World Population Day 2018 highlights ineffective and unsafe pregnancy prevention behaviors and practices. What about emergency contraception?

By Melissa Garcia

Melissa Garcia is a Technical Advisor for the International Consortium for Emergency Contraception, hosted by MSH. This article originally appeared on the ICEC website

For this year’s World Population Day on 11 July, our community celebrated and affirmed the right to family planning. On this day, the United Nations Population Fund (UNFPA) also called attention to the many people around the world unable to realize this right.

The Guttmacher Institute’s analysis , Adding it Up, estimates that globally, 214 million women of reproductive age in developing regions want to avoid pregnancy but are not using a modern method of contraception. One hundred and fifty five million women are not using a contraceptive method. Some 59 million women use traditional practices and remedies for pregnancy prevention. UNFPA has listed some of these practices in this article and accompanying photo essay. They are cause for concern because the users of such “pseudo” contraceptive practices act in the belief that they are protecting themselves from the risk of unintended pregnancy. But in fact they are exposing themselves to that risk, and potentially to further health consequences.

This phenomenon affects emergency contraception (EC) as well. The majority of women are not aware that a contraceptive option after sex exists, in most countries that capture EC knowledge in their most recent Demographic and Health Survey (DHS) data.  Most women have never heard of the dedicated, safe and effective pill, and copper- IUD regimens that are the only effective post-coital method. Continue reading “World Population Day 2018 highlights ineffective and unsafe pregnancy prevention behaviors and practices. What about emergency contraception?”

Recent Provider Training and Client Counseling Tools on Emergency Contraception

By Melissa Garcia

Melissa Garcia is the technical advisor for the International Consortium for Emergency Contraception (ICEC), which is hosted by MSH. This article originally appeared on the ICEC website

Emergency contraceptive pills (ECPs) are an important part of the family planning method mix and for post-rape care, being the only effective way to reduce the risk of pregnancy after sex, whether unprotected, insufficiently protected or coerced.

At the global level, women have low levels of awareness of ECPs as a contraceptive option. This could be due in part that ECPs are not consistently included in contraceptive counselling, and/or because the right tools and information are lacking to dispel myths and misinformation. As ICEC’s mission is to ensure the safe and locally-appropriate use of EC in all reproductive health programming, we have made recent investments to support the global health care workforce by improving provider training and client counselling and awareness of ECPs at global, regional and national levels. In partnership with several other organisations, materials were created to provide up-to-date guidance on EC. While the focus is on levonorgestrel (LNG) ECPs–the most commonly available type of EC globally–select resources provide detail on the expanded post-coital contraceptive method mix.

ICEC has provided technical review to several global-level provider training materials, including EC training modules on FPTraining.org for providers (in English and in French) and for pharmacists (in English and in French). The latest edition of Family Planning: A Global Handbook for Providers has updated guidance as well; see the EC chapter here. Continue reading “Recent Provider Training and Client Counseling Tools on Emergency Contraception”

Top tips for advocates working on emergency contraception

By Melissa Garcia and Cristina Puig Borrás

Melissa Garcia is Technical Adviser for the International Consortium for Emergency Contraception (ICEC), hosted by MSH. Cristina Puig Borrás is the Coordinator for the European Consortium for Emergency Contraception. This article orginally appeared on ICEC’s website

Photo: Susana Galdos/MSH

With the current largest generation of young people, there is much to celebrate on August 12, International Youth Day. In particular, there is the growing recognition that as agents of change, adolescents and young people and their organisations are essential stakeholders who contribute to inclusive, just, sustainable and peaceful societies. Crucially, advocates working on sexual and reproductive health (SRH) and reproductive rights (RR) advance access for young people in meaningful ways. Continue reading “Top tips for advocates working on emergency contraception”

An ounce of (after-sex) prevention: At the Family Planning Summit, let’s talk about emergency contraception

By Elizabeth Westley

Elizabeth Westley is the director of the International Consortium for Emergency Contraception, where this article first appeared. 

