Voluntary-Contraception-AoF-4000x1272

Emergency Contraception

Key Messages

  • Emergency contraception (EC) includes medications and devices that can be used after sex to prevent pregnancy.
  • Methods of EC do not cause an abortion.
  • Depending on the method use, emergency contraception can reduce a woman’s risk of becoming pregnant from a single act of intercourse by between 75%
    and 99%.

Facts & Stats

  • As of 2016, 148 countries have at least one EC pill registered in the commercial sector; 46 countries have no EC brands registered.
    • Reference: International Consortium for Emergency Contraception, EC pill brands, 2016.
  • As of 2016, 20 countries allow direct over-the-counter access to progestin-only EC and 60 countries allow ECPs to be provided from a pharmacist without requiring a prescription.
    • Reference: International Consortium for Emergency Contraception, EC pill brands, 2016.
  • Recently DHS data indicates that EC knowledge still varies greatly. In the Dominican Republic, 76.4% of women are aware of EC versus 1.6% in Chad.
    • Reference: Statcompiler, the DHS Program BETA, Knowledge of emergency contraception (all women), USAID, 2016.
  • Women and girls living in humanitarian settings often face high maternal mortality and are vulnerable to unwanted pregnancy, unsafe abortion, and sexual violence. This study conducted in 2013 in Burkina Faso, Democratic Republic of the Congo (DRC), and South Sudan found that emergency contraception had reportedly been provided at 42% and 36% of facilities in DRC and Burkina Faso, respectively, in the three months prior. In South Sudan, three facilities reported providing EC in the previous three months; scarce supplies and lack of authorization were the primary reasons given for not providing EC.
    • Reference: Casey, S. E., Chynoweth, S. K., Cornier, N., Gallagher, M. C., & Wheeler, E. E. (2015). Progress and gaps in reproductive health services in three humanitarian settings: mixed-methods case studies. Conflict and Health, 9(Suppl 1), S3.

Global

  • Regional estimates of the contraceptive prevalence of “other modern methods” among married or in-union women aged 15 to 49 in 2015 includes: East Africa (0.0% Middle Africa (0.2%), Northern Africa (0.2%), South Africa (0.0%), West Africa (0.0%), Eastern Asia (0.0%), Central Asia (0.0%), South Asia (0.1%), Europe (0.0%), Latin America, and the Caribbean (0.4%).
  • As of 2016, 148 countries have at least one EC pill registered in the commercial sector; 46 countries have no EC brands registered.
    • Reference: International Consortium for Emergency Contraception, EC pill brands, 2016.
  • As of 2016, 20 countries allow direct over-the-counter access to progestin-only EC and 60 countries allow ECPs to be provided from a pharmacist without requiring a prescription.
    • Reference: International Consortium for Emergency Contraception, EC pill brands, 2016.
  • Recent DHS data indicates that EC knowledge still varies greatly. In the Dominican Republic, 76.4% of women are aware of EC versus 1.6% in Chad.
    • Reference: Statcompiler, the DHS Program BETA, Knowledge of emergency contraception (all women), USAID, 2016.
  • Depending on the method used, emergency contraception can reduce a woman’s risk of becoming pregnant from a single act of intercourse by between 75 and 99 percent.
    • Reference: International Consortium for Emergency Contraception, EC pill brands, 2016.
  • Studies show that women with easier access to ECPs are more likely to use it when needed. However, EC availability does not change sexual habits or use of other contraceptive methods. This demonstrates that providing women with EC does not lead women to abandon ongoing contraception, to have unprotected sex more frequently, or to repeatedly use ECPs.
    • Reference: Atkins, D. N., & Bradford, W. D. (2015). Association between Increased Emergency Contraception Availability and Risky Sexual Practices. Health Services Research, 50(3), 809–829.

