According to Polish law, EC can be prescribed by any primary care doctor to any woman who needs it. A journalist in Poland, Agata Diduszko-Zyglewska, undertook an experiment to try and obtain EC in public health care centers with the aim of exposing how many doctors prefer to break the law and professional ethics’ rules instead of prescribing EC to women who need it. Diduszko-Zyglewska visited three health care centers and was told at each one that she could not be prescribed EC without a full exam by a gynecologist to rule out pregnancy, for which she would have to wait between two and four hours (or longer), and even then it was not assured that the doctor would prescribe it. She finally was able to obtain EC from friends who had procured it on holiday in those European countries where it is available without a prescription. Diduszko-Zyglewska encourages women to speak out against this mistreatment so that the Polish Minister of Health will be forced to react to this unethical behavior. Read the full article here.
Upon request by the manufacturer of ulipristal acetate emergency contraception (UPA EC) pills, the Committee for Medicinal Products for Human Use of the European Medicines Agency will consider a proposed change in the classification for supply of UPA EC pills from “medicinal product subject to medical prescription” to “medicinal product not subject to medical prescription” in the European Union[i].
As a Consortium striving to increase access to EC, we envision a European region where all women receive evidence-based information about all EC methods available to them and are free to chose the EC method they prefer to use to reduce the risk of pregnancy after unprotected sex.
We believe that an additional and more effective oral EC method available without prescription would be an important public health benefit to the women of Europe. Keeping in mind the data available from post-marketing surveillance of UPA EC and the fact that in most European countries women prefer to obtain their EC methods directly from the pharmacy, we believe that the benefits of increased access to the newest EC method exceed any potential risks.
Europe has a renewed opportunity to show its commitment and global leadership in protecting and promoting the reproductive rights of its population. Making all oral EC methods equally accessible will contribute to strengthening European women’s capacity to exercise their reproductive and human rights.
[i] European Medicines Agency: EMA/CHMP/59462/2014 – Committee for Medicinal Products for Human Use (CHMP). Minutes of the 20-23 January 2014 meeting. http://www.ema.europa.eu/docs/en_GB/document_library/Minutes/2014/02/WC500162067.pdf, October 2014
As many of you know, the European Consortium for Emergency Contraception (ECEC) brings together a group of individuals and organizations committed to increasing access to and knowledge of emergency contraception in Europe. ECEC works with the support of an organization that hosts the Consortium, making it possible for us to operate.
Since its inception in November 2011, ECEC has been hosted by the International Consortium for Emergency Contraception (ICEC) at Family Care International (FCI). We thank the ICEC and FCI teams for all their work and help during this period.
We are now very pleased to announce that as of September 2014, ECEC is hosted by the East European Institute for Reproductive Health (EEIRH), an international NGO based in Tirgu-Mures (Romania), working to promote the right of women and men to sexual and reproductive health, to a life without gender-based violence, and to a healthy and dignified ageing. EEIRH is a regional implementing partner for UNFPA, active in countries in Eastern Europe and Central Asia.
EEIRH will provide legal status and perform legal obligations on behalf of ECEC and will ensure financial management and administrative and logistical support. EEIRH will also provide advice and guidance to ECEC in the process of getting formally established as an operative network and of acquiring legal acting capacity. The EEIRH team working with ECEC will be led by Dr. Mihai Horga.
We are confident that being based in the region will open new opportunities for collaboration with regional partners, and will hopefully make us more effective in advancing our mission.
A study by Cristina Trilla, Raquel Senosiain, Joaquim Calaf, and Juan José Espinós entitled “Effect of changes to cost and availability of emergency contraception on users’ profiles in an emergency department in Catalunya” was recently published in The European Journal of Contraception and Reproductive Health Care. The study examined whether free-of-charge EC access within the Public Health System, which was authorized in 2004, and over-the-counter access of EC, which was implemented in 2009, impacted demand and users’ profiles at a health institution in Catalunya. See abstract below.
Objective Emergency contraception (EC) accessibility has evolved differently in Catalunya as compared with other autonomous communities in Spain. Free-of-charge access within the Public Health System was authorised in 2004, and over-the-counter (OTC) access was implemented in 2009. The aim of the study is to assess the impact of these measures on demand and users’ profiles at our institution.
Methods A retrospective study, in our Emergency Department, was conducted to evaluate EC requests in relationship to accessibility modifications. The age of women and which days of the week they attended were analysed.
