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/

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 in https://www.epfweb.org/european-contraception-atlas.
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.