The fourth edition of the clinical summary of emergency contraceptive pills (ECP) provides a two-page overview of ICEC’s Medical and Service Delivery Guidance. New information on the hormone UPA and new studies on the influence of BMI on effectiveness are briefly discussed, as well as how ECP regimens work, their efficacy and safety, guidelines on repeat use, and considerations for starting or resuming regular contraceptives following ECP regimens.
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.
Updated in 2018, the Medical and Service Delivery Guidance is ICEC’s most widely distributed publication. Designed to serve as a key reference and training document for service provision, it includes a range of medical and service delivery issues in an easy to use format, from screening, dosages, and counseling to EC pill regimens. Local programs can adapt this guidance as necessary to comply with national or other requirements.
EC is a vital option for women and girls in crisis-affected settings. Women living in crisis settings, such as countries or regions affected by conflicts and natural disasters, face particular challenges that make access to EC essential. Regular contraceptive supplies can be disrupted when a crisis strikes, while sexual assault and transactional sex can often rise; both of these factors result in an increased need for EC. Moreover, the especially harsh living conditions in most crisis-affected settings make pregnancy and childbirth even more difficult and life-threatening. This document, co-authored by ICEC and the Inter-Agency Working Group on Reproductive Health in Crises, provides information for policymakers, decision-makers, and program managers about EC in crisis-affected settings, including how to ensure that women in crisis-affected settings have access to EC.
This paper presents a narrative synthesis of research to: identify provider factors that facilitate and constraint access to ECP; assess the effectiveness of associated interventions and; explore associated health system issues in LMIC. The analysis revealed provider knowledge gaps, less than favorable attitudes, and practice issues. The findings provide limited insight into products prescribed and/or dispensed, the frequency of provision, and information and advice offered to consumers. As the provision of ECPs shifts from the clinic-based health sector to increasing provision by the private sector, the limited understanding of provider performance and the practice gaps revealed in this review highlight the need to further examine provider performance to inform the development of appropriate workforce interventions. Authors: Angela Dawson, Nguyen-Toan Tran, Elizabeth Westley, Viviana Mangiaterra, and Mario Festin
ICEC’s Emergency Contraceptive Pills Medical and Service Delivery Guidelines were adapted in 2013 by the Latin American Consortium for Emergency Contraception (CLAE) and the Latin American Federation of Societies of Obstetrics and Gynecology (FLASOG) to reflect the cultural and political environment in the region. The guidelines address EC pill regimens including levonorgestrel and ulipristal acetate, and also the Yuzpe method, which is still the only choice available in many communities in Latin America and the Caribbean. In 2015 this version of the guidelines were translated into Portuguese by the Rede Brasileira de Promoção de Informações e Disponibilização da Contracepção de Emergência (REDECE), and reviewed and endorsed by the Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (FEBRASGO), the Associação de Obstetrícia e Ginecologia do Estado de São Paulo (SOGESP) and the Sociedade Brasileira de Reprodução Humana (SBRH).
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.