EMERGENCY CONTRACEPTION OVER THE COUNTER

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EMERGENCY CONTRACEPTION OVER THE COUNTER

• E. Aubeny
• French Association for Contraception
• Paris - France

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EMERGENCY CONTRACEPTION OVER THE
COUNTERClarification about the designation

• Emergency contraception over the counter actually
  means
• you help yourself without asking anybody.
• It is the case only in Sweden and Norway

• . It would be more precise to say
• Emergency contraception without medical
  prescription
• i.e. no medical prescription needed but you have
  to ask the chemist to get the drug
• But usually we speak of  E.C.over the counter 

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Emergency contraception over the counter

• Nowadays,
• two hormonal methods are available

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Emergency contraception over the counter
Efficacy of the method

• WHO trials have shown emergency contraception is
  more effective when taken very quicklyafter
  unprotected intercourse.

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Emergency contraception over the counter

• A doctors prescription

• Delays the use of medication because of the
  waiting time for an appointment.

• Prevents women to use E.C.
• Women find this process too complicated because
  it is preventing an hypothetical pregnancy.

A doctors physical or gynaecological exam is
useless for EC.
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Emergency contraception over the counter
The Yuzpe method has one contra-indication thr
ombo-embolic antecedents Before its use, medical
or paramedical staffmust review the patients
medical history
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Emergency contraception over the counter

• Levonorgestrel is very efficient used as
  emergency contraception (WHO trials)
• 0.75 mg taken orally twice at 12 hours interval

Levonorgestrel has no contra-indications
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Emergency contraception over the counter

• June 1999, France has allowed levonorgestrel in
  emergency contraception over the counter.
• A law was pasted to confirm this decision in
  December 1999

This makes its use easier and quicker as
pharmacies are widespread and open day and night
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EMERGENCY CONTRACEPTION OVER THE COUNTERResults

• Women used EC more than 2 000 000 times
• - In France
• More than 1 000 000 have used it since June 1999
• Now 70 000 women used it each month

- In others countries sales are growing
regularly
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EMERGENCY CONTRACEPTION OVER THE COUNTERResults

• Women use EC in a proper way (focus groups)
• as emergency contraception not as a regular
  contraception

• In France
• contraceptive pills sales keep on rising
• Majority of women are satisfied to be in charge
  of their contraception

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EMERGENCY CONTRACEPTION OVER THE
COUNTERResults
No increase of ectopic pregnancies
No medical publication about complication
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Emergency contraception over the counter
Actually

• The authorisation
• to dispense levonorgestrelE.C.over the counter
  is
• a success story

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EMERGENCY CONTRACEPTION OVER THE COUNTER

• Beneficial consequences in France

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Emergency contraception over the counter
Beneficial consequences in France

• Involvement of new health professionals in
  contraception
• 1-1 Pharmacists (focus group 2002)

At the beginning, some ? Felt that they had
inadequate information about the drug ? Had
ethical issues with the drug ? Felt that it was
too much responsibility
Now, this decision is well accepted.
The majority is very pleased to have this
responsibility and to be included in the
contraception development
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Emergency contraception over the counter
Beneficial consequences in France

• Involvement of new health professionals in
  contraception
• 1- 2 High school nurses
• They are authorised to issue levonorgestrel EC
• free to their students in (December 1999 law)

• They also start discussions
• between them and their students
• on contraception and on any sexual problems

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Emergency contraception over the counter
Beneficial consequences in France
2) Recognition of teenagers sexuality
Levonorgestrel EC delivered by high school nurses
and freely in pharmacies for minors

• Pro-life associations challenged the decree
• Public opinion in France supported this practice
  (63 in favour)
• The decision was legalized by a law (December
  2000)
• This opened the discussion about teenage
  sexuality and contraception
• This recognition is the best way
• to prevent abortion and STD

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Emergency contraception over the counter
Beneficial consequences in France

• Renewed interest in contraception particularly
  regarding non compliance with regular
• contraception

• 2 national campaigns in favour of contraception

• Study on contraception failure and non compliance

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EMERGENCY CONTRACEPTION OVER THE COUNTER
Beneficial consequences in France

• 4) Liberalisation of regulation of contraceptive
  drugs

• July 2001 law
• Any new contraceptive drug with no known medical
  contra-indications will be sold without medical
  prescription
• before this all contraceptive drugs needed a
  medical prescription

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EMERGENCY CONTRACEPTION OVER THE
COUNTERConclusion

• Levonorgestrel EC without medical prescription or
  over the counter is safe

• Women use it properly and not as a regular
  contraception

• It opens discussion about contraception
  acceptability

• It permits acknowledgement of and discussion
  about teenagers contraception and sexuality

• E.C contraception over the counter
• changes attitudes of professionals and women
• boosts interest in contraception