Emergency Contraception in Africa (NPF)

8/7/2019 Emergency Contraception in Africa (NPF)

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NEW FRONTIERSFOR EMERGENCY

CONTRACEPTION INAFRICA


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SETTING THE STAGE

Describe what EC is

Review the current status of EC services in Africa

Introduce a new regional network on EC and describe

its mission and activities

Highlight three issues of significance to the future of EC

services in Africa and womens access to them


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WHAT IS EC? Method ofpreventingpregnancy after

unprotected sexual intercourse

Method that can not interrupt an establishedpregnancy

Not the abortion pill


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TYPES OF EC

Combined OCs: 2 doses ofpills containing ethinyl

estradiol (100 mcg) & levonorgestrel (0.5 mg) taken 12

hrs apart 75% reduction in risk (2/100 vs. 8/100 will

get pregnant)

Progestin-only OCs in preferred regimen one dose of

1.5 mg levonorgestrel (or can be in 2 doses of 0.75mg,

12 hrs apart) 88% reduction in risk (1/100 will get

pregnant); less side effects (nausea and vomiting) thanwith COCs, 6% vs 23%


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HOW DOES EC WORK?Possible means of action

Interferes with ovulation (only mechanism clearly

supported by data)

alter endometrium, impairing implantation

alter cervical mucus, thus trapping sperm

change tubal transport of gametes or embryo

EC does not affect an established pregnancy


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EFFICACY OF EC

0

10

20

30

40

50

60

70

80

90

100

Progestin-only Combined

up to 24 hours 25-48 hours 49-72 hours

Percentage ofpregnancies prevented


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FIRST APPEARANCES

Twenty-six countries currentlyhave a dedicated EC productregistered with their nationalregulatory authorities

Postinor 2Norlevo/Vikela

Between 1995 and 2000, sixAfrican countries undertookpilot studies, designed to

introduce EC into the publicsector health care system

Across Africa, a plethora ofinitiatives are underway toexpand access to EC


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Product registration does not mean availability

In not one of the six pilot countries has the delivery of ECservices been maintained, let alone mainstreamed withinin the public sector at a national level

Throughout Africa as a whole, only 13 countries includeEC within their national national FP/RH guidelines andprotocols and only 9 of those are found in countries witha dedicated ECP

CAN BE DECEIVING


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REMAINS LOWKNOWLEDGE AND USE OF ECREMAINS LOWKNOWLEDGE AND USE OF EC

Knowledge of EC Ever Use of EC

Kenya (2003) 23.7 [25.2] 0.9 [1.0]

Eritrea (2002) 10.4 [9.6] 0.4 [0.4]

Benin (2001) 15.2 [15.2] 1.5 [1.3]

Mali (2001) 6.4 [6.1] 0.2 [0.2]

Nigeria (2003) 15.7 [18.7] 2.8 [1.8]

Ghana (2003) 28.2 [28.8] 1.1 [1.1]

Zambia (2001/02) 9.4 [9.9] 0.3 [0.4]


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There are incentives that sustain the delivery of othercontraceptives that do not exist for EC

Governments are unfamiliar with the status ofpost-introduction ECservices

There are no natural constituencies in-country to shepherd ECthrough the system or to advocate for its mainstreaming

Africa remains marginalized from current international discourse

over EC

MAINSTREAM ECSERVICES?

WHY THE FAILURE TO


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THE SOLUTION?

A broad-based exchange of information,

unencumbered by linguistic barriers, in support of

efforts to introduce, deliver and mainstream qualityemergency contraception services

A concerted, participatory effort at the national level

to get EC back on track especially in the

countries where the method has already beenintroduced


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GOALS OF ECAFRIQUE

To serve as a forum for exchanging of ideas among health careprofessionals engaged in efforts to expand EC services in Africa

To inspire interest and encourage new initiatives in the provision

of EC services where there is an unmet need for them

To build collectively the knowledge and experience base needed

to introduce, improve, and mainstream quality EC services, with a

specific focus on the needs and challenges of Africa.


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Worldwide network of 20founding members, and over200 corresponding

institutional and individualmembers

Active in over half of allcountries in Africa

ECAFRIQUETODAY

Developed a comprehensive data-base

of institutional and individual members


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Published and distributed five issues ofECAFRIQUEbulletin

Provided technical support to partner agencies, and otherregional consortia under the auspices ofECAFRIQUE (proposal

writing, translation, material development, informationdissemination)

Attracted/leveraged new funding for EC-related research andservice delivery in Africa

Disseminated information at international fora

Has already established itself as a resp

ected, independentbodyfor supporting EC initiatives across Africa

ECAFRIQUETODAY


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Commercial pricing can be a barrier to widerproduct access

Private sector distribution favors urban settings

Commercial distributors and/or licensees can restrict (ordictate) the terms ofproduct availability

Private sector distribution can impede the provision ofaccurate information on EC coverage or utilization

Emphasis on dedicated ECP can undermine provision of

Yuzpe formulation

SOME LIMITATIONSPRIVATE SECTOR PROVISION:


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Private sectorprovision frees EC availability fromdependence on private sector/donorprocurement

Commercial interests have spawned a host of socialmarketing and private/public sector collaborations toincrease product access

Increases product acceptability on the part of certainpopulation segments

Market interests can further efforts to disseminateinformation on EC

SOME ADVANTAGESPRIVATE SECTOR PROVISION:


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Traditional service delivery outlets are not necessarily (oreven typically) the first points of contact for assault

survivors

Existing policies and protocols are typically designed tosatisfy the needs of the legal system not the healthneeds of the victim

Despite the logical connection between the prevention of

pregnancy and of HIV transmission, one must not becomethe ball and chain of the other

VIOLENCE AND RAPEADDRESSING SEXUAL


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Discourse on EC both positive and negative -

is dominated by concerns over HIV/AIDS

Young people are at especially high risk ofunwanted pregnancy

Use of EC does not undermine continued use

of regular contraception

We need better information on those who use

EC and on the interplay between EC and

condom use

THE NEEDS OF YOUTH

Documents

Emergency Contraception in Africa (NPF)