2ESOURCES FOR %MERGENCY #ONTRACEPTIVE 0ILL 0ROGRAMMING
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Acknowledgement
PATH gratefully acknowledges the fi nancial support of the Compton Foundation, Inc.; the Andrew W. Mellon Foundation; the Mildred and Mary Wohlford Fund of the Tides Foundation; and the William and Flora Hewlett Foundation for the development of Resources for Emergency Contraceptive Pill Programming: A Toolkit. We would like to thank all of the organizations that contributed materials and experiences to the development of the toolkit: AltaCare; Association of Reproductive Health Professionals; Deliver Project at John Snow, Inc.; Family Guidance Association of Ethiopia; Family Health International (FHI); International Federation of Gynecologists and Obstetricians; Family Planning Association of Sri Lanka; International Consortium for Emergency Contraception; International Planned Parenthood Federation; Pacifi c Institute for Women’s Health; Population Action International; Population Council; Population Services International; Profamilia Colombia; Reproductive Health Research Unit of the University of the Witwatersrand; United Nations Population Fund; United States Agency for International Development; and the World Health Organization. Special thanks to Daya Abeywickrema, Charlotte Ellertson, John Skibiak, Jenni Smit, Elizabeth Warnick, Elisa Wells, and all of the organizations and individuals who participated in the needs assessment and who have played an active role in paving the way for the mainstreaming of emergency contraception. PATH takes full responsibility for this document’s content, which does not necessarily refl ect the opinions of the document’s reviewers or contributors.
Copyright © 2004, Program for Appropriate Technology in Health (PATH). All rights reserved. The material in this document may be reproduced and freely used for educational or noncommercial purposes, provided that PATH is acknowledged and the materials are made available free of charge or at cost.
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4ABLE OF #ONTENTS
)NTRODUCTIONVII
-ODULE ! )NFORMATION FOR 0OLICY -AKERS ! 4OOLS !#/' .EWS 2ELEASE! )#%# %VIDENCE "ASED 0OLICY 3TATEMENTS ! &)'/ %THICS #OMMITTEE 2EPORT ! )00& 3TATEMENT! 53!)$ AND 5.&0! 3TATEMENTS! 7(/ 3TATEMENT ON %MERGENCY #ONTRACEPTION ! !NNOTATED "IBLIOGRAPHY OF #ORE %VIDENCE "ASED 2ESEARCH ON %MERGENCY #ONTRACEPTION ! +EY &ACTS !BOUT %MERGENCY #ONTRACEPTION!
-ODULE " #OST #ONSIDERATIONS "
-ODULE # 2AISING 0UBLIC !WARENESS# 4OOLS !GENDA FOR A -EDIA 7ORKSHOP ON %MERGENCY #ONTRACEPTION # %MERGENCY #ONTRACEPTION 2ADIO 3CRIPT # %MERGENCY #ONTRACEPTION 4ELEPHONE (OTLINE 3CRIPT # 0OSTERS # 0OSTCARDS #
-ODULE $ )NFORMING #LIENTS $ 4OOLS 3AMPLE 4EXT FOR "ROCHURES $ "ROCHURE IN 4HREE &ORMATS $ 3OUTH !FRICA "ROCHURE $
-ODULE % !SSESSMENT % 4OOLS #LIENT +NOWLEDGE !TTITUDES 0RACTICES 1UESTIONNAIRE % 0ROVIDER +NOWLEDGE !TTITUDES 0RACTICES 3URVEY ON %MERGENCY #ONTRACEPTIVE 0ILLS% )N $EPTH )NTERVIEW 'UIDE FOR +EY 2EPRODUCTIVE (EALTH !UTHORITIES % -YSTERY 3HOPPER 3URVEY % 4ABLE OF #ONTENTS -ODULE ) %VALUATION -ODULE ( 0ROVIDER 4RAINING #ONTRACEPTIVE 0ILLS %#0S #ONTRACEPTIVES #/#S AS .ON $EDICATED %MERGENCY -ODULE ' 4HE /PTION OF 0ROVIDING #OMBINED /RAL AND $ISTRIBUTION OF A 0ROGESTIN /NLY %#0 -ODULE & 2EGULATION 0ROCUREMENT 4OOLS 4OOLS 4OOLS 4OOLS %XAMPLE /UTLINE OF AN %#0 0ROGRAM %VALUATION 2EPORT %XAMPLE 2ESULTS &RAMEWORK FOR AN %MERGENCY #ONTRACEPTION 0ROJEC 3ITUATION 2OLE 0LAYS 4RAINING !ID %MERGENCY #ONTRACEPTIVE 0ILL #LIENT 4RAINING !ID $EMONSTRATION 2OLE 0LAY #ONTRACEPTIVE 0ILL #LIENTS 4RAINING !ID 'RAB "AG+EY -ESSAGES FOR %MERGENCY (ANDOUT #OUNSELING 3KILLS /BSERVER #HECKLIST (ANDOUT #OUNSELING FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 3CREENING #HECKLIST (ANDOUT 3AMPLE %MERGENCY #ONTRACEPTIVE 0ILL (ANDOUT +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENT 0RE AND 0OST 3ESSION 1UESTIONNAIRE %MERGENCY #ONTRACEPTION #URRICULUM %MERGENCY #ONTRACEPTION 0ROVISION OF A /NE -ONTH 3UPPLY OF #/#S FOR %MERGENCY #ONTRACEPTION )NFORMATION TO )NCLUDE 7HEN 0ROVIDING #/#S FOR !SSOCIATION OF %THIOPIA 2EPACKAGING &ORMAT 5SED BY THE &AMILY 'UIDANCE #/#S FOR %MERGENCY #ONTRACEPTION %XAMPLE OF THE 0ROTOTYPE 0ACKAGE &ORMAT 0ROCUREMENT 4HROUGH )NTERNATIONAL 0ROCUREMENT 3ERVICES 0REFERENTIAL 0RICING FOR 0UBLIC 3ECTOR !GENCIES 3AMPLE 0ROCUREMENT 3PECIlCATION ,EVONORGESTREL /NLY %#03 )NFORMATION TO )NCLUDE IN A ,EVONORGESTREL /NLY %#0 0ACKAGE )NS 0OTENTIAL -ARKET FOR %#0S ! "ASIC $EMAND -ODEL & & ( ) & ( ( ) ' ' ( & ' ' ' ( & ERT ( S & ( T ( ) ( ( 4ABLE OF #ONTENTS 7EBSITE 2ESOURCES %MERGENCY #ONTRACEPTIVE 0ILLS -EDICAL AND 3ERVICE $ELIVERY 'UIDELINES !PPENDIX ! !PPENDIX "
)NTRODUCTION
2ESOURCES FOR %MERGENCY #ONTRACEPTIVE 0ILL 0ROGRAMMING ! 4OOLKIT
%MERGENCY #ONTRACEPTIVE 0ILLS %#0S ! CONTRACEPTIVE METHOD THAT CAN PREVENT PREGNANCY AFTER UNPROTECTED SEX 2ESOURCES FOR %MERGENCY #ONTRACEPTIVE 0ILL 0ROGRAMMING ! 4OOLKIT 4OOLS TO HELP PROGRAM MANAGERS POLICY MAKERS AND DONORS MAKE %#0S WIDELY AVAILABLE TO WOMEN IN DEVELOPING COUNTRIES THROUGH LARGE SCALE FAMILY PLANNING PROGRAMS
%#0S ARE SPECIAL DOSES OF BIRTH CONTROL PILLS THAT CAN BE USED AFTER UNPROTECTED INTERCOURSE TO PREVENT PREGNANCY !LTHOUGH %#0S OFFER A SAFE AND EFFECTIVE CONTRACEPTIVE OPTION WITH SOME NOTABLE EXCEPTIONS THE METHOD HAS YET TO BE WIDELY INTEGRATED INTO DEVELOPING COUNTRY FAMILY PLANNING PROGRAMS 4HE PURPOSE OF THIS TOOLKIT IS TO FACILITATE THE INTEGRATION OF %#0S INTO DEVELOPING COUNTRY FAMILY PLANNING AND REPRODUCTIVE HEALTH PROGRAMS )T INCLUDES RESOURCES FOR %#0 ADVOCACY ASSESSMENT SERVICE PROVISION AND EVALUATION 4HE PLANNING AND IMPLEMENTATION TOOLS REPRESENT BEST PRACTICES AND EXPERIENCE THAT WILL HELP PROGRAMS MOVE THROUGH THE STEPS REQUIRED TO MAKE %#0 SERVICES ROUTINELY AVAILABLE THROUGH HEALTH SERVICE DELIVERY SYSTEMS 4HE INTENT OF THE TOOLKIT IS TO SHARE WIDELY AN ARRAY OF MATERIALS DEVELOPED BY 0!4( AND BY OTHER ORGANIZATIONS AS THEY WORKED IN A VARIETY OF SETTINGS TO INCORPORATE %#0S INTO FAMILY PLANNING SERVICES )T IS HOPED THAT BY BRINGING TOGETHER THESE RESOURCES IN A FORMAT THAT FACILITATES THEIR USE THE TOOLKIT CAN REDUCE DUPLICATION OF EFFORTS REDUNDANCY AND UNNECESSARY EXPENSE !LTHOUGH THE FOCUS OF THIS TOOLKIT IS TO FACILITATE ACCESS TO %#0SA METHOD THAT CAN BE INTEGRATED INTO A WIDE ARRAY OF SERVICES THROUGH A VARIETY OF PROVIDERSTHE OTHER EMERGENCY CONTRACEPTIVE METHOD INSERTION OF AN INTRAUTERINE DEVICE )5$ WITHIN SEVEN DAYS AFTER UNPROTECTED INTERCOURSE SHOULD NOT BE IGNORED "ECAUSE MANY FAMILY PLANNING PROGRAMS PROVIDE )5$S AS A REGULAR CONTRACEPTIVE METHOD FOR ONGOING FAMILY PLANNING THEY ARE WIDELY AVAILABLE )F EMERGENCY CONTRACEPTION IS TO BE COMPREHENSIVELY
-ATERIALS FOR THIS TOOLKIT WERE GRACIOUSLY PROVIDED BY !LTA#ARE !SSOCIATION OF 2EPRODUCTIVE (EALTH 0ROFESSIONALS $ELIVER 0ROJECT AT *OHN 3NOW )NC &AMILY (EALTH )NTERNATIONAL &() &AMILY 'UIDANCE !SSOCIATION OF %THIOPIA )NTERNATIONAL &EDERATION OF 'YNECOLOGISTS AND /BSTETRICIANS &AMILY 0LANNING !SSOCIATION OF 3RI ,ANKA )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION )NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION 0ACIlC )NSTITUTE FOR 7OMENS (EALTH 0OPULATION !CTION )NTERNATIONAL 0OPULATION #OUNCIL 0OPULATION 3ERVICES )NTERNATIONAL 0ROFAMILIA #OLUMBIA 2EPRODUCTIVE (EALTH 2ESEARCH 5NIT OF THE 5NIVERSITY OF 7ITWATERSRAND 5NITED .ATIONS 0OPULATION &UND 5NITED 3TATES !GENCY FOR )NTERNATIONAL $EVELOPMENT AND THE 7ORLD (EALTH /RGANIZATION VII VIII )NTRODUCTION WWWCECINFOORGHTMLRES DOWNLOADABLE MTRLSHTM #OLLABORATIVE !PPROACH TO -EETING 7OMENS .EEDS )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION %#0S THROUGH THEIR FAMILY PLANNING PROGRAMS NEED TO PROVIDE AS THEY MOVE FORWARD TO SUCCESSFUL SUSTAINABLE THAT WILL HELP THEM IDENTIFY THE GROUPS THEY NEED TO WORK WITH EMERGENCY CONTRACEPTION ADVOCATES DECISION MAKERS AND PROGRAM 2ESOURCES FOR %MERGENCY #ONTRACEPTIVE 0ILL 0ROGRAMMING ! 4OOLK FOR THEIR PARTICULAR SITUATION TO THEIR NEEDS ADAPTING INFORMATION AND MATERIALS IN ORDER TO VARIABILITY THE TOOLKIT IS DESIGNED AS A FOUNDATION UPON WHICH WORK AND WHY IT IS IMPORTANT FOR WOMEN TO HAVE TIMELY ACCESS T GROUPS THAT MUST BE REACHED WITH INFORMATION ABOUT %#0SWHAT TH AND THE STATUS OF A DEDICATED %#0 PRODUCT #OUNTRIES ALSO DIFFE #OUNTRIES VARY AS TO CURRENT AWARENESS AND AVAILABILITY OF EMER PROGRAM PLANNERS MOVE FORWARD TO ACHIEVE BROAD PROGRAMMING OF % INTRODUCTION PROCESS AND PROVIDES INFORMATION AND MATERIALS THA IN AN ARRAY OF COUNTRIES %ACH MODULE OF THE TOOLKIT FOCUSES ON IS INVOLVED IN CARRYING OUT SPECIlC STEPS AND PROVIDES SAMPLES %MERGENCY #ONTRACEPTIVE 0ILL 0ROGRAMMING ! 4OOLKIT !PPROACH TO -EETING 7OMENS .EEDS v )#%#S REPORT h%XPANDING 'LOBAL !CCESS TO %MERGENCY #ONTRACEPTI #ARE 0ROVIDERS AND 0ROGRAM -ANAGERS INFORMATION PACKET CONTRACEPTIONIN SEVERAL DEVELOPING COUNTRIES 4HE FRAMEWORK WA INTRODUCE A DEDICATED %#0A PRODUCT SPECIlCALLY PACKAGED AND LA IMPLEMENTATION )#%# DEVELOPED THIS INTRODUCTION FRAMEWORK TO G #ONTRACEPTION )#%# AND MOVE FROM THE CONCEPT OF %#0 INTRODUCT FOR )NTRODUCTION THAT WAS DEVELOPED BY THE )NTERNATIONAL #ONSOR 4HE TOOLKIT IS DESIGNED TO HELP FAMILY PLANNING PROGRAMS BUILD INTEGRATING EMERGENCY CONTRACEPTION INTO THEIR FAMILY PLANNING AND RESOURCES THAT DEVELOPING COUNTRY PROGRAM MANAGERS WOULD lN MAINSTREAMING EMERGENCY CONTRACEPTION 4HE ASSESSMENT RESULTS I 5.&0! AND DIFFERENT ORGANIZATIONS AND INDIVIDUALS WHO HAVE P !GENCY FOR )NTERNATIONAL $EVELOPMENT 53!)$ AND 5NITED .ATIONS ASSESSMENT OF COUNTRY PROGRAM PLANNERS COUNTRY REPRESENTATIVES 0!4( BEGAN DEVELOPMENT OF THIS %#0 PROGRAMMING TOOLKIT BY CONDU RAISING AND CLINICAL SERVICESFOR PROVISION OF )5$S FOR EMERGE OF EMERGENCY CONTRACEPTION SHOULD ADVOCATE AT ALL LEVELSPOLICY CONTRACEPTION OPTIONS PROVIDED TO WOMEN ALONG WITH %#0S 7HERE INCORPORATED INTO LARGE SCALE PROGRAMS INSERTION OF )5$S SHOUL DISSEMINATING EVALUATION RESULTS "UILDING ON THIS STEP WISE AP PROVIDERS INTRODUCING %#0 SERVICES MONITORING AND EVA ISSUES PLANNING FOR DISTRIBUTION MEETING CLIENTS INF NEEDS RAISING SUPPORT AT THE NATIONAL AND COMMUNITY LEVELS REQUIRED TO SUCCESSFULLY INTEGRATE %#0S INTO LARGE DELIVERY CHA %MERGENCY #ONTRACEPTIVE 0ILLS ! 2ESOURCE 0ACKET FOR (EALTH /CTOBER !CCESSIBLE THROUGH THE #ONSORTIUMS WEBSITE AT PUBLISHED IN AND ALSO WAS FEATURED IN %XPANDING 'LOBAL !CCESS TO %MERGENCY #ONTRACEPTION ! 4HE FRAMEWORK SPELLS OUT NINE STEPS DESCRIBES IN MORE DETAIL WHAT ORMATION NEEDS TRAINING DEVELOP THE BEST APPROACH USERS CAN BUILD ACCORDING NNELS ASSESSING ONE ASPECT OF THE PROACH AND THE INFORMATION THEY R IN POLITICAL CLIMATE AND ADDRESSING PRODUCT OF TOOLS USED SUCCESSFULLY GENCY CONTRACEPTION ON THE &RAMEWORK PROGRAMS D BE ONE OF THE EMERGENCY ROUTINE PROVISION OF TIUM FOR %MERGENCY LUATING SERVICES AND T CAN HELP ADVOCATES AND NCY CONTRACEPTION O THEM "ECAUSE OF THIS OF THE 5NITED 3TATES PUBLIC AWARENESS LAYED AN ACTIVE ROLE IN DENTIlED THE CONTENT UIDE ITS EFFORTS TO MANAGERSA RESOURCE S INCLUDED IN )#%#S BELED FOR EMERGENCY POSSIBLE ADVOCATES D MOST USEFUL IN ION TO EY ARE HOW THEY ON ! #OLLABORATIVE #0S 0OPULATION &UND CTING AN EXTENSIVE IT 2ESOURCES FOR IS A RESOURCE FOR HTTP -ODULE !
)NFORMATION FOR 0OLICY -AKERS
/BJECTIVE
4O DEVELOP A POLICY ENVIRONMENTBOTH POLITICAL AND SOCIALSUPPORTING THE INTRODUCTION AND BROAD PROGRAMMING OF EMERGENCY CONTRACEPTIVE PILLS %#0S
4HIS MODULE PROVIDES INFORMATION THAT WILL HELP ADVOCATES WORK WITH KEY POLITICAL LEADERS GOVERNMENT OFlCIALS AND OTHER STAKEHOLDERS IN THE HEALTH AND FAMILY PLANNING COMMUNITY TO FACILITATE PROVISION OF AN %#0 PRODUCT AND RELATED SERVICES 4HE FOLLOWING TOPICS ARE DISCUSSED s 0OLITICAL #ONTEXT s 2ESOURCES s +EY !UDIENCES s +EY -ESSAGES s -EXICO #ITY 0OLICY AND %MERGENCY #ONTRACEPTION s $OMESTIC 6IOLENCE 2APE AND %MERGENCY #ONTRACEPTION s #HOOSING %FFECTIVE #HANNELS TO #OMMUNICATE -ESSAGES s ,OCAL $ATA )LLUSTRATING .EED FOR %MERGENCY #ONTRACEPTION -ODULE ! )NFORMATION FOR 0OLICY -AKERS -ODULE # 2AISING 0UBLIC !WARENESS AND -ODULE $ )NFORMING #LIENTS ARE CLOSELY RELATED )DEALLY %#0 ACCESS WILL INVOLVE ALL THE AREAS DISCUSSED IN THESE THREE MODULESPOLICY PUBLIC AWARENESS AND INFORMING CLIENTS %ACH MODULE PROVIDES RESOURCES TOOLS AND TECHNIQUES THAT CAN BE ADAPTED ACCORDING TO THE TARGET AUDIENCE AND THE ENVIRONMENT
4OOLS 0ROVIDED AT THE %ND OF 4HIS -ODULE
3TATEMENTS ON %#0S BY )NTERNATIONAL /RGANIZATIONS !GENCIES AND -AJOR $ONORS OF #ONTRACEPTIVE #OMMODITIES !MERICAN #OLLEGE OF /BSTETRICIANS AND 'YNECOLOGISTS !#/' .EWS 2ELEASE &EBRUARY )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION )#%# %VIDENCE "ASED 0OLICY 3TATEMENTS *ULY )NTERNATIONAL &EDERATION OF 'YNECOLOGY AND /BSTETRICS &)'/ %THICS #OMMITTEE 2EPORT 'UIDELINES IN %MERGENCY #ONTRACEPTION )NTERNATIONAL *OURNAL OF 'YNECOLOGY /BSTETRICS )NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION )00& )NTERNATIONAL -EDICAL !DVISORY 0ANEL )-!0 3TATEMENT ON %MERGENCY #ONTRACEPTION /CTOBER
! ! -ODULE ! 2ESOURCES 0OLITICAL #ONTEXT 4OOLS CONTINUED !RE THERE ORGANIZATIONAL RESOURCES TO UNDERTAKE A LARGE SCALE s 7HAT ARE THE POTENTIAL SOURCES OF lNANCIAL SUPPORT FOR PROVID s &ROM WHAT TYPES OF LEADERS IS IT MOST CRITICAL TO GAIN SUPPOR s 7HAT ARE THE REPRODUCTIVE HEALTH ISSUES THAT RAISE CONCERN AM s 7HAT ARE THE SOCIAL CULTURAL OR RELIGIOUS ATTITUDES TOWARD s )S THE CURRENT POLITICAL ENVIRONMENT FAVORABLE TOWARD FAMILY s SHOULD TAKE FOLLOWING QUESTIONS CAN BE USEFUL IN HELPING TO DETERMINE THE D CONSIDERING THE lNANCIAL AS WELL AS THE HUMAN RESOURCES THAT AS HOLDING WORKSHOPS AND MEETING WITH REPRESENTATIVES CAN BE F CONSIDERATION 3OME STRATEGIES FOR INmUENCING POLICY CAN BE VER 4HE AVAILABILITY OF RESOURCES TO BUILD SUPPORT IN A GIVEN ENVIR THEY RELATE TO FAMILY PLANNING BEFORE INITIATING %#0 INTEGRATI ENVIRONMENTS CAN BE DIFlCULT IT IS ESSENTIAL TO UNDERSTAND THE PROVISION OF %#0S THROUGH GOVERNMENT FUNDED PROGRAMS "ECAUSE N A MAJOR POLITICAL ISSUE POLITICAL LEADERS HAVE BEEN RELUCTANT CONTINGENT ON THE APPROVAL OF RELIGIOUS LEADERS )N OTHER COUNT DEDICATED %#0 PRODUCT WAS DELAYED OVER lVE YEARS BECAUSE GOVERN LACK OF SUPPORT PRESENTS SERIOUS BARRIERS &OR EXAMPLE IN ONE SUPPORT IS ESSENTIAL IT CAN BE DIFlCULT TO OBTAIN DUE TO STRO AVAILABILITY OF AN %#0 PRODUCT AND APPROPRIATE SERVICE PROVISIO SUCH AS THE MINISTRY OF HEALTH AND THE DRUG REGULATORY AGENCY I INTEGRATING %#0S INTO A LARGE SCALE PROGRAM 4HE COLLABORATION 'OVERNMENT SUPPORT WHETHER EXPLICIT OR IMPLICIT IS A PREREQUI 2ESOURCES FOR $EVELOPING -ESSAGES FOR 0OLICY -AKERS +EY &ACTS !BOUT %MERGENCY #ONTRACEPTION !NNOTATED "IBLIOGRAPHY OF #ORE %VIDENCE "ASED 2ESEARCH ON %MER 7ORLD (EALTH /RGANIZATION 7(/ 3TATEMENT ON %MERGENCY #ONTRA 5NITED 3TATES !GENCY FOR )NTERNATIONAL $EVELOPMENT 53!)$ 3T 5NITED .ATIONS 0OPULATION &UND 5.0&! 3TATEMENT ON %MERGENCY SUPPORT OR SHOULD A SMALLER MORE FOCUSED CAMPAIGN BE CONSIDER MAKERS AND STAKEHOLDERS AND HOW MUCH EFFORT WILL BE NEEDED TO HEALTH SERVICES .O *UNE #ONTRACEPTION NG POLITICAL PRESSURESAND TO BECOME INVOLVED WITH ONMENT IS ANOTHER IMPORTANT ON POLITICAL CURRENTS AND HOW COUNTRY REGISTRATION OF A RIES WHERE ABORTION IS FAMILY PLANNING S CRITICAL TO ENSURE THE WILL BE INVOLVED THE IRECTION THE STRATEGY N !LTHOUGH GOVERNMENT SITE FOR SUCCESSFULLY T OF GOVERNMENT AGENCIES Y COSTLY OTHERS SUCH PLANNING AND REPRODUCTIVE EFFORT TO GENERATE %#0 AIRLY LOW COST )N ING INFORMATION TO POLICY ONG POLITICAL LEADERS MENT APPROVAL WAS AVIGATING SUCH SECURE THAT SUPPORT ED ATEMENT ON %MERGENCY GENCY #ONTRACEPTION #ONTRACEPTION CEPTION &ACT 3HEET -ODULE !
(ARNESSING RESOURCES AVAILABLE FOR INCORPORATING %#0S INTO FAMILY PLANNING PROGRAMS CAN BE A CHALLENGE )N SOME COUNTRIES LIKE -EXICO FOUNDATION DONORS WERE INTEGRAL TO PROVIDING SUBSTANTIAL FUNDING FOR THE LARGE SCALE ADVOCACY CAMPAIGN UNDERTAKEN THERE )N MANY PLACES HOWEVER THIS TYPE OF FUNDING MAY BE DIFlCULT TO ACCESS AND IT IS IMPORTANT TO BE AWARE OF OTHER SUPPORT AVAILABLE AND THE MECHANISMS THROUGH WHICH IT CAN BE OBTAINED 4HERE ARE DIFFERENT TYPES OF RESOURCES OR ORGANIZATIONS THAT MAY BE INTERESTED IN CONTRIBUTING TO EFFORTS TO INTEGRATE %#0S INTO PUBLIC SECTOR PROGRAMS )N SOME SETTINGS GOVERNMENT MAY BE ABLE TO MAKE %#0S PART OF THE COUNTRYS METHOD MIX AND INTEGRATE %#0 INFORMATION INTO ONGOING CLIENT OUTREACH AND PROVIDER TRAINING "ILATERAL DONORS OR MULTILATERAL DONORS PARTICULARLY THOSE WHO PROVIDE CONTRACEPTIVES OR SUPPORT REPRODUCTIVE HEALTH ACTIVITIES CAN BE A RESOURCE 4HIS SUPPORT IS MOST EFFECTIVELY SOUGHT AT THE COUNTRY LEVEL MISSION OR COUNTRY OFlCE ENGAGED IN HEALTH ANDOR REPRODUCTIVE HEALTH WORK 0RIVATE FOUNDATIONS OR LOCAL DONORS SUPPORTIVE OF REPRODUCTIVE HEALTH MAY HAVE INTEREST IN SUPPORTING ACTIVITIES RELATED TO %#0 INTEGRATION )NCLUDE THESE POTENTIAL DONORS EARLY IN THE PLANNING STAGES TO ASSESS THEIR INTEREST AND lND OUT WHAT THEY CAN OR CANNOT SUPPORT
+EY !UDIENCES 7HEN RESOURCES REQUIREMENTS AND AVAILABILITY ARE KNOWN THE NEXT STEP IS TO IDENTIFY THE STAKEHOLDERS AND POLICY MAKERS WHOSE SUPPORT IS NEEDED )N SEVERAL COUNTRIES THAT HAVE SUCCESSFULLY INTEGRATED %#0S INTO LARGE PROGRAMS THESE WERE INDIVIDUALS FROM THE HEALTH CARE SECTOR INCLUDING GOVERNMENT INTERNATIONAL AID AGENCIES AND PROFESSIONAL MEDICAL GROUPS 1UESTIONS THAT WILL HELP IDENTIFY THE TARGET AUDIENCES INCLUDE s 7HO ARE THE KEY POLICY MAKERS AND STAKEHOLDERS IN THE HEALTH AND FAMILY PLANNING COMMUNITY s 7HO CONTRIBUTES TO DECISIONS ABOUT CONTRACEPTIVE METHOD MIX s !MONG THESE POLICY MAKERS AND STAKEHOLDERS WHICH ONES ARE LIKELY OR UNLIKELY TO SUPPORT %#0 MAINSTREAMING EFFORTS s 7HO ARE THE CULTURAL OR RELIGIOUS LEADERS THAT MIGHT OPPOSE OR SUPPORT INCREASING ACCESS TO %#0S s 7HAT OTHER GROUPS OR INDIVIDUALS INmUENCE POLICY RELATED TO HEALTH AND FAMILY PLANNING AND WHICH OF THEM COULD PROVIDE SUPPORT
! ! -ODULE ! WHEN ADVOCATING FOR WIDE ACCESS TO %#0S SUCCESSFUL INTRODUCTION OF %#0S AND THIS APPROACH SHOULD BE AP FROM IMPORTANT STAKEHOLDERS )N SEVERAL COUNTRIES THIS HAS BEEN OF PEOPLE RECEIVING ACCURATE MESSAGES ABOUT %#0S AND GAIN THE THROUGH WHICH TO ADDRESS ISSUES AROUND EMERGENCY CONTRACEPTION INTRODUCTION FROM A VARIETY OF PERSPECTIVES 4HESE FORUMS CAN S MOMENTUM OF ADVOCACY EFFORTS IS IMPORTANT &ORUMS CAN SORT OUT FROM THESE GROUPS CAN FACILITATE EFFECTIVE COLLABORATION AVOID FOR COMMUNICATION AND COLLABORATION AMONG THEM #REATING A FORU )N CASES WHERE MULTIPLE STAKEHOLDERS ARE INVOLVED IT IS IMPORT %#0 FORUM FOR STAKEHOLDERS %XAMPLES OF STAKEHOLDERS IN THE PROVISION OF %#0S INCLUDE 0ROVIDERS 0RE SERVICE ACADEMIC INSTITUTIONS 0ROFESSIONAL GROUPS ,OCAL LEADERS %XAMPLES OF /RGANIZATIONS LEVELS PLANNERS AT NATIONAL AND LOCAL $ECISION MAKERS AND PROGRAM +EY !UDIENCES -IDWIVESTRADITIONAL BIRTH ATTENDANTS s 3AFE ABORTION SERVICE PROVIDERS s #LINIC HEALTH WORKERS s $IRECTORS OF HOSPITALS AND CLINICS s 0HARMACY SCHOOLS s .URSING SCHOOLS s -EDICAL SCHOOLS s 2ESEARCH COUNCILS AND INSTITUTES s 0HARMACISTS ASSOCIATIONS s -EDICAL EDUCATION INSTITUTIONS s -EDICAL ASSOCIATIONS AND SOCIETIES s 0OLICE AND LOCAL LAW OFlCERS s $OMESTIC VIOLENCE SUPPORT GROUPS s 2ELIGIOUS LEADERS s 7OMENS GROUPS s ,OCAL HEALTH GROUPS s #OMMUNITY s 2EPRESENTATIVES FROM MULTILATERAL AND BILATERAL DONOR s (EALTH INSURANCE PROGRAMS s -INISTRY OF JUSTICE s n .ATIONAL MATERNAL AND CHILD HEALTH DIVISION n .ATIONAL FAMILY PLANNING PROGRAM -INISTRY OF HEALTH s AGENCIES DUPLICATION AND MAINTAIN ANT TO CREATE MECHANISMS A KEY FACTOR IN THE ERVE AS A MECHANISM PLIED WHEREVER POSSIBLE ATTENTION OF AND SUPPORT ISSUES AND LOOK AT %#0 INCREASE THE NUMBER M WHERE INDIVIDUALS -ODULE !
,ESSONS ,EARNED
(OLDING A .ATIONAL #ONSENSUS &ORUM IN )NDIA )N COOPERATION WITH SEVERAL ORGANIZATIONS THE #ONSORTIUM ON .ATIONAL #ONSENSUS FOR EMERGENCY CONTRACEPTION IN )NDIA HELD A TWO DAY FORUM ON EMERGENCY CONTRACEPTION 4HE MAIN OBJECTIVES OF THE FORUM WERE TO PRESENT UPDATES ON THE LATEST ADVANCES IN EMERGENCY CONTRACEPTION TO DISCUSS AND DEBATE THE STRATEGIES FOR %#0 INTRODUCTION AND TO SET FORTH GUIDELINES FOR INTRODUCING EMERGENCY CONTRACEPTION IN )NDIA 0ARTICIPANTS INCLUDED A HOST OF INTERNATIONAL AND NATIONAL TECHNICAL EXPERTS POLICY MAKERS RESEARCHERS PHARMACEUTICAL COMPANIES WOMENS ADVOCATES LEGAL EXPERTS NONGOVERNMENTAL ORGANIZATIONS PROFESSIONAL BODIES AND SERVICE PROVIDERS 4HE lRST DAY OF THE FORUM CONSISTED OF lVE SESSIONS DURING WHICH LEADING EXPERTS ADDRESSED THE MAIN ISSUES CURRENT DATA AND lNDINGS FROM OTHER COUNTRIES WHERE %#0S ARE ALREADY INTEGRATED $URING THE SECOND DAY AN EXPERT FORUM WAS HELD ON SIX KEY ISSUES RELATED TO %#0 INTRODUCTION IN )NDIA ! CONSENSUS ON HOW TO MOVE FORWARD WITH RESPECT TO EACH OF THE AREAS WAS REACHED AND ADOPTED 4HE MAIN ISSUES ON WHICH A CONSENSUS WAS REACHED WERE SELECTION OF A DEDICATED METHOD FOR %# IN )NDIA PREINTRODUCTION OF MEDIA CAMPAIGNS FOR PUBLIC AWARENESS TRAINING CURRICULUM FOR HEALTH CARE PROVIDERS IDEAL APPROACH TO BROAD SCALE INTRODUCTION AND DISTRIBUTION OF %#0S AND CLIENT INFORMATION AND COUNSELING FOR SAFE USE 4HE .ATIONAL #ONSENSUS &ORUM WHICH OCCURRED IN HELPED PAVE THE WAY FOR INTRODUCTION OF EMERGENCY CONTRACEPTION IN )NDIA )NFORMATION ON THIS FORUM HAS BEEN COMPILED IN THE 4HE 2EPORT 2ECOMMENDATIONS OF .ATIONAL #ONSENSUS OF #ONSORTIUM WHICH CAN BE ACCESSED ONLINE AT KWWS ZZZHFLQGLDRUJUHSRUWKWP
)NCLUDING A 2ANGE OF )NTERESTS (ELPS 'ARNER 3UPPORT FOR %MERGENCY #ONTRACEPTION IN :AMBIA )N :AMBIA %#0 ADVOCATES INVITED A GROUP OF INDIVIDUALS REPRESENTING A WIDE RANGE OF ORGANIZATIONS TO PARTICIPATE IN DISCUSSIONS AND MEETINGS ON ISSUES RELATED TO EMERGENCY CONTRACEPTION ,EADERS FROM WOMENS GROUPS THE #ATHOLIC #HURCH THE -INISTRY OF (EALTH AND OTHER GROUPS WERE INVITED TO PARTICIPATE IN A DISCUSSION ABOUT THE RESULTS OF AN %#0 STUDY CONDUCTED BY THE 0OPULATION #OUNCIL 4HE FOCUSED DISCUSSIONS AROUND THIS STUDY HELPED HIGHLIGHT EVIDENCE ABOUT %#0S AND SIMULTANEOUSLY INFORMED GROUPS ON ALL SIDES OF THE ISSUE ABOUT EMERGENCY CONTRACEPTION )T PROVED TO BE A VERY EFFECTIVE WAY TO BUILD CONSENSUS ON THE ISSUES SURROUNDING THE LOCAL INTRODUCTION OF %#0S IN :AMBIA 4HIS STUDY IS INCLUDED IN THE ANNOTATED BIBLIOGRAPHY IN THE TOOLS SECTION OF THIS MODULE 3KIBIAK ET AL
! ! -ODULE ! +EY -ESSAGES "ECAUSE %#0S HAVE BEEN SHOWN TO BE SAFE AND EFFECTIVE MANY C s 7(/ HAS STATED THAT THERE ARE NO CONTRAINDICATIONS TO %#0S DU s )N THE YEAR PERIOD FOLLOWING THE AVAILABILITY OF THE DEDIC s 2ESEARCHERS OFTEN EXTRAPOLATE DATA FROM SAFETY STUDIES CONDUC s /RGANIZATION 7(/ HAVE STATED THAT %#0S ARE SAFE FOR USE "OTH THE 5NITED 3TATES &OOD AND $RUG !DMINISTRATION &$! AND T %#0S ARE BOTH SAFE AND EFFECTIVE FOR WOMEN TO USE %#0S ARE SAFE THAT MAY BE USEFUL IN DEVELOPING MESSAGES WHICH IS LOCATED IN THE TOOLS SECTION 4HE BIBLIOGRAPHY ALSO CO OF THE ARTICLES AND RESOURCES LISTED BELOW ARE INCLUDED IN THE PROGRAM SPECIlC MESSAGES AND INFORMATION DISSEMINATION STRATEGI ARISE AMONG POLICY MAKERS ,INKS TO ARTICLES AND RESOURCES THAT DESIGNED TO PROVIDE SUCCINCT INFORMATION ON IMPORTANT TOPICS AN ISSUES THAT ARE FREQUENTLY BROUGHT UP FOR DISCUSSION 4HE FOLLO WITH INFORMATION ON ISSUES SUCH AS %#0S MECHANISM OF ACTION SA 2ECENT RESEARCH ON %#0S HAS RESULTED IN AN EXCELLENT BODY OF WI ADDRESS COMMON MISPERCEPTIONS ABOUT %#0S THAT ARE OFTEN THE CAU INTEGRATING IT INTO A FAMILY PLANNING PROGRAM 0ROVISION OF COR EMERGENCY CONTRACEPTION INCLUDING WHY IT IS A PUBLIC HEALTH IS AND STRATEGIES IT IS CRITICAL TO DRAW FROM EVIDENCE BASED AND MOST EFFECTIVELY INFORM THEIR /NCE AUDIENCES HAVE BEEN IDENTIlED THE NEXT STEP IS TO DETERMI 4HE ONLY CONDITION RESTRICTING USE OF %#0S IS AN ESTABLISHED s -ADAGASCAR -ALI -AURITIUS .AMIBIA 0ORTUGAL 3ENEGAL 3OUTH #ONGO $ENMARK &INLAND &RANCE 'ABON 'UINEA "ISSAU )SRAEL %#0S ARE AVAILABLE DIRECT FROM A PHARMACIST IN !LBANIA "ELGIUM ACCESS BY MAKING THEM AVAILABLE WITHOUT PRESCRIPTION OR DIRECTL HORMONE DOSE AND SHORT DURATION OF USE EVENTS WITH USE OF THE 9UZPE REGIMEN OVER MILLION TIMES -EDICAL REPORTS SHOWED NO CLEAR EVIDENCE ESTROGEN PROGESTIN OR COMBINED REGIMEN PRODUCT IN 'REAT "RITA DEMONSTRATE THAT %#0S ARE SAFE PILLS /#0S TAKEN DAILY OVER A LONG PERIOD OF TIME FOR REGULAR ORAL CONTRACEPTIVES POSE NO RISK OF BIRTH DEFECTS BASED ON STUDIES OF ORAL CONTRACEPTIVE PILLS INCLUDING HIGH DO INADVERTENTLY DURING PREGNANCY WILL NOT HARM A DEVELOPING FETUS WORK IF A WOMAN IS ALREADY PREGNANT 2ESEARCHERS HAVE CONCLUDED BEGINNING WITH IMPLANTATION NOT BECAUSE %#0S ARE HARMFUL BUT CONTRAINDICATIONS FOR USE OF DAILY ORAL CONTRACEPTION ARE NOT A RESEARCHERS HAVE CONCLUDED IN REVIEWS OF PUBLISHED DATA ON /#0S DECISIONS AND GARNER THEIR SUPPOR "ECAUSE %#0S ARE TAKEN FOR A VERY SHORT PERIOD OF TIME ANNOTATED BIBLIOGRAPHY PUBLISHED INFORMATION ABOUT WING SECTION HAS BEEN NTAINS ADDITIONAL RESOURCES RECT INFORMATION HELPS T )N PLANNING KEY MESSAGES SUE AND THE BENElTS OF CAN BE USED IN DEVELOPING ATED 9UZPE ALSO KNOWN AS THE NE WHAT INFORMATION CAN D QUESTIONS THAT OFTEN PREGNANCY DElNED AS DELY PUBLISHED STUDIES PPLICABLE TO %#0S SE FORMULATIONS THAT SHOW FETY AND EFlCACY TED ON ORAL CONTRACEPTIVE CONTRACEPTION TO ES ARE PROVIDED -ANY SE OF CONTROVERSY E TO THE SMALL OVERALL HE 7ORLD (EALTH Y FROM A PHARMACIST DIRECTLY LINKING ADVERSE 4HESE CONCLUSIONS ARE OUNTRIES HAVE SIMPLIlED IN THE REGIMEN WAS USED BECAUSE THEY WILL NOT "ENIN #AMEROON !FRICA 3RI ,ANKA AND %#0S THAT THE THAT %#0S TAKEN )VORY #OAST ,ITHUANIA -ODULE !
3WITZERLAND 4HAILAND 4OGO 4UNISIA 5NITED +INGDOM AND PARTS OF 5NITED 3TATES AND #ANADA 4HEY ARE AVAILABLE OVER THE COUNTER IN .ORWAY AND 3WEDEN )N AN &$! REVIEW PANEL RECOMMENDED THAT PROGESTIN ONLY %#0S BE AVAILABLE OVER THE COUNTER IN THE 5NITED 3TATES
%#0S ARE EFFECTIVE 4HE EFFECTIVENESS OF %#0S VARIES DEPENDING ON THE REGIMEN AND HOW SOON AFTER SEX THEY ARE TAKEN s 4HERE ARE TWO MAJOR TYPES OF %#0S ON THE MARKET TODAY THE LEVONORGESTREL ONLY ALSO KNOWN AS PROGESTIN ONLY REGIMEN AND THE 9UZPE OR COMBINED ESTROGEN AND PROGESTIN REGIMEN 4HE LEVONORGESTREL ONLY REGIMEN HAS FEWER SIDE EFFECTS AND IS MORE EFFECTIVE s /N AVERAGE IF WOMEN HAVE UNPROTECTED INTERCOURSE DURING THE TIME OF THE MONTH WHEN THEY ARE MOST FERTILE WILL BECOME PREGNANT )F THEY ALL TOOK THE LEVONORGESTREL ONLY %#0 REGIMEN WOULD BE EXPECTED TO BECOME PREGNANT AN PERCENT REDUCTION IN PREGNANCY RISK )F ALL OF THOSE WOMEN USED THE 9UZPE REGIMEN WOULD BE EXPECTED TO BECOME PREGNANT A PERCENT REDUCTION IN PREGNANCY RISK s 4HE SOONER AFTER UNPROTECTED INTERCOURSE A WOMAN TAKES %#0S THE LOWER HER RISK OF PREGNANCY %#0S WILL BE MOST EFFECTIVE IF TAKEN WITHIN HOURS THE EFFECTIVENESS DIMINISHES WITH EACH DAY UP TO HOURS DAYS
-ECHANISM OF ACTION OF %#0S s %#0S ARE EFFECTIVE ONLY BEFORE A PREGNANCY IS ESTABLISHED CLINICALLY DElNED AS IMPLANTATION OF A FERTILIZED EGG IN THE LINING OF THE UTERUS 4HEY CANNOT WORK AFTER A FERTILIZED EGG HAS BEEN IMPLANTED s %#0S PRIMARY MECHANISM OF ACTION IS THE INHIBITION OR DELAY OF OVULATION s "ESIDES INHIBITING OR DELAYING OVULATION THERE IS NO UNEQUIVOCAL CLINICAL EVIDENCE FOR OTHER MECHANISMS OF ACTION ALTHOUGH %#0S MAY WORK BY n )NHIBITING FERTILIZATION THROUGH THICKENING OF THE CERVICAL MUCOUS RESULTING IN TRAPPING OF SPERM OR ALTERATIONS IN THE TUBAL TRANSPORT OF SPERM OR EGGBUT NO DATA EXIST TO CONlRM THIS POSSIBLE MECHANISM OF ACTION n )MPAIRING ENDOMETRIAL RECEPTIVITY TO IMPLANTATION OF A FERTILIZED EGG (OWEVER THE EVIDENCE SHOWING ENDOMETRIAL EFFECTS OF %#0 TREATMENT IS MIXED AND IT IS NOT CLEAR THAT THE ENDOMETRIAL CHANGES WOULD INHIBIT IMPLANTATION s 4IMING PLAYS A KEY ROLE IN HOW %#0S WORK 3TUDIES HAVE SHOWN THAT THE SPECIlC MECHANISM OF ACTION AND EFFECTIVENESS OF %#0S MAY DEPEND ON n #YCLE DAY ON WHICH INTERCOURSE OCCURRED n #YCLE DAY ON WHICH TREATMENT IS USED
4HESE ESTIMATES OF REDUCTION IN THE RISK OF PREGNANCY FOLLOWING %#0 USE ARE BASED ON STUDIES THAT EVALUATED %#0 USE WITHIN A HOUR TIME FRAME )NDIVIDUALS HAVE THEIR OWN INTERPRETATIONS OF WHEN A PREGNANCY BEGINS 4HE DElNITION ABOVE IS PROVIDED WITHIN A MEDICAL CLINICAL CONTEXT
! ! -ODULE ! $EPARTMENT OF (EALTH )N DISCUSSING BARRIER METHODS THESE GUID 34)()6 INFECTION IS PROVIDED BY THE .ATIONAL #ONTRACEPTION 0O
CONTRACEPTIONCONTRACEPTIONPDF HTTPWWWDOHGOVZADOCSF &RAMEWORK 2EPUBLIC OF 3OUTH !FRICA $EPARTMENT OF (EALTH CONTRACEPTION SHOULD BE PROMOTED MORE EXTENSIVELYv .ATIONAL #O ! MODEL FOR A DUAL PROTECTION APPROACH AN APPROACH THAT PROMOT 7OMEN WHO RECEIVED %#0S IN ADVANCE OF NEED WERE MORE LIKELY T s %FFECTIVENESS OF %#0S IS INCREASED BY ADVANCE PROVISION ! STUDY CONDUCTED IN :AMBIA HOWEVER PROVIDED SOME EVIDENCE s !NOTHER STUDY SHOWED THAT WOMEN DID NOT ABANDON REGULAR USE O s ! 3COTTISH STUDY SHOWED THAT WOMEN DID NOT STOP USING OTHER M s -OST RESEARCH SUGGESTS THAT ADVANCE PROVISION OF %#0S DOES NO s NEGATIVELY AFFECT REGULAR ONGOING CONTRACEPTIVE USE -OST EVIDENCE SUGGESTS THAT ADVANCE PROVISION OF %#0S DOES NOT )N A #HINESE STUDY RESEARCHERS ESTIMATED THAT NEARLY HALF s )T IS ESTIMATED THAT IN THE 5NITED 3TATES IN PRE s EACH YEAR 2ESEARCH SUGGESTS THAT ACCESS TO %#0S CAN REDUCE THE NUMBER OF %#0S CAN HELP REDUCE THE NUMBER OF ABORTIONS TOOLS SECTION OF THIS MODULE #ONSORTIUM FOR %MERGENCY #ONTRACEPTIONS STATEMENT ON MECHANISM &OR MORE INFORMATION ON THE MECHANISM OF ACTION OF %#0S REFER WITH EMERGENCY CONTRACEPTION AS A BACKUP -EDICAL PROVIDERS SHOULD EMPHASIZE CONTINUED CONDOM USE FOR CLI NEEDED THAN THOSE WHO DID NOT HAVE A SUPPLY AT HOME TRAINING AND USER EDUCATION TO THE USE OF %#0S AND OTHER FAMILY PLANNING METHODS CAN BE OVE ADVANCE PROVISION OF %#0S TO WOMEN IS AN IMPORTANT OPTION AND T PREFERENCE FOR THE CONVENIENCE OF %#0S $ESPITE THIS RESEARCHE %#0 EFFECTIVENESS GIVEN ITS HIGHER DOSAGE COMPARED TO REGULAR O USERS FOR REASONS SUCH AS COERCION BY SPOUSE CURIOSITY ABOUT T OF %#0S MAY HAVE ENCOURAGED NONUSE OF REGULAR FAMILY PLANNING M RELYING ON CONDOMS IF EMERGENCY CONTRACEPTION IS AVAILABLE AS A INFECTION 34) AND ()6 4HE STUDY CONCLUDED THAT COUPLES MAY F AND DISEASE PROTECTION WHICH WOULD HAVE INCREASED THEIR RISK O CONTRACEPTIVE METHODS WHEN A BACK UP METHOD SUCH AS %#0S WAS AV CONTRACEPTIVE USE BEEN AVAILABLE TO WOMEN 3HANGHAI COULD HAVE BEEN PREVENTED IF COMBINED REGIMEN 9UZPE M RESULTED IN ABORTIONS WERE PREVENTED BY THE USE OF %#0S ELINES STATE h)N THE EVENT OF CONDOM FAILURE ACCESS TO EMERGE ACTSHEETSGUIDELINESCONTRACEPTIONCONTRACEPTIONPDF LICY 'UIDELINES ISSUED BY THE 2EPUBLIC OF 3OUTH !FRICAS NTRACEPTION 0OLICY 'UIDELINES 7ITHIN A 2EPRODUCTIVE (EALTH ES STRATEGIES THAT PREVENT BOTH UNWANTED PREGNANCY AND HTTPWWWDOHGOVZADOCSFACTSHEETSGUIDELINES GNANCIES THAT WOULD HAVE OF THE ABORTIONS IN ABORTIONS THAT OCCUR TO THE )NTERNATIONAL HE METHOD CONlDENCE IN ENTS AT RISK OF 34)S F SEXUALLY TRANSMITTED RS STILL CONCLUDED THAT T NEGATIVELY AFFECT REGULAR ORE EFFECTIVE BACKUP METHOD RAL CONTRACEPTIVES AND EEL MORE CONlDENT ABOUT F CONDOMS FOR PREGNANCY THAT ADVANCE PROVISION RCOME WITH PROVIDER OF ACTION IN THE HAT ISSUES PERTAINING O USE THEM WHEN ETHODS AMONG ETHOD %#0S HAD AILABLE IN ADVANCE NCY -ODULE !
s 7OMEN WHO HAVE %#0S IN ADVANCE OF NEED WILL MOST LIKELY USE THEM SOONER AFTER UNPROTECTED INTERCOURSE WHICH INCREASES THE EFFECTIVENESS OF THIS METHOD s 4HE EFFECTIVENESS OF %#0S DECREASES SIGNIlCANTLY THE LONGER A WOMAN WAITS AFTER INTERCOURSE TO TAKE THEM !DVANCE PROVISION IS AN IMPORTANT OPTION BECAUSE IT REDUCES BARRIERS TO TIMELY ACCESS &OR MORE INFORMATION ON THE TIMING OF %#0S AND EFFECTIVENESS SEE THE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTIONS STATEMENT ON REGIMEN IN THE TOOLS SECTION OF THIS MODULE
!CCESS TO %#0S DOES NOT CAUSE PROMISCUITY AMONG ADOLESCENTS 4HE CONCERN IS FREQUENTLY VOICED THAT ACCESS TO %#0S WILL CAUSE PROMISCUITY AMONG YOUTH 4WO RECENT STUDIES PROVIDED EVIDENCE THAT INFORMATION ABOUT AND ACCESS TO CONTRACEPTIVE METHODS INCLUDING %#0S DOES NOT LEAD TO PROMISCUITY OR EARLIER INITIATION OF SEX AMONG ADOLESCENTS
2EPEAT USE OF %#0S DOES NOT POSE HEALTH RISKS s 2EPEAT USE OF %#0S POSES NO HEALTH RISKS ACCORDING TO 7(/ WHICH HAS PLACED REPEATED %#0 USE IN #ATEGORY OF ITS MEDICAL ELIGIBILITY GUIDELINES INDICATING THAT THERE IS NO RESTRICTION FOR THE REPEATED USE OF THIS CONTRACEPTIVE METHOD s %XPERIENCE WITH %#0S SUGGESTS THAT REPEAT USE WITHIN THE SAME CYCLE IS UNCOMMON 5SE OF LEVONORGESTREL ONLY %#0S AS FREQUENTLY AS FOUR TIMES A MONTH DID NOT REVEAL NEGATIVE HEALTH RISKS 7HILE REPEAT USE IS NOT A REASON TO DENY A WOMAN ACCESS TO %#0S IT IS AN INDICATION THAT A WOMAN NEEDS FURTHER COUNSELING ON ROUTINE CONTRACEPTIVE METHODS AS MOST OTHER METHODS ARE MORE EFFECTIVE FOR REGULAR USE 7OMEN WHO HAVE REGULAR INTERCOURSE MORE THAN FOUR TIMES PER MONTH ARE NOT ADVISED TO USE %#0S AS A REGULAR CONTRACEPTIVE METHOD BECAUSE THEY ARE NOT AS EFFECTIVE AS REGULAR CONTRACEPTION &OR MORE INFORMATION ON REPEAT USE SEE THE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTIONS STATEMENT ON REPEAT USE OF EMERGENCY CONTRACEPTION IN THE TOOLS SECTION OF THIS MODULE
-EXICO #ITY 0OLICY AND %MERGENCY #ONTRACEPTION %MERGENCY CONTRACEPTION LIKE OTHER METHODS OF CONTRACEPTION IS NOT SUBJECT TO 53 GOVERNMENT RESTRICTIONS ON DEVELOPMENT FUNDS THAT APPLY TO ABORTION SERVICES COUNSELING AND REFERRAL OR LOBBYING 4HIS HAS BEEN A POINT OF CONFUSION &OREIGN GOVERNMENTS AND NONGOVERNMENTAL ORGANIZATIONS THAT RECEIVE 53 DEVELOPMENT ASSISTANCE MAY PROVIDE EMERGENCY CONTRACEPTION SERVICES INFORMATION AND REFERRAL &OR MORE INFORMATION SEE THE 0OPULATION !CTION )NTERNATIONAL 0!) PUBLICATION h%MERGENCY #ONTRACEPTION AND THE 'LOBAL 'AG 2ULE!N 5NOFlCIAL 'UIDE v WHICH PROVIDES INFORMATION AND CLARITY ABOUT THE -EXICO #ITY 0OLICY )T CAN BE ACCESSED AT THE 0!) WEBSITE HTTP WWWPOPULATIONACTIONORGRESOURCESPUBLICATIONSGLOBALGAGRULE'AG2ULE?DOWNLOADHTM
! ! -ODULE ! #HOOSING %FFECTIVE #HANNELS TO #OMMUNICATE -ESSAGES $OMESTIC 6IOLENCE 2APE AND %MERGENCY #ONTRACEPTION (OW CAN THESE POINTS BE MADE SO THEY HAVE MAXIMUM IMPACT ON T s 7HAT ARE THE MOST IMPORTANT POINTS THAT NEED TO BE MADE s 7HAT TYPE OF INFORMATION DISSEMINATION ACTIVITIES WOULD BE MO s COMMUNICATION CHANNELS TO USE REACHING THE INTENDED AUDIENCES 4HE FOLLOWING QUESTIONS CAN HE /NCE THE KEY MESSAGES HAVE BEEN IDENTIlED SELECT THE MOST EFFE IN THEIR LIVES BEING HIT OR OTHERWISE PHYSICALLY HARMED BY AN INTIMATE MALE PA POPULATION BASED SURVEYS FOUND THAT BETWEEN AND PERCENT O SEXUAL PSYCHOLOGICAL AND ECONOMIC ABUSE OF WOMEN ! REVIEW OF 'ENDER BASED VIOLENCE IS A SIGNIlCANT PROBLEM WORLDWIDE )T CAN ENVIRONMENT LATINAMERICAHTML -ODULE # 2AISING 0UBLIC !WARENESS AND ON 0)7(S WEBSITE HTTP -ORE INFORMATION ON 0)7(S WORK WITH EMERGENCY CONTRACEPTION CA CONTRACEPTION IN THE FAMILY PLANNING NORMS OF THE -EXICAN -INIS ABOUT EMERGENCY CONTRACEPTION AND ADVOCATE FOR THE INCLUSION OF IN "AJA #ALIFORNIA AND 0LANNED 0ARENTHOOD IN 3AN $IEGO TO RAISE PERSONNEL ON %#0 SERVICE PROVISION 0)7( HAS ALSO WORKED WITH O DE -UJERES )NDEPENDIENTES IN -EXICO WORKED TO TRAIN 4IJUANA 3EC ISSUE IN MANY COMMUNITIES &OLLOWING SUCH A WORKSHOP THE /RGAN ASSAULTED OR WERE LIVING WITH DOMESTIC VIOLENCE HIGHLIGHTING T SEVERAL ,ATIN !MERICAN COUNTRIES ALL HAD ASSISTED WOMEN WHO HAD BASED HEALTH CARE PROVIDERS PARTICIPATING IN A SERIES OF WORKSH PARTNERSHIPS WITH LOCAL ORGANIZATIONS IN ,ATIN !MERICA 0)7( FO AND DOMESTIC VIOLENCE SURVIVORS KNOWLEDGE ABOUT AND ACCESS TO 4HE 0ACIlC )NSTITUTE FOR 7OMENS (EALTH 0)7( HAS BEEN WORKIN TRAININGS IS AN IMPORTANT ASPECT OF ENSURING %#0S REACH WOMEN W AND RAPE SURVIVORS SUCH AS POLICE AND LOCAL LAW OFlCERS IN AD ADVOCACY AVENUES )NCLUDING THOSE GROUPS AND INDIVIDUALS WHO AS ABOUT %#0S CAN BE PROVIDED IT IS IMPORTANT THAT THEY BE REACHE BECAUSE MANY WOMEN IN THIS SITUATION NEVER SEEK MEDICAL CARE WH TO PREVENT DISEASE STOP THEM FROM USING FAMILY PLANNING AND TO HAVE HAD A PARTNER USE FAMILY PLANNING CLANDESTINELY THEY ALSO ARE MORE LIKELY TO WHO HAVE BEEN SEXUALLY ABUSED ARE MUCH MORE LIKELY THAN NONABUS AFFECTED BY VIOLENCE EMERGENCY CONTRACEPTION IS PARTICULARLY I ESPECIALLY IN TERMS OF THEIR REPRODUCTIVE AND SEXUAL HEALTH &O 4HIS VIOLENCE CAN HAVE SERIOUS HEALTH CONSEQUENCES FOR WOMEN 2APE SURVIVORS ARE ALSO AT RISK OF UNINTENDED PREGNANCY BUT HAVE HAD THEIR PARTNER R WOMEN WHO ARE HE SEVERITY OF THE VOCACY CAMPAIGNS AND OPS CONDUCTED IN MPORTANT 7OMEN CTIVE CHANNELS FOR LP IN CONSIDERING WHICH UND THAT COMMUNITY D THROUGH OTHER AWARENESS RTNER AT SOME POINT REFUSE CONDOM USE INCLUDE PHYSICAL TRY OF (EALTH ST EFFECTIVE IN THE CURRENT HO NEED THEM BEEN SEXUALLY %#0S THROUGH SIST SEXUAL ABUSE EMERGENCY RETARY OF (EALTH G TO IMPROVE RAPE RGANIZATIONS ALMOST WWWPIWHORG ERE INFORMATION F WOMEN REPORT IZACIÍN ,ILITH ED WOMEN TO HE INTENDED AUDIENCE N BE FOUND IN -ODULE !
,OCAL $ATA )LLUSTRATING .EED FOR %MERGENCY #ONTRACEPTION 3PECIlC LOCAL DATA CAN SIGNIlCANTLY STRENGTHEN THE ARGUMENT FOR MAKING %#0S WIDELY AVAILABLE IN A COUNTRY $ATA ON SERIOUS HEALTH POVERTY REDUCTION AND SOCIAL PROBLEMS THAT CAN BE POSITIVELY AFFECTED BY DECREASING THE NUMBER OF UNINTENDED PREGNANCIES AND ABORTIONS CAN BE POWERFUL TOOLS IN ADVOCATING POLICY CHANGE TO SUPPORT ACCESS TO %#0S 5SEFUL DATA INCLUDE s !DOLESCENT PREGNANCY RATES s 5NINTENDED PREGNANCY RATES s !BORTION RATES AND SEQUELAE s 'OVERNMENT EXPENDITURES ON UNINTENDED PREGNANCY AND ABORTION OR POSTABORTION CARE s "IRTH SPACING STATISTICS #OUNTRY SPECIlC DATA FOR OVER COUNTRIES CAN BE FOUND ON THE )NTERNET AT THE 0OPULATION 2EFERENCE "UREAU WEBSITE HTTPWWWPRBORG WHICH HAS LINKS TO ADDITIONAL DATA RESOURCES -EASURE AND 0OP.ET !NOTHER RESOURCE IS THE 'LOBAL (EALTH #OUNCIL WEBSITE HTTPGLOBALHEALTHORG 5SEFUL DATA FOR %#0 INFORMATION DISSEMINATION CAN BE ACCESSED AT HTTPWWWGLOBALHEALTHORGNEWSARTICLE
2EFERENCES (O 0# AND +WAN -3 ! PROSPECTIVE RANDOMIZED COMPARISON OF LEVONORGESTREL WITH THE 9UZPE REGIMEN IN POST COITAL CONTRACEPTION (UMAN 2EPRODUCTION
7(/ 4ASK &ORCE ON 0OSTOVULATORY -ETHODS OF &ERTILITY 2EGULATION 2ANDOMISED CONTROLLED TRIAL OF LEVONORGESTREL VERSUS THE 9UZPE REGIMEN OF COMBINED ORAL CONTRACEPTIVES FOR EMERGENCY CONTRACEPTION ,ANCET
'LASIER ! 3AFETY OF EMERGENCY CONTRACEPTION *OURNAL OF !MERICAN -EDICAL 7OMENS !SSOCIATION 3UPPL
.ORRIS 4URNER ! AND %LLERTSON # (OW SAFE IS EMERGENCY CONTRACEPTION $RUG 3AFETY
'LASIER ! %MERGENCY POSTCOITAL CONTRACEPTION .EW %NGLAND *OURNAL OF -EDICINE
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(ARLAP 3 3HIONO 0( AND 2AMCHARAN 3 #ONGENITAL ABNORMALITIES IN THE OFFSPRING OF WOMEN WHO USED ORAL AND OTHER CONTRACEPTIVES AROUND THE TIME OF CONCEPTION )NTERNATIONAL *OURNAL OF &ERTILITY
3AVOLAINEN % 3AKSELA % AND 3AXEN , 4ERATOGENIC HAZARDS OF ORAL CONTRACEPTIVES ANALYZED IN A NATIONAL MALFORMATION REGISTER !MERICAN *OURNAL OF /BSTETRICS AND 'YNECOLOGY
2AMAN 7ILMS , ET AL &ETAL GENITAL EFFECTS OF lRST TRIMESTER SEX HORMONE EXPOSURE A META ANALYSIS /BSTETRICS AND 'YNECOLOGY
! ! -ODULE ! 3TERILITY 3PRING3UMMER EMERGENCY CONTRACEPTION /BSTETRICIA ET 'YNECOLOGICA 3CANDINAVICA &ERTILITY AND 3TERILITY WITH EARLY EMBRYONIC DEVELOPMENT IN THE HUMAN SPECIES PROSPECTIVE STUDIES UTERINE LUMINAL mUID )) %FFECT OF POSTOVULATORY ADMINISTRATION ON OVARIAN FUNCTION EMERGENCY CONTRACEPTION A REVIEW OF THE LITERATURE POSTFERTILIZATION EVENTS IN THE RAT #ONTRACEPTION THE MENSTRUAL CYCLE CONTRACEPTION /BSTETRICS AND 'YNECOLOGY AFTER UNPROTECTED SEXUAL INTERCOURSE CONTRACEPTION TO HOURS 7(/ MULTICENTRE RANDOMIZED TRIAL ,ING 79 ET AL -ODE OF ACTION OF DL NORGESTREL AND ETHINYLE 4RUSSELL * AND 2AYMOND %' 3TATISTICAL EVIDENCE CONCERNING +ESSERU % ET AL )N VITRO ACTION OF PROGESTOGENS ON SPERM MIG +ESSERU % ET AL 4HE HORMONAL AND PERIPHERAL EFFECTS OF DL NO #ROXATTO (" /RITZ -% -ULLER !, -ECHANISMS OF ACTION #ROXATTO (" $EVOTO , $URAND - ET AL -ECHANISM OF ACT -ULLER !, ,LADOS #- AND #ROXATTO (" 0OSTCOITAL TREAT #ROXATTO (" ET AL %FFECTS OF THE 9UZPE REGIMEN GIVEN DURIN 3WAHN -, ET AL %FFECT OF POST COITAL CONTRACEPTIVE METHODS ,ING 79 ET AL -ODE OF ACTION OF DL NORGESTREL AND ETHINYLES (APANGAMA $ 'LASIER !& AND "AIRD $4 4HE EFFECTS OF PE $URAND - ET AL /N THE MECHANISMS OF ACTION OF SHORT TERM LEV -ARIONS , ET AL %MERGENCY CONTRACEPTION WITH MIFEPRISTONE AN "ACIC - 7ESSELIUS DE #ASPARIS ! AND $ICZFALUSY % &AILUR 2ODRIGUES ) 'ROU & AND *OLY * %FFECTIVENESS OF EMERGENC %LLERTSON # %VANS - &ERDEN 3 ET AL %XTENDING THE TIME VON (ERTZEN ( ET AL ,OW DOSE MIFEPRISTONE AND TWO REGIMENS O "RACKEN -" /RAL CONTRACEPTION AND CONGENITAL MALFORMATIONS I 9UZPE !! ET AL 0OST COITAL CONTRACEPTION A PILOT STUDY 9OUNG $# ET AL %MERGENCY CONTRACEPTION ALTERS PROGESTERONE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION 4HE %MERG #ONTRACEPTION /BSTETRICS AND 'YNECOLOGY #ONTRACEPTION /BSTETRICS AND 'YNECOLOGY /BSTETRICS AND 'YNECOLOGY /BSTETRICS AND 'YNECOLOGY #ONTRACEPTION ,ANCET !MERICAN *OURNAL OF /BSTETRICS AND 'YNECOLOGY 0T #ONTRACEPTION 0T !MERICAN *OURNAL OF /BSTETRICS AND 'YNECOLOGY *OURNAL OF 2EPRODUCTIVE -EDICINE AND ENDOMETRIUM LIMIT FOR STARTING THE 9UZPE REGIMEN OF EMERGENCY Y CONTRACEPTIVE PILLS BETWEEN AND HOURS STRADIOL COMBINATION IN POSTCOITAL CONTRACEPTION TRADIOL COMBINATION IN POST COITAL CONTRACEPTION G THE FOLLICULAR PHASE ON OVARIAN FUNCTION RGESTREL IN POSTCOITAL CONTRACEPTION RATION IN HUMAN CERVICAL MUCUS MENT WITH LEVONORGESTREL DOES NOT DISRUPT E OF LARGE DOSES OF ETHINYL ESTRADIOL TO INTERFERE ON THE ENDOMETRIUM AND THE MENSTRUAL CYCLE RI OVULATORY ADMINISTRATION OF LEVONORGESTREL ON THE MECHANISM OF ACTION OF THE 9UZPE REGIMEN OF ION OF HORMONAL PREPARATIONS USED FOR ASSOCIATED ENDOMETRIAL PROTEIN IN SERUM AND ONORGESTREL ADMINISTRATION IN EMERGENCY OF EMERGENCY CONTRACEPTION D LEVONORGESTREL MECHANISM OF ACTION F LEVONORGESTREL FOR EMERGENCY CONTRACEPTION A N OFFSPRING A REVIEW AND META ANALYSIS OF THE ENCY #ONTRACEPTION .EWSLETTER &ERTILITY AND 3TERILITY 3TEROIDS &ERTILITY AND #ONTRACEPTION )N PRESS !CTA -ODULE !
+UBBA !! ET AL 4HE BIOCHEMISTRY OF HUMAN ENDOMETRIUM AFTER TWO REGIMENS OF POSTCOITAL CONTRACEPTION A DL NORGESTRELETHINYLESTRADIOL COMBINATION OR DANAZOL &ERTILITY AND 3TERILITY
-OGGIA ! ET AL 4HE USE OF PROGESTOGENS AS POSTCOITAL CONTRACEPTIVES *OURNAL OF 2EPRODUCTIVE -EDICINE
2AYMOND %' ET AL %FFECT OF THE 9UZPE REGIMEN OF EMERGENCY CONTRACEPTION ON MARKERS OF ENDOMETRIAL RECEPTIVITY (UMAN 2EPRODUCTION
4ASKIN / ET AL (IGH DOSES OF ORAL CONTRACEPTIVES DO NOT ALTER ENDOMETRIAL D AND DX INTEGRINS IN THE LATE IMPLANTATION WINDOW &ERTILITY AND 3TERILITY
,ING 79 ET AL -ODE OF ACTION OF DL NORGESTREL AND THINYLESTRADIOL COMBINATION IN POSTCOITAL CONTRACEPTION ))) %FFECT OF PREOVULATORY ADMINISTRATION FOLLOWING THE LUTEINIZING HORMONE SURGE ON OVARIAN STEROIDOGENESIS &ERTILITY AND 3TERILITY
4RUSSELL * %LLERTSON # AND $ORmINGER , %FFECTIVENESS OF THE 9UZPE REGIMEN OF EMERGENCY CONTRACEPTION BY CYCLE DAY OF INTERCOURSE IMPLICATIONS OF MECHANISM OF ACTION #ONTRACEPTION
*ONES 2+ $ARROCH *% (ENSHAW 3+ #ONTRACEPTIVE USE AMONG 53 WOMEN HAVING ABORTIONS IN 0ERSPECTIVES ON 3EXUAL AND 2EPRODUCTIVE (EALTH
#HAOHUA , ET AL )NVESTIGATION ON KNOWLEDGE OF AND ATTITUDE TO EMERGENCY CONTRACEPTION AMONG INDUCED ABORTION WOMEN 2EPRODUCTION AND #ONTRACEPTION %NGLISH EDITION 2ESULTS SUMMARIZED IN 5SE OF %MERGENCY #ONTRACEPTIVE 0ILLS #OULD (ALVE THE )NDUCED !BORTION 2ATE IN 3HANGHAI #HINA 3OCIAL 3CIENCE 2ESEARCH 0OLICY "RIEFS 3ERIES .O ;!UGUST = 5.$05.&0!7(/7ORLD "ANK 3PECIAL 0ROGRAMME OF 2ESEARCH $EVELOPMENT AND 2ESEARCH 4RAINING IN (UMAN 2EPRODUCTIVE (EALTH AND 2ESEARCH 7ORLD (EALTH /RGANIZATION
'LASIER ! AND "AIRD $ 4HE EFFECTS OF SELF ADMINISTERING EMERGENCY CONTRACEPTION .EW %NGLAND *OURNAL OF -EDICINE
,OVVORN ! ET AL 0ROVISION OF EMERGENCY CONTRACEPTIVE PILLS TO SPERMICIDE USERS IN 'HANA #ONTRACEPTION
%LLERTSON # ET AL %MERGENCY CONTRACEPTION RANDOMIZED COMPARISON OF ADVANCE PROVISION AND INFORMATION ONLY /BSTETRICS AND 'YNECOLOGY
"LANCHARD + ET AL %VALUATION OF AN EMERGENCY CONTRACEPTION ADVANCE PROVISION SERVICE #ONTRACEPTION
3KIBIAK *0 ET AL 4ESTING 3TRATEGIES TO )MPROVE !CCESS TO %MERGENCY #ONTRACEPTION 0ILLS 0RESCRIPTION VS 0ROPHYLACTIC $ISTRIBUTION 0OPULATION #OUNCIL
0IAGGIO ' ET AL 4IMING OF EMERGENCY CONTRACEPTION WITH LEVONORGESTREL OF THE 9UZPE REGIMEN ,ANCET
!IKEN !- 3ACKEY . AND 'OLD -! 4HAT WAS THEN THIS IS NOWCHANGES IN YOUNG WOMENS KNOWLEDGE ATTITUDES AND PERCEIVED BARRIERS TO USING EMERGENCY CONTRACEPTION *OURNAL OF 0EDIATRIC AND !DOLESCENT 'YNECOLOGY !BSTRACT OF PAPER PRESENTED AT THE .ORTH !MERICAN 3OCIETY OF 0EDIATRIC AND !DOLESCENT 'YNECOLOGY -EETING *UNE
'RAHAM ! -OORE , 3HARP $ ET AL )MPROVING TEENAGERS KNOWLEDGE OF EMERGENCY CONTRACEPTION CLUSTER RANDOMIZED CONTROLLED TRIAL OF A TEACHER LED INTERVENTION "RITISH -EDICAL *OURNAL
7(/ 4ASK &ORCE ON 0OSTOVULATORY -ETHODS OF &ERTILITY 2EGULATION %FlCACY AND SIDE EFFECTS OF IMMEDIATE POST COITAL LEVONORGESTREL USED REPEATEDLY FOR CONTRACEPTION #ONTRACEPTION
(EISE , ET AL %NDING 6IOLENCE !GAINST 7OMEN 0OPULATION 2EPORTS 3ERIES , .O "ALTIMORE *OHNS (OPKINS 5NIVERSITY 3CHOOL OF 0UBLIC (EALTH 0OPULATION )NFORMATION 0ROGRAM $ECEMBER
! ! -ODULE ! -ODULE ! 4OOLS ,IST
3PECIAL .OTE 4HE INFORMATION CONTAINED IN SOME OF THESE DOCUMENTS MAY NOT BE UPDATED TO REmECT PUBLISHED RESEARCH REGARDING TIMING AND DOSAGE SEE THE )#%# STATEMENT ON TIMING AND DOSAGE FOR UPDATED ACCURATE INFORMATION ON THESE TOPICS x %#0S SHOULD BE USED AS SOON AS POSSIBLE AFTER UNPROTECTED INTERCOURSE BUT CAN BE USED WITHIN HOURS x ,EVONORGESTREL ONLY %#0S CAN BE ADMINISTERED IN ONE MG DOSE
3TATEMENTS ON %#0S BY )NTERNATIONAL /RGANIZATIONS !GENCIES AND -AJOR $ONORS OF #ONTRACEPTIVE #OMMODITIES !#/' .EWS 2ELEASE 4HIS STATEMENT IN SUPPORT OF EMERGENCY CONTRACEPTION ISSUED BY !#/' CAN BE FOUND ONLINE AT KWWS ZZZDFRJRUJIURPBKRPHSXEOLFDWLRQVSUHVVBUHOHDVHVQUFIP
)#%# %VIDENCE "ASED 0OLICY 3TATEMENTS )#%# HAS ISSUED A SET OF lVE STATEMENTS WITH ACCURATE UP TO DATE INFORMATION ON IMPROVING ACCESS EMERGENCY CONTRACEPTION AND MEDICAL ABORTION REPEAT USE MECHANISM OF ACTION AND TIMING AND DOSAGE 4HEY CAN ALSO BE ACCESSED ONLINE AT KWWS ZZZFHFLQIRRUJKWPOUHV GRZQORDGDEOHPWUOVKWP
&)'/ %THICS #OMMITTEE 2EPORT 4HIS STATEMENT PROVIDES THE GUIDELINES ISSUED BY THE &)'/ %THICS #OMMITTEE ON USE ACCESS AND PROVISION OF EMERGENCY CONTRACEPTION 4HE STATEMENT WAS ORIGINALLY PRINTED IN 'UIDELINES IN %MERGENCY #ONTRACEPTION )NTERNATIONAL *OURNAL OF 'YNECOLOGY /BSTETRICS
)00& 3TATEMENT 4HIS DOCUMENT PRESENTS INFORMATION ISSUED BY THE )00& )NTERNATIONAL -EDICAL !DVISORY 0ANEL ABOUT PROVISION OF EMERGENCY CONTRACEPTION IN FAMILY PLANNING PROGRAMS WORLDWIDE 4HE STATEMENT DEVELOPED -AY AND REVISED IN /CTOBER
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! 53!)$ AND 5.&0! 3TATEMENTS 4WO OF THE MAJOR DONORS OF CONTRACEPTIVES FOR DEVELOPING COUNTRY FAMILY PLANNING PROGRAMS 5.&0! AND 53!)$ HAVE PROVIDED STATEMENTS SUPPORTING THE PROVISION OF %#0S 3TATEMENTS OF BOTH AGENCIES CLARIFYING THE TYPES AND LEVELS OF SUPPORT THEY OFFER ARE PROVIDED -ODULE !
7(/ 3TATEMENT ON %MERGENCY #ONTRACEPTION
4OOLS 4HIS STATEMENT BY 7(/ ARTICULATES THE SAFETY EFlCACY AND EASE OF EMERGENCY CONTRACEPTION USE )T WAS ORIGINALLY PRINTED AS 7(/ &ACT 3HEET .O *UNE
2ESOURCES FOR $EVELOPING -ESSAGES FOR 0OLICY -AKERS
!NNOTATED "IBLIOGRAPHY OF #ORE %VIDENCE "ASED 2ESEARCH ON %MERGENCY #ONTRACEPTION 4HIS ANNOTATED BIBLIOGRAPHY CONTAINS ANNOTATIONS OF THE ARTICLES REFERENCED IN -ODULE ! )NFORMATION FOR 0OLICY -AKERS %XCEPTIONS INCLUDE THOSE ARTICLES SUMMARIZED IN EITHER h3TATISTICAL %VIDENCE #ONCERNING THE -ECHANISM OF !CTION OF THE 9UZPE REGIMEN OF EMERGENCY CONTRACEPTIONv OR h-ECHANISM OF !CTION OF (ORMONAL 0REPARATIONS 5SED FOR EMERGENCY CONTRACEPTION ! 2EVIEW OF THE ,ITERATURE v BOTH OF WHICH ARE INCLUDED IN THIS BIBLIOGRAPHY !DDITIONALLY ARTICLES PERTAINING TO STUDIES CONDUCTED ON ORAL CONTRACEPTIVES AND DOMESTIC VIOLENCE ARE NOT INCLUDED IN THIS BIBLIOGRAPHY 4HE ANNOTATIONS PROVIDE KEY DATA AND SUMMARIES OF STUDIES THAT WILL BE USEFUL IN ADVOCACY AND EDUCATION CAMPAIGNS
+EY &ACTS !BOUT %MERGENCY #ONTRACEPTION ! FACT SHEET SUMMARIZING KEY POINTS ABOUT EMERGENCY CONTRACEPTION 4HIS DOCUMENT CAN BE MODIlED AND ADAPTED TO EMPHASIZE OR HIGHLIGHT PARTICULAR ISSUES TAILORING IT TO THE ENVIRONMENT IN WHICH ADVOCACY ACTIVITIES TAKE PLACE
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4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE !MERICAN #OLLEGE OF /BSTETRICIANS AND 'YNECOLOGISTS
! -ODULE ! 4OOLS
! Tools Module A Module A Tools Tools
A-18 A-19 -ODULE ! 4OOLS
4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION
! 4OOLS 4OOLS -ODULE ! -ODULE !
! -ODULE ! 4OOLS
4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION
! 4OOLS 4OOLS -ODULE ! -ODULE !
! -ODULE ! 4OOLS
4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION
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This material was reprinted with permission from the International Consortium for Emergency Contraception.
A-26 A-27 4OOLS 4OOLS -ODULE ! -ODULE !
