Emergency contraception in Argentina: Grey areas of common sense and public policy

Abstract

This paper discusses specific obstacles to emergency contraception (EC) in Argentina, the ‘grey areas’ between contraception and abortion: potential users as well as health providers do not distinguish clearly between ordinary contraception, EC and abortion. Based on quantitative and qualitative findings, the study shows the need to intervene in providing the population and the health sector with information on EC, its mechanisms and accessibility, and the ‘grey areas’ that hinder an adequate distinction between regular contraception, EC and abortion.

Keywords:

• contraception
• post-coital contraception
• health services accessibility
• reproductive rights
• abortion

Acknowledgements

This research was funded by a Carrillo-Oñativia (Estudios Colaborativos Multicéntricos) from the Argentine Ministry of Health and the United Nations Population Fund. We thank Mark Padilla's comments on a previous version of this text. Previous reports and articles based on this research have been published in Spanish.

Notes

1. In Argentina, recent estimations placed the number of abortions between 372,000 and 522,000 a year (Pantelides and Mario 2006).

2. Barriers to access also exist in many countries. As a result, EC use has not yet reduced the rates of unwanted pregnancies or abortions (Polis et al. 2007, Trussell and Raymond 2008).

3. EC, mistakenly known as ‘the morning-after pill’, is reserved for cases of true emergency: rape, unprotected sex, accidental or incorrect utilisation of regular contraceptives (von Hertzen et al. 2002, WHO 2007). Emergency hormonal contraceptives are simply different doses of the birth-control pills that have been used for decades. Products contain a progestin, levonorgestrel, and should be administered in the first five days after vaginal sexual intercourse. Several products, with different components and purposes, are sometimes mistakenly considered EC: Dosdías, Misoprostol and RU-486. Dosdías: with a similar composition to that of commonly used contraceptives, Dosdías is used to diagnose secondary amenorrhoea, ruling out pregnancy. Misoprostol: Sold under the name Oxaprost in Argentina, Misoprostol prevents gastric ulcers. It is widely used as an abortifacient. This last is off label use – Mifepristone or RU-486: an antiprogesterone used to terminate pregnancy within early weeks of gestation, is prohibited and not sold in Argentina.

4. Each year in Argentina, around 100 women die from complications due to unsafe abortions. These complications are the leading cause of maternal mortality. In 2006, the maternal mortality rate was 4.8 per 10,000 live births; 28% of those deaths were due to abortion-related complications (Ministry of Health 2007). In 2005, there were 68,869 hospitalisations due to abortions in public health institutions (Ministry of Health 2006).

5. The Penal Code criminalises abortion with some exceptions: in case of danger for the life or health of the pregnant woman; and when the pregnancy results from a rape, and from a rape ‘committed to a woman legally declared insane or mentally retarded’.

6. The percentage who mentioned EC would be somewhat higher if we include those who responded ‘taking a pregnancy test and then the morning-after pill’, that is 7.4% of the subset.

7. Health professionals are often reluctant to prescribe EC. Some professionals fear that EC may end up replacing the use of regular contraception. When inquiring about whether they consider EC to be ‘more convenient than using contraception every day’, a large percentage of our sample disagreed (72%). It would be worthwhile to examine to what extent these ‘solutions’ of last resort (including the use of Misoprostol) are actually prevailing over preventive practices, especially within the less educated. However, our data indicate that beliefs about EC do not suggest that EC might compete with regular contraceptive use (also see: Polis et al. 2007, Trussell and Raymond 2008).

8. Answers of 0.8% were ‘inconsistent’ with their knowledge of EC, with the result that questions on this topic were answered by 65.0% of the sample and others by 64.2%.

9. From the point of view of professionals (Andía et al. 2008), obstacles are connected to the lack of EC awareness and its shortage of supply, as well as a shortage of qualified human resources. Besides, EC is difficult to find off hours (gynaecology departments usually see patients in the morning and gynaecologists at primary healthcare clinics do not attend it every day) while EC is not widely available in Emergency Rooms.