Is emergency contraception affordable and equitable for women in developing countries?

Emergency contraception is available in the private commercial sector in many countries around the world; while this means it is highly sustainable in the market place, it may not be affordable for women. Under a grant from the Reproductive Health Supplies Coalition’s (RHSC) Innovation Fund, ICEC explored the price of levonorgestrel (LNG) EC to consumers globally.

ICEC sent out a short survey in English, French, and Spanish to our listserv members and through partners. The survey asked about the lowest and highest prices of EC in the country, which brands of EC are available, and which type of outlets provide EC (pharmacy, clinic, hospital, or other). We combined this information with country-specific data from our EC pills database (https://www.cecinfo.org/country-by-country-information/status-availability-database/), such as whether EC is available in public or social marketing sectors, to round out the picture of EC status and availability for the countries surveyed.

We received responses from 72 countries: 21 African countries, 15 countries in Latin America and the Caribbean (LAC), 17 Asian countries (including 4 from the Middle East), 2 countries in North America, 14 European countries, and 3 countries in Oceania. Because the project focused on the developing country context, we primarily analyzed data from the regions of Africa, Asia, and LAC. We used the lowest price of EC reported (this was averaged if we had multiple respondents per country) and combined this with 2014 GDP per capita, used to create a proxy for “weekly income” to create a measure of affordability within each country. The results are focused on the price of EC in the private sector, where most women obtain EC.

Results

When we examined the findings from each region, it became clear that there are significant differences in how much women pay for EC, both between and within regions. Based on the responses we received, in Africa, the relative price of one dose of EC ranged from 0.84% of weekly income in Nigeria to 70.16% in Guinea. In LAC, the relative price of one dose of EC ranged from 1.45% of a weekly income in Argentina to 17.82% in Guatemala. In Asia, the relative price of one dose of EC ranged from 0.38% of a weekly income in Vietnam to 7.54% in Nepal.

Price of EC in selected countries surveyed

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Our findings show that every country surveyed had a commercial sector product registered and available. Fifteen of the 53 countries (28%) reported the presence of locally manufactured products, 27 countries (51%) had LNG EC available in the public sector, and 21 countries (40%) had social marketing of EC products. None of the African countries had a locally manufactured EC product. We found that countries that had locally-produced EC products available had a statistically significantly lower priced EC product in the private sector than those that did not. For countries that had a local EC product, the lowest cost EC product represented a median of 2.7% of weekly income compared to a median of 5.7% for countries that did not have a local product. We believe that one of the reasons why the price of EC is so expensive in Africa is because there is no locally manufactured EC product there.

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Similarly, countries with socially marketed products had a statistically significant lower median price of EC in the private sector than countries that did not. For countries that had a socially marketed EC product, the lowest cost EC product represented a median of 4.0% of weekly income compared to a median of 4.4% for countries that did not have a socially marketed product. The availability of EC in the public sector did not seem to be associated with lower prices of EC in the private sector, but EC access through the public sector remains important for some women, including lower income women, rural women, and survivors of sexual assault.

 On average, African countries had EC products whose cost represented the highest proportion of weekly income based on GDP, with no significant differences between LAC and Asia. After adjusting for presence of local product, social marketing, and public sector product, women in the Africa region paid EC prices which required 15 more percentage points of their weekly income based on GDP compared to those in Asia (p=0.002). Within regions, Francophone and Lusophone African countries had more expensive products within Africa, and Central America had more expensive prices compared to Latin America as a whole.

Conclusion

In many settings, EC products in the private commercial sector are quite expensive as a proportion of income. The affordability of EC products is greatly influenced by GDP, not just the absolute price of the product. The high price of EC in many regions around the world, and specifically in Africa and Central America, may deter women from using EC now or in the future. A total market approach that takes into account affordability for different populations and the role of different sectors could improve access for women.

Knowledge and Use of Emergency Contraception in PMA2020 Surveys

Performance Monitoring and Accountability 2020 (PMA2020) conducts surveys on family planning (FP) indicators. Launched in 2013, surveys have been conducted in 10 countries to date. PMA2020 uses a multi-stage cluster design, stratifying by urban-rural, major regions and districts and surveys households, individual females aged 15-49, and health facilities.

Every new country conducts surveys semi-annually in the first two years for each project country and annually thereafter.

Data from eight African countries were analyzed to determine trends in emergency contraceptive (EC) knowledge and use. Different countries have different numbers of rounds of data available, the round is indicated when the results are presented.

