Sierra Leone - Counting What Counts: Tracking Access to Emergency Contraception
Publication date: 2014
August 2014 Emergency contraception (EC) is included in Sierra Leone’s national Essential Medicines List and reproductive health guidelines, but women’s awareness of EC in Sierra Leone is very low; fewer than one in 10 women know it exists. ABOUT SIERRA LEONE Sierra Leone is a country in West Africa with a population of 5,612,685.1 39.2% of the popula- tion lives in urban areas.1 The country is restoring peace and rebuilding its infrastructure and econ- omy after a civil war from 1991 to 2002, which resulted in tens of thousands of deaths and the displacement of more than 2 million people. Only 2.3% of women have completed the secondary level of education.2 CONTRACEPTIVE & EC KNOWLEDGE AND USE POLICIES Essential Drug List: Emergency contraceptive pills are included in the 2012 national Essen- tial Medicines List.3 National norms and guidelines: EC is incor- porated into the Reproductive, Newborn and Child Health Policy, 2011-2015. It includes a strategy to “ensure the availability, access to, and utilization of quality FP services using a wide range of contraceptive methods at both facility and community level including emer- gency contraception.”4 Prescription status and who is authorized to dispense: EC is available by prescription only. It is available in public sector clinics, pharmacies, NGO-led clinics and social marketing programs. Post-rape care: The Guidelines on Sexual and Gender Based Violence Case Manage- ment for the Family Support Unit of the Sierra Leone Police (2010) recommend that victims be referred to a hospital within 72 hours of the occurrence of the offense and provided with medical services, including EC.5 PRODUCT AVAILABLITY Registered Products: One levonorgestrel EC pill (ECP) product is registered and distrib- uted: Pregnon (FamyCare). Locally manufactured products: None available. Poor quality or counterfeit EC products: While not specific to EC, counterfeit and sub- standard medicines sold on the street and in Sie rra L eo ne RWANDA SIERRA LEONE COUNTING WHAT COUNTS: TRACKING ACCESS TO EMERGENCY CONTRACEPTION • Total fertility rate: 5.1 children per woman (5.8 rural, 3.8 urban) • Unmet need for contraception (among currently married women): 27.6% • Current contraceptive modern method use (among currently married women): 6.7% Source: Demographic and Health Survey, Sierra Leone 2008 KNOWLEDGE AND EVER USE OF MODERN CONTRACEPTION AND EC 0 10 20 30 40 50 60 70 80 ECAny Modern Method Knowledge Ever Use % o f A ll W om en Type of Contraception 68.7 20.5 1.1 6.2 Source: Demographic and Health Survey, Sierra Leone 2008 Si er ra L eo ne 2 markets are a problem, although media reports suggest that drug quality at pharmacies has improved substantially in recent years.6 WHERE WOMEN CAN ACCESS EC EC in the commercial sector: 38.9% of users get their contraceptive methods from the private medical sector.2 The proportion of women us- ing EC who obtain it in the private sector is not known. The lowest level of health care providers allowed to sell or dispense ECPs in the private sector is auxiliary nurses.3 EC in the public sector: More than half of modern contraceptive users (50.4%) get their contracep- tive methods from the public sector.2 The proportion of women using EC who obtain it in the public sector is not known. The lowest level of health care providers allowed to sell or dispense ECPs in the public sector is auxiliary nurses.3 EC in the NGO, social marketing and social fran- chising sectors: Marie Stopes Sierra Leone offers family planning services in the country, including emergency contraception.7 Community-based distribution of EC: Sierra Leone has many different cadres of community health workers, including Community Based Distribu- tors of Contraceptives (CBDs). However, given that the lowest level of public health care provid- ers who can distribute ECPs is auxiliary nurses, it is unlikely that community health workers can distribute ECPs.8 MEDIA COVERAGE OF EC According to the 2008 DHS, fewer than half of all women (47%) were exposed to family planning messages in the past six months.2 It is not known whether this coverage was ever specific to EC. DONOR SUPPORT Donors have purchased EC for Sierra Leone’s family planning programs. According to RHIn- terchange, 109,916 units of EC were sent in nine shipments between 2004 and 2012. Funding sources for these shipments included IPPF, MSI and UNFPA.9 REFERENCES 1 CIA World Factbook. Retrieved October 30, 2013 from https://www.cia.gov/library/publications/the-world-fact book/geos/sl.html. 2 Demographic and Health Survey, Sierra Leone, 2008. ICF Macro and the Ministry of Health and Sanitation. July 2009. (http://www.measuredhs.com/pubs/pdf/FR225/ FR225.pdf) 3 USAID, John Snow Inc. Sierra Leone Contraceptive Security Indicators Data Dashboard. 2013. 4 Sierra Leone Government Ministry of Health and Sanitation. Reproductive, Newborn and Child Health Strategy (2011-2015). July 2011. 5 United Nations Development Programme. Guidelines on SGBV Case Management: A Reference Handbook for the FSU. 2010. (http://www.undp.org/content/dam/sierrale one/docs/focusareadocs/undp_sle_SGBVCaseManage mentGuidelines.pdf) 6 Sama P, McDiarmid J. Sierra Leone: Substandard and Counterfeit Drugs Flood the Market. Inter Press Service News Agency. June 16, 2011. Retrieved February 21, 2014 from http://www.ipsnews.net/2011/06/sierra-leone- substandard-and-counterfeit-drugs-flood-the-market/. 7 The Global Health Group. Clinical Social Franchising Compendium: An Annual Survey of Programs, 2012. University of California, San Francisco. May 2012. (http://worldhealthpartners.org/Resources/report_01.pdf) 8 Government of Sierra Leone, Ministry of Health and Sanitation. Policy for Community Health Workers in Sierra Leone. June 2012. (http://www.kambia.org.uk/down loads/CHW-Policy.pdf) 9 RHInterchange, Retrieved November 1, 2013 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=%2 Fquantitysummary.do&_rhiuserportlet_WAR_ rhiportlet__sorig=%2Fshipmentsummary.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 firstname.lastname@example.org. Visit our website at www.emergencycontraception.org for more information on EC.