Spain: increase in EC use

November 2020. The Spanish Society for Contraception (SEC) just published the findings of its annual National Contraception Survey 2020, based on phone interviews conducted among 1800 women of reproductive age, between July and August 2020.

With regards to emergency contraception (EC) use, 38% of the women surveyed reported having ever used EC at some point of their lives. The percentage exceeds 40% among women between ages of 20 to 39. In previous surveys conducted by SEC in 2018 and 2011, 30% and 14% of the respondents, respectively, reported having ever used EC.

This shows a clear trend of increased use since prescription requirements were removed in 2009. This trend has also been observed in other European countries such as Italy (see Ministry of Health report of 2018). To our knowledge, only Norway has registered a decrease in EC use in the past few years. According to local experts, this is likely due to efforts to make ongoing contraception more accessible, and to a strong uptake of long acting reversible contraception methods (LARCs) among younger women.

UK: access to EC, coronavirus, and confidentiality

November 2020. In September 2020, BPAS undertook a mystery shopper survey to assess whether and how pharmacies in the United Kingdom deliver the mandatory consultation for emergency contraception (EC) during the COVID-19 pandemic; and to assess whether and how easily women can access EHC without compromising on social distancing practices.

In the UK EC can be purchased from most community pharmacies, however due to licensing restrictions all women purchasing EC need to undergo a mandatory consultation.

A third (32.5%) of pharmacies providing EC surveyed were unable to provide the mandatory consultation in a way that was both confidential and COVID-secure. Consequently, women seeking EHC in these areas may be forced to choose between risking catching or transmitting COVID-19 (by breaching social distancing rules), their privacy (by having a consultation on the shop floor), or an unwanted pregnancy.

BPAS report states: “The physical constraints pharmacists are operating under cannot be changed, but the current regulatory framework, which in the United Kingdom places pharmacists under an obligation to undertake a consultation with every woman requesting EHC could be amended by reclassifying emergency hormonal contraception as a general sales list (GSL) medication. This would enable women to purchase this safe and effective medication directly from the shelf, without placing their health or confidentiality at risk during the pandemic.”

Read the full report here.

UK: Innovative ways to bridge EC to ongoing contraception

November 2020. After using oral emergency contraception (EC), women remain at risk of unintended pregnancy, and thus subsequent use of effective contraception is advised. A study in the United Kingdom tested innovative strategies to bridge EC provision to the uptake of ongoing contraception methods. In this study, a supply of the progestogen-only pill, and an invitation to a sexual and reproductive health clinic, were provided to women who had presented to community pharmacies for emergency contraception. This intervention resulted in a clinically meaningful increase in the subsequent use of effective contraception.

The full article is available on The Lancet’s website: Cameron, S. T., Glasier, A., McDaid, L. M., Radley, A., Baraitser, P., Stephenson, J. M., Gilson, R., Battison, C., Cowle, K., Forrest, M., Goulao, B., Johnstone, A., Morelli, A., Patterson, S., McDonald, A., Vadiveloo, T., & Norrie, J. D. T. (2020). Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial. Lancet, 396(10262), 1585-1594. https://doi.org/10.1016/S0140-6736(20)31785-2

 

Delaying versus immediately starting Combined Oral Contraceptive pill after UPA EC

November 2020. A study investigating timing of combined oral contraceptive pill (COC) restart after missed pills and use of ulipristal acetate emergency contraception (UPA EC), was recently published. According to the study (Banh C, Rautenberg T, Duijkers IJ, et al. The effects on ovarian activity of delaying versus immediately restarting combined oral contraception after missing three pills and taking ulipristal acetate 30 mg. Contraception 2020;102(3):145-151.), in the specific scenario in which established users of 30mcg EE/LNG COC in a 21/7 regimen restart pill-taking for 4 days after a pill-free interval, miss the next 3 consecutive pills, and take UPA EC, ovulation and theoretical risk of pregnancy later in the cycle is less likely if COC is restarted immediately after UPA-EC than if COC restart is delayed for 5 days after UPA-EC.

