JHPIEGO TrainerNews™ |
Contraceptive Technology Update:
Barriers to Widespread Use of Emergency Contraception -- Improving Access
(July 2002)
In the last edition of JHPIEGO TrainerNews, the use of copper-bearing IUDs--a highly effective but not widely used option--was discussed. This issue will focus on barriers to use of and access to emergency contraception.
Barriers to EC Use
The barriers to use of emergency contraception (EC) are similar worldwide. As a result of these barriers, many women are denied the opportunity to prevent an unplanned or unwanted pregnancy. Barriers include:
- Lack of provider knowledge: Many providers do not have accurate, up-to-date information on EC. They may have misinformation on how EC works or lack information on the protocols for safe provision of EC and therefore be hesitant to provide it.
- Provider bias: The types of situations that lead to a need for EC are often difficult ones and providers may have strong personal feelings about the women or couples who find themselves in need of EC. This personal bias may cause providers to deny EC to clients in need, or not offer EC in their facility.
- Lack of general knowledge of EC: Unless there is widespread knowledge of the existence of EC, as well as where to get it, there will be little demand from the population in general. Women also need to be familiar with when EC should be used, the options available, and how to use it effectively (e.g., the need to take it as soon as possible after unprotected intercourse in order to increase its effectiveness).
- Lack of dedicated ECPs: Although several brands of dedicated ECPs are now available, they have not yet reached all countries. When such products are not available, the use of standard COCs or POPs may be confusing to both providers and clients. Certainly, the number of pills that must be taken can be a barrier to taking a complete dose.
- Protocols for provision: Protocols that require a prescription to obtain ECPs or that allow only health facilities to distribute ECPs keep many women from obtaining EC in a timely manner. Many of these protocols have arisen out of a concern that if EC is made widely and easily available, women and couples will increase risk taking (i.e., knowingly engaging in unprotected intercourse). Reported evidence, however, demonstrates that making ECPs more widely available does not increase risk-taking but instead reduces the incidence of unintended pregnancy. Several recent studies in Scotland, San Francisco, USA, and Zimbabwe in which some women received counseling about ECPs while others received ECPs along with their family planning method have demonstrated that women who receive ECPs are more likely to use them when needed, and did not increase risk taking.
Ways to Improve Access to EC
Access to EC can be improved by:
- Obtaining dedicated products in more countries
- Making EC available over-the-counter without a prescription or without seeing a physician and through commercial marketing
- Routinely informing women about the availability of emergency contraception through advertising and educational programs
- Educating providers about EC use
- Where resources allow, providing EC along with a woman's regular contraceptive method in case EC is needed
ECs are effective, safe, simple and feasible for most communities. Making emergency contraception--whether combined or progestin-only pills or IUDs--readily available will significantly reduce unintended pregnancies, which is a major public health problem globally. This health problem is one that affects not only individuals, but also societies at large.
For additional information on any of these topics, contact Lois Schaefer at lschaefer@jhpiego.net.