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Knowledge of EC

Levels of knowledge about EC vary considerably across the different countries, being highest in Kenya and Ghana, and lowest in Burkina Faso, the Democratic Republic of Congo, and Niger (Figure 1). In general, women who are older than 25 have greater levels of awareness than those aged 15-24, as do women with higher levels of education (not shown).

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Use of EC

EC is an underutilized method and use of EC is rare in most countries, according to PMA data. Use of EC among all women, across all countries, is under 1% for both current use and recent use. Women who are sexually active and unmarried have higher levels of EC use than women who are currently married/in union.

Unmarried women were more likely to report that they used EC as their first family planning method, compared to currently married women.

Access to EC

Women in Ghana, Kenya, and Uganda were surveyed on where they accessed EC and other modern methods of contraception. In all three countries, EC was much more likely to be obtained in a pharmacy or store, whereas other modern methods were more likely to be obtained at a health facility. For instance, in Ghana, 94% of EC users reported purchasing it at a pharmacy or store, compared to only 31% of other modern methods. Fees or payment was also more common to obtain EC than other modern methods, and women were more likely to report that they made the decision to use the method alone.

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Conclusion

Women in Kenya and Ghana were the most likely in all the countries to report that they were aware of EC. Knowledge is still low in other countries surveyed. Unmarried women in Nigeria were the most likely to report that they used EC as a first method. The PMA2020 questionnaire does not give an accurate measurement of lifetime use of EC. Addition of such a question would allow for more comparison of use over time.

Notes

Data was used by permission of PMA2020. PMA2020.org

Analysis by Tulane University

Mainstreaming Emergency Contraception on a Global and National Level: Partnerships and Strategies

Emergency contraception (EC) is the only method of contraception that can be used to prevent pregnancy when taken promptly after unprotected sexual intercourse. The International Consortium for Emergency Contraception works to ensure that EC becomes an integrated component of family planning and post-rape care on a global and national level through:

  • Information Sharing
  • Advocacy and technical assistance
  • Research
  • Awareness raising and development of material

ICEC is implementing a three year grant from the Bill & Melinda Gates Foundation (2014-2018), supporting advocacy and knowledge-sharing efforts at the global level, with the addition of focused strategies to expand access in DR Congo and Nigeria and additional technical assistance in other countries.

Global Thought Leadership, Advocacy and Information Sharing

Through participation in technical meetings, our annual “EC Jamboree,” presentations, and outreach at global conferences. ICEC has cultivated a large network of stakeholders. Our email lists reach almost 4,000 individuals with information about EC in English, French, and Spanish. We contribute to the family planning field through engagement with local and global partners.

ICEC publishes and translates factsheets and guidelines, pulling from the highest quality available data and recommendations to provide the international gold standard for information on emergency contraception. Our clinical guidelines are available in eight languages and form the basis of EC guidance in many countries.

Technical Assistance in DRC and Nigeria

EC access is different everywhere, and every country requires tailored approaches to mainstream EC into family planning efforts. ICEC conducts a policy and stakeholder landscaping analyses to create an individualized and multifaceted approaches to advocate for EC.

Mainstreaming EC into the Nigerian Health System

In Nigeria, ICEC is working with multiple local organizations to target the health system at the policy, service delivery, provider and community levels. Our initial landscape analysis showed a country with fairly high integration of a socially marketed product in pharmacies and drug shops, but no support from the public sector in policies or programming. By conducting advocacy events and multiple stakeholder alignment meetings, ICEC and its local partner, Civil Society for Family Planning (CiSFP), were able to successfully advocate for inclusion of EC on the Nigeria EML in 2016 and provide technical support for the Ministry of Health to release a Nigerian EC Strategy in 2017.

Now that there is initial policy acceptance of EC in Nigeria, ICEC is supporting local organizations to mainstream EC into family planning programming. One partner, Association for Reproductive and Family Health (ARFH), is creating a training module on EC that complements the existing national family planning curriculum. To increase awareness of EC, ICEC supported Population Media Center Nigeria to include storylines about EC into radio dramas. Since pharmacies are such important sources of EC in Nigeria, Society for Family Health (SFH), a social marketing organization that introduced EC into Nigerian markets, is creating detailing materials to improve pharmacists’ knowledge and acceptance of EC. At the same time, the Centre for Communication Programs Nigeria (CCPN) is creating brochures that can be used by family planning providers, as EC is introduced into public sector facilities. Supporting multiple Nigerian organizations allows ICEC to purposefully work to strengthen and mainstream EC in different sectors of the health system.

