Revitalizing the Emergency Contraception Agenda

Understanding providers’ and opinion leaders’ attitudes and beliefs related to emergency contraception will help inform strategies to improve access.

The Issue

Emergency contraception (EC) is a highly effective option for women who wish to prevent pregnancy after sexual intercourse. While EC is legally available in more than 150 countries, it is not always accessible to women when they need it. In this project, the Population Council examined the critical barriers to EC in India, Nigeria, and Senegal to inform an advocacy agenda for greater access in these countries and elsewhere.

Women’s access to EC is influenced by a number of factors, including government policy, provider and policymaker knowledge, the quality of service-delivery systems, and prescription requirements. The Population Council sought to understand the role of providers’ and key opinion leaders’ attitudes, beliefs, and practices concerning EC in settings where government policy and prescription requirements were already favorable.

The Progress

The Council conducted a cross-sectional, descriptive study in urban areas of India, Nigeria, and Senegal—all countries where EC is officially incorporated in public-sector family planning programs and legally available without a prescription, but in practice is often not offered or not available.

  • In each country, researchers conducted a national survey of healthcare providers who provide EC to measure their attitudes toward EC, levels of knowledge and training, and their provision packages.
  • Researchers also conducted in-depth interviews with key opinion leaders from the public and private sectors to understand policy, program, service delivery, and civil society positions on access to EC.

Across the three countries, a number of key themes emerged:

  • Many providers have incomplete knowledge of how EC works, when to use it, and its effectiveness.
  • Across and within countries, there is wide variation in levels of training on EC offered to different types of providers.
  • Both providers and opinion leaders have mixed opinions concerning the provision of EC to particular populations (e.g., young unmarried women) and in certain contexts.
  • Providers and opinion leaders generally oppose “advance provision” of EC, believing it will cause women to abandon other forms of contraception and “over-use” EC.
  • Similarly, most providers oppose “repeat use” or “regular use” of EC, although there is wide variation in how they define these terms, ranging from two or three times per menstrual cycle to one or two times per year.

The Impact

Understanding decisionmakers’ perspectives on EC can help frame education and advocacy campaigns to improve women’s access to this important contraceptive option. Upon completion of the research, the Council organized Days of Dialogue in India, Nigeria, and Senegal to discuss the research findings with participants. These dialogues yielded broad consensus on a number of policy and service-delivery needs, which will become the basis for an EC advocacy agenda among policymakers and providers to reduce barriers to access.

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