NEW FRONTIERS

FOR EMERGENCY
CONTRACEPTION IN
AFRICA
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 women’s access to
them
WHAT IS EC?
 Method of preventing pregnancy after
unprotected sexual intercourse
 Method that can not interrupt an established
pregnancy
 Not the “abortion pill”
TYPES OF EC

 Combined OCs: 2 doses of pills 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 OC’s – 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) than with COCs, 6% vs 23%
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

EFFICACY OF EC
Percentage of pregnancies prevented
100
90
80
70
60
50
40
30
20
10
0
up to 24 hours 25-48 hours 49-72 hours
Progestin-only Combined
FIRST APPEARANCES…
 Between 1995 and 2000, six
African countries undertook
pilot studies, designed to
introduce EC into the public
sector health care system
 Twenty-six countries
currently have a dedicated
EC product registered with
their national regulatory
authorities
 Across Africa, a plethora of
initiatives are underway to
expand access to EC Norlevo/Vikela
Postinor 2
 …CAN BE DECEIVING
 Product registration does not mean availability
 In not one of the six pilot countries has the delivery of EC services been
maintained, let alone mainstreamed within in the public sector at a national level
 Throughout Africa as a whole, only 13 countries include EC within their national
national FP/RH guidelines and protocols – and only 9 of those are found in
countries with a dedicated ECP
KNOWLEDGE AND USE OF EC
REMAINS LOW
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]

WHY THE FAILURE
MAINSTREAM TO
EC SERVICES?

 There are incentives that sustain the delivery of other contraceptives

that do not exist for EC
 Governments are unfamiliar with the status of post-introduction EC
services
 There are no natural constituencies in-country to shepherd EC through
the system or to advocate for its mainstreaming
 Africa remains marginalized from current international discourse over EC
THE SOLUTION?

 A broad-based exchange of information, unencumbered by

linguistic barriers, in support of efforts to introduce, deliver
and mainstream quality emergency 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 been introduced
GOALS OF ECAFRIQUE
 To serve as a forum for exchanging of ideas among health care
professionals 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.
 ECAFRIQUE TODAY
 Worldwide network of 20
founding members, and
over 200 corresponding
institutional and individual
members
 Active in over half of all
countries in Africa
 Developed a comprehensive data-base
of institutional and individual members
ECAFRIQUE TODAY
 Published and distributed five issues of ECAFRIQUE bulletin
 Provided technical support to partner agencies, and other regional consortia under the
auspices of ECAFRIQUE (proposal writing, translation, material development, information
dissemination)
 Attracted/leveraged new funding for EC-related research and service delivery in Africa
 Disseminated information at international fora
 Has already established itself as a respected, independent body for supporting EC
initiatives across Africa
PRIVATE SECTOR PROVISION:
SOME LIMITATIONS
 Commercial pricing can be a barrier to wider product access
 Private sector distribution favors urban settings
 Commercial distributors and/or licensees can restrict (or dictate) the terms of
product availability
 Private sector distribution can impede the provision of accurate information on
EC coverage or utilization
 Emphasis on dedicated ECP can undermine provision of Yuzpe formulation
PRIVATE SECTOR PROVISION:
SOME ADVANTAGES
 Private sector provision frees EC availability from dependence on
private sector/donor procurement
 Commercial interests have spawned a host of social marketing and
private/public sector collaborations to increase product access
 Increases product acceptability on the part of certain population
segments
 Market interests can further efforts to disseminate information on EC
ADDRESSING SEXUAL
VIOLENCE AND RAPE
 Traditional service delivery outlets are not necessarily (or even
typically) the first points of contact for assault survivors
 Existing policies and protocols are typically designed to satisfy the
needs of the legal system – not the health needs of the victim
 Despite the logical connection between the prevention of pregnancy
and of HIV transmission, one must not become the “ball and chain”
of the other
THE NEEDS OF YOUTH
 Discourse on EC – both positive and negative - is dominated by concerns over
HIV/AIDS
 Young people are at especially high risk of unwanted 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