EC Knowledge and Perceptions in DRCongo

The family planning landscape is quite different in the Democratic Republic of Congo; policies are generally supportive of EC, but access and awareness are still very low. EC has been generally seen as only relevant in cases of sexual violence in conflict-affected parts of the country, and not part of the family planning method mix. After mapping and analysis of the policy and stakeholder landscape, several events with high level stakeholders were held to generate more knowledge and acceptance.

Because awareness of EC was so low in the general public, support was provided to Population Media Center DRCongo to add EC storylines to radio dramas, and technical support was provided to DKT for their launch of a socially marketed EC brand. In addition, Johns Hopkins University Center for Communication Programs (JHU CCP) was supported to develop a client brochure on EC to match other single-method family planning brochures.

Research

ICEC strives to improve the evidence base on emergency contraception. We have analyzed and shared EC data from Demographic and Health Surveys (DHS), PMA2020, and FPWatch. We have also supported research on key opinion leaders in key countries (India, Nigeria, and Senegal) and on use of EC, including use of EC as a regular contraceptive method, in Kenya and Nigeria. More recently, we have supported Tulane University to conduct qualitative research in Kinshasa, including focus group discussions with women to evaluate levels of knowledge and attitudes about EC, interviews with community religious leaders, and mystery client visits to pharmacies. Taken together, these Kinshasa studies provide fascinating information about the socio-cultural and community contexts in which women make decisions about their fertility.

Awareness raising and materials

As described in the country sections above, we are addressing low levels of awareness of EC among women, providers, and communities. ICEC is working with partners to create accurate EC materials for clients in Nigeria, DRCongo, and for Swahili speaking countries. We also contributed to EC modules in the FPTraining.org set of materials, for clinic and pharmacy-based providers. We are working to increase community awareness through supporting “edutainment” in Nigeria, DRC, and Senegal to incorporate messages about EC into storylines in radio and television dramas.

Conclusion

Globally, EC is increasingly known and included in key policies and documents, but in individual countries, access is still challenging. In some settings, policies are not supportive; in many countries, awareness by women and health care providers is still low. Continued advocacy and technical support is needed to fully mainstream EC into the contraceptive method mix and ensure that it is available to women who need it.

Top Tips for Advocates Working on Emergency Contraception

Top Tips for Advocates Working on Emergency Contraception

By: Melissa Garcia, Technical Adviser, International Consortium for Emergency Contraception &

Cristina Puig Borrás, Coordinator, European Consortium for Emergency Contraception

 

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.

Here are 8 Top Tips for Advocates Working on Emergency Contraception:

(Based on ICEC’s The Unfinished Agenda: Next Steps to Increase Access to Emergency Contraception)

  1. Dispel misperceptions and myths: Promote accurate information on EC. It is critical to disseminate accurate, unbiased information about EC and combat confusion about how EC works and ambivalence about who should be able to use it. Adapt this information for local contexts for a wide range of audiences, including policymakers, health care providers, women and communities. There are some misunderstood aspects of EC: refer to the following key messages:
  • Women of any age, including adolescents and youth, can use EC
  • EC cannot cause an abortion. EC prevents pregnancy.
  • EC is safe and has few side effects. It can be used safely each time a woman or girl wants to prevent an unintended pregnancy.
  • Women and girls have a right to access EC when they need it.
  1. The role of governments: Create supportive national policy environments and ensure public sector engagement in supplying and providing EC. EC should be mainstreamed into current reproductive health programming at all levels, including areas that affect youth. Advance legislation to make EC available over-the-counter without prescription for people of all ages.
  2. Training and integration of EC with broader family planning services. Front-line health care providers (including pharmacists, doctors, nurses, midwives) must know about EC and provide it, incorporating EC into their counselling messages (including for those who use barrier methods, for example). EC should be included in pre- and in-service training for these professionals. This will help reduce the stigma around asking for EC, which young people face especially.
  3. Increase EC awareness and demand among women and communities. EC is the only thing that can be used to prevent pregnancy after unprotected sex, and unfortunately, many women, including young people, have never heard of EC and they don’t know that it exists (Knowledge of EC, globally). EC has to be mainstreamed into reproductive health programming. In addition, encourage the inclusion of EC messages in campaigns so that awareness is increased among communities more broadly. These efforts can dispel myths, reduce stigma and improve access to information about EC.
  4. Require access to EC for survivors of rape. EC provision is critical for the treatment of survivors of rape, regardless of their age. Reduce barriers to access for care, with supportive policies at all levels, so that first responders counsel women about EC and that EC is available on-site.
  5. Make EC consistently available in all crisis settings. Barriers to accessing contraceptive services and supplies are exacerbated during crisis settings, when sexual coercion and transactional sex increase significantly. EC should be made available for all women and girls from the beginning of a response and should continue in the transition to stability.
  6. Further capitalize on the potential for social marketing of EC. Social marketing programs have been very successful in making EC available to women, and yet only 1/3 of such programs include EC. EC should be integrated more fully into existing social marketing programs.
  7. Define and fill knowledge gaps regarding EC access. There are many areas that require further investigation, such as: How and why do people choose EC, within a range of contraceptive options? Do adolescents and young people use EC, and what are their motivations? What are effective strategies to raise awareness of EC? What strategies are effective to defend EC in countries with restrictive laws?

