|Emergency Contraceptive Pills (WHO - OMS, 1998, 44 p.)|
The safety and effectiveness of the emergency contraceptive pill (ECP) formulations described in this packet have been well documented in the scientific literature over the past 20 years. In addition, the methods have been proven safe in widespread use; there have been no reported deaths or serious complications involving ECPs in over two decades of use.
The references listed below include clinical studies of the methods; comprehensive review articles on issues of safety and effectiveness; and statements made in support of ECPs by respected health service delivery organizations, including the International Planned Parenthood Federation. Although the majority of ECP research to date has been on the estrogen-progestin regimen (Yuzpe regimen) and the now much less used high-dose estrogen regimen, the progestin-only regimen also has been widely studied and is approved for use as a regular post-coital method in over 20 countries worldwide. Research is ongoing by the World Health Organization, the Population Council, and others to gather additional clinical data on estrogen-progestin and progestin-only ECP regimens as well as on new compounds for emergency contraception.
The World Health Organizations Special Programme of Research, Development and Research Training in Human Reproduction (WHO/HRP) is establishing a comprehensive database of scientific publications about emergency contraception. This database will be accessible through the Consortium World Wide Web site (http://www.path.org/ecconsor/).
Bellagio Conference on Emergency Contraception. Consensus statement on emergency contraception. Contraception 52:211-213, 1995.
Bracken MB. Oral contraceptives and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstetrics and Gynecology 76:552-557, 1990.
Canzler E, Ahrendt H-J, Arendt S. Erfahrungen mit Levonorgestrel zur postkoitalen Kontrazeption. Zeitblatt für Gynäkologie 106:1182-1191, 1984.
Cardy GC. Outcome of pregnancies after failed hormonal postcoital contraception: an interim report. British Journal of Family Planning 21:112-115, 1995.
Farkas M, Apró G, Sas M. Clinico-pharmacological examination of Postinor (0.75 mg d-norgestrel). Therapia Hungarica 29:22-30, 1981.
Fasoli M, Parazzini F, Cecchetti G, La Vecchia C. Post-coital contraception: an overview of published studies. Contraception 39(4):459-468 and 39(6):699-700,1989.
Hatcher RA, Trussell J, Stewart F, Howells S, Russell CR, Kowal D. Emergency Contraception: The Nations Best Kept Secret. Decatur, GA: Bridging the Gap Communications, 1995.
Ho PC, Kwan MSW. A prospective randomized comparison of levonorgestrel with the Yuzpe regimen in post-coital contraception. Human Reproduction 8:389-392,1993.
Hoffmann KOK. Postcoital contraception: experiences with ethinyloestradiol/norgestrel and levonorgestrel alone. In Harrison RF, Bonnar J, Thompson W (eds), Fertility and Sterility, MTP Press Limited, Lancaster, UK, pp. 311-316,1984.
IPPF. Medical and service delivery guidelines for family planning. Draft, 1996.
IPPF. Statement on emergency contraception. IPPF Medical Bulletin 28(6): 1-4, 1994.
Kesserü E, Larrañaga, A, Parada J. Postcoital contraception with D-norgestrel. Contraception 7(5):367-379, 1973.
Lewin, T. U.S. to advance use of the pill: oral contraceptives are called safe for the morning after. New York Times, July 1,1996.
Pathfinder International. Emergency Contraceptive Pills (ECPs): Service Delivery Guidelines. Draft, February 1996.
Rinehart, W. Postcoital contraception: an appraisal. Population Reports, Series J, Number 9. Washington, D.C., The George Washington University Medical Center, Population Information Program, January 1976.
Seregély G. Results of a multicentre trial of Postinor. Therapia Hungarica 30(2):72-78,1982.
Simpson JL. Mutagenicity and teratogenicity of injectable and implantable progestins: probable lack of effect. In Zatuchni GI, Goldsmith A, Shelton JD, Sciarra JJ (eds), Long-Acting Contraceptive Delivery Systems, Harper & Row, Publishers, Inc., Philadelphia, p. 334-361,1983.
Task Force on Post-Ovulatory Methods for Fertility Regulation. Postcoital contraception with levonorgestrel during the peri-ovulatory phase of the menstrual cycle. Contraception 36(3):275-286,1987.
Trussell J, Ellertson C. Efficacy of emergency contraception. Fertility Control Reviews 4(2): 8-11, 1995.
Trussell J, Ellertson C, Rodriguez G. The Yuzpe regimen of emergency contraception: How long after the morning after? Obstetrics and Gynecology 88(1):150-154, 1996.
Trussell J, Ellertson C, Stewart F. The effectiveness of the Yuzpe regimen of postcoital contraception. Family Planning Perspectives 28(2):58-64, 87, 1996.
Van Look PFA, von Hertzen H. Emergency contraception. British Medical Bulletin 49(1):158-170,1993.
Webb A. How safe is the Yuzpe method of emergency contraception? Fertility Control Reviews 4(2):16-18, 1995.
Webb A, Taberner D. Clotting factors after emergency contraception. Advances in Contraception 9:75-82,1993.
