STRATEGIES USED TO ENHANCE STRATEGIES USED TO ENHANCE ACCEPTABILITY OF ACCEPTABILITY OF

EMERGENCY CONTRACEPTION (EC)EMERGENCY CONTRACEPTION (EC)

Medard M. Lech Medard M. Lech MD, PhD, FPCOG, DPHMD, PhD, FPCOG, DPH

School of Public HealthSchool of Public HealthNational Postgrad. Center of Medical EducationNational Postgrad. Center of Medical Education

Warsaw, Poland.Warsaw, Poland.

BUDAPEST 13th September 2003BUDAPEST 13th September 2003

Abortion rates (for 1000 live births) Abortion rates (for 1000 live births) in selected Europen countriesin selected Europen countries

Czech RepublicCzech Republic -- 410 410 (Year 1999)(Year 1999)

HungaryHungary -- 782782 (Year 1997)(Year 1997)

LithuaniaLithuania -- 518518 (Year 1999)(Year 1999)

PolandPoland -- ? ? RussiaRussia - 1860- 1860 (Year 1997)(Year 1997)

Source: Source: www.who.intwww.who.int

Hormonal Emergency Contraception (EC)

The easy way of distribution,

Simple method of dosage,

Low cost,

High effectiveness.

REASONS for the use of EC are obvious.REASONS for the use of EC are obvious.

MYTHS - Social/Medical restrains from EC MYTHS - Social/Medical restrains from EC

use are more than dubious use are more than dubious Low effectiveness, huge unwanted effects, Low effectiveness, huge unwanted effects,

act as the „early abortion – pills”, act as the „early abortion – pills”,

complications in farther pregnancies sterility/infertility etccomplications in farther pregnancies sterility/infertility etc

EC BARRIERS

Lack of awareness,

Difficult access (in most of the European countries)

Not complete understanding of the mode of action,

Ethics/religious opposition.

Why not?Why not? Awareness Awareness

Taboo (!)

Ambivalent attitude of policy makers,

Lack of sexual education,

Failure of sexual education,

Poor social marketing of EC

Why not? Why not? Difficult access Difficult access

Patients have to know the EC methods,Patients have to know the EC methods,

Patients have to find urgently* the prescriber,Patients have to find urgently* the prescriber,

Patients have to obtain easily the EC product.Patients have to obtain easily the EC product.

*/ time constraints

Why not?Why not? MODE OF ACTION ? MODE OF ACTION ?

Effects on the migration and function of

spermatozoa,

Effects on the ovulatory process,

D o u b t f u l lD o u b t f u l l effects on the endometrium*

*/ Croxattio H.B. Emergency Contraception pills: how do they work?

IPPF Med.. Bull, 2002;36(6):1-2.

Products registered for EC are available all over Europe

LNG 0.75 Postinor Postinor Duo Levonelle Rigesoft Norlevo

EC products approved as an OTC only in France, Sweden, Norway, UK, Portugal, Belgium, Denmark, Switzerland and Finland, (Romania?)

LNG 0.25+EE 0.05 Tetragynon Fertilan

Strategies used to enhance EC useStrategies used to enhance EC use

What to do? Target group

TO INFORM General public, especially adolescent (THE ROLE OF INTERNET!!)

TO EXPLAIN General public, medical/social staff, teachers

TO REGISTER AND PROVIDE EC products as OTC

Policy makers

ESC next step ??ESC next step ??

The ESC Seminar (?)/Special Session(?)The ESC Seminar (?)/Special Session(?)

„„From Biology to Emergency Contraception”From Biology to Emergency Contraception”