! -ODULE ! 4OOLS
4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION
! 4OOLS
'UIDELINES )SSUED BY THE &)'/ %THICS #OMMITTEE -ODULE ! "ACKGROUND 4HE #OMMITTEE RECOGNIZES THAT BASIC HUMAN RIGHTS TO HEALTH INCLUDE THE FREEDOM TO CONTROL SEXUAL AND REPRODUCTIVE HEALTH )NDIVIDUALS ALSO HAVE THE RIGHT TO ENJOY THE BENElTS OF NEW SCIENTIlC KNOWLEDGE IN SEXUAL AND REPRODUCTIVE HEALTH 4HE #OMMITTEE NOTED ITS PRIOR STATEMENT THAT h&AILURE TO ADVOCATE POLICIES THAT WILL IMPROVE WOMENS HEALTH CARE AND ADVANCE WOMENS RIGHTS BROADLY WILL DELETERIOUSLY INmUENCE THE HEALTH CARE OF INDIVIDUAL PATIENTS CARED FOR BY THE /B'YNv )N UNPROTECTED INTERCOURSE EMERGENCY CONTRACEPTION IS HIGHLY EFFECTIVE IN DIMINISHING THE NUMBER OF UNWANTED PREGNANCIES WITHOUT THE NEED OF AN ABORTION %ARLY EVIDENCE SUGGESTS THAT ABORTION RATES AMONG TEENAGERS DROP FOLLOWING ACCESS TO INFORMATION AND USE OF EMERGENCY CONTRACEPTION
2ECOMMENDATIONS %ARLY ACCESS TO HORMONAL EMERGENCY CONTRACEPTION IMPROVES THE SUCCESS RATE AND THEREFORE DECREASES HEALTH RISKS 4HEREFORE AT A PUBLIC POLICY LEVEL THE MEDICAL PROFESSION SHOULD ADVOCATE THAT EMERGENCY CONTRACEPTION BE EASILY AVAILABLE AND ACCESSIBLE AT ALL TIMES TO ALL WOMEN %MERGENCY CONTRACEPTION IS NOT MEDICALLY APPROPRIATE AS AN ONGOING CONTRACEPTIVE METHOD 0HYSICIANS HAVE THE OBLIGATION TO ASSURE ACCURATE INFORMATION IS AVAILABLE REGARDING EMERGENCY CONTRACEPTION AS WELL AS DISCUSS FUTURE STRATEGIES FOR INDIVIDUALS TO AVOID THE NEED FOR EMERGENCY CONTRACEPTION !CCESS TO EMERGENCY CONTRACEPTION SHOULD BE AN ESSENTIAL COMPONENT OF IMMEDIATE CARE FOR WOMEN WHO SUFFER RAPE AND ARE EXPOSED TO PREGNANCY !DOLESCENTS BECAUSE OF THEIR SPECIAL VULNERABILITY IN SOCIETY FORM ANOTHER GROUP FOR WHOM EMERGENCY CONTRACEPTION SHOULD BE MADE EASILY AVAILABLE
4HE 2OLE OF THE /B'YN AS !DVOCATES FOR 7OMENS (EALTH PAGE 2ECOMMENDATIONS ON %THICAL )SSUES IN /BSTETRICS AND 'YNECOLOGY BY 4HE &)'/ #OMMITTEE FOR THE %THICAL !SPECTS OF (UMAN 2EPRODUCTION AND 7OMENS (EALTH !UGUST $ElNITION OF PREGNANCY h.ATURAL HUMAN REPRODUCTION IS A PROCESS WHICH INVOLVES THE PRODUCTION OF MALE AND FEMALE GAMETES AND THEIR UNION AT FERTILIZATION 0REGNANCY IS THAT PART OF THE PROCESS THAT COMMENCES WITH THE IMPLANTATION OF THE CONCEPTUS IN A WOMAN AND ENDS WITH EITHER THE BIRTH OF AN INFANT OR AN ABORTIONv 4HE &)'/ #OMMITTEE FOR THE %THICAL !SPECTS OF (UMAN 2EPRODUCTION AND 7OMENS (EALTH !UGUST 0UBLISHED IN THE )NTERNATIONAL *OURNAL OF 'YNECOLOGY AND /BSTETRICS -ARCH VOLUME h)NDUCED ABORTION MAY BE DElNED AS THE TERMINATION OF PREGNANCY USING DRUGS OR SURGICAL INTERVENTION AFTER IMPLANTATION AND BEFORE THE CONCEPTUS HAS BECOME INDEPENDENTLY VIABLEv 7(/ DElNITION OF A BIRTH WEEKS MENSTRUAL AGE OR MORE 4HE &)'/ #OMMITTEE FOR THE %THICAL !SPECTS OF (UMAN 2EPRODUCTION AND 7OMENS (EALTH !UGUST 0UBLISHED IN THE )NTERNATIONAL *OURNAL OF 'YNECOLOGY AND /BSTETRICS -ARCH VOLUME
4HIS MATERIAL ORIGINALLY PRINTED IN THE )NTERNATIONAL *OURNAL OF 'YNECOLOGY AND /BSTETRICS 2EPRINTED WITH PERMISSION FROM THE )NTERNATIONAL &EDERATION OF 'YNECOLOGY AND /BSTETRICS &)'/ %THICS #OMMITTEE .OTE #OMMITTEE DOCUMENTS DO NOT REPRESENT &)'/S OFlCIAL POSITION RATHER THEY REPRESENT THE VIEWS OF A GROUP OF INDEPENDENT EXPERTS
! -ODULE ! 4OOLS
! 4OOLS
)NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION -ODULE ! 3TATEMENT ON %MERGENCY #ONTRACEPTION
)NTRODUCTION $ESPITE THE AVAILABILITY OF HIGHLY EFFECTIVE METHODS OF CONTRACEPTION MANY PREGNANCIES ARE UNPLANNED AND UNWANTED 3UCH PREGNANCIES CAN RESULT IN ABORTION AND CARRY AN EXCESS RISK OF MORBIDITY AND MORTALITY 4HE RISK OF PREGNANCY WITH ONE UNPROTECTED ACT OF SEXUAL INTERCOURSE CAN BE AS HIGH AS ONE IN THREE DEPENDING ON THE CYCLE DAY OF EXPOSURE IN RELATION TO OVULATION &OR THE WOMAN EXPOSED TO UNPROTECTED SEXUAL INTERCOURSE EG LACK OF CONTRACEPTIVE USE CONDOM BREAKAGE MISSED PILLS OR SEXUAL ASSAULT EMERGENCY CONTRACEPTION CAN BE USED TO PREVENT AN UNWANTED PREGNANCY 3INCE THE MID S THE POST COITAL USE OF CERTAIN ORALLY ADMINISTERED STEROID HORMONES HAS BEEN SHOWN TO BE EFFECTIVE IN PREVENTING PREGNANCY )N ADDITION INTRAUTERINE DEVICES )5$ AND THE ANTI PROGESTOGEN MIFEPRISTONE ARE ALSO HIGHLY EFFECTIVE FOR EMERGENCY CONTRACEPTION
(ORMONAL -ETHODS 4WO COMMONLY AVAILABLE ORAL REGIMENS HAVE PROVED TO BE SAFE AND EFFECTIVE FOR EMERGENCY CONTRACEPTION
,EVONOGESTREL ONLY REGIMEN 4HE MOST CONVENIENT REGIMEN IS A SINGLE DOSE CONSISTING OF MG LEVONORGESTREL TAKEN AS SOON AS POSSIBLE AFTER UNPROTECTED INTERCOURSE ALTERNATIVELY ONE DOSE OF MG LEVONORGESTREL CAN BE TAKEN AS SOON AS POSSIBLE AFTER UNPROTECTED INTERCOURSE FOLLOWED BY THE SAME DOSE TAKEN HOURS LATER ,EVONORGESTREL PILLS ARE MORE EFFECTIVE THE SOONER THEY ARE TAKEN AFTER UNPROTECTED INTERCOURSE 4HEY ARE MOST EFFECTIVE IF TAKEN WITHIN DAYS HOURS (OWEVER THERE IS STILL SOME EFFECT UP TO DAYS AFTER UNPROTECTED INTERCOURSE 7HERE PILLS CONTAINING MG LEVONORGESTREL ARE NOT AVAILABLE MG LEVONORGESTREL PILLS WHICH ARE USED FOR REGULAR CONTRACEPTION OFFER A POSSIBLE ALTERNATIVE 4WENTY lVE OF THESE MINI PILLS SHOULD BE TAKEN INITIALLY AND A FURTHER TWENTY lVE HOURS LATER 4HERE IS ANECDOTAL EVIDENCE TO SUPPORT THIS REGIMEN BUT NO CLINICAL STUDIES HAVE EVALUATED ITS EFlCACY
#OMBINED ESTROGEN PROGESTIN REGIMEN 4HIS REGIMEN CONSISTS OF TWO G ETHINYL ESTRADIOL MG LEVONORGESTREL PILLS OR FOUR G ETHINYL ESTRADIOL MG LEVONORGESTREL PILLS TAKEN AS SOON AS POSSIBLE WITHIN HOURS AFTER UNPROTECTED INTERCOURSE FOLLOWED BY A SECOND SIMILAR DOSE HOURS LATER 4HIS METHOD SHOWS LITTLE EFlCACY AFTER HOURS FROM UNPROTECTED INTERCOURSE
! #HOICE OF METHOD 4HE LEVONOGESTREL ONLY REGIMEN SHOULD BE THE lRST CHOICE WHERE AVAILABLE BECAUSE IT IS MORE EFFECTIVE AND IS LESS LIKELY TO CAUSE NAUSEA THAN THE COMBINED REGIMEN (OWEVER THE COMBINED REGIMEN SHOULD REMAIN AN OPTION WHERE THE LEVONORGESTREL ONLY REGIME IS LESS -ODULE ! ACCESSIBLE AND MORE COSTLY AS IN MANY COUNTRIES
-ECHANISM OF ACTION
4OOLS (ORMONAL EMERGENCY CONTRACEPTION ACHIEVES ITS CONTRACEPTIVE EFFECT BY SEVERAL MECHANISMS DEPENDING ON THE TIME IN A WOMANS CYCLE IT IS TAKEN )T CAN INHIBIT OR DELAY OVULATION AND MAY ALSO INTERFERE WITH OVUM AND SPERM TRANSPORT AND FERTILIZATION 3TUDIES DIFFER ON WHETHER HORMONAL EMERGENCY CONTRACEPTION CAN CAUSE CHANGES IN THE ENDOMETRIUM THAT WOULD BE SUFlCIENT TO INTERFERE WITH IMPLANTATION 4HERE IS NO EVIDENCE THAT HORMONAL EMERGENCY CONTRACEPTION DISLODGES THE EMBRYO AFTER IMPLANTATION HAS OCCURRED (ORMONAL EMERGENCY CONTRACEPTION DOES NOT CAUSE AN ABORTIONv
%FlCACY 6ARIOUS STUDIES HAVE SHOWN THAT THE LEVONORGESTREL ONLY REGIMEN REDUCES THE RISK OF PREGNANCY BY OR MORE AFTER A SINGLE ACT OF INTERCOURSE AND THE COMBINED REGIMEN REDUCES IT BY )N DIRECT COMPARISONS THE LEVONORGESTREL REGIMEN HAS BEEN SHOWN TO BE SUBSTANTIALLY MORE EFFECTIVE THAN THE COMBINED REGIMEN %#0S ARE NOT AS EFFECTIVE AS CONSISTENT AND CORRECT USE OF MOST MODERN CONTRACEPTIVE METHODS
%LIGIBILITY CRITERIA .O KNOWN CONTRAINDICATIONS EXIST TO THE USE OF HORMONAL EMERGENCY CONTRACEPTION !LTHOUGH THIS METHOD IS NOT INDICATED FOR A WOMAN WITH A KNOWN OR SUSPECTED PREGNANCY IT WILL NOT AFFECT THE COURSE OF HER PREGNANCY OR HARM THE FOETUS 4HERE IS NO NEED FOR A PHYSICAL EXAMINATION OR PREGNANCY TEST BEFORE IT IS PROVIDED
3IDE EFFECTS .AUSEA AND VOMITING ARE COMMON AMONG WOMEN USING THE COMBINED REGIMEN AND CONSIDERABLY LESS COMMON AMONG WOMEN USING THE LEVONORGESTREL ONLY REGIMEN 7HEN THE COMBINED REGIMEN IS USED ANTI EMETIC PRE TREATMENT MAY BE CONSIDERED WITH THE LEVONORGESTREL ONLY REGIMEN THIS IS UNNECESSARY )F VOMITING OCCURS WITHIN ONE HOUR AFTER TAKING A DOSE IT IS COMMON PRACTICE TO REPEAT THE DOSE (OWEVER THERE IS NO EVIDENCE THAT THIS IMPROVES EFlCACY INDEED VOMITING CAN BE AN INDICATION THAT THE HORMONE HAS BEEN ABSORBED )N CASE OF VOMITING FURTHER PILLS MAY BE ADMINISTERED VAGINALLY !LTHOUGH THERE ARE NO CLINICAL DATA SUPPORTING THE EFlCACY OF THIS PRACTICE CONTRACEPTIVE STEROID HORMONES ARE KNOWN TO BE READILY ABSORBED FROM THE VAGINA /THER SIDE EFFECTS WITH HORMONAL %# INCLUDE ABDOMINAL PAIN FATIGUE HEADACHE DIZZINESS AND BREAST TENDERNESS !FTER THE USE OF HORMONAL EMERGENCY CONTRACEPTION MENSES USUALLY OCCUR AT THE REGULAR TIME BUT MAY BE EITHER EARLIER OR LATER 3OME WOMEN MAY EXPERIENCE IRREGULAR BLEEDING OR SPOTTING AFTER TAKING %#0S
! 4OOLS
$RUG INTERACTIONS -ODULE ! 7OMEN SHOULD BE ADVISED THAT THE EFFECTIVENESS OF %#0 MAY BE REDUCED IF THEY ARE TAKING DRUGS WHICH REDUCE THE EFlCACY OF REGULAR ORAL CONTRACEPTIVES INCLUDING BUT NOT LIMITED TO RIFAMPICIN GRISEOFULVIN BARBITURATES !T THE CURRENT TIME THERE IS INSUFlCIENT INFORMATION ON DRUG INTERACTIONS TO MAKE ANY SPECIlC RECOMMENDATIONS ON INCREASED %#0 DOSING SCHEDULES
&REQUENCY OF USE (ORMONAL EMERGENCY CONTRACEPTION SHOULD NOT BE USED FOR ROUTINE PREGNANCY PREVENTION SINCE THE CUMULATIVE PREGNANCY RATE FOR FREQUENT USE OF %#0 IS HIGHER THAN THAT WITH REGULAR CONTRACEPTION (OWEVER IF UNPROTECTED INTERCOURSE OCCURS IN A CYCLE WHERE THE EMERGENCY CONTRACEPTION HAS ALREADY BEEN USED IT CAN BE REPEATED 7OMEN SHOULD UNDERSTAND THAT EMERGENCY CONTRACEPTION PILLS MAY NOT PROTECT THEM FROM THE POSSIBILITY OF PREGNANCY FROM EPISODES OF UNPROTECTED INTERCOURSE MORE THAN DAYS BEFORE THE %#0S ARE TAKEN OR FROM INTERCOURSE AFTER THE PILLS ARE TAKEN )N CYCLES WHERE UNPROTECTED INTERCOURSE HAS OCCURRED MORE THAN ONCE HORMONAL EMERGENCY CONTRACEPTION CAN BE USED (OWEVER EFlCACY WILL BE INmUENCED BY THE TIME INTERVAL SINCE THE lRST ACT OF UNPROTECTED INTERCOURSE )F THE WOMAN IS ALREADY PREGNANT BECAUSE OF EARLIER INTERCOURSE EMERGENCY CONTRACEPTION WILL NOT BE EFFECTIVE
-IFEPRISTONE ! SINGLE DOSE OF MIFEPRISTONE MG TAKEN WITHIN DAYS OF UNPROTECTED INTERCOURSE IS HIGHLY EFFECTIVE FOR EMERGENCY CONTRACEPTION )T HAS A LOW INCIDENCE OF SIDE EFFECTS (OWEVER OF WOMEN EXPERIENCE A DELAY OF MENSES OF MORE THAN DAYS 7OMEN SHOULD BE COUNSELLED APPROPRIATELY ! MAJOR CONSTRAINT FROM THE USE OF MIFEPRISTONE IS ITS LIMITED AVAILABILITY
#OPPER RELEASING )5$S 4HE COPPER RELEASING )5$ IS ALSO HIGHLY EFFECTIVE FOR EMERGENCY CONTRACEPTION )T CAN REDUCE THE CHANCE OF PREGNANCY BY MORE THAN WHEN INSERTED WITHIN DAYS OF UNPROTECTED INTERCOURSE 4HIS METHOD MAY BE PARTICULARLY USEFUL WHEN THE CLIENT IS CONSIDERING ITS USE FOR LONG TERM CONTRACEPTION ANDOR WHEN THE HORMONAL REGIMENS ARE LESS EFFECTIVE BECAUSE MORE THAN HOURS HAVE ELAPSED 7HEN USING AN )5$ FOR EMERGENCY CONTRACEPTION THE ELIGIBILITY CRITERIA ARE THE SAME AS THOSE FOR REGULAR USE OF THESE DEVICES
%SSENTIAL INFORMATION FOR USERS )NFORMATION ON EMERGENCY CONTRACEPTION SHOULD BE AVAILABLE TO ALL WOMEN WHO MAY NEED THE METHOD 7HETHER CONTAINED IN PRODUCT PAMPHLETS OR OFFERED BY A SERVICE PROVIDER IT SHOULD INCLUDE GUIDANCE ON THE FOLLOWING s #ORRECT USE s 0OSSIBLE SIDE EFFECTS AND THEIR MANAGEMENT
! s 2ISK OF PREGNANCY DETECTION AND MANAGEMENT OF POSSIBLE FAILURE OF THE %#0S TO PREVENT PREGNANCY s #HANGES IN THE MENSTRUAL PATTERN
-ODULE ! s 0REFERENCES FOR REGULAR CONTRACEPTION s 34) RISK
2ISK OF PREGNANCY
4OOLS )F MENSTRUATION IS DELAYED BY MORE THAN ONE WEEK FROM THE EXPECTED TIME OR IF IT IS MUCH LIGHTER THAN NORMAL EMERGENCY CONTRACEPTION MAY HAVE FAILED AND THE WOMAN SHOULD CONSIDER THE POSSIBILITY THAT SHE MAY BE PREGNANT )N THE EVENT OF A PREGNANCY SHE SHOULD BE COUNSELLED ON THE AVAILABLE OPTIONS AND HER DECISION SHOULD BE RESPECTED AND SUPPORTED )F SHE CHOOSES TO CONTINUE WITH THE PREGNANCY SHE SHOULD BE REASSURED THAT THERE IS NO EVIDENCE THAT HORMONAL EMERGENCY CONTRACEPTION AFFECTS THE FOETUS 4HE USE OF HORMONAL EMERGENCY CONTRACEPTION HAS NO IMPACT ON FUTURE FERTILITY
2EGULAR CONTRACEPTION !FTER USE OF EMERGENCY CONTRACEPTION WOMEN SHOULD EMPLOY ANOTHER METHOD OF CONTRACEPTION EG CONDOMS IF SHE CONTINUES TO HAVE SEXUAL INTERCOURSE )F ORAL CONTRACEPTION IS CHOSEN IT CAN BE STARTED THE DAY AFTER THE %#0 REGIMEN IS COMPLETED 7OMEN WHO BEGAN REGULAR USE OF HORMONAL CONTRACEPTION IMMEDIATELY AFTER EMERGENCY CONTRACEPTION SHOULD BE ADVISED TO EXPECT WITHDRAWAL BLEEDING THREE WEEKS AFTER STARTING THE PILLS 7OMEN CHOOSING A LONG ACTING HORMONAL CONTRACEPTIVE SHOULD START THE METHOD AFTER THE ONSET OF THE lRST MENSTRUAL PERIOD OR AFTER PREGNANCY HAS BEEN EXCLUDED 7OMEN OPTING FOR THE )5$ FOR EMERGENCY CONTRACEPTION SHOULD BE ADVISED THAT THE )5$ WILL PROVIDE ONGOING PROTECTION FROM PREGNANCY FROM THE TIME OF INSERTION FOLLOW UP SHOULD BE ARRANGED AFTER THE EXPECTED DATE OF MENSTRUATION TO ENSURE THAT PREGNANCY HAS BEEN PREVENTED AND FOR COUNSELLING ON REGULAR CONTRACEPTION 7OMEN WHO CHOOSE TO CONTINUE USING THE )5$ FOR LONG TERM CONTRACEPTION SHOULD SUBSEQUENTLY RECEIVE THE SAME SERVICES AS ANY OTHER )5$ USER )F A WOMAN CHOOSES TO HAVE THE )5$ REMOVED SHE SHOULD BE ADVISED TO COME BACK DURING MENSTRUATION FOR REMOVAL AND INITIATION OF ANOTHER CONTRACEPTIVE METHOD
3EXUALLY TRANSMITTED INFECTIONS 34)S %MERGENCY CONTRACEPTION DOES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS 7OMEN WHO HAVE HAD UNPROTECTED INTERCOURSE SHOULD BE ADVISED ABOUT THE POSSIBILITY OF 34)S 4HOSE WHO MAY HAVE BEEN EXPOSED TO 34)S SHOULD BE OFFERED TESTING OR PRESUMPTIVE TREATMENT THAT CURES THE COMMONLY OCCURRING 34)S AND BE COUNSELLED APPROPRIATELY &OR WOMEN WHO MAY HAVE BEEN EXPOSED TO ()6 POST EXPOSURE PROPHYLAXIS WITH !26S SHOULD BE OFFERED WHERE AVAILABLE AND WITH APPROPRIATE COUNSELLING AND FOLLOW UP
!DVOCACY AND !CCESS )00& MEMBER ASSOCIATIONS HAVE AN IMPORTANT ROLE TO PLAY IN INCREASING AWARENESS OF EMERGENCY CONTRACEPTION AND ADVOCATING FOR ITS EASY ACCESS IN LOCAL COMMUNITIES -EMBER ASSOCIATIONS SHOULD UNDERTAKE ACTIVITIES IN THE FOLLOWING AREAS
! 4OOLS
)NCREASING THE AVAILABILITY OF EMERGENCY CONTRACEPTION -ODULE ! -EMBER ASSOCIATIONS PROVIDING SERVICES SHOULD INCLUDE EMERGENCY CONTRACEPTION IN THEIR METHOD MIX AND INTEGRATE EMERGENCY CONTRACEPTION INTO THEIR NATIONAL PROGRAMMES !SSOCIATIONS CAN PLAY A LEAD ROLE IN ENSURING THE EXISTENCE OF A DEDICATED %# PRODUCT IN THEIR COUNTRIES AND CAMPAIGNING FOR ITS OVER THE COUNTER STATUS
!DVOCACY AND DISSEMINATION -EMBER ASSOCIATIONS SHOULD DISSEMINATE INFORMATION ON EMERGENCY CONTRACEPTION AND HOW TO OBTAIN IT BY MEANS INCLUDING MASS MEDIA TRAINING OF SERVICE PROVIDERS AND SEXUAL AND REPRODUCTIVE HEALTH EDUCATION PROGRAMMES )NFORMATION GEARED SPECIlCALLY TO THE NEEDS OF YOUNG PEOPLE IS PARTICULARLY IMPORTANT
)NCREASING ACCESS TO SUPPLIES AND SERVICES %MERGENCY CONTRACEPTION SHOULD BE WIDELY AVAILABLE IN CLINICAL AND NON CLINICAL SETTINGS SUCH AS COMMUNITY BASED SERVICES SOCIAL MARKETING PROGRAMMES AND THE COMMERCIAL SECTOR -EMBER ASSOCIATIONS CAN WORK TO INCREASE ACCESS THROUGH THE ADVANCE PROVISION OF EMERGENCY CONTRACEPTION TO INDIVIDUAL WOMEN
/VERCOMING OBSTACLES -EMBER ASSOCIATIONS SHOULD INITIATE LOCALLY RELEVANT EFFORTS AIMED AT REMOVING THE MULTIPLE SOCIAL CULTURAL AND RELIGIOUS BARRIERS TO EMERGENCY CONTRACEPTION
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4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE )NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION
! -ODULE ! 4OOLS
! 4OOLS
5NITED .ATIONS 0OPULATION &UND 5.&0! -ODULE ! 3TATEMENT ON %MERGENCY #ONTRACEPTION 4HE 5NITED .ATIONS 0OPULATION &UND 5.&0! ENDORSES THE VIEW THAT THE AIM OF FAMILY PLANNING PROGRAMS MUST BE TO ENABLE COUPLES AND INDIVIDUALS TO DECIDE FREELY AND RESPONSIBLY THE NUMBER AND SPACING OF THEIR CHILDREN AND TO HAVE THE INFORMATION AND MEANS TO DO SO AND TO ENSURE INFORMED CHOICES AND MAKE AVAILABLE A FULL RANGE OF SAFE AND EFFECTIVE METHODS )#0$ PARA )N RESPONSE TO GOVERNMENT REQUESTS 5.&0! CAN PROVIDE SUPPLIES FOR THOSE METHODS INCLUDING PROGESTIN ONLY DEDICATED EMERGENCY CONTRACEPTIVE PILLS 5.&0! IS COMMITTED TO REDUCING THE INCIDENCE OF ABORTION AND IT DOES NOT PROMOTE OR SUPPORT ABORTION IN ANY COUNTRY 5.&0! SUPPORTS EMERGENCY CONTRACEPTION AS A MEANS FOR EXPANDING CONTRACEPTIVE CHOICE AND REDUCING ABORTION )N LINE WITH ACCEPTED DElNITIONS OF MEDICAL SCIENCE THE 7ORLD (EALTH /RGANIZATION STATES h%MERGENCY CONTRACEPTIVE PILLS DO NOT INTERRUPT PREGNANCY AND THUS ARE NO FORM OF ABORTIONv "Y MAKING EMERGENCY CONTRACEPTION MORE WIDELY AVAILABLE REPRODUCTIVE HEALTH CARE PROVIDERS OF FAMILY PLANNING CAN HELP REDUCE UNPLANNED PREGNANCIES MANY OF WHICH RESULT IN UNSAFE ABORTION AND TAKE A LARGE TOLL ON WOMENS HEALTH %MERGENCY CONTRACEPTION ALSO IS AN ESSENTIAL PART OF TREATMENT FOR WOMEN WHO ARE VICTIMS OF SEXUAL ASSAULT 5.&0! SHARES THE VIEW THAT %# SHOULD BE PROMPTLY AVAILABLE AS A BACK UP FOR UNPROTECTED INTERCOURSE 7ITH ITS MAJOR ROLE IN THE PREVENTION OF BOTH UNINTENDED PREGNANCIES AND RECOURSE TO ABORTION %# IS A VALUABLE ADDITION TO REPRODUCTIVE HEALTH PROGRAMS 5.&0! COLLABORATES WITH NATIONAL AUTHORITIES TO IMPROVE ACCESS TO %# AS PART OF HIGH QUALITY CARE FOR REPRODUCTIVE HEALTH
4HIS STATEMENT IS PROVIDED HERE WITH PERMISSION FROM THE 5NITED .ATIONS 0OPULATION &UND
! -ODULE ! 4OOLS
! 4OOLS
5NITED 3TATES !GENCY FOR )NTERNATIONAL -ODULE ! $EVELOPMENT 53!)$ 3TATEMENT ON %MERGENCY #ONTRACEPTION 53!)$ IS COMMITTED TO PROVIDING A FULL RANGE OF CONTRACEPTIVE OPTIONS 0ROVIDING INFORMATION ABOUT %#0S HAS BECOME A MEDICAL NORM )N FACT THE !MERICAN #OLLEGE OF /BSTETRICIANS AND 'YNECOLOGISTS !#/' NOW RECOMMENDS THAT WOMEN BE INFORMED OF %#0S AS STANDARD GOOD MEDICAL PRACTICE 4HE 53&$! ACTION FURTHER REINFORCES THIS NORM !CCORDINGLY 53!)$ SUPPLIES INFORMATION ABOUT THE USE OF %#0S IN A VARIETY OF ITS TECHNICAL AND TRAINING MATERIALS AND SUPPORTS SHARING INFORMATION WITH FAMILY PLANNING CLIENTS ABOUT THIS CONTRACEPTIVE OPTION !NOTHER ROLE FOR 53!)$ SUPPORTED PROGRAMS IS TO COLLECT DATA ON THE NEED USE AND POTENTIAL IMPACT OF %#0S IN PARTICIPATING COUNTRIES TO CONDUCT OPERATIONS RESEARCH ON HOW THE PROVISION OF %#0S CAN BE INTEGRATED WITHIN FAMILY PLANNING AND OTHER REPRODUCTIVE HEALTH PROGRAMS AND WHICH GROUPS WOULD BENElT MOST FROM HAVING %#0S AVAILABLE AND BIOMEDICAL RESEARCH ON THE MECHANISM OF ACTION USE AND EFFECTIVENESS OF %#0S !LTHOUGH 53!)$ SUPPLIED ORAL CONTRACEPTIVE PILLS ARE AMONG THE &$! APPROVED FORMULATIONS THAT CAN BE USED FOR EMERGENCY CONTRACEPTION 53!)$ DOES NOT CURRENTLY FUND SEPARATE PACKAGING OF PILLS FOR THIS PURPOSE NOR HAS 53!)$ PURCHASED ANY OF THE TWO 53&$! APPROVED DEDICATED %#0 PRODUCTS 53!)$ IS ABLE TO HELP INTERESTED -ISSIONS SEEK OUT OTHER SOURCES OF DONOR SUPPORT FOR THE PROVISION OF A DEDICATED %# PRODUCT
4HE 53&$! PUBLISHED A FORMAL NOTICE ON &EBRUARY IN THE &EDERAL 2EGISTER STATING THAT ANY ONE OF SIX DIFFERENT ;AND NOW MANY MORE= COMMON BRANDS OF COMBINED ORAL CONTRACEPTIVE PILLS ALL CONTAINING NORGESTREL OR LEVONORGESTREL AND ETHINYL ESTRADIOL ARE SAFE AND EFFECTIVE FOR USE AS EMERGENCY CONTRACEPTION UP TO DAYS AFTER UNPROTECTED SEX
4HIS STATEMENT IS PROVIDED HERE WITH PERMISSION FROM THE 5NITED 3TATES !GENCY FOR )NTERNATIONAL $EVELOPMENT ! -ODULE ! 4OOLS
! 4OOLS
7ORLD (EALTH /RGANIZATION %MERGENCY -ODULE ! #ONTRACEPTION 3TATEMENT
%MERGENCY #ONTRACEPTION %MERGENCY CONTRACEPTION REFERS TO CONTRACEPTIVE METHODS THAT CAN BE USED BY WOMEN IN THE lRST FEW DAYS FOLLOWING UNPROTECTED INTERCOURSE TO PREVENT AN UNWANTED PREGNANCY %MERGENCY CONTRACEPTIVE METHODS ARE EFFECTIVE AND SAFE FOR THE MAJORITY OF WOMEN WHO MAY NEED THEM AS WELL AS BEING SIMPLE TO USE
7HO MAY NEED EMERGENCY CONTRACEPTION !NY WOMAN OF REPRODUCTIVE AGE MAY NEED EMERGENCY CONTRACEPTION AT SOME POINT TO AVOID AN UNWANTED PREGNANCY )T IS MEANT TO BE USED IN SITUATIONS SUCH AS s AFTER VOLUNTARY SEXUAL INTERCOURSE THAT TOOK PLACE WITH NO CONTRACEPTIVE PROTECTION s AFTER INCORRECT OR INCONSISTENT USE OF REGULAR CONTRACEPTIVE METHODS OR WHEN THERE HAS BEEN AN ACCIDENTAL FAILURE OF OTHER CONTRACEPTIVE METHODS SUCH AS s CONDOM BREAKAGE OR SLIPPAGE s MISCALCULATION OF THE INFERTILE PERIOD WHEN USING PERIODIC ABSTINENCE OR FAILURE TO ABSTAIN FROM SEXUAL INTERCOURSE DURING THE FERTILE DAYS s EXPULSION OF AN INTRAUTERINE DEVICE )5$ s FAILED COITUS INTERRUPTUS WHEN EJACULATION HAS OCCURRED IN THE VAGINA OR ON THE EXTERNAL GENITALIA s FAILURE TO TAKE ORAL CONTRACEPTIVES FOR MORE THAN DAYS s BEING LATE FOR A CONTRACEPTIVE INJECTION s WHEN A WOMAN HAS BEEN A VICTIM OF SEXUAL ASSAULT AND HAS HAD NO CONTRACEPTIVE PROTECTION
-ETHODS OF EMERGENCY CONTRACEPTION 4HE MOST COMMON METHODS OF EMERGENCY CONTRACEPTION ARE s HIGH DOSES OF COMBINED ORAL CONTRACEPTIVES #/#S CONTAINING ETHYNYL ESTRADIOL AND LEVONORGESTREL 9UZPE REGIMEN s HIGH DOSES OF PROGESTOGEN ONLY PILL CONTAINING LEVONORGESTREL
-ODE OF ACTION %MERGENCY CONTRACEPTION PILLS %#0S ARE THOUGHT TO PREVENT OVULATION FERTILIZATION ANDOR IMPLANTATION %#0S ARE NOT EFFECTIVE ONCE THE PROCESS OF IMPLANTATION HAS BEGUN AND WILL NOT CAUSE ABORTION
! %FlCACY !FTER A SINGLE ACT OF UNPROTECTED SEXUAL INTERCOURSE THE 9UZPE REGIMEN FAILS IN ABOUT PERCENT OF WOMEN WHO USE IT CORRECTLY THE CHANCES OF PREGNANCY ARE APPROXIMATELY FOUR TIMES GREATER WHEN NO EMERGENCY CONTRACEPTIVE IS USED 4HE PROGESTOGEN ONLY REGIMEN IS -ODULE ! EQUALLY EFFECTIVE
%LIGIBILITY CRITERIA
4OOLS 4HE 7ORLD (EALTH /RGANIZATION 7(/ HAS DRAWN UP MEDICAL ELIGIBILITY CRITERIA FOR THE USE OF EMERGENCY CONTRACEPTION PILLS BASED ON THE RELATIVE HEALTH RISKS AND BENElTS OF THE METHOD FOR WOMEN WITH GIVEN CONDITIONS 4HE SOLE CONTRAINDICATION FOR THE USE OF EMERGENCY CONTRACEPTION PILLS IS PREGNANCY %MERGENCY CONTRACEPTION PILLS SHOULD NOT BE GIVEN TO A WOMAN WHO HAS A CONlRMED PREGNANCY PRIMARILY BECAUSE THEY WILL NOT BE EFFECT %XPERTS BELIEVE THERE IS NO HARM TO A PREGNANT WOMAN OR FETUS IF EMERGENCY CONTRACEPTIVE PILLS ARE INADVERTENTLY USED DURING EARLY PREGNANCY %MERGENCY CONTRACEPTIVE PILLS ARE FOR EMERGENCY USE ONLY AND NOT RECOMMENDED FOR ROUTINE USE BECAUSE OF THE HIGHER POSSIBILITY OF FAILURE COMPARED TO REGULAR CONTRACEPTIVES AND THE INCREASE IN SIDE EFFECTS SUCH AS NAUSEA AND VOMITTING (OWEVER THEIR REPEATED USE POSES NO KNOWN HEALTH RISKS
&URTHER READING #ONSORTIUM FOR %MERGENCY #ONTRACEPTION %MERGENCY #ONTRACEPTIVE 0ILLS ! RESOURCE PACKET FOR HEALTH CARE PROVIDERS AND 0ROGRAMME -ANAGERS 7ELLS % #ROOK " -ULLER . %MERGENCY #ONTRACEPTION ! RESOURCE -ANUAL FOR 0ROVIDERS 0!4( 7ORLD (EALTH /RGANIZATION %MERGENCY #ONTRACEPTION ! GUIDE FOR SERVICE DELIVERY 7(/ &2(&00 7ORLD (EALTH /RGANIZATION )MPROVING !CCESS TO 1UALITY #ARE IN &AMILY 0LANNING -EDICAL %LIGIBILITY #RITERIA FOR #ONTRACEPTIVE 5SE 7(/&2(&00
4HIS INFORMATION ORIGINALLY PRINTED AS 7(/ FACT SHEET .O *UNE WAS REPRINTED WITH PERMISSION FROM THE 7ORLD (EALTH /RGANIZATION
! 4OOLS
!NNOTATED "IBLIOGRAPHY OF #ORE %VIDENCE "ASED -ODULE ! 2ESEARCH ON %MERGENCY #ONTRACEPTION
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PREGNANCY FROM OCCURRING BEFORE IMPLANTATION WHICH IS CONTRACEPTION AND NOT ABORTION "ASED ON MEDICAL DElNITIONS EMERGENCY CONTRACEPTION IS PREVENTION OF PREGNANCY BECAUSE IT WORKS BEFORE IMPLANTATION %MERGENCY CONTRACEPTIVES ARE INEFFECTIVE ONCE IMPLANTATION HAS BEGUN 4HEY CANNOT CAUSE AN ABORTION IF THE WOMAN IS ALREADY PREGNANT 4OOLS !RE %#0S SAFE 4HE 7ORLD (EALTH /RGANIZATION HAS STATED THAT THERE ARE NO ABSOLUTE CONTRAINDICATIONS TO THE USE OF EMERGENCY CONTRACEPTIVE PILLS DUE TO THE SMALL OVERALL HORMONE DOSE AND SHORT DURATION OF USE %#0S DO NOT HAVE THE SAME CONTRAINDICATIONS AS DAILY ORAL CONTRACEPTIVES 2ESEARCHERS HAVE CONCLUDED THAT NO EVIDENCE EXISTS TO SUGGEST THAT %#0S WILL HARM A DEVELOPING FETUS )S REPEAT USE OF %#0S HARMFUL 2EPEAT USE OF %#0S POSES NO HEALTH RISKS %XPERIENCE WITH %#0S SUGGESTS THAT REPEAT USE WITHIN THE SAME CYCLE IS UNCOMMON 5SE OF LEVONORGESTREL ONLY %#0S AS FREQUENTLY AS FOUR TIMES A MONTH DID NOT REVEAL NEGATIVE HEALTH RISKS 7HILE REPEAT USE IS NOT A REASON TO DENY A WOMAN ACCESS TO %#0S IT IS AN INDICATION THAT A WOMAN NEEDS FURTHER COUNSELING ON ROUTINE CONTRACEPTIVE METHODS AS ALL OTHER METHODS ARE MORE EFFECTIVE 7OMEN WHO HAVE REGULAR INTERCOURSE MORE THAN FOUR TIMES PER MONTH ARE NOT ADVISED TO USE %#0S AS A REGULAR CONTRACEPTIVE METHOD BECAUSE IT IS NOT AS EFFECTIVE AS REGULAR CONTRACEPTION $O %#0S PREVENT SEXUALLY TRANSMITTED INFECTIONS %#0S DO NOT PROTECT AGAINST ()6!)$3 OR OTHER SEXUALLY TRANSMITTED INFECTIONS LIKE SYPHILIS GONORRHEA CHLAMYDIA AND HERPES 4HIS MATERIAL WAS DEVELOPED BY 0!4( ! -ODULE " #OST #ONSIDERATIONS /BJECTIVE 4O DEMONSTRATE HOW %#0S CAN REDUCE THE PUBLIC SECTOR COSTS ASSOCIATED WITH UNINTENDED PREGNANCY IN A DEVELOPING COUNTRY CONTEXT #ONSIDERATIONS FOR $ECISION -AKERS ,OW COST PROVISION OF %#0S THROUGH NONCLINICAL STAFF FOR EXAMPLE CAN LEAD TO COST SAVINGS IN UNINTENDED PREGNANCY COSTS PER WOMAN HAVING UNPROTECTED SEX )NCREASED COST OF %#0 PROVISION SUCH AS CLINICAL CONSULTATION OR EXAMINATION REDUCES THESE COST SAVINGS 4HE LARGER THE PRICE DIFFERENTIAL BETWEEN THE COST OF PROVIDING %#0S AND THE COST OF PREGNANCY OUTCOMES THE MORE COST EFFECTIVE THE USE OF %#0S WILL BE #OUNTRIES WITH HIGH MATERNAL HEALTH CARE COSTS ARE LIKELY TO ACCRUE LARGE BENElTS FROM MAKING %#0S AVAILABLE )N ADVOCATING FOR LARGE SCALE PROVISION OF %#0S IT IS IMPORTANT TO DEMONSTRATE HOW %#0S CAN REDUCE THE PUBLIC SECTOR COSTS ASSOCIATED WITH UNINTENDED PREGNANCIES IN DEVELOPING COUNTRIES 0ROVIDED HERE IS A SIMPLE MODEL THAT ASSESSES THE COST EFFECTIVENESS OF PROVIDING %#0S THROUGH DEVELOPING COUNTRY PUBLIC SECTOR SERVICES 4HE RESULTS HIGHLIGHT CONSIDERATIONS FOR MAKING DECISIONS ABOUT INCORPORATING EMERGENCY CONTRACEPTIVE PILLS INTO THE BROADER PACKAGE OF FAMILY PLANNING OPTIONS AVAILABLE TO WOMEN IN LOW RESOURCE SETTINGS 4HESE CONSIDERATIONS ARE SUMMARIZED ABOVE )NTRODUCTION %VERY YEAR NEARLY MILLION UNINTENDED PREGNANCIES OCCUR WORLDWIDE &ROM TO NEARLY WOMEN DIED AS A RESULT OF UNINTENDED OR UNWANTED PREGNANCY -ATERNAL MORBIDITY AND MORTALITY ASSOCIATED WITH UNINTENDED PREGNANCY INCUR INCALCULABLE SOCIAL COSTS AND PERSONAL COSTS TO FAMILIES 5NINTENDED PREGNANCY ALSO IMPOSES AN ECONOMIC BURDEN ON A COUNTRYS HEALTH CARE SYSTEM BECAUSE OF THE INCREASED MATERNAL HEALTH CARE COSTS ASSOCIATED WITH ANTENATAL CARE BIRTHS ABORTIONS AND POSTABORTION CARE %MERGENCY CONTRACEPTION AS THE ONLY EASILY ACCESSIBLE SAFE AND EFFECTIVE POSTCOITAL CONTRACEPTIVE METHOD HAS AN IMPORTANT ROLE TO PLAY IN PREVENTING UNINTENDED PREGNANCY #ONSIDER THAT IF WOMEN WHO DO NOT WANT TO BECOME PREGNANT HAVE UNPROTECTED INTERCOURSE AN ESTIMATED WILL BECOME PREGNANT )F ALL WOMEN USE LEVONORGSTREL ONLY %#0S THE NUMBER OF PREGNANCIES CAN BE REDUCED TO AN PERCENT REDUCTION IN UNINTENDED PREGNANCY " " -ODULE " #OUNTRY 3ETTINGS !SSESSING THE #OST %FFECTIVENESS OF %#0S IN $EVELOPING "ACKGROUND ANALYSIS DESCRIBED BELOW EXAMINES THE COSTS TO A PUBLIC HEALTH ANALYSIS THAT MODELS THE COSTS AND OUTCOMES ASSOCIATED WITH PRO MAKING 4HIS SECTION DESCRIBES THE RESULTS OF A RELATIVELY SIMP EVEN A SIMPLE APPROACH CAN PROVIDE USEFUL ILLUSTRATIVE INFORMAT EFFECTIVENESS ANALYSIS AROUND THE PROVISION OF %#0S IN A DEVELO 4HERE ARE A NUMBER OF CHALLENGES IN DEVELOPING A RIGOROUS AND C THE 5NITED 3TATES AND #ANADA 4HE PUBLISHED LITERATURE TO DATE PROVIDES EVIDENCE OF THE COST REDUCED MATERNAL MORBIDITY AND MORTALITY DIFlCULT TO CAPTURE THE COST SAVINGS TO THE HEALTH SECTOR AND S RESULTING IN LOWER DIRECT MEDICAL COSTS WHICH CAN BE CAPTURED AND MORTALITY )NCREASED ACCESS TO %#0S WILL RESULT IN FEWER PR AND RELATED COMPLICATIONS ABORTION AND ABORTION COMPLICATIONS CRITICAL COSTS INCLUDE THOSE ASSOCIATED WITH PROVISION OF THE % WITH THE STATUS QUO 7HEN LOOKING AT THE IMPLICATIONS OF WIDESP OR MORE ALTERNATIVES MAKING IT POSSIBLE TO SEE HOW A NEW INTER HEALTH SYSTEMS #OST EFFECTIVENESS ANALYSIS COMPARES THE COSTS INCORPORATING NEW HEALTH INTERVENTIONS HEALTH TECHNOLOGIES OR EFFECTIVENESS ANALYSIS CAN PROVIDE HELPFUL INFORMATION FOR MAKI HAVE AN IMPORTANT HEALTH IMPACT BUT ALSO MAKE THE MOST OF SCAR 3EVERELY LIMITED HEALTH BUDGETS REQUIRE FUNDS BE ALLOCATED TO I IN DEVELOPING COUNTRIES AND NOT AVAILABLE THROUGH THE PUBLIC SE CAPITA HEALTH EXPENDITURES AND THE COST OF SERVICES 4HIRD ABO AND MIDDLE INCOME COUNTRIES WHERE THE PRODUCT COST OF %#0S MAY HIGH INCOME COUNTRIES SUCH AS #ANADA AND THE 5NITED 3TATES 4H DEVELOPED COUNTRIES 3ECOND THE PRODUCT COST OF THE %#0S IS RE INTENSIVE THAN IN DEVELOPED COUNTRIES RESULTING IN LOWER HEALT COST STRUCTURES IN DEVELOPING COUNTRIES ARE MORE LABOR INTENSIV DEVELOPING COUNTRIES FOR SEVERAL REASONS &IRST THE HEALTH SER ON THE COSTS AND OUTCOMES FROM DEVELOPED COUNTRY SETTINGS IS NO CONTRACEPTION AS PART OF FAMILY PLANNING PROGRAMS IN DEVELOPING 4HERE IS VERY LITTLE INFORMATION ON THE COSTS OR COST EFFECTIVE UNINTENDED PREGNANCIES CONTRACEPTION REDUCED THE EXPENDITURES ON MEDICAL CARE THROUGH OUTCOMES IS HIGH ESPECIALLY WHEN COMPARED TO THE LOW PRICE OF )N #ANADA AND THE 5NITED 3TATES WHERE THE AVERAGE COST OF BIRT ASSOCIATED WITH INDUCED ABORTION BIRTH SPONTANEOUS ABORTION ADVANCE TO BE USED AS NEEDED 4HESE STUDIES FOCUSED PRIMARILY O PARTY INSURER WHEN USED AFTER AN ACT OF UNPROTECTED INTERCOURS EITHER COST EFFECTIVE OR RESULTED IN COST SAVINGS TO THE PUBLIC 4HESE STUDIES FOUND THAT EMERGENCY CONTRACEPTION WAS PAYER MANAGED CARE OR THIRD NESS OF THE USE OF EMERGENCY OCIETY ASSOCIATED WITH VICE DELIVERY SYSTEMS AND #0S PREGNANCY DELIVERY H CARE COSTS COMPARED TO LE COST EFFECTIVENESS RTION SERVICES MAY BE ILLEGAL EFFECTIVENESS OF %#0S IN NTERVENTIONS THAT NOT ONLY E OR WHEN OBTAINED IN EGNANCIES AND ABORTIONS E AND LESS TECHNOLOGY AS COST SAVINGS )T IS MORE VENTION WOULD COMPARE TREATMENTS INTO EXISTING CTOR AND ECTOPIC PREGNANCIES SYSTEM OF A SET OF EXPECTED ION TO HELP GUIDE DECISION HS AND PREGNANCY RELATED AND OUTCOMES OF TWO NG DECISIONS ABOUT LATIVELY INEXPENSIVE IN PING COUNTRY SETTING BUT CE RESOURCES #OST READ ACCESS TO %#0S AND MATERNAL MORBIDITY VISION OF %#0S 4HE %#0S USE OF EMERGENCY N THE DIRECT MEDICAL COSTS OMPREHENSIVE COST COUNTRIES 4HE EVIDENCE THE PREVENTION OF T DIRECTLY TRANSFERABLE TO IS IS NOT THE CASE IN LOW BE HIGH RELATIVE TO PER -ODULE " OUTCOMES RELATED TO WOMENS USING OR NOT USING %#0S AFTER UNPROTECTED INTERCOURSE 4HE COSTS INCLUDED IN THIS ANALYSIS ARE REPRESENTATIVE OF HEALTH SERVICES PROVIDED BY THE PUBLIC SECTOR CLINICS 4HE MODEL USES AN EXISTING FRAMEWORK THAT DESCRIBES A SPECIlC SET OF POSSIBLE OUTCOMES OCCURRING AS THE RESULT OF UNPROTECTED INTERCOURSE 4HESE INCLUDE PREGNANCY INDUCED ABORTION SPONTANEOUS ABORTION OR MISCARRIAGE ECTOPIC PREGNANCY AND BIRTH SEE &IGURE 5SING THIS MODEL IT IS POSSIBLE TO APPLY PROBABILITIES OF PREGNANCY AND OUTCOMES DRAWN FROM PUBLISHED LITERATURE AS WELL AS COUNTRY SPECIlC DATA ON UNINTENDED PREGNANCY ABORTION AND HEALTH SYSTEM COSTS &IGURE $ECISION MODEL FOR USE OR NONUSE OF EMERGENCY CONTRACEPTIVE PILLS -ODEL AND !SSUMPTIONS 4HE PROBABILITY THAT A WOMAN BECOMES PREGNANT FOLLOWING AN UNPROTECTED ACT OF INTERCOURSE IS ESTIMATED AT PERCENT 4HE USE OF A LEVONORGESTREL ONLY %#0 REDUCES THAT RISK OF PREGNANCY BY PERCENT 4HE RISK OF PREGNANCY IN WOMEN WHO ARE USING %#0S BASED ON THESE PROBABILITIES IS PERCENT 4HE MODEL ASSUMES THAT IF A WOMAN BECOMES PREGNANT THERE IS A PERCENT CHANCE SHE WILL EXPERIENCE A SPONTANEOUS ABORTION AND A PERCENT RISK OF AN ECTOPIC PREGNANCY 4HE PROBABILITY OF INDUCED ABORTION VARIES BY COUNTRY AND IS ESTIMATED AT PERCENT IN #AMBODIA PERCENT IN 0ERU PERCENT IN 5GANDA AND PERCENT IN 'HANA 4HE ANALYSIS ALSO RELIES ON DATA FROM FOUR DEVELOPING COUNTRIES #AMBODIA 'HANA 0ERU AND 5GANDA 4HESE FOUR COUNTRIES WERE SELECTED BECAUSE THEY DEMONSTRATE BOTH GEOGRAPHIC AND ECONOMIC DIFFERENCES !PPENDIX PROVIDES MATERNAL HEALTH CARE COST ESTIMATES IN THE FOUR COUNTRIES 3OCIO DEMOGRAPHIC AND REPRODUCTIVE HEALTH INDICATORS FOR EACH COUNTRY ARE INCLUDED IN !PPENDIX $ATA ON THE COSTS OF MATERNAL HEALTH CARE SERVICES ARE SCARCE AND EVEN MORE DIFlCULT TO DETERMINE ARE THE COSTS ASSOCIATED WITH ABORTION AND POSTABORTION CARE ESPECIALLY IN COUNTRIES WHERE ABORTION IS ILLEGAL 4HE FOUR COUNTRIES ALSO WERE SELECTED BECAUSE OF THE AVAILABILITY OF COST DATA THROUGH PUBLISHED LITERATURE 5GANDA AND 'HANA PERSONAL COMMUNICATION #AMBODIA AND THROUGH A RAPID -/( SURVEY 0ERU 4HE SURVEY IS INCLUDED IN !PPENDICES AND %STIMATED FROM AN UNPUBLISHED INTERNET SOURCE KWWS ZZZXPDQLWREDFDZRPHQVBKHDOWKJOREDOUKWP " " -ODULE " SERVICES 4HE PER UNIT COST IS EXCLUSIVE OF SHIPPING COSTS WH & ON 2EGULATION 0ROCUREMENT AND $ISTRIBUTION OF A 0ROGESTIN /N o OF THE WOMAN IN 5GANDA THE COST OF ABORTION IS THE ESTIMATED ABORTION SERVICES )N 0ERU 'HANA AND 5GANDA WHERE ABORTIONS ,EVIN ET AL COSTS 4HESE COMPLICATION COSTS HAVE BEEN ESTIMATED AT P DEPENDING UPON THE SIZE OF THE ORDER 4HIS IS THE CURRENT PRICE FOR LEVONORGESTREL ONLY PILLS PROCUR )N #AMBODIA WHERE ABORTION IS LEGAL AND SERVICES ARE PROVIDED s s s 3CENARIO s s 3CENARIO s s s 3CENARIO s s 3CENARIO ARE ASSUMED TO BE PERCENT OF BIRTH COSTS CARE VISITS !BORTION COSTS ARE DIFlCULT TO OBTAIN AND WHERE N SERVICES IN PUBLIC SECTOR CLINICS OR HOSPITALS #OST ESTIMATES 4HE MODEL ASSUMES THAT ALL WOMEN WHO BECOME PREGNANT RECEIVE MA 4HE MODEL USED FOUR SCENARIOS INCLUDE CLINICAL CONSULTATIVE SERVICES AND HIGHER ABORTION COST 4O PROVIDE A RANGE OF COST ESTIMATES THE MODEL ESTIMATES COSTS PROBABILITIES OF EACH OUTCOME FOR UNINTENDED PREGNANCIES ABORTION SPONTANEOUS ABORTION ECTOPIC PREGNANCY AND BIRTH WI THE WOMAN BECOME PREGNANT )T IS CALCULATED AS THE WEIGHTED AVE OF THE TREATMENT IE %#0S MINUS THE TOTAL COSTS THAT WOULD 4HE COST OF AN UNINTENDED PREGNANCY REPRESENTS THE hNET COSTv E PROGRAM AT A COST OF PER UNIT !BORTION COSTS ARE PERCENT HIGHER THAN BIRTH COSTS 4HE COST OF A CONSULTATIVE OFlCE VISIT IS INCLUDED %#0S ARE OBTAINED FROM A PUBLIC HEALTH CLINIC WITH A REQUIRED C 4HE COST OF A CONSULTATIVE OFlCE VISIT IS INCLUDED %#0S ARE OBTAINED FROM A PUBLIC HEALTH CLINIC WITH A REQUIRED C !BORTION COSTS ARE PERCENT HIGHER THAN BIRTH COSTS .O COSTS ASSOCIATED WITH AN OFlCE VISIT %#0S CAN BE OBTAINED FROM A PUBLIC HEALTH CLINIC OR DISPENSARY .O COSTS ASSOCIATED WITH AN OFlCE VISIT %#0S CAN BE OBTAINED FROM A PUBLIC HEALTH CLINIC OR DISPENSARY o AND ARE PROVIDED TO CLIENTS FREE OF CHARGE ED THROUGH 5.&0! 3EE INFORMATION IN THE TOOLS SECTION OF -ODU ICH WILL RAISE THE PER UNIT COST BY PERCENT TO OVER PERC AVERAGE COST TO THE PUBLIC SECTOR FOR POSTABORTION COMPLICATION ER COMPLICATION FOR 0ERU AND 'HANA AND FOR 5GANDA ARE PERMITTED ONLY UNDER CERTAIN CONDITIONS EG TO SAVE THE L %#0S ARE ASSUMED TO BE PROCURED BY THE LY %#0 ON PROCUREMENT THROUGH INTERNATIONAL PROCUREMENT BY THE PUBLIC SECTOR THE COST ESTIMATE IS FOR THE PROVISION O FOR BIRTH INCLUDE ANTENATAL HAVE BEEN INCURRED HAD OT AVAILABLE THESE COSTS S FOR FOUR SCENARIOS THAT QUAL TO THE TOTAL COST TH THE WEIGHTS EQUAL TO THE RAGE OF THE COSTS OF LINICAL CONSULTATION LINICAL CONSULTATION WITHOUT AN OFlCE VISIT WITHOUT AN OFlCE VISIT TERNAL HEALTH CARE ENT F IFE LE -ODULE " &INDINGS 5NDER THE ASSUMPTIONS OF 3CENARIO THE PROVISION OF %#0S IS COST SAVING IN ALL COUNTRIES 3EE &IGURE BELOW FOR AN ILLUSTRATION OF THE COST SAVINGS IN 53 VERSUS THE COST INCREASES UNDER THE FOUR SCENARIOS &OR EXAMPLE IN 0ERU THE AVERAGE COST OF AN UNINTENDED PREGNANCY WAS PER WOMAN 4HE USE OF %#0S REDUCES THAT COST BY AN PERCENT REDUCTION )N 5GANDA COSTS WERE REDUCED BY PERCENT REDUCED BY IN #AMBODIA BY PERCENT REDUCED BY AND IN 'HANA BY PERCENT REDUCED BY 5NDER 3CENARIO IF WOMEN EXPERIENCED UNINTENDED PREGNANCY IN A SINGLE YEAR IN 0ERU AND HALF OF THESE WOMEN RECEIVED %#0S FROM A PUBLIC HEALTH DISPENSARY MILLION WOULD BE SAVED IN UNINTENDED PREGNANCY COSTS WITHIN THE PUBLIC SECTOR 4HIS LEVEL OF COST SAVINGS IS PARTICULARLY NOTEWORTHY BECAUSE OF THE NEED TO TREAT ALL WOMEN AT RISK OF UNINTENDED PREGNANCY WITH %#0S EVEN THOUGH ONLY A PORTION OF THEM WOULD LIKELY BECOME PREGNANT FROM A SINGLE ACT OF INTERCOURSE &IGURE 3AVINGS OR COSTS IN 53 PER WOMAN TO PUBLIC PAYER TO AVOID AN UNINTENDED PREGNANCY RESULTING FROM UNPROTECTED SEX IN #AMBODIA 0ERU 5GANDA AND 'HANA UNDER FOUR %#0 PROVISION SCENARIOSÁ !S MIGHT BE ANTICIPATED EVEN GREATER COST SAVINGS ARE REALIZED ACROSS ALL COUNTRIES WHEN THE COST OF ABORTION IS PERCENT HIGHER THAN THE COST OF A BIRTH AND WHEN %#0S ARE ACCESSIBLE WITHOUT A CLINICAL CONSULTATION 3CENARIO 7HEN A REQUIRED CLINICAL CONSULTATION IS INCLUDED 3CENARIO THE COST OF PROVIDING %#0 INCREASESWITH THE RESULT THAT IN THREE OF THE FOUR COUNTRIES #AMBODIA IS THE EXCEPTION THE COSTS INCURRED IN PROVIDING %#0S APPEAR TO OUTWEIGH THE COST SAVINGS GAINED FROM PREVENTION OF UNINTENDED PREGNANCY )N 3CENARIO WHERE ABORTION COSTS ARE INCREASED AND %#0S ARE OBTAINABLE ONLY WITH A CLINICAL CONSULTATION %#0 PROVISION STILL APPEARS COST EFFECTIVE IN #AMBODIA ALMOST NEUTRAL IN 5GANDA AND HIGHER IN 0ERU AND 5GANDA Á #OSTS BELOW THE LINE REPRESENT SAVINGS AND COSTS ABOVE THE LINE REPRESENT EXPENDITURES " " -ODULE " UNPROTECTED INTERCOURSE BY WOMEN IN #AMBODIA 0ERU 5GA 4ABLE 5NINTENDED PREGNANCIES ABORTIONS AND MATERNAL DEATH $ISCUSSION +INGDOM AND PARTS OF 5NITED 3TATES AND #ANADA 4HEY ARE AVAILA -ADAGASCAR -ALI -AURITIUS .AMIBIA 0ORTUGAL 3ENEGAL 3OUTH IN !LBANIA "ELGIUM "ENIN #AMEROON #ONGO $ENMARK &INLAND 4HE %MERGENCY #ONTRACEPTION .EWSLETTER REPORTS THAT AS OF 3PRI AVAILABLE OVER THE COUNTER OR THROUGH PHARMACIES PROlLE OF %#0S HAS LED A NUMBER OF COUNTRIES TO INCREASE %#0 AC ABOUT %#0S AND IF THEY ARE EASILY AVAILABLE WITHOUT A CLINICAL LOW IF %#0S ARE AVAILABLE AT A SUBSIDIZED PRICE TO THE GOVERNME TO THE PUBLIC SECTOR WHEN THE COST OF PROVIDING THE %#0S IS KEP 4HE RESULTS OF THIS ANALYSIS SUGGEST THAT EMERGENCY CONTRACEPTI USED %#0S PREVENTED IF WOMEN AT RISK OF UNINTENDED PREGNANCY IN E TABLE PROVIDES AN ESTIMATED NUMBER OF ABORTIONS AND MATERNAL DE ALSO LEAD TO MATERNAL DEATHS "ASED ON DATA FROM THE 'LOBAL (EA PERCENT IN #AMBODIA TO PERCENT IN 'HANA END IN ABORTION 5N SCARCE RESOURCES ! SIGNIlCANT PROPORTION OF UNINTENDED PREGNAN NOT THE ONLY FACTOR POLICY MAKERS MUST CONSIDER WHEN MAKING DEC &INALLY ALTHOUGH THE FOCUS OF THIS ANALYSIS WAS COST EFFECTIVE OR THE PRIVATE SECTOR HEALTH SERVICES OR ABORTION SERVICES THROUGH OTHER SECTORS FO PUBLIC HEALTH CARE SYSTEM 4HIS MAY NOT BE THE CASE IF A WOMAN PRODUCTIVITY AND MATERNAL DEATHS &INALLY THE MODEL ASSUMES ALL COMPLETE SOCIETAL COSTS SUCH AS THE INDIRECT COSTS ASSOCIATED PREGNANCY BECAUSE IT DID NOT INCLUDE COSTS RELATED TO PREGNANCY !DDITIONALLY THE MODEL MOST LIKELY UNDERESTIMATED COSTS ASSOCI ASSOCIATED WITH PREGNANCY OUTCOMES AND ONLY INCLUDED SOME VARIA 4HE FOUR SCENARIOS IN THE MODEL DID NOT INCLUDE VARIATION IN AN ASSUMPTIONS COMPLETENESS OF THE COST DATA AND DATA ACCURACY THE PUBLIC PAYER 4HE COSTS AND POTENTIAL SAVINGS WILL ALSO VAR ABORTION AND BIRTH RELATIVE TO THE COST OF PROVIDING %#0S THE PARTICULAR HOW %#0S ARE DELIVERED TO WOMEN 4HE HIGHER THE COS PREGNANCY AND RESULTING ABORTIONS COSTS OF PREGNANCY OUTCOMES COSTS INCURRED WILL DEPEND UPON MANY FACTORS INCLUDING THE EXT 4HE RESULTS OF THE ANALYSIS ALSO DEMONSTRATE THAT THE EXTENT OF THIS EASY ACCESS APPROACH 5NINTENDED PREGNANCIES -ATERNAL DEATHS !BORTIONS ABDA0R GNA'HANA 5GANDA 0ERU #AMBODIA !FRICA 3RI ,ANKA 3WITZERLAND 4HAILAND 4OGO 4UNISIA 5NITED BLE OVER THE COUNTER IN .ORWAY AND 3WEDEN NG3UMMER %#0S ARE AVAILABLE DIRECT FROM A PHARMACIST &RANCE 'ABON 'UINEA "ISSAU )SRAEL )VORY #OAST ,ITHUANIA 0UBLIC HEALTH SYSTEMS COULD EMULATE S AVERTED THROUGH USE OF %#0S AFTER NDA AND 'HANA WITH LOSSES IN LABOR NESS DIRECT MEDICAL COSTS ARE GREATER THE COST SAVINGS TO R EXAMPLE THROUGH AN .'/ COST SAVINGS OR OF ADDITIONAL Y DEPENDING ON THE MODEL CONSULTATION 4HE SAFETY Y OF THE PROBABILITIES VE PILLS CAN BE COST SAVING T LOW 4HE COST CAN BE KEPT NT IF WOMEN ARE INFORMED COMPLICATIONS OR ENT OF UNINTENDED ATED WITH UNINTENDED COSTS ARE BORNE WITHIN THE ACCESSES %#0S MATERNAL LTH #OUNCIL THE FOLLOWING CIES RANGING FROM COST OF %#0S AND IN ATHS THAT COULD BE TS ASSOCIATED WITH BOTH CESS BY MAKING THEM INTENDED PREGNANCIES ACH OF THE FOUR COUNTRIES ISIONS ABOUT ALLOCATING TION IN COSTS -ODULE " 4HE SIGNIlCANT NUMBER OF NEGATIVE OUTCOMES AVERTED THROUGH THE USE OF EMERGENCY CONTRACEPTION ILLUSTRATED IN THE TABLE ABOVE DEMONSTRATES AN ADDITIONAL CRITICAL BENElT OF THE USE OF EMERGENCY CONTRACEPTION IN DEVELOPING COUNTRY SETTINGS 4HE COSTS ASSOCIATED WITH MATERNAL DEATHS ARE NOT REmECTED IN THIS ANALYSIS BUT THE ISSUE SHOULD CERTAINLY BE CONSIDERED WHEN ASSESSING THE COSTS ASSOCIATED WITH INTEGRATING EMERGENCY CONTRACEPTION INTO THE PUBLIC SECTOR " " -ODULE " !PPENDIX #OST ESTIMATES 53 3PONTANEOUS ABORTION %CTOPIC PREGNANCY )NDUCED ABORTION %# OFlCE VISIT "IRTH %#0 ABDA0R GNA'HANA 5GANDA 0ERU #AMBODIA #OUNTRY -ODULE " !PPENDIX 3ELECTED SOCIO DEMOGRAPHIC AND REPRODUCTIVE HEALTH INDICATORS FOR THE PERIOD #OUNTRY #AMBODIA 0ERU 5GANDA 'HANA 4OTAL 0OPULATION '$0 PER CAPITA .UMBER OF WOMEN AGED -- RATE -ATERNAL DEATHS 0REGNANCIES "IRTHS 5NINTENDED PREGNANCIES !BORTIONS 5NINTENDED BIRTHS 3OURCE 'LOBAL (EALTH #OUNCIL 0ROMISES TO +EEP 4HE 4OLL OF 5NINTENDED 0REGNANCIES ON 7OMENS ,IVES IN THE $EVELOPING 7ORLD " " -ODULE " ABORTION AND ABORTION RELATED COSTS !PPENDIX 'UIDELINES FOR COLLECTING INFORMATION ON BIRTH MAY BE ABLE TO COLLECT ACROSS DIFFERENT TYPES OF FACILITIES !PPENDIX IS A SUMMARY TABLE THAT CAN BE USED TO ENTER AVERAGE !PPENDIX IS A MORE DETAILED TABLE THAT CAN BE USED FOR A SING 4WO TABLES ARE PROVIDED TO HELP COLLECT AND ORGANIZE COST DATA OF SERVICE )F NOT ASK WHAT PERCENTAGE OF THE FULL COST DO THE )F YOU RECEIVE A USER FEE MANUAL OR FEE SCHEDULE ASK IF THESE INFORMATION MAY BE INSURANCE HOSPITAL OR CLINIC USER FEES MAN LABOR MATERIALS AND INDIRECT COSTS USED IN PROVIDING ANY SERV )T WOULD BE EASIEST TO GET #OSTS ASSOCIATED WITH ABORTION COMPLICATIONS !BORTIONS USING -6! AND SURGICAL PROCEDURES %CTOPIC PREGNANCY OR COMPLICATED DELIVERY AS A PROXY 5NCOMPLICATED VAGINAL DELIVERY !NTENATAL CARE AVERAGE COST PER WOMAN !N OFlCE VISIT TO OBTAIN %#0S %XPLAIN TO WHOEVER YOU MEET THAT YOU ARE INTERESTED IN GETTING WOULD BE USEFUL TO GET URBAN AND RURAL ESTIMATES SINCE THESE PRESUMABLY COVER COSTS AND MAY BE MORE REALISTIC OF CENTERS AND .'/ HEALTH CENTERS 9OU MAY ALSO BE INTERESTED IN P 4RY TO MEET WITH INDIVIDUALS WHO CAN PROVIDE INFORMATION ON PUB AVERAGE PER PATIENT COSTS BUT THESE COSTS SHOULD INCLUDE ICE TO WOMEN ! SOURCE OF LE FACILITY ESTIMATES OF COSTS FOR USER FEES REPRESENT UALS OR FEE SCHEDULES FEES COVER THE FULL COST TRUE RESOURCE USE )T RIVATE HOSPITAL OR CLINICS COST ESTIMATES THAT YOU LIC HOSPITALS AND HEALTH -ODULE " !PPENDIX #OST DATA BY FACILITY 4RY TO lLL IN THE FOLLOWING INFORMATION &ILL IN ONE OF THESE TABLES FOR EACH FACILITY AS NEEDED .AME OF FACILITY?????????????????????? ,OCATION???????????????? 4YPE OF FACILITY 0UBLIC 0RIVATE .'/ CIRCLE ONE #HARGES PER PATIENT FROM USER FEES #OST PER PATIENT OTHER !VERAGE NUMBER SOURCEFULL COST OF OF HOURS OR DAYS IN ,OCAL PROVIDING SERVICE IN CLINIC OR HOSPITAL CURRENCY OF FULL COST LOCAL CURRENCY HOURS OR DAYS /FlCE VISIT MINUTE !NTENATAL CARE "IRTH 6AGINAL DELIVERY #OMPLICATED DELIVERY )NDUCED ABORTION -6! 3URGICAL %CTOPIC PREGNANCY 3PONTANEOUS ABORTION 0OSTABORTION COMPLICATIONS /PTIONAL $AILY BED CHARGES /BGYN CONSULTATION .OTE 7E ARE INTERESTED IN THE FULL COST TO THE PROVIDER FOR EACH OF THESE SERVICES )F NOT AVAILABLE WE CAN USE PATIENT CHARGES OR USER FEES THAT IS WHAT THE PATIENT PAYS AS A PROXY AND TRY TO ESTIMATE HOW MUCH THOSE COSTS ARE SUBSIDIZED IN PUBLIC HEALTH SETTINGS " " -ODULE " !PPENDIX 3UMMARY OF COSTS UP %#0S MINUTE %CTOPIC PREGNANCY /FlCE VISIT TO PICK )NDUCED ABORTION 6AGINAL DELIVERY !NTENATAL CARE COMPLICATIONS 3PONTANEOUS 0OSTABORTION ABORTION 3URGICAL -6! "IRTH VISIT ,OCAL CURRENCY 0ROVIDE EXCHANGE RATE 53 ??????????? (OSPITAL 0UBLIC (OSPITALS (OSPITAL 0RIVATE #ENTER (EALTH 0UBLIC (EALTH #ENTERS .'/ OR -ISSION #ENTER (EALTH 0RIVATE #LINIC -ODULE " 2EFERENCES 'LOBAL (EALTH #OUNCIL 0ROMISES TO +EEP 4HE 4OLL OF 5NINTENDED 0REGNANCIES ON 7OMENS ,IVES IN THE $EVELOPING 7ORLD .EW 9ORK 'LOBAL (EALTH #OUNCIL 4RUSSELL * +OENIG * %LLERTSON # AND 3TEWART & 0REVENTING UNINTENDED PREGNANCY THE COST EFFECTIVENESS OF THREE METHODS OF EMERGENCY CONTRACEPTION !MERICAN *OURNAL OF 0UBLIC (EALTH 4RUSSELL * 7IEBE % 3HOCHET 4 AND 'UILBERT % #OST SAVINGS FROM EMERGENCY CONTRACEPTIVE PILLS IN #ANADA /BSTETRICS AND 'YNECOLOGY -ARCIANTE + 'ARDNER * 6EENSTRA $ AND 3ULLIVAN 3 -ODELING THE COST AND OUTCOMES OF PHARMACIST PRESCRIBED EMERGENCY CONTRACEPTION !MERICAN *OURNAL OF 0UBLIC (EALTH 7(/ 4ASK &ORCE ON 0OSTOVULATORY -ETHODS OF &ERTILITY 2EGULATION 2ANDOMISED CONTROLLED TRIAL OF LEVONORGESTREL VERSUS THE 9UZPE REGIMEN OF COMBINED ORAL CONTRACEPTIVES FOR EMERGENCY CONTRACEPTION ,ANCET !WOJOB /! AND /GUNSINA 3 %CTOPIC PREGNANCY IN A RURAL PRACTICE .IGER *OURNAL OF -EDICINE " -ODULE # 2AISING 0UBLIC !WARENESS /BJECTIVE 4O GENERATE PUBLIC SUPPORT FOR LARGE SCALE PROVISION OF EMERGENCY CONTRACEPTIVE PILLS %#0S "UILDING COMMUNITY SUPPORT AND CREATING DEMAND FOR %#0S ARE IMPORTANT STEPS IN PREPARING FOR THEIR INTRODUCTION INTO A LARGE SCALE FAMILY PLANNING PROGRAM )N ORDER FOR AN %#0 PROGRAM TO BE EFFECTIVE POTENTIAL CLIENTS NEED TO BE AWARE THAT THE OPTION EXISTS UNDERSTAND WHEN %#0S ARE APPROPRIATE AND KNOW WHERE TO OBTAIN %#0S WHEN THEY NEED THEM "Y EDUCATING THE COMMUNITY ABOUT EMERGENCY CONTRACEPTION AND INVOLVING ALL STAKEHOLDERS IN PLANNING FOR %#0 INTRODUCTION %#0 ADVOCATES CAN HELP TO CREATE BROAD AWARENESS AND SUPPORT FOR THE METHOD THAT WILL LEAD TO CLIENT DEMAND 4HE FOLLOWING TOPICS ARE DISCUSSED IN THIS MODULE s 3OCIAL #ONTEXT AND &INANCIAL 2ESOURCES s +EY !UDIENCES s &RAMING +EY -ESSAGES 7OMENS RIGHTS AND HUMAN RIGHTS APPROACH %#0S AND PUBLIC HEALTH MESSAGES 7EB BASED RESOURCES FOR RIGHTS AND PUBLIC HEALTH MESSAGES s #HOOSING %FFECTIVE #HANNELS TO #OMMUNICATE -ESSAGES #OMMUNITY RESOURCES -EDIA s !WARENESS 2AISING !PPROACHES )NFORMATIONAL WORKSHOPS FOR THE MEDIA .ETWORKING WITH ADVOCATES 4HIS MODULE IS CLOSELY RELATED TO -ODULE ! )NFORMATION FOR 0OLICY -AKERS AND -ODULE $ )NFORMING #LIENTS 4HE TOOLS PROVIDED IN THESE MODULES CAN BE USED ACROSS ALL THREE AREAS OF ACTIVITIES 4HE TOOLS ARE PRESENTED AS EXAMPLES AND SHOULD BE ADAPTED ACCORDING TO LOCAL NEEDS 4OOLS 0ROVIDED AT THE %ND OF 4HIS -ODULE !GENDA FOR A -EDIA 7ORKSHOP ON %MERGENCY #ONTRACEPTION %MERGENCY #ONTRACEPTION 2ADIO 3CRIPT %MERGENCY #ONTRACEPTION 4ELEPHONE (OTLINE 3CRIPT 0OSTERS 0OSTCARDS # # -ODULE # +EY !UDIENCES 3OCIAL #ONTEXT AND &INANCIAL 2ESOURCES s s s s IDENTIFY THE CRITICAL TARGET AUDIENCES OF THE ORGANIZATION CARRYING OUT THE ADVOCACY WORK 4HE FOLLOWI ON THE AVAILABILITY OF %#0S IN THE COUNTRY lNANCIAL RESOURCES CARRIED OUT AT THE GRASSROOTS LEV AUDIENCES WHO ARE THE MOST IMPORTANT TO REACH !WARENESS RAIS 'IVEN THE RESOURCES AND CONSTRAINTS IDENTIlED ABOVE THE NEXT S s s s s HELPFUL IN WORKING THROUGH THIS PROCESS INCLUDE EFFORTS WILL HELP DETERMINE THE DIRECTION OF THE STRATEGY 3OME lNANCIAL RESOURCES AVAILABLE AS WELL AS THE ORGANIZATIONAL CAPA BE TARGETED IN ASSESSING THE MOST COST EFFECTIVE STRATEGIES TO AGAINST POTENTIAL OUTCOMES )T IS IMPORTANT TO BE CLEAR ABOUT T IMPLEMENTING ALL OF THE STRATEGIES THEY WOULD LIKE )NSTEAD RE WITH WOMENS GROUPS CAN BE FAIRLY INEXPENSIVE 2ARELY DO PEOPL ADVERTISEMENTS CAN BE VERY COSTLY OTHERS SUCH AS HOLDING WOR AVAILABILITY OF RESOURCES 3OME STRATEGIES FOR RAISING PUBLIC A SOCIAL AND CULTURAL ENVIRONMENT OF THE COUNTRY !NOTHER IMPORTA 7HEN DEVELOPING STRATEGIES FOR RAISING PUBLIC AWARENESS IT IS SECTION ON RESOURCES IN -ODULE ! )NFORMATION FOR 0OLICY -AKERS &OR INFORMATION ON POTENTIAL SOURCES OF lNANCIAL RESOURCES THAT %#0S 7HICH GROUPS WILL HAVE THE GREATEST IMPACT IN TERMS OF HELPING !RE THERE ORGANIZED GROUPS THROUGH WHICH THESE PEOPLE CAN BE RE 7HO HAS THE GREATEST NEED FOR THIS METHOD 7HO WILL HAVE THE MOST INTEREST IN MESSAGES ABOUT %#0S TARGETED APPROACH RESOURCES AVAILABLE SHOULD ADVOCACY EFFORTS FOCUS ON A LARGE S 'IVEN THE SOCIAL CONTEXT AND THE ACCOMPANYING POLITICAL CURREN WHAT OTHER RESOURCES WILL BE NEEDED 'IVEN THE ORGANIZATIONS STAFF EXPERTISE AND CAPACITY TO CONDUC 7HAT lNANCIAL RESOURCES ARE AVAILABLE TO CONDUCT AN AWARENESS R MECHANISMS OF AWARENESS RAISING REPRODUCTIVE HEALTH ISSUES IN THE COUNTRY AND HOW WILL THEY AF 7HAT ARE THE SOCIAL CULTURAL AND RELIGIOUS ATTITUDES TOWARD F EL AS WELL AS AT THE NATIONAL LEVEL 4HE STRATEGY WILL DEPEND IMPLEMENT +NOWING THE WARENESS SUCH AS TELEVISION HE AUDIENCES THAT WILL SOURCES MUST BE WEIGHED QUESTIONS THAT MAY BE AND THE GEOGRAPHICAL REACH VITAL TO UNDERSTAND THE CITY TO CARRY OUT ADVOCACY TEP IS TO DETERMINE THE KEY MAY BE AVAILABLE SEE THE KSHOPS AND MEETINGS NT CONSIDERATION IS THE NG QUESTIONS WILL HELP AMILY PLANNING AND ING CAN BE EFFECTIVELY E HAVE THE LUXURY OF FECT THE MESSAGES AND CALE CAMPAIGN OR A MORE T AN AWARENESS CAMPAIGN SPREAD THE MESSAGE ABOUT TS AS WELL AS THE AISING CAMPAIGN ACHED EFFECTIVELY -ODULE # 3UCCESSFUL %#0 ADVOCACY CAMPAIGNS AROUND THE WORLD HAVE BEEN AIMED AT THE FOLLOWING AUDIENCES s 7OMENS GROUPS s /RGANIZATIONS OF HEALTH PROFESSIONALS s #LIENTS OF PUBLIC HEALTH CLINICS s 9OUTH SERVING ORGANIZATIONS 'ENERAL PUBLIC .'/S BOTH LOCAL AND INTERNATIONAL .'/S AND THEIR AFlLIATES #OMMUNITY BASED HEALTH ORGANIZATIONS AND COMMUNITY BASED DISTRIBUTORS -EDIA INCLUDING JOURNALISTS &RAMING +EY -ESSAGES 7HEN DEVELOPING A PUBLIC AWARENESS CAMPAIGN KEY MESSAGES ARE OFTEN COMMUNICATED WITHIN AN OVERALL FRAMEWORK OR APPROACH DESIGNED TO APPEAL TO A SPECIlC AUDIENCE %XAMPLES OF FRAMEWORKS THAT HAVE BEEN USED WHEN ADVOCATING FOR %#0S IN DIFFERENT POLITICAL AND CULTURAL ENVIRONMENTS INCLUDE WOMENS RIGHTS AND HUMAN RIGHTS AS WELL AS PUBLIC HEALTH 4HE FRAMEWORK MUST BE APPROPRIATE FOR THE SOCIAL AND POLITICAL CONTEXT AND RESONATE WITH THE PUBLIC IF THE CAMPAIGN IS TO BE SUCCESSFUL 2EGARDLESS OF THE MESSAGES SELECTED IT IS IMPORTANT TO PRETEST THEM WITH MEMBERS OF THE TARGET AUDIENCE 3OME FRAMING APPROACHES THAT HAVE BEEN USED SUCCESSFULLY ARE DESCRIBED BELOW 7OMENS RIGHTS AND HUMAN RIGHTS APPROACH 4HE RIGHTS BASED APPROACH FOR REPRODUCTIVE AND SEXUAL HEALTH HAS BEEN HIGHLIGHTED AT SEVERAL INTERNATIONAL CONFERENCES DURING THE PAST TWO DECADES INCLUDING THE )NTERNATIONAL #ONFERENCE ON 0OPULATION AND $EVELOPMENT )#0$ IN AND THE &OURTH 7ORLD #ONFERENCE ON 7OMEN IN 4HE )#0$ 0ROGRAMME OF !CTION CLEARLY PUTS ACCESS TO CONTRACEPTION WITHIN THE FRAMEWORK OF HUMAN RIGHTS STATING h2EPRODUCTIVE RIGHTS EMBRACE CERTAIN HUMAN RIGHTS THAT ARE ALREADY RECOGNIZED IN NATIONAL LAWS INTERNATIONAL HUMAN RIGHTS DOCUMENTS AND OTHER CONSENSUS DOCUMENTS 4HESE RIGHTS REST ON THE RECOGNITION OF THE BASIC RIGHT OF ALL COUPLES AND INDIVIDUALS TO DECIDE FREELY AND RESPONSIBLY THE NUMBER SPACING AND TIMING OF THEIR CHILDREN AND TO HAVE THE INFORMATION AND MEANS TO DO SO AND THE RIGHT TO ATTAIN THE HIGHEST STANDARD OF SEXUAL AND REPRODUCTIVE HEALTHv %#0S ARE A UNIQUE CONTRACEPTIVE METHOD AND AS SUCH NEED TO BE PUT IN THE CONTEXT OF THE RIGHT TO CONTRACEPTIVE CHOICE ! USEFUL RESOURCE FOR CONSIDERING A RIGHTS BASED APPROACH IN THE CONTEXT OF REPRODUCTIVE HEALTH IS THE RECENT ISSUE OF 0!4(S PUBLICATION /UTLOOK ! 2IGHTS "ASED !PPROACH TO 2EPRODUCTIVE (EATH HTTPWWWPATHORGRESOURCESPUB?OUTLOOKHTM # # -ODULE # ELEMENT OF THEIR SUCCESS BEEN A CORNERSTONE OF THE WORK DONE BY ,!#%# GROUPS AND HAS BEE EMPOWERS WOMEN TO DECIDE WHETHER AND WHEN THEY WILL BECOME PREG EMPHASIZING THE FACT THAT %#0S ARE A FEMALE CONTROLLED METHOD A PLANNING PROGRAMS AND NORMS WITHIN A SEXUAL AND REPRODUCTIVE RI EFFORTS OF ,!#%# MEMBER ORGANIZATIONS FOCUS ON INTEGRATING %#0S THE ,ATIN !MERICAN #ONSORTIUM FOR %MERGENCY #ONTRACEPTION ,!