Results The number of EC requests, the distribution by age and the demand over the
week remained stable after access to EC became free of charge. However, requests sharply decreased following OTC access implementation. Distribution by age also changed, with a significant increase in requests from women under 25 years (72% vs 56%, p 0.001). Demand was greatest on Sunday and Monday, and this distribution persisted over the study period.
Conclusion EC requests remained unchanged following free-of-charge access to EC, but decreased after OTC implementation. Women currently seeking EC at no cost at our institution are more likely to be younger and to request it on a Monday.
A study by Charles Picavet, Ineke van der Vlugt, and Ciel Wijsen entitled “Intention to use emergency contraceptive pills and the role of knowledge in a Dutch national sample” was recently published in the The European Journal of Contraception and Reproductive Health Care. The study examined whether increased knowledge of ECPs among Dutch women increased their intention to use them. See abstract below.
Objectives Emergency contraceptive pills (ECPs) are underused for preventing unintended pregnancy. Not all women are willing to use them even when at risk of conceiving. This paper examines whether increased knowledge about ECPs may increase the intention to use these products.
Methods Factors associated with intention to use emergency contraception (EC) were
assessed among 1310 women who participated in the nationally representative Sexual Health in the Netherlands 2009 Survey. Logistic regression models included demographics, prior use of ECPs, and ECP knowledge.
Results Seventeen percent of the women did not intend to use EC after unprotected
sexual intercourse and a further 27% were unsure whether they would use it. Intention
is most strongly related to prior use and not having children. Only two of six knowledge
items were related to intention in the multivariate analyses. Being aware that ECPs can be obtained without prescription upgrades intention, whereas knowing that a woman can still get pregnant after having taken the ECP has a negative impact on intention.
Conclusions Improving knowledge may contribute to intention to use EC, but its
role will be modest. To understand the reasons behind ECP use it is essential to study the contribution of other factors, like attitudes and social norms.
SEXUAL HEALTH Switzerland has recently published information on its website detailing all the methods of emergency contraception that are available in Switzerland. This resource, entitled “Emergency contraception in 4 steps: How to avoid an unwanted pregnancy in an emergency,” is available in French, German, and Italian and integrates the recent conclusions of the EMA regarding EC.
The European Medicines Agency (EMA) released the following statement today:
“The European Medicines Agency has concluded its review of emergency contraceptives containing levonorgestrel or ulipristal acetate to assess whether increased bodyweight affects the effectiveness of these medicines in preventing unintended pregnancy following unprotected sexual intercourse or contraceptive failure. The Agency’s Committee for Medicinal Products for Human Use (CHMP) recommends that these emergency contraceptives can continue to be used in women of all weights as the benefits are considered to outweigh the risks.”
To read the full statement, click here.
On Saturday, May 31, 2014, ECEC and ICEC hosted the event, Women’s BMI as a factor in EC failure: An open discussion on the data available to date, at the Lisboa Congress Center in Lisbon, Portugal. The goal of this event was to present the data, facilitate a transparent information-sharing process, and engage in a scientific discussion. During the panel, which had approximately 250 people in attendance, representatives from Gedeon Richter, HRA Pharma, and the World Health Organization presented their respective analyses of the data they have available on this issue (see here for the event’s programme). In addition, and for those who were unable to attend the event, we hosted a webinar on Wednesday, June 4, which replicated the panel’s presentation.
In January 2014, the European Medicines Agency (EMA) began a review of emergency contraceptives in order to assess whether increased body weight and body mass index (BMI) reduce the efficacy of these medicines in preventing an unintended pregnancy following unprotected sexual intercourse or contraceptive failure. We are attentive to the EMA’s recommendations on this issue.
In Switzerland, a paper endorsed by gynecologists, pharmacists, and family planning center health workers has been released, in which these cadres of health care professionals support a common position to the three methods of EC available in Switzerland (levonorgestrel EC pills, ulipristal acetate EC pills, and copper IUDs). The paper has already been sent to pharmacies and family planning centers across the country and will be published on the gynecologists’ association website in the next few days. Read the paper in German and French.
In the UK, new guidance issued by the National Institute for Health and Clinical Excellence (NICE) aims to improve access to high quality contraceptive services, especially for young people up to the age of 25.
Recommendations on emergency contraception (EC) include:
- ensuring that young women (and young men) know where to obtain free EC;
- informing young women that an intrauterine device is a more effective form of EC;
- ensuring that young people have timely access to EC; and
- ensuring arrangements are in place to provide a course of oral emergency contraception in advance in those circumstances where the regular contraceptive method being used, such as condoms or the pill, is subject to ‘user failure.’
Click here to access the NICE guidance.