Asia

  • A study conducted in 4 cities in India with medical providers found 96% of doctors understood ECP prevents implantation while paramedics (40%) and most pharmacists (61%) lacked this knowledge. Eighty four percent of providers also believed ECP was a safe and effective method.
    • Reference: Khan, M. E., Varma, D. S., Bhatnagar, I. S. H. A., Dixit, A., & Brady, M. (2012). Attitudes, beliefs, and practices of providers′ and key opinion leaders′ on emergency contraception in India. New Delhi: Population Council.
  • The Population Council conducted a study focusing on providers’ attitudes, specifically in North India in 2014. All surveyed physicians cited the correct dose and regimen for ECPs. However, the large majority of those surveyed incorrectly believed that ECPs work by preventing implantation. Most doctors also incorrectly believed that ECPs have several contraindications and significant side effects. Respondents also had strong reservations against OTC provision of ECPs by pharmacists and community health workers (CHWs), and negative attitudes toward ECP users, which serve as serious medical barriers to mainstreaming use of ECPs.
    • Reference: Medical barriers to emergency contraception: A cross-sectional survey of doctors in North India. M.E. Khan, Anvita Dixit, Isha Bhatnagar, Martha Brady Global Health: Science and Practice 2(2): 210-218. Published 2014
  • An analysis of abortion patients in Shanghai city found 28.5% were aware of EC, while only 14.9% knew ECP should be taken within 24 hours of sexual intercourse.
    • Reference: Zhao, S. L., Lou, C. H., & Gao, E. S. (2015). Analysis on the emergency contraception knowledge level and its influencing factors among abortion patients in Shanghai city. REPRODUCTION AND CONTRACEPTION, 11(3), 158-68.

Middle East and North Africa

  • A 2013 evaluation of the status of the Minimum Initial Services Package (MISP) for reproductive health in two Syrian refugee sites in Jordan, found emergency contraception was available for post rape care in one setting.
    • Reference: Casey, S. E. (2015). Evaluations of reproductive health programs in humanitarian settings: a systematic review. Conflict and health, 9(Suppl 1), S1

Sub-Saharan Africa

  • Women and girls living in humanitarian settings often face high maternal mortality and are vulnerable to unwanted pregnancy, unsafe abortion, and sexual violence. A study conducted in 2013 in Burkina Faso, Democratic Republic of the Congo (DRC), and South Sudan found that emergency contraception had reportedly been provided at 42% and 36% of facilities in DRC and Burkina Faso, respectively, in the three months prior. In South Sudan, three facilities reported providing EC in the previous three months; scarce supplies and lack of authorization were the primary reasons given for not providing EC.
    • Reference: Casey, S. E., Chynoweth, S. K., Cornier, N., Gallagher, M. C., & Wheeler, E. E. (2015). Progress and gaps in reproductive health services in three humanitarian settings: mixed-methods case studies. Conflict and Health, 9(Suppl 1), S3.
  • In Rwanda, approximately 37% of providers said they had ever provided ECPs; of these providers, 85.7% had provided it in the previous year (2010-2011). Among government-supported facility employees, 34% have ever provided ECPs and 25% of private facility employees have ever provided ECPs. Across all participants, only 5% said that they regularly include ECPs as part of family planning discussions. Most of the respondents (86%) said that they did not have any guidelines for use of ECPs.
  • The recent crisis in Burundi has forced the flight of more than 220,000 refugees, half of whom are female. Many experienced GBV, including sexual violence. Nearly 50% of Burundian women and girls reporting GBV upon arrival in Tanzania required post-rape care. Yet many refugees in Tanzania say that the threat of violence continues in their country of refuge – in and around the very camps where they should feel safe.
  • An investigation by the Population Council found that less than half of the Somali and Sudanese refugees in a Kenyan refugee camp were aware that anything could be done to prevent a potential pregnancy following unprotected sex. This study also reflected the lack of knowledge and training on EC among health care providers serving the refugees.
    • Reference: (E. Muia, F. Fikree, J. Olenja, Enhancing the use of emergency contraception: A baseline survey in Kakuma Refugee Camp, Kenya. Unpublished abstract presented at the Reproductive Health Response in Conflict Consortium Conference, Washington, D.C., 2000.)