Emergency contraception: The reproductive health innovation everyone should know about

By Elizabeth Westley and Monica Kerrigan

Elizabeth Westley leads the International Consortium for Emergency Contraception. Monica Kerrigan is a global leader in family planning and previously served at the Bill & Melinda Gates Foundation and as a senior adviser to Family Planning 2020.

This article originally appeared on Devex.

Unintended pregnancies take a harrowing toll on women, young people, families and nations. When women are unable to decide whether and when to have children, maternal and newborn deaths rise, educational and economic opportunities are lost, families, communities and countries suffer greatly.

Global data highlights the tremendous challenge we face: 213 million pregnancies occur annually and an astonishing 40 percent — about 85 million — of these are unintended. In the United States alone, there are approximately 3 million unintended pregnancies each year, and in India, a staggering 18 million. A woman’s ability to make informed decisions about her reproductive health is one of the most basic human rights. It is a decision that can determine what kind of future she will have — and whether she will have one at all.

Emergency contraception is a unique tool for women to space and time their pregnancies. It is grossly underutilized, underfunded, and not fully optimized globally. It is the only contraceptive method that can be taken after unprotected sex and is effective for several days to prevent pregnancy. It is especially needed by women who have been sexually assaulted, who are often desperate to avoid becoming pregnant by their rapist. Continue reading “Emergency contraception: The reproductive health innovation everyone should know about”

A script-writer walks into a pharmacy…

By Melissa Garcia and Elizabeth Westley

Melissa Garcia is senior technical officer and Elizabeth Westley is the director of the International Consortium for Emergency Contraception (ICEC), hosted by Management Sciences for Health.

“What happened when you went to the pharmacy and asked for emergency contraception?” Melissa surveyed a room full of television and radio writers attending a workshop in the Democratic Republic of the Congo (DRC). The participants looked around, waiting for someone to speak up first.

“The pharmacist gave me a look, so I had to show him my PMC badge to prove I was there for research, not for myself!” said a woman from Population Media Center, an organization that produces educational soap operas to improve the health and well-being of people around the world. Writers in Nigeria had similar stories to tell. An older man in flowing traditional robes confessed “I walked up and down the street three times before I summoned the courage to enter the store.” A young family planning (FP) advocate joined the media training in Senegal, and wearing her hijab, reported that the pharmacist demanded to know who the pill was meant for.

Melissa visits actors and writers on the set of C'est la vie in Senegal.
Melissa visits actors and writers on the set of C’est la vie in Senegal.

Continue reading “A script-writer walks into a pharmacy…”

Misoprostol for postpartum hemorrhage: Closing the gap between knowledge and action

By Shafia Rashid and JoAnn Paradis

Shafia Rashid is Senior Technical Advisor for the FCI Program of Management Sciences for Health and JoAnn Paradis is Strategic Communications Advisor for African Strategies for Health.

In many countries around the world, women give birth at home, often with only a family member or traditional birth attendant by their side. For these women, and for those giving birth in a health facility without reliable electricity, refrigeration, and/or IV therapy, misoprostol may be the best option for preventing and treating postpartum hemorrhage (PPH), one of the leading causes of maternal death globally.

A pregnant girl at Kigali District Hospital, Kigali, Rwanda. (Photo Credit: Todd Shapera)
Photo: Todd Shapera

Despite a global consensus on misoprostol’s safety and effectiveness for PPH prevention, few countries have closed the gap between knowledge and action–taking the steps to ensure that misoprostol is available to women where they are and when they most need it. Only a handful of countries have adopted evidence-based national policies and clinical guidelines that support the use of misoprostol for PPH, and even fewer have scaled these policies into national programs. Continue reading “Misoprostol for postpartum hemorrhage: Closing the gap between knowledge and action”

Preventing pregnancy after sexual assault: Do women and girls have access to emergency contraception?

Sarah Rich is Senior Technical Advisor at the International Consortium for Emergency Contraception, hosted by Management Sciences for Health.

Mapingure was raped and sought EC at a hospital. The provider told her that she needed a police report. But by the time she came back… she was told it was too late to assist her. She became pregnant as a result of the rape.