#% 4HE RIGHTS BASED APPROACH HAS ALSO BEEN SUCCESSFUL IN THE INITI CAN BE FOUND ON THEIR WEBSITE HTTPWWWPIWHORGLATINAMERICA WHEN AND IF SHE WILL HAVE CHILDREN -ORE INFORMATION ON 0)7(S WOMAN WANTING TO AVOID OR DELAY PREGNANCY AND THAT IT IS A WOMA TRAINING AND ADVOCACY ABOUT %#0S STRESSING THAT IT IS AN IMPOR 0)7( HAS COLLABORATED CLOSELY WITH OTHER GROUPS IN THESE COUNTR AND .ICARAGUA IN A PROJECT TITLED h%MERGENCY #ONTRACEPTION AS A 7OMENS (EALTH 0)7( HAS USED THIS APPROACH TO ADVOCATE FOR %# SUCCESSFUL IN THE ,ATIN !MERICAN REGION 3INCE THE 0ACIlC ,INKING %#0 ACCESS TO HUMAN AND WOMENS RIGHTS ISSUES HAS BEEN EMAIL INFO PROFAMILIAORGCO &AMILIA #OLOMBIANA #ALLE .O 3ANTA &E DE "OGOT´ "OGO &OR ADDITIONAL INFORMATION CONTACT 0ROFAMILIA AT !SOCIACION 0 ON 0ROFAMILIAS EXPERIENCE CAN BE FOUND IN BOTH %NGLISH AND 3PA REGISTRATION AND WOMENS ACCESS TO A DEDICATED %#0 PRODUCT -OR %#0S SHOULD BE AN INTEGRAL OPTION IN FAMILY PLANNING PROGRAMS T GROUPS AND THE UNDERSTANDING ON THE PART OF THE GOVERNMENT AND REGISTRATION OF A DEDICATED %#0 PRODUCT )N THE END IT WAS THE 0ROFAMILIA WHEN THE LOCAL RELIGIOUS LEADERS MOUNTED A CAMPAIGN AND YOUTH NETWORKS 4HE GROUPS WITHIN THESE ALLIANCES PROVED TO AND HELPED BUILD ALLIANCES WITH THE MEDIA WOMENS GROUPS MEDI THE FAMILY PLANNING PROGRAM 0ROFAMILIA STAFF CHAMPIONED THE CA STANDARDS ALREADY INCLUDED %#0S WHICH MEANT THEY WERE SANCTION REITERATED !DDITIONALLY 0ROFAMILIA PUBLICIZED THE FACT THAT T GOVERNMENT TO ENSURE ACCESS TO THE WIDEST RANGE OF CONTRACEPTIV OF THE )#0$ WHICH #OLOMBIA SIGNED IN THE RESPONSIBILITY TO %#0S AS A SEXUAL AND REPRODUCTIVE RIGHT AS STATED BY THE 0RO %#0S lRST AND FOREMOST AS AN IMPORTANT RIGHTS AND LEGAL ISSUE REGISTERING A DEDICATED LEVONORGESTREL ONLY %#0 PRODUCT IN #ATHOLIC RELIGIOUS LEADERS 3EVERAL ELEMENTS WERE CRUCIAL TO 0R PLANNING SYSTEM DUE TO STRONG OPPOSITION BY CONSERVATIVE FORCES )N #OLOMBIA 0ROFAMILIA FACED AN UPHILL BATTLE TO INTEGRATE %#0 ZZZLSSIZKURUJSXEOLFDWLRQVGRZQORDGVHULDOBLVVXHVVSRW(&BVS %#0S (UMAN 2IGHTS AND 7OMENS 2IGHTS IN ,ATIN !MERICA HE -INISTRY OF (EALTH OFAMILIAS SUCCESS IN SUPPORT OF THESE S INTO THE FAMILY ATIVES UNDERTAKEN BY "Y HIGHLIGHTING ACCESS RO "IENSTAR DE LA TANT OPTION FOR ANY GRAMME OF !CTION )NSTITUTE FOR HAT HELPED SECURE 0ROFAMILIA FRAMED OF THE #OLOMBIAN GI USE OF %#0 ACCESS INCLUDING LOCAL NISH AT BE KEY ALLIES WITH 7OMANS 2IGHTv OPPOSING THE E METHODS WAS ND THAT THIS METHOD IES TO PROVIDE APPROACH AND WORK GHTS FRAMEWORK HTMLECRIGHT CAL ASSOCIATIONS INTO FAMILY THE PUBLIC THAT ED AS PART OF E INFORMATION PARTICULARLY NS RIGHT TO DECIDE T´ #OLOMBIA OR 0S IN -EXICO # !DVOCACY N CITED AS A KEY NANT )T HAS KWWS -ODULE # %#0S AND PUBLIC HEALTH MESSAGES 5NINTENDED PREGNANCY "Y PREVENTING PREGNANCY BEFORE IT HAPPENS %#0S HELP REDUCE THE NUMBER OF UNINTENDED PREGNANCIES AND PREGNANCY RELATED MATERNAL DEATHS WHICH CAN HAVE A DEVASTATING EFFECT ON THE LIVES OF WOMEN AND FAMILIES IN THE WORLDS POOREST COUNTRIES x 4HE 5NITED .ATIONS ESTIMATES THAT MILLION WOMEN BECOME PREGNANT EACH YEAR AND ONE THIRD OF THOSE PREGNANCIES ARE UNINTENDED x %VERY YEAR TO MILLION WOMEN EXPERIENCE CONTRACEPTIVE FAILURE x 4HE STRESS AND RISKS RELATED TO CARRYING A PREGNANCY TO TERM AND DELIVERING A CHILD ARE EXTREMELY HIGH IN COUNTRIES WHERE FAMILY PLANNING SERVICES ARE LIMITED )N FACT A WOMAN DELIVERING A CHILD IS TWICE AS LIKELY TO DIE AS A WOMAN UNDERGOING AN ABORTION x 4HE 'LOBAL (EALTH #OUNCIL CALCULATES THAT FROM TO NEARLY WOMEN DIED AS A RESULT OF AN UNINTENDED OR UNWANTED PREGNANCY !BORTION 'REATER ACCESS TO %#0S COULD REDUCE NOT ONLY THE NUMBER OF UNINTENDED PREGNANCIES BUT ALSO THE NUMBER OF ABORTIONS AND ASSOCIATED MATERNAL MORTALITY x 7ORLDWIDE ABORTION RELATED COMPLICATIONS ARE THE CAUSE OF PERCENT OF ALL MATERNAL DEATHS x -ANY UNINTENDED PREGNANCIES IN THE DEVELOPING WORLD RESULT FROM A LACK OF ACCESS TO ADEQUATE FAMILY PLANNING SERVICES 7OMEN WHO DECIDE TO TERMINATE THEIR PREGNANCIES ARE OFTEN FACED WITH UNDERGOING UNSAFE ABORTIONS WHICH SEVERELY THREATENS THEIR LIVES )N THE REPORT 0ROMISES TO +EEP 4HE 4OLL OF 5NINTENDED 0REGNANCIES ON 7OMENS ,IVES IN THE $EVELOPING 7ORLD THE 'LOBAL (EALTH #OUNCIL NOTES THAT EVERY YEAR NEARLY MILLION UNINTENDED PREGNANCIES OCCUR RESULTING IN APPROXIMATELY MILLION ABORTIONS /F THESE MILLION ABORTIONS APPROXIMATELY RESULT IN THE DEATH OF THE MOTHER 4HESE DEATHS OCCUR NOT BECAUSE ABORTION IS AN INHERENTLY UNSAFE PROCEDURE BUT BECAUSE OF THE POOR AND UNSAFE CONDITIONS IN WHICH ABORTIONS OFTEN TAKE PLACE IN COUNTRIES WHERE ADEQUATE FAMILY PLANNING SERVICES ARE NOT AVAILABLE AND ACCESS TO SAFE ABORTION IS RESTRICTED /PTIMAL BIRTH SPACING !CCESS TO %#0S WOULD ENABLE WOMEN TO ACHIEVE THE OPTIMAL SPACING OF THREE YEARS BETWEEN BIRTHSWHICH HAS SHOWN TO IMPROVE THE HEALTH OF BOTH MOTHERS AND CHILDREN x /VER PERCENT OF NONlRST BIRTHS IN DEVELOPING COUNTRIES OCCUR WITH LESS THAN THREE YEARS SPACING WHICH CAN HAVE SERIOUS ADVERSE EFFECTS ON THE HEALTH OF BOTH MOTHERS AND CHILDREN x )NFANTS AND CHILDREN BORN LESS THAN THREE YEARS APART ARE SIGNIlCANTLY MORE LIKELY TO DIE THAN THEIR COUNTERPARTS BORN MORE THAN THREE YEARS APART#HILDREN BORN WITH BIRTH SPACING INTERVALS OF TO MONTHS SHOW A PERCENT PERCENT AND PERCENT REDUCTION IN NEONATAL INFANT AND UNDER lVE DEATHS RESPECTIVELY COMPARED TO THOSE CHILDREN BORN JUST TO MONTHS APART # # -ODULE # #HOOSING %FFECTIVE #HANNELS TO #OMMUNICATE -ESSAGES x x x WHICH CHANNELS AND MESSAGES WOULD BE MOST EFFECTIVE MESSAGES FOR THE TARGET AUDIENCES !NSWERING THE FOLLOWING QUES NECESSARY TO DECIDE WHICH CHANNELS WILL BE MOST EFFECTIVE AS W 4O EDUCATE THE PUBLIC AND RAISE AWARENESS ABOUT EMERGENCY CONTR ADOLESCENCE EMPOWERMENT AND ()6!)$334) PREVENTION AREAS INCLUDING OPTIMAL BIRTH SPACING POSTABORTION CARE SOUT 4HIS SITE CONTAINS INFORMATION ABOUT #ATALYST #ONSORTIUM PROJEC #ATALYST #ONSORTIUM PUBLICATIONS CAN BE FOUND ON THIS SITE )NFORMATION FOR MEDIA AND ADVOCACY EFFORTS AND DESCRIPTIONS OF 0)7( CONTRACEPTION ABORTION ADOLESCENTS EQUALITY AND SAFE PREGNA SITES PUBLICATIONS NEWS AND INFORMATION ON ADVOCACY HUMAN R ISSUES AND EVENTS RELATED TO REPRODUCTIVE HEALTH AND RIGHTS )T 4HE #ENTER FOR 2EPRODUCTIVE 2IGHTS WEBSITE CONTAINS UPDATED INF 0ROMISES4O+EEPPDF 7OMENS ,IVES IN THE $EVELOPING 7ORLD 'LOBAL (EALTH #OUNCIL REPORT ISSUES AND NEWS FROM AROUND THE WORLD AS WELL AS PUBLICATIONS U 4HE 'LOBAL (EALTH #OUNCIL WEBSITE CONTAINS INFORMATION ON INTER 'LOBAL (EALTH #OUNCIL RESOURCES FOR CREATING ADVOCACY MESSAGES ARE ALSO INCLUDED IN THE WEBSITE RESOURCES APPENDIX WHICH LIST ADVOCATING FOR %#0 ACCESS BASED ON THE ISSUES OF RIGHTS AND PUB ,ISTED BELOW ARE WEBSITES OFFERING INFORMATION AND RESOURCES TH 7EB BASED RESOURCES FOR RIGHTS AND PUBLIC HEALTH ISSUES x x 4HE #ENTER FOR 2EPRODUCTIVE 2IGHTS ABORTION AND RELATED MATERNAL MORTALITY AS WELL AS LINKS TO OT $OES THE AUDIENCE HAVE ACCESS TO MASS MEDIA SUCH AS NEWSPAPERS 7HAT IS THE LITERACY LEVEL OF THE AUDIENCE )S THE AUDIENCE IN A RURAL OR URBAN AREA MORTALITY IN A STUDY CONDUCTED USING DATA FROM NINETEEN ,ATIN ! ,ONGER BIRTH INTERVALS ALSO SHOWED SIGNIlCANTLY REDUCED RISKS I STUNTING AND A PERCENT REDUCTION IN UNDERWEIGHT CHILDREN $ATA SHOW THAT BIRTH INTERVALS OF TO MONTHS SHOW A PER ,ONGER BIRTH INTERVALS ARE ALSO ASSOCIATED WITH IMPROVED NUTRIT HTTPWWWPIWHORG HTTPWWWPIWHORGLATINAMERICAHTML CONTAINS GLOBAL AND REGIONAL STATISTICS ON UNINTENDED PREGNAN HTTPWWWRHCATALYSTORG HTTPWWWGLOBALHEALTHORG 0ROMISES TO +EEP 4HE 4OLL OF 5NINTENDED 0REGNANCIES ON HTTPWWWCRLPORG HTTPWWWGLOBALHEALTHORGASSETSPUBLICATIONS INCLUDES LINKS TO OTHER HER DATA SOURCES H TO SOUTH COLLABORATION NCY S WEBSITES AND OTHER ELL AS HOW TO TAILOR KEY AT CAN BE USED FOR 0)7( PROGRAMS AND IGHTS LEGAL ISSUES LIC HEALTH 4HESE WEBSITES SEFUL FOR ADVOCATES 4HE TS AND FOCUS PROGRAM TIONS CAN HELP DETERMINE ORMATION ON GLOBAL NATIONAL PUBLIC HEALTH ACEPTION IT WILL BE IONAL STATUS OF CHILDREN N TERMS OF MATERNAL CENT REDUCED RATE OF MERICAN COUNTRIES MAGAZINES AND RADIO CY AND -ODULE # s #AN THE AUDIENCE BE TARGETED AS A GROUP OR WOULD PERSON TO PERSON CONTACT BE MORE FEASIBLE AND EFFECTIVE 4HE FOLLOWING APPROACHES HAVE BEEN USED SUCCESSFULLY FOR %#0 ADVOCACY #OMMUNITY RESOURCES s %NLISTING LOCAL CHAMPIONS SUCH AS EDUCATORS STUDENTS WOMENS ADVOCATES COMMUNITY WORKERS .'/ STAFF AND FACTORY UNION REPRESENTATIVES TO CONDUCT ADVOCACY ABOUT EMERGENCY CONTRACEPTION 7ITH TRAINING THESE INDIVIDUALS CAN SPREAD THE MESSAGE THROUGH MECHANISMS OF THEIR OWN CHOOSING SUCH AS HOLDING MEETINGS AND DISCUSSIONS AT WORKPLACES COMMUNITY GATHERING HALLS AND SCHOOLS PUTTING UP POSTERS PASSING OUT INFORMATION AND SHARING INFORMATION WITH FRIENDS AND FAMILY s (OLDING INFORMATION SESSIONS AT WOMENS GROUP MEETINGS SCHOOLS OFlCES FACTORIES AND OTHER WORKPLACES -EDIA -ASS MEDIA CAN BE AN EXCELLENT METHOD OF RAISING PUBLIC AWARENESS 0AID ADVERTISING TENDS TO BE AN EXPENSIVE APPROACH HOWEVER MESSAGES CAN ALSO BE INTEGRATED INTO TELEVISION OR RADIO PROGRAMMING INCORPORATED INTO THE THEMES OF STORY LINES OR DELIVERED THROUGH PUBLIC SERVICE ANNOUNCEMENTS 0RESS BRIElNGS CAN PROVIDE JOURNALISTS WITH INFORMATION THAT THEY USE TO WRITE THEIR OWN STORIES ABOUT %#0S -EDIA OUTLETS TO CONSIDER INCLUDE s 2ADIO s 46 s .EWSPAPERS PRESS RELEASES s -AGAZINES s 4RADITIONAL FOLK MEDIA THEATER s 3OAP OPERAS !WARENESS 2AISING !PPROACHES )NFORMATIONAL WORKSHOPS FOR THE MEDIA 7ORKSHOPS THAT PREPARE JOURNALISTS TO REPORT ACCURATELY AND EFFECTIVELY ON ISSUES RELATED TO EMERGENCY CONTRACEPTION HELP ENSURE THAT CORRECT INFORMATION IS COMMUNICATED TO A LARGE AUDIENCEINCLUDING POTENTIAL USERS PROVIDERS ADVOCATES AND EVEN OPPONENTS 4HE 0OPULATION #OUNCIL IN -EXICO CONDUCTED SUCCESSFUL WORKSHOPS FOR JOURNALISTS IN BOTH -EXICO AND (ONDURAS THAT PROVIDED BACKGROUND ON REPRODUCTIVE HEALTH ISSUES AND KEY INFORMATION ABOUT EMERGENCY CONTRACEPTION %MERGENCY CONTRACEPTION ADVOCATES FOUND THAT THIS APPROACH NOT ONLY RAISED AWARENESS BUT ALSO HELPED TO NEUTRALIZE A MISINFORMATION CAMPAIGN MOUNTED BY SEVERAL OPPOSITION GROUPS IN -EXICO 4HE AGENDA OF THE 0OPULATION #OUNCILS JOURNALIST WORKSHOP IS PROVIDED AS A TOOL AT THE END OF THIS SECTION 4HE EMERGENCY CONTRACEPTION FACT SHEET PROVIDED AS A TOOL IN -ODULE ! )NFORMATION FOR 0OLICY -AKERS CAN BE DISTRIBUTED TO WORKSHOP PARTICIPANTS TO TAKE WITH THEM AS A REFERENCE FOR INFORMING THE PUBLIC ABOUT EMERGENCY CONTRACEPTION IN THE MEDIA # # -ODULE # 2EFERENCES s s s s s DISSEMINATED MORE BROADLY 'ROUPS THAT WOULD BE EFFECTIVE NETWO SHARING EMERGENCY CONTRACEPTION INFORMATION AND ADVOCACY MATERI OR FORMING LOCAL EMERGENCY CONTRACEPTION ALLIANCES CAN BE EFFEC STRENGTHEN THE BASE OF SUPPORT FOR EMERGENCY CONTRACEPTION ADVO .ETWORKING WITH GROUPS THAT PROVIDE REPRODUCTIVE HEALTH INFORMA .ETWORKING WITH ADVOCATES 5NITED .ATIONS 0OPULATION &UND 0ACIlC )NSTITUTE FOR 7OMENS (EALTH WEBSITE WWWPIWHORG 0!4( ! 2IGHTS "ASED !PPROACH TO 2EPRODUCTIVE (EALTH )#0$ 0ROGRAM OF !CTION 0ARAGRAPH GOVERNMENT OFlCIALS THE BARRIERS CREATED BY POLITICAL PRESSURES AND THE MULTIPLE CO WAS POSSIBLE TO MAKE PROGRESS WITHIN THE GOVERNMENT SYSTEMS AND TWO PHYSICIANS WHO ACTIVELY CHAMPIONED THE CAUSE OF GREATER ACC ON RADIO AND TELEVISION "Y IDENTIFYING AND WORKING WITH INDIVI INFORMATION ABOUT %#0S TO THE PUBLIC THROUGH THE MEDIA PARTICI THE HEALTH SYSTEM 4HE TWO PHYSICIANS ALSO BECAME VERY INVOLVED CLINICIANS AND BECAUSE OF THIS WERE ABLE TO BECOME A CATALYST F 4HE PHYSICIANS CONDUCTED NUMEROUS %#0 TRAINING SESSIONS FOR -IN RESPECTED PHYSICIANS WHO WERE STRONGLY SUPPORTIVE OF INCREASED OUT mYERS AT FAIRS AND CONCERTS 4HE 0OPULATION #OUNCIL ALSO WO AWARENESS OF EMERGENCY CONTRACEPTIONESPECIALLY AMONG ADOLESCEN OF GRASSROOTS ORGANIZATIONS SUCH AS YOUTH GROUPS WHOSE MEMBERS CONTRACEPTION IN -EXICO 4HE 0OPULATION #OUNCIL IN -EXICO ENLIS LOCAL CHAMPIONS WERE SUCCESSFUL STRATEGIES FOR INCREASING ACCE 7ORKING WITH LOCAL NETWORKS AND COMMUNITY GROUPS AS WELL AS EN %#0 MANUFACTURER OR DISTRIBUTOR 'OVERNMENT SECTOR !CADEMIC AND HEALTH INSTITUTIONS 9OUTH ADVOCACY GROUPS 7OMENS GROUPS $EVELOPING ,OCAL #HAMPIONS 4HE 3TATE OF 7ORLD 0OPULATION /UTLOOK ACCESSED 3EPTEMBER .EW 9ORK 5.&0! NCERNS FACED BY DUALS LIKE THESE TIVE MECHANISMS FOR OR CHANGE WITHIN SS TO EMERGENCY CACY (OLDING WORKSHOPS RKED WITH TWO HIGHLY TION AND SERVICES CAN PATING IN INTERVIEWS RKING ADVOCATES INCLUDE ACCESS TO %#0S IN PROVIDING ALS WHICH CAN BE TED THE HELP ESS TO %#0S IT ISTRY OF (EALTH HELPED RAISE CIRCUMVENT COURAGING ACTIVE TSBY HANDING -ODULE # 3EGAL 3* AND ,A'UARDIA +$ 4ERMINATION OF PREGNANCYA GLOBAL VIEW "AILLIERES #LINICAL /BSTETRICS AND 'YNAECOLOGY 'LOBAL (EALTH #OUNCIL 0ROMISES TO +EEP 4HE 4OLL OF 5NINTENDED 0REGNANCIES ON 7OMENS ,IVES IN THE $EVELOPING 7ORLD .EW 9ORK 'LOBAL (EALTH #OUNCIL 3ETTY 6ENUGOPAL 6 AND 5PADHYAY 5$ "IRTH 3PACING 4HREE TO &IVE 3AVES ,IVES 0OPULATION 2EPORTS 3ERIES , .O "ALTIMORE *OHNS (OPKINS 5NIVERSITY "LOOMBERG 3CHOOL OF 0UBLIC (EALTH 0OPULATION )NFORMATION 0ROGRAM 2UTSTEIN 3 h%FFECTS OF "IRTH )NTERVAL ON -ORTALITY AND (EALTH -ULTIVARIATE #ROSS #OUNTRY !NALYSISv 0RESENTATION AT THE /"3) #HAMPIONS -EETING 7ASHINGTON $# -AY #ONDE !GUDELO ! AND "ELIZAN *- -ATERNAL MORBIDITY AND MORTALITY ASSOCIATED WITH INTERPREGNANCY INTERVAL CROSS SECTIONAL STUDY "RITISH -EDICAL *OURNAL # # -ODULE # 4OOLS ,IST !GENDA FOR A -EDIA 7ORKSHOP ON %MERGENCY #ONTRACEPTION 4HE 0OPULATION #OUNCIL CONDUCTED SUCCESSFUL WORKSHOPS FOR JOURNALISTS IN BOTH -EXICO AND (ONDURAS WHICH PROVIDED BACKGROUND ON REPRODUCTIVE HEALTH ISSUES AND KEY INFORMATION ABOUT EMERGENCY CONTRACEPTION TO ENCOURAGE ACCURATE REPORTING ON THE ISSUES ! SAMPLE AGENDA FROM THESE MEETINGS IS PROVIDED HERE TO ASSIST IN IMPLEMENTING SUCH A WORKSHOP IN OTHER SETTINGS %MERGENCY #ONTRACEPTION 2ADIO 3CRIPT /UTREACH THROUGH MASS MEDIA CAN BE VERY EFFECTIVE 0ROFAMILIA #OLOMBIA USED RADIO STATIONS TO AIR MESSAGES TAILORED TO DIFFERENT DEMOGRAPHIC GROUPS IN THE COUNTRY 0ROFAMILIA STRATEGICALLY AIRED MESSAGES AT DIFFERENT TIMES THROUGHOUT THE DAY TO COVER THE VARIOUS TARGET AUDIENCES &OR 46 OR RADIO ADVERTISING A SERIES OF MESSAGES THAT CHANGE FREQUENTLY CAN MORE EFFECTIVELY RETAIN PEOPLES ATTENTION THAN A SINGLE MESSAGE 5SING MULTIPLE MESSAGES ALSO MAKES IT POSSIBLE TO COVER MULTIPLE ISSUES ! TRANSCRIPTION OF A RADIO SPOT DEVELOPED BY 0ROFAMILIA IN #OLOMBIA IS PROVIDED HERE %MERGENCY #ONTRACEPTION 4ELEPHONE (OTLINE 3CRIPT (OTLINES ARE TELEPHONE SERVICES INDIVIDUALS CAN CALL TO RECEIVE INFORMATION OR TO REQUEST HELP WITH AN EMERGENCY OR A PROBLEM REQUIRING IMMEDIATE ATTENTION (OTLINES USUALLY TOLL FREE HAVE PROVEN TO BE USEFUL TOOLS FOR INCREASING ACCESS TO EMERGENCY CONTRACEPTION INFORMATION 4HEY CAN PROVIDE INFORMATION ABOUT WHAT EMERGENCY CONTRACEPTION IS HOW IT WORKS ITS ADVANTAGES AND DISADVANTAGES WHERE TO GET IT AND HOW TO TAKE IT 3OME HOTLINES PROVIDE RECORDED INFORMATION OTHERS ARE STAFFED BY TRAINED OPERATORS WHO SPEAK DIRECTLY WITH CALLERS ABOUT THEIR CONCERNS AND PROVIDE INFORMATION ABOUT HOW AND WHERE TO OBTAIN %#0S !N EMERGENCY CONTRACEPTION HOTLINE SET UP BY THE 0OPULATION #OUNCIL WAS SUCCESSFUL IN -EXICO RECEIVING OVER CALLS A MONTH AT ITS PEAK 4HE 0OPULATION #OUNCIL IN -EXICO HAS DOCUMENTED THIS SUCCESS IN TWO ARTICLES 4HE HOTLINE RECEIVED A GREAT DEAL OF ATTENTION FROM JOURNALISTS AND RECEIVED GOOD COVERAGE IN THE MEDIA RAISING AWARENESS OF %#0S AND HELPING THE EFFORTS OF ADVOCATES 7HEN DEVELOPING AN EMERGENCY CONTRACEPTION HOTLINE IT IS CRITICAL TO ENSURE THAT WOMEN RECEIVE ACCURATE AND OBJECTIVE INFORMATION 4HIS TOOL IS ADAPTED FROM A TRANSCRIPT OF INFORMATION PROVIDED TO WOMEN CALLING THE .OT ,ATE AUTOMATED EMERGENCY CONTRACEPTION HOTLINE IN THE 5NITED 3TATES DEVELOPED AND OPERATED BY THE /FlCE OF 0OPULATION 2ESEARCH AT 0RINCETON 5NIVERSITY AND THE !SSOCIATION OF 2EPRODUCTIVE (EALTH 0ROFESSIONALS )T PROVIDES INFORMATION ABOUT %#0S AND ALSO DIRECTS CALLERS TO PROVIDERS WHO HAVE SAID THEY ARE WILLING AND LICENSED TO PRESCRIBE %#0S )T IS AN EXAMPLE OF THE KIND OF %#0 INFORMATION THAT CAN BE PROVIDED THROUGH AN EMERGENCY CONTRACEPTION HOTLINE # 0OSTERS 0OSTERS PLACED STRATEGICALLY IN PLACES FREQUENTED BY WOMEN ARE ANOTHER EFFECTIVE WAY TO RAISE AWARENESS ABOUT EMERGENCY CONTRACEPTION 7OMENS CENTERS HEALTH CENTERS NIGHT SPOTS SUCH -ODULE # AS BARS OR DISCOS UNIVERSITIES AND PUBLIC TRANSPORTATION SUCH AS BUSES SUBWAYS AND TRAINS ARE JUST SOME OF THE PLACES WHERE POSTERS ADVOCATING EMERGENCY CONTRACEPTION CAN BE PLACED %XAMPLES OF POSTERS USED IN :AMBIA AND 3OUTH !FRICA ARE PROVIDED HERE TO STIMULATE IDEAS !LL MESSAGES AND VISUAL PRESENTATIONS SHOULD BE TESTED WITH AUDIENCES TO ENSURE THEY WILL WORK WELL 4OOLS 0OSTCARDS 4HE 0OPULATION #OUNCIL IN -EXICO USED ADVERTISING POSTCARDS IN EFFORTS TO EDUCATE WOMEN ABOUT EMERGENCY CONTRACEPTION 3TAFF PLACED POSTCARDS IN CAFES BARS RESTAURANTS ON PUBLIC TRANSPORTATION AT BRIDAL SHOWS AND OTHER AREAS WHERE YOUNG WOMEN MIGHT HAVE THE CHANCE TO SEE THEM 3AMPLE POSTCARDS FROM THE -EXICO CAMPAIGN ARE PROVIDED HERE %LLERTSON # ET AL )NFORMATION CAMPAIGN AND ADVOCACY EFFORTS TO PROMOTE ACCESS TO EMERGENCY CONTRACEPTION IN -EXICO #ONTRACEPTION (EIMBURGER ! ET AL 0RACTICES AMONG PROVIDERS AND POTENTIAL CLIENTS AFTER A YEAR INTRODUCTION EFFORT #ONTRACEPTION # 4OOLS !GENDA FOR A -EDIA 7ORKSHOP ON -ODULE # %MERGENCY #ONTRACEPTION %# 'ENERAL /BJECTIVE )NFORM MEMBERS OF THE MEDIA ABOUT THE IMPORTANCE OF EMERGENCY CONTRACEPTION 3PECIlC /BJECTIVES A ,EARN THE LEGAL STANDARD OR FRAMEWORK FOR THE INTRODUCTION OF %# IN (ONDURAS B ,EARN THE MOST IMPORTANT MEDICAL ASPECTS OF %# C $ETERMINE THE ROLE OF MASS MEDIA IN REPORTING ON AND PROMOTING %# 4ARGET !UDIENCE MEMBERS OF THE MEDIA $ATE .OVEMBER ,OCATION 4EGUCIGALPA !GENDA n AM 7ELCOME $R 3ANDRA 'ARCÓA 0OPULATION #OUNCIL $R #ARLOS -ORLACCHI %XECUTIVE $IRECTOR !SHONPLAFA n AM 7HAT IS %# (ISTORY AND MEDICAL ASPECTS OF %# $R 'UILLERMINA -EJÓA #ONSULTANT 0OPULATION #OUNCIL -EXICO n AM %XPERIENCES FROM %# INTRODUCTION IN OTHER ,IC 0ATRICIA -ERLO )-)&!0 -EXICO COUNTRIES n AM 0RESENTATION OF THE %# PROJECT IN (ONDURAS AND -TRA 3UYAPA 0AVØN !SHONPLAFA PRESENTATION OF RESEARCH RESULTS IN !SHONPLAFA (ONDURAS CLINICS $R $IANA ,ARA 0OPULATION #OUNCIL -EXICO n AM ,EGAL FRAMEWORK FOR %# INTRODUCTION IN $R -ARIELOS "ARAHONA !SHONPLAFA (ONDURAS AND STRATEGY OF INTRODUCTION IN (ONDURAS !SHONPLAFA n AM 4HE ROLE OF MASS MEDIA IN REPORTING ON AND -TRO 6LADIMIR ,ØPEZ 2ECINOS PROMOTING %# 2ESULTS OF A REVIEW OF VARIOUS TYPES OF MEDIA n AM 1UESTIONS AND ANSWERS n PM #LOSING $R #ARLOS -ORLACCHI !SHONPLAFA n PM ,UNCH 4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE 0OPULATION #OUNCIL OF -EXICO # -ODULE # 4OOLS # 4OOLS %MERGENCY #ONTRACEPTION 2ADIO 3CRIPT -ODULE # %MERGENCY #ONTRACEPTION 9OU HAD SEX "UT THERE WAS NO PROTECTION 9OU WERE FORCED OR THE METHOD FAILED ,OOK ) WILL GIVE YOU THE SOLUTION !LTHOUGH IT IS BETTER TO USE FAMILY PLANNING THERE ARE EMERGENCY METHODS #ALL ??????????????? OR LOG ONTO ?????????FOR MORE INFORMATION 4HIS MATERIAL ORIGINALLY DEVELOPED IN 3PANISH WAS REPRODUCED WITH PERMISSION FROM 0ROFAMILIA # -ODULE # 4OOLS # 4OOLS %MERGENCY #ONTRACEPTION 4ELEPHONE -ODULE # (OTLINE 3CRIPT !PPLICATION 6OICE 3CRIPT %NGLISH 'REETING 7ELCOME TO THE %MERGENCY #ONTRACEPTION (OTLINE NOW MANAGED BY THE !SSOCIATION OF 2EPRODUCTIVE (EALTH 0ROFESSIONALS )F YOU ARE CALLING FROM A ROTARY PHONE PLEASE GET READY TO WRITE DOWN THE NAMES AND PHONE NUMBERS OF THE PROVIDERS NEAR YOU )F YOU HAVE A TOUCHTONE PHONE PLEASE PRESS TO HEAR MORE IN %NGLISH )NTRODUCTION %MERGENCY CONTRACEPTIVES ARE BIRTH CONTROL METHODS THAT CAN PREVENT PREGNANCY AFTER SEX %MERGENCY CONTRACEPTION DOES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS 4HIS HOTLINE TELLS YOU ABOUT EMERGENCY CONTRACEPTION AND GIVES THE NAMES AND PHONE NUMBERS OF PLACES NEARBY WHERE YOU CAN GET EMERGENCY CONTRACEPTIVES $O NOT USE EMERGENCY CONTRACEPTION EXCEPT UNDER THE CARE OF A HEALTH CARE PROVIDER WHO IS LICENSED TO PRESCRIBE 4HIS HOTLINE IS NOT TIED TO ANY COMPANIES THAT MAKE OR SELL EMERGENCY CONTRACEPTIVES 9OU WILL NOW HEAR A MENU OF SIX CHOICES 4O RETURN TO THIS MENU AT ANY TIME PRESS THE STAR KEY -ENU &OR INFORMATION ON WHERE YOU CAN GET EMERGENCY CONTRACEPTION PRESS &OR MORE INFORMATION ON EMERGENCY CONTRACEPTIVE PILLS PRESS &OR MORE INFORMATION ON EMERGENCY INSERTION OF A #OPPER 4 )5$ PRESS &OR GUIDELINES ON MAKING CALLS TO PROVIDERS PRESS )F YOU ARE A PROVIDER WHO WOULD LIKE TO BE INCLUDED IN THE DIRECTORY OR YOUR DIRECTORY INFORMATION HAS CHANGED OR IF YOU ARE A CONSUMER WHO WOULD LIKE TO COMMENT ON THE HOTLINE PRESS &OR MORE INFORMATION ABOUT EMERGENCY CONTRACEPTION AND WHERE TO OBTAIN IT ANYWHERE IN THE COUNTRY PLEASE VISIT OUR WEBSITE /UR ADDRESS IS INSERT WEB ADDRESS )F YOU WOULD LIKE ADDITIONAL WRITTEN INFORMATION ABOUT EMERGENCY CONTRACEPTION ASK YOUR HEALTH CARE PROVIDER OR PRESS 0ROVIDERS 4HIS DIRECTORY LISTS HOSPITALS PRIVATE DOCTORS FAMILY PLANNING CLINICS PHARMACIES AND OTHERS WHO CAN TELL YOU ABOUT EMERGENCY CONTRACEPTIVES AND WHO HAVE SAID THEY ARE WILLING AND LICENSED TO PRESCRIBE EMERGENCY CONTRACEPTION !S WITH ALL HEALTH CARE CHOICES TAKE CARE WHEN CHOOSING A PROVIDER OF EMERGENCY CONTRACEPTION 4HE OPERATORS OF THIS HOTLINE MAKE NO CLAIMS ABOUT THE QUALITY OR COST OF THE SERVICES OFFERED )F YOU HAVE A REGULAR HEALTH CARE PROVIDER YOU MAY WISH TO CALL THE PROVIDER lRST )F YOU HAVE HAD SEX THAT WAS NOT PROTECTED BY BIRTH CONTROL OR IF YOUR METHOD FAILED IN THE # PAST FEW DAYS AND YOU DO NOT WISH TO BECOME PREGNANT CALL A PROVIDER AS SOON AS YOU CAN AND TELL THE PERSON WHO ANSWERS THE PHONE THAT YOU NEED EMERGENCY CONTRACEPTION 9OU WILL NOW HEAR THE NAME LOCATION AND PHONE NUMBER OF lVE CLINICS NEAR YOU (AVE A PEN AND PAPER READY )F YOU lND AN ERROR IN THE NAMES AND PHONE NUMBERS LISTED PLEASE CALL THE -ODULE # HOTLINE AGAIN AND PRESS TO LET US KNOW 4HE lVE PROVIDERS NEAREST YOU ARE 4OOLS 2EPEAT /PTION 4O RETURN TO THE MAIN MENU PRESS THE STAR KEY 4O REPEAT THIS MESSAGE PRESS THE POUND KEY %MERGENCY #ONTRACEPTIVE 0ILLS 4HERE ARE TWO TYPES OF EMERGENCY CONTRACEPTIVE PILLS /NE TYPE IS NOTHING MORE THAN ORDINARY BIRTH CONTROL PILLS THAT CONTAIN HORMONES CALLED ESTROGEN AND PROGESTIN 4HE BRAND NAME OF THE COMBINED BIRTH CONTROL SPECIALLY PACKAGED AND LABELED FOR EMERGENCY USE IN INSERT NAME OF COUNTRY IS INSERT BRAND NAME !BOUT PERCENT OF WOMEN WHO USE THIS TYPE GET NAUSEATED AND PERCENT VOMIT 5SE OF THIS TYPE OF PILL CUTS THE CHANCE OF PREGNANCY BY PERCENT 4HE OTHER TYPE OF EMERGENCY CONTRACEPTIVE PILL CONTAINS ONLY THE HORMONE CALLED PROGESTIN 4HIS TYPE IS SPECIALLY PACKAGED AND LABELED FOR EMERGENCY USE AS THE BRAND NAME INSERT BRAND NAME )T IS MORE EFFECTIVE THAN THE lRST TYPE AND THE RISK OF NAUSEA AND VOMITING IS ALSO LOWER 3OME PEOPLE CALL EMERGENCY CONTRACEPTIVE PILLS hMORNING AFTERv PILLS "UT YOU DO NOT HAVE TO WAIT UNTIL THE MORNING AFTER 9OU CAN START THE PILLS RIGHT AWAY OR UP TO lVE DAYS AFTER YOU HAVE HAD UNPROTECTED SEXTHAT IS SEX DURING WHICH YOU DID NOT USE BIRTH CONTROL OR YOUR BIRTH CONTROL MAY HAVE FAILED 9OUR HEALTH CARE PROVIDER WILL TELL YOU TO TAKE THE lRST DOSE WITHIN HOURS AFTER UNPROTECTED SEX 4HE PROVIDER WILL TELL YOU TO TAKE THE SECOND DOSE HOURS AFTER THE lRST DOSE %ACH DOSE IS OR PILLS DEPENDING ON THE BRAND .OT ALL BRANDS OF BIRTH CONTROL PILLS CAN BE USED FOR EMERGENCY CONTRACEPTION %MERGENCY CONTRACEPTIVE PILLS REQUIRE A PRESCRIPTION $O NOT USE THEM EXCEPT UNDER THE CARE OF SOMEONE LICENSED TO PRESCRIBE -OST WOMEN CAN SAFELY USE EMERGENCY CONTRACEPTIVE PILLS EVEN IF THEY CANNOT USE BIRTH CONTROL PILLS AS THEIR REGULAR METHOD OF BIRTH CONTROL 4O RETURN TO THE MAIN MENU PRESS THE STAR KEY 4O REPEAT THIS MESSAGE PRESS THE POUND KEY %MERGENCY )NSERTION OF A #OPPER 4 )5$ !N )5$ OR INTRAUTERINE DEVICE IS A SMALL DEVICE THAT IS PLACED INTO THE UTERUS ALSO CALLED THE WOMB 9OU CAN GET THE EMERGENCY #OPPER 4 )5$ INSERTED UP TO SEVEN DAYS AFTER UNPROTECTED SEXTHAT IS SEX DURING WHICH YOU DID NOT USE BIRTH CONTROL OR YOUR BIRTH CONTROL MAY HAVE FAILED )5$S REQUIRE A PRESCRIPTION ! PROVIDER WILL TELL YOU THE ADVANTAGES AND DISADVANTAGES OF USING AN )5$ &OR MEDICAL REASONS THE )5$ IS NOT THE BEST OPTION FOR MANY WOMEN WHO NEED EMERGENCY # 4OOLS CONTRACEPTION 4HE )5$ IS THE MOST EXPENSIVE EMERGENCY CONTRACEPTIVE BUT IT MAY BE LEFT IN PLACE TO PROVIDE HIGHLY EFFECTIVE CONTRACEPTION FOR UP TO YEARS AFTER INSERTION 4HE COPPER -ODULE # 4 )5$ IS THE MOST EFFECTIVE EMERGENCY CONTRACEPTIVE !N EMERGENCY INSERTION OF THE #OPPER 4 )5$ CUTS THE CHANCE OF PREGNANCY BY MORE THAN PERCENT 4O RETURN TO THE MAIN MENU PRESS THE STAR KEY 4O REPEAT THIS MESSAGE PRESS THE POUND KEY 3END A -ESSAGE )F YOU ARE A CONSUMER WITH COMMENTS ABOUT THIS HOTLINE OR A PROVIDER WHOSE INFORMATION HAS CHANGED YOU MAY EITHER WRITE IN YOUR COMMENTS OR LEAVE A VOICE MAIL MESSAGE #ONSUMERS SHOULD WRITE TO PROVIDE ADDRESS FOR WRITTEN CORRESPONDENCE 0ROVIDERS SHOULD WRITE TO PROVIDE ADDRESS FOR WRITTEN CORRESPONDENCE 0LEASE STAY ON THE LINE TO LEAVE A VOICE MAIL MESSAGE 1UESTIONS ABOUT INDIVIDUAL MEDICAL PROBLEMS WILL NOT BE ANSWERED 0LEASE CONSULT A CLINICIAN FOR THOSE QUESTIONS 4IPS FOR #ALLING 0ROVIDERS )F YOU NEED EMERGENCY CONTRACEPTION CHANCES ARE YOU ARE FEELING WORRIED MAYBE EVEN PANICKED 7HEN YOU CALL TO MAKE AN APPOINTMENT ASK ANY QUESTIONS YOU MAY HAVE ABOUT EMERGENCY CONTRACEPTION OR ABOUT WHAT WILL HAPPEN WHEN YOU COME IN FOR AN APPOINTMENT -ANY PROVIDERS ARE HAPPY TO TAKE THE TIME TO GIVE MORE INFORMATION WHEN ASKED "Y SEEKING OUT INFORMATION AND SERVICES TO AVOID AN UNINTENDED PREGNANCY YOU ARE ACTING RESPONSIBLY 4HE FOLLOWING TIPS MAY HELP YOU GET THE MOST OUT OF YOUR CALLS TO HOTLINE PROVIDERS "E AWARE THAT THE DIRECTORY OF PROVIDERS IS NOT PERCENT FAILPROOF )F A HOTLINE PROVIDER CANNOT HELP YOU WE STRONGLY ENCOURAGE YOU TO LET US KNOW BY LEAVING A MESSAGE ON THE HOTLINE OPTION ON THE MAIN MENU +EEP IN MIND THAT THE COST OF SERVICES WILL VARY "E SURE TO ASK HOW MUCH A VISIT WILL COST AND CHECK TO SEE IF THERE IS A SLIDING SCALE FEE DEPENDING ON YOUR INCOME )F THE RECEPTIONIST DOES NOT HAVE INFORMATION EMERGENCY CONTRACEPTION OR THINKS IT IS NOT PROVIDED THERE ASK TO SPEAK TO A NURSE OR PHYSICIAN IF POSSIBLE )F YOU CALL A SITE WITH A SPECIlC CLINICIAN LISTED AND THAT CLINICIAN IS UNAVAILABLE ASK IF THERE IS SOMEONE ELSE THERE WHO WILL PRESCRIBE EMERGENCY CONTRACEPTION OR ASK FOR A REFERRAL TO ANOTHER PROVIDER !SK WHETHER THE CLINICIAN CAN PHONE IN AN EMERGENCY CONTRACEPTION PRESCRIPTION TO YOUR LOCAL PHARMACIST "E PREPARED TO ANSWER QUESTIONS REGARDING THE START DATE OF YOUR LAST PERIOD WHEN UNPROTECTED INTERCOURSE TOOK PLACE YOUR MEDICAL HISTORY AND YOUR LAST PELVIC EXAM )F YOU ARE CONCERNED YOU WILL RUN OUT OF TIME BEFORE A PROVIDER CAN SEE YOU TRY YOUR LOCAL EMERGENCY ROOM 4O RETURN TO THE MAIN MENU PRESS THE STAR KEY 4O REPEAT THIS MESSAGE PRESS THE POUND KEY 2EQUEST 0HONE .UMBER # )N ORDER TO CONNECT YOU TO THE EMERGENCY CONTRACEPTION HOTLINE PLEASE ENTER YOUR TEN DIGIT TELEPHONE NUMBER BEGINNING WITH THE AREA CODE lRST 0LEASE ENTER NOW 'OODBYE -ODULE # 4HANK YOU AND GOOD BYE 4OOLS #ONTENT AND FORMAT ADAPTED WITH PERMISSION FROM !SSOCIATION OF 2EPRODUCTIVE (EALTH 0ROFESSIONALS !2(0 %MERGENCY #ONTRACEPTIVE (OTLINE !PPLICATION 6OICE 3CRIPT # 4OOLS 0OSTERS -ODULE # 4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE 2EPRODUCTIVE (EALTH 2ESEARCH 5NIT OF THE 5NIVERSITY OF 7ITWATERSRAND 3OUTH !FRICA # -ODULE # 4OOLS 4HESE MATERIALS WERE REPRINTED WITH PERMISSION FROM THE 0OPULATION #OUNCIL # 4OOLS 0OSTCARDS -ODULE # )F YOU FORGOT TO SAVE FOR A RAINY DAY )F SPRING ISNT OVER YET AND YOU DIDNT TAKE PRECAUTIONSx xYOU HAVE HOURS TO AVOID PREGNANCY 4HESE MATERIALS WERE REPRINTED FROM THE 0OPULATION #OUNCIL xYOU HAVE HOURS TO AVOID PREGNANCY # -ODULE # 4OOLS )F YOU ATE THE WHOLE PIEx xYOU HAVE HOURS TO AVOID PREGNANCY IN THREE DAYS 9OUR CALL IS CONlDENTIAL WWWINTHREEDAYSORGMX 4HESE MATERIALS WERE DEVELOPED AND TRANSLATED BY THE 0OPULATION #OUNCIL OF -EXICO AND REPRINTED HERE WITH THEIR PERMISSION )F LOVE WAS SUGAR SWEET AND YOU DIDNT TAKE PRECAUTIONSx #ONSULT YOUR PHYSICIAN # -ODULE $ )NFORMING #LIENTS /BJECTIVE 4O EDUCATE CLIENTS ABOUT THE AVAILABILITY OF EMERGENCY CONTRACEPTIVE PILLS %#0S AND ENSURE CORRECT USE 7HEN %#0S HAVE BEEN SUCCESSFULLY INCORPORATED INTO A FAMILY PLANNING PROGRAM IT IS IMPORTANT TO PROVIDE ADEQUATE INFORMATION ABOUT THIS CONTRACEPTIVE OPTION SO THAT CLIENTS CAN MAKE AN INFORMED DECISION ABOUT WHETHER OR NOT TO USE %#0SAND IF THEY CHOOSE TO USE THEM TO ENSURE THEY DO IT CORRECTLY -ANY WOMEN DO NOT KNOW ABOUT %#0S AND MANY WHO HAVE HEARD ABOUT THEM THROUGH ADVOCACY CAMPAIGNS MAY HAVE QUESTIONS AND CONCERNS ABOUT THE METHOD 4HIS MODULE DISCUSSES DEVELOPMENT OF CLIENT MATERIALS THAT PROVIDE ESSENTIAL INFORMATION AND ANSWER SPECIlC QUESTIONS WOMEN MAY HAVE ABOUT %#0S )N DEVELOPING CLIENT MATERIALS IT IS IMPORTANT TO AVOID OVERBURDENING THE CLIENT WITH INFORMATION YET STILL PROVIDE ENOUGH SO THAT SHE FEELS CONlDENT AND SAFE TAKING %#0S 4HE FOLLOWING TOPICS ARE DISCUSSED IN THIS MODULE s )DENTIFYING +EY !UDIENCES s $EVELOPING )NFORMATIONAL -ATERIALS FOR #LIENTS s #HANNELS FOR #OMMUNICATING %#0 -ESSAGES TO #LIENTS 4HIS MODULE IS CLOSELY RELATED TO -ODULE ! )NFORMATION FOR 0OLICY -AKERS AND -ODULE # 2AISING 0UBLIC !WARENESS 4HE TOOLS PROVIDED IN THESE MODULES CAN BE USED ACROSS ALL THREE AREAS OF ACTIVITIES 4HE TOOLS ARE PRESENTED AS EXAMPLES AND SHOULD BE ADAPTED ACCORDING TO LOCAL NEEDS 4OOLS 0ROVIDED AT THE %ND OF 4HIS -ODULE 3AMPLE 4EXT FOR "ROCHURES "ROCHURE IN 4HREE &ORMATS 3OUTH !FRICA "ROCHURE !DDITIONAL TOOLS THAT MAY BE USEFUL FOR PROVIDING INFORMATION FOR CLIENTS CAN BE FOUND IN THE TOOLS SECTION OF -ODULE & 2EGULATION 0ROCUREMENT AND $ISTRIBUTION OF A 0ROGESTIN /NLY %#0 AND -ODULE ' 4HE /PTION OF 0ROVIDING #OMBINED /RAL #ONTRACEPTIVES #/#S AS .ONDEDICATED %MERGENCY #ONTRACEPTIVE 0ILLS %#0S 4HE APPROACHES USED FOR INFORMING %#0 CLIENTS AND POTENTIAL %#0 USERS WILL DEPEND ON A NUMBER OF FACTORS INCLUDING RESOURCES AVAILABLE AND THE SOCIAL AND CULTURAL ENVIRONMENTS OF THE CLIENTS 4HE MAIN OBJECTIVE IS TO REACH AS LARGE A NUMBER OF POTENTIAL CLIENTS AS POSSIBLE WITH CORRECT CONCISE INFORMATION ABOUT %#0S $ $ -ODULE $ A PREGNANCY BEGINS 4HE DElNITION PROVIDED ABOVE IS PROVIDED WITHIN A MEDICALCLIN $EVELOPING )NFORMATIONAL -ATERIALS FOR #LIENTS )DENTIFYING +EY !UDIENCES %#0S ARE SAFE 4HERE IS NO EVIDENCE THAT TAKING %#0S HARMS A s %#0S ARE NOT RECOMMENDED FOR USE AS A REGULAR CONTRACEPTIVE s %#0S ARE CONVENIENTLY AVAILABLE s %#0S ARE EASY TO USE s %#0S CANNOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS s %#0S CANNOT INTERRUPT AN ESTABLISHED PREGNANCY s %#0S WORK BY PREVENTING A PREGNANCY BEFORE IT HAPPENS %#0S s +EY FACTS AND MESSAGES FOR CLIENTS TO UNDERSTAND AND TO PRE TEST MESSAGES TO BE SURE T FACTS THAT WOMEN MAY NEED OR WANT TO KNOW )T IS IMPORTANT TO U IN ORDER TO MAKE INFORMED CHOICES ABOUT USING EMERGENCY CONTRAC PLANNING PROGRAMS CLIENT MATERIALS TYPICALLY PROVIDE FACTUAL I )N COUNTRIES WHERE %#0S HAVE BEEN SUCCESSFULLY INTEGRATED INTO QUESTIONNAIRE ARE PROVIDED IN -ODULE % !SSESSMENT WITH SEVERAL ASSESSMENT TOOLSINCLUDING A CLIENT KNOWLEDGE ATT ASSESSMENT OF CLIENT INFORMATION NEEDS ! DISCUSSION OF THE ASS AMONG OTHERS ! STARTING POINT IN DEVELOPING %#0 MATERIALS FOR NOT USING REGULAR ONGOING CONTRACEPTION METHODS AND THOSE WHO PILL USERS MAY MISS PILLS WOMEN WHO HAVE INTERCOURSE INFREQUE CONSISTENTLY CONDOM USERS MAY EXPERIENCE BREAKAGE OR SLIPPAGE CONTRACEPTIVE USERS WHO EXPERIENCE A METHOD FAILURE OR DO NOT U 7OMEN WHO MAY NEED EMERGENCY CONTRACEPTION INCLUDE SEXUALLY ACT !LTHOUGH NO STUDIES HAVE BEEN CONDUCTED ON %#0S AND FUTURE FE s ,EVONORGESTREL ONLY %#0S AND COMBINED PROGESTIN ESTROGEN %#0 s EFFECTS EFFECTIVE FOR REGULAR USE MATERIALS PROVIDE INFORMATION ON WHERE WOMEN CAN GO TO GET %#0S REPLACE CONDOMS FOR PROTECTION AGAINST 34)S OR ()6!)$3 %#0S CAN PROTECT AGAINST PREGNANCY AFTER UNPROTECTED INTERCOURS TO THE UTERUS IS ALREADY PREGNANT 0REGNANCY IS DElNED AS IMPLANTATION WHEN CONTRACEPTION HAS NO EFFECT ON FUTURE FERTILITY EFFECT ON LONG TERM FERTILITY 2ESEARCHERS HAVE THUS CONCLUDED ON ORAL CONTRACEPTIVES TO DETERMINE THEIR EFFECT ON FERTILITY H MIFEPRISTONE WHICH IS COMMONLY KNOWN AS THE ABORTION PILL 25 )F A WOMAN IS ALREADY PREGNANT AND TAKES %#0S THEY WILL NOT n 0ROVIDERS SHOULD MAKE SURE THAT CLIENT OUTREACH ICAL CONTEXT )NDIVIDUALS MAY HAVE THEIR OWN BELIEFS ABOUT WHEN HEY ARE UNDERSTOOD NFORMATION THAT CLIENTS NEED ESSMENT PROCESS ALONG AVE SHOWN THAT THEY HAVE NO CLIENTS IS TO CONDUCT AN SE LANGUAGE THAT IS EASY LARGE SCALE FAMILY SE THEIR METHOD ITUDES AND PRACTICES NTLY THOSE WHO ARE 34)S OR ()6!)$3 7HILE WANT TO SPACE BIRTHS ORAL CONTRACEPTIVE THAT HORMONAL EMERGENCY HARM THE DEVELOPING FETUS EPTION "ELOW ARE KEY WOMAN OR CAUSES ILL HEALTH OTHER METHODS ARE MORE WILL NOT WORK IF A WOMAN E THIS METHOD CANNOT THE FERTILIZED EGG ATTACHES RTILITY STUDIES CONDUCTED IVE ADOLESCENTS S ARE NOT THE SAME AS -ODULE $ +EY TECHNICAL INFORMATION FOR DEVELOPING CLIENT INFORMATION s 4HERE ARE TWO OPTIONS FOR EMERGENCY CONTRACEPTION DOSES OF THE HORMONES USED IN ORAL CONTRACEPTIVES AND INSERTION OF AN )5$ (ORMONAL CONTRACEPTION USED AS EMERGENCY CONTRACEPTION IS EFFECTIVE FOR UP TO DAYS HOURS AFTER UNPROTECTED SEX )NSERTION OF THE )5$ IS EFFECTIVE AS EMERGENCY CONTRACEPTION FOR UP TO DAYS AFTER UNPROTECTED INTERCOURSE s %#0S SHOULD BE TAKEN AS SOON AS POSSIBLE BUT NOT LATER THAN HOURS OR lVE DAYS AFTER UNPROTECTED INTERCOURSE )T IS IMPORTANT TO TAKE THE PILLS AS SOON AS POSSIBLE BECAUSE THEIR EFFECTIVENESS DECREASES OVER TIME 4HERE ARE TWO TYPES OF ORAL CONTRACEPTIVE HORMONES USED FOR EMERGENCY CONTRACEPTION n 0ROGESTIN ONLY %#0S /NE MG DOSE TABLETS TAKEN AS SOON AS POSSIBLE AFTER UNPROTECTED INTERCOURSE IDEALLY WITHIN HOURS OR lVE DAYS 7HEN USED CORRECTLY PROGESTIN ONLY %#0S REDUCE THE RISK OF PREGNANCY BY PERCENT FOR A SINGLE ACT OF UNPROTECTED INTERCOURSE 0ROGESTIN ONLY %#0S HAVE FEWER SIDE EFFECTS THAN COMBINED ORAL CONTRACEPTIVES USED FOR %# n #OMBINED %STROGEN0ROGESTIN %#0S 4HE lRST DOSE SHOULD BE TAKEN AS SOON AS POSSIBLE AFTER UNPROTECTED INTERCOURSE AND THE SECOND DOSE HOURS LATER 4HE PILLS SHOULD BE TAKEN AS SOON AS POSSIBLE AFTER UNPROTECTED INTERCOURSE AS EFFECTIVENESS DECREASES OVER TIME BUT THEY CAN BE USED UP TO HOURS OR lVE DAYS LATER 7HEN USED CORRECTLY COMBINED ORAL CONTRACEPTIVES TAKEN FOR EMERGENCY CONTRACEPTION REDUCE THE RISK OF PREGNANCY BY PERCENT FOR A SINGLE ACT OF UNPROTECTED INTERCOURSE /THER SOURCES OF INFORMATION FOR CLIENTS %MERGENCY CONTRACEPTION MATERIALS SHOULD DIRECT CLIENTS TO OTHER RESOURCES WHERE THEY CAN GET MORE INFORMATION ABOUT %#0S %XAMPLES INCLUDE HOTLINE NUMBERS WEBSITES AND ORGANIZATIONS THAT PROVIDE %#0 SERVICES !DVICE FOR DEVELOPING MESSAGES FOR CLIENTS s +EEP MESSAGES SHORT CLEAR AND EASY TO UNDERSTAND s 5SE INNOVATIVE LANGUAGE AND A PRESENTATION STYLE THAT IS EYE CATCHING AND APPEALING s "E SENSITIVE TO ETHNIC CULTURAL AND REGIONAL PERSPECTIVES ON TOPICS RELATED TO SEX AND REPRODUCTIVE HEALTH s #ONSIDER TRANSLATION OF EMERGENCY CONTRACEPTION INFORMATION INTO LOCAL DIALECTS AND MULTIPLE LANGUAGES IF NEEDED TO COVER THE WIDE SPECTRUM OF CLIENTS TO BE SERVED 4HE SINGLE DOSE REGIMEN MAY DIFFER FROM PRODUCT LABELING DUE TO THE PUBLICATION IN OF THE RESULTS OF A STUDY INDICATING THAT A SINGLE DOSE OF MG OF LEVONORGESTREL CAN SUBSTITUTE FOR TWO MG OF LEVONORGESTREL 4HESE ESTIMATES OF REDUCTION IN THE RISK OF PREGNANCY FOLLOWING %#0 USE ARE BASED ON STUDIES THAT EVALUATED %#0 USE WITHIN A HOUR TIME FRAME $ $ -ODULE $ -ESSAGES TO #LIENTS #HANNELS FOR #OMMUNICATING %MERGENCY #ONTRACEPTION 2EFERENCES ABOUT EMERGENCY CONTRACEPTION CONDOMS HORMONAL INJECTIONS AND OTHERS TO INCLUDE ACCURATE AN IMPORTANT TO UPDATE BROCHURES ON OTHER CONTRACEPTIVE METHODS SU AND WALLET CARDS WHICH CLIENTS CAN TAKE HOME WITH THEM FOR FUT OTHER METHODS THAT CAN FAIL OR BE USED INCORRECTLY #LINICS ALS BIRTH CONTROL METHODS SUCH AS ORAL CONTRACEPTIVES CONDOMS HOR CLIENTS AT RISK OF UNINTENDED PREGNANCY 4HIS IS PARTICULARLY I EMERGENCY CONTRACEPTIONAND WHERE POSSIBLE TO DISTRIBUTE %#0S REGULAR VISITS FOR CONTRACEPTIVE AND OTHER HEALTH SERVICES AS O COMMUNICATING EMERGENCY CONTRACEPTION INFORMATION 0ROVIDERS CA (EALTH CARE AND FAMILY PLANNING CLINICS HAVE PROVEN TO BE VERY /BSTETRICS 'YNECOLOGIC 4ERMINOLOGY INTERFERE WITH EARLY EMBRYONIC DEVELOPMENT IN THE HUMAN SPECIES ,ANCET LEVONORGESTREL VERSUS THE 9UZPE REGIMEN OF COMBINED ORAL CONTRA IN POST COITAL CONTRACEPTION 'YNECOLOGY 7(/ 4ASK &ORCE ON 0OSTOVULATORY -ETHODS OF &ERTILITY 2EGULATION (O 0# AND +WAN -3 ! PROSPECTIVE RANDOMIZED COMPARISON OF 'LASIER ! %MERGENCY CONTRACEPTION .ORRIS 4URNER ! AND %LLERTSON # (OW SAFE IS EMERGENCY CONTR (UGHES %# AND #OMMITTEE OF 4ERMINOLOGY OF THE !MERICAN #OLLE "ACIC - 7ESSELIUS DE #ASPARIS ! 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YOU ARE ALREADY PREGNANT 7HEN DO ) USE EMERGENCY CONTRACEPTIVE PILLS %#0S CAN BE USED IF YOU HAD UNPROTECTED SEX IN THE LAST DAYS 5SE %#0S IF s 9OU DIDNT USE ANY BIRTH CONTROL s 4HE CONDOM BROKE s 9OU MISSED OR MORE BIRTH CONTROL PILLS OR STARTED YOUR PACK LATE s 9OUR DIAPHRAGM SLIPPED s 9OU MISSED YOUR BIRTH CONTROL SHOT s 9OU WERE FORCED TO HAVE SEX (OW DO EMERGENCY CONTRACEPTIVE PILLS WORK %#0S PREVENT PREGNANCY BY s 4EMPORARILY STOPPING AN EGG FROM BEING RELEASED s 3TOPPING FERTILIZATION OF THE EGG s 3TOPPING A FERTILIZED EGG FROM ATTACHING TO THE WALL OF THE UTERUS %#0S DO NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS INCLUDING ()6!)$3 !RE THERE SIDE EFFECTS %#0S MAKE SOME WOMEN FEEL SICK TO THEIR STOMACH OR VOMIT 3OME WOMEN MAY HAVE SORE BREASTS OR HEADACHES 4HESE SIDE EFFECTS LAST ABOUT ONE DAY %#0S CAN ALSO CAUSE SOME WOMENgS PERIODS TO COME A LITTLE EARLY OR LATE 4HEY DO NOT AFFECT A WOMANS ABILITY TO BECOME PREGNANT IN THE FUTURE (OW DO ) TAKE EMERGENCY CONTRACEPTIVE PILLS s &OR THE PROGESTIN ONLY REGIMEN TAKE A SINGLE DOSE OF MG LEVONORGESTREL AS SOON AS POSSIBLE WITHIN HOURS AFTER UNPROTECTED SEX s &OR THE ESTROGEN AND PROGESTIN REGIMEN TAKE THE lRST DOSE AS SOON AS POSSIBLE WITHIN HOURS AFTER UNPROTECTED SEX AND TAKE THE SECOND DOSE HOURS LATER s +EEP A PACKET OF %#0S AT HOME TO USE WHEN YOU NEED THEM $ !RE THERE DIFFERENT TYPES OF %#0S s 9ES DIFFERENT TYPES OF %#0S HAVE DIFFERENT LEVELS OF EFFECTIVENESS s 4AKEN IN SPECIAL DOSES SOME REGULAR BIRTH CONTROL PILLS CAN BE USED AS EMERGENCY -ODULE $ CONTRACEPTION 3OMETIMES YOU NEED A SECOND CHANCE 9OU HAVE HOURS TO ACT 4OOLS &OR EMERGENCY CONTRACEPTIVE PILLS s #ALL YOUR DOCTOR OR CLINIC s 6ISIT THE EMERGENCY CONTRACEPTION WEBSITE WWWNOT LATECOM 4HIS MATERIAL WAS DEVELOPED BY 0!4( $ 4OOLS "ROCHURE IN 4HREE &ORMATS -ODULE $ 4HESE TRI FOLD BROCHURES INCLUDE INFORMATION ABOUT %#0S ON THE INSIDE 4HIS MATERIAL WAS DEVELOPED BY 0!4( $ -ODULE $ 4OOLS $ 4OOLS 3OUTH !FRICA "ROCHURE -ODULE $ $ -ODULE $ 4OOLS 4HIS MATERIAL WAS REPRINTED WITH PERMISSION FROM THE 2EPRODUCTIVE (EALTH 2ESEARCH 5NIT OF THE 5NIVERSITY OF 7ITWATERSRAND 3OUTH !FRICA $ -ODULE % !SSESSMENT /BJECTIVE 4O GATHER INFORMATION FOR GUIDING THE INTEGRATION OF EMERGENCY CONTRACEPTIVE PILLS %#0S INTO LARGE SCALE FAMILY PLANNING OR HEALTH PROGRAMS !N IMPORTANT STEP IN DEVELOPING A SUCCESSFUL EMERGENCY CONTRACEPTION PROGRAM IS TO GAIN AN UNDERSTANDING OF THE EXISTING CONTEXT INCLUDING THE PERCEPTIONS OF CLIENTS PROVIDERS PROGRAM PLANNERS AND DECISION MAKERS 4HIS UNDERSTANDING WILL PROVIDE THE BASIS FOR DEVELOPING APPROPRIATE %#0 INTRODUCTION STRATEGIES AND WILL ENSURE THAT %#0 INFORMATION AND SERVICES ARE TAILORED TO LOCAL NEEDS 4HE FOLLOWING TOPICS ARE DISCUSSED IN THIS MODULE s !SSESSMENT OF %XISTING 0ROGRAM s %#0 )NTRODUCTION !SSESSMENT s +EY 1UESTIONS AND #ONSIDERATIONS FOR !N !SSESSMENT s %FFECTIVE 7AYS TO 'ATHER )NFORMATION s -OVING FROM !SSESSMENT TO !CTION s 5SING AND !DAPTING !SSESSMENT 4OOLS 4OOLS 0ROVIDED AT THE %ND OF THIS -ODULE #LIENT +NOWLEDGE !TTITUDES AND 0RACTICES 1UESTIONNAIRE 0ROVIDER +NOWLEDGE !TTITUDES AND 0RACTICES 3URVEY ON %MERGENCY #ONTRACEPTIVE 0ILLS )N $EPTH )NTERVIEW 'UIDE FOR +EY 2EPRODUCTIVE (EALTH !UTHORITIES -YSTERY 3HOPPER 3URVEY 'UIDELINES !SSESSMENT OF %XISTING 0ROGRAM 4HE 7ORLD (EALTH /RGANIZATION 7(/ PUBLICATION -AKING $ECISIONS ABOUT #ONTRACEPTIVE )NTRODUCTION ! 'UIDE FOR #ONDUCTING !SSESSMENTS TO "ROADEN #ONTRACEPTIVE #HOICE AND )MPROVE 1UALITY OF #ARE IS A USEFUL TOOL THAT CAN HELP PROGRAM PLANNERS PREPARE FOR INTRODUCTION OF A NEW CONTRACEPTIVE METHOD BY ASSESSING USER PERSPECTIVES AS WELL AS THE QUALITY OF FAMILY PLANNING SERVICES CURRENTLY BEING DELIVERED )T ADDRESSES THREE QUESTIONS )S THERE A NEED TO IMPROVE THE PROVISION OF CURRENTLY AVAILABLE CONTRACEPTIVE METHODS )S THERE A NEED TO REMOVE ANY METHODS FROM A GIVEN SETTING )S THERE A NEED TO INTRODUCE NEW CONTRACEPTIVE METHODS % % -ODULE % +EY 1UESTIONS AND #ONSIDERATIONS FOR AN !SSESSMENT %#0 )NTRODUCTION !SSESSMENT 7HAT ARE PROVIDERS CAPABILITIES WITH REGARD TO %#0 INFORMATI s 7HAT STANDARDS OF CARE WOULD BE REQUIRED FOR %#0 SERVICES s $O PROVIDERS PERCEIVE A NEED FOR %#0S s 7HAT IS THE CURRENT OVERALL KNOWLEDGE AMONG PROVIDERS OF FAMI s 3ERVICE DELIVERY CAPABILITIES !RE PHARMACISTS AND OTHER NONMEDICAL HEALTH PROFESSIONALS AUT s #AN MEDICAL PROVIDERS PRESCRIBE COMBINED ORAL CONTRACEPTIVES s 7HAT ARE THE PROCEDURES FOR CHANGING THE LABELING FOR EXISTIN s )S A POST COITAL CONTRACEPTIVE OR SPECIALLY PACKAGED %#0 PROD s 2EGULATORY SYSTEM REQUIREMENTS EMERGENCY CONTRACEPTION INTRODUCTION #ONTRACEPTION CAN HELP STIMULATE THINKING ON ISSUES THAT NEED 4HE FOLLOWING QUESTIONS OUTLINED BY THE )NTERNATIONAL #ONSORTI 4HE INFORMATION THAT IS AVAILABLE AND INFORMATION GAPS THE G s 4HE PRIORITY GROUPSINFORMANTS FROM WHOM INFORMATION SHOULD B s 0RIOR TO DEVELOPING AN ASSESSMENT PLAN IT WILL BE IMPORTANT TO RELATE TO THESE INFORMATION NEEDS IN ORDER TO OBTAIN APPROPRIA WHAT INFORMATION IS NEEDED AND HOW IT WILL BE USED 4HE ASSESSM DESIGN AN INTRODUCTION PLAN 4HE lRST STEP IN UNDERTAKING THIS ASSESSMENT SPECIlC TO %#0 INTRODUCTION WILL PROVIDE INFORMATION /NCE THE DECISION HAS BEEN MADE TO INTRODUCE %#0S INTO A LARGE STRATEGIES FOR IMPROVING ACCESS TO AND THE QUALITY OF EMERGENCY DELIVERY SUPPORT SYSTEMS WERE DEVELOPED AND TESTED TOGETHER WIT :AMBIAN NATIONAL FAMILY PLANNING PROGRAM &OLLOWING THIS RECOMM ONE RECOMMENDATION THAT EMERGED WAS TO INTRODUCE EMERGENCY CONT 7HEN THIS 7(/ ASSESSMENT PROCESS WAS UNDERTAKEN IN :AMBIA BEGI THROUGH THE ASSESSMENT PROCESS DETERMINING WHAT INFORMATION IS ALREADY KNOWN AND WHAT GAPS WIL GENERAL AND %#0S IN PARTICULAR CONTRACEPTIVES )F SO DOES THAT AUTHORIZATION ALSO APPLY TO %# NOT WHAT REQUIREMENTS MUST BE MET FOR REGISTRATION APPROVAL KEY QUESTIONS %#0 INTRODUCTION STRATEGIES EG MINISTRY OF HEALTH OFlCIALS 4HIS LIST OF KEY QUESTIONS CAN PROVIDE A START FOR TE AND TARGETED INFORMATION ASSESSMENT IS TO IDENTIFY IDENTIFY TO BE ADDRESSED IN UM FOR %MERGENCY CONTRACEPTION SERVICES H SEVERAL ALTERNATIVE APS WILL DETERMINE THE G PRODUCTS SOCIAL MARKETING GROUPS SCALE PROGRAM AN ENT TOOLS SHOULD DIRECTLY UCT REGISTERED FOR USE )F THAT CAN BE USED TO ON AND SERVICES 0S L NEED TO BE ADDRESSED HORIZED TO DISTRIBUTE FOR OFF LABEL USES LY PLANNING METHODS IN ENDATION %#0 SERVICE RACEPTION INTO THE E GATHERED TO HELP SHAPE NNING IN -ODULE % s 7HAT MECHANISMS EXIST FOR THE DISTRIBUTION OF REGULAR ORAL CONTRACEPTIVES CLINICS HOSPITALS PHARMACIES SOCIAL MARKETING AND COMMUNITY BASED AND COMMERCIAL DISTRIBUTION SYSTEMS s 7HAT IS THE CAPACITY OF THESE DISTRIBUTION CHANNELS TO TAKE ON AN ADDITIONAL CLOSELY RELATED PRODUCT s 7HAT IS THE CAPACITY OF NON FAMILY PLANNINGREPRODUCTIVE HEALTH CARE PROVIDERS EG HOSPITAL EMERGENCY ROOMS MATERNAL AND CHILD HEALTH CLINICS AND SEXUAL ASSAULT CRISIS CENTERS TO SUPPLY %#0S s 7HAT LEVEL OF PROVIDER TRAINING WOULD BE REQUIRED TO ENSURE HIGH QUALITY SERVICES s 7HAT TRAINING AND INFORMATION MECHANISMS ARE PREFERRED BY PROVIDERS s 7HAT DO PROVIDERS CONSIDER TO BE BARRIERS TO PROVIDING QUALITY %#0 SERVICES #LIENT NEEDS AND PERSPECTIVES s !RE POTENTIAL CLIENTS AWARE OF FAMILY PLANNING IN GENERAL AND THE METHOD IN PARTICULAR s 7HEN TOLD ABOUT THE METHOD DO POTENTIAL CLIENTS PERCEIVE A NEED FOR IT s 7HAT QUESTIONS DO THEY HAVE ABOUT IT s !RE RUMORS OR MISINFORMATION ABOUT THE METHOD WIDESPREAD s 7HICH POPULATION GROUPS REPORT THE GREATEST NEED FOR %#0 SERVICES s 7HAT DISTRIBUTION MECHANISMS WOULD BE MOST CONVENIENT AND ACCEPTABLE TO POTENTIAL CLIENTS s 7HAT ARE USER PERCEPTIONS OF EXISTING SERVICES THROUGH WHICH %#0S MIGHT BE PROVIDED s 7HAT INFORMATION CHANNELS BOTH FORMAL AND INFORMAL ARE PREFERRED BY POTENTIAL CLIENTS % % -ODULE % $# 0!4( 7ITTET 3 3OURCE )NFORMATION ON +!0 SURVEYS IN DEPTH INTERVIEWS AND &'$ %FFECTIVE 7AYS TO 'ATHER )NFORMATION PRACTICE +!0 $ATA 'ATHERING ATTITUDE AND $ESK RESEARCH &OCUS GROUP +NOWLEDGE CONSIDER IN DETERMINING WHICH METHODS WILL BE USED AS PART OF T 4HE FOLLOWING TABLE SUMMARIZES CHARACTERISTICS OF DATA GATHERIN GATHERING INFORMATION WILL MEET THE PROGRAM NEEDS FOR ASSESSMEN PROCESS NEEDS TO BE AND WHETHER RELATIVELY SIMPLE INEXPENSIVE METHODS ARE BEST IN A PARTICULAR SETTING #ONSIDER HOW SCIENTIl )T IS IMPORTANT TO THINK ABOUT HOW THE INFORMATION WILL BE USED 4HERE ARE A NUMBER OF USEFUL INFORMATION GATHERING METHODS TO H DISCUSSIONS INTERVIEWS SHOPPERS OR )N DEPTH SURVEYS &'$S -YSTERY EHD)SSUES TO #ONSIDER -ETHOD CLIENTS $EVELOPING (EALTH AND &AMILY 0LANNING -ATERIALS FOR ,OW ,ITERAT 2EQUIRE PARTICIPANTS RANDOMLY SELECTED FROM VARIOUS PARTS OF s #AN USE CLOSE ENDED OR OPEN ENDED QUESTIONS OR BOTH (OWEVER s !RE USEFUL FOR ASSESSING CLIENT AND PROVIDER PERSPECTIVES ABO s !RE USED WHEN IT IS IMPORTANT TO DETERMINE WHAT PERCENTAGE OF s 2EQUIRE MORE TIME TO ANALYZE BECAUSE THEY CONTAIN MANY OPEN E s !RE A GOOD METHOD FOR GATHERING INFORMATION FROM HARD TO REAC s 0ROVIDE DETAILED INSIGHT INTO PEOPLES THOUGHTS FEELINGS AN s .EED TO ENSURE THAT MYSTERY CLIENT SURVEYS ARE HANDLED ETHICA s #AN BE USED TO PROVIDE A MEASURE OF WHETHER AND HOW %#0 INFOR s !RE RESEARCHERS OR MEMBERS OF THE RESEARCH TEAM WHO POSE AS s -AY BE POSSIBLE TO FRAME THE ISSUE OF %#0 PROVISION IN A BROA s #AN IDENTIFY EXISTING INFORMATION ON RELEVANT TOPICS SUCH AS s )S COLLECTING DATA FROM SECONDARY SOURCES WHICH CAN BE A USE s !RE OFTEN THE METHOD OF CHOICE FOR AUDIENCE RESEARCH GEARED T s 0RODUCE QUALITATIVE RESULTS THEY ARE AN EXPLORATION OF KNOWL s !RE IN DEPTH DISCUSSIONS USUALLY ONE TO TWO HOURS IN LENGTH s QUESTIONS ARE MORE DIFlCULT TO COLLECT AND ANALYZE COMMUNITY OR PARTICULAR GROUP KNOW OR BELIEVE CERTAIN THINGS OR RESEARCH TECHNIQUES MAY BE MORE APPROPRIATE OF THINGS PEOPLE BELIEVE )N THE LATTER CASE QUICKER AND LESS PROPORTION OF PEOPLE BELIEVE SOMETHING OR WHETHER IT IS ENOUGH BE EXPENSIVE AND TIME CONSUMING #ONSIDER WHETHER IT IS NECESSA AUDIENCE MEMBERS SUCH AS POLICY MAKERS USED CONSTRUCTIVELY SERVICES ARE PROVIDED PROVIDERS RESPONSE THE PROVIDER THAT SHE HAD SEX AND DOES NOT WANT TO GET PREGNANT HOW SERVICES ARE BEING PROVIDED EG A MYSTERY SHOPPER WALKS ECONOMIC AND POLITICAL ENVIRONMENT BASED ON EXISTING INFORMATI REGULATORY INFORMATION ASSESSMENT PROCESS PRINT MATERIALS AND ATTITUDES TOPICS OF PARTICULAR IMPORTANCE TO THE FORTHCOMING PROGRAM REPRESENTATIVES OF THE TARGET AUDIENCE UNDER THE GUIDANCE OF A S ADAPTED FROM :IMMERMAN - .EWTON . &RUMIN , E !UDIENCES ! 'UIDE REVISED ED C THE INFORMATION GATHERING IN DETERMINING WHICH AND QUICK METHODS OF G METHODS AND ISSUES TO HE %#0 ASSESSMENT ELP %#0 INTRODUCTION T D BEHAVIORS EXPENSIVE QUALITATIVE DEMOGRAPHIC OR EDGE BELIEFS CONCERNS IN WHICH SIX TO TEN UT %#0S THE COMMUNITY AND CAN DER SOCIOCULTURAL LLY AND THAT RESULTS ARE FUL lRST STEP IN AN %#0 OWARD DEVELOPING FACILITATOR DISCUSS H OR INmUENTIAL TARGET PEOPLE IN A INTO CLINIC AND TELLS CLIENTS TO ASSESS ON TO KNOW WHAT KINDS ACT IN SPECIlC WAYS AND DOCUMENTS THE OPEN ENDED NDED QUESTIONS MATION AND RY TO KNOW WHAT 7ASHINGTON -ODULE % -OVING FROM !SSESSMENT TO !CTION 4HE MOST IMPORTANT ASPECT OF AN ASSESSMENT IS ENSURING THAT THE INFORMATION GATHERED IS USED TO GUIDE AND INFORM THE PROGRAM DEVELOPMENT DECISION MAKING PROCESS "EFORE UNDERTAKING THE ASSESSMENT IT IS GENERALLY HELPFUL TO DEVELOP A PLAN FOR ANALYZING AND INTERPRETING THE DATA THAT WILL BE GATHERED )T MAY BE USEFUL TO ORGANIZE THE ASSESSMENT lNDINGS IN A MATRIX ACCORDING TO THE ORIGINAL RESEARCH QUESTIONS THE CENTRAL lNDINGS FROM THE ASSESSMENT AND PROGRAMMATIC RECOMMENDATIONS THAT COME OUT OF THE lNDINGS 4HE MATRIX BELOW BASED ON AN INITIAL ASSESSMENT IN 3RI ,ANKA DEMONSTRATES HOW ASSESSMENT lNDINGS CAN INFORM PROGRAMMATIC DECISIONS 0ROGRAM PLANNERS IN 3RI ,ANKA COMPLETED A BASELINE SURVEY A POSTAL QUESTIONNAIRE OF MEDICAL SERVICE DELIVERY PERSONNEL IN DEPTH INTERVIEWS WITH COMMUNITY LEADERS AND GROUP DISCUSSIONS WITH FAMILY HEALTH WORKERS MIDWIVES SELECTED FROM DIFFERENT PARTS OF THE COUNTRY 4HE INTRODUCTION PLAN INFORMED BY THIS ASSESSMENT WAS SUCCESSFUL 4HE NEW METHOD WAS WELL RECEIVED BY BOTH PROVIDERS AND CLIENTS AND %#0 USE HAS CONTINUED TO EXPAND OVER TIME !SSESSMENT 1UESTIONS +EY &INDINGS 0ROGRAMMATIC 2ECOMMENDATIONS 7HAT ARE s $OCTORS AND MIDWIVES WILLING TO s 4RAIN CLINIC STAFF AND TELEPHONE OPERATORS ON PROVIDER DISTRIBUTE %#0S HOW %#0 INFORMATION SHOULD BE PROVIDED TO ATTITUDES ABOUT s #ONCERNS EXPRESSED THAT SOME POSSIBLE USERS %#0S PEOPLE WOULD RESORT TO %#0 USE s 4RAIN CLINICIANS WILLING TO INTRODUCE %#0S IN IN PLACE OF REGULAR CONTRACEPTIVE CLINICS METHODS s )N PROVIDER TRAINING ADDRESS CONCERNS s #ONCERNS EXPRESSED ABOUT POSSIBLE REGARDING USE OF %#0S AS A REGULAR SPREAD OF 34)S AND ()6!)$3 CONTRACEPTIVE METHOD AND POSSIBLE DUE TO INCREASED SEXUAL ACTIVITY DECREASE IN CONDOM USE 3TUDIES HAVE WITHOUT CONDOMS SINCE PREGNANCY PROVIDED EVIDENCE THAT THESE CONCERNS PROTECTION AVAILABLE THROUGH %#0S ARE NOT BORNE OUTSEE A DISCUSSION OF THIS ISSUE IN -ODULE ! )NFORMATION FOR 0OLICY -AKERS s 4RAIN PROVIDERS TO USE %#0 PROVISION AS AN OPPORTUNITY TO DISCUSS ITS CORRECT USE AND ENCOURAGE CLIENTS TO ADOPT REGULAR CONTRACEPTIVE METHODS (OW WILL THE s 3UBJECT IS NEW TO THE GENERAL PUBLIC s !N AGGRESSIVE EDUCATIONAL AND PUBLICITY PUBLIC RESPOND s )DEA OF %#0 WELL ACCEPTED BY BOTH CAMPAIGN SHOULD BE IMPLEMENTED TO AN %#0 MARRIED AND UNMARRIED MEN AND s %DUCATIONAL ACTIVITIES AND MATERIALS SHOULD PRODUCT WOMEN BE AIMED AT PREVENTING THE MISCONCEPTION s 0ERCEPTION THAT %#0 CAN BE USED TO THAT %#0 WOULD BE ABORTIFACIENT 3EE CAUSE AN ABORTION -ODULE ! )NFORMATION FOR 0OLICY -AKERS 7HAT ARE s "RAND NAME SHOULD BE GIVEN s 'IVEN THAT PUBLICITY OF THE BRAND NAME THE ISSUES WIDE PUBLICITY TO MAXIMIZE PUBLIC IS NOT POSSIBLE DUE TO GOVERNMENT REGARDING AWARENESS RESTRICTIONS PROMOTIONAL CAMPAIGN SHOULD MARKETING OF A s 3ERVICE PROVIDERS WOULD BE HAPPY FOCUS ON THE CONCEPT OF EMERGENCY BRANDED %#0 TO POPULARIZE SUCH A PRODUCT CONTRACEPTION s 'OVERNMENT RESTRICTIONS PREVENT MEDIA ADVERTISING OF DRUGS THAT REQUIRE A DOCTORS PRESCRIPTION 3OURCE -ATRIX ADAPTED FROM ASSESSMENT lNDINGS DESCRIBED IN !BEYWICKREMA $ "ASNAYAKE 3 3UBASINGHE # AND "AMUNUSINGHE * !N EVALUATION REPORT ON THE MARKETING OF 0OSTINOR IN 3RI ,ANKA &AMILY 0LANNING !SSOCIATION OF 3RI ,ANKA -ARCH % % -ODULE % 5SING AND !DAPTING !SSESSMENT 4OOLS 2EFERENCES IMPORTANT TO SEEK HELP FROM LOCAL EXPERTS TO MEET THAT NEED DEVELOPMENT TO MEET LOCAL NEEDS )F MORE ACADEMIC RESEARCH IS T INTENDED TO BE USED FOR OPERATIONS RESEARCH BUT RATHER ARE GEA EXAMPLES OF THE MULTIPLE WAYS THAT ASSESSMENTS CAN BE PERFORMED BEEN USED IN A VARIETY OF lELD SETTINGS AROUND THE WORLD 4HEY 4HE ASSESSMENT TOOLS INCLUDED IN THIS MODULE ARE ADAPTATIONS OF SUCCESSFUL PROGRAM WHEN DETERMINING HOW TO BEST TRANSLATE THE DATA COLLECTED INTO CONSIDER AVAILABLE RESOURCES THE FEASIBILITY OF PROPOSED SOLUT IS A WAY OF ENSURING THAT APPROPRIATE SOLUTIONS TO ISSUES ARE I )NCLUDING PARTNERS AND COMMUNITY MEMBERS IN THE DEVELOPMENT OF $EVELOPING RECOMMENDATIONS FROM ASSESSMENT lNDINGS CAN BE A DIF GUIDE AND TO STANDARDIZE THE WAY IN WHICH THE QUESTIONS ARE ASK TO HOLD A TRAINING SESSION FOR INTERVIEWERS OR MYSTERY SHOPPER POSSIBLE RESPONSE OR RECORD ONLY THE RESPONSES OFFERED BY THE I INTERVIEWERS SUCH AS WHETHER THEY ARE SUPPOSED TO PROMPT THE I TO DEVELOP A GUIDE THAT EXPLAINS EACH QUESTION AND DETAILS ANY )F MULTIPLE INTERVIEWERS WILL PARTICIPATE IN THE DATA COLLECTIO $ATA COLLECTION AND ANALYZING THE TYPE OF DATA THAT WILL BE COLLECTED -AKE SURE THAT THE ASSESSMENT TEAM INCLUDES STAFF WITH EXPERIEN ENSURE THAT THE INSTRUMENTS ARE DESIGNED TO FACILITATE THESE PR )T IS USEFUL TO DEVELOP A PLAN FOR DATA ENTRY AND ANALYSIS BEFO $ATA ENTRY AND ANALYSIS EFFECTIVELY YIELD THE INFORMATION SOUGHT AND CULTURALLY APPROPRIATE FOR THE SETTING IN WHICH THEY WILL B DEVELOPED PRIOR TO PRODUCING THE lNAL VERSION TO MAKE SURE THA NEEDED FOR USE IN PARTICULAR SETTINGS )T WILL BE IMPORTANT TO 4HESE INSTRUMENTS OR PORTIONS OF THEM MAY BE TRANSLATED AND F 4OOL ADAPTATION AND PRETESTING #ONTRACEPTION ! 