Mahatma Gandhi Institute of Medical Sciences

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By: LohanP (117 month(s) ago)

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Emergency Contraceptives: Enhancing Access & Use : 

1 Emergency Contraceptives: Enhancing Access & Use 2nd Annual Forum of MCH Community Mahatma Gandhi Institute of Medical Sciences Sewagram, Maharashtra 9-10 February 2007

Presentation Outline : 

2 Presentation Outline RCH2 Programme Goal/Strategies NFHS findings Emergency Contraception: methods, indications and use Programmatic Evidences Action Agenda Conclusions

RCH 2 Programme Goals: Reduction in TFR : 

3 RCH 2 Programme Goals: Reduction in TFR Reduce Unmet Need for limiting and spacing Enhance Access Expand Contraceptive Choices Focus on Quality Assurance Method specific Counseling and Respect client choices

Focus on Contraception : 

4 Focus on Contraception Reproductive Rights Help couples/individuals to attaining their reproductive intentions Reduce unwanted /untimed pregnancies and thus impact maternal mortality and morbidity Closely spaced children: High childhood morbidity/mortality Reproductive Health is central to achieving MDGs

National Family Health Survey (NFHS 3) : 

5 National Family Health Survey (NFHS 3)

Unmet Need for Family Planning [Total] : 

6 Unmet Need for Family Planning [Total]

Unmet Need for Family Planning [For Limiting] : 

7 Unmet Need for Family Planning [For Limiting]

Unmet Need for Family Planning [For Spacing] : 

8 Unmet Need for Family Planning [For Spacing]

Emergency Contraception: Method,Indication and use : 

9 Emergency Contraception: Method,Indication and use

Emergency Contraceptive Pills(ECPs) : 

10 Emergency Contraceptive Pills(ECPs) Emergency contraception: It is method of contraception that is used before missing a period to prevent pregnancy. It is also called ‘morning after” or postcoital contraception.

Indications for using emergency contraception : 

11 Indications for using emergency contraception A woman who had an unprotected sex, and she wants to prevent pregnancy: She did not expect to have sex and was not using any contraception Sex was forced Contraceptive Accidents: A condom broke or slipped, dis lodged Failed Coitus interreptus Complete or partial expulsion of IUDs Missed OCPs Mid cycle IUD removal She ran out of contraceptives, She is late for a contraceptive injection – more than 2 weeks late for DMPA

Types of Ecs: : 

12 Types of Ecs: Progestin-only dedicated products Combined oral contraceptives: Yuzpes regime Combined progestin-estrogen dedicated product Anti –Progestogene Mifepristone IUDs

Slide 13: 

13 The Government of India guidelines for Emergency Contraception recommends use of Levonorgestrel (progestogen only) LNG 0.75 mg as a “dedicated product” for effective emergency contraception.The Drug Controller of India has approved only Levonorgestrel for use as ECP.

Slide 14: 

14 This method has been found to be highly effective and has only mild and less frequent side effects compared to other combinations/regimen. In order to simplify LNG regimen, a single dose of LNG 1.5 mg was tried in a WHO multicentric randomized trial. It has been found that a single dose of LNG 1.5 mg is as effective as 2 doses given 12 hours apart upto 120 hours of exposure.

Need for EC In India : 

15 Need for EC In India High Incidence of unwanted pregnancy Unsafe abortions with complications and maternal deaths Lack of correct and consistent use of condoms. Increasing use of condoms for dual protection

How effective are ECPs? : 

16 How effective are ECPs? Among 100 women, if each has sex once in the second or third week of the menstrual cycle without using contraception, 8 women are likely to become pregnant. If all 100 women use progestin-only ECPs, only one is likely to become pregnant. If all 100 women use combined oral contraceptives for emergency contraception, only 2 women are likely to become pregnant.