–Zimbabwe case from 2014, presented by Godfrey Dalitso Kangaude in “Country overviews of legal grounds/policies related to health, rape, and safe abortion,” April 2016

Emergency contraception (EC) can prevent pregnancy after unprotected sex, including in cases of rape. Global guidance on EC access for sexual assault survivors is clear: EC should be offered to women and girls within 120 hours of the assault to prevent the traumatic consequences of pregnancy resulting from rape. The World Health Organization’s (WHO) clinical and policy guidelines for sexual assault and clinical handbook  include strong recommendations to provide EC as part of comprehensive, woman-centered care. Continue reading “Preventing pregnancy after sexual assault: Do women and girls have access to emergency contraception?”

EML Search: New resource for reproductive and maternal health advocates

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

In June 2013, Imtiaz Kamal–a crusader for midwifery and women’s health–celebrated Pakistan’s official recognition of the essential maternal health medicine, misoprostol, which has proven easy to administer, safe and effective for preventing and treating excessive postpartum bleeding. “Given the high prevalence of home births,” Imtiaz explained, “we need to invest in solutions, such as misoprostol, that save lives now, until we can achieve the long-term goals of strengthening health systems and increasing rates of facility births.” Continue reading “EML Search: New resource for reproductive and maternal health advocates”

Misoprostol For Postpartum Hemorrhage – A Life-Saving Technology for Maternal Health

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

Available since the 1980s, the medicine misoprostol was initially marketed to prevent stomach ulcers. Health professionals eventually discovered that misoprostol also stimulates contractions of the uterus, making it useful for a number of maternal and reproductive health conditions, including postpartum hemorrhage (PPH), induction of labor, treatment of miscarriage, and induced abortion (alone or in combination with mifepristone). Misoprostol is stable at room temperature, available in pill form, and inexpensive. Because of these advantages and misoprostol’s wide availability in many countries, health providers began using misoprostol off-label—in a way not specified on its registration—with differing regimens and routes of administration, and in the absence of evidence-based clinical guidelines. Continue reading “Misoprostol For Postpartum Hemorrhage – A Life-Saving Technology for Maternal Health”

New research calls for a different approach for misoprostol for postpartum hemorrhage

Shafia Rashid is senior program officer for the Global Advocacy program at Family Care International.

Postpartum hemorrhage (PPH)—excessive, uncontrolled bleeding during or after childbirth—is the leading cause of maternal death around the world.  Despite this, the condition is almost entirely preventable and treatable. In some parts of the world, women give birth at home or in health facilities lacking the essential supplies and equipment to manage PPH and other life-threatening complications.

Wherever a woman decides to give birth, she needs access to life-saving, uterus-contracting drugs, called uterotonics, for the prevention and treatment of PPH. The recommended uterotonic, injectable oxytocin, requires cold storage and technical skill to administer, making it difficult or impossible to use in many rural and low-resource areas. Misoprostol is a safe and effective uterotonic and a good alternative in community settings since it doesn’t require refrigeration or administration by a professional.

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Continue reading “New research calls for a different approach for misoprostol for postpartum hemorrhage”

Misoprostol for treatment of postpartum hemorrhage added to WHO Essential Medicines List

Shafia Rashid is senior program officer for Global Advocacy at Family Care International.

For more than five years, FCI has been working with Gynuity Health Projects and other partners to build the evidence base for expanded availability and use of misoprostol for the prevention and treatment of postpartum hemorrhage (PPH). PPH is the leading cause of maternal death, and misoprostol is a safe, effective medicine that is especially practical in low-resource settings, because it is available as a tablet and does not require refrigeration or injection.

This week marked an important milestone in global efforts to make misoprostol available to the women who need it, as the World Health Organization (WHO) approved its inclusion on the Model List of Essential Medicines (EML) for the treatment of PPH. Misoprostol was included on the EML for prevention of PPH in 2011, and the recent decision signifies WHO’s full endorsement of misoprostol as an essential maternal health medicine in settings where oxytocin — which requires cold storage and intravenous injection — is not available or cannot be used safely. The WHO Expert Committee for the Selection and Use of Essential Medicines, a panel that meets every two years to update the EML, recommended that misoprostol be listed for the additional indication of treating PPH[1] and retained on the list for prevention of PPH. Continue reading “Misoprostol for treatment of postpartum hemorrhage added to WHO Essential Medicines List”