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'UIDE FOR RE TOOLS ARE lNALIZED TO DENTIlED )T IS IMPORTANT TO OCESSES AS MUCH AS POSSIBLE SPECIAL INSTRUCTIONS FOR THE S TO REVIEW THE INTERVIEW NTERVIEWEE )T IS ALSO USEFUL OVE 1UALITY OF #ARE !VAILABLE AT E USED AND THAT THEY WILL IONS AND PROGRAM PRIORITIES S RED TOWARD SHAPING PROGRAM /CTOBER ED AND DATA IS RECORDED NTERVIEWEE BY READING EACH ARE INTENDED TO SERVE AS THE ACTIONS REQUIRED FOR A T THE QUESTIONS ARE CLEAR INSTRUMENTS THAT HAVE REELY ADAPTED AS CE DESIGNING DATABASES HE OBJECTIVE IT WILL BE 4HESE TOOLS ARE NOT RECOMMENDATIONS lCULT PROCESS -ODULE % 4OOLS ,IST #LIENT +NOWLEDGE !TTITUDES AND 0RACTICES 1UESTIONNAIRE 4HIS STRUCTURED INTERVIEW GUIDE WAS DEVELOPED BY THE 0OPULATION #OUNCIL IN -EXICO AS A FOLLOW UP TO A BASELINE SURVEY EVALUATING THE INTRODUCTION OF %#0S IN -EXICO )T WAS IMPLEMENTED BY INTERVIEWING CLIENTS AT A FAMILY PLANNING CLINIC 4HE QUESTIONS HOWEVER ARE RELEVANT FOR USE AS PART OF A PRELIMINARY ASSESSMENT OF CLIENT +!0 THOUGH THEY SHOULD BE ADAPTED FOR AND PRETESTED IN THE SETTING IN WHICH THEY WILL APPLIED 4HE FORMAT OF THE TOOL COULD ALSO BE ADAPTED FOR USE AS A PAPER SURVEY IF A PAPER SURVEY IS APPROPRIATE FOR THE LITERACY LEVEL OF THE CLIENT POPULATION 0ROVIDER +NOWLEDGE !TTITUDES AND 0RACTICES 3URVEY ON %MERGENCY #ONTRACEPTIVE 0ILLS 4HIS PROVIDER +!0 SURVEY WAS ADAPTED FROM DIFFERENT PROVIDER SURVEYS DEVELOPED BY 0!4( THE 0OPULATION #OUNCIL IN -EXICO AND THE &AMILY 0LANNING !SSOCIATION OF 3RI ,ANKA )T IS FORMATTED AS A PAPER SURVEY THAT COULD BE MAILED OR DISTRIBUTED TO PROVIDERS PERHAPS AT A MEETING OR CONFERENCE HOWEVER THE QUESTIONS COULD BE ADAPTED FOR USE IN A DIFFERENT FORMAT SUCH AS AN INTERVIEW IF A PAPER SURVEY IS NOT PRACTICAL )N $EPTH )NTERVIEW 'UIDE FOR +EY 2EPRODUCTIVE (EALTH !UTHORITIES 4HIS IN DEPTH INTERVIEW GUIDE WAS DEVELOPED BY 0!4( FOR USE WITH HIGH LEVEL REPRODUCTIVE HEALTH MEDICAL AUTHORITIES )T IS GEARED TOWARD LEARNING ABOUT REPRODUCTIVE HEALTH AUTHORITIES ATTITUDES TOWARD %#0S THEIR PERCEPTIONS OF THE NEED FOR %#0S AND BARRIERS TO PROVIDING HIGH QUALITY %#0 SERVICES AND THEIR OPINIONS ABOUT TRAINING NEEDS OF THEIR STAFF AND THE BEST MECHANISM TO EXPAND %#0 INFORMATION -YSTERY 3HOPPER 3URVEY 4HIS MYSTERY SHOPPER SURVEY WAS ADAPTED FROM MYSTERY SHOPPER SURVEYS DEVELOPED BY 0!4( AND THE 2EPRODUCTIVE (EALTH 2ESEARCH 5NIT OF THE 5NIVERSITY OF 7ITWATERSRAND 3OUTH !FRICA )T IS INTENDED AS A MEASURE OF WHETHER AND HOW %#0 INFORMATION AND SERVICES ARE PROVIDED IN A PHARMACY SETTING )N THIS TOOL THE PRIMARY SCENARIO INCLUDES A WOMAN POSING AS A SECRET SHOPPER AND WALKING INTO A PHARMACY AND TELLING THE PHARMACIST h9ESTERDAY ) HAD SEX AND DIDNT USE ANY METHOD OF CONTRACEPTION ) AM WORRIED ABOUT GETTING PREGNANT AND ) WOULD LIKE TO KNOW IF THERE IS SOMETHING ) CAN DO TO PREVENT PREGNANCYv )MMEDIATELY FOLLOWING THE PHARMACY VISIT ANOTHER MEMBER OF THE RESEARCH TEAM INTERVIEWS THE WOMAN WHO VISITED THE PHARMACY AND DOCUMENTS HER EXPERIENCE IN THE PHARMACY ON THE RECORDING SHEET 7HILE THIS TOOL WAS DEVELOPED FOR USE IN A PHARMACY SETTING THE QUESTIONS COULD BE ADAPTED FOR USE IN CLINICAL SETTINGS % -ODULE % 4OOLS % 4OOLS #LIENT +NOWLEDGE !TTITUDES AND -ODULE % 0RACTICES 1UESTIONNAIRE &OLLOW UP ON %MERGENCY #ONTRACEPTIVE 0ILLS 1UESTIONNAIRE FOR &AMILY 0LANNING 5SERS ) )DENTIlCATION $ATA $ATE OF INTERVIEW $AY-ONTH9EAR 5SERS SEX &EMALE -ALE 4IME INTERVIEW BEGAN (OURS -INUTES 4IME INTERVIEW lNISHED (OURS -INUTES 0LACE )NTERVIEWER INITIALS )NTRODUCTION 4HIS INTERVIEW IS PART OF A STUDY TO EVALUATE THE INTRODUCTION ON A LARGER SCALE OF A CONTRACEPTIVE METHOD !S A FOLLOW UP TO A SURVEY WE ARE NOW INTERVIEWING CLIENTS OF SOME FAMILY PLANNING CLINICS 7E EXPECT THE INTERVIEW TO TAKE ABOUT MINUTES 9OU DO NOT NEED TO PROVIDE YOUR NAME NONE OF THE INFORMATION COLLECTED THROUGH THIS INTERVIEW WILL BE INCLUDED IN YOUR CLINICAL RECORD )F YOU PREFER NOT TO RESPOND YOUR DECISION WILL NOT AFFECT IN ANY WAY THE SERVICES YOU ARE RECEIVING AT THE CLINIC 0LEASE BE ASSURED THAT ALL THE INFORMATION GATHERED WILL BE KEPT STRICTLY CONlDENTIAL !RE YOU WILLING TO PARTICIPATE IN OUR STUDY 9ES 3KIP TO .O 4HANK YOU ANYWAY (AVE A NICE DAY % )) "ACKGROUND )NFORMATION 4HE lRST QUESTIONS ARE TO OBTAIN GENERAL INFORMATION (OW OLD ARE YOU -ODULE % $OES NOT RESPOND 7HAT IS THE HIGHEST LEVEL OF EDUCATION YOU ATTAINED 0RIMARY 4OOLS 3ECONDARY 4ECHNICAL NOT LEADING TO SECONDARY DEGREE 0REPARATORY 4ECHNICAL LEADING TO SECONDARY DEGREE 5NIVERSITY 0OSTGRADUATE STUDIES $EGREE OBTAINED ???????????????? 9EARS ????????? $OES NOT KNOWNOT RESPOND .O STUDIES AT ALL (AVE YOU EVER HAD SEXUAL RELATIONSHIPS 9ES .O 3KIP TO (AVE YOU OR YOUR PARTNER EVER BEEN PREGNANT 9ES 9ES ) AM PREGNANT RIGHT NOW .O )N THE CASE OF A MALE USER (AVE YOU EVER GOTTEN A PARTNER PREGNANT 9ES .O .! $O YOU OR YOUR PARTNER USE A CONTRACEPTIVE METHOD )N CASE THE CLIENT IS PREGNANT7ERE YOU OR YOUR PARTNER USING A METHOD BEFORE YOU GOT PREGNANT 9ES .O 3KIP TO 7HICH CONTRACEPTIVE METHOD OR METHODS ARE YOU USING 2EAD AND CHECK THOSE METHODS MENTIONED AND THEN PROMPT !NY OTHER 0ILLS )NJECTABLES #ONDOMS % 4OOLS )5$ 4UBAL LIGATION -ODULE % 6ASECTOMY 7ITHDRAWAL YOUR HUSBAND TAKES CARE OF YOU #ALENDAR RHYTHM /THER 3PECIFY ??????????????? ))) +NOWLEDGE !BOUT %MERGENCY #ONTRACEPTION (AVE YOU EVER HEARD ABOUT EMERGENCY CONTRACEPTION OR THE MORNING AFTER PILL 9ES .O 3KIP TO 7HEN WAS THE lRST TIME YOU HEARD SOMETHING ABOUT EMERGENCY CONTRACEPTION ,ESS THAN MONTHS AGO MONTHS AGO YEARS AGO YEARS AGO $OES NOT REMEMBER 7HERE DID YOU HEAR ABOUT IT 2EAD AND CHECK THOSE METHODS MENTIONED AND THEN PROMPT 3OMEWHERE ELSE !T THIS CLINIC !T A DIFFERENT CLINICHEALTH CENTER 4HROUGH FRIENDS OR RELATIVES COMMENTS 4HROUGH THE NEWS IN MAGAZINES 4HROUGH THE RADIO 4ELEVISION #OURSE OR FORMAL LECTURE 4ELEPHONE LINE )NTERNET PAGE /THER 3PECIFY ??????????????? $OES NOT REMEMBER % $O YOU KNOW WHERE A WOMAN CAN OBTAIN EMERGENCY CONTRACEPTIVE PILLS 2EAD AND CHECK THOSE METHODS MENTIONED AND THEN PROMPT 3OMEWHERE ELSE (OSPITALHEALTH CENTERCLINIC -ODULE % 3OCIAL WORKERCOMMUNITY WORKER 0RIVATE CLINIC 0HARMACY 3UPERMARKET 4OOLS /THER 3PECIFY ??????????????? )T IS NOT POSSIBLE TO OBTAIN THEM $OES NOT KNOW 7OULD EMERGENCY CONTRACEPTIVE PILLS WORK IF THERE IS A MENSTRUAL DELAY 9ES .O $OES NOT KNOW (OW LONG AFTER UNPROTECTED SEX SHOULD EMERGENCY CONTRACEPTIVE PILLS BE TAKEN )MMEDIATELY AFTER SEX 7ITHIN HOURS 7ITHIN HOURS DAYS 7ITHIN ONE WEEK !T ANY TIME BEFORE THE lRST DAY OF THE NEXT MENSES /THER $OES NOT KNOW 3PECIFY ??????????????? 7HICH DRUG DO YOU BELIEVE IS CONTAINED IN EMERGENCY CONTRACEPTIVE PILLS 2EAD AND CHECK RESPONSES MENTIONED 4HE SAME AS IN NORMAL CONTRACEPTIVE PILLS 4HE SAME ONE BUT STRONGER ! COMPLETELY DIFFERENT DRUG $OES NOT KNOW % 4OOLS $ID THE PERSON OR MEDIA FOR EXAMPLE TELEVISION RADIO ETC FROM WHICH YOU OBTAINED INFORMATION ABOUT %# EXPLAIN TO YOU 2EAD AND CIRCLE THOSE METHODS MENTIONED -ODULE % 9%3 ./ .2 7HICH METHODS CAN BE USED (OW OFTEN YOU CAN USE THEM 7HERE THEY CAN BE OBTAINED 4HAT IT WOULD BE ADVISABLE TO TALK ABOUT THE METHOD WITH YOUR PARTNER 4HAT YOU WOULD NOT HAVE ANY PROBLEM TO BECOME PREGNANT IN THE FUTURE 4HAT AFTER USING EMERGENCY CONTRACEPTION IT WOULD BE ADVISABLE TO START USING A DIFFERENT CONTRACEPTIVE METHOD (OW EFFECTIVE ARE EMERGENCY CONTRACEPTIVE PILLS IN PREVENTING A PREGNANCY 2EAD AND CHECK THOSE METHODS MENTIONED !LMOST ALWAYS 4HREE OUT OF FOUR (ALF OF THE TIMES ,ESS THAN THE THIRD PART .OT SURE )6 1UALITY OF #ARE (AVE YOU RECEIVED DURING THE LAST YEAR LATELY INFORMATION ABOUT EMERGENCY CONTRACEPTION AT THIS CENTER 9ES .O 3KIP TO $OES NOT REMEMBER 7HO PROVIDED THIS INFORMATION $OCTOR 0SYCHOLOGIST 3OCIAL WORKER 'ROUP TALK 0OSTER "ROCHURES 6IDEO /THER 3PECIFY ??????????????? $OES NOT REMEMBER % 6 5SE OF %MERGENCY #ONTRACEPTIVE -ETHOD (AVE YOU OR YOUR PARTNER EVER USED EMERGENCY CONTRACEPTIVE PILLS 9ES -ODULE % .O 3KIP TO (OW MANY TIMES HAVE YOU USED THIS METHOD DURING THE LAST YEAR ??????????????? $OES NOT REMEMBER 4OOLS 7HO RECOMMENDED IT 2EAD IF THE PERSON DOES NOT RESPOND ! FRIEND 0ARTNER MALE 4ELEPHONE LINE 7EB PAGE 2ADIO PROGRAM 4ELEVISION PROGRAM /THER 3PECIFY ??????????????? $OES NOT REMEMBERKNOW 7HY DID YOU USE IT 2EAD AND CHECK THOSE METHODS MENTIONED 9OU DO NOT USE A CONTRACEPTIVE METHOD 4HE TIMING WAS MISCALCULATED RHYTHM 4HE CONDOM BROKE OR SLIPPED 9OU MISSED PILLS 9OU WERE FORCED TO HAVE SEX 4HE WITHDRAWAL FAILED /THER 3PECIFY ??????????????? $OES NOT REMEMBER !FTER YOU OR YOU PARTNER USED EMERGENCY CONTRACEPTION DID YOU START USING A REGULAR METHOD OF BIRTH CONTROL OR ONE DIFFERENT FROM THE METHOD YOU WERE USING 9ES .O 3KIP TO $OES NOT REMEMBER 3KIP TO $OES NOT KNOW 3KIP TO % 4OOLS 7HICH METHOD DID YOU START USING 0ILLS -ODULE % )NJECTABLES #ONDOMS )5$ 4UBAL LIGATION 6ASECTOMY 7ITHDRAWAL #ALENDAR RHYTHM /THER 3PECIFY ??????????????? $OES NOT REMEMBER 6) !TTITUDES 4OWARD %MERGENCY #ONTRACEPTION ,ET ME DElNE BRIEmY WHAT EMERGENCY CONTRACEPTIVE PILLS ARE 4HEY ARE TRADITIONAL CONTRACEPTIVE PILLS THOSE THAT ARE TAKEN DAILY BUT ADMINISTERED IN HIGHER DOSES AND FOR A SHORT TIME 7OMEN CAN USE THEM AFTER HAVING HAD UNPROTECTED SEX AND AS A WAY TO HELP THEM PREVENT A PREGNANCY 4HIS METHOD IS SOMETIMES CALLED THE hMORNING AFTER PILL v BUT THE WOMAN ACTUALLY HAS UP TO lVE DAYS AFTER INTERCOURSE TO GET PROTECTED %MERGENCY CONTRACEPTIVE PILLS MUST BE TAKEN AS SOON AS POSSIBLE WITHIN THE lRST HOURS AFTER UNPROTECTED SEX )F TAKEN WITHIN HOURS AND WITH THE CORRECT DOSES THEY PREVENT ABOUT OUT OF PREGNANCIES THAT WOULD HAVE OTHERWISE OCCURRED 3OME WOMEN WHO HAVE TAKEN THEM HAVE EXPERIENCED NAUSEA OR VOMITING 4HE INGREDIENT IN THESE PILLS IS THE SAME AS THE ONE IN NORMAL CONTRACEPTIVE PILLS BUT IN HIGHER DOSES 4HIS METHOD IS USED IN CASE OF EMERGENCY IT IS NOT RECOMMENDED FOR ROUTINE USE 7HAT DO YOU THINK ABOUT THIS METHOD !DEQUATE FOR WOMEN )NADEQUATE FOR WOMEN !DEQUATE FOR SOME WOMEN 9OU WOULD LIKE TO HAVE MORE INFORMATION /THER $OES NOT KNOW 3PECIFY ??????????????? $O YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT THIS METHOD 9ES .O 3KIP TO % 7HICH ARE YOUR CONCERNS )T MAY CAUSE HEALTH PROBLEMS )T MAY HURT THE BABY IN CASE IT DOES NOT WORK -ODULE % )T MAY RESULT IN COMPLICATIONS TO GET PREGNANT IN THE FUTURE )T IS ABORTIFACIENT )TS USE MAY BE ILLEGAL 4OOLS )T WILL RESULT IN MORE WOMEN SUFFERING FROM 34) AND EVEN !)$3 )F MEN KNOW THAT THIS METHOD EXISTS THEY WOULD EXERT PRESSURE ON WOMEN TO USE IT 3OME WOMEN MAY USE IT FREQUENTLY INSTEAD OF USING REGULAR CONTRACEPTIVES /THER 3PECIFY ??????????????? ) DO NOT HAVE ENOUGH INFORMATION 7HERE DO YOU THINK THIS CONTRACEPTIVE METHOD SHOULD BE PROVIDED 2EAD AND CHECK THOSE METHODS MENTIONED 0UBLIC HOSPITALS 0RIVATE HOSPITALS )NSTITUTIONAL HEALTH CENTERS #OMMUNITY HEALTH CENTERS !T MIDWIVES HOUSES 0HARMACIES !NY SHOP WHERE DRUGS ARE EXPENDED 3CHOOLS 6ENDING MACHINES /THER 3PECIFY ??????????????? 7HO SHOULD PROVIDE IT 2EAD AND CHECK THOSE METHODS MENTIONED $OCTORS .URSES 3OCIAL WORKERS 3EX #OUNSELORS #OMMUNITY HEALTH WORKERS 0SYCHOLOGISTS -IDWIVES 0HARMACISTS /THER 3PECIFY ??????????????? % 4OOLS &ROM WHAT YOU HAVE LEARNT ABOUT EMERGENCY CONTRACEPTION DO YOU THINK YOU WOULD EVER USE IT OR RECOMMEND IT TO A FRIEND OR RELATIVE IN CASE OF NEED -ODULE % 9ES .O .OT SURE $O YOU BELIEVE YOUR PARTNER WOULD ACCEPT THAT YOU USE THIS METHOD /R WOULD YOU ACCEPT THAT YOUR PARTNER USES IT 9ES .O .OT SURE !CCORDING TO YOU WHICH WOULD BE THE BEST WAYS TO INFORM PEOPLE ABOUT EMERGENCY CONTRACEPTION 2EAD AND CHECK THOSE METHODS MENTIONED !T THE CLINIC 'ROUP TALKS "ROCHURES 0OSTERS 2ADIO 4ELEVISION -AGAZINESNEWSPAPERS 3CHOOLS 4ELEPHONE LINE )NTERNET PAGE /THER 3PECIFY ??????????????? $OES NOT KNOW 6)) $ISTRIBUTION )N SOME COUNTRIES PROVIDERS SUPPLY WOMEN IN ADVANCE WITH KITS CONTAINING EMERGENCY CONTRACEPTIVE PILLS 4HUS WOMEN CAN EASILY RESORT TO THEM IN CASE OF NEED WITHOUT HAVING TO RETURN TO THE CLINIC 7HAT DO YOU THINK ABOUT THIS IDEA !DEQUATE (AS DOUBTS )NADEQUATE 7HY ????????????????????????????????????????????????????????? % 3OME PHARMACEUTICAL COMPANIES HAVE DEVELOPED SOMETHING CALLED hA DEDICATED PRODUCTv FOR EMERGENCY CONTRACEPTIVE PILLS 4HIS DEDICATED PRODUCT CONTAINS THE EXACT DOSE BUT IT CONSISTS OF TWO PILLS ONLY AND HAS FEWER SIDE EFFECTS THE COST OF THE PRODUCT HOWEVER IS HIGHER THAN THAT OF USING REGULAR ORAL CONTRACEPTIVE PILLS FOR -ODULE % EMERGENCY CONTRACEPTION 7OULD YOU PREFER THIS DEDICATED PRODUCT 9ES .O 4OOLS )T DEPENDS $OES NOT KNOW 7HY ????????????????????????????????????????????????????????? (OW MUCH WOULD YOU BE WILLING TO PAY FOR THIS PRODUCT 53 ??????????? 53 53 53 53 53 53 -ORE THAN 53 $OES NOT KNOWRESPOND % 4OOLS 7E HAVE COME TO THE END "UT BEFORE WE lNISH -ODULE % 7E WOULD LIKE TO MENTION THAT EMERGENCY CONTRACEPTIVE PILLS DO NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS INCLUDING ()6 THE VIRUS WHICH CAUSES !)$3 #ONDOMS ARE BELIEVED TO BE THE MOST EFFECTIVE METHOD TO PROTECT AGAINST THESE DISEASES $O YOU HAVE ANY FURTHER DOUBTS ABOUT EMERGENCY CONTRACEPTION 5SERS QUESTIONS ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????? 7RITE THE TIME THE INTERVIEW lNISHED ???(OURS ???-INUTES 7RITE THIS SAME TIME ON THE lRST PAGE OF THE QUESTIONNAIRE 4HANKS AGAIN FOR PARTICIPATING IN THIS PROJECT 4HIS SURVEY WAS ORIGINALLY DEVELOPED IN 3PANISH BY THE 0OPULATION #OUNCIL OF -EXICO )T WAS TRANSLATED AND ADAPTED WITH PERMISSION FROM THE 0OPULATION #OUNCIL OF -EXICO BY 0!4( % -ODULE % 4OOLS % 4OOLS 0ROVIDER +NOWLEDGE !TTITUDES AND 0RACTICES -ODULE % 3URVEY ON %MERGENCY #ONTRACEPTIVE 0ILLS /UR ORGANIZATION ????????????? IS SEEKING TO LEARN ABOUT MEDICAL PROVIDERS KNOWLEDGE OF AND PERCEPTIONS OF THE NEED FOR EMERGENCY CONTRACEPTIVE PILLS %#0S AS WELL AS BARRIERS TO PROVIDING HIGH QUALITY %#0 SERVICES 4HE INFORMATION YOU PROVIDE WILL BE USED TO DESIGN TRAINING CURRICULA AND MATERIALS ABOUT %#0S AND OTHER CONTRACEPTIVE METHODS 9OUR ANSWERS WILL NOT BE RELEASED TO ANYONE AND WILL REMAIN ANONYMOUS 9OUR NAME WILL NOT BE WRITTEN ON THE QUESTIONNAIRE OR BE KEPT IN ANY OTHER RECORDS 0LEASE RETURN THE SURVEY BY ???? TO ??? 4HANK YOU FOR YOUR HELP ???????????????????????????????????????????????????????????????????????? 0LEASE CHECK BELOW /BSTETRICIAN'YNECOLOGIST .URSE 0SYCHOLOGIST /THER ???????????????? 0LEASE CHECK BELOW &EMALE -ALE 2EGION WHERE YOU WORK 5RBAN 2URAL $O YOU AGREE THAT UNINTENDED PREGNANCIES AND AS A RESULT INDUCED ABORTIONS ARE SERIOUS PROBLEMS IN OUR COUNTRY 9ES .O (OW LONG DOES A TYPICAL APPOINTMENT WITH YOUR CLIENT LAST ,ESS THAN MIN MIN MIN -ORE THAN MIN $OES A TYPICAL APPOINTMENT INCLUDE A DISCUSSION OF FAMILY PLANNING 0LEASE CHECK ONE !LWAYS -OST OF THE TIME 3OMETIMES 7HEN THE CLIENT REQUESTS INFORMATION .EVER % 7HAT ARE THE CONTRACEPTIVE METHODS AVAILABLE AT YOUR CLINIC OR HEALTH CENTER 0LEASE CHECK ALL THAT APPLY (ORMONAL METHODS -ODULE % /RAL CONTRACEPTIVE PILLS %MERGENCY CONTRACEPTIVE PILLS #ONTRACEPTIVE INJECTION #ONTRACEPTIVE IMPLANT 4OOLS "ARRIER METHODS -ALE CONDOM &EMALE CONDOM $IAPHRAGM /THER METHODS 6AGINAL SPERMICIDES 3AFE PERIOD RHYTHM 7ITHDRAWAL 3TERILIZATION )5$ $O YOU HAVE CONCERNS ABOUT THE METHODS LISTED BELOW #HECK ONLY WHERE YOU HAVE A CONCERN .OT EFFECTIVE 5NSAFE /THER (ORMONAL METHODS /RAL CONTRACEPTIVE PILLS %MERGENCY CONTRACEPTIVE PILLS #ONTRACEPTIVE INJECTION #ONTRACEPTIVE IMPLANT "ARRIER METHODS -ALE CONDOM &EMALE CONDOM $IAPHRAGM /THER METHODS 6AGINAL SPERMICIDES 3AFE PERIOD RHYTHM 7ITHDRAWAL 3TERILIZATION )5$ % 4OOLS )F FOR ANY METHOD YOU CHECKED hOTHER v PLEASE EXPLAIN -ODULE % ???????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????????????? 7HAT CONTRACEPTIVE METHODS WOULD YOU LIKE TO LEARN MORE ABOUT ???????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????????????? 7HAT ADVICETREATMENT WOULD YOU GIVE TO A WOMAN WHO CAME TO YOU WITH A HISTORY OF A MISSED OR DELAYED PERIOD ???????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????????????? 7HAT ADVICE OR TREATMENT WOULD YOU GIVE TO A WOMAN WHO CAME TO YOU WITH CONCERNS ABOUT CONTRACEPTIVE FAILURE CONDOM BREAKAGE MISSED PILLS MISSED INJECTION ???????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????????????? ???????????????????????????????????????????????????????????????????????????????? $O YOU AGREE OR DISAGREE WITH THE FOLLOWING STATEMENT h%#0S ARE PRIMARILY A FORM OF CONTRACEPTIONv !GREE SKIP TO QUESTION $ISAGREE GO TO QUESTION $O YOU AGREE OR DISAGREE WITH THE FOLLOWING STATEMENT h%#0S ARE PRIMARILY A FORM OF ABORTIONv !GREE $ISAGREE % 7HEN YOU OR SOMEONE AT YOUR CLINIC DISCUSS FAMILY PLANNING DO YOU INCLUDE A DISCUSSION OF EMERGENCY CONTRACEPTION 0LEASE CHECK ONE !LWAYS -ODULE % -OST OF THE TIME 3OMETIMES 7HEN THE CLIENT REQUESTS INFORMATION .EVER 4OOLS (AVE YOU EVER PRESCRIBED %#0S 9ES .O SKIP TO QUESTION )F YES PLEASE CHECK ONE OF THE FOLLOWING )N THE LAST YEAR HOW MANY TIMES HAVE YOU PRESCRIBED %#0S TIMES TIMES TIMES TIMES -ORE THAN TIMES (OW FAMILIAR ARE YOU WITH THE USE OF %#0S 6ERY FAMILIAR 3OMEWHAT FAMILIAR .OT AT ALL FAMILIAR 7HAT ADVANTAGES DO YOU BELIEVE THIS METHOD HAS .ONE 0REVENTS UNINTENDED PREGNANCY )DEAL WHEN NO CONTRACEPTION WAS USED !CCESSIBLE %ASY TO MANAGE DOSE .OT NECESSARY TO USE A ROUTINE CONTRACEPTIVE 7OMEN CAN SELF PRESCRIBE ,OW COST %FFECTIVE &EW CONTRAINDICATIONS .O IMPORTANT SIDE EFFECTS #AN BE MANAGED BY THE WOMAN WITHOUT THE MANS PARTICIPATION /THER PLEASE DESCRIBE ?????????????????????????????? % 4OOLS 7HAT CONCERNS DO YOU HAVE ABOUT %#0S 0LEASE CHECK ALL THAT APPLY .O CONCERNS -ODULE % -ORAL OR RELIGIOUS OBJECTION 7OMEN WILL RELY ON %#0S AS A REGULAR FORM OF CONTRACEPTION 3IDE EFFECTSNAUSEA AND VOMITING )NEFFECTIVE IN PREVENTING PREGNANCY 3AFETY OF FETUS IF %#0S ARE NOT EFFECTIVE IN PREVENTING PREGNANCY .OT SAFE $OES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS )NSUFlCIENT TIME FOR ADEQUATE PATIENT COUNSELINGEDUCATION %NCOURAGES IRRESPONSIBLE BEHAVIOR /THER PLEASE DESCRIBE ?????????????????????????????? 7HAT WOULD YOU LIKE TO LEARN MORE ABOUT EMERGENCY CONTRACEPTION 0LEASE CHECK ALL THAT APPLY 4YPES OF EMERGENCY CONTRACEPTION -ECHANISM OF ACTION OF EMERGENCY CONTRACEPTION %FFECTIVENESS )5$ AS EMERGENCY CONTRACEPTION 3AFETY OF %# AND HORMONAL CONTRACEPTIVES 0OSSIBLE SIDE EFFECTS !DVANCE DISTRIBUTION /THER PLEASE DESCRIBE ????????????????????????????? 7HERE DO YOU BELIEVE %#0S SHOULD BE OFFERED 0LEASE CHECK ALL THAT APPLY 'OVERNMENT HOSPITALS 0RIVATE HOSPITALS 'OVERNMENT HEALTH CENTERS 0RIVATE CLINICS #OMMUNITY HEALTH CENTERS -IDWIVES 0HARMACIES 3UPERMARKETS 3CHOOLS 6ENDING MACHINES /THER PLEASE DESCRIBE ?????????????????????????????? % 7HO DO YOU THINK SHOULD OFFER %#0S 0LEASE CHECK ALL THAT APPLY $OCTORS .URSES -ODULE % 3OCIAL WORKERS #OMMUNITY HEALTH PROMOTERS 0SYCHOLOGISTS 4OOLS -IDWIVES 0HARMACISTS /THER PLEASE DESCRIBE ????????????????????????????? (OW SATISlED ARE YOU WITH CURRENT GUIDELINES GOVERNING %#0 USE IN THIS COUNTRY 6ERY SATISlED SKIP TO QUESTION 3OMEWHAT SATISlED SKIP TO QUESTION .OT AT ALL SATISlED )F YOU ANSWERED h.OT AT ALL SATISlEDv TO THE PREVIOUS QUESTION WHAT OFlCIAL DOCUMENTATION WOULD MAKE IT EASIER FOR YOU TO PROVIDE %# INFORMATION TO WOMEN 0LEASE CHECK ALL THAT APPLY (EALTH AUTHORITIES GUIDELINES 0ROFESSIONAL ASSOCIATION RECOMMENDATIONS /THER PLEASE DESCRIBE ????????????????????????????? 0LEASE CHECK THE STATEMENT THAT BEST DESCRIBES YOUR CLIENTS h!LL OF MY CLIENTS KNOW THAT THERE IS A CONTRACEPTIVE METHOD THAT CAN PREVENT PREGNANCY AFTER UNPROTECTED SEXv h3OME OF MY CLIENTS KNOW THAT THERE IS A CONTRACEPTIVE METHOD THAT CAN PREVENT PREGNANCY AFTER UNPROTECTED SEXv h&EW OF MY CLIENTS KNOW THAT THERE IS A CONTRACEPTIVE METHOD THAT CAN PREVENT PREGNANCY AFTER UNPROTECTED SEXv 4O WHICH CLIENTS DO YOU OFFER THE METHOD 0LEASE CHECK ALL THAT APPLY !DOLESCENTS -ARRIED OR PARTNERED WOMEN 2APE CASES #LIENTS WHO USED A CONTRACEPTIVE METHOD #OMMERCIAL SEX WORKERS /THER PLEASE DESCRIBE ????????????????????????????? % 4OOLS $O YOU HAVE ANY MATERIALS FOR CLIENTS THAT DISCUSS EMERGENCY CONTRACEPTION 9ES -ODULE % .O $O NOT KNOW !RE THERE ANY WRITTEN GUIDELINES THAT YOU USE FOR EMERGENCY CONTRACEPTION 9ES .O $O NOT KNOW 7HAT INFORMATION WOULD MAKE IT EASIER FOR YOU TO PROVIDE %# INFORMATION TO WOMEN 0LEASE CHECK ALL THAT APPLY 7RITTEN MATERIALS AND RESOURCES DESIGNED FOR MEDICAL PROVIDERS 7RITTEN MATERIALS AND RESOURCES FOR WOMEN $ATASTUDIES ON EMERGENCY CONTRACEPTION EFFECTIVENESS AND SAFETY #OMPREHENSIVE EMERGENCY CONTRACEPTION TRAINING /THER PLEASE DESCRIBE ????????????????????????????? 7HAT ARE THE OBSTACLES TO INCREASED ACCESS TO THIS METHOD IN THIS COUNTRY IN GENERAL 0LEASE CHECK ALL THAT APPLY .ONE 2ELIGIOUS OPPOSITION (EALTH CENTER POLITICS /PPOSITION FOR HEALTH REASONS /PPOSITION FROM CIVIL GROUPS /PPOSITION FROM MEDICAL PERSONNEL ,ACK OF AWARENESS ON THE PART OF CLIENTS #OST !VAILABILITY ,EGAL RESTRICTIONS /THER PLEASE DESCRIBE ????????????????????????????? % $O YOU HAVE ANY IDEAS ABOUT HOW TO OVERCOME THESE OBSTACLES 0LEASE CHECK ALL THAT APPLY 4RAINING COURSES #LARIFYING ERRONEOUS PRECONCEPTIONS -ODULE % 'OVERNMENT NORMS )NFORMATION TO THE GENERAL POPULATION )NCORPORATION INTO COUNSELING ON FAMILY PLANNING METHODS 4OOLS /FFER IT AT A LOW COST 0ROVISION IN APPROPRIATE DOSES $EDICATED PRODUCT /VER THE COUNTER PROVISION %ASY ACCESS TO THE METHOD /THER PLEASE DESCRIBE ?????????????????????????????? 7HAT BARRIERS EXIST FOR YOUR CLIENTS TO ACCESS EMERGENCY CONTRACEPTION 0LEASE CHECK ALL THAT APPLY ,ACK OF AWARENESS ABOUT %#0S &EAR OF SIDE EFFECTS &EAR OF EFFECTS ON FETUS IF ALREADY PREGNANT #ULTURAL BARRIERS #OST /THER PROVIDERS RELUCTANCE TO REFER CLIENTS FOR %#0S #LINIC OR PHARMACY HOURS 4RANSPORTATION #LIENT FEAR OR EMBARRASSMENT ABOUT DISCUSSING THE NEED FOR %#0S /THER PLEASE DESCRIBE ????????????????????????????? )N YOUR COMMUNITY IS EMERGENCY CONTRACEPTION INFORMATION EASILY AVAILABLE FOR WOMEN 9ES .O )N YOUR COMMUNITY WHAT ORGANIZATIONS OR INFORMATION SOURCES CAN MOST EFFECTIVELY REACH WOMEN WITH INFORMATION ON HEALTH AND LIFESTYLE ISSUES 0LEASE CHECK THREE -EDICAL INSTITUTIONS -EDIA RADIO 46 NEWSPAPERS .ONGOVERNMENTAL /RGANIZATIONS 7OMENS ORGANIZATIONS PLEASE SPECIFY ???????????????? 0RINTED MATERIALS POSTERS BROCHURES BOOKLETS (OTLINE /THER PLEASE DESCRIBE ????????????????????????????? % 4OOLS 7HICH HEALTH PROVIDERS DO YOU CONSIDER ARE MOST IMPORTANT TO REACH WITH INFORMATION ABOUT EMERGENCY CONTRACEPTION 0LEASE NUMBER IN ORDER FROM MOST IMPORTANT TO LEAST -ODULE % IMPORTANT /BSTETRICIANSGYNECOLOGISTS .URSES (OSPITAL EMERGENCY ROOMS /THER MEDICAL PROVIDERS PLEASE SPECIFY ????????????????? &AMILY PLANNING COUNSELORS This material was adapted from provider surveys developed by PATH, Population Council of Mexico, and the Family Planning Association of Sri Lanka. % -ODULE % 4OOLS % 4OOLS )N $EPTH )NTERVIEW 'UIDE FOR +EY 2EPRODUCTIVE -ODULE % (EALTH !UTHORITIES $ATE DAYMONTHYEAR ??????????????????????? 4IME INTERVIEW BEGAN?????????? .AME OF FACILITATOR ?????????????????????????? 4IME INTERVIEW ENDED?????????? )NTRODUCTION )NTRODUCE YOURSELF AND EXPLAIN THE PURPOSE OF THE INTERVIEW )F A NOTETAKER IS PRESENT INTRODUCE THE NOTETAKER IT IS OFTEN HELPFUL TO HAVE A NOTETAKER WORKING IN COLLABORATION WITH THE INTERVIEWER /UR ORGANIZATION ;INSERT THE NAME OF ORGANIZATION HERE= IS SEEKING TO LEARN ABOUT REPRODUCTIVE HEALTH AUTHORITIES ATTITUDES TOWARD EMERGENCY CONTRACEPTIVE PILLS %#0S THEIR PERCEPTIONS OF THE NEED FOR %#0S AND BARRIERS TO PROVIDING HIGH QUALITY %#0 SERVICES AND THEIR OPINION ON TRAINING NEEDS OF THEIR STAFF AND THE BEST MECHANISM TO EXPAND %#0 INFORMATION 4HE INFORMATION YOU PROVIDE WILL BE USED TO DESIGN TRAINING CURRICULA AND MATERIALS ON EMERGENCY CONTRACEPTION AND OTHER CONTRACEPTIVE METHODS ,ET THE INTERVIEWEE KNOW THAT IF AT ANY TIME HESHE DOES NOT FEEL COMFORTABLE WITH A TOPIC HESHE IS NOT REQUIRED TO RESPOND 4HERE ARE NO WRONG OR RIGHT ANSWERS !SK INTERVIEWEE TO COMPLETE THE BACKGROUND INFORMATION FORM THEN PROCEED WITH THE INTERVIEW GUIDE % "ACKGROUND )NFORMATION &ORM FOR +EY 2EPRODUCTIVE (EALTH -EDICAL !UTHORITIES -ODULE % 4HIS FORM IS TO BE lLLED OUT BY THE REPRODUCTIVE HEALTH MEDICAL AUTHORITY BEFORE THE INTERVIEW BEGINS 0LEASE CHECK &EMALE -ALE (OW MANY STAFF ARE EMPLOYED BY YOUR INSTITUTION ???????? 4OOLS (OW MANY STAFF DO YOU DIRECTLY SUPERVISE ???????? 7HICH CONTRACEPTIVE METHODS DOES YOUR STAFF RECOMMEND MOST OFTEN #HECK UP TO lVE METHODS (ORMONAL METHODS /RAL CONTRACEPTIVE PILLS %MERGENCY CONTRACEPTIVE PILLS #ONTRACEPTIVE INJECTION #ONTRACEPTIVE IMPLANT "ARRIER METHODS -ALE CONDOM &EMALE CONDOM $IAPHRAGM /THER METHODS 6AGINAL SPERMICIDES 3AFE PERIOD RHYTHM 7ITHDRAWAL 3TERILIZATION )5$ $O YOU HAVE CONCERNS ABOUT THE METHODS LISTED BELOW #HECK ONLY WHERE YOU HAVE A CONCERN 1RWHIIHFWLYH 8QVDIH 2WKHU (ORMONAL METHODS /RAL CONTRACEPTIVE PILLS %MERGENCY CONTRACEPTIVE PILLS #ONTRACEPTIVE INJECTION #ONTRACEPTIVE IMPLANT 1RWHIIHFWLYH 8QVDIH 2WKHU "ARRIER METHODS -ALE CONDOM &EMALE CONDOM $IAPHRAGM % 4OOLS 1RWHIIHFWLYH 8QVDIH 2WKHU /THER METHODS -ODULE % 6AGINAL SPERMICIDES 3AFE PERIOD RHYTHM 7ITHDRAWAL 3TERILIZATION )5$ )F FOR ANY METHOD YOU CHECKED hOTHERv PLEASE EXPLAIN BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB 7HAT CONCERNS DO YOU HAVE ABOUT %#0S 0LEASE CHECK ALL THAT APPLY .O CONCERNS -ORAL OR RELIGIOUS OBJECTION 7OMEN WILL RELY ON %#0S AS A REGULAR FORM OF CONTRACEPTION 3IDE EFFECTSNAUSEA AND VOMITING )NEFFECTIVE IN PREVENTING PREGNANCY 3AFETY OF FETUS IF %#0S ARE NOT EFFECTIVE IN PREVENTING PREGNANCY .OT SAFE $OES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS )NSUFlCIENT TIME FOR ADEQUATE PATIENT COUNSELINGEDUCATION %NCOURAGES IRRESPONSIBLE BEHAVIOR /THER PLEASE DESCRIBE ????????????????????????????? )N YOUR OPINION WHAT ASPECTS RELATED TO EMERGENCY CONTRACEPTION SHOULD BE INCLUDED IN THE TRAINING FOR MEDICAL PROVIDERS 0LEASE CHECK ALL THAT APPLY 4YPES OF EMERGENCY CONTRACEPTION -ECHANISM OF ACTION OF EMERGENCY CONTRACEPTION %FFECTIVENESS )5$ AS EMERGENCY CONTRACEPTION 3AFETY OF EMERGENCY CONTRACEPTION AND HORMONAL CONTRACEPTIVES 0OSSIBLE SIDE EFFECTS !DVANCE DISTRIBUTION /THER PLEASE DESCRIBE ????????????????????????????? % )NTERVIEW 'UIDE FOR +EY 2EPRODUCTIVE (EALTH -EDICAL !UTHORITIES .OTE 7HEN POSSIBLE IT IS BEST TO HAVE TWO PEOPLE ATTEND THE INTERVIEW AN INTERVIEWER AND A -ODULE % NOTE TAKER 4HE INTERVIEWER SHOULD BEGIN BY SAYING 4ODAY ) WOULD LIKE TO DISCUSS WITH YOU SOME ISSUES THAT ARE IMPORTANT TO WOMEN IN ;INSERT YOUR COUNTRY HERE= !S A KEY MEDICAL AUTHORITY YOUR OPINIONS AND EXPERIENCE 4OOLS ARE IMPORTANT TO US AND WILL HELP US TO DESIGN TRAINING CURRICULUM AND MATERIALS FOR MEDICAL PROVIDERS %MERGENCY #ONTRACEPTION 3ERVICE 0ROVISION 0ERCEPTIONS AND !TTITUDES 7HAT DO YOU THINK ABOUT THE RATE OF UNINTENDED PREGNANCIES AND ABORTION RATE 0ROBE $O YOU THINK SOMETHING SHOULD BE DONE TO LOWER THOSE RATES 7HAT DO YOU AND YOUR STAFF DO TO MAKE IT HAPPEN 7HAT DO WOMEN DO IF THEY NEED TO GET HELP WITH PREVENTING PREGNANCY AFTER UNPROTECTED SEX 0ROBE $O MEDICAL PROVIDERS OF YOUR MEDICAL INSTITUTION OFFER EMERGENCY CONTRACEPTION TO THE WOMEN )F YES WHO ARE THEIR POTENTIAL EMERGENCY CONTRACEPTION CLIENTS 7HEN IS EMERGENCY CONTRACEPTION IS OFFERED (OW OFTEN DO THEY DISCUSS EMERGENCY CONTRACEPTION WITH THEIR CLIENTS )S EMERGENCY CONTRACEPTION INFORMATION CURRENTLY AVAILABLE TO WOMEN IN YOUR MEDICAL INSTITUTION )N WHAT FORM 7HAT DO YOU THINK ABOUT EMERGENCY CONTRACEPTION 0ROBE )N YOUR OPINION ARE %#0S PRIMARILY A FORM OF CONTRACEPTION OR A FORM OF ABORTION 7HY 7HAT ARE YOUR CONCERNS ABOUT %#0S 7HAT IS THE CURRENT OVERALL KNOWLEDGE AMONG PROVIDERS REGARDING %#0S )N YOUR MEDICAL INSTITUTIONS WHAT ARE MEDICAL PROVIDERS PERCEPTIONS OF A NEED FOR %#0S % 4OOLS "ARRIERS TO 0ROVIDING (IGH 1UALITY %MERGENCY #ONTRACEPTION 3ERVICES -ODULE % 7HAT BARRIERS IF ANY MIGHT PREVENT YOUR STAFF FROM ROUTINELY PROVIDING EMERGENCY CONTRACEPTION INFORMATION AND SERVICES TO WOMEN 7HY DONT READ LIST s 0ERSONAL MORAL OR RELIGIOUS OBJECTION s 7OMEN WILL RELY ON %#0S AS A REGULAR FORM OF CONTRACEPTION s 3IDE EFFECTSNAUSEA AND VOMITING s )NEFFECTIVE IN PREVENTING PREGNANCY s 3AFETY OF FETUS IF %#0S IS NOT EFFECTIVE IN PREVENTING PREGNANCY s .OT SAFE s $OES NOT PROTECT AGAINST SEXUALLY TRANSMITTED INFECTIONS s )NSUFlCIENT TIME FOR ADEQUATE PATIENT COUNSELINGEDUCATION s %NCOURAGES IRRESPONSIBLE BEHAVIOR s ,ACK OF SUPPORT OR OPPOSITION FROM LOCAL BOARD OF HEALTH 7HAT STANDARDS OF CARE MIGHT AFFECT PROVISION OF EMERGENCY CONTRACEPTION 0ROBE !RE YOU SATISlED WITH CURRENT GUIDELINES GOVERNING %#0 USE IN THIS COUNTRY 7HAT POLITICAL OR OTHER CONCERNS MIGHT LIMIT MORE EXTENSIVE DEVELOPMENT OF %MERGENCY CONTRACEPTION SERVICES OR INFORMATION DISSEMINATION IN THE COMMUNITIES YOU SERVE 7HAT lNANCIAL OR STAFF CONSTRAINTS COULD LIMIT THE EXPANSION OF EMERGENCY CONTRACEPTION INFORMATION PROVISION AND SERVICES IN YOUR MEDICAL INSTITUTION 7HAT DO YOU SEE AS THE MOST EFFECTIVE MECHANISMS TO EXPAND EMERGENCY CONTRACEPTION INFORMATION AND SERVICES TO WOMEN IN YOUR MEDICAL INSTITUTIONS DONT READ LIST s 3TAFF TRAINING s -ATERIALS s &UNDING s %#0 PRODUCT AVAILABILITY s !UTHORITY FOR STAFF TO PROVIDE %#0S s /THER 7HAT IS THE CAPACITY OF NONFAMILY PLANNINGREPRODUCTIVE HEALTH PERSONNEL PHARMACISTS FELDSHERS TEACHERS ETC TO SUPPLY %#0 INFORMATION 0ROBE 7HO ARE THE MOST IMPORTANT PROVIDERS TO BE REACHED WITH %#0 INFORMATION % #ONTRACEPTION 0ROVISION 7HICH CONTRACEPTIVE METHODS ARE RECOMMENDED TO WOMEN MOST OFTEN IN YOUR MEDICAL INSTITUTION 7HY DONT READ LIST -ODULE % s (ORMONAL METHODS s "ARRIER METHODS s /THER METHODS 4OOLS )NFORMATION4RAINING .EEDS 7HAT INFORMATION WOULD BE MOST HELPFUL IN ENABLING YOU AND YOUR STAFF TO PROVIDE EMERGENCY CONTRACEPTION INFORMATION AND SERVICES TO WOMEN DONT READ LIST s 7RITTEN MATERIALS AND RESOURCES DESIGNED FOR MEDICAL PROVIDERS s 7RITTEN MATERIALS AND RESOURCES FOR CLIENTS s $ATASTUDIES ON %#0 EFFECTIVENESS AND SAFETY s #OMPREHENSIVE %#0 TRAINING FOR SERVICE PROVIDERS s /THER )N YOUR MEDICAL INSTITUTIONS WHAT ARE MEDICAL PROVIDER TRAINING NEEDS IN FAMILY PLANNING AND CONTRACEPTION 7HY (OW WOULD YOU ORGANIZE THIS TRAINING (OW LONG SHOULD IT BE 7HAT ISSUES ON %#0S AND OTHER CONTRACEPTIVE METHODS SHOULD BE INCLUDED IN THE TRAINING )N YOUR OPINION WHICH MEDICAL PROVIDERS SHOULD BE TRAINED ON %#0S lRST OF ALL 7HERE DO YOU FEEL MOST WOMEN GET INFORMATION ABOUT FAMILY PLANNING DONT READ LIST s &RIENDS OR COWORKERS s &AMILY MEMBERS OR SPOUSE s -EDICAL PROVIDER s 46 s 2ADIO s "ILLBOARDS s -AGAZINES s .EWSPAPERS s "ROCHURE OR PRINTED MATTER s /THER % 4OOLS 7HAT SOURCE OF INFORMATION DO YOU THINK WOMEN CAN TRUST THE MOST AND WHY )N YOUR OPINION WHAT INFORMATIONAL MATERIALS DO WOMEN NEED lRST OF ALL -ODULE % 0ROBE )F YOU WERE TO HAVE EDUCATIONAL MATERIALS ON %MERGENCY #ONTRACEPTION OR OTHER CONTRACEPTIVE METHODS TO GIVE TO WOMEN WHAT WOULD MAKE THEM INTERESTING &ROM WHAT SOURCE WOULD YOU LIKE WOMEN TO LEARN MORE ABOUT %MERGENCY #ONTRACETPION AND OTHER CONTRACEPTIVES )F MEDIA WHAT KIND OF MEDIA )F PEOPLE WHAT PEOPLE )F PRINTED MATERIALS WHAT KIND DESCRIBE 7HY DO YOU PREFER THIS SOURCE OF INFORMATION 7HAT MAKES THIS SOURCE TRUSTWORTHY 7HAT MESSAGES ON %#0S ARE MOST IMPORTANT TO PASS TO THE WOMEN #ONCLUSION 7E WILL CLOSE TODAYS INTERVIEW WITH SOME lNAL THOUGHTS 7E WANT TO THANK YOU FOR SHARING YOUR IDEAS AND OPINIONS TODAY $O YOU HAVE ANYTHING YOU WOULD LIKE TO ADD (OW DO YOU FEEL ABOUT OUR DISCUSSION $O YOU HAVE ANY SUGGESTIONS FOR IMPROVING THE INTERVIEW PROCESS (ERE IS CONTACT INFORMATION IN CASE YOU HAVE ANY MORE QUESTIONS OR COMMENTS YOU WISH TO SHARE AFTER THE INTERVIEW 4HE INTERVIEWER SHOULD THANK THE INTERVIEWEE AND TELL THEM THAT THEIR CONTRIBUTION HAS BEEN VERY VALUABLE %MPHASIZE THAT THIS INFORMATION IS BEING USED DEVELOP TRAINING AND INFORMATION MATERIALS ON %#0S AND OTHER CONTRACEPTIVES !FTER THE )NTERVIEW )MMEDIATELY AFTER THE DISCUSSION s &ACILITATOR AND NOTETAKER DEBRIEF TOGETHER s -AKE A NOTE OF SUGGESTED CHANGES IN THE WAY THE INTERVIEW IS CONDUCTED OR IN THE TECHNICAL ASPECTS OF THE LOGISTICS s 2EVISE EDIT AND COMPLETE NOTES 4HAT AFTERNOON OR EVENING NOTETAKER ANDOR FACILITATOR DO NOT DELAY THIS STEP s 2EVIEW THE NOTES MAKE CLARIlCATION NOTES AS NECESSARY s #OMPLETE AND CORRECT THE NOTES IN ACCORDANCE WITH THE RECORDING s 3UMMARIZE IMPORTANT THEMES OR POINTS MADE IN THE SUMMARY SECTION OF THE INTERVIEW s 3END THE TAPE AND THE CLARIlCATION NOTES TO BE TRANSCRIBED s -EET WITH THE OTHER PROJECT STAFF TO DISCUSS HOW THE INTERVIEWS ARE GOING 3HARE SUGGESTIONS FOR CHANGES TO THE GUIDE OR ABOUT THE INTERVIEWS 4HIS MATERIAL DEVELOPED BY 0!4( % -ODULE % 4OOLS % 4OOLS -YSTERY 3HOPPER 3URVEY -ODULE % 'UIDELINES .OTE 4HIS PAGE IS FOR USE IN PREPARING FOR THE PHARMACY VISIT )T SHOULD NOT BE USED WHILE IN THE PHARMACY 4HE FOLLOWING ARE TWO SCENARIOS ONE FOR A FEMALE SHOPPER ONE FOR A MALE SHOPPER FOR USE IN THE PHARMACY 4HE ATTACHED PAGE IS TO BE USED BY THE INTERVIEWER WHO WILL INTERVIEW THE MYSTERY SHOPPER AFTER HESHE HAS lNISHED HISHER VISIT Female Mystery Shopper: 9ESTERDAY ) HAD SEX AND DIDNT USE ANY METHOD OF CONTRACEPTION ) AM WORRIED ABOUT GETTING PREGNANT AND ) WOULD LIKE TO KNOW IF THERE IS SOMETHING ) CAN DO TO PREVENT PREGNANCY Male Mystery Shopper: ) HAD SEX TWO DAYS AGO 7E ALWAYS USE CONDOMS BUT THIS TIME THE CONDOM BROKE ) AM WORRIED THAT MY GIRLFRIEND WILL GET PREGNANT )S THERE ANYTHING WE CAN DO TO PREVENT THIS )F THE COUNTER STAFF PERSON OR PHARMACIST SAYS 9%3 !FTER THE EMPLOYEE HAS TOLD YOU ABOUT WHAT YOU CAN DO TO PREVENT PREGNANCY ASK THE FOLLOWING TWO QUESTIONS TO HELP INITIATE A DISCUSSION ABOUT SEXUALLY TRANSMITTED INFECTIONS AND ONGOING CONTRACEPTION )F THE PHARMACY STAFF MEMBER PROVIDES THIS INFORMATION WITHOUT BEING ASKED THERE IS NO NEED TO ASK THE PROMPTING QUESTIONS s 7HAT ELSE CAN HAPPEN TO ME OR MY GIRLFRIEND IF MYSTERY SHOPPER IS MALE s )S THERE ANYTHING ELSE ) NEED TO KNOW )F THE COUNTER STAFF PERSON OR PHARMACIST SAYS ./ CONTINUE BY SAYING ) HAD A FRIEND WHO SAID THERE WERE PILLS ) MY GIRLFRIEND COULD TAKE DO YOU KNOW ANYTHING ABOUT THAT /R ) SEE THE POSTER IN YOUR WINDOW THAT SAYS SOMETHING ABOUT EMERGENCY CONTRACEPTION 7HAT IS THAT )F THE FRONTLINE STAFF MEMBER OR PHARMACIST 34),, SAYS ./ ASK $O YOU KNOW FROM WHOM OR WHERE ) MAY GET INFORMATIONHELP .OTE -YSTERY SHOPPER SHOULD BE SURE TO EMPHASIZE HESHE IS INTERESTED IN 02%6%.4).' PREGNANCY TO AVOID ANY POTENTIAL CONFUSION WITH ABORTIFACIENTS % -YSTERY 3HOPPER 2ECORDING 3HEET .AME OF MYSTERY SHOPPER?????????????????????? $ATE?????????????????????? -ODULE % .AME OF INTERVIEWER ????????????????????????????????????????????????????????? 1DPHRISKDUPDF\ 4OOLS $GGUHVVRISKDUPDF\ 6H[RISHUVRQVSRNHQWRLQSKDUPDF\ 0DOH )HPDOH 7HAT WAS THE GENERAL ATTITUDE OF THE PERSON WHO 0OSITIVE FRIENDLY WELCOMING ATTENTIVE ATTENDED YOU AT THE "%')..).' OF THE VISIT )NDIFFERENT .EGATIVE JUDGMENTAL IMPATIENT RUDE 7HAT WAS THE GENERAL ATTITUDE OF THE PERSON WHO 0OSITIVE FRIENDLY WELCOMING ATTENTIVE ATTENDED YOU AT THE %.$ OF THE VISIT )NDIFFERENT .EGATIVE JUDGMENTAL IMPATIENT RUDE )F THE STAFF PERSON HAD A POOR ATTITUDE ARE THERE /THER CUSTOMERS REASONS OR THINGS YOU OBSERVED THAT MIGHT HAVE AFFECTED HISHER ATTITUDE -ANY CUSTOMERS #IRCLE ALL THAT ARE MENTIONED %MBARRASSED 4OO MANY QUESTIONS $IDNT KNOW HOW TO ANSWER QUESTIONS "ORED /THER ???????????????????????????????? 3PECIFY $ONT KNOW .OT APPLICABLE +RZORQJZDVWKHLQWHUDFWLRQZLWKWKHVWDII SHUVRQ" BBBBBBBBBBPLQXWHV 7ERE YOU ASKED WHEN YOU HAD YOUR YOUR % 4OOLS 7ERE YOU ASKED WHETHER THE PERIOD WAS NORMAL IN LENGTH AND TIMING 1R -ODULE % :HUH\RXRIIHUHGDQ\WUHDWPHQWVRUPHGLFDWLRQV" 7HAT WERE YOU OFFERED %MERGENCY CONTRACEPTION DEDICATED PRODUCT ;INSERT SITE SPECIlC NAME= ??????????????????????????????????????? /RAL CONTRACEPTIVES FOR USE AS EMERGENCY CONTRACEPTION /THER ???????????????????????????????? 3PECIFY BRAND NAME (OW MUCH DID IT COST BBBBBBBBBB $ID THE STAFF PERSON EXPLAIN WHAT THE PRODUCT WAS $ID THE STAFF PERSON EXPLAIN HOW EFFECTIVE THE $ID THE STAFF PERSON DISCUSS SIDE EFFECTS 9RPLWLQJ ,UUHJXODUEOHHGLQJ /THER ???????????????????????????????? 3PECIFY % 'LG\RXREVHUYHDQ\SULQWHGPDWHULDOVDERXW ??????????????????????????????? ??????????????????????????????? 4OOLS ??????????????????????????????? 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Content and format for this tool were adapted from mystery shopper surveys developed by PATH and the Reproductive Health Research Unit of the University of Witwatersrand, South Africa. % -ODULE & 2EGULATION 0ROCUREMENT AND $ISTRIBUTION OF A 0ROGESTIN /NLY %#0 /BJECTIVE 4O SECURE AND DISTRIBUTE AN ADEQUATE SUPPLY OF A HIGH QUALITY PROGESTIN ONLY EMERGENCY CONTRACEPTIVE PILL %#0 PRODUCT 4HE FOLLOWING TOPICS ARE DISCUSSED IN THIS MODULE s 0ROJECT 2EGULATION n .ATIONAL REGULATORY AUTHORITY .2! n 0RODUCT REGISTRATION s 0RODUCT 0ROCUREMENT n %STIMATING INITIAL QUANTITY OF %#0S n /NGOING MONITORING OF %#0 DEMAND n 2OLE OF PROGRAM STAFF IN PROCUREMENT CYCLE n -ANAGING THE PROCUREMENT PROCESS n %NSURING PRODUCT QUALITY n -ONITORING SUPPLIER PERFORMANCE s $ISTRIBUTION n $ISTRIBUTION SYSTEMS n 3ERVICE DELIVERY OPTIONS 4OOLS 0ROVIDED AT THE %ND OF 4HIS -ODULE 0OTENTIAL -ARKET FOR %#0S ! "ASIC $EMAND -ODEL LNFORMATION TO )NCLUDE IN A ,EVONORGESTREL /NLY %#0 0ACKAGE )NSERT 3AMPLE 0ROCUREMENT 3PECIlCATION ,EVONORGESTREL /NLY %#0S 0REFERENTIAL 0RICING FOR 0UBLIC 3ECTOR !GENCIES 0ROCUREMENT 4HROUGH )NTERNATIONAL 0ROCUREMENT 3ERVICES & & -ODULE & 0RODUCT 2EGULATION !PPROVAL OF PRODUCT LABELING THE PACKAGE INSERT AND USE INS s 2EGISTRATION OF DRUGS MEDICINES AND OTHER HEALTH PRODUCTS F s /VERSIGHT OF PRODUCT MANUFACTURER IMPORTER AND DISTRIBUTOR s AND ENFORCED )N GENERAL MAJOR .2! AUTHORITY TYPICALLY INCLUDE ADMINISTRATIVE AGENCY TO ENSURE THAT REGULATORY REQUIREMENTS A )N MOST COUNTRIES AN .2! IS ESTABLISHED BY NATIONAL LEGISLATIO .ATIONAL REGULATORY AUTHORITY .2! THE RESOURCES AVAILABLE LEGISLATIVE REQUIREMENTS )N ADDITION THE DEGREE OF OVERSIGHT AND PROCESSES IN ANY SPECIlC COUNTRY THEY WILL VARY ACCORDING PROCESS 7HAT IS PRESENTED HERE IS THE GENERALLY ACCEPTED MODEL IS A BRIEF SUMMARY OF THE REGULATORY FUNCTION FOLLOWED BY A DE ENSURE THE SAFETY EFlCACY AND QUALITY OF ALL MEDICINES PROVID WITH WHICH PRODUCTS MUST COMPLY 4HE OVERALL PURPOSE OF REGULAT IDENTIlES THE REGISTRATION LICENSING MARKET AUTHORIZATION AN REGULATORY REQUIREMENTS 4HESE REQUIREMENTS ARE BASED ON NATION )N MOST COUNTRIES ALL MEDICINES INCLUDING CONTRACEPTIVES ARE EVENT THE DOSE WOULD BE ONE MG TABLET -ANUFACTURERS MAY INTRODUCE A SINGLE DOSE TABLET FOR EMERGENCY ORAL CONTRACEPTIVE ETHINYL ESTRADIOLLEVONORGESTREL MG LEVONORGESTREL FOR EMERGENCY CONTRACEPTION INSTEAD OF TW /RGANIZATION 7(/ REVISED THE %SSENTIAL $RUGS ,IST TO RECOMMEN FEWER SIDE EFFECTS THAN COMBINED ESTROGENPROGESTIN %#0S )N PLANNING PROGRAMS BECAUSE THEY ARE MORE EFFECTIVE CAN BE TAKEN 0ROGESTIN ONLY %#0S CONTAINING LEVONORGESTREL ARE THE PREFERRED HIGH QUALITY OF THE %#0 PRODUCT THEY PLAN TO PROVIDE UNDERSTAND AND SUPPORT THESE STEPS TO ENSURE TIMELY PROVISION PROCESS OF INCORPORATING EMERGENCY CONTRACEPTION INTO A PROGRAM A PROGESTIN ONLY %#0S 2EGULATION PROCUREMENT AND DISTRIBUTIO WELL AS SPECIlC TOOLS TO HELP A FAMILY PLANNING PROGRAM PREPAR PRODUCT TO ENSURE THEY ARE ACCURATE COMPLETE AND BALANCED ,.' MG &ORMULATION PER PILL 0ROGESTIN /NLY $EDICATED %#0S 0LAN " 0OSTINOR 6IKELA OMN"AD.MS3INGLE $OSE #OMMON "RAND .AMES ,EVONELLE .OR,EVO 4HIS MODULE PROVIDES INFORMATION AS D INSPECTION REQUIREMENTS AND ENFORCEMENT DEPENDS ON ED TO THE PUBLIC &OLLOWING SUBJECT TO NATIONAL N TO SERVE AS AN RE PROPERLY IMPLEMENTED ADEQUATE QUANTITIES AND SCRIPTION OF THE REGISTRATION TO NATIONAL POLICY AND E FOR ROUTINE PROVISION OF FOR THESE FUNCTIONS PRODUCT FOR FAMILY OR USE IN COUNTRY N ARE CRITICAL STEPS IN THE S TRUCTIONS THAT ACCOMPANY A O DOSES OF THE COMBINED LICENSES IN ONE DOSE AND HAVE THE 7ORLD (EALTH AL LEGISLATION THAT ORY REQUIREMENTS IS TO 0ROGRAM PLANNERS MUST CONTRACEPTION IN THIS D A SINGLE DOSE OF NUMBER OF TABLETS -ODULE & s $ETERMINATION OF WHETHER A PRODUCT WILL BE PROVIDED BY PHYSICIAN PRESCRIPTION ONLY OR WILL BE WIDELY AVAILABLE OVER THE COUNTER IE WITH NO PRESCRIPTION REQUIRED s 0OSTMARKETING SURVEILLANCE TO MONITOR PROBLEMS WITH ADVERSE REACTIONS AND PRODUCT QUALITY 0RODUCT REGISTRATION 0RODUCT REGISTRATION IS ONE OF THE CRITICAL FUNCTIONS THAT ALMOST ALL .2!S PERFORM 4HE PROCESS OF REGISTERING A PRODUCT VARIES ACCORDING TO NATIONAL REQUIREMENTS BUT CERTAIN CLINICAL MANUFACTURING AND DISTRIBUTION INFORMATION IS TYPICALLY REQUIRED 4HE MOST COMMONLY REQUIRED INFORMATION IS CONTAINED IN THE MANUFACTURERS PRODUCT DOSSIER WHICH COVERS s 0RODUCT FORMULATION s -ANUFACTURING PROCESS s 0ACKAGING REQUIREMENTS s #LINICAL RESEARCH RESULTS s 0RODUCT QUALITY TESTS s /THER PRODUCT SPECIlC INFORMATION )N MOST CASES THE PRODUCT MANUFACTURER WORKING WITH ITS LOCAL DISTRIBUTOR IS RESPONSIBLE FOR REGISTERING ITS PRODUCT WITH THE .2! AND WILL SUBMIT THE REQUIRED DOCUMENTS TO THE .2! FOR PRODUCT REGISTRATION &ACILITATION OF THE 2EGISTRATION 0ROCESS 0ROGRAM PLANNERS INTERESTED IN INTRODUCING A NEW %#0 INTO A FAMILY PLANNING PROGRAM CAN HELP FACILITATE THE REGISTRATION PROCESS BY s #ONTACTING THE MANUFACTURER AND ITS IN COUNTRY DISTRIBUTOR OR HELPING TO IDENTIFY A DISTRIBUTOR WHERE NONE EXISTS TO DEMONSTRATE THAT A MARKET FOR THE %#0 PRODUCT EXISTS s "UILDING SUPPORT AMONG THOSE WHO INmUENCE POLICY SUCH AS COMMUNITY LEADERS AND MEDICAL PROVIDERS AND THOSE WHO INmUENCE REGISTRATION OF NEW DRUGSIN PARTICULAR DECISION MAKERS AT THE MINISTRY OF HEALTH AND THE .2!BY INCLUDING THEM IN INITIAL ADVOCACY AND PLANNING ACTIVITIES 4HEIR PARTICIPATION IS CRITICAL AS THEIR ADVICE AND COLLABORATION CAN HELP ENSURE TIMELY PROGRESS THROUGH THE REGISTRATION PROCESS s 0ROVIDING KEY INFORMATION ABOUT %#0S TO LEADERS AND DECISION MAKERS FOR EXAMPLE THE ROLE %#0S CAN PLAY IN PREVENTING UNINTENDED PREGNANCY AND ABORTION THE MECHANISM OF ACTION OF %#0S EVIDENCE BASED INFORMATION ON THE SAFETY AND EFlCACY OF %#0S AND THE FACT THAT PROGESTIN ONLY %#0S ARE INCLUDED IN 7(/S %SSENTIAL $RUGS ,IST 4HIS INFORMATION IS PROVIDED IN -ODULE ! )NFORMATION FOR 0OLICY -AKERS & & -ODULE & 4HE INSERT SHEET USUALLY CONTAINS THE FOLLOWING INFORMATION MANUFACTURER THEREFORE PROVIDES A PACKAGE INSERT SHEET WITH EAC FOR CONSUMER USE CONTAIN PRINTED MATERIALS WITH INFORMATION ABO 2EGULATORY AUTHORITIES REQUIRE THAT DRUGS MEDICINES AND CONTR 0ACKAGE INSERT SHEET AND CLIENT USE INSTRUCTIONS #ONTENTS AND QUANTITY s -ANUFACTURERS NAME OR SYMBOL s $ATE OF MANUFACTURE s %XPIRATION DATE MONTH AND YEAR s ,OTBATCH NUMBER s 0RODUCTBRAND NAME s FOLLOWING COMMON LABELING INFORMATION REQUIRED FOR THE INDIVIDUAL BLISTER REQUIREMENTS WILL VARY FROM COUNTRY TO COUNTRY HOWEVER FOR %# BEFORE IT CAN BE APPROVED FOR REGISTRATION AND IN COUNTRY USE 2EGULATORY AUTHORITIES REQUIRE A PRODUCTS PRIMARY PACKAGE TO B 0RODUCT LABELING )F A WOMAN WHO WAS ALREADY PREGNANT TOOK %#0S IT WOULD NOT H s #ONTRAINDICATIONS RELEVANT TO FREQUENT LONG TERM USE LISTED s -EDICAL INTERVENTION IS NOT NECESSARY TO ENSURE SAFE AND CORR s 3TUDIES HAVE SHOWN THAT WOMEN ARE ABLE TO FOLLOW THE INSTRUCT s %#0S ARE SAFE FOR SELF MEDICATION AS THERE ARE NO SERIOUS SI s CONTRACEPTIVE METHOD SPECIlCALLY IN REGARD TO THE FOLLOWING KE FACT THAT %#0S HAVE GAINED /4# STATUS IN MANY COUNTRIESSPEAK T $RUG !DMINISTRATION 4HE CRITERIA THAT DETERMINE /4# STATUS FOC PROGESTIN ONLY DEDICATED %#0 IS CURRENTLY UNDER CONSIDERATION B FOR /4# STATUSIE EXEMPTION FROM PRESCRIPTION DISPENSING REQ INCLUDING "ELGIUM &RANCE )TALY .ORWAY AND THE 5NITED +INGDO ONLY %#0S ARE AVAILABLE WITHOUT PRESCRIPTION IN MANY COUNTRIES AVAILABLE /4# IN PHARMACIES HAS BEEN DECIDED DIFFERENTLY IN VAR 4HE ISSUE OF WHETHER A DEDICATED %#0 PRODUCT SHOULD BE PROVIDED 0RESCRIPTIVE OR OVER THE COUNTER /4# STATUS WOMEN CAN INDEPENDENTLY DETERMINE WHETHER THEY NEED TO USE %#0S INAPPROPRIATE USE COULD NOT CAUSE SERIOUS HARM HAVE NO IMPORTANT DRUG INTERACTIONS WITHOUT JUSTIlCATION AS %#0 TREATMENT IS OF SHORT DURATION %# OF REGULAR ORAL CONTRACEPTIVES ARE SOMETIMES INCLUDED ON %#0 PA THERE ARE NO DOCUMENTED MEDICAL CONTRAINDICATIONS FOR EMERGENCY TREATMENT CORRECTLY 0RODUCT PACKAGE LABELING ACEPTIVES PACKAGED DE EFFECTS Y ISSUES IN THE PACKAGE LABELING E PROPERLY LABELED PACK SHOULD INCLUDE THE H CONSUMER UNIT PACKAGE IN THE %UROPEAN 5NION IOUS COUNTRIES 0ROGESTIN US ON SAFETYAND THE Y THE 53 &OOD AND ECT USE OF %#0S BECAUSE UT THE PRODUCT 4HE 0 PRODUCTS THE MOST UIREMENTSFOR A M !N APPLICATION IONS AND SELF ADMINISTER THE BY PRESCRIPTION ONLY OR 0S ARE NOT TOXIC AND THEY O THE SAFETY OF THIS ARM THE FETUS CKAGINGBUT THIS IS CONTRACEPTION AND AN OVERDOSE OR AND -ODULE & s !CTIVE INGREDIENT s /THER INGREDIENTS EXCIPIENTS s 0RECAUTIONS AND CONTRAINDICATIONS FOR USE s 5SE INSTRUCTIONS s 3IDE EFFECTS s 3TORAGE INSTRUCTIONS 4HE PACKAGE INSERT SHEET SHOULD BE EASY FOR CLIENTS TO READ AND UNDERSTAND )NFORMATION THAT SHOULD BE INCLUDED IN A LEVONORGESTREL ONLY %#0 PACKAGE INSERT IS PROVIDED IN THE TOOLS SECTION OF THIS MODULE 0RODUCT 0ROCUREMENT 0ROCUREMENT IS THE PROCESS BY WHICH %#0 PRODUCTS ARE REQUESTED AND OBTAINED FROM MANUFACTURERS AND DISTRIBUTORS 2EGARDLESS OF WHETHER THE REQUESTING INSTITUTION IS A NONGOVERNMENTAL ORGANIZATION OR A GOVERNMENT AGENCY THE STANDARD PROCUREMENT PROCESS IS TRADITIONALLY MANAGED BY DEDICATED PROCUREMENT PERSONNEL AND INCLUDES #ONlRMING THE QUANTITY REQUIRED -ANAGING THE PROCUREMENT PROCESS %NSURING PRODUCT QUALITY -ONITORING SUPPLIER PERFORMANCE 0ROGRAM PLANNERS SUPPORT THIS PROCESS BY PROVIDING INFORMATION ON PROGRAM REQUIREMENTS SUCH AS QUANTITIES DELIVERY SCHEDULE AND OTHER SPECIlC PROGRAM NEEDS 4HIS MODULE PROVIDES EXTENSIVE INFORMATION ABOUT PROCUREMENT -UCH OF THIS INFORMATION WILL ACTUALLY BE USED ONLY BY THOSE INVOLVED IN THE PROCUREMENT PROCESS (OWEVER THIS INFORMATION ALSO CAN BE USEFUL AS AN OVERVIEW FOR DECISION MAKERS OF WHAT IS INVOLVED IN SUPPLYING A PROGRAM WITH THIS CONTRACEPTIVE METHOD WHICH DIFFERS FROM OTHER METHODS DUE TO ITS IRREGULAR USE BY CLIENTS %STIMATING INITIAL QUANTITY OF %#0S "ECAUSE %#0S ARE NOT INTENDED FOR REGULAR USE TRADITIONAL TECHNIQUES FOR ESTIMATING DEMAND ARE LIKELY NOT TO BE APPROPRIATE 4HERE CURRENTLY DOES NOT APPEAR TO BE A CONSISTENTLY USED METHOD FOR FORECASTING DEMAND PARTLY DUE TO THE FACT THAT DEDICATED %#0 PRODUCTS HAVE ONLY RECENTLY BEGUN TO BE WIDELY AVAILABLE 7HEN INITIATING PROVISION OF %#0S THE EXPERIENCE OF A SOCIAL MARKETING ORGANIZATION HAS INDICATED THAT A SIMPLE CALCULATION CAN BE USEFUL 4HE ORGANIZATION PURCHASES INITIAL SUPPLIES OF %#0S BASED ON AN ESTIMATE OF TO PERCENT OF THE VOLUME OF ORAL CONTRACEPTIVES REGULARLY SOLD IN THE COUNTRYADJUSTING TOWARD THE LOW OR HIGH END DEPENDING ON HOW WELL KNOWN %#0S ARE IN THE COUNTRY AND THE COUNTRYS STATISTICS ON CONTRACEPTIVE PREVALENCE BY METHOD !S THIS INITIAL SUPPLY OF %#0S IS USED STAFF RECORD DATA ON THE NUMBER OF CLINICS OR PHARMACIES SUPPLIED AND THE NUMBER OF %#0 PACKETS IN THE DISPENSERS SOLD TO THESE LOCATIONS 4HESE SALES DATA ARE THEN USED FOR FORECASTING FUTURE DEMAND & & -ODULE & DISCUSSED BELOW 3OME OF THE KEY FACTORS THAT DETERMINE THE PROCUREMENT METHOD T WITH PROCUREMENT PERSONNEL TO OBTAIN ACCURATE ESTIMATES OF THE PRODUCT )T IS THEREFORE IMPORTANT FOR PLANNING PURPOSES FOR ENTIRE PROCUREMENT CYCLE FROM INITIAL IDENTIlCATION OF REQUIRE PRODUCT IS NEEDED 4HESE FACTORS ALSO AFFECT THE LENGTH OF TIM NUMBER OF MANUFACTURERS AND THE PROGRAM DELIVERY SCHEDULE REQU GOVERNING USE OF FUNDS EG WHETHER IT IS DONOR PROVIDED OR G SUPPLY DEPENDS ON SEVERAL FACTORS INCLUDING THE FUNDING SOURCE 4HE PROCUREMENT PROCESS A FAMILY PLANNING PROGRAM WILL USE TO E -ANAGING THE PROCUREMENT PROCESS RESPONSIBLE FOR %#0 PROCUREMENT MAINTAIN A CONTINUOUS COLLABORATIVE WORKING RELATIONSHIP WITH CYCLE OF PROCUREMENT &OR THESE REASONS IT IS IMPORTANT FOR PR AND USE IT IN EVALUATING SUPPLIER PERFORMANCE AS THEY CONSIDER PROBLEMS ENCOUNTERED IN THE lELD 4HE PROCUREMENT UNIT WILL DOC CHANGES REQUESTED BY THE SUPPLIER 0ROGRAM STAFF ALSO PROVIDE I IN ASSISTING PROCUREMENT STAFF TO PROMPTLY RESPOND TO PRODUCT A PROGRAM REQUIREMENTS AND DELIVERY SCHEDULE NEEDS THEY ALSO SER 0ROGRAM STAFF PLAY AN IMPORTANT ROLE IN THE PROCUREMENT CYCLE 2OLE OF PROGRAM STAFF IN PROCUREMENT CYCLE NEEDED PROGRAM MANAGERS ARE RESPONSIBLE FOR PROVIDING THEM WITH A FORE NEXT PROCUREMENT CYCLE !S THE PROCUREMENT UNIT PLANS FOR THE N CONSUMPTION AND EXTRAPOLATIONS OF THOSE PATTERNS FOR THE TIME P AND FACTORED INTO THE RESUPPLY PROCESS 0ROJECTIONS CAN BE BASE TO CAMPAIGNS FOR INCREASED AWARENESS OF THE METHOD THESE TREND REQUIREMENTS -ONITORING USE SHOULD INCLUDE NOTING TRENDS SUCH USE OVER ONE YEAR WILL ESTABLISH DEMAND DATA THAT CAN BE USED I THE INITIAL SUPPLY WAS INADEQUATE AND A STOCKOUT IS POSSIBLE - %#0 PRODUCT SHOULD BE REORDERED EVEN BEFORE THE NEXT CYCLE IF M MAKE REORDERING BEFORE THE NEXT PROCUREMENT CYCLE DIFlCULT HOW AND COMPILING DATA THAT CAN BE USED TO FORECAST FUTURE DEMAND STOCK DEPLETION OVER TIME #AREFUL MONITORING IS CRITICAL FOR B /NCE AN INITIAL SUPPLY OF %#0S HAS BEEN RECEIVED IT IS IMPORTA /NGOING MONITORING OF %#0 DEMAND SUPPLY REQUIRED FOR AN INITIAL ORDER BE NEEDED AND THEN TO RElNE THIS lRST ESTIMATE TO PRODUCE A MOR -ODEL 4HE SPREADSHEET ENABLES THE USER TO CALCULATE AN ESTIMA INCLUDED IN THE TOOLS SECTION OF THIS MODULE 0OTENTIAL -ARKET ! SPREADSHEET FOR ESTIMATING THE QUANTITY OF %#0S A PROGRAM SHO )NITIAL DEMAND ESTIMATION PROGRAM STAFF TO WORK CLOSELY OTH AVOIDING STOCKOUTS E IT WILL TAKE TO COMPLETE THE OGRAM STAFF TO ESTABLISH AND MENTS TO lNAL DELIVERY OF FOR %#0S ! "ASIC $EMAND OVERNMENT FUNDED THE SUPPLIERS FOR THE NEXT ONITORING AND RECORDING NT TO MONITOR USE AND D ON THE PATTERNS OF %#0 NFORMATION ON PRODUCT N FORECASTING FUTURE ND DELIVERY SCHEDULE )N ADDITION TO IDENTIFYING ERIOD COVERED BY THE &UNDING CYCLES MAY PROCUREMENT PERSONNEL PROCUREMENT CYCLE TIME E REALISTIC ESTIMATE OF %#0 AND RELEVANT REQUESTS TED MAXIMUM THAT COULD EXT PROCUREMENT CYCLE S SHOULD BE QUANTIlED VE AS A TECHNICAL RESOURCE AS INCREASED USE DUE ONITORING INDICATES THAT ULD INITIALLY PURCHASE IS O BE USED ARE BRIEmY UMENT THIS INFORMATION EVER IF IT IS FEASIBLE CAST OF %#0 PRODUCT NSURE AN %#0 PRODUCT IREMENTS WHEN THE -ODULE & &UNDING SOURCE $ONOR PROVIDED 7HEN %# PRODUCTS ARE DIRECTLY PROVIDED BY A DONOR THE PROCUREMENT PROCESS IS SHORTENED BECAUSE SEVERAL STEPS IN THE PROCESS ARE ELIMINATED REQUESTING QUOTES NEGOTIATING CONTRACTS WITH SUPPLIERS ETC )F THE DONOR PROVIDES DIRECT FUNDING TO THE RESPONSIBLE GOVERNMENT PROCUREMENT AGENCY THESE STEPS WILL HAVE TO BE INCLUDED THE PROCESS WILL TAKE MORE TIME AND ANY SPECIAL PROCUREMENT REQUIREMENTS IMPOSED BY THE DONOR MUST BE COMPLIED WITH $ONOR AGENCIES VARY IN THEIR APPROACH TO EMERGENCY CONTRACEPTION AS SEEN IN THE POLICIES OF TWO OF THE MAJOR CONTRACEPTIVE DONOR AGENCIES THE 5NITED 3TATES !GENCY FOR )NTERNATIONAL $EVELOPMENT 53!)$ AND THE 5NITED .ATIONS 0OPULATION &UND 5.&0! "OTH 53!)$ AND 5.&0! ENDORSE COUNTRY PROGRAMS ROUTINE PROVISION OF %#0S AS ONE OF THE CONTRACEPTIVE OPTIONS OFFERED IN THE METHOD MIX 4HROUGH 53!)$ HOWEVER HAS NOT PROVIDED A DEDICATED PROGESTIN ONLY %#0 PRODUCT TO COUNTRY PROGRAMS 5.&0! PROVIDES DEDICATED %#0S TO REQUESTING COUNTRIES -ODULE ! )NFORMATION FOR 0OLICY -AKERS DISCUSSES THE %#0 SUPPORT AVAILABLE THROUGH THESE AGENCIES 5.&0! ALSO OFFERS A SERVICE UNDER WHICH THEY PROCURE AND SHIP DEDICATED %#0S TO SUPPORT A COUNTRY PROGRAM FOR A FEE )NFORMATION ON 5.&0! PROCUREMENT SERVICES IS PROVIDED IN THE TOOLS SECTION OF THIS MODULE 'OVERNMENT FUNDED 'OVERNMENT FUNDED PROCUREMENT MUST COMPLY WITH NATIONAL PROCUREMENT REQUIREMENTS WHICH IN MOST CASES FOLLOW A TRADITIONAL PUBLIC SECTOR PROCESS THAT INCLUDES IDENTIFYING REQUIREMENTS OBTAINING BUDGET APPROVAL PREPARING BIDDING DOCUMENTS WHICH INCLUDE SPECIlCATIONS QUALITY ASSURANCE AND INSPECTION REQUIREMENTS PROPOSED TERMS AND CONDITIONS REQUESTING BIDS OR QUOTES EVALUATING BIDS OR QUOTES NEGOTIATING AND AWARDING CONTRACT ARRANGING FOR SHIPMENT AND PRODUCT INSPECTION !S MENTIONED ABOVE PROGRAM PLANNERS SUPPORT THIS PROCESS BY PROVIDING PROCUREMENT MANAGERS WITH SPECIlC INFORMATION ON PROGRAM REQUIREMENTS .UMBER OF PRODUCT MANUFACTURERS 7HEN THERE ARE MULTIPLE MANUFACTURERS OF A PRODUCT THERE IS A COMPETITIVE ENVIRONMENTWHICH CAN RESULT IN A LOWER PRICE )N A COMPETITIVE ENVIRONMENT AS IS THE CASE FOR COMBINED ORAL CONTRACEPTIVES DONORS AND NATIONAL PROCUREMENT POLICY OFTEN WILL REQUIRE OPEN OR LIMITED INTERNATIONAL BIDDINGA FORMAL PROCESS REQUIRING A LEAD TIME OF SEVERAL MONTHS )N THE CASE OF PROGESTIN ONLY DEDICATED %#0 PRODUCTS THE NUMBER OF SUPPLIERS CURRENTLY IS LIMITED 4HE TWO PHARMACEUTICAL COMPANIES THAT ARE THE DOMINANT SUPPLIERS OF DEDICATED PROGESTIN ONLY %#0 PRODUCTS IE PRODUCTS PACKAGED AND LABELED SPECIlCALLY FOR EMERGENCY CONTRACEPTION ARE 'EDEON 2ICHTER ,TD AND ,ABORATOIRE (2! 0HARMA 4HEIR %#0 PRODUCTS 0OSTINOR 'EDEON 2ICHTER ,TD AND .OR,EVO ,ABORATOIRE (2! 0HARMA ARE REGISTERED IN MANY COUNTRIES 4HERE ARE OTHER MANUFACTURERS OF LEVONORGESTREL PRINCIPALLY IN #HINA AND )NDIA THAT HAVE SIGNIlCANT LOCAL MARKET SHARES AND THAT COULD BECOME SUPPLIERS OF A DEDICATED LEVONORGESTREL ONLY %#0 IN THE FUTURE 0RODUCT AND CONTACT INFORMATION OF ADDITIONAL SUPPLIERS WILL BE MADE ACCESSIBLE ON THE WEBSITE OF THE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION WHEN THEY ENTER THE INTERNATIONAL MARKET !S OF HOWEVER BECAUSE 'EDEON 2ICHTER ,TD AND ,ABORATOIRE (2! 0HARMA ARE THE ONLY TWO MAJOR SUPPLIERS THE PROCUREMENT AGENCY CAN ISSUE A REQUEST FOR QUOTE DIRECTLY TO EACH MANUFACTURER RATHER THAN REQUESTING BIDS FROM MULTIPLE MANUFACTURERS WHICH WILL STREAMLINE THE PROCUREMENT PROCESS AND SHORTEN THE PROCUREMENT CYCLE #ONTACT INFORMATION FOR BOTH 'EDEON 2ICHTER ,TD AND ,ABORATOIRE (2! 