We are trying to learn as much as we can on adolescents and how they access emergency contraception, and youth advocates for SRH & RR can help! Please fill out and circulate our survey here: Links to Survey/sondage/encuesta in English– en français– en castellano

For further information, please contact Melissa Garcia, [email protected], and Cristina Puig Borrás, [email protected]

An ounce of (after-sex) prevention: At the Family Planning Summit, let’s talk about emergency contraception

To meet the global Family Planning 2020 goals, a full range of family planning methods must be available, including user-controlled, short-acting methods. The Guttmacher Institute’s analysis , Adding it Up, estimates that 214 million women of reproductive age in developing regions want to avoid pregnancy but are not using a modern contraceptive method.  Half of unmarried women with an unmet need for family planning report infrequent sex as the reason that they do not use a family planning method. A quarter of married women not using contraception fall into the same category.  Not feeling themselves at high levels of risk, these women may wish to avoid the appointments and waiting times, dependence on providers, side effects, discomforts, and other commitments that long-acting contraceptive methods sometimes entail. Other women may not be using modern contraception because they are unaware of their options or are faced with inaccessibility due to distance barriers, poor health infrastructures, stock outs, or high prices. As well, many women are located in humanitarian and fragile settings where contraceptive access can be challenging.  For many women and girls not currently using a long-acting contraceptive method, a simple, discreet, user-controlled, low-commitment, one-time “on demand” form of contraception that can be accessed easily and quickly is a critically important option. This method already exists: emergency contraception.

Emergency contraceptive pills (ECPs) can bridge this gap for millions of women. This form of contraception can be accessed across a range of settings, without a prescription, in pharmacies and in humanitarian settings in UN emergency reproductive health kits. ECPs can be taken by women without needing to negotiate with a partner and without her taking time off work to go to a clinic. Women are willing to pay for ECPs out of pocket, which will be increasingly important in a shifting donor landscape. Women seem to like ECPs: the latest data from PMA2020 shows that emergency contraception accounts for a quarter of the contraceptive use by unmarried women aged 15-24 in Ghana, more than any other method. It also makes up 10% of contraceptive use in younger married women. In Kenya, ECPs are the second most used method by younger unmarried women, after condoms.

Promising and important as this method is, we don’t know enough about it.  Demographic and Health Surveys (DHS) don’t consistently include a question about use of emergency contraception. This means that many countries are not considering, and counting, the use of emergency contraception when calculating their Contraceptive Prevalence Rates (CPR). The data that could inform better decision-making for ECPs in programming, procurement, quantification, counselling, training, provision, monitoring and evaluation is very limited or simply unavailable. Knowledge gaps still exist regarding ECP access for survivors of sexual assault, and in humanitarian settings, settings characterized by disruption to supply chains and of increased vulnerabilities.

We know that emergency contraception is the only method that can be used after sexual intercourse has already occurred. It is the only recourse when a method fails, no method was used, or when sex was coerced. It is critically important for survivors of sexual assault and for women and girls in humanitarian and fragile settings. We know that most women in developing countries are largely still unaware of emergency contraception—and without knowledge, they cannot realize their right to make a fully informed contraceptive choice.

As the development and humanitarian communities convene at the Family Planning Summit next week, we must ensure the agenda prioritizes a diversified and complete range of contraception in response to women’s needs.  Emergency contraception must be included in data collection as well as programming investments, particularly in efforts to raise awareness of contraceptive methods. A greater commitment to emergency contraception and other forms of user-controlled contraception is fully supportive of the spirit and the goals of the FP2020 movement, providing women and girls with options to decide—freely and for themselves—whether, when, and how many children they want to have.

