Access denied: Political, regulatory, and institutional barriers to emergency contraception access in Palestine

Introduction: In the Arab world, dedicated emergency contraceptive pills (ECPs) have been registered in Algeria, Egypt, Lebanon, Libya, Tunisia, Yemen, as well as Israel, and thus, theoretically, Palestine. The aim of our study is to better understand the political, institutional, and regulatory factors influencing the status and availability of emergency contraception (EC) in Palestine (defined as East Jerusalem, the West Bank, and the Gaza Strip). Methods: Our situation analysis is informed by a review of regulatory and policy documents, in-depth interviews with government, United Nations Relief Works Agency (UNRWA), and NGO representatives, and discussions with clinicians and pharmacists in East Jerusalem and the West Bank. Results: ECPs are not incorporated into the UNRWA health system and thus not available to refugees. While Postinor-2 is available in Israel and parts of East Jerusalem, dedicated ECPs are not available in the West Bank or Gaza. Thus Palestinian women without a Jerusalem identity card or Israeli work permit are unable to access ECPs. Although oral contraceptive pills are widely available in Palestine, few clinicians or pharmacists are aware of their potential for postcoital use. Conclusion: The worsening political situation, frequent curfews, restrictions on movement, and sexual violence contribute to high rates of unintended pregnancy among Palestinian women. Refugee and unmarried women are particularly vulnerable and EC has the potential to make a significant contribution to reproductive health in Palestine. Our study points to several avenues for expanding access to EC, including reform of UNWRA policies and educational campaigns targeting clinicians and pharmacists.