The German Bundesrat, the legislative body that represents the sixteen Länder (federal states) at the federal level, recently voted in favor of a resolution to remove the prescription-only status of LNG emergency contraception (EC). The resolution now goes to the Bundestag, the constitutional and legislative body, for a vote next January. If approved, women would no longer have to visit a doctor for a prescription before being able to obtain LNG EC.
Read the original article in German.
In September 2013, the Spanish Society of Contraception (SEC) published the study ESTUDIO POBLACIONAL SOBRE USO Y OPINIÓN DE LA PÍLDORA POSTCOITAL 2013, which assesses women’s knowledge, opinions, and use of emergency contraception pills (ECPs) in Spain among 14 to 50 year olds. The study was conducted by SIGMA DOS and sponsored by Chiesi and is a follow up to a similar study conducted in 2011 which you can see here.
The study found that 16.6% of women of reproductive age have ever purchased ECPs, and 14.7% have ever used ECPs (this increased from 14.1% in 2011). The use of ECPs is associated with being in an emergency situation, primarily due to contraceptive failure (78.9%), usually the condom. Read the full 2013 survey report here (in Spanish only).
In June 2013, the International Planned Parenthood Federation European Network (IPPF EN) launched The Barometer of Women’s Access to Modern Contraceptive Choice in 10 EU Countries. This report provides a policy and status overview of women’s access to modern contraceptive choices in Bulgaria, the Czech Republic, France, Germany, Italy, Lithuania, the Netherlands, Poland, Spain, and Sweden.
The report reveals inequalities in access to contraceptive choice and calls for coherent policies on sexual and reproductive health and rights. “This report shows the diversity in which national governments address the issue of contraceptive choice across Europe and highlights inadequacies in national policy frameworks, pressing the need for increased dialogue between stakeholders and policy makers around sexual and reproductive health and rights.”
In an effort to curb the number of unwanted pregnancies in Latvia, a small-scale study was undertaken to determine male students’ knowledge about and attitudes towards EC, the first of its kind undertaken in this country. Researchers posited that within Riga Stradins University, male students of the Social Science Faculty were less informed about EC than male students of the Medical Faculty. Additionally, the researchers believed that first-year students would be less knowledgeable about EC than third-year students. To test this, the researchers administered an anonymous survey with a closed and structured questionnaire consisting of 23 questions, and the results were varied. 95.2% of the students knew when to use EC, but only slightly more than half of respondents, 59.4%, knew such specific things as time limit for use. The study also showed that 91.4% of students believed that EC was harmful to women’s health. As stated in the hypothesis, the third-year Medical Faculty students knew more about EC than the first-year Medical Faculty students, but the first-year Social Science Faculty students were more aware and knowledgeable about EC than the third-year Social Science Faculty students. Promisingly, though, 86.7% of students knew where to buy EC and 83.8% knew that it was available over-the-counter. This study also found that although most of the students had very little information about EC, many stated that they would like to learn more. The researchers interpreted this as meaning that male students care about the problem of unwanted pregnancy and are ready to help solve it.
In 2012, HRA Pharma and the BVA Institute conducted a survey among a representative sample of 2,500 women aged 16-45 on their perceptions of EC. The survey found that among women who reported having unprotected or inadequately protected intercourse, only 20% used EC, due mainly to an underestimation of the risk of pregnancy. This survey also confirmed that women expect to receive more information on EC from health professionals but wish to obtain EC directly from pharmacists. Concurrently, the French Society of Gynecology and the National Federation of Colleges of Medical Gynecology conducted a survey, called GYNECUR, among 500 gynecologists to gauge their perceptions of EC. The vast majority of the gynecologists reported that they are adequately informed about EC, they are conscious of the important preventive role they play in this matter, and in case of need, they refer their patients to pharmacists who provide EC. According to 70% of the gynecologists, women, in general, do not know how to identify situations that put them at risk for unwanted pregnancy, and they are not adequately informed about EC. However, contrary to the view of the gynecologists, 2/3 of the women surveyed reported that they believe that they would be perceived by others as imprudent when requesting EC, and 1/5 of them reported that they would feel ashamed to use EC. Overall, these surveys proved that gynecologists’ and women’s perceptions of EC are similar on two points: (1) the progress EC represents for women and (2) making EC available and increasing access and use is a responsible action. These two surveys show that there is an important need to inform women about emergency contraception and the situations that put them at increased risk for unwanted pregnancies.
For more information on the methodology behind the GYNECUR survey, please review this presentation in English or French.
Amid concerns that OTC (over the counter) EC access might result in less efficient use of contraceptive methods, overuse, and riskier sexual behavior, Swiss researchers studied whether the behaviors of EC users have changed since EC was made OTC in 2002. The researchers studied the profiles of EC users in a pharmacy in the city of Zurich one and six years after EC was made OTC and analyzed age, contraceptive methods used, reasons for EC use, and last contact with a gynecologist. The study found that OTC EC access had no impact on regular contraceptive behavior, as the percentage of pill and condom users was very high (85%) and the percentage of EC users without any contraception remained consistent over the years (17-18%). However, six years after EC was made OTC, condom rupture was reported more frequently, and significantly more women reported having used EC previously in their history. The authors concluded that OTC EC access has not resulted in less use of efficient contraceptive methods, even among adolescents, who reported using EC mainly as a back-up method and seldom in the context of unprotected intercourse.
Do you want to know more about access to emergency contraception in a specific country? In cooperation with national experts, ECEC is developing country profiles. Click here to learn more about EC accessibility, prescription status, cost, guidelines, common practices, and use in European countries.
On June 20, the US Food and Drug Administration (FDA) officially announced its approval to sell LNG EC over-the-counter with no age or point-of-sale restrictions. This decision puts an end to an almost decade-long dispute over the accessibility of EC, and the US now joins a small group of countries where LNG EC is sold without restrictions. In Europe, according to the EC access mapping conducted by ECEC, LNG EC can be bought over the counter in only 8 countries: the Czech Republic, Denmark, Estonia, the Netherlands, Norway, Portugal, Slovakia, and Sweden. For more information, please visit Emergency Contraception Availability in Europe.
A recent UK study examined how the use of ulipristal acetate (UPA), levonorgestrel (LNG), and the copper-intrauterine device for emergency contraception changed following the introduction of new UK Faculty of Sexual & Reproductive Healthcare (FSRH) guidelines. The new guidelines recommend that for emergency contraception, health professionals should discuss individual needs and inform women of the different methods, efficacy, adverse effects, interactions, eligibility, and additional contraception. The researchers studied (1) how the use of EC changed, (2) which methods were offered and how this changed, (3) which method was chosen by women who were offered all three UK licensed methods of EC, and (4) the appropriateness of the offer of only LNG. The authors concluded that when comparing the period before the adoption of the new guidelines with that of the period after, more women were offered all three methods, the use of LNG fell (93.0% to 76.0%), and the use of UPA increased (3.0% to 18.7%). Additionally, women were encouraged to exercise choice. However, increasing choice did not lead to a wholesale change from LNG to UPA.
On May 15th, the Health Committee of the Bundestag (German parliament) resolved not to remove the prescription status of LNG EC. The coalition currently in office (CDU and FDP), turned down the request by the SPD and Die LINKE parties to change LNG to prescription-free status. The political parties that requested the change of status claim that the decision responds to pressures from professional groups and economic interests.
Unlike many other women in Europe, German women at risk of unwanted pregnancy will continue needing to visit a physician to get a prescription, before they can use EC.