The World Health Organization released its 2015 updated essential medicines list and for the first time included the progesterone contraceptive vaginal ring (CVR), a contraceptive safe and effective for lactating women in the postpartum period.
The progesterone CVR, developed by the Population Council, is an intravaginal ring that provides women who breastfeed at least four times a day with a contraceptive option as early as four weeks after giving birth. It can be used for up to a year for improved birth spacing.
'More than 220 million women in the developing world want to prevent pregnancy but are not using modern contraception. Vaginal rings like the progesterone CVR represent an important advance in contraceptive development. The inclusion of the progesterone CVR on the WHO's essential medicines list will provide a new option to address unmet need among new mothers, allow women to safely space their pregnancies, and improve the health of women and children -- in Senegal and around the world,' said Dr. Bocar Mamadou Daff, director of the Reproductive Health and Child Survival Unit for Senegal's Ministry of Health and Social Action.
The WHO and UNICEF recommend that women breastfeed exclusively for the first six months after birth and continue breastfeeding up to two years of age. However, the percentage of women who breastfeed exclusively varies greatly by culture, economic context, and time since giving birth. And once a woman stops breastfeeding exclusively or resumes regular menstruation, she is at risk of pregnancy before she may be ready to have another child. Short intervals between births can put a mother, her baby, and its siblings at risk of health complications and death.
'The Population Council applauds the World Health Organization for its recognition of the progesterone vaginal ring,' said Régine Sitruk-Ware, Population Council distinguished scientist. 'Inclusion of the progesterone CVR on the essential medicines list is good news for women. It is an important step in making the ring more widely available to the 70 percent of women in the first postpartum year who want to breastfeed for a long time and do not want to get pregnant but are not using contraception.'
The WHO has also added guidance to its medical eligibility criteria to ensure that providers understand the method and how to counsel patients on it as a contraceptive option. This is important because when providers are familiar with a method, they are more likely to provide it as an option to their clients.
The progesterone CVR works by releasing a continuous low dose of the natural hormone progesterone, which reinforces the contraceptive effect of breastfeeding. Clinical trials have demonstrated that the ring is 98.5 percent effective in preventing pregnancy when used correctly, is safe for mother and baby, and does not affect a woman's ability to produce breast milk, unlike estrogen-containing oral contraceptives.
Women can begin using the ring as early as four weeks after giving birth. Once she receives an initial examination and orientation to the method by a healthcare provider, a woman can insert and remove the ring by herself, reducing the need for frequent visits to her provider. The ring does not require refrigeration or special storage conditions, an advantage in countries that do not have a strong health system infrastructure. Each ring can be used continuously for three months, and the method can be used for up to a year as long as the woman continues to breastfeed at least four times a day. Fertility returns shortly after a woman stops using the ring.
The three-month progesterone CVR is approved for use in eight Latin American countries: Bolivia, Chile, Dominican Republic, Ecuador, El Salvador, Guatemala, Panama, and Peru. Although not yet approved for use in other countries, efforts are underway to determine the feasibility and likely impact of introducing the ring in Kenya, Nigeria, and Senegal, and results are expected soon from a clinical study of the ring required for registration of the progesterone CVR in India.
The WHO established the essential medicines list to satisfy priority health care needs. Medicines are selected for their public health relevance, efficacy, safety, and comparative cost-effectiveness. They are intended to be available within health systems at all times in adequate amounts, appropriate doses, with assured quality and adequate information on their use, and at a price that individuals and communities can afford. The WHO's essential medicines list is considered a model to help guide the development of national and institutional essential medicine lists.