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  • Title: Expanding access to emergency contraception in developing countries.
    Author: Ellertson C, Winikoff B, Armstrong E, Camp S, Senanayake P.
    Journal: Stud Fam Plann; 1995; 26(5):251-63. PubMed ID: 8571440.
    Abstract:
    Emergency contraception has been called the best-kept contraceptive secret. Previous research shows that several regimens of postcoital contraception offer safe and effective ways for women to avoid pregnancy. Yet the methods are typically unavailable to women in developing countries. In this article, the authors review the main methods of emergency contraception and describe experience with them to date. The prevalence and urgency of the need for making these methods available to women in developing countries are assessed. The necessary elements for creating such access are described. In several developing countries, conditions for introducing the methods may be more favorable than in industrialized countries. These advantages are reviewed. Finally, the authors describe the challenges anticipated for broadening the availability of postcoital methods in the developing world. They conclude with a brief series of recommendations for policymakers. In the order of the amount of research available on each, five regimens of emergency contraception are reviewed: 1) the estrogen/progestin combination of ethinyl estradiol and levonorgestrel, known as the Yuzpe regimen; 2) the copper IUD; 3) levonorgestrel-only regimens; 4) danazol, a synthetic steroid; and 5) mifepristone, also known as RU-486, a progesterone antagonist that appears to work well as a postcoital contraceptive. The Yuzpe regimen was discovered more than 20 years ago, and it consists of 200 mcg of ethinyl estradiol and 1.0 mg of levonorgestrel taken 12 hours apart and initiated within 72 hours of unprotected intercourse. In the late 1970s, Lippes discovered that copper-bearing IUDs could prevent pregnancy when inserted within 5 days after intercourse. This method may even be effective for up to 7 or 10 days postcoitally. Studies have confirmed that the IUD method had a failure rate of less than 0.1%. The levonorgestrel regimen requires the taking of 1.5 mg levonorgestrel divided into two doses 12 hours apart and initiated within 48 hours of unprotected intercourse. Tablets containing 0.75 mg of levonorgestrel are marketed for infrequent intercourse to be taken immediately after intercourse. Postinor, marketed by Gedeon Richter of Hungary, is registered in eastern European countries and some developing countries. The synthetic steroid danazol produces fewer side effects than the Yuzpe regimen. 600 mg of danazol has to be taken within 72 hours after unprotected intercourse and another 600 mg taken 12 hours later. The RU-486 regimen consists of a single 600 mg dose postcoitally within 72 hours of unprotected intercourse. A variety of other regimens, including ethinyl estradiol, conjugated estrogens, diethylstilbestrol, and quingestanol acetate have also been studied for use as postcoital contraceptives. The prevalence of need in developing countries depends on conditions for use and potential users. The urgency of need (unintended pregnancies, social conditions, age, and cost), expanding access, challenges to expansion, and some recommendations are also discussed.
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