0HARMA IS CONTAINED IN THE TOOLS SECTION OF THIS MODULE & & -ODULE & -INIMIZING THE NUMBER OF SHIPMENTS FOR THE ORDER 4HE MORE FR s ,IMITING SPECIAL REQUESTS !NY TIME A MANUFACTURER HAS TO CHA s -AXIMIZING THE VOLUME OF A SINGLE ORDER 4HE VOLUME OF PRODUC s ORDER ! PROGRAM CAN REALIZE SAVINGS BY FAVORABLE PRICES BY TRYING TO MINIMIZE THE COSTS INCURRED BY TH #OST IMPACT ON THE SUPPLIER &ACTORS THAT AFFECT THE PROCUREMENT PRICE OF A PRODUCT HTTPWWWCECINFOORGlLESECSTATUSAVAILABILITYPDF STATUS OF DEDICATED %#0 PRODUCTS 4HE LIST WHICH IS UPDATED AN PROVIDES A LIST OF COUNTRIES IN !FRICA !SIA AND ,ATIN !MERICA PRODUCT )N ADDITION THE )NTERNATIONAL #ONSORTIUM FOR %MERGENC BE USED FOR EMERGENCY CONTRACEPTION 4HE DATABASE CAN BE SEARCH BOTH COMBINED ORAL CONTRACEPTIVE PILLS AND PROGESTIN ONLY CONTR 4HIS WEBSITE PROVIDES A SEARCHABLE DATABASE OF ORAL CONTRACEPTI ON THE WEBSITE HTTPECPRINCETONEDUWORLDWIDEDEFAULTASP 0ARENTHOOD &EDERATION )00& $IRECTORY OF (ORMONAL #ONTRAC )NFORMATION ABOUT THE AVAILABILITY OF %#0 PRODUCTS DRAWN FROM 0RODUCT AVAILABILITY ITS PRODUCT IN COUNTRY BEFORE IT CAN BE CONSIDERED FOR A CONTRA BID DOCUMENTS BY INCLUDING A REQUIREMENT THAT THE SUPPLIER BE R .2! ARE PURCHASED FOR USE IN COUNTRY 4HIS IS TRADITIONALLY ADD 4HE PROCUREMENT AGENCY SHOULD ALWAYS ENSURE THAT ONLY PRODUCTS PRODUCT SPECIlCATION AT THE END OF THIS MODULE 4HE PROCUREMENT AGENCY CAN USE THIS PROCUREMENT SPECIlCATION FOR LEVONORGESTREL ONLY %#0S CAN BE FO BRAND NAME )F USING PROCUREMENT SPECIlCATIONS TO REQUEST QUOTE 2EQUESTS FOR A QUOTE CAN BE BASED ON PROCUREMENT SPECIlCATIONS FORM OF HIGHER PRICES PURCHASER 4HIS INCREASE IN ADMINISTRATIVE COSTS CAN BE PASSED SHIPMENTS THE PURCHASER REQUESTS THE GREATER THE ADMINISTRATIV INCURRED ARE MOST OFTEN PASSED ON AS HIGHER PRICES TO THE PURCH ORDER DIFFERENT SIZE BOXES AND ADJUST ITS STANDARD PACKAGING PR REQUESTING FOUR PRODUCTS PER BOX WHEN THE NORM IS SIX PER BOX &OR EXAMPLE IF A PURCHASER REQUESTS SPECIAL PACKAGING REQUIREM PROCESS TO ACCOMMODATE A PURCHASERS SPECIAL REQUEST AN ADDITI PRODUCT 4HESE SAVINGS ARE OFTEN THEN PASSED ON TO THE PURCHASER BY OFFE MAY BE ABLE TO ACHIEVE THROUGH SUCH MEASURES AS BULK PROCUREMEN CUSTOMER 4HE GREATER THE VOLUME OF PRODUCT ORDERED THE GREATE THAT MOST MANUFACTURERS WILL CONSIDER WHEN DETERMINING THE PRIC 4HE PURCHASER CAN IMPROVE THE CHANCES OF OBTAINING CT AWARD WITH INFORMATION ABOUT THE E SUPPLIER IN lLLING THE RESSED IN THE REQUEST FOR VES AVAILABLE WORLDWIDE NUALLY CAN BE ACCESSED AT ESPONSIBLE FOR REGISTERING ACEPTIVE PILLSTHAT CAN SAMPLE TO DEVELOP ITS OWN Y #ONTRACEPTION WEBSITE THE )NTERNATIONAL 0LANNED S A SAMPLE GENERIC OR THE MANUFACTURERS ED BY COUNTRY OR BY UND IN THE TOOLS SECTION NGE OR ADAPT A STANDARD OCESS 4HE ADDITIONAL COSTS ON TO THE PURCHASER IN THE E COST INCURRED BY THE REGISTERED THROUGH THE ASER RING A LOWER PRICE FOR THE EQUENT THE NUMBER OF ONAL COST IS INCURRED R SAVINGS A MANUFACTURER THE MANUFACTURER MUST EPTIVES IS ACCESSIBLE T ORDERED IS A FACTOR ENTS FOR EXAMPLE E THEY WILL CHARGE A T OF RAW MATERIALS -ODULE & 0REFERENTIAL PRICING )F A GOVERNMENTAL OR PUBLIC SECTOR AGENCY IS CONDUCTING THE PROCUREMENT IT IS POSSIBLE TO REQUEST PREFERENTIAL PUBLIC SECTOR PRICING DIRECTLY FROM THE MANUFACTURER "OTH 'EDEON 2ICHTER ,TD AND ,ABORATOIRE (2! 0HARMA OFFER PUBLIC SECTOR PRICING SEE 0REFERENTIAL 0RICING FOR 0UBLIC 3ECTOR !GENCIES IN THE TOOLS SECTION FOR THESE MANUFACTURERS CONTACT INFORMATION AND MORE DETAILS %NSURING PRODUCT QUALITY !S MENTIONED IN THE SECTION ABOVE ON PRODUCT REGULATION THE .2! HAS THE RESPONSIBILITY OF ENSURING THE QUALITY OF DRUGS AND MEDICINES BY ESTABLISHING INSPECTION AND QUALITY ASSURANCE TESTING REQUIREMENTS (OWEVER IT IS THE RESPONSIBILITY OF THE PROCUREMENT UNIT TO ENSURE COMPLIANCE WITH THESE REQUIREMENTS 4HIS IS TRADITIONALLY ACCOMPLISHED BY INCLUDING APPROPRIATE CERTIlCATION INSPECTION AND TESTING REQUIREMENTS IN THE TECHNICAL SPECIlCATIONS AND SPECIAL CONDITIONS OF CONTRACTS ISSUED TO SUPPLIERS #OMMONLY REQUESTED CERTIlCATION REQUIREMENTS FOR PHARMACEUTICAL CONTRACEPTIVES CAN BE FOUND IN SECTIONS THROUGH OF THE 3AMPLE 0ROCUREMENT 3PECIlCATION ,EVONORGESTREL /NLY %#0S CONTAINED IN THE 4OOLS SECTION OF THIS MODULE #OMMON INSPECTION AND TESTING REQUIREMENTS ARE ALSO INCLUDED IN THIS SAMPLE PROCUREMENT SPECIlCATION -ONITORING SUPPLIER PERFORMANCE /NCE THE ELEMENTS DESCRIBED ABOVE HAVE BEEN CONSIDERED AND THE PROCESS FOR PROCURING AN EMERGENCY CONTRACEPTION PRODUCT HAS BEEN DETERMINED THE PROCUREMENT PROCESS CAN BE SET IN MOTION -ANAGING THIS PROCESS INVOLVES PREPARING APPROPRIATE DOCUMENTS ESTABLISHING CONTRACT TERMS THAT ENSURE PRODUCT QUALITY ARRANGING FOR PRODUCT SHIPMENT ENSURING ADHERENCE TO CONTRACT TERMS AND MONITORING THE SUPPLIERS PERFORMANCE )NFORMATION THAT WILL HELP IN CARRYING OUT THIS PROCESS IS FOUND IN THE 3AMPLE 0ROCUREMENT 3PECIlCATION ,EVONORGESTREL /NLY %#0S IN THE TOOLS SECTION OF THIS MODULE 4HIS DOCUMENT IS PROVIDED TO ILLUSTRATE THE LEVEL OF DETAIL THAT IS REQUIRED FOR A SPECIlCATION THAT ADDRESSES PRODUCT QUALITY INSPECTION AND TESTING ISSUES 4HE PROCUREMENT SPECIlCATION IS AN IMPORTANT COMPONENT OF MANAGING THE PROCESS BECAUSE ALONG WITH APPROPRIATE CONTRACT TERMS AND CONDITIONS IT HELPS TO ENSURE THAT PRODUCTS PROVIDED TO THE PROGRAM ARE OF ACCEPTABLE QUALITY $ISTRIBUTION "ECAUSE %#0S ARE MOST EFFECTIVE WHEN TAKEN AS SOON AS POSSIBLE AFTER UNPROTECTED SEX AND SHOULD BE TAKEN WITHIN HOURS EASY ACCESS TO THIS METHOD IS OF PARTICULAR IMPORTANCE "ARRIERS TO %#0 ACCESS HAVE INCLUDED s #LIENT EMBARRASSMENT IN REQUESTING %#0S BECAUSE THEY HAVE TO ADMIT THAT THEY HAD SEX WITHOUT PROTECTION s 0ROVIDER BIASES AGAINST %#0S OR CERTAIN USERS s 2ESTRICTIVE HOURS OF SERVICE DELIVERY & & -ODULE & &AMILY PLANNING .'/S FRANCHISING 3OCIAL MARKETING SOCIAL #OMMERCIAL PHARMACIES TRANSMITTED INFECTIONS ASSAULT OR SEXUALLY SERVICES FOR SEXUAL CLINICS HOSPITALS SPECIAL 0UBLIC SECTOR ITIUIN3SE DATGS$ISADVANTAGES !DVANTAGES $ISTRIBUTION 3YSTEM FRANCHISING NONGOVERNMENTAL ORGANIZATIONS COMMERCIAL PHARMACIES AND SOCIA WITH THREE BROAD CATEGORIES OF DISTRIBUTION SYSTEMS PUBLIC SEC 4HE TABLE BELOW DESCRIBES SOME OF THE ADVANTAGES AND DISADVANTA $ISTRIBUTION SYSTEMS ,OW OR NO COST TO CLIENTS s 0OTENTIAL FOR LINKING CLIENTS TO OTHER s /RGANIZATIONAL STRUCTURE MAY PROVIDE s ,ARGE CLIENTELE s -AY PROVIDE LOW COST SERVICES TO s 0OTENTIAL FOR LINKING CLIENTS TO OTHER s /RGANIZATIONAL STRUCTURE MAY PROVIDE s 3PECIALIZED FAMILY PLANNING SERVICES s #AN MAKE %#0 DISTRIBUTION SELF s 4YPICALLY USES TRAINING TO IMPROVE s )NCLUDES ADVERTISING AND AWARENESS s 0OTENTIAL FOR LOW COST TO CLIENT s #AN MAKE %#0 DISTRIBUTION SELF s !TTRACTIVE TO YOUTH AND OTHER s %ASY ACCESS OPEN LONG HOURS s REPRODUCTIVE HEALTH SERVICES SERVICES AND COUNSELING FOR EFFECTIVE QUALITY CONTROL OF CLIENTS REPRODUCTIVE HEALTH SERVICES SERVICES AND COUNSELING FOR EFFECTIVE QUALITY CONTROL OF INTO SYSTEMS MAY MAKE IT EASIER TO INTEGRATE %#0S SUSTAINING SERVICE QUALITY RAISING SUSTAINING CLINICS POPULATIONS LESS COMFORTABLE WITH WEEKENDS -AY BE DIFlCULT TO INCORPORATE %#0S s -AY PRESENT CHALLENGES FOR YOUTH OR s ,OCATIONS MAY NOT BE EASILY ACCESSIBLE TO s -AY NOT HAVE THE mEXIBILITY TO RESPOND s -AY HAVE RESTRICTED HOURS s ,OCATIONS MAY NOT BE EASILY ACCESSIBLE TO s -AY HAVE RESTRICTED HOURS s $OES NOT ALWAYS PROVIDE A LINK TO OTHER s $ISTRIBUTION STAFF MAY NOT HAVE CORRECT s /FTEN REQUIRES ONGOING SUBSIDY FOR s $O NOT ALWAYS PROVIDE A LINK TO OTHER s 0HARMACIES THAT LACK SEPARATE COUNSELING s 0HARMACY STAFF PROVIDING %#0S TO CLIENTS s 0RICING GENERALLY HIGHER THAN THROUGH s PROVIDED FAMILY PLANNING INTO PROGRAMS THAT HAVE NOT TRADITIONALLY %#0S UNMARRIED WOMEN OR COUPLES REQUESTING CLIENTS QUICKLY TO %#0 NEEDS CLIENTS NEEDED SERVICES DOSAGE INFORMATION ABOUT INDICATIONS FOR USE OR PRODUCT ANDOR ADVERTISING NEEDED SERVICES POTENTIAL USERS SETTING MAY BE INTIMIDATING TO SOME INDICATIONS FOR USE OR DOSAGE MAY NOT HAVE CORRECT INFORMATION ABOUT CLIENTS THEREFORE LESS ACCESSIBLE TO LOW INCOME PUBLIC DISTRIBUTION MECHANISMS AND TOR FAMILY PLANNING GES ASSOCIATED L MARKETING OR -ODULE & 3ERVICE DELIVERY OPTIONS 'IVEN THE TIME SENSITIVE NATURE OF %#0 USE PROGRAM PLANNERS SHOULD DEVELOP AWARENESS RAISING SYSTEMS TO ENSURE THAT WOMEN KNOW ABOUT %#0S AND WHERE TO ACCESS THEM )NFORMATION ABOUT %#0S CAN BE DELIVERED IN A VARIETY OF VENUES INCLUDING PUBLIC SECTOR CLINICS WHERE PROVIDERS CAN ROUTINELY MENTION %#0S DURING FAMILY PLANNING VISITS AND SOCIAL SERVICE AND OTHER PUBLIC SECTOR OR .'/ NONCLINICAL SERVICE POINTS -ASS MEDIA CAMPAIGNS ARE ANOTHER MECHANISM FOR RAISING AWARENESS 3EE -ODULE # 2AISING 0UBLIC !WARENESS FOR MORE DETAILED DISCUSSION OF THESE ISSUES /NE APPROACH FOR ENSURING TIMELY ACCESS TO %#0S IS TO PROVIDE WOMEN WITH AN ADVANCE SUPPLY ALONG WITH INSTRUCTIONS FOR USE OR AN ADVANCE PRESCRIPTION THAT CAN BE lLLED IF NEEDED !DVANCE PROVISION OF %#0S HAS BEEN FOUND TO REDUCE UNINTENDED PREGNANCIES WITHOUT INCREASING REPEATED USE OR ENCOURAGING WOMEN TO ABANDON OTHER METHODS OF CONTRACEPTION )T MAY BE POSSIBLE TO INTEGRATE %#0 PRODUCTS AS WELL AS INFORMATION AND COUNSELING INTO SPECIALIZED SERVICE DELIVERY OPTIONS BEYOND THE CATEGORIES DESCRIBED ABOVE 4HESE MIGHT INCLUDE s #OMMUNITY BASED DISTRIBUTION PROGRAMS s 3CHOOL NURSES s 5NIVERSITY HEALTH CENTERS s .'/ PROGRAMS s 3OCIAL SERVICES s &ACTORIES WITH MANY YOUNG FEMALE WORKERS s 0RIVATE SECTOR MEDICAL PROVIDERS s 3EXUAL ASSAULT SERVICES 2EGARDLESS OF THE DISTRIBUTION SYSTEM IMPLEMENTED IT IS IMPORTANT TO ENSURE A CONSISTENT SUPPLY OF THE %#0 PRODUCT 2EFERENCES HTTPWWWWHOINTMEDICINESORGANIZATIONPAREDLEXPCOMMEM?REPRODDOC 7(/ 4ASK &ORCE ON 0OSTOVULATORY -ETHODS OF &ERTILITY 2EGULATION 2ANDOMISED CONTROLLED TRIAL OF LEVONORGESTREL VERSUS THE 9UZPE REGIMEN OF COMBINED ORAL CONTRACEPTIVES FOR EMERGENCY CONTRACEPTION ,ANCET 'RIMES $! 2AYMOND %' AND 3COTT *ONES " %MERGENCY CONTRACEPTION OVER THE COUNTER THE MEDICAL AND LEGAL IMPERATIVES /BSTETRICS AND 'YNECOLOGY !UGENY % #AN HORMONAL EMERGENCY CONTRACEPTION %# BE AVAILABLE WITHOUT MEDICAL PRESCRIPTION %UROPEAN *OURNAL OF #ONTRACEPTION AND 2EPRODUCTIVE (EALTH #ARE 3UPPL ABSTRACT 7ORLD (EALTH /RGANIZATION )MPROVING !CCESS TO 1UALITY #ARE IN &AMILY 0LANNING -EDICAL %LIGIBILITY #RITERIA FOR #ONTRACEPTIVE 5SE ND EDITION 7(/&2(&00 'ENEVA7(/ 'RIMES $! 3WITCHING EMERGENCY CONTRACEPTION TO OVER THE COUNTER STATUS .EW %NGLAND *OURNAL OF -EDICINE & & -ODULE & 'LASIER ! AND "AIRD $ 4HE EFFECTS OF SELF ADMINISTERING EME OF THE PROSPECTIVE STUDIES "RACKEN -" /RAL CONTRACEPTION AND CONGENITAL MALFORMATIONS /BSTETRICS AND 'YNECOLOGY RGENCY CONTRACPETION IN OFFSPRING A REVIEW AND META ANALYSIS .%*- -ODULE & 4OOLS ,IST 0OTENTIAL -ARKET FOR %#0S ! "ASIC $EMAND -ODEL "ECAUSE %#0S ARE USED ON AN IRREGULAR AND UNEXPECTED BASIS FORECASTING THE NEED AND PLANNING THE SUPPLY PROCESS WILL DIFFER FROM REGULAR CONTRACEPTIVE PILLS 4HIS TOOL WILL HELP PROGRAM MANAGERS PLAN FOR AN INITIAL SUPPLY OF %#0S )NFORMATION TO )NCLUDE IN A ,EVONORGESTREL /NLY %#0 0ACKAGE )NSERT 2EGULATORY AUTHORITIES REQUIRE THAT DRUGS MEDICINES AND CONTRACEPTIVES PACKAGED FOR CONSUMER USE CONTAIN PRINTED MATERIALS WITH INFORMATION ABOUT THE PRODUCT )T IS IMPORTANT TO ENSURE THAT THIS INFORMATION SHEET USES CLEAR LANGUAGE AND IS EASY FOR CLIENTS TO UNDERSTAND 4HE PACKAGE INSERT SHOULD BE DESIGNED TO MEET REGULATORY REQUIREMENTS AND PROVIDE CLIENTS WITH KEY INFORMATION THAT THEY WILL NEED FOR USING THE PILLS 4HIS TOOL PROVIDES ESSENTIAL INFORMATION FOR PILL USERS AS WELL AS OPTIONAL ADDITIONAL INFORMATION THAT CAN BE CONSIDERED IF SPACE PERMITS 3AMPLE 0ROCUREMENT 3PECIlCATION ,EVONORGESTREL /NLY %#0S 0ROCUREMENT UNITS CAN USE THIS SAMPLE FORMAT AS A GUIDE ADDING COUNTRY SPECIlC INFORMATION WHERE APPROPRIATE 4HE SAMPLE SPECIlCATION IS DESIGNED TO BE USED IN CONJUNCTION WITH BIDDING AND CONTRACT DOCUMENTS 4HE SPECIlCATION ALSO CAN BE USEFUL AS AN OVERVIEW OF THE KIND OF INFORMATION THAT WILL BE NEEDED FOR PROCUREMENT PURPOSES 0REFERENTIAL 0RICING FOR 0UBLIC 3ECTOR !GENCIES #ONTACT INFORMATION IS PROVIDED FOR TWO MANUFACTURERS OF A DEDICATED LEVONORGESTREL ONLY %#0 WHO OFFER PUBLIC SECTOR PRICING 0ROCUREMENT 4HROUGH )NTERNATIONAL 0ROCUREMENT 3ERVICES /RGANIZATIONS WITH LIMITED PROCUREMENT CAPACITY OR WANTING TO PROCURE SMALL QUANTITIES OF %#0S MAY lND THAT ORDERING THROUGH A REPUTABLE INTERNATIONAL PROCUREMENT AGENCY IS ADVANTAGEOUS )NFORMATION ABOUT THIS OPTION IS PROVIDED & 4OOLS 0OTENTIAL -ARKET FOR %#0S ! "ASIC $EMAND -ODEL -ODULE & 4HIS MODEL IS A TOOL TO HELP PROGRAM MANAGERS USE GENERALLY AVAILABLE STATISTICS AND DATA TO DElNE THE POTENTIAL MARKET FOR %#0S IN THEIR SERVICE AREABOTH THE MAXIMUM DEMAND PER YEAR AND THE REALISTIC DEMAND PER YEAR 4HE MAXIMUM DEMAND IS THE TOTAL NUMBER OF %#0S THAT COULD POTENTIALLY BE NEEDED BY THE TARGET POPULATION BASED ON ESTIMATES OF UNPROTECTED SEX ACTS 4HE REALISTIC DEMAND REDUCES THIS ESTIMATE BY TAKING INTO ACCOUNT ISSUES OF %#0 KNOWLEDGE ACCESSIBILITY AND WOMENS ABILITY TO PAY FOR THE PILLS )N THE BEGINNING WHEN %#0S ARE JUST BEING INTRODUCED THE MAXIMUM DEMAND WILL BE MUCH HIGHER THAN THE REALISTIC DEMAND "UT OVER TIME BY INCREASING CLIENT AWARENESS AND PROVIDER TRAINING THE TOTAL REALISTIC DEMAND WILL GROW BECAUSE OF INCREASED KNOWLEDGE AND INCREASED ACCESS AND WILL THEREFORE MORE CLOSELY MATCH THE MAXIMUM DEMAND -ODEL $ESCRIPTION $ATA AND !SSUMPTION -AXIMUM DEMAND PER YEAR 4HE lRST SECTION OF THE MODEL ESTIMATES THE MAXIMUM DEMAND PER YEAR FOR %#0S 4HIS IS CALCULATED BY COMBINING ESTIMATES OF THE MAXIMUM NUMBER OF COITAL ACTS THAT COULD REQUIRE %#0S FOR WOMEN USING CONTRACEPTIVES AND WOMEN NOT USING ANY CONTRACEPTION 4HE ESTIMATE FOR WOMEN USING CONTRACEPTION IS CALCULATED BY COMPUTING THE TOTAL NUMBER OF WOMEN OF REPRODUCTIVE AGE USING TRADITIONAL METHODS MALE CONDOMS AND ORAL CONTRACEPTIVE PILLS ESTIMATING THE TOTAL NUMBER OF THEORETICALLY PROTECTED COITAL ACTS PER YEAR AND THEN BASED ON OBSERVED DEPARTURE FROM EFFECTIVE USE OF CONTRACEPTION CALCULATING THE NUMBER OF COITAL ACTS THAT REQUIRE PREGNANCY PREVENTION 4RADITIONAL METHODS CONDOMS AND PILLS ARE THE ONLY CONTRACEPTIVES INCLUDED IN THE MODEL BECAUSE THEY ARE THE METHODS FOR WHICH A WOMAN WOULD BE AWARE OF A DEPARTURE FROM EFFECTIVE USE AND WOULD PERCEIVE THE NEED FOR %#0S SEXUAL RELATIONS OUTSIDE OF THE SAFE PERIOD PARTNER FAILING TO WITHDRAW INCONSISTENT CONDOM USE OR MISSED ORAL CONTRACEPTIVE PILLS 5SERS OF OTHER METHODS OF CONTRACEPTION SUCH AS STERILIZATION AND INTRAUTERINE DEVICES ARE NOT LIKELY TO NEED %#0S 4O CALCULATE THE TOTAL NUMBER OF COITAL ACTS IN THIS POPULATION THE MODEL USES THE WORLD AVERAGE OF COITAL ACTS PER YEAR 4HE OBSERVED DEPARTURE FROM EFFECTIVE USE OF CONTRACEPTION IS INCLUDED IN THE MODEL AS A lXED RATE OF PERCENT BASED ON ESTIMATES OF OBSERVED DEPARTURE FROM EFFECTIVE USE OF CONTRACEPTION THE PERCENTAGE OF COITAL ACTS THAT CONTRACEPTIVE USERS WOULD KNOW THEY DID NOT ACTUALLY USE THEIR CONTRACEPTION EFFECTIVELY 4HE PERCENT ESTIMATE IS BASED ON DATA INDICATING THAT AN AVERAGE OF PERCENT OF WOMEN KNOWINGLY MISS MORE THAN PILLS PER CYCLE APPROXIMATELY PERCENT OF COITAL ACTS BY CONDOM USERS ARE KNOWINGLY UNPROTECTED AND FAILURE RATES OF WITHDRAWAL AND RHYTHM METHODS ARE PERCENT AND PERCENT RESPECTIVELY 7HILE THE FAILURE RATE OF TRADITIONAL METHODS IS NOT PARALLEL TO THE DATA FOR CONDOMS OR PILLS THE ASSUMPTION IS THAT MOST FAILURE OF TRADITIONAL METHODS WOULD BE CLEARLY OBSERVED EITHER BECAUSE WOMEN FOLLOWING THEIR CYCLE HAD INTERCOURSE DURING THEIR FERTILE PERIOD OR THEIR PARTNER DID NOT WITHDRAW IN TIME &URTHERMORE SINCE UNPROTECTED ACTS DO NOT ALWAYS LEAD TO PREGNANCY THE OBSERVED RATE WOULD NOT BE ANY LOWER THAN ACTUAL FAILURE RATE & 4HE ESTIMATE FOR WOMEN NOT USING ANY CONTRACEPTION IS CALCULATED BY COMPUTING THE TOTAL NUMBER OF SEXUALLY ACTIVE WOMEN OF REPRODUCTIVE AGE NOT USING CONTRACEPTION ESTIMATING THE TOTAL NUMBER OF UNPROTECTED COITAL ACTS PER YEAR AND THENBASED ON THE ESTIMATE OF THE PROPORTION OF WOMEN WHO WOULD PREFER TO AVOID A PREGNANCYCALCULATING THE TOTAL NUMBER -ODULE & OF COITAL ACTS AMONG WOMEN NOT USING ANY CONTRACEPTION THAT WOULD REQUIRE PREGNANCY PREVENTION 4HE PROPORTION OF WOMEN NOT USING CONTRACEPTION WHO WOULD PREFER TO AVOID PREGNANCY IS BASED ON DATA INDICATING THAT ABOUT PERCENT OF MARRIED WOMEN IN THE DEVELOPING WORLD 4OOLS WOULD PREFER TO AVOID A PREGNANCY BUT ARE NOT USING ANY FORM OF CONTRACEPTION 2EALISTIC DEMAND PER YEAR 4HE SECOND SECTION OF THE MODEL ESTIMATES A MORE REALISTIC DEMAND FOR %#0S BY CALCULATING A SUBSET OF THE MAXIMUM DEMAND BY DETERMINING THE NUMBER OF THOSE WOMEN WHO WOULD HAVE KNOWLEDGE OF %#0S LIVE IN AN AREA WHERE %#0S ARE ACCESSIBLE AND HAVE THE ABILITY TO PAY 4HESE PERCENTAGES ARE ESTIMATED BASED ON LOCAL KNOWLEDGE OF THE POPULATION AND WILL VARY BY COUNTRY 2EFERENCES -AC+AY * 4HE 0ENGUIN !TLAS OF (UMAN 3EXUAL "EHAVIOR .EW 9ORK 0ENGUIN 2EFERENCE 2OSENBERG -* 7AUGH -3 AND "URNHILL -3 #OMPLIANCE COUNSELING AND SATISFACTION WITH ORAL CONTRACEPTIVES A PROSPECTIVE EVALUATION &AMILY 0LANNING 0ERSPECTIVES -YER , -ATHEWS # AND ,ITTLE & #ONDOM USE AND SEXUAL BEHAVIORS AMONG INDIVIDUALS PROCURING FREE MALE CONDOMS IN 3OUTH !FRICA A PROSPECTIVE STUDY 3EXUALLY 4RANSMITTED $ISEASES (ATCHER 2! 4RUSSELL * 3TEWARD & ET AL #ONTRACEPTIVE 4ECHNOLOGY TH REVISED EDITION .EW 9ORK )RVINGTON 0UBLISHERS 2OSS *! AND 7INFREY 7, 5NMET NEED FOR CONTRACEPTION IN THE DEVELOPING WORLD AND THE FORMER 3OVIET 5NION AN UPDATED ESTIMATE )NTERNATIONAL &AMILY 0LANNING 0ERSPECTIVES #ONTENT AND FORMAT FOR THIS TOOL WERE ADAPTED FROM A FORECASTING MODEL DEVELOPED BY !LTA#ARE 0!4( GREATLY APPRECIATES CONTRIBUTIONS MADE TO THE MODEL BY THE $ELIVER 0ROJECT AT *OHN 3NOW )NC AND 0OPULATION 3ERVICES )NTERNATIONAL & 4OOLS 0OTENTIAL -ARKET FOR %#0S ! "ASIC $EMAND -ODEL -!8)-5- $%-!.$ 0%2 9%!2 -ODULE & -AXIMUM NUMBER OF COITAL ACTS FOR WHICH WOMEN MAY QUESTION THEIR PREGNANCY STATUS IMMEDIATELY AFTER INTERCOURSE 7OMEN 5SING #ONTRACEPTION A 4OTAL POPULATION B 0ERCENTAGE OF WOMEN OF REPRODUCTIVE AGE C 4OTAL NUMBER OF WOMEN OF REPRODUCTIVE AGE A XB D #ONTRACEPTIVE PREVALENCE RATETRADITIONAL METHODS WITHDRAWAL RHYTHM E #ONTRACEPTIVE PREVALENCE RATEMALE CONDOMS F #ONTRACEPTIVE PREVALENCE RATEORAL CONTRACEPTIVE PILLS G 4OTAL CONTRACEPTIVE PREVALENCE RATE OF TRADITIONAL METHODS CONDOMS AND PILLS D E F H 4OTAL NUMBER OF WOMEN OF REPRODUCTIVE AGE USING TRADITIONAL METHODS CONDOMS OR PILLS C XG I !VERAGE NUMBER OF COITAL ACTS PER YEAR J 4OTAL NUMBER OF THEORETICALLY 02/4%#4%$ COITAL ACTSYEAR H XI K /BSERVED DEPARTURE FROM EFFECTIVE USE OF CONTRACEPTION IE MISSED ORAL CONTRACEPTIVE PILLS UNPROTECTED COITAL ACTS BY CONDOM USERS L 4OTAL NUMBER OF COITAL ACTS AMONG WOMEN USING TRADITIONAL METHODS CONDOMS AND PILLS REQUIRING PREGNANCY PREVENTIONYEAR J XK 7OMEN ./4 5SING !NY #ONTRACEPTION M 4OTAL NUMBER OF SEXUALLY ACTIVE WOMEN OF REPRODUCTIVE AGE N 2ATE OF NON CONTRACEPTIVE USE O 4OTAL NUMBER OF SEXUALLY ACTIVE WOMEN OF REPRODUCTIVE AGE NOT USING CONTRACEPTION M XN P !VERAGE NUMBER OF COITAL ACTS PER YEAR Q 4OTAL NUMBER OF THEORETICALLY 5.02/4%#4%$ COITAL ACTS YEAR O XP R 0ROPORTION OF WOMEN NOT USING ANY CONTRACEPTION WHO PREFER TO AVOID PREGNANCY S 4OTAL NUMBER OF COITAL ACTS AMONG WOMEN NOT USING ANY CONTRACEPTION REQUIRING PREGNANCY PREVENTIONYEAR Q XR -AXIMUM OPPORTUNITY T 4/4!, -!8)-5- $%-!.$ 0%2 9%!2 L S 2%!,)34)# $%-!.$ 0%2 9%!2 3UBSET OF COITAL ACTS FROM MAXIMUM OPPORTUNITY OF WOMEN THAT HAVE KNOWLEDGE OF %#0S LIVE IN AREA WHERE %#0S ARE ACCESSIBLE AND HAVE ABILITY TO PAY U 4OTAL NUMBER OF COITAL ACTS REQUIRING PREGNANCY PREVENTION PER YEAR TOTAL MAXIMUM DEMAND FROM T ABOVE V OF WOMEN WITH KNOWLEDGE OF %#0S W OF WOMEN WHO LIVE IN AREAS WHERE %#0S ARE ACCESSIBLE X OF WOMEN WHO HAVE ABILITY TO PAY FOR %#0S Y 4OTAL OF WOMEN WHO MAY SEEK %#0S V XW XX Z 4/4!, 2%!,)34)# $%-!.$ 0%2 9%!2 .UMBER OF COITAL ACTS FOR WHICH WOMEN MAY SEEK %#0S U XY 4HE SHADED BOXES ARE CALCULATED AUTOMATICALLY IN THE ELECTRONIC VERSION OF THIS DOCUMENT 2EFERENCES INCLUDED IN MODEL DESCRIPTION & -ODULE & 4OOLS & 4OOLS )NSTRUCTIONS FOR 5SING THE "ASIC $EMAND -ODEL TO -ODULE & !SSESS THE 0OTENTIAL -ARKET FOR %#0S -AXIMUM $EMAND PER 9EAR 7OMEN USING CONTRACEPTION A %NTER THE TOTAL NUMBER OF WOMEN IN THE POPULATION )NDIVIDUAL COUNTRY DATA IS AVAILABLE ONLINE FROM THE 0OPULATION 2EFERENCE "UREAU WEBSITE KWWS ZZZZRUOGSRSRUJGDWD¿QGHUKWP THE 5NITED .ATIONS 7ORLD #ONTRACEPTIVE 5SE WEBSITE KWWS ZZZXQRUJHVDSRSXODWLRQ SXEVDUFKLYHZFXZFXKWP AND THE -EASURE $EMOGRAPHIC AND (EALTH 3URVEYS WEBSITE KWWS ZZZPHDVXUHGKVFRPFRXQWULHVVWDUWFIP B %NTER THE PERCENTAGE OF WOMEN OF REPRODUCTIVE AGE #OUNTRY SPECIlC DATA MAY BE AVAILABLE ON THE WEBSITES DESCRIBED IN A ABOVE C -ULTIPLY A XB TO lND THE TOTAL NUMBER OF WOMEN OF REPRODUCTIVE AGE D %NTER THE CONTRACEPTIVE PREVALENCE RATES FOR TRADITIONAL METHODS IE WITHDRAWAL AND RHYTHM AS A PERCENTAGE #OUNTRY SPECIlC DATA MAY BE AVAILABLE ON THE WEBSITES DESCRIBED IN A ABOVE E %NTER THE CONTRACEPTIVE PREVALENCE RATES FOR MALE CONDOMS AS A PERCENTAGE #OUNTRY SPECIlC DATA MAY BE AVAILABLE ON THE WEBSITES DESCRIBED IN A ABOVE F %NTER THE CONTRACEPTIVE PREVALENCE RATES FOR ORAL CONTRACEPTIVE PILLS AS A PERCENTAGE #OUNTRY SPECIlC DATA MAY BE AVAILABLE ON THE WEBSITES DESCRIBED IN A ABOVE G !DD D E F FOR THE TOTAL CONTRACEPTIVE PREVALENCE RATE OF TRADITIONAL METHODS CONDOMS AND PILLS H -ULTIPLY C XG TO lND THE TOTAL NUMBER OF WOMEN OF REPRODUCTIVE AGE USING TRADITIONAL METHODS CONDOMS OR PILLS AS THEIR CONTRACEPTIVE METHOD I 4HERE IS NO NEED TO ENTER ANYTHING HERE 4HE AVERAGE NUMBER OF COITAL ACTS PER YEAR AROUND THE WORLD IS ESTIMATED TO BE 4HIS IS A lXED NUMBER (OWEVER IT CAN BE SUBSTITUTED WITH A NUMBER MORE REmECTIVE OF LOCAL CONDITIONS IF LOCAL DATA ARE AVAILABLE J -ULTIPLY H XI FOR THE TOTAL NUMBER OF THEORETICALLY 02/4%#4%$ COITAL ACTS PER YEAR FOR TRADITIONAL METHODS CONDOMS AND PILLS K 4HERE IS NO NEED TO ENTER ANYTHING HERE 4HIS IS A lXED RATE OF PERCENT BASED ON ESTIMATES OF OBSERVED DEPARTURE FROM EFFECTIVE USE OF CONTRACEPTION THE PERCENTAGE OF COITAL ACTS THAT CONTRACEPTIVE USERS WOULD +./7 THEY DID NOT ACTUALLY USE THEIR CONTRACEPTION EFFECTIVELY L -ULTIPLY J XK FOR THE TOTAL NUMBER OF COITAL ACTS USING TRADITIONAL METHODS CONDOMS AND PILLS REQUIRING PREGNANCY PREVENTION PER YEAR 7OMEN ./4 USING ANY CONTRACEPTION M %NTER THE TOTAL NUMBER OF SEXUALLY ACTIVE WOMEN OF REPRODUCTIVE AGE #OUNTRY SPECIlC DATA MAY BE AVAILABLE ON THE WEBSITES DESCRIBED IN A ABOVE & N %NTER THE RATE OF NONCONTRACEPTIVE USE &IND THIS RATE BY SUBTRACTING THE TOTAL PERCENT OF CONTRACEPTIVE USE FROM TO GET THE NONCONTRACEPTIVE USE RATE 4HE TOTAL CONTRACEPTIVE USE RATE CAN BE FOUND AT THE 0OPULATION 2EFERENCE "UREAU THE 5NITED .ATIONS 7ORLD #ONTRACEPTIVE 5SE OR THE -EASURE $EMOGRAPHIC AND (EALTH 3URVEYS WEBSITES -ODULE & DESCRIBED IN A ABOVE O -ULTIPLY M XN FOR THE TOTAL NUMBER OF WOMEN NOT USING CONTRACEPTION P 4HERE IS NO NEED TO ENTER ANYTHING HERE 4HE AVERAGE NUMBER OF COITAL ACTS PER YEAR AROUND 4OOLS THE WORLD IS ESTIMATED TO BE 4HIS IS A lXED NUMBER (OWEVER IT CAN BE SUBSTITUTED WITH A NUMBER MORE REmECTIVE OF LOCAL CONDITIONS IF LOCAL DATA ARE AVAILABLE Q -ULTIPLY O XP FOR THE TOTAL NUMBER OF THEORETICALLY 5.02/4%#4%$ COITAL ACTS PER YEAR R 4HERE IS NO NEED TO ENTER ANYTHING HERE 4HIS NUMBER IS BASED ON THE ESTIMATE THAT PERCENT OF MARRIED WOMEN IN THE DEVELOPING WORLD WOULD PREFER TO AVOID A PREGNANCY BUT ARE NOT USING ANY FORM OF CONTRACEPTION 4HIS IS A lXED NUMBER S -ULTIPLY Q XR FOR THE TOTAL NUMBER OF COITAL ACTS REQUIRING PREGNANCY PREVENTION PER YEAR T !DD L S FOR THE TOTAL MAXIMUM DEMAND PER YEAR 5HDOLVWLFGHPDQGSHU\HDU U %NTER THE TOTAL NUMBER OF COITAL ACTS REQUIRING PREGNANCY PREVENTION PER YEAR 4HIS IS THE TOTAL MAXIMUM DEMAND PER YEAR FROM T ABOVE V %STIMATE THE PERCENTAGE OF WOMEN WITH KNOWLEDGE OF %#0S +NOWLEDGE ATTITUDES AND PRACTICES STUDIES ABOUT %#0S PERFORMED LOCALLY MAY PROVIDE THIS INFORMATION W %STIMATE THE PERCENTAGE OF WOMEN WHO LIVE IN AREAS WHERE %#0S ARE OR WILL BE ACCESSIBLE &OR EXAMPLE IF %#0S ARE ONLY AVAILABLE IN URBAN AREAS USE THE PERCENTAGE OF THE POPULATION LIVING IN URBAN SETTINGS X %STIMATE THE PERCENTAGE OF WOMEN WITH THE ABILITY TO PAY FOR %#0S 4HIS ESTIMATE MAY DEPEND ON WHETHER %#0S ARE AVAILABLE AT A SUBSIDIZED PRICE Y -ULTIPLY V XW XX FOR THE TOTAL PERCENTAGE OF WOMEN WHO MAY SEEK %#0S Z -ULTIPLY U XY FOR THE TOTAL NUMBER OF COITAL ACTS FOR WHICH WOMEN MAY SEEK %#0S 4HIS IS THE REALISTIC DEMAND PER YEAR #ONTENT AND FORMAT FOR THIS TOOL WERE ADAPTED FROM A FORECASTING MODEL DEVELOPED BY !LTA#ARE 0!4( GREATLY APPRECIATES CONTRIBUTIONS MADE TO THE MODEL BY THE $ELIVER 0ROJECT AT *OHN 3NOW )NC AND 0OPULATION 3ERVICES )NTERNATIONAL & 4OOLS )NFORMATION TO )NCLUDE IN A ,EVONORGESTREL /NLY -ODULE & %#0 0ACKAGE )NSERT %SSENTIAL INFORMATION FOR CLIENTS s "RIEF INSTRUCTIONS ¥ %#0S ARE MEDICINE TO PREVENT PREGNANCY AFTER UNPROTECTED SEXUAL INTERCOURSE 5SE %#0S IF YOU DO NOT WANT TO BECOME PREGNANT IF YOU THINK YOUR CONTRACEPTIVE METHOD FAILED OR IF YOU WERE RAPED ¥ 4AKE A SINGLE DOSE OF MG LEVONORGESTREL AS SOON AS POSSIBLE WITHIN HOURS AFTER UNPROTECTED SEX %#0S ARE MORE EFFECTIVE THE SOONER THEY ARE TAKEN ¥ %#0S CAN BE USED ANYTIME IN THE MENSTRUAL CYCLE s "RIEF INFORMATION ABOUT SIDE EFFECTS ¥ -OST WOMEN DO NOT FEEL ANYTHING AFTER TAKING %#0S 3OME WOMEN HAVE SORE BREASTS AND HEADACHES 3OME WOMEN HAVE THEIR PERIOD A LITTLE LATER OR A LITTLE EARLIER THAN USUAL 3OME WOMEN FEEL SICK TO THEIR STOMACH AND SOME WOMEN EVEN VOMIT AFTER TAKING %#0S ¥ )F YOU VOMIT WITHIN HOUR AFTER TAKING %#0S IT MAY MEAN YOU HAVE VOMITED UP THE %#0S YOU SHOULD TRY TO TAKE ANOTHER DOSE IMMEDIATELY ¥ )F YOU VOMIT MORE THAN ONE HOUR AFTER TAKING %#0S YOU DO NOT NEED TO TAKE EXTRA PILLS ¥ 4HESE %#0 SIDE EFFECTS MAY BE UNCOMFORTABLE BUT THEY ARE NOT HARMFUL AND USUALLY LAST FOR ONLY ONE DAY OR LESS ¥ )T IS NORMAL FOR YOUR NEXT PERIOD TO BEGIN A FEW DAYS EARLIER OR LATER THAN EXPECTED s 3EXUALLY TRANSMITTED INFECTIONS 34)S %#0S DO NOT PROTECT 34)S OR ()6 )F YOU THINK YOU MAY HAVE CONTRACTED AN 34) OR ()6 VISIT YOUR HEALTH OR 34) CLINIC /PTIONAL ADDITIONAL INFORMATION s %#0S DO NOT WORK IF YOU ARE ALREADY PREGNANT s %#0S ARE EFFECTIVE CONTRACEPTION BUT THEY DO NOT WORK EVERY TIME )F YOUR PERIOD DOES NOT START WITHIN WEEKS AFTER TAKING %#0S YOU MAY BE PREGNANT (AVE A PREGNANCY TEST TO KNOW FOR SURE s !S SOON AS POSSIBLE BEGIN USING A BIRTH CONTROL METHOD YOU WILL BE ABLE TO USE ON AN ONGOING BASIS %#0S ARE INTENDED FOR EMERGENCY PROTECTION 4HEY ARE NOT AS EFFECTIVE AS OTHER FORMS OF BIRTH CONTROL s !FTER USING %#0S 5SE A BARRIER METHOD LIKE A CONDOM EACH TIME YOU HAVE SEX UNTIL YOU BEGIN YOUR NEXT MENSTRUAL PERIOD !FTER THAT TIME YOU MAY CONTINUE USING YOUR BIRTH CONTROL METHOD OR BEGIN A NEW ONE & /R )F YOU WERE USING ORAL CONTRACEPTIVES PILLS YOU SHOULD CONTINUE TAKING THE TABLETS STARTING ON THE DAY AFTER YOU TOOK THE %#0S UNTIL THE END OF THE CYCLE 9OU SHOULD THEN USE A CONDOM OR OTHER BARRIER CONTRACEPTIVE METHOD FOR AT LEAST SEVEN DAYS AFTER RESTARTING ORAL -ODULE & CONTRACEPTIVE PILLS 4OOLS 4HIS MATERIAL WAS DEVELOPED BY 0!4( & 4OOLS 3AMPLE 0ROCUREMENT 3PECIlCATION -ODULE & ,EVONORGESTREL /NLY %#0S 4HE FOLLOWING SAMPLE FORMAT CAN BE USED IN DEVELOPING PROCUREMENT SPECIlCATIONS FOR EMERGENCY CONTRACEPTIVES )N DEVELOPING A PROCUREMENT SPECIlCATION IT IS IMPORTANT TO THOROUGHLY REVIEW NATIONAL REGULATORY AND REGISTRATION REQUIREMENTS FOR THE PRODUCT TO ENSURE THAT APPROPRIATE PRODUCT REQUIREMENTS ARE INCORPORATED INTO THE SPECIlCATION )N THIS SAMPLE EXAMPLES OF PRODUCT SPECIlCATIONS ARE IN ITALICS WHEN PREPARING A PROCUREMENT SPECIlCATION APPROPRIATE PRODUCT SPECIlCATIONS CAN BE SUBSTITUTED FOR THE ITALICIZED EXAMPLES 4HE SAMPLE PROCUREMENT SPECIlCATION IS DESIGNED TO BE USED IN CONJUNCTION WITH BIDDING AND CONTRACT DOCUMENTS .OTES FOR SUBMISSION OF SAMPLE OF PRODUCT 4HE SAMPLE EMERGENCY CONTRACEPTIVES PILLS SUBMITTED BY THE BIDDER IN RESPONSE TO THIS SOLICITATION MUST BE EXACTLY THE SAME AS WOULD BE SUPPLIED IF A CONTRACT WERE AWARDED TO THE BIDDER )N OTHER WORDS SAMPLES SHOULD HAVE SAME TABLET SHAPE COLOR WEIGHT INGREDIENTS AND IDENTIlCATION IMPRINT SAME BLISTER PACK SIZE MATERIAL TEXT AND IDENTIlCATION MARKINGS SAME INNER BOX SIZE MATERIAL TEXT AND IDENTIlCATION MARKINGS 2EQUIREMENTS %MERGENCY #ONTRACEPTIVE 4ABLETS IN !CCORDANCE WITH THE &OLLOWING 3PECIlCATIONS 4WO TABLET PACKAGE CONSISTING OF TWO EMERGENCY CONTRACEPTIVE LEVONORGESTREL ONLY TABLETS %ACH TABLET SHALL CONTAIN MILLIGRAMS OF LEVONORGESTREL 0RODUCT AND "RAND .AMES 0RODUCT .AME ????????????????????? "RAND .AMES ?????????????????????? 2AW -ATERIALS %MERGENCY CONTRACEPTIVES OFFERED UNDER THIS PURCHASE DESCRIPTION SHALL BE PRODUCED FROM VALIDATED RAW MATERIALS OBTAINED FROM A LICENSED MANUFACTURER OR ITS AUTHORIZED DISTRIBUTOR ! TYPICAL VALIDATION INCLUDES BUT IS NOT LIMITED TO THESE AREAS s -ANUFACTURING RECORDS AND PROCEDURES FOR THE RAW MATERIAL SYNTHESIS PROCESSING PACKING AND STORAGE s 1UALITY CONTROL RECORDS AND PROCEDURES FOR THE RAW MATERIAL IN PROCESS AND lNAL PRODUCT s 0LANT CERTIlCATION BY LOCAL REGULATORY AUTHORITIES SUCH AS #OMMERCE )NDUSTRY (EALTH %NVIRONMENT AS REQUIRED %HFDXVHWKHUDZPDWHULDOVWKDWPDNHXSERWKDFWLYHDQGLQDFWLYHLQJUHGLHQWVDUHRIJUHDWLPSRUWDQFHIRU¿QDO SURGXFWELRDYDLODELOLW\DQGVWDELOLW\JRRGPDQXIDFWXULQJSUDFWLFHVUHTXLUHWKDWPDQXIDFWXUHUVYDOLGDWHYHQGRUV IRUDOOUDZPDWHULDOV & x #ERTIlCATION OF WORKERS TRAINING IN GOOD MANUFACTURING PRACTICES AND SAFETY PROTECTION x 2ECORDS DEMONSTRATING RAW MATERIALS WITH THE REQUIRED PHYSICAL AND CHEMICAL CHARACTERISTICS 2EGISTRATION 2EQUIREMENTS -ODULE & %MERGENCY CONTRACEPTIVES OFFERED UNDER THIS PURCHASE DESCRIPTION SHALL BE CURRENTLY REGISTERED IN THE COUNTRY OF DESTINATION AND APPROVED BY ???????????????? LOCAL REGULATORY AUTHORITY 4OOLS #ERTIlCATE OF ,ICENSING 3TATUS %MERGENCY CONTRACEPTIVES OFFERED UNDER THIS PURCHASE DESCRIPTION SHALL BE LICENSED FOR MARKETING BY THE DRUG REGULATORY AUTHORITY OF THE COUNTRY OF ORIGIN 0RIOR TO AWARD OF THE #ONTRACT THE SUCCESSFUL OFFERORS MAY BE REQUIRED TO SUBMIT A hSTATEMENT OF LICENSING STATUS OF PHARMACEUTICAL PRODUCTS v AS PROVIDED UNDER THE 7ORLD (EALTH /RGANIZATION 7(/ #ERTIlCATION 3CHEME .O /BJECTION #ERTIlCATE )N THE CASE OF GOODS OF FOREIGN ORIGIN EMERGENCY CONTRACEPTIVES OFFERED UNDER THIS PURCHASE DESCRIPTION SHALL HAVE BEEN AWARDED A .O /BJECTION #ERTIlCATE BY ?????????LOCAL REGULATORY AUTHORITY ON BEHALF OF ANY LOCAL MANUFACTURERS OF THE IMPORTING COUNTRY #OMPLIANCE WITH 'OOD -ANUFACTURING 0RACTICES 4HE 3UPPLIER MUST BE ABLE TO PROVIDE CERTIlCATION THAT THE EMERGENCY CONTRACEPTIVES ARE MANUFACTURED ACCORDING TO 7(/ GOOD MANUFACTURING PRACTICES '-0 3UCH CERTIlCATION CAN BE FOUND IN THE 7(/ #ERTIlCATION 3CHEME h#ERTIlCATE OF A 0HARMACEUTICAL 0RODUCTv 3UPPLIER ALSO MUST BE ABLE TO PROVIDE COPIES OF ITS ANNUAL '-0 AUDIT REPORTS 7(/ #ERTIlCATION-OVEMENT IN )NTERNATIONAL #OMMERCE 4HE 3UPPLIER MUST BE ABLE TO PROVIDE DOCUMENTATION INDICATING MANUFACTURER OF THE PRODUCT HAS RECEIVED CONlRMATION FROM THE -INISTRY OF (EALTH OF THE COUNTRY OF MANUFACTURE THAT THE PHARMACEUTICAL MEETS THE REQUIREMENTS IN THE 7(/ #ERTIlCATION 3CHEME 3HAPE AND $IMENSIONS 4ABLETS SHALL BE OF THE SHAPE AND DIMENSIONS OF THE "IDDERS NORMAL STANDARD COMMERCIAL TABLET #OLORS %MERGENCY CONTRACEPTIVE TABLETS SHALL BE SIMILAR TO "IDDERS NORMAL STANDARD COMMERCIAL TABLETS :+2&HUWL¿FDWLRQ6FKHPHIRUWKH4XDOLW\RI3KDUPDFHXWLFDO3URGXFWV0RYLQJLQ,QWHUQDWLRQDO&RPPHUFH)RU DGGLWLRQDOLQIRUPDWLRQVHHZZZZKRLQWPHGLFLQHVOLEUDU\TVPZKRHGPTVPFHUWLIVFKHPHVKWPO & 4OOLS 4ABLET -ARKING -ODULE & %ACH TABLET SHALL BEAR THE IDENTIFYING IMPRINT OF ITS MANUFACTURER IF SUCH IMPRINT IS PROVIDED ON THE "IDDERS NORMAL STANDARD COMMERCIAL TABLET 0ACKAGING 0RESENTATION %ACH INDIVIDUAL TABLET SHALL BE ENCLOSED IN A TRANSPARENT BLISTER PACK OF THERMOFORMED POLYMER WITH A FOIL BACKING 4HE SUPPLIER SHALL BE ABLE TO PROVIDE TO THE SATISFACTION OF THE REGISTRATIONNATIONAL QUALITY CONTROL AUTHORITIES THE MANUFACTURERS STABILITY TEST DATA TO VALIDATE THE PRODUCTS STATED SHELF LIFE AT AMBIENT TEMPERATURE DEGREES # OR ABOVE AND RELATIVE HUMIDITY OF PERCENT6ARIATIONS MUST BE PROVEN SCIENTIlCALLY COMPARABLE BY MEANS OF STABILITY DATA 4HE SIZE OF THE PACKAGE SHALL NOT BE LESS THAN MM INCHES X MM INCHES 4HICKER POLYMER OR FOIL OR THE ADDITION OF A CARD TO EITHER THE FRONT OR BACK OF THE PACKAGE IN ADDITION TO THE MINIMUM POLYMER OR FOIL IS ACCEPTABLE -OUNTING 4ABLETS SHALL BE MOUNTED TWO TABLETS PER PACKAGE )DENTIlCATION -ARKINGS ON )NDIVIDUAL "LISTER 0ACKS %ACH INDIVIDUAL BLISTER PACK SHALL HAVE THE FOLLOWING INFORMATION s 0RODUCTBRAND NAME s ,OTBATCH NUMBER s %XPIRATION DATE MONTH AND YEAR s $ATE OF MANUFACTURE s -ANUFACTURERS NAME OR SYMBOL s #ONTENTS AND QUANTITY s 0RODUCT USE AND STORAGE INSTRUCTIONS ACCOMPANYING THE BLISTER PACK 0RINTING AND LAYOUT /N THE BACK OF EACH BLISTER PACKAGE THE TRADE OR BRAND NAME OF THE PRODUCT SHALL BE PRINTED IN PRECISION FULL REGISTRATION 4HE MONTH AND YEAR OF EXPIRATION AND THE LOTBATCH CONTROL NUMBER SHALL BE SHOWN ON EACH INDIVIDUAL BLISTER PACK $EBOSSING IS ACCEPTABLE FOR THESE NUMBERS 4HE TABLET FORMULATION ANDOR THE INTERNATIONAL NONPROPRIETARY NAME SHALL BE PRINTED ON THE INDIVIDUAL PACKET AND MAY BE PRINTED ON THE REVERSE SIDE SMALLEST TYPE NO LESS THAN ONE MM HIGH & 7ORKMANSHIP 0RODUCTS AND PACKAGING SHALL BE FREE OF DEFECTS THAT IMPAIR THEIR SERVICEABILITY AFFECT THEIR DURABILITY OR DETRACT FROM THEIR APPEARANCE -ODULE & ,OTS 0ER /RDER 4HE 3UPPLIER SHALL lLL THE ORDER USING THE FEWEST NUMBER OF MANUFACTURING LOTS POSSIBLE 4OOLS 3HELF ,IFE 4HE SHELF LIFE OF THE PRODUCT PROVIDED UNDER THIS SOLICITATION SHALL BE ??? ? YEARS FROM THE DATE OF MANUFACTURE WHEN STORED UNDER TROPICAL CONDITIONS SUCH AS THOSE PREVAILING IN ????????????RECIPIENT COUNTRY NAME 4HE 3UPPLIER SHALL BE ABLE TO PROVIDE TO THE SATISFACTION OF REGISTRATIONNATIONAL QUALITY CONTROL AUTHORITIES MANUFACTURERS STABILITY TEST DATA SUBSTANTIATING THIS ???YEAR SHELF LIFE AT AMBIENT TEMPERATURES DEGREES # OR ABOVE AND RELATIVE HUMIDITY OF PERCENT IN THE PROPOSED BLISTER PACKAGE !T THE TIME OF INSPECTION OR ACCEPTANCE FOR DELIVERY TO THE COUNTRY OF DESTINATION NO MORE THAN ??? ?? MONTHS SHALL HAVE EXPIRED SINCE THE DATE OF MANUFACTURE SHOWN ON THE BATCH RELEASE OR #ERTIlCATE OF !NALYSIS 4EST $ATA #HEMICAL AND PHYSICAL TEST DATA FOR RAW MATERIALS COMPONENTS IN PROCESS AND lNISHED PRODUCT TESTING MUST BE ON RECORD FOR EACH LOT SHIPPED AND MUST BE AVAILABLE TO 0URCHASERS REPRESENTATIVES WHEN REQUESTED 1UALITY !SSURANCE 0ROVISIONS #OMPLIANCE 4HE 3UPPLIER SHALL GUARANTEE THAT THE PRODUCTS AS PACKED FOR SHIPMENT COMPLY WITH ALL PROVISIONS OF THE SPECIlCATION AND RELATED DOCUMENTS $OCUMENTATION 4HE 3UPPLIER SHALL PROVIDE EVIDENCE OF THE SATISFACTION OF THE TECHNICAL SPECIlCATION REQUIREMENTS FOR WHICH SPECIlC INSPECTION INSTRUCTIONS OR PROTOCOLS HAVE NOT BEEN PROVIDED 3UCH EVIDENCE IS CONTAINED IN THE h-ANUFACTURERS "ATCH #ERTIlCATEv UNDER THE 7(/ #ERTIlCATION 3CHEME ,QFOXGLQJTXDOLW\FRQWURODQGPDQXIDFWXULQJUHFRUGVLQSURFHVVFRQWUROUHFRUGVDQG¿QDOSURGXFWFHUWL¿FDWHRIDQDO\VLV & 4OOLS 4HE 3UPPLIER SHALL PROVIDE A COPY OF THE MANUFACTURING RECORD AND PROCEDURES TO THE -ODULE & 0URCHASER FOR EACH LOT INTENDED FOR SHIPMENT 4HE 3UPPLIER SHALL PROVIDE A COPY OF THE #ERTIlCATE OF !NALYSIS TO THE 0URCHASER FOR EACH LOT INTENDED FOR SHIPMENT 4HE 3UPPLIER SHALL PROVIDE TO THE 0URCHASER A COPY OF THE APPROVAL OF EACH COMPONENT FOR EACH LOT INTENDED FOR SHIPMENT )NSPECTION BY THE 0URCHASER 4HE 0URCHASER RESERVES THE RIGHT TO PERFORM OR CAUSE TO BE PERFORMED ANY OF THE INSPECTIONS AND TESTS SET FORTH IN THE 3PECIlCATION AND 3PECIAL #ONDITIONS OF #ONTRACT TO ENSURE THAT THE GOODS CONFORM TO PRESCRIBED REQUIREMENTS 4HE 0URCHASER RESERVES THE RIGHT AND OR MAY ASSIGN THE RIGHT TO A REPRESENTATIVE TO ENTER AND INSPECT THE PRODUCTION FACILITY PRIOR TO SHIPMENT OF THE GOODS AND TO DRAW SAMPLES FROM THE 3UPPLIERS FACTORY ANDOR WAREHOUSE %XCEPT AS OTHERWISE SPECIlED IN THE CONTRACT OR PURCHASE ORDER PRIOR TO SHIPMENT THE 0URCHASER WILL SAMPLE OR CAUSE TO BE SAMPLED THE PRODUCT AS PACKED IN INNER BOXES PREPARATORY TO PACKING IN EXTERIOR SHIPPING CARTONS 4HE SAMPLING SHALL BE ACCORDING TO RECOGNIZED STANDARDS 4HE 0URCHASER MAY HAVE SOME OR ALL OF THE TESTS SPECIlED IN 3ECTION ??????????OF THE CONTRACT PERFORMED BY A LABORATORY SUITABLY EQUIPPED AND QUALIlED TO CONDUCT QUALITY ASSURANCE TESTS ON PHARMACEUTICAL PRODUCTS ACCORDING TO ????????????0HARMACOPOEIA 3AMPLING 0ROCEDURES 4HE 0URCHASER OR THE 0URCHASERS REPRESENTATIVE SHALL SELECT THE REQUIRED SAMPLES FROM THE LOT ACCORDING TO 3ECTION ???? OF THE 3PECIAL #ONDITIONS OF #ONTRACT )F THE ORDER IS TO BE lLLED USING MORE THAN ONE PRODUCTION LOT EACH PRODUCTION LOT SHALL BE SEPARATELY SAMPLED AND TESTED 7HERE AN INSPECTION LOT IS SMALLER THAN UNITS IT WILL BE DEEMED TO BE FOR DETERMINATION OF SAMPLE SIZES 4HE NORMAL TIGHTENED AND REDUCED INSPECTION PROVISIONS OF )3/ )NSPECTION BY !TTRIBUTES MAY BE USED FOR VISUAL INSPECTION 3AMPLING FOR ANALYTICAL TESTING SHALL BE DONE IN ACCORDANCE WITH PHARMACOPOEIAL REQUIREMENTS !LL SAMPLED BOXES AND SHIPPING CARTONS SHALL BE SO MARKED AND SHALL INCLUDE THE DATE AND INITIALS OF SAMPLER )N SOME CASES 3PECIAL #ONDITIONS OF #ONTRACT ARE ADDED TO THE GOVERNING CONTRACT 4HESE TERMS ACCOMMODATE ANY SPECIAL NEEDS NOT OTHERWISE COVERED SUCH AS REQUIREMENTS TO REMEDY NON CONFORMING PRODUCT TIME LIMITATIONS ON INSPECTIONS OR THE USE OF SPECIlC INSPECTION AGENCIES $EPENDING ON THE TESTS REQUIRED SAMPLING MAY BE CONDUCTED ACCORDING TO THE STANDARDS OF THE )NTERNATIONAL /RGANIZATION FOR 3TANDARDIZATION )3/ )NSPECTION BY !TTRIBUTES OR AS DICTATED BY LOCAL OR INTERNATIONAL PHARMACOPOEIAE &OLLOWING RECOGNIZED SAMPLING PROCEDURES HELPS TO ENSURE THAT THE PRODUCTS TESTED ARE REPRESENTATIVE OF THE WHOLE &OR INFORMATION ON OBTAINING )3/ )NSPECTION BY !TTIBUTES SEE ZZZLVRFKLVRHQ&DWDORJXH'HWDLO3DJH & 3AMPLE 2ETENTION 4HE 3UPPLIER SHALL RETAIN A SAMPLE OF TEN BLISTER PACKAGES OR THE EQUIVALENT REQUIRED TO PERFORM THREE COMPLETE CHEMICAL ASSAYS FROM EACH LOT SHIPPED FOR A PERIOD OF ONE YEAR AFTER -ODULE & THE PRINTED EXPIRATION DATE 0ACKING )NNER "OXES 4OOLS 0RODUCTS SEALED IN INDIVIDUAL PACKAGES AS SPECIlED IN 3ECTION SHALL BE PACKED IN INNER BOXES OF ??? ?? PACKAGES PER INNER BOX )NNER BOXES SHALL BE MADE OF LIGHT lBERBOARD WHITE OF A SIZE SUFlCIENT TO CONTAIN THE SPECIlED NUMBER OF PACKAGES 4HE OVERALL DIMENSIONS SHOULD BE SUCH THAT THE PRODUCT DOES NOT GET DAMAGED DURING TRANSPORTATION AND STORAGE &OR INNER BOXES THE "IDDER SHALL lLL IN THE BLANKS PROVIDED BELOW 4HE PRODUCTS IN EACH INNER BOX WILL BE ??? ?? INDIVIDUAL PACKAGES THE OVERALL DIMENSION OF A BOX WILL BE ???CM X ???CM X ???CM %XTERIOR 3HIPPING #ARTONS 0RODUCT AND PRINTED MATERIALS PACKAGED AND PACKED AS SPECIlED ABOVE SHALL BE CONTAINED IN EXTERIOR SHIPPING CARTONS OF STRONG EXPORT QUALITY MATERIAL ABLE TO WITHSTAND ROUGH HANDLING AND THE PREVAILING CLIMATIC CONDITIONS DURING TRANSPORT AND STORAGE 4HE "IDDER SHALL lLL IN THE FOLLOWING BLANKS 4HE EXTERIOR SHIPPING CARTON WILL CONTAIN ???? INNER BOXES THE OVERALL DIMENSIONS OF A CARTON WILL BE ? CM X ?? CM X ?? CM AND THE GROSS WEIGHT OF ONE SHIPPING CARTON WILL BE ??? KG ! STANDARD FOOT METER CONTAINER WILL ACCOMMODATE ?????? EXTERIOR SHIPPING CARTONS -ARKINGS )NNER "OXES 4HE INNER BOXES SHALL BE MARKED WITH THE FOLLOWING INFORMATION IN A CLEARLY LEGIBLE MANNER THAT IS ACCEPTABLE TO THE 0URCHASER 7KHVPDOOHVWW\SHVKDOOEHQROHVVWKDQPPKLJKXQOHVVRWKHUZLVHVSHFL¿HGE\WKHFRPPHUFLDOODZVRIWKHFRXQWU\LI LPSRUWDWLRQ & 4OOLS s 3URGXFWEUDQGQDPH s /RWEDWFKQXPEHU -ODULE & s ([SLUDWLRQGDWH PRQWKDQG\HDU s 'DWHRIPDQXIDFWXUH s 0DQXIDFWXUHU¶VQDPHDGGUHVV s &RQWHQWVDQGTXDQWLW\ s 'UXJUHJLVWUDWLRQQXPEHUV LIDSSOLFDEOH s ,QVWUXFWLRQVIRUVWRUDJHDQGKDQGOLQJ %XTERIOR 3HIPPING #ARTONS 4HE FOLLOWING INFORMATION SHALL BE STENCILED OR LABELED ON THE EXTERIOR SHIPPING CARTONS ON TWO OPPOSING SIDES IN BOLD LETTERS AT LEAST ?? MM HIGH WITH WATERPROOF INK IN A CLEARLY LEGIBLE MANNER THAT IS ACCEPTABLE TO THE 0URCHASER 2EGULATORY )NFORMATION ON TWO OPPOSING SIDES OF CARTON s 3URGXFWEUDQGQDPH s /RWEDWFKQXPEHU s ([SLUDWLRQGDWH PRQWKDQG\HDU s 'DWHRIPDQXIDFWXUH s 0DQXIDFWXUHU¶VQDPHDGGUHVV s &RQWHQWVDQGTXDQWLW\ s 'UXJUHJLVWUDWLRQQXPEHUV LIDSSOLFDEOH s ,QVWUXFWLRQVDQGV\PEROV VHHEHORZ IRUVWRUDJHDQGKDQGOLQJ s 1RWLFHRIQHHGWRSURWHFWIURPH[SRVXUHWRZDWHUDQGH[WUHPHKHDWRUH[WUHPHFROG #USTOMS3HIPPING )NFORMATION ON TWO OPPOSING SIDES OF CARTON s 0DGHLQBBBBBBBBBBBBBBBBBBB s 6XSSOLHU¶VQDPHDQGDGGUHVV LIGLIIHUHQWIURPPDQXIDFWXUHU s &RQVLJQHH¶VDGGUHVVLQIXOO s *URVVZHLJKWRIHDFKFDUWRQ LQNJ s 3RUWRIHQWU\ s &RQWUDFWQXPEHU s 4XDQWLW\RIJRRGV s &DUWRQBBBRIBBB 7KHVPDOOHVWW\SHVKDOOEHQROHVVWKDQWHQPPKLJKXQOHVVRWKHUZLVHVSHFL¿HGE\WKHFRPPHUFLDOODZVRIWKHFRXQWU\ RILPSRUWDWLRQ & 0RINTED -ATERIALS0RODUCT )NFORMATION 3HEETS #ONSUMER INFORMATION AND DIRECTIONS FOR USE SHALL BE PRINTED IN %NGLISH ANDOR IN ???? ??? AND PROVIDED AS PACKAGE INSERTS ONE COPY FOR EACH CONSUMER UNIT -ODULE & )NFORMATION FOR 0HYSICIANS 5SE SHALL BE PRINTED IN %NGLISH ANDOR IN ??????? 4WO COPIES OF SUCH INFORMATION SHALL BE PROVIDED FOR EACH BLISTER PACKAGES AND SHALL BE PLACED IN EACH EXTERIOR SHIPPING CARTON 4OOLS 4HIS MATERIAL WAS DEVELOPED BY 0!4( & 4OOLS 0REFERENTIAL 0RICING FOR 0UBLIC 3ECTOR !GENCIES -ODULE & )N CONSIDERATION OF THE NEED AND THE PUBLIC GOOD MANUFACTURERS MAY DECIDE TO OFFER A PREFERENTIAL PRICE TO PUBLIC SECTOR OR NONPROlT PROGRAMS 'EDEON 2ICHTER ,TD 0OSTINOR AND ,ABORATOIRE (2! 0HARMA .ORLEVO THE TWO MAJOR INTERNATIONAL PHARMACEUTICAL COMPANIES THAT CURRENTLY MANUFACTURE AND DISTRIBUTE LEVONORGESTREL ONLY PRODUCTS PACKAGED AND LABELED SPECIlCALLY FOR EMERGENCY CONTRACEPTION HAVE BOTH INDICATED A WILLINGNESS TO PROVIDE THEIR PRODUCT TO QUALIlED GOVERNMENTAL ORGANIZATIONS AND PUBLIC SECTOR AGENCIES AT PREFERENTIAL PRICES 2EQUESTS FOR PREFERENTIAL PUBLIC SECTOR PRICING SHOULD BE ISSUED DIRECTLY TO THE COMPANIES AT THE FOLLOWING ADDRESSES *HGHRQ5LFKWHU/WG %XGDSHVW *\RPURLX +XQJDU\ $WWHQWLRQ 0V$JQHV+D]VOLQV]N\$UHD0DQDJHU,QWHUQDWLRQDO'RVDJH)RUP3URGXFWV DKD]VOLQV]N\#UL FKWHUKX 7HO )D[ $OWD&DUHRQEHKDOIRI/DERUDWRLUH+5$3KDUPD UXH)UHGHULFN/HPDLWUH 3DULV)UDQFH $WWHQWLRQ 0U6DDG+DUWL0DQDJLQJ'LUHFWRU VDDGKDUWL#DOWDFDUHIU 0UV6RSKLH*RGHIUR\%UDQG0DQDJHU JRGHIUR\#DOWDFDUHIU 7HO )D[ 4HE COMPANIES MAY REQUEST INFORMATION THAT CONlRMS THE ORGANIZATION IS A BONA lDE GOVERNMENTAL ORGANIZATION OR PUBLIC SECTOR AGENCY 4HEY MAY REQUEST INFORMATION ON THE PLANS FOR SUCCESSFULLY INTRODUCING EMERGENCY CONTRACEPTION INTO THE EXISTING FAMILY PLANNING REPRODUCTIVE HEALTH PROGRAM /THER INFORMATION THAT THE COMPANIES MAY REQUEST INCLUDES x 1UANTITY OF %#0 DOSAGES REQUIRED x $ELIVERY DATE FOR SHIPMENT x 3HIPPING INSTRUCTIONS AND SHIPPING DOCUMENT REQUIREMENTS x )NSPECTION OR TESTING REQUIREMENTS x 2EGISTRATION LICENSING AND QUALITY ASSURANCE DOCUMENTATION REQUIRED TO REGISTER AND IMPORT PRODUCT x .AME AND CONTACT INFORMATION FOR FOLLOW UP QUESTIONS 3INCE PROCUREMENT PERSONNEL ARE TRADITIONALLY RESPONSIBLE FOR CONTACTING MANUFACTURERS AND SUPPLIERS TO REQUEST PRICING AND DETAILED PRODUCT INFORMATION PROGRAM PLANNERS SHOULD WORK CLOSELY WITH THEIR PROCUREMENT STAFF TO PROVIDE THE INFORMATION THAT THE MANUFACTURERS MAY REQUEST & -ODULE & 4OOLS & 4OOLS 0ROCUREMENT 4HROUGH )NTERNATIONAL -ODULE & 0ROCUREMENT 3ERVICES !N ORGANIZATION WOULD WANT TO USE THE SERVICES OF A REPUTABLE INTERNATIONAL PROCUREMENT AGENCY TO OBTAIN LEVONORGESTREL ONLY EMERGENCY CONTRACEPTIVE PILLS IF THE ORGANIZATION HAS LIMITED PROCUREMENT CAPACITY OR THE VALUE OF AN ORDER IS SMALL 4WO INTERNATIONAL AGENCIES WITH EXPERIENCE IN PROCURING AND PROVIDING LEVONORGESTREL ONLY %#0S ARE 5.&0! AND )00& WHICH HAVE PROVIDED THE GENERAL ORDERING AND CONTACT INFORMATION BELOW 5.&0! 5.&0! HAS CONSIDERABLE EXPERIENCE IN THE INTERNATIONAL PROCUREMENT AND SHIPMENT OF DEDICATED %#0S AND ITS PROCUREMENT SERVICES ARE AVAILABLE TO GOVERNMENT MINISTRIES MULTILATERAL AND BILATERAL AGENCIES AND .'/S 'ENERAL ORDERING REQUIREMENTS FOR 5.&0! PROCUREMENT SERVICES ARE AS FOLLOWS &OR ORDERS OF PACKS OR MORE OF LEVONORGESTREL ONLY %#0 DELIVERY TIME IS AN AVERAGE OF TWO TO THREE MONTHS AFTER THE PURCHASE ORDER IS ISSUED 5.0&! IS CURRENTLY ABLE TO lLL ORDERS OF FEWER THAN PACKS 4HE DELIVERY TIME FOR SMALL ORDERS IS A PERIOD OF SEVERAL DAYS 5.&0! PAYMENT TERMS ARE NET DAYS AND THERE IS A SERVICE FEE CHARGE OF PERCENT OF THE COST OF INSURANCE AND FREIGHT VALUE OF THE GOODS TO COVER 5.&0! EXPENSES TO PROCESS THE ORDER 2EQUESTS FOR 5.&0! PROCUREMENT SERVICES AND GENERAL INQUIRIES SHOULD BE ISSUED DIRECTLY TO 5.&0! AT THE FOLLOWING ADDRESS 0V1DQD(VVDK6U3URFXUHPHQW2I¿FHU 3URFXUHPHQW6HUYLFHV6HFWLRQ 8QLWHG1DWLRQV3RSXODWLRQ)XQG 81)3$ (DVWQG6WUHHW 1HZ &OR PLANNING PURPOSES THE APPROXIMATE ORDER VALUE OF PACKS IS 53 AT A CURRENT PRICE OF 53 PER PACK OF TWO TABLETS 4HE GROSS WEIGHT OF A SHIPMENT OF PACKS OF 0OSTINOR IS APPROXIMATELY KILOGRAMS & )NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION )00& )00& WORKING THROUGH A SUBSIDIARY %.%4 PROVIDES INTERNATIONAL PROCUREMENT AND SHIPMENT OF DEDICATED LEVONORGESTREL ONLY %#0S TO ITS MEMBER ASSOCIATIONS AND THIRD PARTY CUSTOMERS -ODULE & /RGANIZATIONS PLACING ORDERS THROUGH )00& MUST GUARANTEE THAT THEIR LEVONORGESTREL ONLY %#0 PRODUCTS EXAMPLES OF WHICH ARE 0OSTINOR AND .ORLEVO WILL BE EXCLUSIVELY DISTRIBUTED THROUGH FAMILY PLANNING CLINICS AND YOUTH CENTERS WHERE THE END USERS WILL RECEIVE THE %#0S EITHER FREE OF CHARGE OR FOR A MINIMAL FEE TO COVER COSTS -EMBER ASSOCIATIONS AND THIRD 4OOLS PARTY CUSTOMERS WHO CAN COMPLY WITH THIS REQUIREMENT MUST SUBMIT AN OFlCIAL LETTER TO )00& CONlRMING THAT THE PRODUCT WILL BE DISTRIBUTED THROUGH THE PUBLIC SECTOR OR AN .'/ 4HE LETTER SHOULD ALSO IDENTIFY THE ANNUAL QUANTITY OF %#0S REQUIRED 7ITHIN TWO WEEKS OF RECEIPT OF THE ABOVE LETTER )00& WILL STUDY THE POSSIBILITIES OF SUPPLYING WITHIN THAT COUNTRY AND A DECISION WILL BE TAKEN )00&S ABILITY TO SUPPLY THE PRODUCT IS CONDITIONED BY SEVERAL FACTORS INCLUDING WHETHER OR NOT THE PRODUCT IS REGISTERED IN A COUNTRY AND )00&S AGREEMENT WITH %#0 MANUFACTURERS )00& WILL NOTIFY THE REQUESTING PARTY OF ITS ABILITY TO SUPPLY PRODUCT INCLUDING INFORMATION ON ANY CONDITIONS OF PROVISION THAT WOULD BE REQUIRED &OR THOSE REQUESTS FOR %#0 THAT HAVE BEEN APPROVED )00& CURRENTLY HAS A MINIMUM ORDER QUANTITY REQUIREMENT OF PACKS OF LEVONORGESTREL ONLY %#0S 4HE APPROXIMATE PRICE FOR %#0 RANGES FROM 53 TO 53 DEPENDING UPON THE MANUFACTURER SUPPLYING THE PRODUCT 4HE TIME REQUIRED TO PROCESS AN ORDER FOR %#0S IS APPROXIMATELY TO MONTHS AFTER THE PURCHASE ORDER HAS BEEN RECEIVED BY )00& )00& PAYMENT TERMS ARE DAYS AND THERE IS A SERVICE FEE CHARGE OF OF THE #)& COST OF INSURANCE AND FREIGHT VALUE OF THE GOODS TO COVER )00& EXPENSES TO PROCESS THE ORDER 2EQUESTS FOR )00& PROCUREMENT SERVICES SHOULD BE ISSUED DIRECTLY TO )00& AT THE FOLLOWING ADDRESS 0UV9DQHVVD*HUEURQ6HUYLFHV3URYLGHU % MAIL VGERBRON IPPFORG OR #ARL &OISSEY "USINESS !NALYST % MAIL CFOISSEY IPPFORG )NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION )00& 2EGENTS #OLLEGE )NNER #IRCLE 2EGENTS 0ARK ,ONDON .7 .3 5NITED +INGDOM 4ELEPHONE &AX 4HIS MATERIAL WAS DEVELOPED BY 0!4( & -ODULE ' 4HE /PTION OF 0ROVIDING #OMBINED /RAL #ONTRACEPTIVES #/#S AS .ON $EDICATED %MERGENCY #ONTRACEPTIVE 0ILLS %#0S /BJECTIVE 4O GUIDE DECISION MAKING AND PROGRAM PLANNING WHEN PROVISION OF COMBINED ORAL CONTRACEPTIVES FOR EMERGENCY CONTRACEPTION IS BEING CONSIDERED 4HERE ARE TWO TYPES OF %#0S PROGESTIN ONLY PILLS CONTAINING LEVONORGESTREL AND #/#S 4HIS MODULE BRIEmY DISCUSSES ISSUES TO CONSIDER WHEN LOOKING AT THE OPTION OF PROVIDING #/#S FOR EMERGENCY CONTRACEPTION 4HE FOLLOWING TOPICS ARE DISCUSSED s 0ROVISION OF #/#S FOR %MERGENCY #ONTRACEPTION s !PPROACHES FOR 0ROVIDING #/#S AS .ON $EDICATED %#0S s 0ROS AND #ONS OF 0ROVIDING #/#S AS .ON $EDICATED %#0S s 0LANNING FOR 0RODUCT 3UPPLY 4OOLS 0ROVIDED AT THE %ND OF 4HIS -ODULE 0ROTOTYPE 0ACKAGE &ORMAT #/#S FOR %MERGENCY #ONTRACEPTION %XAMPLE OF THE 2EPACKAGING &ORMAT 5SED BY THE &AMILY 'UIDANCE !SSOCIATION OF %THIOPIA )NFORMATION TO )NCLUDE 7HEN 0ROVIDING #/#S FOR %MERGENCY #ONTRACEPTION 0ROVISION OF A /NE -ONTH 3UPPLY OF #/#S FOR %MERGENCY #ONTRACEPTION 0ROVISION OF #/#S FOR %MERGENCY #ONTRACEPTION !S DESCRIBED IN THE 7ORLD (EALTH /RGANIZATION 7(/ PUBLICATION %MERGENCY #ONTRACEPTION ! 'UIDE FOR 3ERVICE $ELIVERY THERE ARE TWO KINDS OF PRODUCTS THAT CAN BE USED AS EMERGENCY CONTRACEPTIVE PILLS PROGESTIN ONLY PILLS CONTAINING LEVONORGESTREL AND #/#S CONTAINING PROGESTIN AND ESTROGEN WHICH ARE WIDELY USED FOR REGULAR CONTRACEPTION 4HE PROGESTIN ONLY PILLS HAVE A HIGHER EFFECTIVENESS RATE FOR EMERGENCY CONTRACEPTION AND HAVE FEWER SIDE EFFECTS THAN #/#S WHEN TAKEN FOR EMERGENCY CONTRACEPTION )N ADDITION PROGESTIN ONLY PILLS CAN BE TAKEN IN ONE DOSE &OR THESE REASONS PROGESTIN ONLY PILLS ARE CONSIDERED THE PREFERRED EMERGENCY CONTRACEPTIVE PRODUCT FOR FAMILY PLANNING PROGRAMS ' ' -ODULE ' $ISTRIBUTION OF A 0ROGESTIN /NLY %#0 'EDEON 2ICHTER ,TD AND ,ABORATOIRE (2! 