ICEC - Emergency Contraception in National Essential Medicines Lists 2016

Publication date: 2016

June 2016 1 World Health Organization. “National Medicines List/Formulary/Standard Treatment Guidelines.” Web site: www.who.int/selection_medicines/country_lists/en/index.html. Emergency Contraception in National Essential Medicines Lists _________________________________________________________________________________________________________ Emergency Contraceptive Pills (ECPs) are an essential component of women’s reproductive health. They offer women an important second chance to prevent pregnancy when a regular method fails, no method was used, or sex was forced. Research over the past 30 years has shown that ECPs are safe and effective. The most recent (April 2015) World Health Organization’s Essential Medicines List (EML) includes one form of ECP, containing levonorgestrel (LNG) as an active ingredient. While other drugs can be used for EC, only the LNG form is listed by the WHO at this time. The WHO list includes two regimen options for LNG ECPs: two tablets of 0.75 milligrams, or one tablet of 1.5 milligrams (mg). (These may also be written as 750 micrograms and 1500 micrograms (µg).) Either regimen can be used; although the two-pill regimen is labeled for the pills to be taken 12 hours apart, the current recommendation is for both pills to be taken together as a single 1.5 mg dose. A new drug used for emergency contraception, called ulipristal acetate (UPA), is included in one country’s EML but is not included in the WHO EML at this time. A number of countries have shared their national EMLs on the WHO website1; others have been shared via personal correspondence. Those that include ECPs are listed below, with the year of publication; two countries specify a different method of EC, based on taking a higher dose of regular oral contraceptives (called the “Yuzpe” regimen). The countries whose EMLs are available but do not include EC are also listed. However, the fact that a country does not include EC in its EMLs does not mean there is no product registered or on the market. For those countries with no EC listed in its EML, we have listed whether or not EC is available locally. Of the 118 countries with available EMLs, 62 countries are known to list ECPs: 6 include only the 1.5 mg dose 38 include only the 0.75 mg dose 12 include both the 1.5 and 0.75 mg doses 5 include LNG but do not specify the dose 1 includes UPA EC 2 include the Yuzpe regimen (high dose of regular oral contraceptives as EC) 56 countries do not include ECPs. Of these, 7 do not include any contraceptives 6 National EMLs are known to include only the 1.5 mg LNG ECP regimen: Brazil: 2010 Cook Islands: 2007 Ghana: 2010 Peru: 2010 Sweden: 2011 Tunisia: 2008 38 National EMLs are known to include only the 0.75 mg LNG ECP regimen: Algeria: 2007 Armenia: 2010 Bhutan: 2012 Bolivia: 2011-2013 Burkina Faso: 2014 Cape Verde: 2009 Chile: 2005 Dem. Rep. of Congo: 2010 Dominican Republic: 2005 Ethiopia: 2015 Fiji: 2006 Gabon: Year unknown Georgia: 2007 Haiti: 2012 Iran: 2009 Jamaica: 2008 Kenya: 2010 Kyrgyzstan: 2009 Malawi: 2015 Mali: 2008 Mexico: 2009 Nauru: 2010 Nicaragua: 2009 Niue: 2006 Paraguay: 2009 Rwanda: 2010 Senegal: 2008 Seychelles: 2010 Solomon Islands: 2010 South Africa: 2008 June 2016 1 World Health Organization. “National Medicines List/Formulary/Standard Treatment Guidelines.” Web site: www.who.int/selection_medicines/country_lists/en/index.html. Sri Lanka: 2009 Sudan: 2007 Suriname: 2014 Thailand: 2008 Tuvalu: 2008 Uganda: 2012 Zambia: 2013 Zimbabwe: 2011 12 National EMLs are known to include both the 1.5 and 0.75 mg LNG ECP regimens: Cameroon: 2009 Colombia: 2011 Congo: 2013 Ecuador: 2011 Laos: Year unknown Moldova: 2009 Myanmar: 2010 Nepal: 2009 Pakistan: 2007 Russia: Year unknown St. Vincent & the Grenadines: 2010 Tajikistan: 2009 5 National EMLs are known to include LNG ECPs without specifying indication or dose: Belize: 2009-2011 Central African Rep.: 2009 China: 2007 Syria: 2008 Ukraine: 2009 2 National EMLs are known to include the Yuzpe regimen (high dose of regular oral contraceptives as EC): Tanzania: 2013 Zimbabwe 2011 1 National EML is known to include UPA ECPs: Sweden: 2011 56 National EMLs are known NOT to include ECPs: Afghanistan: 2007 Angola: 2008 (no contraceptives in EML; no EC product registered, but allows for import with license) Argentina: 2005 (EC product registered) Bahrain: 2009 Bangladesh: 2008 (EC product registered) Barbados: 2011-2012 (EC product registered) Botswana: 2012 (EC product registered) Bulgaria: 2009 (EC product registered) Burundi: 2012 (no EC product registered, but allows for import with license) Cambodia: 2003 (EC product registered) Chad: 2007 (no EC product registered, but allows for import with license) Cote d’Ivoire: Year unknown (EC product registered) Croatia: 2010 (EC product registered) Djibouti: 2007 (EC product registered) Egypt: 2006 (EC product registered) El Salvador: 2009 (EC product registered) Eritrea: 2010 Guinea-Conakry: 2013 (EC product registered) Guyana: 2009-2010 Honduras: 2009-2011 India: 2011 (no contraceptives in EML, but EC product registered) Indonesia: 2008 (Listed as removed since 2005 edition) (EC product registered) Iraq: 2010 Jordan: 2009 Kiribati: 2009 Lesotho: 2005 (no contraceptives in EML, but EC product registered) Macedonia: 2010 (no contraceptives in EML, but EC product registered) Madagascar: 2008 (EC product registered) Malaysia: 2008 (EC product registered) Maldives: 2009 Malta: 2008 Marshall Islands: 2007 (no contraceptives in EML) Mauritania: 2007 (EC product registered) Montenegro: 2011 (EC product registered) Morocco: 2008 (no contraceptives in EML, but EC product registered) Namibia: 2008 (EC product registered) Nigeria: 2010 (EC product registered) June 2016 1 World Health Organization. “National Medicines List/Formulary/Standard Treatment Guidelines.” Web site: www.who.int/selection_medicines/country_lists/en/index.html. North Korea: 1999, list for international agencies (no contraceptives) Oman: 2009 Palau: 2006 Papua New Guinea: 2002 Philippines: 2008 Poland: 2009 (EC product registered) Serbia: 2010 (EC product registered) Slovakia: 2010 (EC product registered) Slovenia: 2010 (EC product registered) Somalia: 2006 (no contraceptives in EML) Timor Leste: 2004 Togo: 2012 (EC product registered) Tonga: 2007 Trinidad and Tobago: 2010 (EC product registered) Uruguay: 2011 (EC product registered) Vanuatu: 2007 Venezuela: 2004 (EC product registered) Vietnam: 2008 (EC product registered) Yemen: 2007 (EC product registered) A note on methodology: ICEC downloaded all the available EMLs from the WHO website in October 2015 and used the “find” function to search for the following key words: levonorgestrel, ulipristal acetate, norgestrel, contraception, and emergency contraception.

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