World Health Organization. Improving Access to Quality Care in Family Planning. Medical Eligibility Criteria for Contraceptive Use, 1996.
World Health Organization. Levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception: a randomized controlled trial. WHO Task Force on Post-Ovulatory Methods of Fertility Regulation (submitted for publication, 1998).
Yuzpe A, Lancee W. Ethinylestradiol and dl-norgestrel as a postcoital contraceptive. Fertility and Sterility 28(9):932-936, 1977.
Yuzpe A, Percival-Smith RKL, Rademaker AW. A multicenter clinical investigation employing ethinylestradiol combined with dl-norgestrel as a postcoital contraceptive agent. Fertility and Sterility 37(4):508-513, 1982.
For additional information about Consortium activities, contact any of the member organizations listed here.
The Concept Foundation*
37 Soi Petchburi 15
Bangkok 10400 THAILAND
Tel: 662 255 5516
Fax: 662 255 2578
Attn: Ms. Lynn Hill
International Planned Parenthood
Inner Circle Regents Park
NW1 4NS UNITED KINGDOM
Tel: 44 171 487 7864
Fax: 44 171 487 7865
Attn: Dr. Pramilla Senanayake
Pacific Institute for Womens Health*
Western Consortium for Public Health
2999 Overland Avenue, Suite 111
Los Angeles, CA 90064 USA
Tel: 310 842 6828
Fax: 310 280 0600
Attn: Dr. Francine Coeytaux
Nine Galen Street, Suite 217
Watertown, MA 02172 USA
Tel: 617 924 7200
Fax: 617 924 3833
Attn: Ms. Carol Wall
The Population Council*
One Dag Hammarskjold Plaza
New York, NY 10017 USA
Tel: 212 339 0500
Fax: 212 755 6052
Attn: Ms. Charlotte Ellertson
Population Services International
1120 Nineteenth Street, N.W., Suite 600
Washington, D.C. 20036 USA
Tel: 202 785 0072
Fax: 202 785 0120
Attn: Ms. Elizabeth Gardiner
Program for Appropriate Technology in Health (PATH)*
4 Nickerson Street
Seattle, WA 98109 USA
Tel: 206 285 3500
Fax: 206 285 6619
Attn: Ms. Elisa Wells
World Health Organization*
Special Programme of Research,
Development and Research Training in Human Reproduction
1221 Geneva 27 SWITZERLAND
Tel: 41 22 791 3307
Fax: 41 22 791 4171
Attn: Dr. Paul Van Look
Emergency contraceptives occupy a uniquely important position in the range of family planning options currently available. They are the only methods couples can use to prevent pregnancy after they have had unprotected sexual intercourse or a contraceptive accident. By making emergency contraception more widely available, family planning and reproductive health care providers can help reduce unplanned pregnancies, many of which result in unsafe abortion and take a large toll on womens health. Emergency contraception also is an essential part of treatment for women who are victims of sexual assault.
Eight organizations working in the field of reproductive health have joined forces to form the Consortium for Emergency Contraception. The Consortium is committed to making emergency contraceptive pills - a widely studied form of emergency contraception - a standard part of reproductive health care around the world. The member organizations are:
· The Concept Foundation (Bangkok)*;
· International Planned Parenthood Federation (London)*;
· Pacific Institute for Womens Health (Los Angeles)*;
· Pathfinder International (Boston)*;
· Population Council (New York)*;
· Population Services International (Washington, D.C.);
· Program for Appropriate Technology in Health (Seattle)*;
· WHO Special Programme of Research, Development and Research Training in Human Reproduction (Geneva)*.
* founding members
International Planned Parenthood Federation
Pacific Institute for Womens Health
Population Services International
Program for Appropriate Technology in Health
WHO Special Programme of Research, Development and Research Training in Human Reproduction
The Consortium is working in collaboration with the pharmaceutical industry to improve worldwide access to specially packaged pills for emergency contraception. These products can make emergency contraception easier to provide and use in many settings. Meanwhile, however, a variety of oral contraceptives currently available in every country could be used more widely for emergency contraception, with a relatively small investment in public education and in-service training for health care providers.
The enclosed prototype materials, variously designed for family planning clients, health care providers, programme managers, national policy-makers, community groups, and the media, represent a collaborative effort by the Consortiums nine member organizations to provide colleagues internationally with some of the basic materials they might need to expand the availability of information and services for emergency contraception.
Because the Consortium recognizes that client and programme needs differ from place to place, the materials in this packet are designed for local adaptation and use by yourself and your colleagues. Suggestions for adapting the materials based on local needs are included in the packet. All of the materials have been extensively reviewed by leading international authorities on emergency contraception - including the prestigious IPPF International Medical Advisory Panel and WHO - and reflect the most up-to-date studies available on the method.
We hope you will find our prototype materials of assistance in your efforts to initiate or expand emergency contraception services. These materials can be freely reproduced, translated, and adapted to meet local needs. Because we are interested in how these materials are being used, we would like to receive copies of any locally adapted materials. We also welcome comments on how we might further improve the package. Please feel free to contact any of the partner organizations with suggestions.
Our very best wishes for your every success.
The Consortium for Emergency Contraception