, legal, and regulatory barriers; facility protocols and provider biases; and women’s low level of knowledge of EC and delayed care-seeking. As these barriers are often exacerbated in crisis settings, the blog piece calls for new approaches for ensuring that survivors receive EC.
In August 2016, Stuart Derbyshire published an article in Conscience Magazine entitled “Does Big Pharma Believe in Autonomy?” In it, Derbyshire argues that pericoital contraception, contraception that women take just before or just after sex, could help dramatically decrease the rate of unintended pregnancies, but that pharmaceutical companies seem hesitant to fill this need because of moral implications. Specifically, pericoital contraception will facilitate women’s sexual autonomy, which is not welcome because such autonomy includes the possibility of unplanned sex.
In response to Derbyshire’s article, Elizabeth Westley and Elizabeth Raymond wrote a letter to the editor, entitled “Pericoital Contraception and the Market” and published in December 2016, in which they state that Derbyshire’s argument that “big pharma” is keeping EC pills out of the hands of women who want to use it as a regular method because of moral control is too simplistic. They argue that pharmaceutical companies are not investing in pericoital contraception because of markets, not morality. There are a number of challenges that pharmaceutical companies would have to overcome before the routine use of EC can become widespread, such as approval by a stringent regulatory authority and expensive clinical trials proving efficacy and safety. The authors do make the point, though, that in the absence of a dedicated pericoital pill, manufacturers and drug stores are starting to sell EC in multipacks, which encourages advance planning and makes it easier for women to use them more than once, destigmatizes repeat or routine use of emergency contraception, and may offer a price that allows some women to use this pill several times a month.
The Brazilian Health Institute has recently published an e-Book about EC. While the book, called “Panorama da Contracepção de Emergência no Brasil” [Overview of Emergency Contraception in Brazil], touches on global issues relating to EC as well as issues specific to Latin America, its primary focus is on EC access issues in Brazil. The topics explored in the book are wide-ranging and include the knowledge and use of EC among adolescents in Brazil, EC and sexual violence, Brazilian pharmacists’ views on EC, and how EC is being portrayed in the Brazilian press. The first chapter, titled “A Global Assessment of Emergency Contraception Accessibility,” was written by Elizabeth Westley and Jamie Bass of ICEC and Cristina Puig of ECEC.
The book is in Portuguese, except for the first chapter, which is in English. The book can be viewed here, as well as on our Partner Publications page.
The British Pregnancy Advisory Service (bpas) recently launched a campaign in the UK calling for LNG EC to be made available directly on pharmacy shelves at an affordable price. Currently in the UK, women can only obtain EC from behind the pharmacy counter after a consultation with a pharmacist, and LNG EC costs up to £30, which is more than anywhere else in Europe with the exception of Ireland. bpas’s campaign is calling for EC to be reclassified as a General Sales List medication so that it can be placed on pharmacy shelves for women to buy without a consultation. The organization is also calling for all those involved in the pricing of EC to consider how they can provide women with a much more affordable product.
To launch the campaign, bpas created a tongue-in-cheek video highlighting that for some women in the UK it would be cheaper to fly to France to buy EC than purchase it in their local community. Click here
to see the video, and for more information on the campaign, please visit http://www.justsaynon.org.uk/
The Johns Hopkins Center for Communication Programs and ICEC, working closely with the National Reproductive Health Program, recently developed a leaflet on EC for health providers, community-based distribution agents, and pharmacists in the Democratic Republic of the Congo (DRC) to use when counseling their patients or clients. Knowledge and use of EC is very low in the DRC and the goal of this leaflet, which was produced in French, Swahili, Lingala, and Kikongo, is to bring an increased awareness and understanding of EC to the populations who most need it.