0HARMA #ONTACT INFORM OMLTO #OMMON "RAND .AMES &ORMULATION %MERGENCY #ONTRACEPTION /CTOBER P 3OURCE !DAPTED FROM %XPANDING 'LOBAL !CCESS TO %MERGENCY #ONTR HOURS AND THE SECOND DOSE SHOULD BE TAKEN HOURS AFTER T &OR ALL REGIMENS THE lRST DOSE SHOULD BE TAKEN AS SOON AS POSS !BBREVIATIONS %% ETHINYL ESTRADIOL ,.' LEVONORGESTREL %% MCG .' MG OR %% MCG ,.' MG %% MCG ,.' MG OR %% MCG ,.' MG EMERGENCY CONTRACEPTION 4HE DATABASE CAN BE SEARCHED BY COUNTR WORLDWIDEBOTH #/#S AND PROGESTIN ONLY CONTRACEPTIVE PILLSTHAT DEFAULTASP 4HIS WEBSITE PROVIDES A SEARCHABLE DATABASE OF OR #ONTRACEPTIVES IS ACCESSIBLE ON THE WEBSITE HTTPECPRINCET FROM THE )NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION $IREC !DDITIONAL INFORMATION ABOUT THE AVAILABILITY OF #/# AND %#0 PR MOST COMMON BRAND NAMES OF THE #/#S THAT ARE USED FOR EMERGENCY MEANS OFFERING A LESS EFFECTIVE PRODUCT 4HE TABLE BELOW SHOWS THERE ARE TRADE OFFS WITH REGARD TO COST AND QUALITY -OST IMPO EMERGENCY CONTRACEPTIVE USE !LTHOUGH THESE APPROACHES HAVE BEE EMERGENCY CONTRACEPTION OR BY PROVIDING AN ENTIRE CYCLE OF PILL BY CUTTING UP REGULAR #/# PACKETS AND REPACKAGING THE PILLS IN VIABLE WAY TO ROUTINELY OFFER EMERGENCY CONTRACEPTION TO CLIENT PLANNING PROGRAMS IN THIS SITUATION HAVE FOUND THAT PROVIDING # NOT FEASIBLE OR PROGESTIN ONLY PILLS MAY BE REGISTERED BUT ACCE )N SOME COUNTRIES HOWEVER THE OPTION OF PROVIDING A DEDICATED SPECIlCALLY FOR EMERGENCY CONTRACEPTION WIDELY DISTRIBUTE A DEDICATED PROGESTIN ONLY %#0THAT IS AN %# PROGESTIN ONLY PILLS FOR EMERGENCY CONTRACEPTION 4HERE ARE TWO )N THE 7(/ -ODEL ,IST OF %SSENTIAL -EDICINES WAS REVISED #OMBINED /RAL #ONTRACEPTIVES .ORDETTE /VRAL , 2IGEVIDON ,O&EMENAL -ICROGYNON /VRAN 0# 0REVEN .ORAL .ORDIOL /VIDON /VRAL %UGYNON &ERTILAN .EOGYNON ATION IS PROVIDED IN -ODULE & 2EGULATION 0ROCUREMENT AND .' NORGESTREL IBLE AFTER INTERCOURSE BUT OPTIMALLY WITHIN HE lRST DOSE ACEPTION )NTERNATIONAL #ONSORTIUM FOR ONEDUWORLDWIDE SS MAY BE LIMITED &AMILY RTANTLY OFFERING #/#S AL CONTRACEPTIVES AVAILABLE .UMBER OF S 4HEY HAVE DONE THIS S WITH INSTRUCTIONS FOR THE FORMULATIONS AND &IRST DOSE /#S MAY BE THE ONLY THE CORRECT DOSAGE FOR PROGESTIN ONLY %#0 IS MANUFACTURERS THAT TABLETS 0 LABELED AND PACKAGED ODUCTS DRAWN TORY OF (ORMONAL Y OR BY PRODUCT N USED SUCCESSFULLY TO INCLUDE ONLY THE CAN BE USED FOR CONTRACEPTION 3ECOND DOSE .UMBER OF TABLETS -ODULE ' !PPROACHES FOR 0ROVIDING #/#S AS .ON $EDICATED %#0S "ECAUSE #/#S GENERALLY COME IN ONE MONTH SUPPLY PACKETS PROVIDERS DISTRIBUTING #/#S FOR EMERGENCY CONTRACEPTION DEVELOP VARIOUS APPROACHES FOR DELIVERING THE PILLS TO CLIENTS &REQUENTLY USED APPROACHES FOR DELIVERING #/#S AS NONDEDICATED %#0S INCLUDE THE FOLLOWING s 0ROVIDING A MONTHS CYCLE OF PILLS TO THE CLIENT WITH VERBAL INSTRUCTIONS ON HOW TO TAKE THEM s #UTTING UP CYCLES AS NEEDED AND GIVING THE PILLS TO THE CLIENTS WITH VERBAL INSTRUCTIONS s #UTTING UP #/#S IN ADVANCE ON SITE AT A HEALTH CARE FACILITY AND INSERTING THEM IN ENVELOPES ALONG WITH SOME FORM OF WRITTEN INSTRUCTIONS s 2EPACKAGING #/#S IN A CENTRALIZED SUPERVISED FACILITY AND INSERTING PRINTED INSTRUCTIONS !LTHOUGH EACH OF THESE APPROACHES HAS ADVANTAGES THERE ARE ALSO DISADVANTAGES WHICH MEANS THERE IS A TRADE OFF AS TO SAFETYRISK OR COST SAVINGSINCREASED EXPENSE AS DISCUSSED BELOW 0ROS AND #ONS OF 0ROVIDING #/#S AS .ON $EDICATED %#0S 4HERE ARE SEVERAL FACTORS TO ADDRESS WHEN CONSIDERING WHETHER PROVISION OF #/#S AS NON DEDICATED %#0S IS AN APPROPRIATE CHOICE 4HESE INCLUDE THE POLITICAL SITUATION REGARDING EMERGENCY CONTRACEPTION REGULATORY REQUIREMENTS THE SCALE OF THE PROGRAM COST SAVING OPPORTUNITIES DONOR PROVISION OF APPROPRIATE #/# PRODUCTS AND POSSIBLE DONOR RESTRICTIONS ON USE OF THOSE PRODUCTS AND COSTS OF REPACKAGING AND QUALITY ASSURANCE 0ROGRAM PLANNERS MUST EVALUATE ALL OF THESE ELEMENTS CAREFULLY BEFORE MAKING A DECISION ABOUT REPACKAGING #/#S FOR %# 2EASONS WHY PROGRAMS WOULD CHOOSE THE OPTION OF PROVIDING #/#S AS NONDEDICATED %#0S 0OTENTIAL OPPOSITION )F THERE ARE SECTORS OR GROUPS IN A COUNTRY WHOSE SENSITIVITIES TOWARD EMERGENCY CONTRACEPTION MIGHT DELAY REGISTRATION PROCUREMENT AND DISTRIBUTION OF A PROGESTIN ONLY %#0 PROVISION OF #/#S FOR EMERGENCY CONTRACEPTIONA LOW PROlLE APPROACHMAY BE THE BEST ALTERNATIVE HELPING AVOID CONTROVERSY AND MAKING IT POSSIBLE TO MOVE AHEAD AND INCORPORATE EMERGENCY CONTRACEPTION INTO A PROGRAM IN A TIMELY WAY 0ROVISION OF A MONTHS CYCLE OF PILLS IN PARTICULAR HAS THE POTENTIAL ADVANTAGE OF BEING MORE ANONYMOUS IN THAT NO ONE WILL KNOW HOW THE CLIENT INTENDS TO USE THE PILLS !VAILABILITY "ECAUSE #/#S ARE WIDELY USED FOR REGULAR CONTRACEPTION THEY ARE REGISTERED AND EASILY AVAILABLE IN MOST COUNTRIES !CCESS )F #/#S ARE DONOR PROVIDED IT MAY BE EASIER FOR A PROGRAM TO USE SOME OF THE PRODUCT FOR EMERGENCY CONTRACEPTION RATHER THAN TO PROCURE AN ADDITIONAL PRODUCT #OST 0ROVIDING A MONTHS CYCLE OF PILLS OR CUTTING UP CYCLES AS NEEDED AND GIVING THEM TO THE CLIENT WITH VERBAL INSTRUCTIONS ON HOW TO TAKE THEM WOULD BE A LOW COST APPROACH ' ' -ODULE ' 0LANNING FOR 0RODUCT 3UPPLY -IXING OF DIFFERENT PACKETS AND BATCHES #/# PACKETS MAY NOT 0OTENTIAL FOR INCORRECT ADMINISTRATION 7HEN PROVIDING A MON #OST 4HE COST OF CUTTING UP #/#S IN ADVANCE AND INSERTING T 1UALITY CONTROL 4HE FARTHER ONE GETS FROM A CENTRALIZED PRO 2EGULATORY CONSTRAINTS 4HERE MAY BE REGULATORY BARRIERS TO NUMBER OF PACKETS TO ORDER WASTING PILL FROM EACH CYCLE 4HE WASTAGE SHOULD BE FACTORED THERE ARE %# CYCLES OF PILLS EACH IN ONE PACKET OF -ICR TO PROVIDE %# IN SEGMENTS OF PILLS AS SMALLER SEGMENTS COULD CYCLES )N :AMBIA WHERE PILL PACKETS OF -ICROGYNON ARE USED DETERMINE HOW MANY PACKETS OF #/#S WILL BE NEEDED TO YIELD THE 7HEN CUTTING UP #/# PACKETS FOR EMERGENCY CONTRACEPTION IT WIL %FFECTIVENESS #/#S ARE LESS EFFECTIVE FOR EMERGENCY CONTRAC NONDEDICATED %#0S 2EASONS WHY PROGRAMS WOULD NOT CHOOSE TO PROVIDE #/#S AS PROVIDING A DEDICATED LEVONORGESTREL ONLY %#0 SOME FORM OF WRITTEN INSTRUCTIONS COULD DEPENDING ON THE SCALE INACCURATE EXPIRY DATE OR DIFlCULTY IN TRACING PILLS IF A PRODU MANUFACTURING BATCHES OR LOTS COULD BE REPACKAGED TOGETHER 4HI NUMBER OF %#0 DOSES WHICH MEANS THAT PILLS FROM DIFFERENT PACK FOR LOW LITERATE CLIENTS CORRECT ADMINISTRATION IS PLACED ENTIRELY ON THE CLIENT 4HE RI INSTRUCTIONS ON THE NUMBER OF PILLS TO TAKE FOR EMERGENCY CONTR COULD UNDERMINE AN EMERGENCY CONTRACEPTION PROGRAM CENTRALIZED SUPERVISED FACILITY AND INSERTING PRINTED INSTRUCT INSERTING THEM IN ENVELOPES ALONG WITH WRITTEN INSTRUCTIONS OR RISK OF ERROR AND LACK OF QUALITY CONTROL THAN CUTTING UP #/#S CYCLES AS NEEDED AND GIVING THEM TO THE CLIENT WITH VERBAL INST THAT PROTECT EACH PILL COULD BE DESTROYED 0ROVIDING A MONTHS PACKS BY HAND AT MULTIPLE SITES ! PARTICULAR RISK IS THAT THE INCORRECT OR INCOMPLETE INSTRUCTIONS 1UALITY CONTROL CAN BE DI FOR ERROR INCLUDE PROVISION OF THE WRONG PRODUCT THE INCORRECT GREATER THE RISKS FOR ERROR IN PACKAGING OR IN PROVIDING INSTRU SEEKING SPECIAL .2! APPROVAL ORGANIZATIONS INFORMALLY CUT UP #/# PACKETS FOR EMERGENCY CONTR THERE IS NOT A DEDICATED EMERGENCY CONTRACEPTION PRODUCT HOWEV BUT REQUIRES A MANUFACTURERS LICENSE FOR LARGE SCALE REPACKAGI ALLOWS A REPACKAGINGRELABELING PROCESS WHEN IT IS DONE ON AN I .2! REQUIREMENTS )N THE 5NITED 3TATES FOR EXAMPLE THE &OOD PROGRAM CONSIDERING THIS APPROACH SHOULD BE AWARE OF THE .ATION USING THE PILLS FOR ANY PURPOSE OTHER THAN THAT FOR WHICH THEY FORMULATIONS AND THEY HAVE MORE SIDE EFFECTS OGYNON THIS PRACTICE MEANS INTEGRITY OF THE BLISTER PACKS DUCT QUALITY CONTROL SYSTEM THE CUTTING UP #/# PACKETS AND SK OF ERROR IS HIGH ESPECIALLY CT RECALL WERE NECESSARY IONS 1UALITY CONTROL PROBLEMS CTIONS FOR USE 0OSSIBILITIES TOO EASILY BE LOST 3INCE IN WHEN DECIDING ON THE HEM IN ENVELOPES ALONG WITH EPTION THAN PROGESTIN ONLY WERE ORIGINALLY REGISTERED ! THS CYCLE OF #/#S WITH FlCULT WHEN CUTTING UP PILL NUMBER OF PILLS AND IN ADVANCE ON SITE AND RUCTIONS WOULD ENTAIL GREATER NG )N MANY COUNTRIES WHERE REPACKAGING THE #/#S IN A CYCLE OF PILLS OR CUTTING UP THE PRACTICE IS ALWAYS ACEPTION THE BURDEN FOR DIVIDE INTO THE CORRECT NDIVIDUAL BASIS FOR CLIENTS DESIRED NUMBER OF %# L BE NECESSARY TO BE AS HIGH AS THE COST OF S COULD RESULT IN AN ER FAMILY PLANNING AND $RUG !DMINISTRATION ETS AND PERHAPS DIFFERENT AL 2EGULATORY !UTHORITY ACEPTION WITHOUT -ODULE ' 2EFERENCES 7ORLD (EALTH /RGANIZATION %MERGENCY #ONTRACEPTION ! 'UIDE FOR 3ERVICE $ELIVERY 7(/&2(&00 'ENEVA7(/ 7(/ 4ASK &ORCE ON 0OSTOVULATORY -ETHODS OF &ERTILITY 2EGULATION 2ANDOMIZED CONTROLLED TRIAL OF LEVONORGESTREL VERSUS THE 9UZPE REGIMEN OF COMBINED ORAL CONTRACEPTIVES FOR EMERGENCY CONTRACEPTION ,ANCET VON (ERTZEN ( ET AL ,OW DOSE MIFEPRISTONE AND TWO REGIMENS OF LEVONORGESTREL FOR EMERGENCY CONTRACEPTION A 7(/ MULTICENTRE RANDOMISED TRIAL ,ANCET 0!4( GREATFULLY ACKNOWLEDGES THE CONTRIBUTIONS OF *OHN 3KIBIAK OF THE 0OPULATION #OUNCIL .AIROBI TO THE DEVELOPMENT AND THE CONTENT OF THIS MODULE ' ' -ODULE ' -ODULE ' 4OOLS ,IST 0ROTOTYPE 0ACKAGE &ORMAT ! PACKAGE FORMAT THAT CAN BE ADAPTED AS NEEDED #/#S FOR %MERGENCY #ONTRACEPTION %XAMPLE OF THE 2EPACKAGING &ORMAT 5SED BY THE &AMILY 'UIDANCE !SSOCIATION OF %THIOPIA !N ILLUSTRATION OF A REPACKAGING FORMAT USED FOR REPACKAGED #/#S FOR EMERGENCY CONTRACEPTION )NFORMATION TO )NCLUDE 7HEN 0ROVIDING #/#S FOR %MERGENCY #ONTRACEPTION %SSENTIAL INFORMATION THAT SHOULD BE PROVIDED EITHER ON THE PACKAGE OR ON A PACKAGE INSERT AND ADDITIONAL OPTIONAL INFORMATION 0ROVISION OF A /NE -ONTH 3UPPLY OF #/#S FOR %MERGENCY #ONTRACEPTION 3UGGESTED INSTRUCTIONS TO PROVIDE WHEN DISPENSING A MONTHS SUPPLY OF ORAL CONTRACEPTIVES FOR THE INDICATION OF EMERGENCY CONTRACEPTION ' -ODULE ' 4OOLS ' 4OOLS -ODULE ' ([SLU\GDWH %DWFK ' -ODULE ' 4OOLS ' 4OOLS #/#S FOR %MERGENCY #ONTRACEPTION %XAMPLE OF THE 2EPACKAGING &ORMAT 5SED BY THE -ODULE ' &AMILY 'UIDANCE !SSOCIATION OF %THIOPIA ' -ODULE ' 4OOLS 4HE &AMILY 'UIDANCE !SSOCIATION OF %THIOPIA DEVELOPED THIS PACKAGE FORMAT IN COLLABORATION WITH THE -ODERN #ENTER FOR "USINESS 3ERVICES IN $UBAI AND WITH THE 0OPULATION #OUNCIL )T WAS REPRINTED WITH PERMISSION ' 4OOLS )NFORMATION TO )NCLUDE 7HEN 0ROVIDING #/#S -ODULE ' FOR %MERGENCY #ONTRACEPTION %SSENTIAL )NFORMATION 4HERE ARE TWO KINDS OF ESSENTIAL INFORMATION PRODUCT INFORMATION AND INFORMATION FOR THE USER 4HIS INFORMATION SHOULD BE PROVIDED EITHER ON THE PACKAGE OR ON A PACKAGE INSERT 0RODUCT INFORMATION s ,ABEL %MERGENCY #ONTRACEPTIVE 0ILLS OR %#0S s %XPIRY DATE OF PILLS INCLUDING MONTH DAY AND YEAR s -ANUFACTURERS BATCH OR LOT NUMBER s ,OCALLY MANDATED INFORMATION REQUIRED BY GOVERNMENT AGENCIES )NFORMATION FOR THE USER s "RIEF INSTRUCTIONS %#0S CAN PREVENT PREGNANCY AFTER UNPROTECTED SEXUAL INTERCOURSE 5SE %#0S IF YOU DO NOT WANT TO BECOME PREGNANT IF YOU THINK YOUR CONTRACEPTIVE METHOD HAS FAILED OR IF YOU WERE RAPED 4HE lRST DOSE SHOULD BE TAKEN AS SOON AS POSSIBLE AFTER SEX BUT CAN BE TAKEN UP TO DAYS HOURS AFTER SEX %#0S ARE MORE EFFECTIVE THE SOONER THEY ARE TAKEN 4HE SECOND DOSE SHOULD BE TAKEN HOURS AFTER THE lRST DOSE 4RY TO TAKE THE lRST DOSE SO THAT THE TIMING OF THE SECOND DOSE HOURS LATER IS PRACTICAL FOR YOU IE DURING WAKING HOURS %#0S CAN BE USED ANYTIME IN THE MENSTRUAL CYCLE s "RIEF INFORMATION ABOUT SIDE EFFECTS 3OME WOMEN HAVE SORE BREASTS HEADACHES OR FEEL NAUSEOUS 3OME WOMEN EVEN VOMIT AFTER TAKING %#0S )F YOU VOMIT WITHIN ONE HOUR AFTER TAKING %#0S TAKE ANOTHER DOSE IMMEDIATELY )F YOU VOMIT MORE THAN ONE HOUR AFTER TAKING %#0S YOU DO NOT NEED TO REPEAT THE DOSE 4HE SIDE EFFECTS OF %#0S MAY BE UNCOMFORTABLE BUT THEY ARE NOT HARMFUL AND USUALLY LAST FOR ONLY ONE DAY OR LESS )T IS NORMAL FOR YOUR NEXT PERIOD TO BEGIN A FEW DAYS EARLIER OR LATER THAN EXPECTED s 3EXUALLY TRANSMITTED INFECTIONS 34)S %#0S DO NOT PROTECT AGAINST 34)S OR ()6 )F YOU THINK YOU MAY HAVE CONTRACTED AN 34) OR ()6 VISIT YOUR HEALTH OR 34) CLINIC s ,OCALLY MANDATED INFORMATION REQUIRED BY GOVERNMENT AGENCIES ' /PTIONAL !DDITIONAL )NFORMATION )F THE PROGRAM IS PROVIDING A PACKAGE INSERT THE FOLLOWING ADDITIONAL INFORMATION COULD BE INCLUDED -ODULE ' s %#0S DO NOT WORK IF YOU ARE ALREADY PREGNANT s %#0S ARE EFFECTIVE CONTRACEPTION BUT THEY DO NOT WORK EVERY TIME )F YOUR PERIOD DOES NOT START WITHIN WEEKS AFTER TAKING %#0S YOU MAY BE PREGNANT (AVE A PREGNANCY TEST TO KNOW FOR SURE 4OOLS s !S SOON AS POSSIBLE BEGIN USING A BIRTH CONTROL METHOD YOU WILL BE ABLE TO USE ON AN ONGOING BASIS %#0S ARE INTENDED FOR EMERGENCY PROTECTION 4HEY ARE NOT AS EFFECTIVE AS OTHER FORMS OF BIRTH CONTROL s !FTER USING %#0S 5SE A BARRIER METHOD LIKE A CONDOM EACH TIME YOU HAVE SEX UNTIL YOU BEGIN YOUR NEXT MENSTRUAL PERIOD !FTER THAT TIME YOU MAY CONTINUE USING YOUR CONTRACEPTIVE METHOD OR BEGIN A NEW ONE OR )F YOU WERE USING ORAL CONTRACEPTIVES PILLS YOU SHOULD CONTINUE TAKING THE TABLETS STARTING ON THE DAY AFTER YOU TOOK THE %#0S UNTIL THE END OF THE CYCLE 9OU SHOULD THEN USE A CONDOM OR OTHER BARRIER CONTRACEPTIVE METHOD FOR AT LEAST SEVEN DAYS AFTER RESTARTING CONTRACEPTIVE PILLS %#0S AND #ONDOMS 0ACKAGING FOR $UAL 0ROTECTION %#0S ARE SOMETIMES PACKAGED WITH CONDOMS AS DUAL PROTECTION SINCE %#0S DO NOT PROTECT AGAINST 34)S INCLUDING ()6!)$3 )N SUCH CASES THERE WILL BE TWO EXPIRY DATESONE FOR THE PILLS AND ONE FOR THE CONDOM )T WILL BE IMPORTANT WHEN PLANNING DISTRIBUTION TO USE THE EARLIER OF THE TWO EXPIRY DATES 4HERE ALSO MAY BE SOME ADDITIONAL CLIENT INFORMATION PROVIDED WITH THE PACKAGE WHEN TWO PRODUCTS ARE PROVIDED 4HIS MATERIAL WAS DEVELOPED BY 0!4( ' 4OOLS 0ROVISION OF A /NE -ONTH 3UPPLY OF #/#S -ODULE ' FOR %MERGENCY #ONTRACEPTION )N A FEW COUNTRIES PROGRAMS HAVE CHOSEN TO DISTRIBUTE THE ENTIRE ONE MONTH SUPPLY OF #/#S ALONG WITH INSTRUCTIONS ON THE NUMBER OF PILLS TO TAKE FOR %# 7HILE IT MAY BE EASIER TO DISPENSE %# USING THIS APPROACH OF THE FOUR APPROACHES OUTLINED IN THIS MODULE THIS ONE ENTAILS THE MOST RISK BECAUSE IT PLACES THE BURDEN FOR CORRECT DOSAGE SQUARELY ON THE CLIENT 4HE RISK OF INCORRECT DOSAGE IS GREATLY ENHANCED IF LITERACY IS LOW IF THERE IS NO WAY TO CONlRM THAT THE CLIENT THOROUGHLY UNDERSTANDS THE INSTRUCTIONS SHE HAS BEEN GIVEN IF MULTIPLE PILL BRANDS ARE AVAILABLE IN THE COUNTRY ANDOR IF THE PACK CONTAINS IRON PILLS OR PLACEBOS IN ADDITION TO THE BIRTH CONTROL PILLS 4HE FOLLOWING INSTRUCTIONS COULD BE GIVEN TO CLIENTS WHEN PROVIDING THEM WITH A MONTHS SUPPLY FOR %# IN ADDITION TO PROVIDING USE INSTRUCTIONS SUCH AS THOSE PRINTED ON THE PROTOTYPE PACKAGE IN THE TOOLS SECTION OF THIS MODULE s &OR EMERGENCY CONTRACEPTION PILLS CAN BE TAKEN FROM A WHOLE PACKET OF REGULAR ORAL CONTRACEPTIVE PILLS $O NOT MIX BRANDS 4AKE THE TWO DOSES FROM THE SAME PACKET s )F YOU HAVE A COMPLETE PACKET OF REGULAR ORAL CONTRACEPTIVE PILLS THE LAST PILLS SHOULD NOT BE USED %# DOSES SHOULD BE TAKEN USING PILLS FROM THE lRST PILLS IN THE PACKET 4HIS MATERIAL WAS DEVELOPED BY 0!4( ' -ODULE ( 0ROVIDER 4RAINING /BJECTIVE 4O PROVIDE TECHNIQUES AND MATERIALS FOR TRAINING MEDICAL AND NONMEDICAL PERSONNEL WHO WILL BE DISTRIBUTING EMERGENCY CONTRACEPTION TO CLIENTS 4RAINING HEALTH CARE PROVIDERS TO SCREEN AND COUNSEL CLIENTS FOR EMERGENCY CONTRACEPTIVE PILLS %#0S WILL HELP ENSURE SUCCESSFUL INTRODUCTION OF THE METHOD AND ITS CORRECT USE 4HE SUBSTANCE OF THIS MODULE IS A PROTOTYPE TRAINING CURRICULUM THAT CAN BE ADAPTED TO DIFFERENT KINDS OF HEALTH PROVIDERS !S AN INTRODUCTION TO THE CURRICULUM THE FOLLOWING TOPICS ARE DISCUSSED s 0ROVIDER 4RAINING s 4ARGET !UDIENCES FOR 4RAINING s (OW TO 5SE THE %MERGENCY #ONTRACEPTION #URRICULUM 4OOLS 0ROVIDED AT THE %ND OF 4HIS -ODULE %MERGENCY #ONTRACEPTION #URRICULUM 0RE AND 0OST 3ESSION 1UESTIONNAIRE (ANDOUT +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS (ANDOUT 3AMPLE %MERGENCY #ONTRACEPTIVE 0ILL 3CREENING #HECKLIST (ANDOUT #OUNSELING FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS (ANDOUT #OUNSELING 3KILLS /BSERVER #HECKLIST 4RAINING !ID 'RAB "AG+EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 4RAINING !ID $EMONSTRATION 2OLE 0LAY 4RAINING !ID %MERGENCY #ONTRACEPTIVE 0ILL #LIENT 3ITUATION 2OLE 0LAYS 0ROVIDER 4RAINING &OR MORE THAN YEARS EMERGENCY CONTRACEPTION HAS BEEN KNOWN TO BE AN EFFECTIVE METHOD FOR PREVENTING PREGNANCY AFTER UNPROTECTED SEXUAL INTERCOURSE (OWEVER IT IS ONLY WITHIN THE PAST TEN YEARS THAT EMERGENCY CONTRACEPTION HAS RECEIVED WIDESPREAD ATTENTION AS A CONTRACEPTIVE OPTION AND DEDICATED %#0S HAVE ONLY RECENTLY BECOME AVAILABLE !S A RESULT INFORMATION ABOUT SCREENING AND COUNSELING %#0 CLIENTS IS NOT YET INCLUDED IN MANY TRAINING PROGRAMS FOR HEALTH PROVIDERS %MERGENCY CONTRACEPTION IS UNIQUE IN THAT IT IS A POSTCOITAL METHOD WOMEN NEED IT DUE TO UNEXPECTED CIRCUMSTANCES AND IT MUST BE TAKEN WITHIN A SHORT TIME FRAME 0ROVIDER TRAINING CAN HELP ENSURE QUALITY OF SERVICES 0RE SERVICE TRAINING AS ( ( -ODULE ( HOWEVER THEY DO NOT TYPICALLY DISTRIBUTE %#0S OR PROVIDE THE K 0EER EDUCATORS CAN PLAY A CRITICAL ROLE IN RAISING AWARENESS (OW TO 5SE THE %MERGENCY #ONTRACEPTION #URRICULUM 4ARGET !UDIENCES FOR 4RAINING AS WELL AS CONTINUING EDUCATION PROGRAMS OF HEALTH PROFESSIONAL 6ARIOUS ADAPTATIONS HAVE BEEN INCORPORATED INTO THE CURRICULUMS GROUPS 4HIS CURRICULUM HAS BEEN ADAPTED AND USED SUCCESSFULLY SPENT ON INTERACTIVE EXERCISES CAN BE MODIlED AND ADAPTED TO ME LEVELS OF KNOWLEDGE &OR EXAMPLE THE EMPHASIS ON TECHNICAL INF 4HIS TRAINING CURRICULUM CAN BE ADAPTED AND USED FOR A RANGE OF s s s s s DETERMINING PARTICIPANTS FOR TRAINING INCLUDE !SSESSMENT WORK CAN HELP GUIDE TRAINING 3OME IMPORTANT QUESTIO 4RAINING SHOULD BE ADAPTED TO MEET THE SPECIlC NEEDS OF THE TRA s s s s s s s SERVICES TO WOMEN INCLUDE THAT HAVE BEEN INSTRUMENTAL IN PROVIDING EMERGENCY CONTRACEPTIO REGULATIONS AND THE SOCIOCULTURAL SITUATIONS 'ROUPS IN BOTH T 0ROVIDERS OF EMERGENCY CONTRACEPTION WILL DIFFER IN EACH COUNTR OF STUDIES #AMBODIAINTEGRATED 0!4(S PHARMACY PERSONNEL TRAINING CURRICUL &ACULTY OF 0HARMACY ADAPTED ANDIN COLLABORATION WITH THE 0HARM HAS BEEN INSTITUTIONALIZED BY THE 5NIVERSITY OF (EALTH 3CIENCE TERM SUSTAINABILITY OF PROVIDER TRAINING &OR EXAMPLE IN #AMBO PART OF THE CURRICULUM IN UNIVERSITY SCHOOLS OF MEDICINE AND PH :KLFK 7HICH PROVIDER GROUPS WILL BE ABLE TO REACH THE LARGEST NUMBER CONTRACEPTION 7HICH PROVIDER GROUPS ARE MOST ACCESSIBLE TO POTENTIAL USERS OF 7HAT IS THE EDUCATIONAL BACKGROUND OF PARTICIPANTS !T WHAT STAGE OF INTRODUCTION IS EMERGENCY CONTRACEPTION CURREN $OMESTIC AND SEXUAL ABUSE AND RAPE SURVIVOR COUNSELORS AND ADVO 0EER EDUCATORS SUCH AS YOUTH LEADERS AT FACTORIES 0HARMACISTS AND PHARMACY COUNTER STAFF #OMMUNITY BASED DISTRIBUTORS 4RAINED HEALTH WORKERS SUCH AS COMMUNITY HEALTH VOLUNTEERS AND 0HYSICIANS .URSES PROVIDER JURXSVDUHWKHPRVWPRWLYDWHG" AMONG WOMEN WHO MIGHT NOT OTHERWISE RECEIVE INFORMATION IND OF TECHNICAL INFORMATION CONTAINED IN THIS MODULE HE PUBLIC AND PRIVATE SECTORS &ACULTY OF 0HARMACY 4HE ARMACY CAN ENSURE LONG INING PARTICIPANTS Y DEPENDING ON THE LAWS DIA PROVIDER TRAINING PROVIDERS WITH DIFFERING ORGANIZATIONS %FFORTS TO ORMATION OR THE TIME OF SCHOOLS OF PHARMACY IN SEVERAL COUNTRIES ET THE NEEDS OF SPECIlC N INFORMATION AND NS TO ASK WHEN EMERGENCY ACISTS !SSOCIATION OF OF WOMEN TLY UM INTO THE lNAL YEAR MIDWIVES CATES -ODULE ( INCLUDE EMERGENCY CONTRACEPTION IN THE CURRICULUMS OF HEALTH PROVIDER TRAINING PROGRAMS CAN HELP TO ENSURE WIDESPREAD PROVIDER KNOWLEDGE ABOUT EMERGENCY CONTRACEPTION 0ROVIDERS WHO ARE ALREADY TRAINED IN EMERGENCY CONTRACEPTION WILL BENElT FROM PERIODIC hREFRESHERv TRAINING SESSIONS THAT EMPHASIZE KEY ELEMENTS OF %#0 SERVICE DELIVERY AS WELL AS UPDATED SERVICE DELIVERY GUIDELINES BASED ON CURRENT MEDICAL EVIDENCE 4HE CURRICULUM GUIDES THE TRAINER THROUGH ESSENTIAL INFORMATION ABOUT %#0S RELATED REPRODUCTIVE HEALTH ISSUES SUCH AS SEXUALLY TRANSMITTED INFECTIONS 34)S AND COUNSELING ISSUES SUCH AS CONTINUED CONTRACEPTION AND REFERRAL )T IS IMPORTANT FOR THE TRAINER TO BECOME FAMILIAR WITH ALL OF THE MATERIAL IN THIS CURRICULUM HOWEVER IT IS NOT INTENDED TO BE READ ALOUD OR USED AS A LECTURE SCRIPT 4HE CURRICULUM IS FORMATTED TO CREATE AN INTERACTIVE LEARNING ENVIRONMENT AND QUESTIONS AND ACTIVITIES ARE INCLUDED TO PROMOTE DISCUSSION 4HE ACTIVITIES AIM TO HELP THE TRAINEES IMPROVE THEIR SKILLS IN PROVIDING %#0S AND OTHER REPRODUCTIVE HEALTH SERVICES 4HE CURRICULUM AND TRAINING MATERIALS PRESENTED HERE WERE DRAWN FROM A NUMBER OF EXISTING CURRICULA AND TRAINING RESOURCES 4RAINING TECHNIQUES USED THROUGHOUT THE CURRICULUM INCLUDE s 3MALL AND LARGE GROUP DISCUSSIONS s 0RESENTATION OF MATERIAL BY THE TRAINER s 2OLE PLAY s "RAINSTORMING s 'AMES s 7ORKING IN SMALL GROUPS OR PAIRS 4HE TRAINING TOOLS ARE DESIGNED AS A GENERIC MODEL FOR TRAINING VARIOUS TYPES OF PROVIDERS INCLUDING CLINICIANS AND PHARMACISTS #ONSIDER INCLUDING ADDITIONAL INFORMATION SPECIlC TO THE LEVEL OF PROVIDER THAT WILL BE TRAINED AND THE SETTING IN WHICH THEY WILL BE PROVIDING %#0S TO CLIENTS 3OME TOPICS FOR CONSIDERATION INCLUDE #LINICIANS s 0ROVIDING INFORMATION BOTH VERBAL AND WRITTEN DEPENDING ON THE WOMANS NEED ABOUT OTHER ONGOING FAMILY PLANNING METHODS INCLUDING THE INTRAUTERINE DEVICE s 0ROVIDING INFORMATION ABOUT 34)S INCLUDING ()6!)$3 MANAGEMENT AND TREATMENT s 0ROVIDING INFORMATION TO WOMEN IN A CLINIC SETTING ENSURING A PRIVATE AND SUPPORTIVE ENVIRONMENT s 0ROVIDING %#0S IN ADVANCE OF NEED TO WOMEN AT RISK OF UNINTENDED PREGNANCY 0HARMACISTS s %NSURING PRIVACY IN PHARMACY SETTINGS s 0ROVIDING WOMEN WITH APPROPRIATE VERBAL AND PRINTED INSTRUCTIONS FOR USING %#0S s 2EFERRING WOMEN TO OTHER HEALTH CARE PROVIDERS FOR FAMILY PLANNING METHODS AND 34) MANAGEMENTTREATMENT ( ( -ODULE ( !DDITIONAL 2ESOURCES FOR $EVELOPING 4RAINING 3ESSIONS HTTPWWWPATHORGlLES2(?00)+?PDF INTERNET AT REPRODUCTIVE HEALTH PHARMACY PROGRAM 0ROGRAM )MPLEMENTATION +IT 'UIDELINES AND TOOLS FOR IMPLEMENTI KWWS ZZZFHFLQIRRUJKWPOUHVGRZQORDGDEOHPWUOVKWP FOUND IN THE APPENDIX )T IS ALSO AVAILABLE ON LINE AT SERVE AS A STANDARD OF CARE FOR IMPLEMENTING A SERVICE PROTOCOL 0ILLS -EDICAL AND 3ERVICE $ELIVERY 'UIDELINES 4HE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTIONS HTTPWWWPATHORGlLES2(?00)+?PDF HTTPWWWPATHORGlLES2(?00)+?PDF /NCE PARTICIPANTS HAVE COMPLETED THE TRAINING CERTIlCATES OF C CURRICULUM TO CONDUCTING THE TRAINING WORKSHOP 4ECHNICAL REFERENCES ARE L MODULE 4HE TRAINER SHOULD COLLECT THIS INFORMATION AND INSERT 4HE TRAINER IS ALSO PROVIDED WITH A LIST OF COUNTRY SPECIlC INF OF EACH SESSION THE TRAINER IS PROVIDED WITH A LIST OF 4!S AND AS ANY OTHER MATERIALS DEEMED APPROPRIATE BY THE TRAINER OR PRE OF HANDOUTS (/S AND REFERENCE MATERIALS INCLUDED IN THE CURRI KEY POINTS COVERED IN THE TRAINING 4HE PACKET OF MATERIALS SHO 4RAINERS SHOULD PROVIDE EACH TRAINING PARTICIPANT WITH A PACKET 4!S WHICH ARE REFERENCED THROUGHOUT THE CURRICULUM MESSAGES ARE COVERED DURING THE TRAINING 4HE TRAINING CURRICUL +EY POINTS ARE INCLUDED AT THE END OF EACH SECTION 4HE TRAINER EXPERIENCES THROUGHOUT THE TRAINING TECHNIQUES USED PARTICIPANTS SHOULD BE ENCOURAGED TO SHARE THE CERTAIN ACTIVITIES OR SECTIONS THAT MIGHT ONLY BE USED FOR CERT CHANGED TO A PRESENTATION )N ADDITION DEPENDING ON LOCAL REAL FOR EACH SECTION ACCORDING TO THE AUDIENCEFOR INSTANCE A GROU IS ALSO INCLUDED AFTER THE SECTION TITLE 4HE TRAINER MAY CHANG 4HE TYPE OF TRAINING TECHNIQUE EG ROLE PLAY OR GROUP DISCUS ARE ALSO PROVIDED BUT THE TRAINER SHOULD ADJUST THE TIME AS AP COUNTRY SITUATION AND MODIFY THE TRAINING CURRICULUM TO BEST MEET THE NEEDS OF TH %ACH SECTION BEGINS ON A NEW PAGE DEPENDING ON HOW MANY BREAKS ARE INCLUDED 4HE TRAINING SESSION IS SCHEDULED TO LAST FOR APPROXIMATELY lVE WWWPATHORGRESOURCESEC?DIVERSE COMMUNITIES PROJHTMNOTEBOOK ! RESOURCE FOR DEVELOPING TRAINING SESSIONS FOR PHARMACISTS IS 2ESOURCES FOR DEVELOPING CLINICIAN FOCUSED TRAINING SESSIONS CA 3UGGESTIONS FOR THE AMOUNT OF TIME NEEDED TO CONDUCT EACH SESSI 4HE TRAINERPRESENTER IS ENCOURAGED TO ADAPT 0!4( 4HIS IS ALSO AVAILABLE ON THE HTTPWWWPATHORGlLES2(?00)+?PDF HTTPWWWPATHORGlLES2(?00)+?PDF PROVIDES MEDICAL GUIDELINES THAT CAN AIN GROUPS 2EGARDLESS OF THE E THE METHODOLOGY USED (/S USED FOR THAT MODULE PROPRIATE FOR THE AUDIENCE ORMATION NEEDED FOR EACH SION USED FOR EACH SECTION SHOULD ENSURE THAT THESE IT INTO THE CURRICULUM PRIOR ULD INCLUDE PHOTOCOPIES %MERGENCY #ONTRACEPTION ITIES AND NEEDS THERE ARE OMPLETION SHOULD BE GIVEN OF MATERIALS TO REINFORCE AND A HALF HOURS UM INCLUDES TRAINING AIDS AROUND %#0S )T CAN BE SENTER !T THE BEGINNING ISTED AT THE END OF THE N BE FOUND AT HTTP CULUM NOTEBOOK AS WELL IR THOUGHTS IDEAS AND 9OUTH &RIENDLY 0HARMACY P DISCUSSION COULD BE NG A YOUTH FRIENDLY E AUDIENCE AND ON -ODULE ( 4OOLS ,IST %MERGENCY #ONTRACEPTION #URRICULUM ! CURRICULUM FOR TRAINING PROVIDERS OF EMERGENCY CONTRACEPTION WITH INFORMATION ON UNINTENDED PREGNANCY BACKGROUND ON EMERGENCY CONTRACEPTION REGIMEN EFFECTIVENESS MECHANISM OF ACTION SAFETY AND USE COMMON SIDE EFFECTS COUNSELING SCREENING AND EDUCATION FOLLOW UP AND AWARENESS AND INCREASING AWARENESS OF %#0S 4HE TOOLS LISTED BELOW ARE TO BE USED IN CONJUNCTION WITH THE CURRICULUM 0RE AND 0OST 3ESSION 1UESTIONNAIRE 1UESTIONNAIRES TO BE USED BOTH BEFORE AND AFTER THE TRAINING TO HELP THE TRAINER UNDERSTAND AND MEASURE PARTICIPANT KNOWLEDGE LEVEL AND AWARENESS (ANDOUT +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 4HIS TOOL HAS A LIST OF KEY TOPICS AND ISSUES THAT SHOULD BE DISCUSSED WITH THE CLIENT WHEN PROVIDING %#0S !LTERNATIVELY IF PRIVACY CANNOT BE ASSURED THE HANDOUT CAN BE GIVEN TO THE CLIENT TO TAKE HOME (ANDOUT 3AMPLE %MERGENCY #ONTRACEPTIVE 0ILL 3CREENING #HECKLIST 4HIS TOOL IS DESIGNED TO HELP PROVIDERS REMEMBER WHAT TO ASK A CLIENT WHEN SCREENING HER FOR %#0 PROVISION (ANDOUT #OUNSELING FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 4HIS TOOL HELPS TRAIN PROVIDERS TO COUNSEL WOMEN IN A MANNER THAT IS RESPECTFUL OF THE CLIENT AND RESPONSIVE TO HER NEEDS FOR INFORMATION AND COUNSELING (ANDOUT #OUNSELING 3KILLS /BSERVER #HECKLIST 4HIS TOOL CAN BE USED BOTH IN TRAINING AND AS A REMINDER FOR PROVIDERS ON THE BEST WAYS TO COUNSEL WOMEN FOR %#0 USE ( 4RAINING !ID 'RAB "AG+EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 4HESE STATEMENTS ARE INTENDED TO BE USED AS TRAINING TOOLS FOR PROVIDERS 4HE PIECES CAN BE -ODULE ( DRAWN FROM A BAG OR HAT AND ACT AS PROMPTS FOR WHAT A PROVIDER SHOULD TELL A CLIENT ABOUT %#0S 4OOLS 4RAINING !ID $EMONSTRATION 2OLE 0LAY 4HIS ROLE PLAY IS A TOOL THAT CAN HELP PROVIDERS PREPARE FOR A VARIETY OF SITUATIONS IN WHICH MANY DIFFERENT TYPES OF WOMEN MAY REQUEST %#0S 4RAINING !ID %MERGENCY #ONTRACEPTIVE 0ILL #LIENT 3ITUATION 2OLE 0LAYS 4HESE ROLE PLAYS ARE TOOLS THAT CAN HELP PROVIDERS PREPARE FOR THE MANY DIFFERENT TYPES OF SITUATIONS AND WOMEN THAT MAY REQUEST %#0S ( 4OOLS %MERGENCY #ONTRACEPTION #URRICULUM -ODULE ( FOR [INSERT GROUP] IN [INSERT COUNTRY] /VERVIEW ,EARNING OBJECTIVES "Y THE END OF THIS TRAINING PARTICIPANTS WILL BE ABLE TO Ŷ $ESCRIBE THE HISTORY AND EXPANDING ROLE OF EMERGENCY CONTRACEPTION IN PREGNANCY PREVENTION Ŷ $ESCRIBE KEY FACTS ABOUT EMERGENCY CONTRACEPTION INCLUDING DIFFERENT REGIMENS EFFECTIVENESS MECHANISM OF ACTION SAFETY AND SIDE EFFECTS Ŷ %XHIBIT GOOD EMERGENCY CONTRACEPTIVE COUNSELING SKILLS Ŷ )DENTIFY MECHANISMS FOR RAISING AWARENESS OF EMERGENCY CONTRACEPTION WITHIN THE CLIENT POPULATION Ŷ )NCREASE THEIR AWARENESS OF EMERGENCY CONTRACEPTION RESOURCES IN ;INSERT COUNTRY= 4IME !PPROXIMATELY HOURS AND MINUTES DEPENDING ON LENGTH AND FREQUENCY OF BREAKS !GENDA )NTRODUCTION AND 0RE 3ESSION 1UESTIONNAIRE MIN 5NINTENDED 0REGNANCY MIN "ACKGROUND ON %MERGENCY #ONTRACEPTION MIN %FFECTIVENESS OF 4WO %MERGENCY #ONTRACEPTIVE 0ILL 2EGIMENS MIN $ESCRIPTION OF %MERGENCY #ONTRACEPTIVE 0ILL 2EGIMENS MIN %MERGENCY #ONTRACEPTIVE 0ILL -ECHANISM OF !CTION MIN %MERGENCY #ONTRACEPTIVE 0ILL 3AFETY AND 5SE MIN #OMMON 3IDE %FFECTS MIN %MERGENCY #ONTRACEPTION 3CREENING AND #OMMUNICATION MIN #OUNSELING FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS MIN &OLLOW 5P AND 2EFERRAL FOR #LIENTS MIN )NCREASING !WARENESS OF %MERGENCY #ONTRACEPTION MIN 2EVIEW #ONCLUSION AND 0OST 3ESSION 1UESTIONNAIRE MIN (ANDOUTS AND TRAINING AIDS 0RE AND 0OST 3ESSION 1UESTIONNAIRE (/ +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS (/ 3AMPLE %MERGENCY #ONTRACEPTIVE 0ILL 3CREENING #HECKLIST (/ #OUNSELING FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS ( (/ #OUNSELING 3KILLS /BSERVER #HECKLIST 4! 'RAB "AG+EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 4! $EMONSTRATION 2OLE PLAY 4! %MERGENCY #ONTRACEPTIVE 0ILL #LIENT 3ITUATION 2OLE 0LAYS -ODULE ( 0REPARATION 9OU WILL NEED THE FOLLOWING MATERIALS 4OOLS Ŷ &LIP CHART OVERHEAD OR CHALKBOARD Ŷ -ARKERS OR CHALK ,OCAL DATA ON THE FOLLOWING ISSUES CAN BE USED Ŷ .UMBER OF UNINTENDED PREGNANCIES BY YEAR FOR THE PAST SEVERAL YEARS Ŷ .UMBER OF PREGNANCIES IN GIRLS UNDER YEARS OF AGE FOR THE PAST SEVERAL YEARS Ŷ .UMBER OF ABORTIONS BY YEAR Ŷ .UMBER OF ABORTIONS TO GIRLS UNDER YEARS OF AGE BY YEAR Ŷ %MERGENCY CONTRACEPTION AVAILABILITY Ŷ 3TATUS OF DEDICATED EMERGENCY CONTRACEPTIVE PILL PRODUCT Ŷ %MERGENCY CONTRACEPTION AWARENESS OR USE Ŷ ,OCAL BRANDS OF ANTIEMITICS IE ANTINAUSEA DRUGS #ONTENT AND FORMAT FOR THIS CURRICULUM WERE ADAPTED FROM s $IVERSE !UDIENCES %MERGENCY #ONTRACEPTION #LINICAL 0ROVIDER 4RAINING #URRICULUM 3EATTLE 7! 0!4( s #OMPREHENSIVE 2EPRODUCTIVE (EALTH AND &AMILY 0LANNING 4RAINING #URRICULUM -ODULE %MERGENCY #ONTRACEPTIVE 0ILLS 7ATERTOWN -! 0ATHlNDER )NTERNATIONAL REVISED s 3PECIAL 2EPORT ON %MERGENCY #ONTRACEPTION 4HE 0HARMACISTS 2OLE !MERICAN 0HARMACEUTICAL !SSOCIATION s %XPANDING 'LOBAL !CCESS TO %MERGENCY #ONTRACEPTION ! #OLLABORATIVE !PPROACH TO -EETING 7OMENS .EEDS 3EATTLE 7! )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION ( 4OOLS )NTRODUCTION AND 0RE 3ESSION 1UESTIONNAIRE -INUTES -ODULE ( )NTRODUCE TRAINER AND PARTICIPANTS 2EVIEW OBJECTIVES OF THIS SESSION WRITE OUT ON mIP CHART PAPER OVERHEAD OR CHALKBOARD %STABLISH TIME FRAME FOR THIS SESSION 3EE /VERVIEW FOR OBJECTIVES %MPHASIZE PRACTICAL APPROACH OF TRAINING 4HIS TRAINING IS DESIGNED TO BUILD KNOWLEDGE OF EMERGENCY CONTRACEPTION %# BY PROVIDING ACCURATE UP TO DATE INFORMATION 4HE SESSION IS SCHEDULED TO LAST FOR APPROXIMATELY lVE HOURS AND THIRTY MINUTES $URING THE SESSION PARTICIPANTS WILL SHARE THEIR THOUGHTS IDEAS AND EXPERIENCES IN DISCUSSIONS SMALL GROUP WORK ROLE PLAYS AND LARGE GROUP DISCUSSIONS %NCOURAGE PARTICIPANTS TO ASK QUESTIONS WHEN THEY HAVE THEM $ISTRIBUTE PRE SESSION QUESTIONNAIRE !LLOW PARTICIPANTS APPROXIMATELY TEN MINUTES TO COMPLETE THE QUESTIONNAIRE ( 5NINTENDED 0REGNANCY -INUTES $ISCUSSION PRESENTATION PAIR WORK AND BRAINSTORMING -ODULE ( !SK PARTICIPANTS h7HAT IS UNINTENDED PREGNANCY (OW COMMON IS IT v ,IST PARTICIPANTS RESPONSES ON A mIP CHART OVERHEAD OR CHALKBOARD 5SING THE PARTICIPANT RESPONSES DElNE UNINTENDED PREGNANCY AND ITS CONSEQUENCES 0RESENT 4OOLS INFORMATION BELOW IF NECESSARY ,INK THIS INFORMATION TO THE NEED FOR %# CITING DATA ON NEED FROM ;INSERT COUNTRY= $ElNITION 5NINTENDED PREGNANCY IS hA PREGNANCY THAT IS UNWANTED OR MISTIMED AT CONCEPTIONv 5NINTENDED PREGNANCY DOES NOT MEAN UNWANTED BIRTHS OR UNLOVED CHILDREN (OWEVER IT DOES MEAN LESS OPPORTUNITY TO PREPARE AND LESS TIME FOR s 0REPREGNANCY RISK IDENTIlCATION s -ANAGEMENT OF PREEXISTING CONDITIONS s #HANGES IN DIET AND VITAMINS s !VOIDANCE OF ALCOHOL TOXIC EXPOSURE AND SMOKING s %NSURING THE lNANCIAL RESOURCES NEEDED TO DELIVER AND SUPPORT A NEW CHILD %ACH YEAR IN THE WORLD s 3EVENTY lVE MILLION WOMEN EXPERIENCE AN UNINTENDED PREGNANCY s 4HIRTY MILLION WOMEN EXPERIENCE CONTRACEPTIVE FAILURE s !PPROXIMATELY MILLION ABORTIONS OCCUR OF WHICH TWENTY MILLION ARE UNSAFE !SK PARTICIPANTS TO WORK IN PAIRS FOR lVE MINUTES %ACH PAIR SHOULD MAKE A LIST OF THEIR RESPONSES TO THE QUESTION h7HAT ARE THE CONSEQUENCES OF UNINTENDED PREGNANCY v !SK SEVERAL VOLUNTEERS TO OFFER ITEMS FROM THEIR LIST 0RESENT INFORMATION BELOW AS SUMMARY #ONSEQUENCES OF UNINTENDED PREGNANCIES CAN BE SIGNIlCANT 0OSSIBLE RESPONSES INCLUDE s (EALTH RISKS TO MOTHER s 2ELIANCE ON ABORTION TO END PREGNANCY s $ISCONTINUATION OF SCHOOLING FOR ADOLESCENTS s %MOTIONAL DISTRESS s %CONOMIC HARDSHIP s $ISAPPROVAL FROM THE COMMUNITY ESPECIALLY FOR YOUNG UNMARRIED WOMEN s 0OSSIBLE HEALTH RISKS TO INFANTS INCLUDING BIRTH INJURIES LOWER BIRTH WEIGHT AND A LOWER CHANCE OF SURVIVAL 7HERE ABORTION IS ILLEGAL OR RESTRICTED BY AGE WOMEN MAY SEEK AN ILLEGAL PROVIDER WHO MAY BE UNSKILLED OR MAY PRACTICE UNDER UNSANITARY CONDITIONS 5NSAFE ABORTION REPRESENTS A HIGH ( 4OOLS PROPORTION OF THE MATERNAL DEATHS .EARLY PERCENT OF ALL MATERNAL DEATHS ARE THE RESULT OF ABORTION COMPLICATIONS ;)NSERT COUNTRY SPECIlC DATA ON UNSAFE ABORTION= -ODULE ( "RIEmY INTRODUCE %# USING THE INFORMATION BELOW %MERGENCY CONTRACEPTION IS THE ONLY CURRENTLY AVAILABLE CONTRACEPTIVE METHOD THAT PREVENTS PREGNANCY AFTER SEXUAL INTERCOURSE AND BEFORE IMPLANTATION "ECAUSE THERE IS NO PERFECT FORM OF CONTRACEPTION AND THERE ARE VERY FEW PERFECT CONTRACEPTIVE USERS IT IS IMPORTANT TO REMEMBER THAT EVEN THOSE COUPLES USING CONTRACEPTION FAITHFULLY AND CORRECTLY CAN EXPERIENCE CONTRACEPTIVE FAILURE !SK PARTICIPANTS h7HY OR WHEN WOULD SOMEONE NEED %# v ,IST PARTICIPANTS RESPONSES ON A mIP CHART OVERHEAD OR CHALKBOARD $ISCUSS AND COMPLEMENT PARTICIPANT RESPONSES WITH THE INFORMATION BELOW 4HERE ARE DIFFERENT REASONS A CLIENT MIGHT NEED %# 4HOSE REASONS ARE s )F A COUPLE RECENTLY HAD SEX WITHOUT USING CONTRACEPTION s )F A CONDOM BROKE OR SLIPPED s )F A WOMAN USING ORAL CONTRACEPTIVE PILLS MISSED THREE OR MORE PILLS s )F A WOMAN USING CONTRACEPTIVE INJECTIONS WAS LATE FOR HER SHOT s )F A WOMAN THINKS THAT HER DIAPHRAGM OR CERVICAL CAP SLIPPED s )F A WOMAN EXPERIENCED AN )5$ EXPULSION s )F SEX WAS FORCED RAPE 3UMMARY OF KEY POINTS Ŷ ;)NSERT COUNTRY SPECIlC DATA TO DEMONSTRATE THE MAGNITUDE OF THE PROBLEM OF UNINTENDED PREGNANCY= Ŷ %# HAS A VERY STRONG POTENTIAL ROLE IN REDUCING UNINTENDED PREGNANCY Ŷ 4HE HEALTH AND SOCIAL CONSEQUENCES OF UNINTENDED PREGNANCY ARE SIGNIlCANT Ŷ 5SE OF %# AFTER CONTRACEPTIVE FAILURE OR WHEN NO CONTRACEPTION WAS USED REPRESENTS A RESPONSIBLE CHOICE TO PREVENT PREGNANCY ( "ACKGROUND ON %MERGENCY #ONTRACEPTION -INUTES "RAINSTORMING AND PRESENTATION -ODULE ( !SK PARTICIPANTS h7HAT DO YOU KNOW OR WHAT HAVE YOU HEARD ABOUT %# v ,IST PARTICIPANTS RESPONSES ON mIP CHART OVERHEAD OR CHALKBOARD 4ELL PARTICIPANTS THAT WHILE SOME OF THE THINGS THEY HAVE HEARD OR BELIEVE ABOUT %# MAY NOT BE COMPLETELY 4OOLS CORRECT THE TRAINING SESSION TODAY WILL CLARIFY POINTS OF CONFUSION AND CORRECT ANY MISINFORMATION (IGHLIGHT THE HISTORY OF %# INTRODUCTION WITH SPECIlC INFORMATION ABOUT %# INTRODUCTION AND AVAILABILITY IN ;INSERT COUNTRY= %MERGENCY CONTRACEPTION IS NOT NEW s (IGH DOSE ESTROGENS WERE USED FOR %# IN THE S s )N THE MID S $R !LBERT 9UZPES RESEARCH ON HIGH DOSE ESTROGEN REGIMENS LED TO THE CURRENT REGIMEN UTILIZING AVAILABLE COMBINED ORAL CONTRACEPTIVE PRODUCTS !LSO IN THE S RESEARCH BEGAN ON THE USE OF PROGESTIN ONLY PILLS s 2EGULATORY AUTHORITIES THROUGHOUT THE WORLD INCLUDING &RANCE THE 5NITED +INGDOM AND THE 5NITED 3TATES HAVE APPROVED %# PRODUCTS %MERGENCY #ONTRACEPTIVE 0ILLS %#0S ARE ON THE 7ORLD (EALTH /RGANIZATION -ODEL %SSENTIAL -EDICINE ,IST 3EE THE APPENDIX FOR A LIST OF WEBSITE RESOURCES AND A LINK TO THE 7(/ %SSENTIAL -EDICINE ,IST 4HIS LIST ALSO PROVIDES A LINK TO THE )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTIONS LIST OF OTHER COUNTRIES WITH REGISTERED %# PRODUCTS s ;)NSERT RELEVANT COUNTRY SPECIlC DATA ON %# INTRODUCTION AND AVAILABILITY= s 7ITH THESE DEVELOPMENTS THE USE OF %# IS INCREASING AND LIKELY WILL CONTINUE TO EXPAND )T IS IMPORTANT THAT PROVIDERS BE PREPARED TO HELP WOMEN USE IT EFFECTIVELY %XPLAIN THE TWO TYPES OF %# 4HERE ARE TWO TYPES OF %# %#0S AND )5$ INSERTION %#0S %#0S ARE HIGHER DOSES OF THE SAME HORMONES FOUND IN ORDINARY BIRTH CONTROL PILLS %#0S SHOULD BE INITIATED AS SOON AS POSSIBLE WITHIN DAYS HOURS AFTER UNPROTECTED SEX %#0S ARE MORE EFFECTIVE THE SOONER THEY ARE TAKEN 7OMEN SHOULD BE ENCOURAGED TO TAKE THE %#0S AS SOON AS POSSIBLE WITHIN HOURS BUT THEY SHOULD UNDERSTAND THAT THE EFFECTIVENESS OF THE PILLS IS LESSENED THE LONGER ONE WAITS AFTER INTERCOURSE TO TAKE THEM %#0S ARE SOMETIMES REFERRED TO AS THE hMORNING AFTER PILL v DESPITE THE LONGER WINDOW OF OPPORTUNITY FOR THEIR USE 2ECOMMENDED DOSING DIFFERS DEPENDING ON THE TYPE OF %#0 THAT IS TAKEN %#0S ARE NOT THE SAME AS MISOPROSTOL MIFEPRISTONE OR 25 THE &RENCH ABORTION PILL AND THEY CANNOT CAUSE AN ABORTION %#0S CAN BE PROVIDED TO WOMEN BEFORE THEY NEED THEM 7E KNOW THAT CONTRACEPTIVES FAIL AND SOMETIMES WOMEN ARE UNABLE TO USE A CONTRACEPTIVE METHOD 4HEREFORE IT MAY BE IMPORTANT FOR ( 4OOLS WOMEN TO HAVE %#0S AVAILABLE AT HOME IN THE EVENT THAT THEY HAVE UNPROTECTED INTERCOURSE AND DO NOT WANT TO GET PREGNANT (AVING %#0S AT HOME WILL HELP ENSURE THAT THEY ARE EASILY AVAILABLE AND CAN BE -ODULE ( USED SOON AFTER INTERCOURSE WHEN THEY ARE MOST EFFECTIVE )5$ )NSERTION )5$ INSERTION WITHIN DAYS OF UNPROTECTED SEX ALSO IS AN EFFECTIVE FORM OF %# AND HAS THE ADDED BENElT OF PROVIDING THE CLIENT WITH A LONG TERM CONTRACEPTIVE METHOD 0ROVIDERS NOT TRAINED IN )5$ INSERTION CAN REFER WOMEN TO HEALTH CARE PROVIDERS FOR THIS PROCEDURE (OWEVER THIS MUST OCCUR WITHIN THE TIME FRAME ABOVE $FRSSHU7,8'XVHGIRU(&UHGXFHVWKHULVNRISUHJQDQF\DIWHUXQSURWHFWHGLQWHUFRXUVHE\ SHUFHQW )F INSERTED FOR %# )5$S CAN BE RETAINED FOR UP TO YEARS OR REMOVED DURING THE CLIENTS NEXT MENSTRUATION 3CREENING FOR AN )5$ AS AN %# METHOD SHOULD FOLLOW REGULAR )5$ SCREENING CRITERIA )N ADDITION THE PROVIDER SHOULD ASCERTAIN THAT THE UNPROTECTED INTERCOURSE OCCURRED WITHIN DAYS OF SEEKING TREATMENT ./4% )F ASKED ABOUT THE MECHANISM OF ACTION THE TRAINER MAY EXPLAIN THAT THE COPPER ON THE )5$ CAN PREVENT FERTILIZATION OR INHIBIT IMPLANTATION .OTE TO PARTICIPANTS THAT THE TRAINING WILL FOCUS ON %#0S BECAUSE THEY ARE ACCESSIBLE THROUGH A VARIETY OF PROVIDERS WHEREAS )5$S CAN ONLY BE INSERTED BY PHYSICIANS 3UMMARY OF KEY POINTS Ŷ %# HAS BEEN IN USE FOR OVER YEARS AND MANY INTERNATIONAL REGULATORY BODIES APPROVE IT Ŷ 4HERE ARE TWO TYPES OF %# %#0S AND )5$ INSERTION %#0S ARE THE FOCUS OF THE TRAINING SINCE THEY ARE THE MOST EASILY ACCESSIBLE AND AVAILABLE Ŷ %# IS INCREASINGLY BEING RECOGNIZED AS A STANDARD OF CARE FOR PREVENTION OF PREGNANCY AFTER UNPROTECTED INTERCOURSE ( %FFECTIVENESS OF 4WO %MERGENCY #ONTRACEPTIVE 0ILL 2EGIMENS -INUTES 0RESENTATION -ODULE ( )NTRODUCE THE TWO TYPES OF %#0 REGIMENS REVIEW THEIR EFFECTIVENESS AND DISCUSS THE DOSAGE REQUIREMENTS 5SE THE INFORMATION BELOW 4HERE ARE TWO TYPES OF %#0S CURRENTLY IN USE THAT WILL BE DISCUSSED IN THIS TRAINING %ACH TYPE OR 4OOLS REGIMEN IS DElNED BY THE TYPE OF HORMONE OR ACTIVE INGREDIENTS USED s 4HE PROGESTIN ONLY REGIMEN CONSISTS OF MG LEVONORGESTREL OR NORGESTREL TAKEN IN A SINGLE DOSE AS SOON AS POSSIBLE AFTER UNPROTECTED INTERCOURSE )T CAN BE TAKEN UP TO HOURS OR lVE DAYS AFTER UNPROTECTED INTERCOURSE )T IS IMPORTANT TO TAKE THE PILLS AS SOON AS POSSIBLE BECAUSE THEIR EFFECTIVENESS DECREASES OVER TIME s %STROGEN AND PROGESTIN THE COMBINED REGIMEN OR THE 9UZPE REGIMEN IS ETHINYL ESTRADIOL PLUS LEVONORGESTREL OR NORGESTREL 4AKE THE lRST DOSE AS SOON AS POSSIBLE AFTER UNPROTECTED INTERCOURSE AND THE SECOND DOSE HOURS LATER )T CAN BE TAKEN UP TO HOURS OR lVE DAYS AFTER UNPROTECTED INTERCOURSE )T IS IMPORTANT TO TAKE THE PILLS AS SOON AS POSSIBLE BECAUSE THEIR EFFECTIVENESS DECREASES OVER TIME .OTE 4HE TWO DOSES OF THE COMBINED %#0 REGIMEN SHOULD ./4 BE TAKEN AT ONE TIME BECAUSE OF THE INCREASED RISK OF NAUSEA AND VOMITING 4HE DIFFERENCES IN BOTH EFFECTIVENESS AND SIDE EFFECTS BETWEEN THE TWO METHODS ARE SIGNIlCANT AND SUBSTANTIAL 4HE PROGESTIN ONLY METHOD IS BOTH MORE EFFECTIVE AND PRODUCES FEWER SIDE EFFECTS 2EGIMEN %FFECTIVENESS 6LGHHIIHFWV 2EDUCES THE RISK OF PREGNANCY .AUSEA IN PERCENT OF WOMEN AND VOMITING 0ROGESTIN ONLY BY PERCENT IN PERCENT #OMBINED ESTROGEN 2EDUCES THE RISK OF PREGNANCY .AUSEA PRESENT IN PERCENT OF WOMEN USING PROGESTIN BY PERCENT THIS REGIMEN AND VOMITING IN PERCENT )F VOMITING OCCURS WITHIN ONE HOUR AFTER TAKING A DOSE TAKE ANOTHER DOSE AS SOON AS POSSIBLE )F VOMITING OCCURS MORE THAN ONE HOUR AFTER TAKING %#0S YOU DO NOT NEED TO REPEAT THE DOSE 1HLWKHUPHWKRGZLOOZRUNLIDZRPDQLVDOUHDG\SUHJQDQW 5HVHDUFKKDVGHPRQVWUDWHGWKDWWKHHI¿FDF\RI(&3VGHFUHDVHVDVWKHWLPHLQFUHDVHVEHWZHHQ LQWHUFRXUVHDQGXVHRI(&3V 7KLVPHDQVWKDWZRPHQPXVWKDYHUHDG\DFFHVVWR(&3VLQRUGHUWR PD[LPL]HWKHLUHIIHFWLYHQHVV !LMOST ALL OTHER CONTRACEPTIVE METHODS ARE MORE EFFECTIVE THAN %#0S FOR REGULAR ONGOING USE %#0S ARE NOT PERCENT EFFECTIVE 7OMEN WHO USE THEM ON A REGULAR BASIS REPEATEDLY EXPOSE THEMSELVES TO THE RISK OF METHOD FAILURE %#0S REDUCE THE RISK OF PREGNANCY BY TO PERCENT 4HAT IS TO SAY THAT IF WOMEN HAVE UNPROTECTED INTERCOURSE DURING THEIR MOST FERTILE TIMES OF THE MONTH AND TAKE s ! PROGESTIN ONLY %# REGIMEN THEN WILL BECOME PREGNANT A PERCENT REDUCTION IN PREGNANCY RISK s ! COMBINED ESTROGENPROGESTIN %# REGIMEN THEN WILL BECOME PREGNANT A PERCENT REDUCTION IN PREGNANCY RISK 7KHVHHVWLPDWHVRIUHGXFWLRQLQWKHULVNRISUHJQDQF\IROORZLQJ(&3XVHDUHEDVHGRQVWXGLHVWKDWHYDOXDWHG(&3XVHZLWKLQD KRXUWLPHIUDPH ( 4OOLS 4HE MORE TIMES A WOMAN USES THE METHOD THE MORE TIMES SHE EXPOSES HERSELF TO PREGNANCY RISK !DDITIONALLY REGULAR %#0 USE FOUR OR MORE TIMES A MONTH CAUSES BLEEDING IRREGULARITY 7HILE NOT -ODULE ( NECESSARILY A HEALTH RISK IRREGULAR BLEEDING IS UNACCEPTABLE TO MOST WOMEN 3UMMARY OF KEY POINTS Ŷ 4HERE ARE TWO %#0 REGIMENS PROGESTIN ONLY AND COMBINED ESTROGEN AND PROGESTIN Ŷ 4HE PROGESTIN ONLY REGIMEN IS MORE EFFECTIVE AND HAS FEWER SIDE EFFECTS Ŷ "OTH %#0 REGIMENS ARE MORE EFFECTIVE THE SOONER THEY ARE TAKEN Ŷ 4HE PROGESTIN ONLY REGIMEN MG DOSE OF LEVONORGESTREL CAN BE SAFELY AND EFFECTIVELY TAKEN AT ONE TIME RATHER THAN HOURS APART Ŷ %#0S ARE NOT INTENDED FOR REGULAR USE ALMOST ALL OTHER CONTRACEPTIVE METHODS ARE MORE EFFECTIVE ( $ESCRIPTION OF %MERGENCY #ONTRACEPTIVE 0ILL 0RODUCT 2EGIMENS -INUTES -ODULE ( 0RESENTATION AND DISCUSSION %XPLAIN THAT %#0S ARE AVAILABLE IN MANY COUNTRIES AS A DEDICATED SPECIlCALLY PACKAGED PRODUCT $ISCUSS THE AVAILABILITY OF A DEDICATED PRODUCT IN ;INSERT COUNTRY= 4OOLS "OTH THE PROGESTIN ONLY AND COMBINED REGIMENS ARE AVAILABLE IN SOME COUNTRIES AS DEDICATED %#0 PRODUCTSTHOSE PACKAGED AND LABELED SPECIlCALLY FOR USE AS %#0S )F IT IS AVAILABLE AND AFFORDABLE THE PROGESTIN ONLY REGIMEN IS RECOMMENDED OVER THE COMBINED REGIMEN 4HE PROGESTIN ONLY REGIMEN IS MORE EFFECTIVE AND HAS FEWER SIDE EFFECTS 4HE COMBINED REGIMEN HOWEVER IS BETTER THAN NO %#0S AT ALL ;)NSERT COUNTRY SPECIlC DATA ON STATUS OF DEDICATED PRODUCT )NCLUDE INFORMATION ON THE BRAND NAME THE COST AND WHETHER THE PRODUCT IS AVAILABLE IN PHARMACIES= !SK PARTICIPANTS IF THEY HAVE HEARD OF REGULAR ORAL CONTRACEPTIVE PILL PACKETS BEING USED FOR %# !SK h(OW CAN REGULAR ORAL CONTRACEPTIVE PILLS BE USED AS %# v %XPLAIN THE DIFFERENT WAYS %# MAY BE PROVIDED WITH REGULAR ORAL CONTRACEPTIVE PILLS USING THE INFORMATION PROVIDED BELOW (AVE PARTICIPANTS FOLLOW THE DISCUSSION USING THE TABLE IN (/ +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 2EGULAR ORAL CONTRACEPTIVE PILLS CAN BE USED FOR %# 4HE DOSES OF COMBINED ORAL CONTRACEPTIVES APPROXIMATE THE AMOUNT OF THE ESTROGEN AND THE PROGESTIN USED IN THE 9UZPE REGIMEN -OST OF THE BRANDS LISTED IN THE TABLE ON THE THIRD PAGE OF (/ +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS AND THE NEXT PAGE REQUIRE TAKING OR PILLS FOR THE lRST DOSE AND OR PILLS FOR THE SECOND DOSE "ECAUSE THESE ARE COMBINED ESTROGEN AND PROGESTIN PILLS THEY CANNOT BE TAKEN IN A SINGLE DOSE ( 4OOLS %#0 &ORMULATIONS -ODULE ( 3ECOND &IRST $OSE $OSE &ORMULATION NUMBER OF NUMBER OF PER PILL #OMMON "RAND .AMES TABLETS TABLETS 0ROGESTIN ONLY ,.' MG ,EVONELLE .OR,EVO 2EGIMEN 0LAN " 0OSTINOR 6IKELA 3INGLE $OSE #OMBINED %% MCG ,.' MG %UGYNON &ERTILAN 2EGIMEN OR .EOGYNON .ORAL %% MCG .' MG .ORDIOL /VIDON /VRAL /VRAN 0# 0REVEN %% MCG ,.' MG ,O&EMENAL -ICROGYNON OR .ORDETTE /VRAL , 2IGEVIDON %% MCG .' MG !BBREVIATIONS %% ETHINYL ESTRADIOL ,.' LEVONORGESTREL .' NORGESTREL &OR ALL REGIMENS THE lRST DOSE SHOULD BE TAKEN AS SOON AS POSSIBLE AFTER INTERCOURSE BUT OPTIMALLY WITHIN HOURS 4HE SECOND DOSE OF THE COMBINED REGIMEN SHOULD BE TAKEN HOURS AFTER THE lRST DOSE 4HE PROGESTIN ONLY REGIMEN DOSES MAY BE TAKEN ALL AT ONE TIME !DAPTED FROM %XPANDING 'LOBAL !CCESS TO %MERGENCY #ONTRACEPTION )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION /CTOBER P )NFORMATION IN THIS TABLE HAS BEEN UPDATED TO REmECT CURRENT RESEARCH VON (ERTZEN ( ET AL ,OW DOSE MIFEPRISTONE AND TWO REGIMENS OF LEVONORGESTREL FOR EMERGENCY CONTRACEPTION A 7(/ MULTICENTRE RANDOMIZED TRIAL ,ANCET 7RKHOSWKHFOLHQWDYRLGPLVWDNHVLQWDNLQJWKHUHJLPHQWKHSURYLGHURUVWDIIVKRXOGFXWXSRUDO FRQWUDFHSWLYHSLOOSDFNHWVDQGJLYHRQO\WKHVSHFL¿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¿HGFOHDUO\DQGWKDW WKHZRPHQDUHLQVWUXFWHGFDUHIXOO\DERXWWKHQXPEHUDQGFRORURIWKHWDEOHWVUHTXLUHGIRUHDFKGRVH 7RKHOSHQVXUHFRPSOLDQFHZLWKWKHUHJLPHQZKHQXVLQJUHJXODURUDOFRQWUDFHSWLYHVSURYLGHZULWWHQ LQIRUPDWLRQ0DQXIDFWXUHUVRIRUDOFRQWUDFHSWLYHVGRQRWSURYLGHSDWLHQWLQIRUPDWLRQDERXW(& ( (IGH DOSE ORAL CONTRACEPTIVE COMBINATIONS PILLS CONTAINING MORE THAN G OF ESTROGEN AND TRIPHASIC FORMULATIONS SHOULD NOT BE USED AS %#0S 3UMMARY OF +EY 0OINTS Ŷ 4HERE ARE DEDICATED %#0 PRODUCTS IN MANY COUNTRIES -ODULE ( Ŷ $EDICATED %#0 PRODUCTS ARE PREFERRED BECAUSE THEY ARE PACKAGED AND LABELED SPECIlCALLY FOR USE AS %#0S AND BECAUSE THERE IS LESS CHANCE FOR ERROR Ŷ 7HERE NO DEDICATED PRODUCT IS AVAILABLE REGULAR ORAL CONTRACEPTIVE PILLS CAN BE USED FOR %# 4OOLS Ŷ 7HEN #/#S ARE REPACKAGED AS %#0S PROVIDE CLEAR PRODUCT IDENTIlCATION AND CLIENT INSTRUCTIONS Ŷ %#0 AVAILABILITY IN ;INSERT COUNTRY= 7ULSKDVLFIRUPXODWLRQRI2&VDOWHUWKHGRVDJHRIHVWURJHQDQGSURJHVWLQWKURXJKRXWWKHPRQWKO\UHJLPHQWRDOWHUVWHURLGOHYHOVLQDQ HIIRUWWRPLQLPL]HPHWDEROLFHIIHFWVDQGEUHDNWKURXJKEOHHGLQJDQGDPHQRUUKHD7KH\VKRXOGQRWEHXVHGDV(&3V ( 4OOLS %MERGENCY #ONTRACEPTIVE 0ILL -ECHANISM OF !CTION -INUTES -ODULE ( "RAINSTORMING DISCUSSION AND PRESENTATION .OTE TO 4RAINER 9OU MAY WISH TO HAVE A PHYSICIAN OR OTHER CLINICIAN PRESENT DURING THE DISCUSSION ON %#0 MECHANISM OF ACTION TO HELP EXPLAIN THE PROCESS OF PREGNANCY AND HOW HORMONAL CONTRACEPTIVES WORK !SK PARTICIPANTS h(OW DO %#0S PREVENT PREGNANCY v #ONlRM OR CORRECT PARTICIPANTS RESPONSES .OTE THE CONTENT OF PARTICIPANTS RESPONSES RELATED TO %#0S MECHANISM OF ACTION ON A mIP CHART OVERHEAD OR CHALKBOARD 0ROVIDE THE INFORMATION BELOW IF IT IS NOT COVERED THROUGH THE QUESTION AND ANSWERS %#0S WORK THE SAME WAY REGULAR ORAL CONTRACEPTIVE PILLS WORK 4HESE PILLS MAY WORK IN MORE THAN ONE WAY 7E CLEARLY UNDERSTAND SOME OF THESE WAYS OTHERS ARE POSSIBLE BUT NOT YET PROVEN s 6WDWLVWLFDOHYLGHQFHVXJJHVWVWKDW(&3VPXVWZRUNWKURXJKPRUHWKDQRQHPHFKDQLVPRIDFWLRQRU WKH\FRXOGQRWEHDVHIIHFWLYHDVWKH\DUH s 5HVHDUFKKDVVKRZQWKDW(&3VFDQLQKLELWRUGHOD\RYXODWLRQ s (&3VPD\SUHYHQWLPSODQWDWLRQ LHWKHLPSODQWLQJRIWKHIHUWLOL]HGHJJLQWKHOLQLQJRIWKHXWHUXV E\ DOWHULQJWKHHQGRPHWULXP WKHOLQLQJRIWKHXWHUXV +RZHYHUWKHHYLGHQFHIRUHQGRPHWULDOHIIHFWVRI (&3WUHDWPHQWLVPL[HGDQGLWLVQRWFOHDUWKDWWKHHQGRPHWULDOFKDQJHVZRXOGLQKLELWLPSODQWDWLRQ s ,WLVSRVVLEOHWKDW(&3VLQKLELWIHUWLOL]DWLRQ²WKURXJKWKLFNHQLQJRIWKHFHUYLFDOPXFRXVUHVXOWLQJLQ WUDSSLQJRIVSHUPRUDOWHUDWLRQVLQWKHWXEDOWUDQVSRUWRIVSHUPRUHJJ²EXWQRGDWDH[LVWUHJDUGLQJ FRQ¿UPDWLRQRIWKLVSRVVLEOHPHFKDQLVPRIDFWLRQ 4IMING PLAYS A KEY ROLE IN HOW %#0S WORK /F PARTICULAR IMPORTANCE IS s &\FOHGD\RQZKLFKLQWHUFRXUVHRFFXUUHG s &\FOHGD\RQZKLFKWUHDWPHQWLVXVHG %#0S ROLE IN PREVENTING PREGNANCY s ,WWDNHVDERXWGD\VDIWHURYXODWLRQIRUDIHUWLOL]HGHJJWREHJLQWRLPSODQW7KHUHIRUHLQWHUYHQWLRQ ZLWKLQKRXUVRUXSWRGD\VFDQQRWUHVXOWLQDERUWLRQ s $VPHQWLRQHGHDUOLHU(&3VZLOOQRWZRUNLILPSODQWDWLRQKDVRFFXUUHGDQGDZRPDQLVDOUHDG\ SUHJQDQW (&3VGRQRWLQWHUIHUHZLWKDQHVWDEOLVKHGSUHJQDQF\6WXGLHVRIRUDOFRQWUDFHSWLYHVWDNHQ LQDGYHUWHQWO\LQHDUO\SUHJQDQF\VKRZQRLQFUHDVHGULVNRIPLVFDUULDJHRUFRQJHQLWDO DEQRUPDOLWLHV :RPHQPD\ZDQWWRNQRZKRZ(&3VZRUNLQRUGHUWRPDNHDQLQIRUPHGFKRLFHDERXW(&3XVH 7KHUHIRUHLWLVLPSRUWDQWWKDWWKHSURYLGHUXQGHUVWDQGDQGEHDEOHWRGHVFULEHKRZ(&3VZRUN ,PSRUWDQWSRLQWVWRFRPPXQLFDWHWRFOLHQWVDERXWWKHPHFKDQLVPRIDFWLRQDUHWKDW(&3V s :RUNWKURXJKYDULRXVPHFKDQLVPV s :LOOQRWLQWHUUXSWRUKDUPDQHVWDEOLVKHGSUHJQDQF\ LHLWLV127DPHGLFDODERUWLRQ ( s $UHQRWWKHVDPHDVPLIHSULVWRQH 58WKH³$ERUWLRQ3LOO´ ZKLFKLVXVHGWRWHUPLQDWHDQ HVWDEOLVKHGSUHJQDQF\ 3UMMARY OF +EY 0OINTS Ŷ %#0S ARE THOUGHT TO WORK IN SEVERAL WAYS 7E HAVE MORE CLINICAL EVIDENCE ON SOME OF THESE WAYS -ODULE ( THAN ON OTHERS %#0S WORK THE SAME WAY REGULAR ORAL CONTRACEPTIVE PILLS WORK Ŷ %#0S WILL NOT CAUSE AN ABORTION Ŷ 4IMING PLAYS A KEY ROLE IN HOW %#0S WORK 4OOLS Ŷ )F A WOMAN TAKES %#0S AND STILL BECOMES PREGNANT THE PREGNANCY WILL NOT BE HARMED BY THE %#0 USE Ŷ %#0S WILL NOT AFFECT A WOMANS ABILITY TO BECOME PREGNANT IN THE FUTURE ( 4OOLS %MERGENCY #ONTRACEPTIVE 0ILL 3AFETY AND 5SE -INUTES -ODULE ( "RAINSTORMING DISCUSSION AND PRESENTATION !SK PARTICIPANTS h$O YOU THINK %#0S ARE SAFE v AND h!RE THERE HEALTH CONDITIONS THAT WOULD PREVENT YOU FROM PROVIDING %#0S TO A WOMAN v #ONlRM OR CORRECT PARTICIPANTS RESPONSES 5SE A mIP CHART TO RECORD RESPONSES (IGHLIGHT THE POINTS ON SAFETY PROVIDED BELOW !CCORDING TO THE 7ORLD (EALTH /RGANIZATION AND THE )NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION THERE ARE NO CONTRAINDICATIONS FOR %#0S BECAUSE THE AMOUNT OF HORMONE IS TOO SMALL TO HAVE A CLINICALLY SIGNIlCANT IMPACT AND THE DURATION OF USE IS VERY SHORT -ANY OF THE CONTRAINDICATIONS FOR DAILY ORAL CONTRACEPTIVES ARE BASED ON THE PRESUMPTION OF LONG TERM USE 4HE 7ORLD (EALTH /RGANIZATION STATES THAT %#0S HAVE NO CLINICALLY SIGNIlCANT IMPACT ON CONDITIONS SUCH AS CARDIOVASCULAR DISEASE ANGINA ACUTE FOCAL MIGRAINE OR SEVERE LIVER DISEASE 2EPEATED USE OF %#0S IS NOT HARMFUL FOR MOST WOMEN &OR SOME WOMEN WHO HAVE SEXUAL INTERCOURSE INFREQUENTLY DElNED AS FOUR OR LESS TIMES PER MONTH AND WHO ARE NOT AT RISK OF SEXUALLY TRANSMITTED INFECTIONS 34)S OR ()6 %#0S MAY BE AN APPROPRIATE METHOD &OR A WOMAN WHO HAS REGULAR INTERCOURSE MULTIPLE TIMES WITHIN A CYCLE FREQUENT USE OF %#0S IS NOT RECOMMENDED BECAUSE OTHER METHODS ARE MORE EFFECTIVE AT PREVENTING PREGNANCY !DDITIONALLY FREQUENT %#0 USE MAY BE MORE EXPENSIVE THAN USING REGULAR CONTRACEPTIVE METHODS !S MENTIONED EARLIER REPEATED USE OF %#0S WITHIN THE SAME CYCLE MAY CAUSE BLEEDING DISTURBANCES WHICH WHILE NOT HARMFUL ARE LIKELY TO BE UNACCEPTABLE TO A WOMAN (OWEVER A WOMAN SHOULD NOT BE DENIED %#0 SERVICES BECAUSE SHE IS A REPEAT USER UNLESS SHE IS SOMEONE FOR WHOM ORAL CONTRACEPTIVES ARE CONTRAINDICATED )N THIS SITUATION NONJUDGMENTAL COUNSELING ABOUT OTHER METHODS IS AN IMPORTANT PART OF GOOD SERVICE )F A WOMAN REGULARLY USES %#0S IT IS IMPORTANT TO TRY TO DETERMINE WHY THE WOMAN IS NOT USING REGULAR CONTRACEPTION AND TO COUNSEL HER ABOUT ONGOING CONTRACEPTION 4HERE ARE NO KNOWN DRUG INTERACTIONS WITH %#0S 'IVEN THE SHORT DURATION OF TREATMENT IT IS UNLIKELY THAT DRUG INTERACTIONS THAT AFFECT ORAL CONTRACEPTIVE USE ALSO AFFECT %#0 USE (OWEVER WOMEN TAKING DRUGS THAT MAY REDUCE THE EFlCACY OF ORAL CONTRACEPTIVES INCLUDING 2IFAMPIN AND CERTAIN ANTICONVULSANT DRUGS SHOULD BE ADVISED THAT THE EFlCACY OF %#0S MAY BE REDUCED 3UMMARY OF KEY POINTS Ŷ %#0S CAN BE SAFELY USED BY WOMEN Ŷ &REQUENT %#0 USE MULTIPLE TIMES WITHIN ONE CYCLE DOES NOT PRESENT A HEALTH RISK BUT IS NOT RECOMMENDED BECAUSE IT IS NOT AS EFFECTIVE AS OTHER METHODS ( &RPPRQ6LGH(IIHFWV -INUTES "RAINSTORMING DISCUSSION AND PRESENTATION -ODULE ( !SK PARTICIPANTS h7HAT ARE THE COMMON SIDE EFFECTS OF %#0S AND HOW CAN THEY BE MANAGED v 7RITE RESPONSES ON A mIP CHART 4OOLS #ONlRM OR CORRECT RESPONSES USING THE INFORMATION BELOW (&3VVRPHWLPHVFDXVHVLGHHIIHFWVVXFKDVQDXVHDYRPLWLQJKHDGDFKHVGL]]LQHVVFUDPSLQJIDWLJXH RUEUHDVWWHQGHUQHVV7KHVHVLGHHIIHFWVXVXDOO\JRDZD\ZLWKLQWRGD\VDIWHUWDNLQJWKH(&3V (&3VDOVRPD\FDXVHLUUHJXODUEOHHGLQJXQWLOWKHZRPDQ¶VQH[WSHULRGDQGKHUSHULRGPD\FRPH HDUO\RUODWH+RZHYHULQPRUHWKDQ SHUFHQWRIFDVHVPHQVHVZLOOEHRIQRUPDOGXUDWLRQIRUWKH ZRPDQ$VPHQWLRQHGHDUOLHUWKHSURJHVWLQRQO\UHJLPHQFDXVHVIHZHURIWKHVHVLGHHIIHFWV ,IDZRPDQ¶VSHULRGKDVQRWUHVXPHGZLWKLQZHHNVDIWHUWDNLQJWKH(&3VVKHPD\EH SUHJQDQW,WLVLPSRUWDQWWKDWZRPHQXQGHUVWDQGWKLVDQGHLWKHUUHWXUQWRWKH(&3SURYLGHUIRU UHIHUUDOLQIRUPDWLRQRUJRWRDFOLQLF7KLVLVHVSHFLDOO\LPSRUWDQWIRUZRPHQZKRWDNH(&3VPRUH WKDQKRXUVDIWHUXQSURWHFWHGLQWHUFRXUVH s 7KHSURJHVWLQRQO\UHJLPHQLVSUHIHUUHGEHFDXVHLWKDVIHZHUVLGHHIIHFWVWKDQWKHFRPELQHGUHJLPHQ s 1DXVHDDQGYRPLWLQJDUHFRPPRQVLGHHIIHFWVRIWKHFRPELQHGUHJLPHQ 2EGIMEN .AUSEA 6OMITING 2ECOMMENDATIONS 3URJHVWLQRQO\ 2FFXUVLQDERXW 2FFXUVLQRQO\ 2OUTINE USE OF AN ANTIEMETIC IS NOT SHUFHQWRI DERXWSHUFHQW RECOMMENDED BEFORE WOMEN TAKE A ZRPHQ RIZRPHQ DOSE OF THE PROGESTIN ONLY REGIMEN &RPELQHG 2FFXUVLQDERXW 2FFXUVLQ 3URSK\ODFWLFXVHRIDQDQWLHPHWLFVXFK HVWURJHQSURJHVWLQ SHUFHQWRI DERXW DVGLPHQK\GULQDWH 'UDPDPLQHRU ZRPHQ SHUFHQWRI >LQVHUWORFDOEUDQGQDPH@ LVURXWLQHO\ XVHUV UHFRPPHQGHGWRUHGXFHWKHULVNRI QDXVHDDQGYRPLWLQJZLWKWKHFRPELQHG UHJLPHQ s ,IYRPLWLQJRFFXUVZLWKLQRQHKRXUDIWHUWDNLQJDGRVHWKHZRPDQVKRXOGUHSHDWWKHGRVH7KLVPHDQV VKHPD\QHHGWRUHWXUQWRWKH(&3SURYLGHURUSKDUPDF\IRUDQRWKHUGRVH,IYRPLWLQJRFFXUVPRUH WKDQRQHKRXUDIWHUWDNLQJDGRVHWKHSLOOVDOUHDG\KDYHEHHQDEVRUEHGDQGWKHZRPDQGRHVQRWQHHG WRUHSHDWWKHGRVH )NSERT SIDE EFFECT INFORMATION FOR LOCALLY AVAILABLE DEDICATED PRODUCT IF APPLICABLE 3UMMARY OF KEY POINTS Ŷ .AUSEA AND SOMETIMES VOMITING ARE POTENTIAL SIDE EFFECTS OF %#0 USE 4HEY ARE NOT DANGEROUS AND ARE FAR MORE COMMON AMONG WOMEN WHO USE THE COMBINED %#0 REGIMEN Ŷ 4HE PROGESTIN ONLY REGIMEN IS BETTER TOLERATED Ŷ )F A WOMAN VOMITS WITHIN ONE HOUR AFTER TAKING %#0S SHE SHOULD REPEAT THE DOSE ( 4OOLS Ŷ !NTIEMETICS CAN REDUCE THE FREQUENCY OF NAUSEA AND VOMITING WITH THE COMBINED REGIMEN Ŷ )F A WOMANS MENSTRUAL PERIOD IS MORE THAN WEEKS LATE SHE MAY BE PREGNANT AND MAY NEED FURTHER -ODULE ( COUNSELING OR REFERRAL SERVICES )T IS ESPECIALLY IMPORTANT THAT WOMEN WHO TAKE %#0S MORE THAN HOURS AFTER INTERCOURSE BE INFORMED ABOUT THE POSSIBILITY OF PREGNANCY OR %#0 FAILURE ( %MERGENCY #ONTRACEPTION 3CREENING AND #OMMUNICATION -INUTES "RAINSTORMING PAIR WORK PRESENTATION AND DISCUSSION -ODULE ( !SK PARTICIPANTS h7HAT KEY SCREENING QUESTIONS SHOULD A WOMAN BE ASKED WHEN PROVIDING HER WITH %#0S FOR RECENT UNPROTECTED INTERCOURSE v ,IST RESPONSES ON A mIP CHART OVERHEAD OR CHALKBOARD #ORRECT OR COMPLEMENT PARTICIPANTS 4OOLS RESPONSES WITH THE QUESTIONS LISTED BELOW 4HIS INFORMATION IS ALSO PROVIDED IN (/ 3AMPLE %MERGENCY #ONTRACEPTIVE 0ILL 3CREENING #HECKLIST -AKE SURE PARTICIPANTS UNDERSTAND THAT %#0S ALSO CAN BE PROVIDED BEFORE A WOMAN NEEDS THEM &OR EXAMPLE CONDOM USERS MAY WISH TO KEEP A PACKET OF %#0S AT HOME IN CASE OF CONDOM BREAKAGE 4HE IMPORTANT SCREENING QUESTIONS FOR %#0 USE FOLLOWING RECENT UNPROTECTED INTERCOURSE ARE s $O YOU WANT TO PREVENT PREGNANCY s (AVE YOU HAD UNPROTECTED SEX DURING THE LAST DAYS HOURS s )F hYESv THEN THE CLIENT MAY BE ELIGIBLE FOR %#0S %FFECTIVENESS WILL BE LOWER THE LONGER A WOMAN TAKES TO TAKE %#0S s 7AS THE LAST MENSTRUAL PERIOD LESS THAN WEEKS AGO s 7AS THIS PERIOD NORMAL IN BOTH ITS LENGTH AND TIMING s )F hYESv TO THE PREVIOUS TWO QUESTIONS %#0S MAY BE PROVIDED s )S THERE REASON TO BELIEVE YOU MAY BE PREGNANT s )F THE CLIENT IS NOT PREGNANT %#0S MAY BE GIVEN )F THE CLIENTS PREGNANCY STATUS IS UNCLEAR %#0S MAY STILL BE GIVEN WITH THE EXPLANATION THAT THE METHOD WILL NOT WORK IF SHE IS ALREADY PREGNANT 4ELL PARTICIPANTS WE WILL NOW DO AN EXERCISE TO HELP THEM ANSWER COMMON QUESTIONS CLIENTS WHO SEEK %#0S MAY HAVE #UT UP A COPY OF 4! 