To meet the global Family Planning 2020 goals, a full range of family planning methods must be available, including user-controlled, short-acting methods. The Guttmacher Institute’s analysis , Adding it Up, estimates that 214 million women of reproductive age in developing regions want to avoid pregnancy but are not using a modern contraceptive method.  Half of unmarried women with an unmet need for family planning report infrequent sex as the reason that they do not use a family planning method. A quarter of married women not using contraception fall into the same category.  Not feeling themselves at high levels of risk, these women may wish to avoid the appointments and waiting times, dependence on providers, side effects, discomforts, and other commitments that long-acting contraceptive methods sometimes entail. Other women may not be using modern contraception because they are unaware of their options or are faced with inaccessibility due to distance barriers, poor health infrastructures, stock outs, or high prices. As well, many women are located in humanitarian and fragile settings where contraceptive access can be challenging.  For many women and girls not currently using a long-acting contraceptive method, a simple, discreet, user-controlled, low-commitment, one-time “on demand” form of contraception that can be accessed easily and quickly is a critically important option. This method already exists: emergency contraception. Continue reading “An ounce of (after-sex) prevention: At the Family Planning Summit, let’s talk about emergency contraception”

Universal health coverage and gender

By Stacy Lu

This interview with Kiley Workman Diop originally appeared on the blog for Systems for Improved Access to Pharmaceuticals and Services (SIAPS), a program funded by USAID and implemented by Management Sciences for Health. This interview has been edited for length. 

Kiley Workman Diop is a Technical Advisor for SIAPS, and Stacy Lu is a Technical Writer for SIAPS.

A pharmacist with a client at the pharmacy for the the Hospital Notre Dame des Palmistes, Ile la Tortue, Haiti  (Photo credit: Jean Jacques Augustin)

How does attention to gender figure into the work SIAPS does in strengthening pharmaceutical systems?
In public health, when you’re designing an intervention you’re trying to think broadly about what’s going to help the whole population. But you also need to pay special attention to vulnerable groups, including groups that derive their vulnerability from their gender. In a broad sense, it’s about equity—if half the population (whether men or women, boys or girls) isn’t being served appropriately by our interventions, that dilutes SIAPS’s success and we miss out on achieving equitable access to medicines and services that help save lives. We have to think about gender to ensure equitable access to quality care.

Continue reading “Universal health coverage and gender”

Trump’s global gag rule silences doctors and midwives and harms their patients

By Catharine Taylor

Catharine Taylor is Vice President for health programs at Management Sciences for Health. This post originally appeared on STAT News

Midwifery students in Sierra Leone, which has one of the highest maternal mortality rates in the world. Funding for safe pregnancy and delivery worldwide is threatened by President Trump’s reinstatement of the global gag rule. (Photo by MARCO LONGARI/AFP/Getty Images)

President Trump’s reinstatement of the Mexico City Policy, better known as the global gag rule, came as no surprise to anyone working in the field of global health. We have been through this before — in 1984, when the policy was first put into effect by President Reagan, and then in 1993, 2001, and 2009, when it was repealed, reinstated, and repealed again.

The Mexico City Policy is called a gag rule because it limits not just what organizations and health providers do but what they are permitted to say. It prevents foreign organizations that receive US government funding from performing abortions — even if they are using funds from non-US government sources and even if abortion is completely legal in their countries.

The global gag rule also steps right between a woman and her doctor, nurse, or midwife, preventing these frontline health providers from telling their patients about the full, legal range of health options available to them. It forbids trusted advisers from giving honest, comprehensive health advice and information. I started my career as a nurse-midwife, and then worked in maternal and newborn health programs in Africa and Asia, so I know what this will mean for the lives and health of women and their families. Continue reading “Trump’s global gag rule silences doctors and midwives and harms their patients”

Emergency contraception is a simple part of post-rape care: Why is it not routinely provided?

By Melissa Garcia and Sarah Rich

Melissa Garcia is Senior Technical Officer for the International Consortium for Emergency Contraception and Sarah Rich is Senior Program Officer at Women’s Refugee Commission. This post originally appeared on the blog for the Sexual Violence Research Initiative

Emergency contraception (EC) can reduce the risk of pregnancy after unprotected sex, including in cases of sexual violence. Global guidance is clear that EC should be offered to women and girls within 120 hours of sexual violence to prevent the traumatic consequences of pregnancy resulting from rape.

