ICEC - Emergency Contraception in National Essential Medicines Lists 2013

Publication date: 2013

December 2013 Emergency Contraception in National Essential Medicines Lists _________________________________________________________________________________________________________ Emergency Contraceptive Pills (ECPs) are an essential component of women’s reproductive health. They offer women an important second chance to prevent pregnancy when a regular method fails, no method was used, or sex was forced. Research over the past 30 years has shown that ECPs are safe and effective. The most recent (March 2011) World Health Organization’s Essential Medicines List (EML) includes one form of ECP, containing levonorgestrel (LNG) as an active ingredient. While other drugs can be used for EC, only the LNG form is listed by the WHO at this time. The WHO list includes two regimen options for LNG ECPs: two tablets of 0.75 milligrams, or one tablet of 1.5 milligrams (mg). (These may also be written as 750 micrograms and 1500 micrograms (µg).) Either regimen can be used; although the two-pill regimen is labeled for the pills to be taken 12 hours apart, the current recommendation is for both pills to be taken together as a single 1.5 mg dose. A number of countries have shared their national EMLs on the WHO website1; others have been shared via personal correspondence. Those that include ECPs are listed below, with the year of publication; two countries specify a different method of EC, based taking a higher dose of regular oral contraceptives (called the (“Yuzpe” regimen). The countries whose EMLs are available but do not include EC are also listed. However, the fact that a country does not include EC in its EMLs does not mean there is no product registered or on the market. For those countries with no EC listed in its EML, we have listed whether or not EC is available locally. Of the 113 countries with available EMLs, 58 countries are known to list ECPs: 5 include only the 1.5 mg dose. 36 include only the 0.75 mg dose. 11 include both the 1.5 and 0.75 mg doses. 4 include LNG but do not specify the dose. 2 include the Yuzpe regimen (high dose of regular oral contraceptives as EC). 55 countries do not include ECPs. Of these, 7 do not include any contraceptives. 5 National EMLs are known to include only the 1.5 mg ECP regimen: Brazil: 2010 Cook Islands: 2007 Peru: 2010 Tunisia: Year unknown Ghana: 2010 36 National EMLs are known to include only the 0.75 mg ECP regimen: Algeria: 2006 Armenia: 2010 Bhutan: 2009 Bolivia: 2011 Burkina Faso: 2007 Burundi: 2009 Cape Verde: 2009 Chile: 2005 Dem. Rep. of Congo: 2010 Dominican Republic: 2005 Ecuador: Undated Fiji: 2006 Gabon: Year unknown Georgia: 2007 Iran: 2009 Jamaica: 2008 Kenya: 2003 Kyrgyzstan: 2009 Malawi: 2009 Mali: 2008 Mexico: 2010 Nauru: 2010 Niue: 2006 Paraguay: 2009 Rwanda: 2010 Senegal: 2008 Seychelles: 2010 Solomon Islands: 2010 South Africa: 2008 Sri Lanka: 2009 Sudan: 2007 Suriname: 2004 Sweden: 2004 Thailand: 2008 Tuvalu: 2008 Uganda: 2012 December 2013 1 World Health Organization. “National Medicines List/Formulary/Standard Treatment Guidelines.” Web site: www.who.int/selection_medicines/country_lists/en/index.html. 11 National EMLs are known to include both the 1.5 and 0.75 mg ECP regimens: Belize: 2009-2011 Cameroon: 2009 Congo: 2008 Laos: 2012 Moldova: 2009 Myanmar: Year unknown Nepal: 2009 Pakistan: 2007 Russia: 2012 St. Vincent & the Grenadines: 2010 Tajikistan: 2009 4 National EMLs are known to include LNG ECPs without specifying indication or dose: Central African Rep.: 2009 China: 2009 Syria: 2008 Ukraine: 2009 2 National EMLs are known to include only the Yuzpe regimen (high dose of regular oral contraceptives as EC): Tanzania: 2007 Zimbabwe 2006 55 National EMLs are known NOT to include ECPs: Afghanistan: 2007 Angola: 2008 (no contraceptives in EML; no EC product registered, but allows for import with license) Argentina: 2005 (EC product registered) Bangladesh: 2008 (EC product registered) Barbados: 2011 (EC product registered) Bulgaria: 2009 (EC product registered) Cambodia: 2003 (EC product registered) Chad: 2007 (no EC product registered, but allows for import with license) Colombia: 2011 (no contraceptives in EML, but EC product registered) Cote d’Ivoire: Year unknown (EC product registered) Croatia: 2010 (EC product registered) Djibouti: 2007 (EC product registered) Egypt: 2006 (EC product registered) El Salvador: 2011 (EC product registered) Eritrea: 2010 Ethiopia: 2010 (EC product registered) Guyana: 2009 Haiti: National Strategic Plan for Health, 2003-2008 Honduras: 2009-11 India: 2011 (no contraceptives in EML, but EC product registered) Indonesia: 2008 (Listed as removed since 2005 edition) (EC product registered) Iraq: 2010 Jordan: 2009 (no contraceptives in EML) Kiribati: 2009 Lesotho: 2005 (no contraceptives in EML, but EC product registered) Macedonia: 2010 (no contraceptives in EML, but EC product registered) Madagascar: 2008 (EC product registered) Malaysia: 2008 (EC product registered) Maldives: 2009 Malta: 2008 (EC product registered) Marshall Islands: 2007 (no contraceptives in EML) Mauritania: 2007 (EC product registered) Montenegro: 2011 (EC product registered) Morocco: 2008 (no contraceptives in EML, but EC product registered) Namibia: 2008 (EC product registered) Nicaragua: year unknown (EC product registered) Nigeria: 2003 (EC product registered) North Korea: 1999, list for international agencies (no contraceptives) Oman: 2009 Palau: 2006 Papua New Guinea: 2002 Philippines: 2008 Poland: 2009 (EC product registered) Serbia: 2010 (EC product registered) Slovakia: 2010 (EC product registered) Slovenia: 2010 (EC product registered) Somalia: 2007 (no contraceptives in EML) Timor Leste: 2004 Togo: 2006 (EC product registered) Tonga: 2007 Trinidad: 2010 (EC product registered) Uruguay: 2011 (EC product registered) Vanuatu: 2007 Venezuela: 2004 (EC product registered) Yemen: 2007 (EC product registered) December 2013 1 World Health Organization. “National Medicines List/Formulary/Standard Treatment Guidelines.” Web site: www.who.int/selection_medicines/country_lists/en/index.html. A note on methodology: ICEC downloaded all the available EMLs from the WHO website in December 2012 and used the “find” function to search for the following key words: levonorgestrel, norgestrel, contraception, and emergency contraception. December 2013 1 World Health Organization. “National Medicines List/Formulary/Standard Treatment Guidelines.” Web site: www.who.int/selection_medicines/country_lists/en/index.html.

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