'RAB "AG+EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS SO THAT EACH QUESTION IS ON A SEPARATE STRIP OF PAPER 0LACE FOLDED QUESTIONS IN A BAG AND SHAKE TO DISTRIBUTE THEM WITHIN THE BAG )NVITE ONE PARTICIPANT AT A TIME TO PICK A QUESTION FROM THE BAG READ IT ALOUD AND ANSWER IT )F THE PARTICIPANT IS UNABLE TO ANSWER THE QUESTION IT CAN BE PASSED TO ANOTHER PARTICIPANT )F THE QUESTION CANNOT BE ANSWERED BY THE SECOND PARTICIPANT ANSWER THE QUESTION AND ASSIST PARTICIPANTS TO UNDERSTAND IT #ONlRM OR CORRECT ANSWERS USING THE INFORMATION BELOW AND IN (/ +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS !FTER A WOMAN IS SCREENED FOR %#0S AND GIVEN INSTRUCTIONS ON HOW TO USE THEM IT IS IMPORTANT TO ASK IF SHE HAS ANY FURTHER QUESTIONS ABOUT %#0S 3OME WOMEN WILL HAVE MANY QUESTIONS WHILE OTHERS WILL HAVE FEW IF ANY BUT IT IS IMPORTANT TO BE ABLE TO ANSWER WOMENS QUESTIONS WHEN ASKED "ECAUSE NOT ALL WOMEN WILL NEED OR WANT ALL OF THE INFORMATION PROVIDED BELOW IN THE KEY MESSAGES IT IS RECOMMENDED THAT IT BE USED ONLY WHEN WOMEN ASK FOR IT 4HESE MESSAGES ARE PROVIDED BELOW AND IN (/ +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS ( 4OOLS 7HAT ARE EMERGENCY CONTRACEPTIVE PILLS %#0S ARE PILLS THAT YOU CAN TAKE AFTER SEX TO PREVENT PREGNANCY %#0S ARE USEFUL IF YOU HAVE HAD SEX -ODULE ( WITHOUT USING CONTRACEPTION OR IF YOU HAD A CONTRACEPTIVE FAILURE SUCH AS A BROKEN CONDOM %#0S CONTAIN THE SAME INGREDIENTS AS PILLS USED FOR REGULAR CONTRACEPTION BUT IN HIGHER AMOUNTS 4HEY ARE EFFECTIVE AND SAFE (OW DO EMERGENCY CONTRACEPTIVE PILLS WORK $EPENDING ON WHEN YOU USE %#0S DURING YOUR MONTHLY CYCLE %#0S MAY s 3TOP OR DELAY AN EGG FROM BEING RELEASED FROM THE OVARY s 3TOP A FERTILIZED EGG FROM ATTACHING TO YOUR UTERUS s 0REVENT THE SPERM FROM GETTING TO THE EGG %#0S WILL NOT WORK ONCE A PREGNANCY HAS STARTED A FERTILIZED EGG HAS IMPLANTED (OW EFFECTIVE ARE EMERGENCY CONTRACEPTIVE PILLS %#0S PREVENT MOST PREGNANCIES BUT THEY ARE NOT PERCENT EFFECTIVE 7HEN CAN ) USE %#0S %#0S CAN BE USED WITHIN lVE DAYS OF UNPROTECTED INTERCOURSE BUT ARE MOST EFFECTIVE THE SOONER THEY ARE USED 7HAT IF ) HAD UNPROTECTED SEX MORE THAN DAYS AGO )F MORE THAN DAYS HAVE PASSED SINCE YOU HAD UNPROTECTED SEX THE %#0S MAY STILL HAVE SOME EFFECT BUT IT IS IMPORTANT TO TAKE THEM AS SOON AS POSSIBLE $O EMERGENCY CONTRACEPTIVE PILLS CAUSE SIDE EFFECTS %#0S SOMETIMES CAUSE NAUSEA VOMITING AND LESS FREQUENTLY HEADACHES DIZZINESS CRAMPING FATIGUE OR BREAST TENDERNESS 4HESE SIDE EFFECTS USUALLY GO AWAY WITHIN A FEW DAYS AFTER YOU TAKE THE %#0S %#0S ALSO MAY CAUSE IRREGULAR BLEEDING UNTIL YOUR NEXT PERIOD AND YOUR PERIOD MAY COME EARLY OR LATE 7HAT SHOULD ) DO AFTER USING EMERGENCY CONTRACEPTIVE PILLS 9OU WILL NOT SEE ANY IMMEDIATE SIGNS SHOWING WHETHER THE %#0S WORKED 9OUR MENSTRUAL PERIOD MAY COME ON TIME OR IT MAY BE EARLY OR LATE )F YOUR PERIOD HAS NOT STARTED WITHIN WEEKS OF TAKING %#0S YOU MIGHT BE PREGNANT )F YOU ARE PREGNANT YOU NEED TO CONSIDER WHAT YOUR OPTIONS ARE )F YOU HAVE ANY CAUSE FOR CONCERN SEE YOUR HEALTH CARE PROVIDER OR PHARMACIST )F THE EMERGENCY CONTRACEPTIVE PILLS DO NOT WORK AND ) BECOME PREGNANT WILL THE PREGNANCY BE NORMAL "ASED ON AVAILABLE EVIDENCE THERE IS NO REASON TO BELIEVE THAT THE PREGNANCY WOULD BE ABNORMAL OR THAT THE FETUS WOULD BE HURT IN ANY WAY 7HAT IF ) HAVE UNPROTECTED SEX AGAIN AFTER TAKING THE EMERGENCY CONTRACEPTIVE PILLS )F YOU HAVE UNPROTECTED SEX AFTER USING %#0S THEY WILL NOT PROTECT YOU 5SE A REGULAR CONTRACEPTIVE METHOD TO PREVENT PREGNANCY IN THE FUTURE ( #AN ) USE EMERGENCY CONTRACEPTIVE PILLS EVERY TIME ) HAVE SEX .O %#0S SHOULD NOT BE USED ROUTINELY TO PREVENT PREGNANCY BECAUSE THEY ARE LESS EFFECTIVE AND FREQUENTLY MORE EXPENSIVE THAN OTHER FAMILY PLANNING METHODS AND MAY CAUSE IRREGULAR BLEEDING $O EMERGENCY CONTRACEPTIVE PILLS PREVENT SEXUALLY TRANSMITTED INFECTIONS -ODULE ( .O %#0S DO NOT PROTECT AGAINST ()6!)$3 OR OTHER 34)S LIKE SYPHILIS GONORRHEA CHLAMYDIA AND HERPES )F YOU ARE WORRIED ABOUT WHETHER YOU HAVE AN INFECTION TALK TO YOUR HEALTH CARE PROVIDER OR PHARMACIST ABOUT YOUR CONCERNS AND ASK HOW YOU CAN GET TREATMENT AND PROTECT YOURSELF IN THE FUTURE 4OOLS 7HAT IF ) HAD SEX MULTIPLE TIMES BEFORE TAKING EMERGENCY CONTRACEPTIVE PILLS %#0S ARE MORE EFFECTIVE THE SOONER AFTER SEX THEY ARE TAKEN 0ROTECTION IS GREATEST IF SEX OCCURRED WITHIN HOURS 5SE THE MOST RECENT ACT OF UNPROTECTED INTERCOURSE TO DETERMINE IF YOU SHOULD TAKE %#0S 7HILE YOU MAY BE PREGNANT FROM A PREVIOUS ACT OF UNPROTECTED INTERCOURSE TAKING %#0S WILL NOT HARM A DEVELOPING FETUS AND IF YOU ARE NOT PREGNANT USING %#0S MAY STILL PREVENT PREGNANCY FROM THE MOST RECENT ACT OF UNPROTECTED INTERCOURSE #AN ) HAVE A PACKET OF EMERGENCY CONTRACEPTIVE PILLS TO KEEP AT HOME IN CASE ) NEED THEM 9ES %#0S ARE MORE EFFECTIVE THE SOONER THEY ARE USED )T MAY BE APPROPRIATE FOR SOME PEOPLE CONDOM USERS FOR EXAMPLE TO KEEP A PACKET OF %#0S AT HOME TO USE IN THE EVENT OF UNPROTECTED SEX 4HIS WILL HELP ENSURE YOU CAN USE %#0S AS SOON AS POSSIBLE AFTER SEX WHEN THEY ARE MOST EFFECTIVE (OW DO ) USE EMERGENCY CONTRACEPTIVE PILLS ;4HIS SECTION WILL VARY DEPENDING ON COUNTRY CONTEXT AND PRODUCT AVAILABILITY= &OR THE PROGESTIN ONLY REGIMEN TAKE A SINGLE DOSE OF MG LEVONORGESTREL AS SOON AS POSSIBLE WITHIN HOURS AFTER UNPROTECTED INTERCOURSE &OR THE ESTROGEN AND PROGESTIN REGIMEN TAKE THE lRST DOSE AS SOON AS POSSIBLE WITHIN HOURS AFTER UNPROTECTED INTERCOURSE AND TAKE THE SECOND DOSE HOURS LATER 3UMMARY OF KEY POINTS Ŷ +EY SCREENING QUESTIONS DETERMINE WHETHER %#0S ARE AN APPROPRIATE METHOD FOR A CLIENT Ŷ 0ROVIDERS SHOULD BE PREPARED TO ANSWER CLIENTS QUESTIONS ABOUT %#0S AND PROVIDE THEM WITH KEY INFORMATION TO USE %#0S CORRECTLY Ŷ %#0S CAN BE PROVIDED TO WOMEN AND COUPLES BEFORE THEY ARE NEEDED AS A BACK UP TO CONDOM USE FOR EXAMPLE ( 4OOLS #OUNSELING FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS -INUTES -ODULE ( 0RESENTATION DEMONSTRATION ROLE PLAYING AND DISCUSSION 2EMIND PARTICIPANTS THAT COUNSELING IS AN IMPORTANT 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$VNLQJKHUZKDWVKHKDVKHDUGDERXW(&3V s 'LVFXVVLQJKHUH[SHULHQFHZLWKRWKHUFRQWUDFHSWLYHPHWKRGV s 9DOLGDWLQJRUFRUUHFWLQJKHULGHDVDVDSSURSULDWH -AINTAIN PRIVACY BY ENSURING THAT COUNSELING IS CONDUCTED IN A PRIVATE AND SUPPORTIVE ENVIRONMENT TO THE GREATEST EXTENT POSSIBLE 7HEN IT IS DIFlCULT TO MAINTAIN PRIVACY GIVE THE METHOD TO THE CLIENT WITH APPROPRIATE VERBAL AND PRINTED INSTRUCTIONS ABOUT BOTH %#0S AND OTHER FORMS OF REGULAR CONTRACEPTIVE METHODS )F IN A NONCLINIC SETTING ADVISE HER TO ATTEND A CLINIC OR CONTACT A HEALTH CARE OR FAMILY PLANNING PROVIDER FOR COUNSELING ABOUT REGULAR CONTRACEPTIVE METHODS 2EASSURE THE WOMAN THAT ALL INFORMATION WILL BE KEPT CONlDENTIAL INCLUDING THE FACT THAT SHE HAS RECEIVED %#0S )NTRODUCE THE COUNSELING STEPS OF '!4(%2 DESCRIBED BELOW %XPLAIN THAT THIS IS A WAY OF REMEMBERING THE ESSENTIAL STEPS IN COUNSELING 'REET !SK QUESTIONS 4ELL CLIENT ABOUT SPECIlC REPRODUCTIVE HEALTH TOPICS (ELP CLIENT MAKE DECISION THAT IS BEST FOR HERHIM %XPLAIN WHAT TO DO 2EFER OR SCHEDULE RETURN VISIT IF APPROPRIATE !SK FOR A VOLUNTEER TO PLAY THE PART OF CLIENT IN A ROLE PLAY TO DEMONSTRATE EFFECTIVE COUNSELING 4HE TRAINER PLAYS THE ROLE OF THE PROVIDER 'IVE THE PARTICIPANT 4! $EMONSTRATION 2OLE 0LAY TO READ QUICKLY ( 4HE OTHER PARTICIPANTS WILL OBSERVE lLLING OUT A CHECKLIST TO TAKE NOTE OF WHAT EFFECTIVE BEHAVIORS HAVE BEEN DEMONSTRATED BY THE TRAINER $ISTRIBUTE (/ #OUNSELING 3KILLS /BSERVER #HECKLIST 0ARTICIPANTS SHOULD ALSO REFER BACK TO (/ 3AMPLE %MERGENCY #ONTRACEPTIVE 0ILL 3CREENING #HECKLIST FOR ADDITIONAL QUESTIONS TO ASK WHEN SCREENING CLIENTS FOR %#0S -ODULE ( $ISCUSSION !SK SEVERAL PARTICIPANTS TO SUMMARIZE WHAT COUNSELING STEPS THEY OBSERVED IN THE ROLE PLAY 0ROCESS THE ACTIVITY WITH THE FOLLOWING QUESTIONS h7HAT DID YOU LIKE ABOUT THE WAY THE PROVIDER DEALT WITH THIS CLIENT v h7HAT COULD HESHE HAVE DONE TO MAKE THE INTERACTION MORE EFFECTIVE v h7HAT HAVE YOU LEARNED FROM THIS EXERCISE v 'O OVER THE SUMMARY OF THE BASIC STEPS OF THE CLIENT PROVIDER INTERACTION AS PROVIDED BELOW 4OOLS )N THE ROLE PLAY THE TRAINER SHOULD BE SURE TO SHOW A RESPECTFUL ATTITUDE !SK OPEN ENDED QUESTIONS TO INVITE THE CLIENTS TO COMMUNICATE THEIR NEEDS OPENLY 3CREEN BRIEmY AND CONlRM THE CONlDENTIAL NATURE OF THESE SERVICES !SK IF CLIENTS HAVE QUESTIONS AND LISTEN TO THEIR CONCERNS 3UMMARY OF THE BASIC STEPS OF THE CLIENT PROVIDER INTERACTION s 'REET CLIENT INTRODUCE YOURSELF AND ASK WHAT SHE NEEDS s !SK QUESTIONS SCREEN CLIENT s 4ELL CLIENT ABOUT %#0S GIVE CLEAR INFORMATION ABOUT USE SIDE EFFECTS AND FOLLOW UP s (ELP CLIENT MAKE DECISIONS 0ROVIDE WRITTEN OR PICTORAL INSTRUCTIONS IF AVAILABLE s %XPLAIN WHAT THE OPTIONS ARE WHAT THE CLIENT SHOULD DO $ISCUSS OPTIONS FOR ON GOING CONTRACEPTION WITH CLIENT s 2EFER TO OTHER HEALTH CARE PROVIDER IF NECESSARY !SK PARTICIPANTS TO WORK IN PAIRS %ACH PAIR WILL WORK FOR TEN MINUTES TO PREPARE A SHORT ROLE PLAY TO DEMONSTRATE CLIENT COUNSELING 'IVE EACH PAIR ONE OF THE CASE STUDIES ON 4! %MERGENCY #ONTRACEPTIVE 0ILL #LIENT 3ITUATION 2OLE 0LAYS 2EQUEST THAT PARTICIPANTS DO THEIR BEST TO DEMONSTRATE EFFECTIVE CLIENT SERVICE SKILLS IN THE ROLE PLAY !SK EACH PAIR TO PRESENT THEIR ROLE PLAY 4HE OTHER PARTICIPANTS WILL OBSERVE 7HEN ALL THE GROUPS HAVE PRESENTED PROCESS THE ACTIVITY WITH THE FOLLOWING QUESTIONS A h7HAT DID YOU LIKE ABOUT THE WAY THE HESHE DEALT WITH THIS CLIENT v B h$ID HESHE PROVIDE CORRECT INFORMATION ABOUT %#0S AND THEIR USE v C h7HAT COULD HESHE HAVE DONE TO MAKE THE INTERACTION MORE EFFECTIVE v D h7HAT HAVE YOU LEARNED FROM THIS EXERCISE v !SK PARTICIPANTS WHAT CHALLENGES THEY MIGHT ENCOUNTER IN PROVIDING GOOD QUALITY SERVICES !SK THE GROUP TO BRAINSTORM WAYS TO MEET THESE CHALLENGES 3UMMARY OF KEY POINTS Ŷ 4REATMENT OF CLIENTS REGARDLESS OF AGE OR MARITAL STATUS SHOULD ALWAYS BE COURTEOUS RESPECTFUL NONJUDGMENTAL AND HELPFUL Ŷ 7HEN POSSIBLE THE REGULAR USE OF CONTRACEPTIVE METHODS SHOULD BE EMPHASIZED Ŷ 7HEN APPROPRIATE ASSESSMENT OF 34) RISK SHOULD BE MADE Ŷ 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ET AL 4HE BIOCHEMISTRY OF HUMAN ENDOMETRIUM AFTER TWO REGIMENS OF POSTCOITAL CONTRACEPTION A DL NORGESTREL ETHINYLESTRADIOL COMBINATION OR DANAZOL &ERTILITY AND 3TERILITY 4ASKIN / ET AL (IGH DOSES OF ORAL CONTRACEPTIVES DO NOT ALTER ENDOMETRIAL D AND DQE INTEGRINS IN THE LATE IMPLANTATION WINDOW &ERTILITY AND 3TERILITY VON (ERTZEN ( AND 6AN ,OOK 0 2ESEARCH ON NEW METHODS OF EMERGENCY CONTRACEPTION &AMILY 0LANNING 0ERSPECTIVES 53 $EPARTMENT OF (EALTH AND (UMAN 3ERVICES &OOD AND $RUG !DMINISTRATION 0RESCRIPTION DRUG PRODUCTS CERTAIN COMBINED ORAL CONTRACEPTIVES FOR USE AS POST COITAL EMERGENCY CONTRACEPTION .OTICE &EDERAL 2EGISTER 'RIMES $ ET AL %MERGENCY #ONTRACEPTION !NNALS OF )NTERNAL -EDICINE 7ORLD (EALTH /RGANIZATION )MPROVING !CCESS TO 1UALITY #ARE IN &AMILY 0LANNING -EDICAL %LIGIBILITY #RITERIA FOR #ONTRACEPTIVE 5SE 3ECOND %DITION 7(/2(2 'ENEVA 7(/ )NTERNATIONAL 0LANNED 0ARENTHOOD &EDERATION 3TATEMENT ON %MERGENCY #ONTRACEPTION ,ONDON )00& !VAILABLE ONLINE AT HTTPMIRRORIPPFORGMEDICALIMAPSTATEMENTSENG?BHTM !CCESSED $ECEMBER !MERICAN 0HARMACEUTICAL !SSOCIATION 3PECIAL 2EPORT ON %MERGENCY #ONTRACEPTION 4HE 0HARMACISTS 2OLE ( 4OOLS 0RE AND 0OST 3ESSION 1UESTIONNAIRE -ODULE ( %MERGENCY #ONTRACEPTIVE 0ILLS %#0S 2ESPONDENT "ACKGROUND ,DP BBB 0DOH BBB )HPDOH ,DP BBB 3KDUPDFLVW BBB 'RFWRU BBB 1XUVH BBB 0LGZLIH BBB2WKHUVSHFLI\ BBBBBBBBBBB -ARK THE FOLLOWING STATEMENTS AS TRUE OR FALSE 4RUE &ALSE 0ROGESTIN ONLY EMERGENCY CONTRACEPTION PILLS %#0S REDUCE THE RISK OF PREGNANCY BY PERCENT %#0S MAY BE USED UP TO HOURS DAYS AFTER UNPROTECTED INTERCOURSE 4HERE ARE NO CONTRAINDICATIONS TO %#0 USE %#0S PROVIDE PROTECTION AGAINST ()6!)$3 AND OTHER SEXUALLY TRANSMITTED INFECTIONS $EPENDING ON LOCAL REGULATIONS %#0S CAN BE PROVIDED SAFELY BY PROPERLY TRAINED DOCTORS NURSES PHARMACISTS AND PHARMACY STAFF %#0S ARE AN EFFECTIVE REGULAR CONTRACEPTIVE METHOD #ONDOMS AND OTHER BARRIER METHODS MAY BE STARTED IMMEDIATELY FOLLOWING %#0 USE %#0S CANNOT CAUSE AN ABORTION 4HE MOST COMMON SIDE EFFECTS OF %#0S ARE NAUSEA AND VOMITING !LL CLIENTS SHOULD UNDERGO A FULL PELVIC EXAM BEFORE RECEIVING %#0S %#0S CAN BE USED SAFELY BY ADOLESCENT GIRLS %#0S ARE MORE EFFECTIVE THE SOONER THEY ARE TAKEN AFTER INTERCOURSE %#0S SHOULD NOT BE PROVIDED TO CLIENTS BEFORE THEY NEED THEM 2EGULAR ORAL CONTRACEPTIVE PILLS CANNOT BE USED FOR %# ( 0RE AND 0OST 3ESSION 1UESTIONNAIRE %MERGENCY #ONTRACEPTIVE 0ILLS %#0S -ODULE ( !NSWER +EY -ARK THE FOLLOWING STATEMENTS AS TRUE OR FALSE 4RUE &ALSE 4OOLS 0ROGESTIN ONLY EMERGENCY CONTRACEPTION PILLS %#0S REDUCE THE 8 RISK OF PREGNANCY BY PERCENT %#0S MAY BE USED UP TO HOURS DAYS AFTER UNPROTECTED 8 INTERCOURSE 4HERE ARE NO CONTRAINDICATIONS TO %#0 USE 8 %#0S PROVIDE PROTECTION AGAINST ()6!)$3 AND OTHER SEXUALLY 8 TRANSMITTED INFECTIONS $EPENDING ON LOCAL REGULATIONS %#0S CAN BE PROVIDED SAFELY BY 8 PROPERLY TRAINED DOCTORS NURSES PHARMACISTS AND PHARMACY STAFF %#0S ARE AN EFFECTIVE REGULAR CONTRACEPTIVE METHOD 8 #ONDOMS AND OTHER BARRIER METHODS MAY BE STARTED IMMEDIATELY 8 FOLLOWING %#0 USE %#0S CANNOT CAUSE AN ABORTION 8 4HE MOST COMMON SIDE EFFECTS OF %#0S ARE NAUSEA AND VOMITING 8 !LL CLIENTS SHOULD UNDERGO A FULL PELVIC EXAM BEFORE RECEIVING 8 %#0S %#0S CAN BE USED SAFELY BY ADOLESCENT GIRLS 8 %#0S ARE MORE EFFECTIVE THE SOONER THEY ARE TAKEN AFTER 8 INTERCOURSE %#0S SHOULD NOT BE PROVIDED TO CLIENTS BEFORE THEY NEED THEM 8 2EGULAR ORAL CONTRACEPTIVE PILLS CANNOT BE USED FOR %# 8 4HIS MATERIAL WAS DEVELOPED BY 0!4( ( 4OOLS (ANDOUT -ODULE ( +EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 7HAT ARE EMERGENCY CONTRACEPTIVE PILLS s %MERGENCY CONTRACEPTIVE PILLS %#0S ARE PILLS THAT YOU CAN TAKE AFTER SEX TO PREVENT PREGNANCY %#0S ARE USEFUL IF YOU HAD SEX WITHOUT USING CONTRACEPTION OR IF YOU HAD A CONTRACEPTIVE FAILURE SUCH AS A BROKEN CONDOM s %#0S CONTAIN THE SAME INGREDIENTS AS SOME PILLS USED FOR REGULAR CONTRACEPTION BUT IN HIGHER AMOUNTS 4HEY ARE EFFECTIVE AND SAFE FOR ALMOST ALL WOMEN (OW DO EMERGENCY CONTRACEPTIVE PILLS WORK $EPENDING ON WHEN YOU USE %#0S DURING YOUR MONTHLY CYCLE %#0S MAY s 3TOP OR DELAY AN EGG FROM BEING RELEASED FROM THE OVARY s 3TOP A FERTILIZED EGG FROM ATTACHING TO YOUR UTERUS s 0REVENT THE SPERM FROM GETTING TO THE EGG %#0S WILL NOT WORK ONCE A PREGNANCY HAS STARTED (OW EFFECTIVE ARE EMERGENCY CONTRACEPTIVE PILLS s %#0S PREVENT MOST PREGNANCIES BUT THEY ARE NOT PERCENT EFFECTIVE 7HEN CAN ) USE %#0S s %#0S CAN BE USED WITHIN lVE DAYS OF UNPROTECTED TERCOURSE BUT ARE MOST EFFECTIVE THE SOONER THEY ARE USED 7HAT IF ) HAD UNPROTECTED SEX MORE THAN DAYS AGO s )F MORE THAN DAYS HAVE PASSED SINCE YOU HAD UNPROTECTED SEX THE %#0S MAY STILL HAVE SOME EFFECT BUT IT IS IMPORTANT TO TAKE THEM AS SOON AS POSSIBLE $O EMERGENCY CONTRACEPTIVE PILLS CAUSE SIDE EFFECTS s %#0S SOMETIMES CAUSE NAUSEA VOMITING HEADACHES DIZZINESS CRAMPING FATIGUE OR BREAST TENDERNESS 4HESE SIDE EFFECTS USUALLY GO AWAY WITHIN A FEW DAYS AFTER YOU TAKE THE %#0S %#0S ALSO MAY CAUSE IRREGULAR BLEEDING UNTIL YOUR NEXT PERIOD AND YOUR PERIOD MAY COME EARLY OR LATE 7HAT SHOULD ) DO AFTER USING EMERGENCY CONTRACEPTIVE PILLS s 9OU WILL NOT SEE ANY IMMEDIATE SIGNS SHOWING WHETHER THE %#0S WORKED 9OUR MENSTRUAL PERIOD MAY COME ON TIME OR IT MAY BE EARLY OR LATE )F YOUR PERIOD HAS NOT STARTED WITHIN WEEKS OF TAKING %#0S YOU MIGHT BE PREGNANT )F YOU ARE PREGNANT YOU NEED TO DISCUSS YOUR OPTIONS WITH A HEALTH CARE PROVIDER )F YOU HAVE ANY CAUSE FOR CONCERN SEE YOUR HEALTH CARE PROVIDER OR PHARMACIST ( )F THE EMERGENCY CONTRACEPTIVE PILLS DO NOT WORK AND ) BECOME PREGNANT WILL THE PREGNANCY BE NORMAL s "ASED ON AVAILABLE INFORMATION THERE IS NO REASON TO BELIEVE THAT THE PREGNANCY WOULD BE ABNORMAL OR THAT THE FETUS WOULD BE HURT IN ANY WAY -ODULE ( 7HAT IF ) HAVE UNPROTECTED SEX AGAIN AFTER TAKING THE EMERGENCY CONTRACEPTIVE PILLS 4OOLS s )F YOU HAVE UNPROTECTED SEX AFTER USING %#0S THEY WILL NOT PROTECT YOU 9OU WILL NEED TO REPEAT THE TREATMENT 5SE A REGULAR CONTRACEPTIVE METHOD TO PREVENT PREGNANCY IN THE FUTURE #AN ) USE EMERGENCY CONTRACEPTIVE PILLS EVERY TIME ) HAVE SEX s .O %#0S SHOULD NOT BE USED ROUTINELY TO PREVENT PREGNANCY BECAUSE THEY ARE LESS EFFECTIVE AND FREQUENTLY MORE EXPENSIVE THAN OTHER FAMILY PLANNING METHODS AND MAY CAUSE IRREGULAR BLEEDING $O EMERGENCY CONTRACEPTIVE PILLS PREVENT SEXUALLY TRANSMITTED INFECTIONS s .O %#0S DO NOT PROTECT AGAINST ()6!)$3 OR OTHER SEXUALLY TRANSMITTED INFECTIONS 34)S LIKE SYPHILIS GONORRHEA CHLAMYDIA AND HERPES )F YOU ARE WORRIED ABOUT WHETHER YOU HAVE AN INFECTION TALK TO YOUR HEALTH CARE PROVIDER OR PHARMACIST ABOUT YOUR CONCERNS AND ASK HOW YOU CAN GET TREATMENT AND PROTECT YOURSELF IN THE FUTURE 7HAT IF ) HAD SEX MULTIPLE TIMES BEFORE TAKING EMERGENCY CONTRACEPTIVE PILLS s 9OU CAN STILL USE %#0S IF THE LAST TIME YOU HAD SEX IS WITHIN DAYS )F YOU ARE ALREADY PREGNANT FROM AN EARLIER ACT OF UNPROTECTED SEX THE %#0S WILL NOT HAVE ANY EFFECT %#0S ARE MORE EFFECTIVE THE SOONER AFTER SEX THEY ARE TAKEN #AN ) HAVE A PACKET OF EMERGENCY CONTRACEPTIVE PILLS TO KEEP AT HOME IN CASE ) NEED THEM s 9ES %#0S ARE MORE EFFECTIVE THE SOONER THEY ARE USED )T MAY BE APPROPRIATE FOR SOME PEOPLE CONDOM USERS FOR EXAMPLE TO KEEP A PACKET OF %#0S AT HOME TO USE IN THE EVENT OF UNPROTECTED SEX 4HIS WILL HELP ENSURE YOU CAN USE %#0S AS SOON AS POSSIBLE AFTER SEX WHEN THEY ARE MOST EFFECTIVE (OW DO ) USE EMERGENCY CONTRACEPTIVE PILLS s &OR THE PROGESTIN ONLY REGIMEN TAKE A SINGLE DOSE OF MG LEVONORGESTREL AS SOON AS POSSIBLE WITHIN HOURS AFTER UNPROTECTED SEX s &OR THE ESTROGEN AND PROGESTIN REGIMEN TAKE THE lRST DOSE AS SOON AS POSSIBLE WITHIN HOURS AFTER UNPROTECTED SEX AND TAKE THE SECOND DOSE HOURS LATER ( 4OOLS 3PECIlC INFORMATION ABOUT THE %#0 FORMULATIONS IS PROVIDED IN THE TABLE BELOW -ODULE ( ;4HIS SECTION DEPENDS ON COUNTRY CONTEXT AND PRODUCT AVAILABILITY= %#0 &ORMULATIONS &IRST $OSE 3ECOND $OSE &ORMULATION #OMMON "RAND NUMBER OF NUMBER OF PER PILL .AMES TABLETS TABLETS 0ROGESTIN ONLY ,.' MG ,EVONELLE .OR,EVO 2EGIMEN 0LAN " 0OSTINOR 6IKELA 3INGLE $OSE #OMBINED 2EGIMEN %% MCG ,.' MG %UGYNON &ERTILAN OR .EOGYNON .ORAL %% MCG .' MG .ORDIOL /VIDON /VRAL /VRAN 0# 0REVEN %% MCG ,.' MG ,O&EMENAL OR -ICROGYNON %% MCG .' MG .ORDETTE /VRAL , 2IGEVIDON !BBREVIATIONS %% ETHINYL ESTRADIOL ,.' LEVONORGESTREL .' NORGESTREL &OR ALL REGIMENS THE lRST DOSE SHOULD BE TAKEN AS SOON AS POSSIBLE AFTER INTERCOURSE BUT OPTIMALLY WITHIN HOURS 4HE SECOND DOSE OF THE COMBINED REGIMEN SHOULD BE TAKEN HOURS AFTER THE lRST DOSE 4HE PROGESTIN ONLY REGIMEN DOSES MAY BE TAKEN ALL AT ONE TIME !DAPTED FROM %XPANDING 'LOBAL !CCESS TO %MERGENCY #ONTRACEPTION )NTERNATIONAL #ONSORTIUM FOR %MERGENCY #ONTRACEPTION /CTOBER P )NFORMATION IN THIS TABLE HAS BEEN UPDATED TO REmECT CURRENT RESEARCH VON (ERTZEN ( ET AL ,OW DOSE MIFEPRISTONE AND TWO REGIMENS OF LEVONORGESTREL FOR EMERGENCY CONTRACEPTION A 7(/ MULTICENTRE RANDOMIZED TRIAL ,ANCET #ONTENT AND FORMAT WERE ADAPTED FROM 3PECIAL 2EPORT ON %MERGENCY #ONTRACEPTION 4HE 0HARMACISTS 2OLE !MERICAN 0HARMACEUTICAL !SSOCIATION ( -ODULE ( 4OOLS ( 4OOLS (ANDOUT -ODULE ( 3AMPLE %MERGENCY #ONTRACEPTIVE 0ILL 3CREENING #HECKLIST $O YOU WANT TO PREVENT PREGNANCY 9ES .O (AVE YOU HAD UNPROTECTED SEX DURING THE LAST DAYS 9ES .O HOURS )F h9ESv THEN THE CLIENT MAY BE ELIGIBLE FOR %#0S )T IS IMPORTANT TO TAKE THEM AS SOON AS POSSIBLE AFTER UPROTECTED SEX !FTER HOURS DAYS %#0S CAN NO LONGER BE CONSIDERED TO BE EFFECTIVE 7AS THE LAST MENSTRUAL PERIOD LESS THAN WEEKS AGO 9ES .O 7AS THIS PERIOD NORMAL IN BOTH ITS LENGTH AND TIMING 9ES .O )F h9ESv TO THE PREVIOUS TWO QUESTIONS %#0S MAY BE PROVIDED )S THERE REASON TO BELIEVE THAT THE YOU MAY BE PREGNANT 9ES .O )F THE CLIENT IS NOT PREGNANT %#0S MAY BE GIVEN )F THE CLIENTS PREGNANCY STATUS IS UNCLEAR %#0S MAY STILL BE GIVEN WITH THE EXPLANATION THAT THE METHOD WILL NOT WORK IF SHE IS ALREADY PREGNANT AND WILL NOT HARM THE FETUS #ONTENT AND FORMAT FOR THIS CHECKLIST WERE ADAPTED FROM #OMPREHENSIVE 2EPRODUCTIVE (EALTH AND &AMILY 0LANNING 4RAINING #URRICULUM -ODULE %MERGENCY #ONTRACEPTIVE 0ILLS 7ATERTOWN -! 0ATHlNDER )NTERNATIONAL REVISED ( -ODULE ( 4OOLS ( 4OOLS (ANDOUT -ODULE ( #OUNSELING FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS !S WITH ANY CONTRACEPTIVE METHOD %#0S SHOULD BE PROVIDED IN A MANNER THAT IS RESPECTFUL OF THE CLIENT AND RESPONSIVE TO HER NEEDS FOR INFORMATION AND COUNSELING $URING COUNSELING PROVIDERS SHOULD 2EASSURE ALL CLIENTS REGARDLESS OF AGE OR MARITAL STATUS THAT ALL INFORMATION WILL BE KEPT CONlDENTIAL "E SUPPORTIVE OF THE CLIENTS CHOICES AND REFRAIN FROM MAKING JUDGMENTAL COMMENTS OR INDICATING DISAPPROVAL THROUGH BODY LANGUAGE OR FACIAL EXPRESSIONS WHILE DISCUSSING %#0S WITH CLIENTS 3UPPORTIVE ATTITUDES WILL HELP SET THE STAGE FOR FOLLOW UP COUNSELING ABOUT REGULAR CONTRACEPTIVE USE AND 34) PREVENTION !CTIVELY INVOLVE THE CLIENT IN THE COUNSELING PROCESS 4HIS MAY BE MORE EFFECTIVE IN ENSURING COMPLIANCE RATHER THAN SIMPLY PROVIDING HER WITH INFORMATION 4HIS ACTIVE INVOLVEMENT MAY INCLUDE s !SKING HER WHAT SHE HAS HEARD ABOUT %#0S s $ISCUSSING HER EXPERIENCE WITH OTHER CONTRACEPTIVE METHODS s 6ALIDATING OR CORRECTING HER IDEAS AS APPROPRIATE -AINTAIN PRIVACY BY ENSURING THAT COUNSELING IS CONDUCTED IN A PRIVATE AND SUPPORTIVE ENVIRONMENT TO THE GREATEST EXTENT POSSIBLE 7HEN IT IS DIFlCULT TO MAINTAIN PRIVACY GIVE THE METHOD TO THE CLIENT WITH APPROPRIATE VERBAL AND PRINTED INSTRUCTIONS ABOUT BOTH %#0S AND OTHER FORMS OF REGULAR CONTRACEPTIVE METHODS )F IN A NONCLINIC SETTING ADVISE HER TO ATTEND A CLINIC OR CONTACT A HEALTH CARE OR FAMILY PLANNING PROVIDER FOR COUNSELING ABOUT REGULAR CONTRACEPTIVE METHODS 2EASSURE THE CLIENT THAT ALL INFORMATION WILL BE KEPT CONlDENTIAL INCLUDING THE FACT THAT SHE HAS RECEIVED %#0S #ONTENT AND FORMAT FOR THIS HANDOUT WERE ADAPTED FROM #OMPREHENSIVE 2EPRODUCTIVE (EALTH AND &AMILY 0LANNING 4RAINING #URRICULUM -ODULE %MERGENCY #ONTRACEPTIVE 0ILLS 7ATERTOWN -! 0ATHlNDER )NTERNATIONAL REVISED ( -ODULE ( 4OOLS ( 4OOLS (ANDOUT -ODULE ( #OUNSELING 3KILLS /BSERVER #HECKLIST #OUNSELING SKILL OBSERVED 9ES .O #OMMENTS 'REETS CLIENT IN FRIENDLY AND HELPFUL WAY )NTRODUCES SELF !SKS CLIENT WHY HESHE HAS COME TO YOU OR WHAT MAKES HIMHER THINK HESHE NEEDS %#0S %NSURES CONlDENTIALITY 3CREENS CLIENT FOR DATE OF UNPROTECTED SEX AND LAST MENSTRUATION 4ELLS CLIENT ABOUT %#0S HOW THEY WORK EFFECTIVENESS POSSIBLE SIDE EFFECTS !LLOWS CLIENT TO ASK QUESTIONS AND ASKS CLIENT IF HESHE HAS ANY QUESTIONS %XPLAINS CORRECT USE OF %#0S AND ASKS CLIENT TO SUMMARIZE INSTRUCTIONS 3HOWS %#0S TO CLIENT AND GIVES CLIENT CORRECT NUMBER OF PILLS %XPLAINS HOW TO MANAGE POSSIBLE SIDE EFFECTS AND TELLS CLIENT TO RETURN OR GO TO A CLINIC OR HOSPITAL IF THERE ARE ANY PROBLEMS OR CONCERNS 4ELLS CLIENT THE MENSTRUAL PERIOD IS LIKELY TO BE WITHIN ONE WEEK BEFORE OR AFTER THE NORMAL EXPECTED DATE !SKS CLIENT ABOUT ONGOING CONTRACEPTIVE METHOD AND ASKS IF HESHE WOULD LIKE TO DISCUSS OTHER CONTRACEPTION OPTIONS %XPLAINS TO THE CLIENT THAT HESHE AND HISHER PARTNER MAY BE AT RISK OF AN 34) 0ROVIDES REFERRAL INFORMATION FOR COMMUNITY HEALTH SERVICES $EMONSTRATES A NONJUDGMENTAL ATTITUDE AND RESPECT FOR CLIENT #ONTENT AND FORMAT FOR THIS CHECKLIST WERE ADAPTED FROM #OMPREHENSIVE 2EPRODUCTIVE (EALTH AND &AMILY 0LANNING 4RAINING #URRICULUM -ODULE %MERGENCY #ONTRACEPTIVE 0ILLS 7ATERTOWN -! 0ATHlNDER )NTERNATIONAL REVISED ( -ODULE ( 4OOLS ( 4OOLS 4RAINING !ID -ODULE ( 'RAB "AG+EY -ESSAGES FOR %MERGENCY #ONTRACEPTIVE 0ILL #LIENTS 7HAT ARE EMERGENCY CONTRACEPTIVE PILLS (OW DO %#0S WORK (OW EFFECTIVE ARE %#0S 7HAT IF ) HAD UNPROTECTED SEX MORE THAN DAYS AGO $O %#0S CAUSE SIDE EFFECTS 7HAT SHOULD ) DO AFTER USING %#0S )F THE %#0S DO NOT WORK AND ) BECOME PREGNANT WILL THE PREGNANCY BE NORMAL 7HAT IF ) HAVE UNPROTECTED SEX AGAIN AFTER TAKING THE %#0S #AN ) USE %#0S EVERY TIME ) HAVE SEX $O %#0S PREVENT SEXUALLY TRANSMITTED INFECTIONS 7HAT IF ) HAD SEX MULTIPLE TIMES BEFORE TAKING %#0S #AN ) HAVE A PACKET OF %#0S TO KEEP AT HOME IN CASE ) NEED THEM (OW DO ) USE %#0S #ONTENT AND FORMAT FOR THIS TRAINING AID WERE ADAPTED FROM #OMPREHENSIVE 2EPRODUCTIVE (EALTH AND &AMILY 0LANNING 4RAINING #URRICULUM -ODULE %MERGENCY #ONTRACEPTIVE 0ILLS 7ATERTOWN -! 0ATHlNDER )NTERNATIONAL REVISED ( -ODULE ( 4OOLS ( 4OOLS 4RAINING !ID -ODULE ( $EMONSTRATION 2OLE 0LAY 9OU HAVE VOLUNTEERED TO PLAY THE PART OF A CLIENT SEEKING %#0S IN A ROLE PLAY TO DEMONSTRATE EFFECTIVE COUNSELING TECHNIQUES 9OU ARE A YEAR OLD WOMAN WHO IS SEEKING %#0S TODAY 9OU HAD UNPROTECTED SEX WITH YOUR NEW BOYFRIEND THE NIGHT BEFORE LAST AND YOUR BEST FRIEND TOLD YOU TO GO TO A PROVIDER AND ASK ABOUT PILLS THAT CAN PREVENT YOU GETTING PREGNANT 4HE lRST DAY OF YOUR LAST MENSTRUAL PERIOD WAS TWO WEEKS AGO 9OU ARE HEALTHY AND DO NOT SMOKE 9OU USUALLY USE CONDOMS BUT THIS TIME YOU DIDNT HAVE ANY AROUND AND HADNT EXPECTED TO HAVE SEX 9OUD LIKE TO KNOW IF THE PROVIDER CAN GIVE YOU SOME OF THESE PILLS TO KEEP AT HOME IN CASE THIS EVER HAPPENS TO YOU AGAIN #ONTENT AND FORMAT FOR THIS TRAINING AID WERE ADAPTED FROM #OMPREHENSIVE 2EPRODUCTIVE (EALTH AND &AMILY 0LANNING 4RAINING #URRICULUM -ODULE %MERGENCY #ONTRACEPTIVE 0ILLS 7ATERTOWN -! 0ATHlNDER )NTERNATIONAL REVISED ( -ODULE ( 4OOLS ( 4OOLS 4RAINING !ID -ODULE ( %MERGENCY #ONTRACEPTIVE 0ILL #LIENT 3ITUATION 2OLE 0LAYS '2/50 2OLE PLAY 9OU ARE A YOUNG WOMAN 3EVERAL DAYS AGO YOU WERE ASSAULTED AND RAPED AND YOU THINK YOU MAY NEED %# TO PREVENT YOU FROM GETTING PREGNANT 9OU GO TO THE INSERT FAMILY PLANNING CLINIC PHARMACY OR OTHER PROVIDER SETTING TO lND OUT MORE INFORMATION 4HE PROVIDER ASKS SCREENING QUESTIONS 9OU BEGIN TO FEEL NERVOUS BUT lNALLY SHARE WITH THE PROVIDER THAT YOU WERE RAPED '2/50 2OLE PLAY 9OU HAVE HEARD ABOUT %# FROM FRIENDS AND THINK YOU MIGHT NEED IT BUT YOU ARE SCARED TO TRY IT BECAUSE YOU THINK IT MIGHT MAKE YOU INFERTILE AND THAT IT MIGHT NOT BE SAFE BECAUSE YOU SMOKE 9OU HAD UNPROTECTED SEX LAST NIGHT YOU WERE NOT EXPECTING TO HAVE SEX WITH YOUR NEW BOYFRIEND AND DID NOT HAVE ANY CONTRACEPTIVE PROTECTION NEARBY 9OUR LAST MENSTRUAL PERIOD ENDED DAYS AGO AND WAS NORMAL 9OU ARE A SMOKER AND HAVE HERPES BUT NO OTHER HEALTH PROBLEMS 9OU HAVE BEEN PREGNANT ONCE BEFORE AND HAD AN ABORTION AND ARE SCARED OF HAVING ANOTHER ONE 9OU HAVE NOT BEEN SEXUALLY ACTIVE FOR A WHILE BUT ARE STARTING A NEW RELATIONSHIP 9OU ARE INTERESTED IN LEARNING MORE ABOUT THE PILL FOR ONGOING CONTRACEPTION '2/50 2OLE PLAY 9OU ARE SEEKING %#0S AT YOUR LOCAL INSERT FAMILY PLANNING CLINIC PHARMACY OR OTHER PROVIDER SETTING 9OU HAD UNPROTECTED SEX YESTERDAY AND KNEW YOU COULD GET PILLS THAT WOULD BE LIKELY TO PREVENT YOU FROM GETTING PREGNANT 4HE PROVIDER HAS ASKED YOU SOME QUESTIONS AND SHOWN YOU HOW TO TAKE BIRTH CONTROL PILLS FOR %# 9OU WANT TO PAY FOR THE PILLS BUT YOU DONT HAVE ANY MONEY RIGHT NOW 9OU ARE INTERESTED IN lNDING OUT ABOUT ONGOING CONTRACEPTIVE OPTIONS BUT YOU ARE NOT SURE WHERE TO GO FOR THIS INFORMATION 9OU WOULD ALSO LIKE TO KNOW IF YOU CAN GET CONDOMS '2/50 2OLE PLAY ! MAN COMES TO YOU AND TELLS YOU THAT WHEN HE WAS HAVING SEX WITH HIS GIRLFRIEND LAST NIGHT THE CONDOM BROKE ( -ODULE ( 4OOLS ( 4OOLS '2/50 2OLE PLAY ! YOUNG WOMAN COMES TO YOU AND TELLS YOU SHE HAS MISSED AT LEAST OF HER BIRTH CONTROL PILLS -ODULE ( 3HE IS WONDERING WHAT SHE SHOULD DO '2/50 2OLE PLAY 9OU HAVE A PATIENT REQUESTING %# 9OU HAVE NO PRIVATE COUNSELING AREA AND THERE ARE MANY OTHER PATIENTS WAITING TO BE SERVED 9OU LOOK CLOSELY AT HER AND SHE APPEARS TO HAVE A BLACK EYE '2/50 2OLE PLAY ! YOUNG WOMAN COMES IN REQUESTING %# 9OU RECOGNIZE HER BECAUSE THIS IS THE THIRD TIME SHE HAS COME IN ASKING FOR %# '2/50 2OLE PLAY ! YOUNG WOMAN FOR WHOM YOU PRESCRIBED %# COMES BACK AND TELLS YOU THAT THE METHOD DIDNT WORK AND NOW SHE IS PREGNANT #ONTENT AND FORMAT FOR THIS TRAINING AID WERE ADAPTED FROM #OMPREHENSIVE 2EPRODUCTIVE (EALTH AND &AMILY 0LANNING 4RAINING #URRICULUM -ODULE %MERGENCY #ONTRACEPTIVE 0ILLS 7ATERTOWN -! 0ATHlNDER )NTERNATIONAL REVISED ( -ODULE ) %VALUATION /BJECTIVE 4O MEASURE ACHIEVEMENT OF OBJECTIVES AND TO DOCUMENT THE IMPACT OF INTERVENTIONS ! SYSTEMATIC EVALUATION OF A PROGRAM OR PROJECT OBJECTIVELY MEASURES CHANGEWHAT IT HAS ACCOMPLISHED IN TERMS OF PROCESS OUTCOMES AND LESS COMMONLY IMPACT 4HIS MODULE ON EVALUATION DISCUSSES THE FOLLOWING TOPICS s 2ELATIONSHIP BETWEEN !SSESSMENT AND %VALUATION s %VALUATION &UNCTIONS s #HARACTERISTICS OF 'OOD %VALUATION s #HOICE OF %VALUATION -ETHOD s %VALUATION 0LAN $EVELOPMENT s ,INKS TO %VALUATION 2ESOURCES 4OOLS 0ROVIDED AT THE %ND OF THIS -ODULE %XAMPLE 2ESULTS &RAMEWORK FOR AN %MERGENCY #ONTRACEPTION 0ROJECT %XAMPLE /UTLINE OF AN %#0 0ROGRAM %VALUATION 2EPORT 2ELATIONSHIP "ETWEEN !SSESSMENT AND %VALUATION 4O MEASURE CHANGE IT IS NECESSARY TO HAVE A STARTING POINT BEFORE THE PROGRAMS ACTIVITIES OR INTERVENTIONS BEGIN WHEN SPECIlC TARGETS OF THE PROGRAM INTERVENTIONSOR INDICATORSARE MEASURED 4HIS STARTING POINT OR BASELINE CAN BE DOCUMENTED AS PART OF ASSESSMENT ACTIVITIES 0LEASE REFER TO -ODULE % !SSESSMENT AND THE ASSESSMENT TOOLS WHICH ARE CLOSELY TIED TO THIS MODULE ON EVALUATION 4HE SAME INDICATORS USED FOR THE BASELINE CAN BE MONITORED AND RECORDED THROUGHOUT THE EVALUATION PERIODMAKING IT POSSIBLE AT THE END OF THE EVALUATION PERIOD TO DOCUMENT THE CHANGES THAT HAVE TAKEN PLACE IN THE INDICATORS %VALUATION &UNCTIONS %VALUATION OF EMERGENCY CONTRACEPTIVE PILL PROGRAMS FULlLLS FOUR KEY FUNCTIONS )T ENABLES PROGRAM MANAGERS AND STAFF TO GUIDE AND IMPROVE THEIR OWN WORK BY PROVIDING SYSTEMATIC AND OBJECTIVE FEEDBACK ON WHAT IS AND IS NOT WORKING AND WHY SO THAT SYSTEMS FOR PROVIDING %#0 PRODUCT AND INFORMATION CAN BE IMPROVED ) ) -ODULE ) #HARACTERISTICS OF 'OOD %VALUATION #HOICE OF %VALUATION -ETHOD )T x x x 4HE METHODS USED TO EVALUATE A PROJECT WILL DEPEND ON x x x x x x MIND AS A NEW EVALUATION STRATEGY IS DEVELOPED &OLLOWING IS A LIST OF CHARACTERISTICS OF A STRONG EVALUATION P )T )T FUTURE PROGRAM SUCCESS REQUESTS FOR FUTURE SUPPORT INTENDED PURPOSESA CRITICAL ELEMENT OF REPORTS ON COMPLETED PR 2ESOURCES AVAILABLE WOMEN REQUESTING %#0S MAY BE MORE IMPORTANT EDUCATION THE NUMBER OF CALLS TO AN EMERGENCY CONTRACEPTION HO MAY BE CENTRAL TO THE EVALUATION )F THE FOCUS OF THE WORK IS O ON PROVIDER TRAINING CHANGES IN PROVIDER KNOWLEDGE ATTITUDES 4HE NATURE OF THE WORK THAT IS BEING EVALUATED NUMBER OF SITES WHERE %#0S ARE AVAILABLE DISTRIBUTION RECORDS TO DEMONSTRATE THE NUMBER OF %#0S DISTRIBU APPROACHES WITH MORE GENERALIZABLE RESULTS SUCH AS USING CONTRA IN -ODULE % !SSESSMENT ,ARGER PROGRAMS MAY ALLOW MORE EFFECT EVALUATION USING QUALITATIVE APPROACHES 3EE QUALITATIVE DATA 4HE SIZE OF THE PROGRAM &INDINGS ARE APPLIED TO FUTURE PROGRAMS OR POLICIES 2ESULTS ARE SHARED IN A TIMELY AND UNDERSTANDABLE MANNER WITH A 2ESOURCES ARE PRUDENTLY USED 3TAKEHOLDERS ARE INVOLVED AT ALL STAGES TO ENHANCE RELEVANCY AN THE INTERESTS AND SAFETY OF ALL PARTICIPANTS $ATA ARE COLLECTED AND ANALYZED IN A SYSTEMATIC AND UNBIASED WA 0ROJECT GOALS AND OBJECTIVES ARE WELL DElNED AND MEASURABLE SIGNIlCANTLY REDUCE THE RESOURCES REQUIRED FOR OBTAINING INFORM IT IS POSSIBLE TO TAP INTO EXISTING DATA COLLECTION SYSTEMS THA OTHER RESOURCES ARE AVAILABLE SUCH AS EXISTING SYSTEMS FOR GAT ACTIVITIES TO THE SCOPE OF THE PROJECT ACTIVITIES )T WILL BE I #LEARLY %#0 INTRODUCTION EFFORTS WITH LIMITED BUDGETS MUST CARE THEM EXPANDING THE IMPACT AND REACH OF THE %#0 PROGRAM INTEGRATION INCREASES THE KNOWLEDGE BASE DEMONSTRATES TO DECISION MAKERS OR DONORS THE EFFECTIVE USE OF DEMONSTRATES TO OTHERS THE EFFECTIVENESS OF STRATEGIES AND APPR SO THAT PROGRAM MANAGERS CAN DECIDE WHETHER AND HOW TO ADAPT PROVIDING DATA THAT WILL FACILITATE MAKING %#0S MORE AVAILABL )T IS IMPORTANT TO BUILD EVALUATION ACTIVITIES INTO THE BUDGET 3MALL PILOT PROJECTS MAY LEND THEMSELVES TO MORE IN DEPTH ABOUT EFFECTIVE INTERVENTIONS AND THE FACTORS THAT AFFECT &OR EXAMPLE IF THE PROJECT IS FOCUSED ROCESS THAT SHOULD BE KEPT IN MPORTANT TO DETERMINE WHAT T COLLECT RELEVANT DATA THIS CAN N CLIENT INFORMATION AND HERING DATA FOR INDICATORS )F COLLECTION TOOLS PROVIDED D ACCURACY AND PRACTICES +!0 ATION FULLY MATCH EVALUATION TED MONTHLY AND THE CEPTIVE COMMODITY OACHES OF %#0 PPROPRIATE PARTIES Y WITH PROPER REGARD FOR TLINE OR NUMBER OF THEIR RESOURCES OJECTS AS WELL AS OF IVE USE OF QUANTITATIVE OR REPLICATE E IN THE FOR THE S -ODULE ) %VALUATION 0LAN $EVELOPMENT "UILD IN EVALUATION FROM THE BEGINNING )T IS IMPORTANT TO INCLUDE THE EVALUATION PLAN AS PART OF THE %#0 INTRODUCTION PROCESS AND TO WORK IN COLLABORATION WITH PARTNERS AND OTHERS WHO WILL BE INTERESTED IN THE OUTCOME OF THE EVALUATION IN ORDER TO ENSURE THAT THE EVALUATION RESULTS PROVIDE USEFUL RELEVANT INFORMATION ,INK YOUR EXPECTED RESULTS TO THE PLANNED ACTIVITIES )N DEVELOPING AN EVALUATION PLAN LINK THE EXPECTED RESULTS OF THE PROJECT TO PLANNED ACTIVITIES 4O DO THIS BE EXPLICIT ABOUT GOALS AND OBJECTIVES OF THE PROJECT AND DElNE WHERE IN THE PROCESS OF INTEGRATING %#0S DATA COULD BE COLLECTED TO MEASURE WHETHER THE PROJECT HAS BEEN SUCCESSFUL $ATA THAT ARE USED TO MEASURE SUCCESS CAN ALSO BE CALLED INDICATORS ! RESULTS FRAMEWORK CAN BE AN EFFECTIVE WAY OF DEVELOPING AN EVALUATION PLAN !N EXAMPLE OF A RESULTS FRAMEWORK IS INCLUDED AT THE END OF THIS MODULE TO DEMONSTRATE HOW A FRAMEWORK LIKE THIS CAN APPLY TO AN EMERGENCY CONTRACEPTION PROGRAM EVALUATION 3ELECT INDICATORS THAT WILL INDICATE CHANGE BROUGHT ABOUT BY THE PROJECT INTERVENTIONS 4HE INDICATORS SHOULD BE PART OF THE BASELINE DATA PROVIDING A MEASUREMENT OF THE STATUS BEFORE THE PROJECT !T THE END OF THE PROJECT LATER DATA ON THE SAME INDICATORS CAN BE COMPARED WITH THE BASELINE DATA TO SHOW CHANGES THAT MAY HAVE RESULTED FROM THE PROJECT ACTIVITIES &OR EACH INDICATOR DETERMINE WHERE OR HOW THE INFORMATION WILL BE OBTAINED $ATA FOR A SINGLE INDICATOR SHOULD BE COLLECTED FROM MORE THAN ONE SOURCE #ROSS CHECKING THE DATA FROM SEVERAL SOURCES WILL INCREASE ACCURACY AND CREDIBILITY 4HE FOLLOWING TABLE SHOWS THE INDICATORS TO INCLUDE !SPECT OF %#0 )NTEGRATION )NDICATOR 0OLICY LEVEL s 3TATED SUPPORT FOR %#0S FROM MINISTRY OF HEALTH FOR EXAMPLE RESOURCES ALLOCATED FOR %#0S OR STANDARD OF CARE GUIDELINES s 3TATED SUPPORT FROM MEDICAL ASSOCIATION LEADERS FOR EXAMPLE A PUBLISHED STATEMENT OR A PUBLIC ANNOUNCEMENT IN SUPPORT OF %#0S s #OMMITMENT TO COLLABORATE BY LOCAL PARTNER ORGANIZATIONS 3ERVICE DELIVERY s .UMBER OF WOMEN REQUESTING %#0S s .UMBER OF %#0S SOLDDISTRIBUTED MONTHLY s .UMBER OF PERSONNEL AUTHORIZED TO PROVIDE %#0S s .UMBER OF PEOPLE TRAINED TO PROVIDE %#0S s .UMBER OF SITES WHERE %#0S ARE AVAILABLE 3ERVICE QUALITY s 0OSITIVE CHANGE IN PROVIDER ATTITUDES TOWARD %#0S s 0OSITIVE CHANGE IN CLIENT EXPERIENCE ACCESSING %#0S s 0ERCENTAGE OF %#0S CLIENTS ALSO COUNSELED ABOUT SEXUALLY TRANSMITTED INFECTIONS s 0ERCENTAGE OF %#0S CLIENTS ALSO REFERRED TO SOURCE OF ONGOING CONTRACEPTIVE METHOD !WARENESS RAISING s .UMBER OF CALLS TO EMERGENCY CONTRACEPTION HOTLINE s 0ERCENTAGE OF PUBLIC WHO KNOW WHAT %#0S ARE OR WHERE TO GET THEM ) ) -ODULE ) ,INKS TO %VALUATION 2ESOURCES NECESSARY TO DEMONSTRATE THE CHANGE THAT THE PROJECTPROGRAM HO THE SAMPLE SIZE IN THIS CASE NUMBER OF PROVIDERS TO INCLUDE I ATTITUDES TOWARD %#0S IT IS IMPORTANT TO CONSULT WITH A STATI THE EVALUATION GOAL IS TO SHOW A STATISTICALLY SIGNIlCANT CHANG SOFTWARE DEVELOPED FOR ENTERING DATA FORMS )F QUANTITATIVE DAT THE FORMS AND INCLUDING MECHANISMS FOR CONlRMING ACCURATE DATA PROVIDING STANDARDIZED FORMS TRAINING THE STAFF THAT WILL COLL DATA ENTRY PROCESSES SHOULD BE IN PLACE BEFORE THE DATA COLLECT OF ALL PROJECTPROGRAM SITES 0LANS FOR ENSURING THE QUALITY OF FRIENDLY TO PROGRAM ORGANIZERS AS IT IS IMPORTANT THAT THE SIT TO RANDOMLY SELECT THE SITES RATHER THAN PICKING SITES THAT ARE &OR EXAMPLE IF ONLY A SELECTION OF SERVICE DELIVERY SITES ARE ENSURING SAMPLE SIZES LARGE ENOUGH TO DETECT THE CHANGES THE PR ESPECIALLY IMPORTANT TO ALSO CONSIDER ISSUES OF AVOIDING BIAS USED AS PART OF AN EVALUATION TO VERIFY SUCCESSFUL RESULTS &OR AS ISSUES TO CONSIDER IN DATA COLLECTION ENTRY AND ANALYSIS IN DEPTH INTERVIEWS FOCUS GROUP DISCUSSIONS AND MYSTERY SHOPP BE USED FOR ASSESSMENT INCLUDING KNOWLEDGE ATTITUDES AND PERC -ODULE % !SSESSMENT PROVIDES GUIDANCE REGARDING DATA COLLECTIO #HOOSE METHODS FOR DATA COLLECTION )NTERNET AT TTPWWWCPCEDUMEASUREMERLINMERLINHTML $EVELOPED BY THE 53!)$ FUNDED -%!352% RESOURCES TO ASSIST IN THE MONITORING AND EVALUATION OF HEALTH 4HE -%2,). 6IRTUAL ,IBRARY IS A COMPREHENSIVE COLLECTION OF BOT %VALUATION 0ROJECT IT IS AVAILABLE ON THE 4HESE METHODS CAN ALL BE ES SELECTED BE REPRESENTATIVE EASY TO REACH OR THAT ARE TO BE EVALUATED IT IS BETTER STICIAN IN DETERMINING EVALUATION HOWEVER IT IS ECT THE DATA ON THE USE OF BOTH THE DATA COLLECTION AND E FOR EXAMPLE IN PROVIDER CONTROLLING QUALITY AND AND POPULATION SERVICES N THE STUDY THAT WILL BE ION BEGINS 4HIS CAN INCLUDE A IS TO BE COLLECTED AND OJECT HOPES TO OBSERVE EPTIONS +!0 SURVEYS PES TO ACHIEVE ER TECHNIQUES AS WELL N METHODS THAT CAN ENTRY IN THE COMPUTER H PRINT AND ELECTRONIC -ODULE ) 4OOLS ,IST %XAMPLE 2ESULTS &RAMEWORK FOR AN %MERGENCY #ONTRACEPTION 0ROJECT 4HIS IS A GENERAL OVERVIEW COVERING KEY ELEMENTS OF AN INTRODUCTION STRATEGY )N A REAL %#0 INTEGRATION EFFORT EACH SECTION WOULD NEED TO BE mESHED OUT MORE FULLY 4HIS RESULTS FRAMEWORK IS INTENDED SOLELY TO DEMONSTRATE HOW A PROGRAM CAN LINK RESULTS ACTIVITIES AND INDICATORS AS WELL AS SPECIFY PROSPECTIVELY HOW INFORMATION WILL BE OBTAINED TO VERIFY WHETHER RESULTS WERE ACHIEVED %XAMPLE /UTLINE OF AN %#0 0ROGRAM %VALUATION 2EPORT 4HIS OUTLINE PROVIDES AN EXAMPLE OF HOW A PROGRAM EVALUATION REPORT OF AN %#0 PROGRAM COULD BE STRUCTURED ) -ODULE ) 4OOLS ) 4OOLS %XAMPLE 2ESULTS &RAMEWORK FOR AN %MERGENCY #ONTRACEPTION 0ROJECT -ODULE ) /VERALL 'OAL 4O IMPROVE WOMENS AWARENESS OF AND ACCESS TO EMERGENCY CONTRACEPTION THROUGH PUBLIC SECTOR PROGRAMS SO THAT WOMEN CAN MAKE INFORMED CHOICES REGARDING EMERGENCY CONTRACEPTIVE USE !SPECT OF %#0 !CTIVITIES AIMING TO INTEGRATION $ESIRED RESULT ACHIEVE THIS RESULT )NDICATORS -EANS OF VERIlCATION 0OLICY LEVEL 3UPPORT FROM s -EETINGS WITH KEY s 3TATED SUPPORT FROM s -EETING MINUTES MINISTRY OF HEALTH REPRESENTATIVES -/( s ,ETTER OF COMMITMENT -/( MEDICAL FROM -/( MEDICAL s 3TATED SUPPORT FROM ASSOCIATIONS AND ASSOCIATIONS AND s )MPLEMENTATION OF MEDICAL ASSOCIATION ACTION PLAN LOCAL PARTNER LOCAL PARTNER LEADERS ORGANIZATIONS FOR ORGANIZATIONS INTEGRATING %#0S s #OMMITMENT TO INTO PUBLIC SECTOR COLLABORATE BY LOCAL SYSTEMS PARTNER ORGANIZATIONS s $EVELOPMENT OF ACTION PLAN 3ERVICE )NCREASED CAPACITY s 0UBLIC SECTOR s .UMBER OF PUBLIC s 4RAINING RECORDS DELIVERY OF PUBLIC SECTOR CLINICIAN TRAINING SECTOR CLINICIANS WHO s 0RE AND POST TRAINING CLINICIANS TO s 2EGULAR MEETINGS ARE TRAINED TO PROVIDE PROVIDER +!0 SURVEY PROVIDE %#0 %#0S WITH PROVIDERS TO s -YSTERY CLIENT SURVEYS INFORMATION AND LEARN FROM ONE s 0OSITIVE CHANGE IN s #LIENT SATISFACTION PRESCRIPTIONS TO ANOTHER AND OPENLY PROVIDER ATTITUDES SURVEYS CLIENTS DISCUSS CONCERNS TOWARD %#0S )NCREASED #ONTRACEPTIVE AND PROBLEMS s .UMBER OF %#0S PROVISION OF %#0S COMMODITY DISTRIBUTION s $ISTRIBUTION OF %#0S DISTRIBUTED MONTHLY THROUGH PUBLIC RECORDS SECTOR SYSTEMS THROUGH PUBLIC s .UMBER OF SITES WHERE SECTOR PROGRAMS %#0S AVAILABLE 3ERVICE %#0S PROVIDED s 0UBLIC SECTOR s 0ERCENTAGE OF CLIENTS s 0RE AND POST TRAINING QUALITY TO CLIENTS AS PART CLINICIAN TRAINING PROVIDED WITH %#0S PROVIDER +!0 SURVEY OF AN INTEGRATED INCLUDES INFORMATION COUNSELED ON SEXUALLY s -YSTERY CLIENT SURVEYS RESPONSE TO ABOUT ONGOING TRANSMITTED INFECTION UNPROTECTED SEX FAMILY PLANNING s %#0 CLIENTS CLINICAL s 0ERCENTAGE OF CLIENTS RECORDS METHODS AND PROVIDED WITH %#0S SEXUALLY TRANSMITTED REFERRED TO ONGOING INFECTIONS CONTRACEPTIVE METHODS !WARENESS )NCREASED s "ACKGROUND s .UMBER OF ARTICLES s -EDIA TRACKING RAISING AWARENESS OF %#0S WORKSHOP FOR ABOUT %#0S IN s (OTLINE TRACKING FOR WOMEN OF JOURNALISTS MAINSTREAM MEDIA REPRODUCTIVE AGE s 3ENTINEL CLINIC TRACKING s $EVELOPMENT s .UMBER OF CALLS TO %#0 OF %#0 REQUESTS OF HOTLINE WITH HOTLINE INFORMATION ABOUT s .UMBER OF WOMEN %#0S REQUESTING %#0S s $EVELOP )%# MATERIALS SUCH AS BROCHURES POSTERS AND RADIO SPOTS 4HIS MATERIAL WAS DEVELOPED BY 0!4( ) -ODULE ) 4OOLS ) 4OOLS %XAMPLE /UTLINE OF AN %#0 0ROGRAM %VALUATION 2EPORT -ODULE ) ) )NTRODUCTION ! "ACKGROUND ON EMERGENCY CONTRACEPTIVE PILLS %#0S %#0S AS A UNIQUE FORM OF CONTRACEPTION THAT CAN BE USED AFTER SEX TO PREVENT PREGNANCY )DEALLY %#0S SHOULD BE USED WITHIN HOURS OF UNPROTECTED SEX AND ARE SIGNIlCANTLY MORE EFFECTIVE THE SOONER THEY ARE TAKEN " $ESCRIPTION OF LOCAL ADVOCACY FRAMEWORK 2ATES OF UNINTENDED PREGNANCY .EGATIVE CONSEQUENCES OF UNINTENDED PREGNANCY FOR BOTH FAMILY AND CHILD %#0S CAN HELP PREVENT UNINTENDED PREGNANCY REDUCE ABORTION RATES AND REDUCE MATERNAL MORTALITY # $ESCRIPTION OF THE PROGRAMS INTEGRATION OF %#0S INTO THE PUBLIC SECTOR SYSTEMS 0ROGRAM GOALS AND OBJECTIVES 0ROGRAM IMPLEMENTATION #OLLABORATING PARTNERS )) %VALUATION -ETHODS /VERVIEW OF %VALUATION 3TRATEGY ! $ESCRIPTION OF METHODS FOR EXAMPLE +!0 SURVEY IN DEPTH INTERVIEW FOCUS GROUP DISCUSSION AND PARTICIPANTS POLICY MAKERS PROVIDERS CLIENTS USED TO EVALUATE PROGRAM SUCCESS 3TUDY POPULATIONS SETTING AND LOCATIONS WHERE DATA COLLECTED 0ARTICIPANT RECRUITMENT 3AMPLING HOW PARTICIPANTS WERE SELECTED RATIONALE FOR NUMBER OF PARTICIPANTS ANALYSIS METHODS USED INCLUDING STATISTICAL TESTS IF APPLICABLE ))) $ESCRIPTION OF EVALUATION RESULTS ! 0OLICY LEVEL )NDICATIONS OF SUPPORT AT THE POLICY LEVEL 3ERVICE DELIVERY A #APACITY OF PROVIDERS TO PROVIDE %#0 INFORMATION AND PRESCRIPTION B 0ROVISION OF %#0S THROUGH PUBLIC SECTOR SYSTEM C 0ROVIDERS SATISFACTION 3ERVICE QUALITY A %#0 PROVISION AS PART OF AN INTEGRATED RESPONSE TO UNPROTECTED SEX B #LIENT SATISFACTION %#0 !WARENESS RAISING A )NCREASE IN LEVEL OF AWARENESS ABOUT %#0S B -EDIA REPORTS ON %#0S )6 $ISCUSSION OF THE EVALUATION lNDINGS AND THEIR IMPLICATIONS ! 3UMMARIZE CENTRAL lNDINGS " $ISCUSS EFFECTIVENESS OF STRATEGIES AND APPROACH 6 0ROVISION OF RECOMMENDATIONS BASED ON EVALUATION RESULTS FOR IMPROVEMENT AND NEXT STEPS POSSIBLE 4HIS MATERIAL WAS DEVELOPED BY 0!4( ) !PPENDIX ! %MERGENCY #ONTRACEPTIVE 0ILLS -EDICAL AND 3ERVICE $ELIVERY 'UIDELINES Emergency Contraceptive Pills: Medical and Service XDelivery Guidelines Second Edition • 2003 International Consortium for Emergency Contraception Emergency Contraceptive Pills: Medical and Service Delivery Guidelines Second Edition X 2003 International Consortium for Emergency Contraception ACKNOWLEDGEMENTS The Consortium’s original guidelines were based on the service delivery guidelines of the International Planned Parenthood Federation, Pathfinder International, and PATH. The first edition was printed in October 2000. The following individuals in particular contributed to that edition: Elizabeth Raymond, Yusuf Ahmed, Sharon Camp, Marilyn Edmunds, Douglas Huber, Carlos Huezo-Toledo, Valerie Koscelnik, Suneeta Mittal, Jose David Ortiz, Karen Ostea, Khama Rogo, Jeff Spieler, James Trussell, Paul Van Look, and Helena von Hertzen. For updating the second edition, the Consortium is grateful to: Elizabeth Raymond, Angeles Cabria, David Grimes, Susan McIntyre, Ilze Melngailis, Claudia Morrissey, Raffaela Schiavon, Harris Solomon, Perger Teodora, Fatiha Terki, James Trussell, Andre Ulmann, Helena von Hertzen, Anne Wilson, and Beverly Winikoff. Emergency Contraceptive Pills: Medical and Service Delivery Guidelines 2003 The International Consortium for Emergency Contraception Washington, DC USA Printed on recycled paper Original graphic design by Elizabeth Sanders INTERNATIONAL CONSORTIUM FOR EMERGENCY CONTRACEPTION Emergency Contraceptive Pills: X Medical and Service Delivery Guidelines Second Edition • 2003 CONTENTS Foreword 4 Summary Service Protocol for Emergency Contraceptive Pills 5 1 Introduction 7 1.1 Definition 7 1.2 Indications 7 2 Emergency Contraceptive Pills 7 2.1 ECP Regimens 7 2.2 Mode of Action 8 2.3 Efficacy 8 2.4 Side Effects, Prevention, and Management 9 2.5 Precautions 9 2.6 Screening 10 2.7 Special Issues 10 2.8 Information for the Client 11 2.9 Counseling 11 2.10 Follow-up 12 2.11 If the Client Becomes Pregnant 12 2.12 Starting or Resuming Regular Contraception after ECP Use 12 3 ECP Service Delivery Systems 13 3.1 Youth 14 3.2 Women Who Have Been Sexually Assaulted 14 Table 1 ECP Formulations 15 Appendix: Use of IUDs for Emergency Contraception 16 References 17 About the International Consortium for Emergency Contraception 19 3 X FOREWORD Offering emergency contraception is an important way for this important option before they need it. Because the time family planning and other reproductive health programs to frame for treatment is short — efficacy declines with each improve the quality of their services and better meet the day or even hour of delay — women need to be aware that needs of their clients. Emergency contraception is needed emergency contraception is an option, know where they because no contraceptive method is 100 percent effective, can seek services, and understand that treatment should be and few people use their method perfectly every time they started as soon as possible after unprotected or inade- have intercourse. Furthermore, emergency contraception quately protected intercourse. Providing emergency con- is useful in cases of sexual assault. traceptive information and, if practical, supplies of ECPs Emergency contraceptive pills (ECPs), the most com- at the time of a regular family planning or medical visit is monly used and most convenient form of emergency con- one way of ensuring that women have the resources they traception, are not difficult to provide. Specially packaged need to protect themselves from pregnancy in the event of ECPs or supplies of regular oral contraceptives that can be unprotected intercourse or a contraceptive failure. used for ECPs are readily available in most places. The organizations that make up the International Providers can be trained easily in the correct use, counsel- Consortium for Emergency Contraception have compiled ing, and follow-up related to ECPs. Nevertheless, provid- these service delivery guidelines to give family planning ing ECPs does entail unique service delivery issues, such and other reproductive health programs and practitioners as the need to ensure rapid access to the method to maxi- the information they need to provide ECPs safely and mize efficacy and the importance of conveying informa- effectively. The recommendations in these guidelines tion about additional, ongoing methods to prevent both reflect the latest available research on emergency contra- pregnancy and sexually transmitted infections after the ception and have been reviewed by internationally recog- ECPs are used. nized reproductive health experts. Local programs should An essential component of programs providing emer- adapt these guidelines as necessary to comply with national gency contraception is education, informing women about or other requirements. X 4 SUMMARY SERVICE PROTOCOL FOR EMERGENCY CONTRACEPTIVE PILLS Emergency contraceptive pills (ECPs) are an important the combined regimen reduces it by 56 percent to 89 per- option for women who recently have had unprotected cent. In direct comparisons, the levonorgestrel regimen has intercourse or a contraceptive failure and who do not want been shown to be substantially more effective than the to become pregnant. ECPs have been shown to be safe and combined regimen. Both regimens appear to be more effective in studies conducted over the past three decades. effective the sooner after intercourse they are used. ECPs are not as effective as consistent and correct use of most Indication modern contraceptive methods. To prevent pregnancy after unprotected or inadequately Side Effects protected intercourse. Side effects of both regimens include nausea, vomiting, Regimens abdominal pain, fatigue, headache, dizziness, breast ten- derness, and irregular vaginal spotting or bleeding. The lev- The two regimens discussed in these guidelines are: onorgestrel-only regimen is associated with a significantly • Levonorgestrel-only regimen: 1.50 mg levonorgestrel lower chance of nausea and vomiting than the combined in a single dose or in two doses of 0.75 mg taken up to regimen. In most women, menses following treatment will 12 hours apart. occur within a week before or after the expected time. • Combined estrogen-progestin regimen: two doses of 100 mcg ethinyl estradiol plus 0.50 mg of levonorgestrel Prevention and Management of Nausea taken 12 hours apart. and Vomiting Treatment with either regimen should be initiated as The best way to minimize nausea and vomiting is to soon as possible after intercourse because data suggest that use the levonorgestrel-only regimen instead of the com- efficacy declines substantially with time. Both regimens bined regimen whenever possible. Pretreatment with the have been shown to be effective through five days (120 antiemetic drugs meclizine or metoclopramide can prevent hours) after intercourse. Longer delays have not been these symptoms in users of the combined regimen. If vom- investigated. iting occurs within two hours after either dose, repeat the In some locations, both regimens are available as prod- dose, if feasible. In cases of severe vomiting, vaginal admin- ucts formulated and labeled specifically for use as ECPs. istration of ECPs may be effective. Alternatively, ECPs can be formulated from a variety of reg- ular oral contraceptive pills (see Table 1 or www.cecinfo.org). Precautions The levonorgestrel-only regimen is preferred because it is more effective and is associated with a lower incidence There are no known medical conditions that preclude of side effects. the use of ECPs. ECPs are not indicated in women with confirmed pregnancy because they will have no effect. Mode of Action However, ECPs may be given without pregnancy testing or when pregnancy status is unclear, as there is no evidence The exact mode of action of ECPs in any given case suggesting harm to a pregnant woman or to her pregnancy. cannot be known. ECPs have been shown to inhibit or delay an egg from being released from the ovary when Screening taken before ovulation. They may also prevent sperm and egg from uniting or stop a fertilized egg from attaching to Because ECPs are not dangerous under any known cir- the uterus. The two ECP regimens discussed in these cumstances, routine screening via examination or labora- guidelines do not interfere with an established pregnancy. tory tests is unnecessary prior to treatment. The client herself can determine whether ECPs are indicated after Effectiveness written or oral instruction. A pregnancy test may be helpful in ruling out pregnancy if the client has missed a menstrual Various studies have shown that the levonorgestrel- period. However, treatment should not be delayed in order only regimen reduces the risk of pregnancy by 60 percent to perform any screening procedures. to 93 percent or more after a single act of intercourse, and 5 X Special Situations Information for Clients • Breastfeeding: There is no evidence that ECPs will Information about ECPs and related issues may be harm a breastfeeding woman or her infant, although provided in person, over the telephone, in writing, or by a some authorities recommend feeding immediately combination of these approaches. At a minimum, the fol- before taking the pills and then expressing and dis- lowing messages should be conveyed: carding the breast milk for the six hours afterwards. • The client should start treatment as soon as possible • Coital act(s) more than 120 hours in the past: ECPs after intercourse. may be used, but clients should be informed that effi- • Following ECP use, if the client’s menstrual period has cacy has not been studied. Emergency intrauterine not come within a week after it was expected, she device (IUD) insertion should be considered. should seek evaluation and care for possible pregnancy. • More than one prior unprotected act: One ECP • If the client has irregular bleeding and lower abdomi- treatment may be used to cover all unprotected or nal pain, she should contact a health care provider for inadequately protected acts within the past 120 hours. possible evaluation for ectopic pregnancy. • Repeated ECP use: ECPs may be used as frequently • The client should use another form of contraception as requested, but clients should be informed that after using ECPs. ECPs are not suitable for ongoing ongoing, correct use of other contraceptive methods contraception. provides more effective protection over time. • ECPs do not protect against HIV or other sexually • Use of ECPs before intercourse: No data are avail- transmitted infections (STIs). able on how long the contraceptive effect of ECPs per- Ideally, the client should also be given information sists after the pills have been taken. Clients should be about efficacy, side effects, mechanism of action, other encouraged to use a contraceptive method other than contraceptive methods, and methods to prevent STIs. She ECPs whenever possible. should be offered a temporary method, such as condoms, • Unprotected intercourse during the “infertile for use in the immediate future, and referrals to facilities period”: Because it is often difficult to define the infer- where she can obtain any needed follow-up services. All tile period with