Technical Reference Team; Commodity: Emergency Contraception

Publication date: 2013

S A F E G U A R D I N G W O M E N A N D C H I L D R E N W I T H E S S E N T I A L C O M M O D I T I E S Technical Reference Team Commodity: Emergency Contraception Background The UN Commission on Life-Saving Commodities for Women and Children (the Commission) was formed in 2012 by the UN Secretary-General as part of the global Every Woman Every Child (EWEC) movement. EWEC challenges the global community to increase access to and appropriate use of essential medicines, medical devices, and health supplies that effectively address the leading preventable causes of death during pregnancy, childbirth, and childhood. Led by a wide range of high-level leaders from around the world, the Commission developed a framework for action on Reproductive, Maternal, Newborn, and Child Health (RMNCH) products that can be applied nationally and utilized in global RMNCH initiatives. The framework outlines a priority list of 13 commodities, key barriers to access and use, and 10 cross-cutting recommendations to rapidly increase both access and use. By increasing access to and use of these 13 commodities, it is estimated that 6 million women and children can be saved by 2017. Moving forward To help carry forward the Commission’s recommendations at the global and national levels, Global Technical Reference Teams (TRT) were established. One group was formed for each of the 13 commodities and 10 recommendations, and an advocacy working group is dedicated to advancing cross-cutting goals. The groups carry out their work through a variety of mechanisms, including guidance documents and tools to support countries in their efforts to implement recommendations and address global and regional bottlenecks. The TRTs are coordinated by a Strategy and Coordination Team hosted by the United Nations Children’s Fund (UNICEF). Spotlight on Emergency Contraception Emergency contraception (EC) offers women an important second chance to prevent pregnancy when a regular method fails, no method was used, or sex was Poster Campaign, DKT International, Ethiopia, 2009. forced. It can be used up to five days after unprotected sex but is more effective the sooner it is used. EC is included as part of World Health Organization’s (WHO) Model List of Essential Medicines (EML) and in norms and guidelines issued by global organizations such as the International Federation of Gynecology and Obstetrics (FIGO). Research over the past 30 years has shown that EC is safe and effective, and that interference with ovulation is the primary and possibly the only mechanism of action. However, a number of barriers limit women’s access to EC, including low awareness among women and health care providers, opposition and bias due to misconceptions about EC, policy restrictions, cultural issues, and supply chain disconnects. The EC Technical Reference Team (TRT) has outlined four key outcomes to address these barriers: • Strengthen and develop policy guidance and tools to expand access to EC, including among vulnerable groups. • Strengthen capacity of providers and pharmacists to implement EC in selected countries. • Strengthen public knowledge and demand for EC. S A F E G U A R D I N G W O M E N A N D C H I L D R E N W I T H E S S E N T I A L C O M M O D I T I E S • Strengthen quality assurance standards throughout the supply chain for EC. Group membership The EC TRT is convened by the World Health Organization (WHO) in collaboration with the International Consortium for Emergency Contraception (ICEC). Progress to date Outcome 1: The WHO and ICEC have collaborated to define topics for the systematic review and initiated the process. The EC TRT has outlined a plan for the operational research and defined the research protocols elements. Outcome 2: The EC TRT conducted a scan of provider training materials that incorporate EC, and wrote a report mapping these materials. The mapping identified a need for additional materials. The EC TRT began writing a proposal for the new training curricula. Outcome 3: The EC TRT prepared and submitted a scientific article, which was accepted and will be published by the International Journal of Gynecology and Obstetrics (IJOG): “Still the best-kept secret in women's health care? A global review of emergency contraception access.” Outcome 4: The EC TRT created fact sheets on country- level registration of EC and inclusion of EC in countries’ EMLs. Among the pathfinder countries, two include dedicated EC products on their EMLs, four do not, and the status is unknown in two others. ECs are registered in all eight of the pathfinder countries. Upcoming activities Outcome 1: Continue to refine the topic for the systematic review and the operations research, and then carry these efforts forward. An experts meeting is planned for October 2013 to present the review outcomes and to prepare programmatic guidance. Outcome 2: Develop training materials for health care providers, based on the gaps identified in the mapping exercise and needs identified by ICEC during field visits. The training materials will be completed by December 2013. A capacity building regional workshop on EC for Francophone countries is planned for December 2013. Outcome 4: WHO teams will continue to carry out the process of updating Expressions of Interest for EC medicines to the WHO Prequalification of Medicines Programme. This activity invites manufacturers to submit dossiers for quality, safety, and efficacy review, and ultimately, for approval. Available resources WHO Fact Sheet N. 244: Emergency Contraception English Fact sheet on the safety of levonorgestrel-alone emergency contraceptive pills (LNG ECPs) English; French Emergency Contraception: Questions and Answers for Decision-Makers English; French Emergency Contraceptive Pills: Medical and Service Delivery Guidelines, Third Edition English; French Mechanism of Action: How do levonorgestrel-only emergency contraceptive pills (LNG ECPs) prevent pregnancy? English; French Emergency Contraception and Medical Abortion: What’s the Difference? English; French EC Access in Nigeria Counting What Counts: Tracking Access to Emergency Contraception Ensuring Access and Correct Use through Social Marketing EC Access in Senegal: Counting What Counts: Tracking Access to Emergency Contraception English; French. Contact us For more information or to request tools and technical assistance, please contact: Viviana Mangiaterra, WHO (mangiaterrav@who.int), Mario Festin, WHO (festinma@who.int), Elizabeth Westley, ICEC (ewestley@familycareintl.org), Sarah Rich, ICEC (srich@familycareintl.org).

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