Emergency contraception is a simple part of post-rape care: Why is it not routinely provided?

Written by Melissa Garcia, International Consortium for Emergency Contraception, and Sarah Rich, Women’s Refugee Commission. Originally posted on the Sexual Violence Research Initiative’s website.

 

Emergency contraception (EC) can reduce the risk of pregnancy after unprotected sex, including in cases of sexual violence. Global guidance is clear that EC should be offered to women and girls within 120 hours of sexual violence to prevent the traumatic consequences of pregnancy resulting from rape.

Yet women and girls who have experienced unprotected sex, including through sexual violence, do not routinely have access to EC. The global aid communities must work together to increase access to EC for sexual violence survivors around the world, including for women and girls who are the most marginalized, like those living in crisis-affected settings. A range of strategies can be implemented to improve access to EC. Further research is also needed to identify, evaluate, and invest in new and innovative solutions.

ABOUT EC    

EC pills are very safe, simple to use, and suitable for all women and girls who wish to prevent pregnancy, including adolescents. They can be used after any instance of unprotected sex, including sexual violence. They work mainly by preventing or delaying ovulation, and cannot terminate an established pregnancy. They should be taken as quickly as possible because they are more effective the sooner they are taken after unprotected sex, but can be taken up to 120 hours later. They have no complicated or long-term side effects.

THE NEED FOR EC AMONG SEXUAL VIOLENCE SURVIVORS

ec_0Provision of EC for rape survivors is a human rights imperative.  Pregnancy resulting from sexual violence can be very traumatic. The World Health Organization’s (WHO) clinical and policy guidelines for sexual violence and companion clinical handbook include recommendations to provide EC pills as part of comprehensive, woman-centered care. The United Nations recognizes EC pills as an essential, life-saving commodity, through its Commission on Life-saving Commodities for Women and Children. Failure to ensure that sexual violence survivors receive EC may harm their physical and psychological health (especially in areas where safe abortion is illegal or unavailable); such failure is a violation of their human rights.

For the millions of women and girls who have been displaced by conflict and natural disasters, access to EC is particularly essential. Forced displacement, exposure to violence, and separation from families and communities expose displaced people to increased risk of sexual violence. At the same time, women in these settings often lack access to regular family planning methods, which protect against the accompanying risk of unwanted pregnancies. EC access is a critical need for these women and girls.

BARRIERS TO EC ACCESS FOR SEXUAL VIOLENCE SURVIVORS

Although EC is a critical, life-saving treatment that is very simple to provide, many barriers to EC access persist; in most settings, EC is neither routinely counselled on nor provided. These barriers are often exacerbated for survivors of sexual violence, and in crisis-affected settings in particular.
Policy, legal, and regulatory barriers. EC access can be facilitated or hindered by a country’s legal and regulatory framework for EC. At least three-fourths of countries have a registered EC product (meaning the pills can be legally sold, purchased, or otherwise made available), representing vast progress over the past few decades. However, some countries remain without a dedicated EC product. Even in countries with a registered product, EC is far from being mainstreamed in many ways:
  •  EC pills are included in only about half of countries’ national Essential Medicines Lists (see database and fact sheet).
  •  Many countries require women to obtain a prescription before accessing EC.
  • Some countries do not have standardized protocols on care for sexual violence survivors; in other countries, such policies may introduce additional barriers, like requiring survivors to first report to the police before receiving care, or requiring that survivors must first take a pregnancy test before providing EC.
All of these factors limit the likelihood that a woman will obtain EC pills within the short 120-hour timeframe for effectiveness. As such, in national health systems, EC access remains low overall.

Facility protocols and provider biases. Barriers to EC access can also arise at the facility and provider levels. Surveys of health care providers in several countries indicate that significant gaps still exist in knowledge about EC and that biases persist around the provision of EC. When women report sexual violence, they are not systematically provided EC pills on-site, even in countries where EC pills are available in the national health system.

Women’s low of knowledge of EC and delayed care-seeking. In most countries that capture EC knowledge in their most recent Demographic and Health Survey (DHS), too few women have any knowledge or awareness that EC pills exist. In 35 countries, less than a quarter of women have heard of them. When women are not aware of EC, they are extremely unlikely to seek it out. Similarly, when women are unaware of the benefits of seeking care following sexual violence, they are not likely to pursue it. Unfortunately, underreporting (or delayed reporting) is frequent for a wide variety of reasons, and these survivors are then also precluded from timely referrals and treatment.