certainty, ECPs are recommended any counseling should be nonjudgmental and supportive. time that unprotected or inadequately protected inter- course occurs and the client is concerned that she is at Follow-up risk for pregnancy. Advise the client to see a health care provider if she • Concurrent use of other drugs: Clients should be experiences irregular bleeding combined with lower abdom- counseled about the possibility of drug interactions inal pain or if she has any questions or reason for concern. and managed accordingly (see Section 2.7). • Use of other formulations: Combined estrogen- progestin pill formulations containing the progestin norethindrone in place of levonorgestrel can be used when the regimens described herein are not available. X 6 EMERGENCY CONTRACEPTIVE PILLS: MEDICAL AND SERVICE DELIVERY GUIDELINES 1 Introduction — more than seven days late for a combined estrogen- plus-progestin monthly injection Despite the availability of highly effective methods of — dislodgment, delay in placing, or early removal of a contraception, many pregnancies are unplanned and contraceptive hormonal skin patch or ring unwanted. These pregnancies carry a higher risk of mor- — dislodgment, breakage, tearing, or early removal of bidity and mortality, often due to unsafe abortion. Many of a diaphragm or cap these unplanned pregnancies can be avoided using emer- — failed coitus interruptus (e.g., ejaculation in vagina gency contraception.1,2 or on external genitalia) — failure of a spermicide tablet or film to melt before 1.1 Definition intercourse — miscalculation of the periodic abstinence method or Emergency contraceptive pills (ECPs) are hormonal failure to abstain on fertile day of cycle methods of contraception that can be used to prevent — IUD expulsion; or pregnancy after an unprotected or inadequately protected act of intercourse. • in cases of sexual assault when the woman was not ECPs sometimes are referred to as “morning-after” or protected by an effective contraceptive method. “postcoital” pills. The term “emergency contraceptive pills” is preferred because it conveys the important mes- 2 Emergency Contraceptive Pills sage that the treatment should not be used as an ongoing contraceptive method, and it avoids giving the mistaken 2.1 ECP Regimens impression that the pills must be taken on the morning after intercourse. Two ECP regimens are discussed in these guidelines: These guidelines address medical and service delivery • Levonorgestrel-only regimen: 1.50 mg levonorgestrel issues related to two regimens of ECPs, one containing a in a single dose or in two doses of 0.75 mg taken up to progestin only (levonorgestrel), and the other containing a 12 hours apart. combination of a progestin (levonorgestrel) and an estro- • Combined estrogen-progestin (Yuzpe) regimen: gen (ethinyl estradiol). two doses of 100 mcg ethinyl estradiol plus 0.50 mg A brief overview of the use of intrauterine devices (IUDs) of levonorgestrel taken 12 hours apart. for emergency contraception is included in the Appendix. Note that levonorgestrel plus an equal amount of a 1.2 Indications related but inactive compound is called norgestrel; there- fore, these regimens can also be formulated by substitut- ECPs are indicated to prevent pregnancy after unpro- ing double the amount of norgestrel as is indicated for tected or inadequately protected sexual intercourse, levonorgestrel. including: Treatment with either regimen should be initiated as • when no contraceptive has been used; soon as possible after unprotected or inadequately pro- • when there is a contraceptive failure or incorrect use, tected intercourse, because efficacy declines substantially 3,4 including: with time. Early data showed that both regimens are 5,6 — condom breakage, slippage, or incorrect use effective when used up to 72 hours after intercourse. — two or more consecutive missed combined oral Consequently, some product package instructions and contraceptive pills older guidelines advise use only within that time frame. — progestin-only pill (minipill) taken more than three However, more recent studies indicate that the regimens hours late continue to be moderately effective if started between 72 4,7 — more than two weeks late for a progestin-only con- and 120 hours. No data are available on efficacy if treat- traceptive injection (depot-medroxyprogesterone ment is started more than 120 hours after intercourse. acetate or norethisterone enanthate) Both regimens are available in some locations as products formulated and labeled specifically for use as 7 X ECPs. They also can be made up from a variety of regular expected pregnancies averted by the treatment. Determining oral contraceptive pills (see Table 1 or www.cecinfo.org). this fraction is not straightforward; it involves many assump- The levonorgestrel-only regimen is preferred because it is tions that are difficult to validate. Therefore, the reported more effective and is associated with a lower risk of nausea efficacy figures presented below may not be precise. Yet, pre- and vomiting.5 cise estimates of efficacy may not be highly relevant to many women who have had unprotected intercourse, since ECPs 2.2 Mode of Action are often the only available treatment. A more important consideration for most ECP clients may be the fact that Like all hormonal contraceptives, ECPs may work in a ECPs (specifically, the levonorgestrel regimen) are certainly variety of ways. The precise mechanism of action of ECPs in more effective than nothing.23 a particular case cannot be determined and probably depends Four studies of the levonorgestrel regimen that on the time in a woman’s menstrual cycle when intercourse included a total of almost 5,000 women reported pre- occurred and when ECPs were taken.8,9 Several studies have vented fractions between 60 percent and 93 percent; that provided direct evidence that when taken before ovulation, is, this regimen reduced a woman’s chance of pregnancy both the combined regimen and the levonorgestrel regimen by that amount.4,5,24,25 A meta-analysis of eight studies of can act by preventing or delaying ovulation.10-14 Some studies the combined regimen including more than 3,800 women have shown changes in histologic and biochemical features concluded that the regimen prevents about 74 percent of of the endometrium after treatment with combined ECPs, expected pregnancies; the proportion ranged from 56 per- suggesting that they may act by impairing endometrial recep- cent to 89 percent in the different studies.26 A large ran- tivity to implantation of a fertilized egg.6,14,15 However, other domized trial that directly compared the two regimens studies have shown no such effects with both the combined showed that the levonorgestrel regimen is significantly and levonorgestrel-only regimens,10,11,13,16,17 and it is not clear more effective than the combined regimen. The relative that the observed changes would be sufficient to prevent risk of pregnancy in this study was 0.36, indicating that the implantation. Additional possible mechanisms include inter- chance of pregnancy among women who received the lev- ference with sperm transport or penetration18,19 and interfer- onorgestrel regimen was about one third of the chance ence with corpus luteum function.14,20 To date, no direct among those who received the combined regimen.5 clinical data exist regarding these possibilities. Nevertheless, Multiple studies have indicated that both regimens are statistical evidence on the effectiveness of ECPs suggests that more effective the sooner after intercourse the pills are they could not be as effective as data indicate if they only taken.4,5,25,27 Some older studies of the combined regimen worked by interfering with ovulation.21 did not show this time effect,28 but they may not have been ECPs have often been confused with medical abortion. as rigorously conducted as more recent research. No data ECPs are effective only in the first few days following inter- are available establishing efficacy if ECPs are taken more course before a pregnancy is established, while medical than 120 hours after intercourse. abortion is a nonsurgical option for terminating a preg- ECPs are inappropriate for regular use as an ongoing nancy. At least five days elapse between intercourse and the contraceptive method for several reasons. First, ECPs are less establishment of a pregnancy, defined as implantation of a effective than most modern methods over the long term. The fertilized egg in the lining of a woman’s uterus. ECPs work prevented fraction statistic used to express efficacy of ECPs in this interval to prevent pregnancy. They are ineffective after a single use cannot be directly compared to published once implantation has begun. Data from studies of high- failure rates of other contraceptives used for prolonged peri- dose oral contraceptives indicate that neither of the two ods of time. However, if ECPs were used as an ongoing ECP regimens discussed here will interrupt an established method, the cumulative risk of pregnancy during a full year of pregnancy or harm a developing embryo.22 use would likely be higher than the risk associated with regu- 2.3 Efficacy lar hormonal contraceptives, male condoms, and other bar- rier methods. In addition, very frequent ECP use would The statistic commonly used to express the efficacy of result in more side effects (such as menstrual irregularities) most contraceptive methods indicates the proportion of and exposure to a higher total hormone dose than would women who become pregnant while using the method over regular use of either combined oral contraceptive pills or a fairly long period of time. This statistic is not meaningful progestin-only pills. Data are not available on the incidence of for ECPs, which are intended for one-time use. Instead, the medical complications (if any) in women who use current contraceptive efficacy of ECPs is commonly expressed in regimens of ECPs frequently over a long period of time. terms of the “prevented fraction,” which is the proportion of X 8 2.4 Side Effects, Prevention, and tion among ECP users); the menstrual period usually Management occurs within one week before or after the expected time. Management No deaths or serious complications have been causally linked to emergency contraception.29 Side effects that are med- After using ECPs, if the menstrual period has not ically minor but troublesome to clients do occur, however. come by a week after it was expected, the client should be advised to consider the possibility that she may be preg- Nausea and vomiting nant and to seek appropriate evaluation (such as a preg- Nausea occurs in about 18 percent of women and nancy test) and care. vomiting occurs in about 4 percent of women using lev- Irregular vaginal bleeding onorgestrel-only ECPs.4,5,24,25 Nausea and vomiting occur in about 43 percent and 16 percent, respectively, of clients Some women may experience irregular bleeding or using the combined regimen.30 In studies directly compar- spotting after taking ECPs. The proportion with this side ing the two regimens, the levonorgestrel regimen has been effect varies substantially in different studies; for example, shown to cause significantly and substantially less nausea trials of the LNG regimen found that between 0 percent and vomiting than the combined regimen.5,25 If they occur, and 17 percent of women reported non-menstrual bleed- these symptoms are usually limited to the first three days ing in the first week after use. after treatment.31 Management Prevention Irregular bleeding due to ECPs is not dangerous and The best way to minimize nausea and vomiting is to will resolve without treatment. However, it is important use the levonorgestrel-only regimen instead of the com- not to discount the possibility that irregular bleeding after bined regimen whenever possible. Nausea and vomiting ECP use may be due to another more serious cause, such are uncommon enough with the levonorgestrel-only regi- as ectopic pregnancy. Consideration should be given to men that prophylactic administration of an antiemetic drug evaluating this symptom with a pregnancy test and other is not routinely warranted. However, if the combined reg- appropriate tests if the woman has other symptoms of imen is used, antiemetic pretreatment may be considered, ectopic pregnancy, such as lower abdominal pain. depending on program and client resources. A single dose Other side effects of ECPs of meclizine (50 mg), taken one hour before the first dose of the regimen, reduces the risk of nausea by about 30 per- Other side effects may include abdominal pain, breast cent and the incidence of vomiting by about 60 percent. tenderness, headache, dizziness, and fatigue. These side effects usually do not occur more than a few days after Clients who use meclizine should be warned that it might 31 cause drowsiness.30 Metoclopramide, 10 mg taken one treatment, and they generally resolve within 24 hours. hour before each dose of the combined regimen, also Management reduces the incidence of nausea.32 Lower doses of these A nonprescription pain reliever can be used to reduce drugs and other antiemetics also may prevent nausea and discomfort due to headaches or breast tenderness. vomiting, but they have not been studied. It is not possible to predict which ECP users will have nausea or vomiting or Effects on pregnancy which women will benefit from antiemetic pretreatment. Results from studies of high-dose oral contraceptives Taking ECPs with food has not been shown to alter the suggest that neither the pregnant woman nor the fetus will risk of nausea.30,33 be harmed if ECPs are inadvertently used during early 36 Management pregnancy. Available evidence suggests that ECPs do not If vomiting occurs within two hours of taking an ECP increase the chance that a pregnancy following ECP use dose, many experts believe that the dose should be will be ectopic; in fact, like all contraceptive methods, ECPs reduce the absolute risk of ectopic pregnancy by pre- repeated. In cases of severe vomiting, ECPs can be admin- 37 istered vaginally. Studies of regular oral contraceptive pills venting pregnancy in general. administered by this route suggest that the hormones are well absorbed through the vaginal mucosa.34,35 2.5 Precautions No evidence exists to indicate that ECPs are danger- Delay in menses ous under any known circumstances or in women with any Clients should be informed that ECPs do not neces- particular medical condition. Although some product sarily bring on menses immediately (a potential mispercep- 9 X package inserts list precautions similar to those associated Use after coital act(s) more than 120 hours in with continuous use of combined oral contraceptives and lev- the past onorgestrel-only pills, experts believe that these precautions do not apply to ECPs because the treatment is so short. No data are available on efficacy if treatment is started Women with previous ectopic pregnancy may use ECPs. more than 120 hours after intercourse. However, since ECPs ECPs are not indicated for a woman who has a confirmed apparently pose no danger either to the woman or to the pregnancy because they will have no effect. However, if an embryo if the ECPs fail, it is reasonable to provide them if evaluation for pregnancy has not been performed or if preg- the client is fully counseled about the possibility of pregnancy. nancy status is unclear, ECPs may be provided, as there is no A more effective approach would be to insert a copper IUD evidence suggesting harm to the woman or to an existing (see Appendix), if the earliest unprotected act occurred pregnancy. In the absence of pregnancy evaluation, though, within the past seven days and the woman is otherwise a can- the client should understand that she could already be preg- didate for emergency IUD insertion. nant, in which case ECP treatment will not be effective. Use after more than one unprotected act 2.6 Screening ECPs should not be withheld if the client has had more than one unprotected or inadequately protected act Because ECPs are safe for all women, and clients can of intercourse, unless she is known to be already pregnant. determine for themselves whether they have had unprotected However, clients should be informed that the efficacy of or inadequately protected intercourse, the only purpose of the ECPs will decline as the interval between the earliest screening is to identify situations when ECPs are clearly not coital act and the use of the ECPs lengthens. Clients needed (e.g., the client is already pregnant) or when an emer- should be encouraged to use ECPs as promptly as possi- gency contraceptive treatment other than ECPs (i.e., an ble after an act of unprotected intercourse and not to wait IUD) should be considered. This screening can be done by a until they have had a series of unprotected acts. Only one clinician or other trained provider or by the client herself after ECP treatment should be given at a time, regardless of the written or oral instruction.38 Clinical assessments (e.g., preg- number of prior unprotected acts. nancy test, blood pressure measurement, laboratory tests, pelvic exam) are not required but can be offered if medically Repeated use indicated for other reasons and desired by the client. A preg- ECPs are not intended for repeated use (see Section nancy test may be helpful in detecting pregnancy if the client 2.3) and no direct data are available about the effects of fre- has missed a menstrual period. quent use of current regimens. However, experience with ECPs should not be withheld or delayed in order to similar regimens39 and with high-dose oral contraceptives carry out screening procedures. suggests that the likelihood of harm from limited repeat use is low. ECPs should not be denied just because the woman 2.7 Special Issues has used them before, even within the same menstrual cycle. All women who use ECPs, especially those who use Use in breastfeeding women them repeatedly, should be given information about other A woman who is less than six months postpartum, is forms of contraception and counseling about how to avoid exclusively breastfeeding, and has not had a menstrual future contraceptive failures. Certainly repeated use of period since delivery is unlikely to be ovulatory and there- ECPs is safer than pregnancy, in particular when the preg- fore is unlikely to need ECPs. However, a woman who is nancy is unintended and women do not have access to safe providing supplemental feeding to her infant or who has abortion services. had menses since delivery may be at risk for pregnancy. A single treatment with ECPs is unlikely to have an impor- Use of ECPs before intercourse tant effect on milk quantity or quality. An unknown No data are available about how long the contracep- amount of hormone may pass into the breast milk. Some tive effect of ECPs persists after the pills have been taken. authorities recommend that nursing women should feed Presumably ECPs taken immediately before intercourse the baby immediately before taking ECPs and then express are as effective as ECPs taken immediately afterwards. and discard the breast milk for the next six hours, but the However, if a woman has the opportunity to plan to use a need for this practice is not proven. contraceptive method before intercourse, a method other than ECPs, such as condoms or another barrier method, is recommended. X 10 Use of ECPs during the “infertile period” • The client should take ECPs as soon as possible after Studies have shown that fertilization can result from intercourse to maximize efficacy. She should not intercourse only during a five- to seven-day interval around take extra doses unless she vomits within two hours the time of ovulation.40 Theoretically, ECPs should not be after a dose. needed if unprotected intercourse occurs at other times of • After taking ECPs, if the next menstrual period has the cycle, because the chance of pregnancy even without not come by a week after it was expected, the client ECPs would be zero. However, in practice, it is often should consider the possibility that she may be preg- impossible to determine for certain whether a specific act nant and seek evaluation and care. of intercourse occurred on a fertile or infertile cycle day. • If the client has irregular bleeding and lower abdomi- Therefore, ECPs generally should be provided any time nal pain, she should contact a health care provider for unprotected or inadequately protected intercourse occurs possible evaluation of ectopic pregnancy. and the client is concerned that she is at risk for pregnancy. In situations when the unprotected act is extremely • ECPs are not suitable for ongoing contraception. The unlikely to result in pregnancy, the client’s anxiety level and client should use a standard method of contraception the availability of program and client resources should be to prevent pregnancy from coital acts in the future. taken into account in making the decision. • ECPs do not protect against HIV or other sexually transmitted infections (STIs). The act of intercourse Drug interactions that prompted the request for ECPs may have put the No specific data are available about the interactions of client at risk for these infections, and she should con- ECPs with other drugs that the client may be taking. sider getting tested. However, it seems reasonable that drug interactions would Ideally, the client should also be given information be similar to those with regular oral contraceptive pills. A about efficacy, side effects, and mechanism of action of full discussion of this matter is beyond the scope of these ECPs, as well as information about other contraceptive guidelines, but several excellent references on the subject methods to use in the future and methods for preventing are available.41-45 Women taking drugs that may reduce the STIs. Whenever feasible, a regular method such as con- efficacy of oral contraceptives (including but not limited doms should be offered for her to use in the immediate to rifampicin, certain anticonvulsant drugs, and Saint future. Depending on the situation, the client should be John’s wort) should be advised that the efficacy of ECPs referred to facilities where she can obtain pregnancy care in may be reduced. Consideration may be given to increas- case of treatment failure, tests for STIs and HIV, and other ing the amount of hormone administered in the ECPs, needed services. either by increasing the amount of hormone in one or However, clients should not be overwhelmed with so both doses, or by giving an extra dose. much information that they cannot absorb it all. In addi- Use of other formulations tion, some clients may not want counseling on certain top- ics (such as information on other contraceptive methods One study has shown that a combined estrogen- or on the mechanism of action of ECPs) at the time they progestin pill formulation containing the progestin receive ECPs. Providers should not deny ECPs to women norethindrone offered an efficacy and side effect profile who refuse more than the minimum information needed similar to the standard combined pill regimen containing to ensure that they use ECPs correctly. levonorgestrel.33 These results suggest that oral contracep- tive pills containing progestins other than levonorgestrel 2.9 Counseling may be used for emergency contraception in situations when the two standard regimens are not available. Two studies have suggested that most women do not need any interaction with a health care provider in order to 2.8 Information for the Client use ECPs safely and effectively.38,46 However, counseling can serve to reinforce any messages given in writing and may Relevant information can be provided to ECP clients lead to better overall outcomes. Counselors should be mind- in person, over the telephone, in writing (e.g., in a pam- ful of possible unique sources of anxiety among women phlet or product package insert), or by a combination of requesting ECPs: embarrassment at failing to use contra- these methods. This information should include at least the ception effectively; rape-related trauma; concern about STIs, following key messages: including HIV, due to condom failure or non-use; and hes- itation due to a misperception that ECPs cause abortion. 11 X Counselors should be as supportive as possible of the client’s Respect and support her decision. Refer her to other choices and refrain from making judgmental comments or service providers as appropriate. indicating disapproval through body language or facial • If she decides to continue the pregnancy, reassure her expressions while discussing ECPs with clients. Supportive that there is no evidence of any teratogenic effect fol- attitudes will help set the stage for follow-up counseling lowing ECP use. Available data suggest that ECPs do about regular contraceptive use and prevention of STIs. not increase the likelihood that a subsequent preg- When possible, give clients written as well as oral instruc- nancy will be ectopic. tions for taking the ECPs. Pictorial instructions may help clients whose literacy may be limited. 2.12 Starting or Resuming Regular Actively involving the client in the counseling process is encouraged. For example, a provider might ask her what Contraception after ECP Use she has heard about ECPs, discuss her experience with Whenever possible, clients receiving ECPs should be other contraceptive methods (particularly the incident that given contraceptive counseling and provided with an led to the ECP request), and explore her current approach ongoing contraceptive method, such as condoms, for at to protecting herself from STIs. Validating or correcting least immediate future use. However, such counseling may her ideas as appropriate may be more effective in ensuring not be appropriate in all situations or may not be desired compliance than simply providing her with information. by clients at the time of ECP provision, and it should not Whenever possible, ensure that counseling is con- be a prerequisite for providing ECP services. Clients who ducted in private. In situations where privacy is inadequate need or desire counseling but who do not receive it at the (for instance, in many pharmacies), advise clients to contact ECP visit should be referred for a follow-up appointment a health care or family planning provider for additional at the earliest convenient time. information and counseling about regular contraceptive Clients may wish to restart their previous contracep- methods. Reassure all clients, regardless of age or marital tive method after taking ECPs, or they may prefer to initi- status, that all information that they give to the provider, as ate a new method. If the reason for requesting ECPs is well as the fact that they have received treatment, will be because the regular contraceptive method failed (for exam- kept confidential. ple, the condom broke or the client missed taking oral contraceptive pills), discuss with the client the reasons for 2.10 Follow-up failure and how it can be prevented in the future. In some No scheduled follow-up is required after ECP use cases, the need for ECPs may be an indication that a unless the client identifies a problem or question. However, change of methods should be considered. the client should be advised to seek follow-up care if she: ECP clients, particularly those with risk factors for STIs, such as young age, multiple partners, or residence in a • needs ongoing contraceptive counseling or a contra- location where STIs are especially prevalent, should ideally ceptive method; receive counseling on how to prevent STIs as well as preg- • has not had a menstrual period by a week after it was nancy by using condoms in addition to or as the primary expected; contraceptive method. • has irregular bleeding and lower abdominal pain; Guidelines for initiating or restarting • suspects she may be pregnant; contraceptive use after using ECPs • needs other services, such as evaluation for STIs; or Male or female condom • has other reasons for concern. Can be used immediately. 2.11 If the Client Becomes Pregnant Diaphragm or cervical cap A woman who has used ECPs may later find herself Can be used immediately. to be pregnant because the ECPs have failed, because she Spermicidal foam, tablets, jelly, cream, or film was already pregnant before taking the ECPs, or because coital acts after taking the ECPs led to pregnancy. In any Can be used immediately. of these cases: • Advise the client about all available options, and let her decide which is most appropriate for her situation. X 12 Oral contraceptives, hormonal contraceptive intercourse occurs in the interim, an alternate con- patch, or vaginal ring traceptive method (such as condoms) or abstinence Two options are offered. Many experts recommend should be used. the first as preferable because the method is initiated Female or male sterilization sooner, which may reduce subsequent pregnancy risk. Perform the operation only after informed consent can a. The client may begin using the method the day be ensured. It is not recommended that clients make this after taking the ECPs. If she is newly starting the decision under the stressful conditions that often sur- method, she should begin with a new pill pack, patch, round ECP use. Defer female sterilization until after the or ring. If she was previously using the method (e.g., client’s first menstrual period, to ensure that she is not the ECPs were indicated because of missed pills or dis- pregnant. Use a backup method or abstain from inter- lodgement of the patch or ring), she may resume using course until the sterilization procedure is performed. the pill pack, patch, or ring that she was previously using. In this case, she should be reminded that the 3 ECP Service Delivery Systems patch or ring will not be effective past the original date on which it was scheduled to be removed. All clients Given that ECPs appear to be most effective when starting hormonal methods immediately after using taken soon after intercourse, every effort should be made ECPs should use a barrier method if they have inter- to ensure that women know about ECPs before they need course in the next seven days after starting or restart- them. This can be accomplished by: ing the method. Clients may have some irregular bleeding until the onset of menses. • routinely informing women about ECPs at the time of regular medical or family planning visits; b. The client may wait until the beginning of her next menstrual cycle and then start the method • including information about ECPs on Web sites or according to the standard instructions for that telephone answering machines; method. In this case, she should be advised to use a • distributing written information about ECPs with barrier contraceptive method or abstain from inter- other contraceptive supplies or medications; course for the remainder of the current cycle. • including information about ECPs within sexual edu- Injectables cation programs; or Initiate progestin-only injectables and combined • instituting mass-media informational campaigns and monthly injectables within seven days after the begin- advertising ECP services. ning of the next menstrual cycle. The client should use Information about ECPs is particularly relevant to a barrier contraceptive or abstain from intercourse adolescents who are not yet sexually active; to women who until she receives the injection. are using contraceptive methods that are often used incon- Implants sistently or incorrectly, such as barrier methods, oral con- Insert within seven days after the beginning of the traceptives, or natural family planning; and to other next menstrual cycle. Use a backup method or abstain high-risk women, such as youth, migrant workers and their from intercourse until the implants are inserted. spouses, and victims of sexual assault. It is also critical that women be able to obtain ECPs IUD quickly when the need arises. Because the instructions for Insert after the start of the next normal menstrual use of ECPs are simple and medical screening is not neces- period. The client should use a barrier contraceptive sary, the requirement for an immediate visit to a doctor is or abstain from intercourse until the IUD is inserted. not necessary for safe and effective use38 and may create barriers to access. Some approaches to facilitating access are: NOTE: If the client intends to use an IUD as a long- term method and meets IUD screening criteria, emer- • providing women with an advance prescription or gency insertion of a copper-bearing IUD may be a supply of ECPs;47 good alternative to ECP use (see Appendix). • prescribing ECPs by telephone without seeing the Natural family planning client; Natural family planning may be initiated after the • training nurses, midwives, pharmacists, or nonclinical first normal menstrual period following ECP use. If individuals such as community health workers and 13 X sexual assault counselors to provide ECPs, if allowed 3.2 Women Who Have Been Sexually by local regulations; Assaulted • ensuring that nonclinical staff in health facilities, whom Reaching women who have been forced to have inter- clients may contact before seeing a clinician, are aware course also poses special challenges. ECP providers should of the availability of ECPs; be attentive to the possibility that these women may be: • distributing ECPs through nonclinical settings, such • unaware that something can be done to prevent preg- as through community-based services, schools, social nancy after sexual assault; marketing programs, and the commercial sector (e.g., pharmacies); or • unwilling to report the assault and therefore unwilling to seek services; • distributing ECPs over the counter.48 • concerned they will be blamed for the assault by the All ECP providers should be given appropriate training medical provider; or and follow clear service delivery guidelines. Training should include information on indications for ECP use, • also in need of diagnosis and treatment for STIs. recommended ECP regimens, mode of action, efficacy, Program managers and providers should ensure that side effects and their management, precautions and screen- police stations, emergency health care centers, and other ing, client information and counseling needs, and follow- facilities where women may seek help after an assault can up procedures. In addition, because ECPs are a backup provide clients with ECPs, if appropriate, or at least with method, the training also should include information information about where to obtain ECPs and other needed about other contraceptive methods, if necessary for the treatments as promptly as possible. audience. The training often is most effective if it is partic- ipatory in nature and includes exercises to build participant skills in the areas of screening, counseling, and follow-up. To obtain provider-training curricula, please contact the International Consortium for Emergency Contraception or visit the Consortium’s Web site at www.cecinfo.org. 3.1 Youth Reaching adolescents with emergency contraceptive information and services poses special challenges to pro- grams. Young women may find it difficult to access relevant information about or services for emergency contraception because they: • are unaware of the availability of ECPs; • lack confidence or are embarrassed to visit a family planning clinic; • do not know of the existence of the clinic; • find the clinic hours inconvenient; • fear a pelvic examination; or • are anxious about judgmental attitudes of the providers. Programs should work to ensure that clinics serving adolescents are youth-friendly (for example, by ensuring privacy and confidentiality, accessible facilities, reasonably priced services, and flexible hours — particularly during evenings and weekends). X 14 TABLE 1 ECP Formulations Formulation (per pill) Common Brand Names Dose Levonorgestrel-only LNG 1.50 mg (registrations pending) 1 tablet Regimen LNG 0.75 mg Imediat N, Levonelle-2, NorLevo, 2 tablets at once OR Plan B, Post-day, Postinor-2, Vika, 1 tablet, followed by Vikela 1 more 12 hours later Combined Regimen EE 50 mcg + LNG 0.25 mg E-Gen-C, Eugynon, Fertilan, 2 tablets, followed by OR Imediat, Neogynon, Nordiol, 2 more 12 hours later EE 50 mcg + NG 0.50 mg Ogestrel, Ovral, Ovran, Preven, Tetragynon EE 20 mcg + LNG 0.10 mg Alesse, Levlite, Aviane, Loette 5 tablets, followed by 5 more 12 hours later EE 30 mcg + LNG 0.15 mg AnNa, Levlen, Levora, Lo/Femenal, 4 tablets, followed by OR Lo/Ovral, Low-Ogestrel, 4 more 12 hours later EE 30 mcg + NG 0.30 mg Microgynon 30, Nordette, Rigevidon Abbreviations: EE = Ethinyl Estradiol LNG = Levonorgestrel NG = Norgestrel When using oral contraceptive pill packs containing 28 pills, the last seven pills should not be used. For all regimens, pills should be taken as soon as possible after intercourse but optimally within 120 hours. This table was prepared in October 2003. An updated table may be found on the Consortium Web site at: www.cecinfo.org. 15 X APPENDIX: USE OF IUDS FOR EMERGENCY CONTRACEPTION Copper-bearing IUDs can be used as a method of emer- infection, and those who are at high risk for STIs. In many gency contraception. They are most appropriate for instances, the act of intercourse that led to the request for women in stable relationships who wish to retain the IUD emergency contraception might put the woman at for long-term contraception and who meet the screening increased risk for STIs, in which case the IUD is not an requirements for regular IUD use. When inserted within optimal contraceptive choice. seven days after intercourse, copper-bearing IUDs are the For further information about use of IUDs for emer- most effective method of emergency contraception; they gency contraception, consult the IPPF Medical and Ser- reduce the risk of pregnancy by more than 99 percent.49,50 vice Delivery Guidelines. The most recent edition, which However, emergency IUD insertion requires a much contains information about emergency contraception, is higher degree of training and clinical oversight than available from IPPF, Regent’s College, Inner Circle, administration of ECPs. Clients must be screened to Regent’s Park, London NW1 4NS, UK; Web site: exclude those who are already pregnant, those who have www.ippf.org. pelvic inflammatory disease or another reproductive tract X 16 REFERENCES 1. Trussell J, Koenig J, Stewart F, Darroch JE. Medical care 17. 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Bacic M, Wesselius de Casparis A, Diczfalusy E. Failure of contraception—a pilot study. J Reprod Med 1974;13:53-8. large doses of ethinyl estradiol to interfere with early embry- 7. Ellertson C, Evans M, Ferden S, et al. Extending the time onic development in the human species. Am J Obstet Gynecol limit for starting the Yuzpe regimen of emergency contra- 1970;107:531-4. ception to 120 hours. Obstet Gynecol 2003;101:1168-71. 23. Raymond E, Taylor D, Trussell J, Steiner M. Minimum 8. Grimes DA, Raymond EG. Emergency contraception. Ann effectiveness of the levonorgestrel regimen of emergency Intern Med 2002;137:180-9. contraception. Contraception 2004;in press. 9. Croxatto HB, Devoto L, Durand M, et al. Mechanism of action 24. Arowojolu AO, Okewole IA, Adekunle AO. Comparative of hormonal preparations used for emergency contraception: a evaluation of the effectiveness and safety of two regimens of review of the literature. Contraception 2001;63:111-21. levonorgestrel for emergency contraception in Nigerians. 10. Marions L, Hultenby K, Lindell I, Sun X, Stabi B, Gemzell Contraception 2002;66:269-73. Danielsson K. Emergency contraception with mifepristone 25. Ho PC, Kwan MS. A prospective randomized comparison and levonorgestrel: mechanism of action. Obstet Gynecol of levonorgestrel with the Yuzpe regimen in post-coital 2002;100:65-71. contraception. Hum Reprod 1993;8:389-92. 11. Durand M, del Carmen Cravioto M, Raymond EG, et al. 26. Trussell J, Rodriguez G, Ellertson C. Updated estimates of On the mechanisms of action of short-term levonorgestrel the effectiveness of the Yuzpe regimen of emergency contra- administration in emergency contraception. Contraception ception. Contraception 1999;59:147-51. 2001;64:227-34. 27. Kane LA, Sparrow MJ. Postcoital contraception: a family 12. Hapangama D, Glasier AF, Baird DT. The effects of peri- planning study. N Z Med J 1989;102:151-3. ovulatory administration of levonorgestrel on the menstrual 28. Trussell J, Ellertson C, Rodriguez G. The Yuzpe regimen of cycle. Contraception 2001;63:123-9. emergency contraception: how long after the morning after? 13. Swahn ML, Westlund P, Johannisson E, Bygdeman M. Effect of Obstet Gynecol 1996;88:150-4. post-coital contraceptive methods on the endometrium and the 29. Vasilakis C, Jick SS, Jick H. The risk of venous thromboem- menstrual cycle. Acta Obstet Gynecol Scand 1996;75:738-44. bolism in users of postcoital contraceptive pills. Contraception 14. Ling WY, Robichaud A, Zayid I, Wrixon W, MacLeod SC. 1999;59:79-83. Mode of action of DL-norgestrel and ethinylestradiol combina- 30. Raymond EG, Creinin MD, Barnhart KT, Lovvorn AE, tion in postcoital contraception. Fertil Steril 1979;32:297-302. Rountree RW, Trussell J. Meclizine for prevention of nausea 15. Young DC, Wiehle RD, Joshi SG, Poindexter AN 3rd. associated with use of emergency contraceptive pills: a ran- Emergency contraception alters progesterone-associated domized trial. Obstet Gynecol 2000;95:271-7. endometrial protein in serum and uterine luminal fluid. 31. Van Santen MR, Haspels AA. Interception II: postcoital low- Obstet Gynecol 1994;84:266-71. dose estrogens and norgestrel combination in 633 women. 16. Raymond EG, Lovely LP, Chen-Mok M, Seppala M, Kurman Contraception 1985;31:275-93. RJ, Lessey BA. Effect of the Yuzpe regimen of emergency 32. Ragan RE, Rock RW, Buck HW. Metoclopramide pretreat- contraception on markers of endometrial receptivity. Hum ment attenuates emergency contraceptive-associated nausea. Reprod 2000;15:2351-5. Am J Obstet Gynecol 2003;188:330-3. 17 X 33. Ellertson C, Webb A, Blanchard K, et al. Modifying the Yuzpe 41. Breckenridge AM, Back DJ, Orme M. Interactions between oral regimen of emergency contraception: a multicenter random- contraceptives and other drugs. Pharmacol Ther 1979;7:617-26. ized controlled trial. Obstet Gynecol 2003;101:1160-7. 42. Shenfield GM. Drug interactions with oral contraceptive 34. Back DJ, Grimmer SF, Rogers S, Stevenson PJ, Orme ML. preparations. Med J Aust 1986;144:205-11. Comparative pharmacokinetics of levonorgestrel and ethiny- 43. Szoka PR, Edgren RA. Drug interactions with oral contracep- loestradiol following intravenous, oral and vaginal adminis- tives: compilation and analysis of an adverse experience report tration. Contraception 1987;36:471-9. database. Fertil Steril 1988;49:31S-38S. 35. Alvarez F, Faundes A, Johansson E, Coutinho E. Blood lev- 44. Guerts TBP, Goorissen EM, Sitsen JMA. Summary of Drug els of levonorgestrel in women following vaginal placement Interactions with Oral Contraceptives. Carnforth, England: of contraceptive pills. Fertil Steril 1983;40:120-3. Parthenon Publishing Group, Ltd., 1993. 36. U.S. Department of Health and Human Services, Food and 45. Dickinson BD, Altman RD, Nielsen NH, Sterling ML. Drug Drug Administration. Prescription drug products; certain interactions between oral contraceptives and antibiotics. combined oral contraceptives for use as postcoital emergency Obstet Gynecol 2001;98:853-60. contraception. Fed Regist 1997;62:8610-2. 46. Raymond EG, Dalebout SM, Camp SI. Comprehension of a 37. Trussell J, Hedley A, Raymond E. Ectopic pregnancy follow- prototype over-the-counter label for an emergency contra- ing use of progestin-only ECPs (letter). J Fam Plann Reprod ceptive pill product. Obstet Gynecol 2002;100:342-9. Health Care 2003;29:249. 47. Glasier A, Baird D. The effects of self-administering emer- 38. Raymond EG, Chen PL, Dalebout SM. “Actual use” study gency contraception. N Engl J Med 1998;339:1-4. of emergency contraceptive pills provided in a simulated 48. Grimes DA, Raymond EG, Scott Jones B. Emergency con- over-the-counter manner. Obstet Gynecol 2003;102:17-23. traception over-the-counter: the medical and legal impera- 39. United Nations Development Programme/ United Nations tives. Obstet Gynecol 2001;98:151-5. Population Fund/World Health Organization/World Bank 49. Zhou L, Xiao B. Emergency contraception with Multiload Special Programme of Research, Development and Research Cu-375 SL IUD: a multicenter clinical trial. Contraception Training in Human Reproduction, Task Force on Post-Ovu- 2001;64:107-12. latory Methods of Fertility Regulation. Efficacy and side effects of immediate postcoital levonorgestrel used repeat- 50. Trussell J, Ellertson C. Efficacy of emergency contraception. edly for contraception. Contraception 2000;61:303-8. Fertil Control Rev 1995;4:8-11. 40. Wilcox AJ, Weinberg CR, Baird DD. Timing of sexual inter- course in relation to ovulation. Effects on the probability of conception, survival of the pregnancy, and sex of the baby. N Engl J Med 1995;333:1517-21. X 18 ABOUT THE INTERNATIONAL CONSORTIUM FOR EMERGENCY CONTRACEPTION The mission of the International Consortium for Emergency update of emergency contraception activities worldwide. If Contraception is to expand access to and ensure safe and you would like to subscribe or contribute an article to this locally appropriate use of emergency contraception world- update, please contact the Consortium at the following wide within the broader context of family planning and address or the American Society for Emergency Contracep- reproductive health, with emphasis on developing countries. tion at [email protected]. The seven founding members of the Consortium ini- tially focused on introducing a dedicated emergency contra- Consortium Coordinator ceptive pill product in selected “demonstration” countries. International Consortium for Emergency Contraception As interest in emergency contraception and the Consortium E-mail: [email protected] grew, the Consortium expanded its membership to include a Web site: www.cecinfo.org wide range of organizations working to ensure that women The International Consortium encourages the forma- have access to all forms of emergency contraception. The tion of regional networks or consortia in order to better specific objectives of the Consortium are to: address specific issues and local barriers to EC access. For X serve as an authoritative source of information about information on these organizations, please contact the fol- emergency contraception; lowing addresses: X X be a voice for expanded access to and safe and appro- Africa: EC Afrique. Web site: www.ec-afrique.org; E-mail: priate use of emergency contraception; [email protected]; Mail: ECafrique Secretariat, Population Council, PO Box 17643, 00500 Nairobi, X serve as a strategic planning forum for emergency con- Kenya. traception service delivery and information, education, X and communication efforts; Latin America: Latin American Consortium for Emer- gency Contraception (LACEC)/Consorcio Latinoamer- X facilitate information sharing and networking among icano de Anticoncepcion de Emergencia (CLAE). Web Consortium members and other groups working to site: www.clae.info; E-mail: [email protected]; Mail: broaden knowledge of and access to emergency Instituto Chileno de Medicina Reproductiva (ICMER), contraception; Jose Victorino Lastarria 26, Depto. 21, Santiago, Chile. X encourage partnerships between public-sector organi- X Asia (Southeast): Asia Pacific Network on Emergency zations and private industry that are designed to make Contraception (APNEC). Web site: N/A; E-mail: equin- high-quality products for emergency contraception for [email protected]; Mail: Pacific Institute for Women’s large numbers of women worldwide at an affordable Health, 3450 Wilshire Boulevard, Suite 1000, Los Angeles, price; and CA 90010 USA. X seek and promote new emergency contraceptive X The Consortium maintains two listings of individuals and methods that are safe and effective. organizations working in the Arab and East European/ NIS/Balkan regions. To join either region’s listserve, The Consortium welcomes applications for member- please e-mail the following addresses: Arab region: arabre- ship from noncommercial agencies that share the Consor- [email protected]. East Europe, the Balkans, and the NIS tium’s overall goal of expanding access to emergency region: [email protected]. Additional information contraceptive products and services in developing countries. and updated contact information are available on the Con- Interested applicants should contact the Consortium Coor- sortium Web site: www.cecinfo.org. dinator. The Consortium and the American Society for Emergency Contraception also jointly produce an electronic 19 X X 20 INTERNATIONAL CONSORTIUM FOR EMERGENCY CONTRACEPTION Association of Reproductive Health Professionals • British Pregnancy Advisory Service • Catholics for a Free Choice • Center for Reproductive Rights • Center for Research on Women and Gender, University of Illinois at Chicago • CEPAM • Concept Foundation • CONRAD Program • DKT International • EngenderHealth • Family Care International • Family Health International • Family Planning Association of Sri Lanka • The Futures Group International • Gynuity Health Projects • Ibis Reproductive Health • Institute for Reproductive Health • International Planned Parenthood Federation • Ipas • JSI Research and Training Center for Women’s Health • Management Sciences for Health • Marie Stopes International • Meridian Development Foundation • Pacific Institute for Women’s Health • Pathfinder International • Planned Parenthood Federation of America — International • Population Action International • Population Council • Population Services International • Program for Appropriate Technology in Health • ProSalud Inter-Americana • SHILO Pregnancy Advisory Service • Reproductive Health Initiative of the American Medical Women’s Association • Women’s Commission for Refugee Women and Children, Reproductive Health Program • World Health Organisation (WHO), Special Programme of Research, Development and Research Training in Human Reproduction !PPENDIX " 7EBSITE 2ESOURCES x !#/'S %MERGENCY #ONTRACEPTIVE 0RACTICE "ULLETIN 4HE !MERICAN #OLLEGE OF /BSTETRICIANS AND 'YNECOLOGYS !#/' 0RACTICE "ULLETIN CONTAINS CLINICAL MANAGEMENT GUIDELINES ON EMERGENCY ORAL CONTRACEPTION FOR CLINICIANS )NFORMATION CONTAINED IN THIS DOCUMENT IS BASED ON EVIDENCE BASED RESEARCH AND lNDINGS ON EMERGENCY CONTRACEPTION )T INCLUDES INFORMATION ON WHAT EMERGENCY CONTRACEPTION IS AND THE MECHANISM OF ACTION AND INFORMATION ON SAFETY EFlCACY RISKS AND BENElTS )N ADDITION CLINICAL RECOMMENDATIONS FOR PRESCRIBING AND DISPENSING EMERGENCY CONTRACEPTION TO PATIENTS IS INCLUDED WITH INFORMATION ON SIDE EFFECTS AND BOTH DEDICATED PRODUCTS AND USE OF ORAL CONTRACEPTIVES AS EMERGENCY CONTRACEPTION 2ECOMMENDATIONS ARE MADE BASED ON SCIENTIlC EVIDENCE AS WELL AS EXPERT OPINION 4HE 0RACTICE "ULLETIN ON %MERGENCY #ONTRACEPTION WHICH HAS USEFUL AND ACCURATE INFORMATION IS AVAILABLE AT KWWS ZZZDFRJRUJ x !#/' .EWS 2ELEASE 3UPPORTING /VER THE #OUNTER 0ROVISION OF %#0S KWWS ZZZDFRJRUJIURPBKRPHSXEOLFDWLRQVSUHVVBUHOHDVHVQUFIP x #ATALYST #ONSORTIUM 7EBSITE )NFORMATION ABOUT #ATALYST #ONSORTIUMS PROJECTS AND THEIR FOCUS PROGRAM AREAS INCLUDING OPTIMAL BIRTH SPACING POSTABORTION CARE SOUTH TO SOUTH COLLABORATION ADOLESCENCE EMPOWERMENT AND ()6!)$3 AND SEXUALLY TRANSMITTED INFECTION PREVENTION KWWS ZZZUKFDWDO\VWRUJ x #ENTER FOR 2EPRODUCTIVE 2IGHTS 7EBSITE 4HE #ENTER FOR 2EPRODUCTIVE 2IGHTS WEBSITE CONTAINS UPDATED INFORMATION ON GLOBAL ISSUES AND EVENTS RELATED TO REPRODUCTIVE HEALTH AND RIGHTS )T INCLUDES LINKS TO OTHER SITES PUBLICATIONS NEWS AND INFORMATION ON ADVOCACY HUMAN RIGHTS LEGAL ISSUES CONTRACEPTION ABORTION ADOLESCENTS EQUALITY AND SAFE PREGNANCYKWWS ZZZFUOSRUJ x #ONSORTIUM FOR %MERGENCY #ONTRACEPTION IN )NDIAS 7EBSITE 4HIS SITE CONTAINS INFORMATION ON THE CONSORTIUM MEETING THAT WAS HELD IN )NDIA IN *ANUARY AND )NDIAS EFFORTS TO INTRODUCE EMERGENCY CONTRACEPTION HTTPWWWECINDIAORG x %MERGENCY #ONTRACEPTION AND THE 'LOBAL 'AG 2ULE!N 5NOFlCIAL 'UIDE ! 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