How do ECPs work? : 

17 How do ECPs work? The probable mechanisms are depending on time of menstrual cycle Inhibition or delay of ovulation Thickening of cervical mucous Direct inhibition of fertilization Histological and biochemical alteration in endometrium leading to impaired endometrial receptivity to implantation of the fertilized egg Alteration in transport of egg, sperm and embryo Interference with corpus luteum function and luteolysis

Medical eligibility criteria for Emergency Oral Contraception : 

18 Medical eligibility criteria for Emergency Oral Contraception Any woman can use emergency oral contraception if she is not already pregnant. There are no absolute contra indications

When should ECPs be taken? : 

19 When should ECPs be taken? The ECPs should be taken as soon as possible after unprotected intercourse. The first dose should be taken within 72 hours after intercourse However new studies suggest effectiveness even in 120 hours.

Explaining how to use Emergency Oral Contraception : 

20 Explaining how to use Emergency Oral Contraception Ask carefully questions to determine likelihood of pregnancy. If she is currently pregnant, do not provide Emergency Oral Contraceptives. Explain Emergency Oral Contraception, its side effects, and effectiveness. Provide the pills for Emergency Oral Contraception Advance provision may work in certain circumstances

Specific reasons to return to the healthcare provider : 

21 Specific reasons to return to the healthcare provider Advise her to return or see another health care provider if her next period is quite different from usual for her, especially if it is: Unusually light bleeding (possibly pregnancy) Does not start within 4 weeks (Possible pregnancy) Unusually painful (possibly ectopic pregnancy). But emergency oral contraception does not cause ectopic pregnancy.) Describe the symptoms of sexually transmitted diseases—for example, unusual vaginal discharge, pain or burning on urination. Advise her to see a health care provider if any of these symptoms occurs.

Some facts about ECPs : 

22 Some facts about ECPs ECPs will not disrupt an established pregnancy No medical conditions rule out ECPs. ECPs do not provide continuing protection from pregnancy. ECPs offer no protection against STIs. No protection in the rest of cycle Can be used any time during the cycle

Providing ECPs: Counselling : 

23 Providing ECPs: Counselling Help the client feel at ease. Let her know that you understand her needs. You will not judge her behaviour, and you will keep her visit confidential. Ask when unprotected sex took place. ECPs should be started as soon as possible within 72 hours after unprotected intercourse. Give the woman pills. Explain how to take them and point to the pills as you explain. She can take first dose at once.

Providing ECPs: counselling : 

24 Providing ECPs: counselling Tell her that, if she vomits within 2 hours of taking pills, she may take another dose either by mouth or vaginally. Explain and discuss important points about ECPs side effects Discuss woman’s ongoing need for contraception

Increasing access to ECPs : 

25 Increasing access to ECPs Educate women and providers about ECPs Make access to ECPs easy Train a range of providers Remove unnecessary medical barriers to access Offer ECPs over the counter

Programmatic Experience : 

26 Programmatic Experience Introduced in 2003 Guidelines developed and distributed Very poor knowledge amongst providers and clients Lately states are asking for supplies OTC approval of the product Likely to be introduced in ASHA kits

Action Agenda for community practitioners : 

27 Action Agenda for community practitioners Increase awareness about the product: Action projects on the reaching out with knowledge on the EC with SHGs/adolescents Work with providers: Address knowledge, attitude and practices of providers in health systems Enhance access for product; how, non traditional outlets?? EC help line ??

Action Agenda : 

28 Action Agenda Demonstrate impact of enhanced availability on Reducing unsafe abortions Establish as how this will help in empowerment of women to reduce burden of unwanted pregnancies Other suggestions??

Conclusions : 

29 Conclusions EC has a legitimate place in the programme EC has a potential for preventing unwanted pregnancies and also unsafe abortions Knowledge levels still remain low: both amongst providers and people in need of contraception Action projects can generate models for effective programming.

THANKS : 

30 THANKS Dr. Dinesh Agarwal National Programme Officer Reproductive Health & HIV/AIDSUNFPA, India agarwal@unfpa.org

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