According to a report published by the Italian Ministry of Health (available in English), the abortion rate in Italy dropped by 9,3% in 2015. In April 2015, the Italian Medicines Agency (AIFA) eliminated the mandatory prescription requirement for UPA EC pills for women older than 18, and in October 2015, AIFA eliminated the mandatory prescription requirement for LNG EC pills as well. This news piece (in Italian) suggests at least a partial connection between the decrease in the abortion rate and the greater access to EC pills.
(December 16, 2016) As of December 14, 2016, and for the first time in the history of Malta, dedicated emergency contraceptive pills are available for purchase behind the counter in Maltese pharmacies. UPA EC pills are already on the market, and LNG pills are expected in the coming weeks.
Untill 2016, Malta was the only European Union country that had no dedicated EC pills registered nor available in the local market. In June 2016 the Women’s Rights Foundation filled a judicial protest to request access to emergency contraception. In October 17th, the Malta Medicines Authority announced that the sale of EC pills would be allowed without a prescription, in order to ensure quality, safety and efficacy of the treatment.
Women in Malta now will have emergency contraception accessible to them as in the rest of the European Union, except for Hungary, the only country of the EU that still requieres a prescription for both LNG and UPA EC pills. We will update our Malta country page soon.
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.
While women in the UK can obtain EC free of charge from GPs and sexual health clinics through the NHS, these are not suitable options for many women. They might not be able to get an appointment in time, and funding cuts mean that sexual health clinics are increasingly restricting services or shutting down altogether. Some pharmacies run local schemes providing EC for free, but they often only serve young women and only those who live in certain areas.
To launch the campaign, bpas created a humorous 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/.
On October 17th, 2016, the head of the Malta Medicines Authority, Serracino Inglott, announced that the sale of EC pills will be allowed without a prescription. According to an article from Times of Malta:
“The authority has always based its decisions on three things; quality, safety of patients and efficacy. By asking patients to go to doctors to get their hands on the contraceptive, you are compromising efficacy,” [Inglott] said. The authority head also insisted that the parliamentary committee failed to take into consideration that Malta’s pharmacists not only have the necessary skills to be able to give the MAP [morning after pill] but they also rank among Europe’s best pharmacists in patient-centered care.
This decision comes shortly after a Parliament Committee recommended to permit the sale of EC pills only with a prescription and to allow doctors to refuse prescribing EC on the basis of conscious objection.
A study published in September 2016 in the European Journal of Contraception & Reproductive Health Care looks at the characteristics and profiles of 1773 women who presented at an emergency service (ES) for a prescription of EC (mandatory until May 2015) in Italy.
The study found that the mean age of the women was 26.0 years; 78.5% of the women were Italian; 91.5% were unmarried; 55.2% were still studying and 51.9% had high school education; 61.2% reached the ES within 12 hours of unprotected sexual intercourse (USI); and 42.4% had USI during days 9–16 of their menstrual cycle. LNG was prescribed in 81.4% of women and UPA in 17.7%. When looking at why women were requesting EC, the majority (57.9%) requested EC for condom rupture; 49.5% reported previous use of EC; and 41.6% received information on the subject through friends. The vast majority (83.8%) reported prior use of contraception; in 25.4% the reason for not using it was the absence of a relationship. This study highlights the importance of understanding the profile of women requesting EC so that they can better choose the right long-term contraception for them.
To read the full article in English, please click here.
(October 5, 2016) Gideon Richter released a new video that provides a very clear and easy-to-understand explanation of the mechanism of action of EC. This video, which incorporates 3-D animation, can be found here and is available for use in educational programas and trainings.
(October 5, 2016) The fall issue of the Journal of the University of Malta Medical School (Vol.28 Issue 3, 2016) focuses its editorial on emergency contraception. The article states that the most recent scientific evidence shows that LNG ECP delays ovulation and does not prevent implantation nor does ECP cause the loss of implanted embryos, and calls for a rigorous and evidence-based approach when debating this issue. Read the editorial here and related news published on Malta Today here.
On May 2016, the European Medicines Agency (EMA) recommended the use of a non-hormonal emergency contraceptive (EC) when a woman in need of EC is using other interacting medicines (such as the HIV medicine efavirenz and ritonavir, certain medicines for tuberculosis and epilepsy, and herbal medicines containing St John’s wort). If using a cooper IUD is not an option, the EMA recommends doubling the dose of levonorgestrel (1500 microgram tablets).
The Agency’s Committee for Medicinal Products for Human Use (CHMP) issued this recommendation upon a review for Levonelle and associated names. The effectiveness of 3mg LNG-EC in women taking enzyme-inducing medications has not been studied, but no concerns are identified in relation to safety or side effects associated with the use of this dose.
On 1 August 2016 the European Commission issued a EU-wide legally binding decision to implement the EMA´s recommendation. The EMA has requested that changes be made on LNG EC product packages and leaflets, in order to ensure the correct use.
European Medicines Agency. Levonelle 1500 microgram tablets and associated names. goo.gl/v0JttY (accessed 27 September 2016)
FSRH Clinical Effectiveness Unit. Statement from the Clinical Effectiveness Unit. Use of double dose (3mg) levonorgestrel emergency contraception by women taking enzyme-inducing medications. 2 July 2016. https://www.fsrh.org/standards-and-guidance/documents/ceu-statement-double-dose-lng-ec-2-july-2016/ (accessed 27 September 2016)
A study published in March 2016 by researchers from the Department of International Health of Maastricht University, assesses the status of EC pills in European Union and associated countries a year after UPA was allowed for sale without prescription, and also looks into the impact of this switch on EC pills sales.
Status of Emergency Contraceptives in Europe One Year after the European Medicines Agency’s Recommendation to Switch Ulipristal Acetate to Non-Prescription Status can be accessed here.
In June 2016, the Maltese NGO Women’s Rights Foundation (WRF) filed a judicial protest on behalf of 102 women, requesting that emergency contraception is licensed, available, and accessible locally. The Minister of Health announced that the issue will be discussed at the Parliament Social Affairs committee in the coming months. Despite being a member of the European Union, Malta does not have a dedicated EC product registered nor available in the local market.
If you want to follow this process or get in touch with the WRF you can do so through their Facebook page.