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PLoS One. 2014 Oct 6;9(10):e109315. doi: 10.1371/journal.pone.0109315. eCollection 2014.

Improving access to emergency contraception pills through strengthening service delivery and demand generation: a systematic review of current evidence in low and middle-income countries.

Author information

World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, Sydney (UTS), Sydney, New South Wales, Australia.
School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.
International Consortium for Emergency Contraception, New York, New York, United States of America.
RMNCH and HSS Technical Advice & Partnerships Department, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Vernier-Geneva, Switzerland.
Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.



Emergency 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.


A 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.


Ten 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.


There 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.

[Indexed for MEDLINE]
Free PMC Article

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