Niger -Counting What Counts: Tracking Access to Emergency Contraception
Publication date: 2014
September 2014 Niger is one of the world’s poorest countries and has the highest fertility rate globally.1 Modern contraceptive use is extremely low and EC is almost unknown by women in Niger – fewer than 5% of women have ever heard of it.2 Most national policies and guidelines do not incorporate EC. ABOUT NIGER Niger is a landlocked country in West Africa with a population of 17,466,172. Almost half of the population is under the age of 15. 17.8% of the population lives in urban areas.3 More than 72% of women have no education at all, and only 0.1% of women have completed the secondary level of schooling.2 The United Nations Development Pro- gram’s 2013 Human Development Index ranked Niger at the bottom of its list4 due to extremely low levels of education, high levels of malnutrition and the highest fertility rate in the world.1 CONTRACEPTIVE & EC KNOWLEDGE AND USE POLICIES Essential Drug List: Unable to obtain information. National norms and guidelines: The 2011- 2015 Health Development Plan6 and the 2012-2020 Family Planning Action Plan do not include EC.7 Prescription status and who is authorized to dispense: EC is available in pharmacies. Levonorgestrel (LNG) EC pills (ECPs) are available without a prescription from pharma- cists. Ulipristal acetate (UPA) ECPs are only available with a prescription. Post-rape care: Unable to obtain information. PRODUCT AVAILABLITY Registered Products: Two levonorgestrel-alone ECP products are registered and distributed: NorLevo 1.5 (HRA Pharma) and Pregnon (FamyCare). One ulipristal acetate ECP product is registered and distributed: ellaOne (HRA Pharma). Locally manufactured products: None available. Poor quality or counterfeit EC products: Given the extensive pharmaceutical trad- ing among West African countries, some of whose markets are known to have counterfeit products, poor quality or counterfeit com- modities may also exist in Niger.8 Nigeria is thought to be the second largest producer of counterfeit medicines,9 and reports of counterfeit EC specifically have emerged in Ni ge r NIGER COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION • Total fertility rate: 7.6 (8.1 rural, 5.6 urban) • Unmet need for contraception (among currently married women): 16% • Current contraceptive modern method use (among all women): 11% Source: Demographic and Health Survey, Niger 20122 KNOWLEDGE AND EVER USE OF MODERN CONTRACEPTION AND EC 0 20 40 60 80 100 ECAny Modern Method Knowledge (DHS 2012) Ever Use (DHS 2006) % o f A ll W om en Type of Contraception 98.1 10.9 87.7 4.4 30.7 Not Available Source: Demographic and Health Survey, Niger2,5 Ni ge r 2 Nigeria; many countries, including Niger, purchase drugs from the Nigerian market.8 WHERE WOMEN CAN ACCESS EC EC in the commercial sector: 5.4% of women who use oral contraceptive pills or injectables (the two most commonly used contraceptive products in Niger) obtain these methods in the private sector.2 The proportion of women using EC who obtain it in the private sector is not known. EC in the public sector: The public sector provides oral contraceptive pills and injectables to 85.3% of women using these methods.2 The proportion of women using EC who obtain it in the public sector is not known. EC in the NGO, social marketing and social fran- chising sectors: The national social marketing organization Animas-Sutura distributes condoms and oral contraceptives, but not EC.10 Community-based distribution of ECPs: There is no community-based distribution of EC.11 MEDIA COVERAGE OF EC According to the 2012 DHS, 46.9% of women were exposed to a family planning message through television, radio or print media in the months before the survey.2 It is not known whether any media coverage was specific to EC. DONOR SUPPORT UNFPA is the only donor importing contracep- tives into Niger, as of 2014.12 According to RHInterchange, no donors purchased EC for family planning programs between 2000 and 2014.13 REFERENCES 1 Potts M, Gidi V, Campbell M, Zureick S. Niger: Too Little, Too Late. Guttmacher Institute. International Perspectives on Sexual and Reproductive Health. June 2011. (http://www.guttmacher.org/pubs/journals/3709511.html). 2 Enquête Démographique et de Santé et à Indicateurs Multiples, Niger 2012. Institut National de la Statistique and ICF International. Septembre 2013. (http://dhspro gram.com/pubs/pdf/FR277/FR277.pdf). 3 CIA The World Factbook. Africa: Niger. Retrieved 31 August 2014, from https://www.cia.gov/library/publica tions/the-world-factbook/geos/ng.html. 4 United Nations Development Programme. Human Devel- opment Report 2013. The Rise of the South: Human Progress in a Diverse World. 2013. (http://hdr.undp.org/ sites/default/files/reports/14/hdr2013_en_complete.pdf). 5 Enquête Démographique et de Santé et à Indicateurs Multiples, Niger 2006. Institut National de la Statistique and Macro International. Février 2007. (http://dhspro gram.com/pubs/pdf/FR193/FR193-NI06.pdf). 6 Republique du Niger, Ministere de la Sante Publique Secretariat General. Plan de Developpement Sanitaire 2011-2015. (http://www.mindbank.info/item/2376). 7 Republic of Niger, Ministry of Public Health. Family Planning in Niger: 2012-2020 Action Plan. June 2012. (http://www.familyplanning2020.org/images/content/ documents/Niger_National_Family_Planning_Plan_ English.pdf). 8 Akunyili D. Lessons from Nigeria: the fight against counterfeit drugs in Africa. Diabetes Voice. September 2006. (http://apps.who.int/medicinedocs/documents/ s18404en/s18404en.pdf). 9 Onwuka C. Be Aware Take Action: The situation of medicines counterfeiting in Africa. 2010. (http://www. whpa.org/Background_medicines_counterfeiting_in_ Africa_Chioma_Jo_Onwuka11-2010.pdf). 10 KfW Development Bank. Sensitive Anti-AIDS campaigns in Niger. June 2012. (https://www.kfw-entwicklungsbank. de/International-financing/KfW-Entwicklungsbank/ Sectors/Gesundheit/Projektbeispiele/Niger-Soziales- Marketing/). 11 McDavid E, Kodjo E. USAID Health Policy Project. Repositioning Family Planning in Niger: A Baseline. July 2012. (http://www.healthpolicyproject.com/pubs/64_ NigerRepositioningFamilyPlanningReporFINAL.pdf). 12 Maradi S. The Economist. Birth control in Niger: Popula- tion Explosion. 16 August 2014. (http://www.economist. com/news/middle-east-and-africa/21612239-runaway- birth-rates-are-disaster-population-explosion). 13 RHInterchange. Niger-Summary of Shipments. Retrieved 28 August 2014, from http://www.myaccessrh. org/rhi-home?p_p_id=rhiuserportlet_WAR_ rhiportlet&p_p_lifecycle=1&p_p_state=normal&p_p_ mode=view&p_p_col_id=column-1&p_p_col_count=1&_ rhiuserportlet_WAR_rhiportlet__spage=%2Fhomerun.do. 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 email@example.com. Visit our website at www.emergencycontraception.org for more information on EC.