Emergency contraception and voluntary abortion in Italy over the years
ESC Congress Library. Arisi E. 05/10/18; 208175; ESC274 Disclosure(s): I was a consultant for HRA Italy and Bayer.
Dr. Emilio Arisi
Dr. Emilio Arisi
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Objective(s): In Italy  Levonorgestrel (LNG) and Ulipristal Acetate (UPA) are both available as Emergency Contraception (EC).  We want to evaluate the evolution of EC and Voluntary Abortion (VA) over the years. The subjects: LNG is a progestin that, at a single dose of 1.5 mg, manages to move forward or cancel ovulation, but only until the first days of the fertile window, after which it is ineffective. It has no effects on a pregnancy  in progress.  In Italy it has been available  since 2000, at the dose of 0.750 mg, and since 2006 at the dose of 1.5 mg. Since 2015 it was sold without prescription, and the pregnancy test was abolished. UPA 30 mg is a selective progesterone receptor modulator, active until after 5 days from risk-related sexual intercourse. Marketed in France, Great Britain and Germany on October 1, 2009. Marketed in Italy in 2012, with prescription requirement, and preliminary pregnancy test. From 9 May 2015  there are no more these requirements. The pregnancy test has been abolished for all ages, but the recipe remains for minors. VA is decreasing from 234.000 in 2008 to less than 90.000 in 2015. Meanwhile EC has increased from 380.000 in 2008 to 390.000 in 2015 (and 490.000  in 2016, we do not have VA data for 2016 yet).  Particularly for UPA 30 mg the sales increased from 7˙796 in 2012,  to 11˙915 in 2013, 16˙796 in 2014 and  83˙346 in 2015. Obviously the merit of reducing VA is not just EC; the components of this change should also be sought elsewhere. But a certain amount of merit is surely due to the EC and especially to UPA which is more effective than LNG and has become the market leader. In fact, the Minister of Health in his report to the parliament in December 2016 said: 'The greater decrease in VA observed in 2015, especially between the second and third quarter, could be at least partially connected with the April 21, 2015 decision of AIFA, which eliminates the necessity of a prescription for UPA  for adults".   Conclusions : Since UPA has been marketed in Italy as EC, UPA is increasingly chosen by women and health workers, and is gradually replacing LNG because it is clinically more effective, and for this reason is preferred by women and professionals.  EC also certainly contributes to the reduction of VA in Italy.
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