Democratic Republic of the Congo - Counting What Counts: Tracking Access to Emergency Contraception
Publication date: 2015
July 2015 Given the high rates of sexual violence in the Democratic Republic of the Congo, the need for emergency contraceptive access is high. Emergency contraception (EC) is included in the country’s Essential Medicines List, but family planning services, including EC, are not mentioned in key national health policies. Women’s knowledge and use of EC remain very low and studies show that access to EC as part of post-rape care is lacking. The Democratic Republic of the Congo (DRC) is a large Francophone country in central Africa with a population of 75,507,308.1 Conflict has plagued the DRC for decades and although a peace deal was signed in 2003, the east of the country continues to be ravaged by ongoing violence and human rights abuses.1 The humanitarian crisis, one of the deadliest since World War II, has claimed more than five million lives.2 15% of women aged 15-49 have received no formal education, while 8.5% of women in this age group have completed secondary school.3 CONTRACEPTIVE KNOWLEDGE AND USE POLICIES Essential Drug List: The 2010 Essential Medicines List includes levonorgestrel (LNG) at the proper dose for EC.5 National norms and guidelines: The 2008 Family Planning Service Provider Training Module includes a chapter on EC pills (ECPs), addressing mechanism of action, instructions for use and safety.6 The National Strategic Plan for Family Planning (2014-2020)7 refers to modern contraceptives generally but does not list out any specific methods. Neither the National Health Development Plan (2011-2015)8 nor the 2006 Strategy for Health Systems Strengthening mentions family planning.9 Prescription status and who is authorized to dispense: EC is available by prescription only. It is available in public sector clinics, pharmacies and NGO-led clinics. PRODUCT AVAILABILITY Registered products: One levonorgestrel EC pill product is registered and distributed: NorLevo 1.5mg (HRA Pharma). Locally manufactured products: None available. Poor quality or counterfeit EC products: While not specific to EC, counterfeit drugs have been found in the DRC. In June 2013, the Congolese National Police seized 30 tons of counterfeit pharmaceuticals in Kinshasa.10 WHERE WOMEN CAN ACCESS EC EC in the commercial sector: The private medical sector provides contraceptives for 57.3% of modern contraceptive users.3 The proportion of D em oc ra tic R ep ub lic o f t he C on go DEMOCRATIC REPUBLIC OF THE CONGO COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION KNOWLEDGE AND EVER USE OF MODERN CONTRACEPTION AND EC 0 20 40 60 80 100 ECAny Modern Method Knowledge (DHS 2013-14) Ever Use (DHS 2007) % o f A ll W om en Type of Contraception 88.1 19.4 18.8 1.1 • Total fertility rate: 6.6 (7.3 rural, 5.4 urban) • Unmet need for contraception: 22.4% • Current contraceptive modern method use (among all women): 8.1% Source: Demographic and Health Survey, Democratic Republic of the Congo 2013-14 Source: Demographic and Health Survey, Democratic Republic of the Congo3,4 ABOUT DEMOCRATIC REPUBLIC OF THE CONGO De m oc ra tic R ep ub lic o f t he C on go 2 women using EC who obtain it in the private sector is not known. EC in the public sector: 31% of contraceptive users get their method from the public sector.3 The proportion of women using EC who obtain it in the public sector is not known; however, one study that assessed 21 public health facilities found that none of the facilities had EC in stock (although one facility reported having provided EC at least once in the previous three months).11 EC in the NGO, social marketing and social franchising sectors: The International Planned Parenthood Federation (IPPF) member association, Association de Bien-Etre Familial – Naissances Désirables, operates two health centers and a maternity center, which offer a full range of contraceptive methods, including emergency contraception.12 Heal Africa and Médecins Sans Frontières (Doctors Without Borders) also provide emergency contraceptive services.13 EC in post-rape care: Studies have found that women in the DRC who have been sexually assaulted lack access to EC within the required time frame. It is estimated that fewer than half of Congolese women who experience sexual violence are able to access health centers, and even fewer do so in a timely manner.11,14 In one study, among 42 self-reported survivors of sexual assault, less than half sought care within the 120-hour