Access to emergency contraception through community pharmacies in Europe: Findings from a participatory survey

January 2021. The European Consortium for Emergency Contraception (ECEC) and the European Youth Network on Sexual and Reproductive Rights (YouAct), launched in 2019 a participatory survey in order to better understand how access to and availability of emergency contraception (EC) pills is through community pharmacies in our region.

We are pleased to introduce the survey report, which focuses on five countries: Andorra, Bosnia and Herzegovina, Malta, Spain and Sweden. You can download the report here.

Our findings suggest that community pharmacies play a very important role in ensuring access to EC pills, with the big majority of pharmacies carrying them (even in countries where they are entitled not to). However, our findings also point at individuals not being systematically offered a choice of postcoital contraception methods in every pharmacy of our sample.

We conclude that access to the highest standard of care in post-coital contraception remains uneven within and among countries in Europe: individuals are likely to have different experiences and outcomes when procuring EC, depending on what European country she/he is in, and also on what pharmacy she/he walks in.

ECEC and YouAct recommend some measures to reduce inequities in access to the highest standard of post-coital contraception care. These include:

  • Reclassifying ECPs so they can be sold in pharmacies and other outlets, without the supervision of a pharmacist.
  • Developing minimum regional and national standards for EC dispensing.
  • Disseminating these standards and making them publicly available, so individuals know what to expect when procuring EC.
  • Conducting non-commercial information campaigns to ensure the ability of all people to access accurate information about all post-coital contraception choices available to them.

Different responsibilities fall on different players. We look forward to starting a conversation to move forward toward a stronger rights-based approach to EC dispensing.

We thank all the organizations, individuals and pharmacy staff that participated in this effort.

Contact us at ecec[at]eeirh[dot]org and join our e-mail list.

 

 

New brands of UPA emergency contraception pills in Europe

January 2021. New brands of ulipristal acetate emergency contraception pills are becoming available in some European countries; as of January 2021 these can be found in Austria, Finland, France, Germany, Greece, Ireland, Italy, Netherlands, Norway, Poland, Portugal, Romania and Spain. Visit the Country by country section of our website for more details on specific brands available in each country.

 

EC for transgender and nonbinary patients

January 2021. The American Society for Emergency Contraception just published EC for Transgender and Nonbinary Patients. This fact sheet is a great resource for all healthcare providers offering care to patients of reproductive age.

Pregnancy is possible for any individual with a uterus and ovary(ies) who has receptive penis-in-vagina sex with partners who produce sperm, regardless of gender identity. Patients who are amenorrheic due to testosterone use may (…)  be at risk for pregnancy. This fact sheet addresses medical and social-emotional aspects of EC for transgender and nonbinary patients.

Download the factsheet from ASEC’s website or from here. We thank the colleagues at ASEC for sharing this valuable work with us.

Some policy makers still don’t understand emergency contraception mechanism of action

December 2020.  In Malta, a discussion is being held in Parliament these days, about the need for all pharmacies in the country to carry emergency contraception (EC) pills, in order to ensure timely access to this contraceptive method.

Surprisingly, some members of parliament still consider that EC pills can threaten Maltese law, under which human life is protected from conception.

We thought it would not be necessary to say it one more time (we are almost in 2021), but we will do this again: EC pills work mainly by preventing or delaying ovulation; if ovulation cannot be stopped and fertilisation occurs, EC pills will not interfere with implantation.

If you are going to design a reproductive health public policy, and think you should learn more about EC before, we kindly advice you to read:

 

EU Parliament urges Polish authorities to repeal law restricting access to emergency contraception

December 2020. On November 26, the Members of the European Parliament adopted a resolution condemning the setback to women’s sexual and reproductive rights in Poland, and drawing attention to the legal obligation of the European Union to uphold and protect these rights. The resolution also urges Polish authorities to repeal the law limiting access to the emergency contraceptive pill.

In 2015, UPA EC pills became directly available from pharmacies in Poland (and in all European Union countries except for Hungary) as a result of European Medicines Agency’ recommendations. However, in July 2017, a new law entered into effect in Poland, reinstating mandatory prescription for UPA EC. Local experts report that doctors often deny prescriptions for EC pills on the grounds of personal beliefs.

Poland and Hungary are the sole European Union countries that still require a prescription for EC pills. Both countries disregard EC pills safety profile, and the fact that time to treatment is essential to maximize efficacy.

Read “European Parliament resolution of 26 November 2020 on the de facto ban on the right to abortion in Poland (2020/2876(RSP))” here.

 

 

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/