Yet women and girls who have experienced unprotected sex, including through sexual violence, do not routinely have access to EC. The global aid communities must work together to increase access to EC for sexual violence survivors around the world, including for women and girls who are the most marginalized, like those living in crisis-affected settings. A range of strategies can be implemented to improve access to EC. Further research is also needed to identify, evaluate, and invest in new and innovative solutions. Continue reading “Emergency contraception is a simple part of post-rape care: Why is it not routinely provided?”

Webinar presentation – Misoprostol for PPH: Innovations for Impact

On December 15, MSH, Gynuity Health Projects and Jhpiego hosted a one-hour webinar to share innovations – interventions, technologies, and distribution approaches – that have the potential to increase access to and use of misoprostol for postpartum hemorrhage (PPH), the leading cause of maternal death. This webinar:

  • Highlighted innovative ways that countries are expanding access to and use of misoprostol for PPH
  • Showed how successful innovations can be scaled up for national impact

PRESENTERS
Esther Azasi
Knowledge Management Specialist & Associate Program Manager, One Million Community Health Workers Campaign-Millennium Promise, Ghana

Holly Anger
Program Associate, Gynuity Health Projects, USA

Gail Webber
Saving Mothers Project, Mara Region, Tanzania and University of Ottawa, Canada

Partamin Manalai
Monitoring, Evaluation and Research Director, Jhpiego, Afghanistan

MODERATOR
Shafia Rashid
Senior Technical Advisor, FCI Program of Management Sciences for Health (MSH)

Listen to the webinar and download the presentation slides here.

Misoprostol for postpartum hemorrhage: Empowering health workers to save lives

Shafia Rashid is a Senior Technical Advisor for the FCI Program of Management Sciences for Health.

In Senegal, approximately 1,800 women lose their lives every year while giving birth. The major cause of these deaths is uncontrolled bleeding after childbirth, or postpartum hemorrhage (PPH). More than half of Senegalese women live in rural areas and have limited access to well-equipped health facilities that can prevent or treat many of these deaths. Many women give birth, attended by matrones or volunteer birth attendants, in maternity huts. Recognized as essential health care providers by their communities, matrones have some formal training and are now registered with the Ministry of Health (MoH).

To effectively prevent or treat PPH, women need access to uterus-contracting drugs, or uterotonics, such as oxytocin or misoprostol. The recommended uterotonic, injectable oxytocin, requires cold storage and technical skill to administer. Misoprostol is a safe and effective alternative where oxytocin isn’t available or feasible; it doesn’t need refrigeration and is easy to use—particularly important features for use in remote, rural areas.

From 2013 to 2014, the Government of Senegal’s Direction of Reproductive Health and Child Survival, in partnership with USAID and Gynuity Health Projects, examined the use of misoprostol (600 mcg oral) or oxytocin (10 UI) via Uniject® for prevention of PPH at the community level. Matrones were trained to assist with deliveries and administer the designated intervention. According to the study, both misoprostol and oxytocin in Uniject® were equally effective and safe in preventing PPH, and matrones  posted at the health huts were capable of administering the medicine they were assigned. Continue reading “Misoprostol for postpartum hemorrhage: Empowering health workers to save lives”

Advocacy success story: Kenya approves misoprostol for PPH

Melissa Wanda Kirowo is advocacy project officer for FCI Program of Management Sciences for Health in Kenya. 

This blog post provides an update to an earlier post.

The Kenya Constitution states that every person has the right to the highest attainable standard of health, including reproductive health. To realize this right, every person must have access to high-quality, life-saving medicines.

Photo credit: Mark Tuschman
Photo credit: Mark Tuschman

Recently, the government achieved great strides toward making this right to health a reality for its citizens. For the first time, the Kenya Essential Medicines List 2016 (KEML) included misoprostol in the oxytocics section, indicating its use for the prevention and treatment of postpartum hemorrhage (PPH), excessive bleeding after childbirth and a leading cause of maternal death. Misoprostol is stable at room temperature, available in pill form, and inexpensive. Because of these advantages and the drug’s wide availability, misoprostol may be a woman’s only chance for surviving PPH in settings with limited infrastructure and a shortage of skilled birth attendants–like many parts of Kenya. Continue reading “Advocacy success story: Kenya approves misoprostol for PPH”