window for ECPs to be effective and only three of those women said they were offered ECPs or post- exposure prophylaxis (PEP) for HIV prevention at the health facility.11 Community-based distribution of EC: It is not known whether community-based health workers can distribute ECPs in the DRC. MEDIA COVERAGE OF EC It is not known whether any media coverage in the DRC has specifically mentioned EC, but exposure to mass media in general is low. In the 2013-14 DHS, 66.3% of women said they were not exposed to any media sources on a weekly basis in the months leading up to the survey.3 86.5% of women said they had no exposure to family planning messages through the television, radio or print publications in the months leading up to the survey.3 DONOR SUPPORT According to RHInterchange, between 2006 and 2015, 375,013 units of EC were purchased by donors for DRC family planning programs. Funding sources were USAID and UNFPA.15 REFERENCES 1 CIA The World Factbook. Africa: Congo, Democratic Republic Of The. Retrieved 1 November 2013 from https://www.cia.gov/library/ publications/the-world-factbook/geos/cg.html. 2 Gettleman J. The World’s Worst War. 15 December 2012. The New York Times. Retrieved 18 March 2014 from http://www.nytimes. com/2012/12/16/sunday-review/congos-never-ending-war.html?_r=0. 3 Enquete Démographique et de Sante 2013-2014. République Démocratique du Congo. Ministere de la Sante Publique, Measure DHS, ICF Interntaional. Rockville, Maryland, USA. Septembre 2014. (http://dhsprogram.com/pubs/pdf/FR300/FR300.pdf) 4 Enquete Demographique et de Sante 2007. Republique Democratique du Congo. Ministere de la Sante, Kinshasa et Macro International Inc, USA. Aout 2008 from http://www.measuredhs. com/pubs/pdf/FR208/FR208.pdf. 5 Liste Nationale des Medicaments Essentiels, Revision Mars 2010. Republique Democratique du Congo. Ministere de la Sante Publique. (http://apps.who.int/medicinedocs/documents/s18817fr/ s18817fr.pdf) 6 Republique Democratique du Congo Ministere de la Sante Publique, Programme National de Sante la Reproduction, USAID and Family Health International. Module de formation des prestataires en planification familiale. May 2008. (http://familyplanning-drc.net/docs/ moduleTraining.pdf) 7 Planification Familiale: Plan stratégique national á vision multisectorielle (2014-2020). Republique Democratique du Congo. (http://advancefamilyplanning.org/sites/default/files/resources/ Final%20Plan%20Strategique%20de%20PF%2020%20Fev% 20Ok.pdf) 8 Plan National de Développement Sanitaire PNDS 2011-2015. Republique Democratique du Congo. Ministere de la Sante Publique. Mars 2010. (http://www.internationalhealthpartnership. net/fileadmin/uploads/ihp/Documents/Country_Pages/DR_Congo/ DR_Congo_Natl_Health_Development_Plan_2011-2015_French.pdf) 9 Health-System Strengthening Strategy. Democratic Republic of the Congo. Ministry of Health. June 2006. (http://www.who.int/ management/country/cod/drcstrategy2006.pdf) 10 Vreeke E. Counterfeit medicines seized in Kinshasa. 21 June 2013. Association Regionale D’Approvisionnement en Medicaments Essentiels. Retrieved 24 February 2014 from http://www.asrames. com/en/counterfeit-medicines-seized-in-kinshasa/. 11 Casey S, Gallagher M, Makanda B, Meyers J, Vinas M, Austin J. Care-Seeking Behavior by Survivors of Sexual Assault in the Democratic Republic of the Congo. American Journal of Public Health. 2011. 101(6):1054-1055. (http://www.ncbi.nlm.nih.gov/ pmc/articles/PMC3093280/) 12 Family Planning in the D.R.C. Congolese NGOs. Tulane University School of Public Health, U.S. and the Programme National la Sante de la Reproduction, Kinshasa. (http://familyplanning-drc.net/ congolese-ngos.php) 13 Family Planning in the D.R.C. International NGOs. Tulane University School of Public Health, U.S. and the Programme National la Sante de la Reproduction, Kinshasa. (http://familyplanning-drc.net/ international-ngos.php) 14 Liebling H, Slegh H. Bearing Children Through Rape in Eastern Congo: Community and State Responses. Coventry University, United Kingdom and Institute of Mental Health, Goma, Democratic Republic of the Congo. October 2012. 15 RHInterchange database, Reproductive Health Supplies Coalition. This fact sheet has been prepared by the International Consortium for Emergency Contraception and represents the best information we have been able to gather. We welcome your input for future revisions. Please contact us at firstname.lastname@example.org. Visit our website at www.emergencycontraception.org for more information on EC.