These barriers are often exacerbated in crisis settings. A 2014 study of reproductive health care in humanitarian contexts found that “systematic, comprehensive clinical management for rape survivors remained limited.” A number of factors make EC access in crisis-affected settings particularly challenging. Many of the countries with no registered EC product are currently or have recently been affected by conflict, such as East Timor, Libya, North Korea, Somalia, and Sudan. Several other countries with no registered product are in the Middle East, which hosts large numbers of displaced people; notably, Jordan, with 2.8 million displaced people, does not have a registered EC pill product. In these settings, off-label use of conventional oral contraceptives for EC (i.e. the Yuzpe regimen) represents an important option, but is less effective and has more side effects than dedicated EC pills.

Fragile settings may also be more likely to lack skilled staff and sufficient supplies. A three-country study in DRC, South Sudan, and Burkina Faso found that “only three out of 63 total facilities met the criteria to adequately provide selected elements of clinical management of rape.” In Jordan, only one of 13 assessed sites “had skilled staff and sufficient supplies to provide clinical care for rape survivors.” Moreover, some humanitarian aid organizations opt out of providing EC for religious reasons, often because they mistakenly conflate EC’s mechanism of action with that of abortion, thereby denying women their right to this essential health treatment.

ADDRESSING THE GAP IN EC PROVISION

A wide range of efforts are needed to increase access to EC, including favorable policy change, donor commitment, secure commodity flow in tandem with responsive programming, provider training, and awareness-raising campaigns among women (see examples here and here). There is also a need to more rigorously evaluate existing approaches to ensuring comprehensive care for sexual violence survivors; literature reviews from 2013 and 2015 found limited research on gender-based violence programming, particularly program evaluations.

Finally, it is urgent that we identify and invest in new and promising approaches to increasing care for sexual violence survivors, with EC included. For EC specifically, distribution by non-health workers like police can yield positive results, whereby women reporting to the authorities can safely and immediately receive EC pills on-site from police officers, along with referrals to health facilities. Novel strategies such as provision of community-based care for sexual violence also merit further research, particularly in settings with limited access to facility-based care.

For more information, please contact: Melissa Garcia [email protected], and Sarah Rich [email protected]mission.org.

Demographic and Health Surveys: Knowledge of Emergency Contraceptive Pills Remains Low

Emergency contraception (EC) fills an important gap in the family planning method mix. its unique characteristics makes it particularly valuable to women who were not able – for a range of reasons – to use contraception in advance of need or who prefer to use contraception on an as-needed basis. To seek out emergency contraception, women must be aware that the option of using a contraceptive method after sex exists. Need for EC is often urgent and unplanned and the time frame for use is short. The method is usually accessed in pharmacies or stores, without substantial counseling. Therefore, individual knowledge or awareness of EC is a crucial precursor to using it. However, in most countries that capture EC knowledge in their most recent DHS, the majority of women do not know that EC exist (see Figure 1). In 35 countries, less than a quarter of women have heard of EC.

Across regions, Asian countries appear to have the lowest levels of knowledge about EC among women of reproductive age. Women in many Francophone African countries were also found to have very low awareness of EC. Highest levels of knowledge are found in Colombia, the Dominican Republic, Kenya, Ghana, and Peru. Lowest levels of knowledge are found in Timor-Leste, Niger, Azerbaijan, Chad, and Egypt. In almost all countries, unmarried sexually active women report higher levels of knowledge of EC than married women.

 

Knowledge of EC has increased over time.

Even though EC knowledge is low at a global level, knowledge within countries has increased over time (see Figure 2). With sustained and concerted effort, it is possible to improve awareness of EC.

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Strategies to increase awareness of EC:

  • Marketing or advertising EC products through traditional and social media
  • Ensuring that women who are counseled on family planning are made aware of the existence of EC
  • Integrating information about EC into family planning counseling materials: brochures, flipcharts, posters, etc.
  • Programming accurate information about EC in the media
  • Increasing the visibility of EC in pharmacies and clinics, such as with posters, brochures, and product placement on shelves/counters.
  • Training a wide range of providers in clinics and pharmacies, as well as those providing care to sexual assault survivors, in how to correctly provide emergency contraception.

 

Conclusion

Despite EC being available for over 20 years, many women in low and middle income countries do not know of it, although awareness is increasing over time. It is essential that new strategies to share information about emergency contraception and other reproductive technologies be tested.

 

Notes

Data are from Demographic Health Surveys: www.statcompiler.com