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British Journal of Family Planning. 2000 Apr; 26(2):67-8.This editorial comments on the superior efficacy of levonorgestrel as an emergency contraceptive. A comparative trial between levonorgestrel and the Yuzpe regimen conducted by the WHO indicated that levonorgestrel has a pregnancy rate one-third that of the comparison group. The result, however, has been questioned in several accounts. First, the Yuzpe regimen did not appear to perform particularly well in the trial, which might have influenced the comparison. Second, the method used to measure the true efficacy of emergency contraception, or proportion of pregnancies prevented, has limitations. Nevertheless, an interesting result of the WHO trial was the correlation between interval to treatment and pregnancy rate, where the shorter the coitus-to-treatment interval, the lower the pregnancy rate. With levonorgestrel, rates of unwanted pregnancies are expected to decrease. However, there are obstacles to the wholesale switch to levonorgestrel; namely, cost, difficulty in distribution relating to its new drug status, and resistance to change. The speed with which levonorgestrel has been introduced in the UK following a high quality randomized trial is impressive. However, the implementation of research findings remains a challenge. The use of levonorgestrel for emergency contraception may be an appropriate service standard for family planning in the future.
GUTTMACHER REPORT ON PUBLIC POLICY. 1999 Jun; 2(3):12-3.In addition to food, clothing, and shelter, the hundreds of thousands of refugees fleeing Kosovo need primary health care services, including reproductive health care. The United Nations Population Fund (UNFPA) estimates that of a population of 350,000 refugees in Albania, 35,000 are women in need of prenatal or postnatal care. According to UNFPA, 7 babies were born in 1 refugee camp alone in one 24-hour period, and there are widespread reports of the systematic rape of ethnic Albanian women as they flee. In response, UNFPA announced in early April that it is coordinating the delivery of emergency reproductive health kits to Albanian refugee camps. Each kit contains clean delivery supplies, emergency contraceptive pills (ECP) for women who have been raped, counseling information for post-rape trauma, supplies to treat the complications of unsafe abortion, and condoms, IUDs, and other contraceptive methods. UNFPA expects to send enough supplies to care for the refugees for up to 6 months, with most supplies aimed at providing safe deliveries. The Vatican immediately condemned UNFPA's distribution of ECPs. Whether the US will renew its funding of UNFPA is pending before Congress.
British Journal of Family Planning. 1998 Oct; 24(3):93.On June 11, 1998, Jenny Tonge, a former family planning doctor, tabled a motion in the House of Commons urging the House to recognize the efficacy and safety of hormonal emergency contraception (EC), and to consider pharmacy prescription to increase its availability in the UK. Dr. Tonge was supported by Members of Parliament from all parties. At the same time, the booklet "Twenty Questions about Emergency Contraception Answered" was launched. The Birth Control Trust hopes that it will serve the current debate on emergency contraception. At the booklet's launch, a panel of experts presented views and answered questions from the press and interested parties. Roger Odd, head of practice at the Royal Pharmaceutical Society (RPS), noted that pharmacists are asked weekly for EC on weekends, often from distraught people looking for sympathetic, friendly assistance. Most pharmacists feel they could supply or sell EC according to approved guidelines. Such guidelines should be put together by the RPS and other professional bodies with the cooperation of the Department of Health. There should be no provision for referral if appropriate and no conclusion to supply by an individual pharmacist if he or she objected. Pharmacists would be covered by their own code of ethics. Practical considerations of increasing the availability of EC were noted by the managing director of Schering Healthcare, the distributor of PC4, the only UK-licensed EC product. The chief executive of the Family Planning Association (FPA) described how many men and women of all ages called the FPA national hotline for EC, while an International Planned Parenthood Federation representative described experience with EC in Pakistan and Sri Lanka. The Emergency Contraception Pilot Project in Washington, US, is noted.