Abstract
ObjectivesEmergency contraception pills (ECP) are among the 13 essential commodities in the framework for action established by the UN Commission on Life-Saving Commodities for Women and Children. Despite having been on the market for nearly 20 years, a number of barriers still limit women's access to ECP in low- and middle-income countries (LMIC) including limited consumer knowledge and poor availability. This paper reports the results of a review to synthesise the current evidence on service delivery strategies to improve access to ECP.MethodsA narrative synthesis methodology was used to examine peer reviewed research literature (2003 to 2013) from diverse methodological traditions to provide critical insights into strategies to improve access from a service delivery perspective. The studies were appraised using established scoring systems and the findings of included papers thematically analysed and patterns mapped across all findings using concept mapping.FindingsTen papers were included in the review. Despite limited research of adequate quality, promising strategies to improve access were identified including: advance provision of ECP; task shifting and sharing; intersectoral collaboration for sexual assault; m-health for information provision; and scale up through national family planning programs.ConclusionThere are a number of gaps in the research concerning service delivery and ECP in LMIC. These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP.
Highlights
Universal access to sexual and reproductive health and rights is an essential component of a healthy society
There are a number of gaps in the research concerning service delivery and Emergency Contraceptive Pills (ECP) in low and middle income countries (LMIC)
These include a lack of knowledge concerning private/commercial sector contributions to improving access, the needs of vulnerable groups of women, approaches to enhancing intersectoral collaboration, evidence for social marketing models and investment cases for ECP
Summary
Universal access to sexual and reproductive health and rights is an essential component of a healthy society. There are 222 million women in the world who wish to prevent pregnancy but are not using effective, modern methods of contraception. This results in an estimated 86 million unplanned pregnancies, 33 million unplanned births [1] and 20 million unsafe abortions every year [2]. In addition there are nearly 15 million births to adolescent women aged 15–19 each year, over 90% are in low and middle income countries (LMIC) [3]. Strengthening service delivery and demand generation are key strategies to achieving universal access to sexual and reproductive health (SRH), including access to Emergency Contraceptive Pills (ECP). Despite having been on the market for close to 20 years, a number of barriers still limit women’s access to ECP [8] in low- and middleincome countries (LMIC), including limited consumer knowledge, social marketing efforts, and inclusion in national family planning programs [9]
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