The UK Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit is the first scientific society to respond to this study. Read the Faculty’s statement and recommendations here: https://www.fsrh.org/news/the-fsrh-ceu-statement-regarding-delaying-versus-immediately/

European Contraception Policy Atlas 2020

November 2020. The European Parliamentary Forum for Sexual and Reproductive Rights launched the 4th edition of the European Contraception Policy Atlas on November 12th. The map scores 46 countries throughout Europe on access to modern contraception. Some of this year’s findings are the following:
• Access to modern, effective and affordable contraception remains a  challenge for European countries;
• 7 countries introduced policies related to supplies and counselling and 4 countries improved online information resources;
• Belgium edges ahead of France, taking the lead for the first time in four years;
• Poland remains at the bottom of the Atlas, being the only European country to increase restrictions to contraception in the past four years.
In addition, this year’s Atlas features a dynamic map that illustrates countries performance according to a number of indicators. See the example of “Availability of EC without prescription” below, and read more here.
If you missed the on-line launch of the Atlas today, YouTube is here to help: https://youtu.be/5sT5mKS-UtI 

Using EC after missed oral contraceptive pills

November  2020. The European Society of Contraception and Reproductive Health (ESC) organises the webinar “Dilemmas in contraception”, which will include a discussion on what to do when emergency contraception pills are needed because of missed oral contraception pills. The webinar will take place on November 18 at 16h00 Central European Time. Register here: https://us02web.zoom.us/webinar/register/WN_xNT5kKbAQMSzet3u2rOHtA 

 

 

Malta: Buying the “morning-after pill” on Sunday is an arduous task

November 2020. A journalist from MaltaToday, recently conducted a phone survey to find out if the pharmacies who will be on-call in the coming 6 weekend and holidays (November until December 8th, 2020) stock EC pills or not. On Sundays and public holidays, only 20 pharmacies across the country’s two islands are open.

From the 120 pharmacies across Malta and Gozo contacted by the journalist, an average of 64% sell the morning-after pill. However, the rate ranges from 50% on one Sunday in November to 75% on another.

Read the full report here and here.

The report also looked at the interaction with the pharmacy staff over the phone, and the questions a woman can be asked when procuring EC. The Chamber of Pharmacists insists that pharmacists should follow their guidelines, which tackle confidentiality and patient safety, among others. This guidelines are not available to the general public.

The news triggered reactions from a number of politicians and activists.

 

Switzerland: a qualitative study of young women experiences obtaining EC in pharmacies 

November 2020. Last April, Unisanté published “Remise de la contraception d’urgence en pharmacie : une étude qualitative sur l’expérience des clientes”, the report of a qualitative research exploring the opinions and perceptions of young
women who obtained EC in community pharmacies in Switzerland.

Individual face-to-face interviews were conducted between April and August 2019 with 30 women ages 18 and younger, who had sought EC in pharmacies in the canton of Vaud between 2014 and 2019. Issues asked included: reasons for choosing to go to a pharmacy; advantages and disadvantages; reception at the pharmacy counter; questions asked; judgments; actual in-take of the pill; price; support; contraception and prevention.

In short, the study concludes that community pharmacies are very convenient points for EC delivery. They are highly appreciated because they provide great accessibility, short waiting time, and extended hours. However, the report points at several avenues for improvement, to ensure that no barriers for young women arise in pharmacies:

  • improving the information and knowledge of young women about the procedure for dispensing EC in pharmacies;
  • improving and systematizing the information that is asked during the mandatory counseling; 
  • reducing embarrassment and prevent judgemental attitudes;
  • raising awareness among young men;
  • reconsidering the price of EC;
  • integrating pharmacists in the reflection around the delivery of EC in pharmacies.

The full document can be downloaded here and directly from our website, here

International solidarity with women in Poland

October 2020. ECEC’s mission is to expand access to and knowledge of emergency contraception (EC) in Europe, within a broader sexual and reproductive health and rights approach. Our work does not occur in a vacuum: ensuring access to EC is just one of the many measures necessary for people to be able to exercise sexual and reproductive rights, which are human rights.

ECEC wants to express its solidarity with the people of Poland, who are seeing their reproductive rights curtailed, and adhered to the joint civil society statement on international solidarity with women and peaceful protestors in Poland, prepared by the Centre for Reproductive Rights.

Italy: women under 18 no longer need a prescription to buy UPA EC

October 2020. On October 8th the Italian Medicines Agency (AIFA) reclassified ulipistral acetate (UPA) EC pill EllaOne to “non-prescription but non-over-the-counter medicinal product” (Resolution no. 998). To date, women under 18  needed a medical prescritpion, prior to purchasing UPA ECPs at the pharmacy.

According to AIFA’s statment, this measure aims to further protect the physical and psychological health of adolescents, and to prevent unplanned pregnancies among youth. The Report to Parliament of the Minister of Health of June 2020 reported that, according to 2018 data, “the increased use of emergency contraception with levonorgestrel  and ulipistral acetate, had a positive effect on the reduction of pregnancy termination, which in Italy has continuously and progressively decreased since 1983”. Eliminating the prescription requirement for emergency contraception for minors aims, therefore, to contribute to reduce the conception rate under the age of 18 in the context of improving, in particular, the sexual health of adolescents and, more generally, of public health.”

You can read AIFA’s resolution here, and announcement of this reclassification here.