Introducing Emergency Contraceptive Services: Communications Strategies and the Role of Women's Health Advocates. (COMMENTS).

Emergency contraception refers to the prevention of pregnancy through use of contraceptive methods after unprotected intercourse. Contraceptives that can be used for emergencies include the IUD and a variety of hormonal methods. Although emergency contraception was first used in the 1960s, it is a largely unknown method: A review of the scientific literature shows a widespread lack of knowledge among both providers and women about emergency contraceptive methods, how to use them, and where to obtain services.(1)

The fact that emergency contraception remains so little used or understood can be traced to a myriad of factors: legal and regulatory obstacles, cultural influences that discourage its provision and use, service delivery obstacles and, above all, lack of knowledge. Research suggests that if emergency contraception were well known and generally available, many women who experience unprotected intercourse would use it rather than resort to abortion.(2) In developing countries, where many thousands of women experience unwanted pregnancies and an estimated 70,000 to 200,000 women die each year from complications related to clandestine abortions performed in unsafe conditions,(3) emergency contraception could save many lives by preventing unplanned pregnancies.

The purpose of this article is to suggest ways in which emergency contraception can be responsibly and safely introduced into established health services and to discuss the role of women's health advocacy groups and communications efforts in this process. No single path to the introduction of emergency contraception will prove acceptable or relevant in all settings. Nevertheless, numerous issues and questions should be addressed by all countries and programs seeking to improve women's access to emergency contraception.

Given the widespread lack of knowledge and availability of emergency contraception, how does one go about crafting strategies to introduce it into public or private health service delivery programs? What assessments, introductory research, consensus-building steps, and communication and training programs must be undertaken? Who are likely to be the actors in this introduction effort, and what roles should they play? Which audiences are the most important, and what messages should they be given?

Key Issues

Characteristics of Emergency Methods

Use of emergency contraception is different from planned use of contraceptive methods in several important ways: