Post on 08-Apr-2018
transcript
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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