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Consensus Statement on
Emergency Contraception
Twenty-four experts from around the world,
representing the fields of research, policy, may need these methods occasionally. Millions communications, women’s advocacy and of unwanted pregnancies could be averted if medicine, gathered at the Rockefeller emergency contraceptives were widely Foundation Conference in Bellagio, Italy, in April 1995 to discuss emergency contraception. The conference was hosted by South-to-South Existing regimens are usually inexpensive, Cooperation in Reproductive Health and co- often consist simply of altered doses of widely sponsored by the International Planned available medications and have been used for Parenthood Federation, Family Health decades in some countries. So why are International, the Population Council and the World Health Organization. The Conference widely? We believe that there are three main was supported by the Rockefeller Foundation. hurdles to making the option of emergency contraception available to all women who Key words: post-coital contraceptives, prevention of unwanted pregnancy, First, women and providers are uninformed antiprogesterone. about the methods. Particularly because of the short time frame within which women must use Background
emergency contraception following unprotected Emergency contraceptives are methods that women can use after intercourse to prevent methods before they need them. We call upon pregnancy. 1, 2 Emergency contraceptives are family providers to educate themselves about sometimes called post-coital or morning-after the methods and to educate women at routine contraceptives. Several methods of emergency visits. We encourage the prophylactic provision contraception are safe and effective. These of emergency contraception so that women can estradiol/levonorgestrel oral contraceptive given twice, 12 hours apart, and the insertion of Second, there are few products marketed for a copper intrauterine device (IUD). These emergency contraceptive use. Most methods regimens avert approximately 75 to 99% of the involve use of medications marketed for routine pregnancies expected among women seeking contraception. We call upon regulatory agencies treatment.3 Levonorgestrel alone may also be throughout the world to require manufacturers of appropriate combined oral contraceptives mifepristone, is currently under study to and copper IUDs to inform the public about the pharmaceutical industry should cooperate to produce and publicize complete, accurate Participants: Marge Berer (UK), Elsimar Coutinho (Brazil), Grace Delano (Nigéria), Charlotte Ellertson (USA), Josue Garza-Flores (México), Ana Glasier (UK), Forrest Greenslade (USA), Helena providers about the emergency use of suitable von Hertzen (Switzerland), Carlos Huezo (UK), Indira Kapoor (UK), Evert Ketting (The Netherlands), O. A. Ladipo (Brazil), Joanne Lewis (USA), Florence Manguyu (Kenia), J. K. G. Mati (Kenia), Elizabeth Robinson (USA), James Shelton (USA), Third, service providers are too often reluctant Sheldon Segal (USA), Pramilla Senanayake (UK), Florence Tadlar to provide this method. In case there is any (The Philippines), Paul van Look (Switzerland), Ninuk misunderstanding, emergency contraceptives Widyantoro (Indonesia), Beverly Winikoff (USA), and Xiao Billan (China). are not abortifacient. Emergency contraceptives Name and address for correspondence: Professor Elsimar M. Coutinho, President, South-to-South Cooperation in Reproductive Health, Rua Caetano Moura 35, Federação 40210, Savador, Bahia, Brazil. Tel: (55 71) 235-3442; Fax: (55 71) 247-8216. these safe and effective ways to prevent Submitted for publication May 26 , 1995 unwanted pregnancy. We must make access to Proposed Recommendations
family planning method but are concerned that the method may have failed or have not used that method one or more times, and women who may currently not be part of the family should be effective, safe, convenient to use and planning client base, such as adolescents and easily accessible. Among the methods now single women. Each group should be considered available, ethinyl-estradiol/dl-norgestrel combination oral contraceptives and the copper 8. In order to prevent pregnancy following intrauterine device (IUD) best meet these acts of sexual violence and coercion, emergency contraception should also be available from recommend additional research, however, to other sources of support, such as sexually improve these methods and to develop new ones transmitted disease clinics, rape crisis centers, responsive to women’s needs. When developing contraceptive products, researchers should should be included in the curricula of all products may have for emergency contraceptive medical and non-medical personnel who will be involved in health care delivery. Training should include counseling as well as method-specific service requirements, including treatment emergency use. Anti-progestogens deserve top regimens, management of side effects and 10. Women seeking emergency contraception should also be counseled and offered a choice of 3. Inter-governmental agencies, governments effective and reliable methods of contraception and non-governmental organizations (NGOs) for regular use in addition to receiving an should ensure that emergency contraceptives appropriate emergency contraceptive. When the are included in all family planning programs and on all national essential drug lists. counseling and/or service provision, clients 4. Drug regulatory authorities should require should be referred to an appropriate service explicit description of emergency use in the labeling of ethinyl-estradiol/dl-norgestrel oral 11. In all family planning consultations, women choosing a method of contraception for 5. Advocacy and information/ education / appropriate backup (e.g., barrier methods, communication (IEC) activities should be periodic abstinence) should be informed about developed collaboratively and should foster community and policy support among women’s emergency contraceptives for future use. groups, professional associations, health advocates, policymakers, non-governmental appropriate for distribution through many organizations, donors and community leaders. channels, including clinics, over-the-country in Potential users of emergency contraception pharmacies, and community-based programs. require information on the methods before they Any provider trained in IUD insertion can need them. Therefore, IEC efforts should be broad-based, culturally sensitive and locally 6. IEC strategies should consider groups with 14. Data should be collected on emergency contraceptive use. Questions about emergency contraception should appear in national surveys Service Delivery, Monitoring, Service Evaluation 7. Emergency contraception should be made demographic/health surveys, as well as in available to all women who seek it, provided no country- or program-based situations analyses. contraindications are present. Women should emergency contraceptive methods. Providers participants and do not necessarily reflect the should think broadly about women for whom views of the cosponsoring organizations of the including women who are not currently using a References
1. Fasoli M, Parazzini F, Cecchetti G, La Vecchia C. Postcoital contraception. Contraception 1989; 39:459-68. 2. Trussel J, Stewart F. The effectiveness of post-coital hormonal contraception. Fam Plann Perspect 1992; 24:262-4. emergency contraception. Fertility Control Reviews 1995; in press. randomized comparison of levonorgestrel with the Yuspe regimen in post-coital contraception. Hum Reprod 1993;8:389-92. 5. Glasier A, Thong KJ, Dewar M, Mackie M, Baird DT. Mifepristone (RU486) compared with high-dose estrogen and progestogen for emergency postcoital contraception. New Engl J Med 1992;327:1041-4. Comparison of Yuspe regimen, danazol and mifepristone (RU 486) in oral postcoital contraception. Br Med J 1992;305:927-31.

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