Emergency contraception: lessons from latin america and the caribbean for asia and africa

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Introduction and Expansion of

Emergency Contraception

Lessons from Latin America and the Caribbean

for a Global Guidance Tool

Prepared by
Araceli Fernández and Ricardo Vernon

November, 2007

Introduction and Expansion of 1
Emergency Contraception 1
Lessons from Latin America and the Caribbean 1
for a Global Guidance Tool 1
1. Introduction 4
1.1. Brief overview of thecurrent situation 4
1.2. Objectives 6
2. Data Sources and Review Methods 8
2.1. Peer reviewed and published literature 8
2.3. Program and institutional documents 9
2.4. Available program guidelines and guidance tools 10
3. EC in Latin America: A decade of lessons learned 11
3.1. Enabling environment: Situation regarding the normative framework and socio-political environment forintroduction and expansion 11
3.2. Articulating the supply: provider knowledge, attitudes and capacity to promote and offer EC to potential users 12
3.3. Consolidating demand 13
3.4. Remaining Challenges 14
4. Existing Implementation Materials: Training Manuals, and Working Tools and Comprehensive Kits 17
4.1 Training materials developed by the Population Council 17
4.2 Program PlanningTools 19
4.3 Conclusions drawn from materials reviewed 34
Recommended Outline for a new Guidance Tool for Project Planning and Implementation ¡Error! Marcador no definido.
5. Recommendations for the development of a new global guidance tool 35
5.1 Regulatory policy framework 35
5.2 Supply-side considerations 36
5.3 Demand creation and marketing of ECP and services 36
5.4Suggested Guidance-tool outline 37
Appendix A. Electronic Material library 40
Apendix B. Country Case Summaries 41
B.1 Argentina: moving fast at last…before the opposition gathers 41
B.2 Bolivia: Low-key progress with a supportive government 42
B.3 Brazil: Avant-garde policy and slow market maturation 43
A.4 Chile: Political change, social pressure and scientific proof 46
B.5 Colombia:Experience pays 48
B.6 Ecuador 49
B.7 Honduras: sustained progress with limited resources 50
B.7 Mexico: A delayed but explosive demand 53
B.8 Paraguay: Large alliances in a small country 55
A.9 Peru: is unstable democracy a risk to reproductive rights? 56
B.10 Venezuela: Limited public services and strong social marketing 56
B.11 Rest of Central America 58
B.12 CaribbeanIslands 59
References 61

1. Introduction

1.1. Brief overview of the current situation

Emergency contraception (EC) is a safe and effective contraceptive method that can be used to prevent pregnancy after unprotected coitus. Given its potential to reduce unwanted pregnancies—and thereby abortions—it is especially important in contexts where pregnancy termination is legally restricted andwhere there is high morbidity and mortality linked to unsafe abortions. For these reasons, widespread access to EC is considered of critical importance for the protection of women’s reproductive health and rights in Latin America and the Caribbean (LAC). In addition, given the high prevalence of hormonal contraceptive use in the region, introduction of the method was expected to be relativelystraightforward.

However, its introduction has been hampered by conservative political environments and vocal opposition by religious groups. Despite this fact, significant progress has been made in the last decade. The largely successful introduction of EC in LAC, has been achieved through the collaborative efforts of national and international reproductive health organizations active in the region.There has been progress in the establishment of an enabling regulatory framework and the registration of Levonorgestrel-only products as dedicated emergency contraceptive pills (ECP). Figure 1 shows the situation in the Latinamerican region regarding which countries have approved and registered ECP products and have relevant regulation in place.

The efforts to date have contributed to...