|Emergency Contraceptive Pills (WHO - OMS, 1998, 44 p.)|
What is emergency contraception?
The term emergency contraception covers a number of methods used by women within a few hours or a few days following unprotected intercourse to prevent pregnancy. Most of these methods have been known to the medical community for many years and involve the use of standard contraceptive products.
The most common method, used in many countries for over 20 years, involves taking an elevated dose of birth control pills (oral contraceptives containing estrogen [ethinyl estradiol] and progestin [levonorgestrel or norgestrel]) within 72 hours, followed by a second dose 12 hours later.
High doses of estrogen or progestin alone also can be used for emergency contraception, although there is less clinical experience with these regimens. A copper-T IUD, inserted within five days of unprotected sex, also is occasionally used.
How do the pills work?
Emergency contraceptive pills work by interrupting a womans reproductive cycle. Depending on when in the cycle the pills are taken, they can stop or delay an egg from being released from the ovary or, possibly, stop a fertilized egg from attaching to the uterus. The pills will not have any effect once a pregnancy has started.
Does emergency contraception cause an early abortion?
Medical science considers that a pregnancy has begun once implantation of a fertilized egg in the lining of a womans uterus is complete. The process of implantation begins about five days after fertilization and is completed about one week later, around the time of the expected menses. Emergency contraceptives are ineffective once implantation has begun; they cannot cause an abortion if the woman is already pregnant.
How safe are available emergency contraceptives?
Emergency contraceptive pills carry few medical risks for most women. Although some women - those at risk of stroke, heart disease, blood clots, or other cardiovascular problems - should not use combined oral contraceptives on a regular basis, medical experts believe one-time emergency use of birth control pills does not carry the same risks. However, for some of these women, progestin-only pills may be a better option. There have been no reported deaths or serious complications involving emergency contraceptive pills in over two decades of use.
How effective is emergency contraception?
Emergency contraceptive pills reduce the chance of pregnancy by about 75 percent. However, very few of the women who take the pills correctly actually get pregnant. This is because, on average, less than 35 percent of all women who have unprotected intercourse mid-cycle (during the most fertile period) will get pregnant, even if they do nothing. The risk of pregnancy drops still further at other times during the menstrual cycle. Experience shows that of all the women who take emergency contraceptives pills, only about 2 percent get pregnant.
What happens in cases of failure if a fetus is carried to term?
Over the years, many women have accidentally taken birth control pills (including older, high-dose pills) after they were already pregnant. Studies show no increased risk of birth defects or other problems when the pregnancies were carried to term. Thus, there is no reason to suspect that one-time emergency use of the pills would be associated with birth defects if the pills fail to prevent pregnancy or if they are taken after a woman is already pregnant.
What is the need for emergency contraception? Who uses the method now?
All current methods of contraception sometimes fail. Emergency contraception is an important backup when routine contraception fails to work properly, as when a condom breaks or a diaphragm or IUD becomes dislodged.
For couples who did not use any contraceptive but wish they had, emergency contraception provides a critical second chance to prevent an unwanted pregnancy. Young people in particular may not be prepared for their first sexual experience.
Worldwide, one of the most critical uses for emergency contraception has been in cases of sexual assault. Rape crisis centres routinely provide emergency contraception, even in countries where the method is not generally in use.
Could emergency contraception reduce the number of abortions?
By preventing unintended pregnancies, emergency contraception can reduce the need for abortion. In the Netherlands, which has the lowest abortion rate of any industrialized country, contraceptive use is high among young people and emergency contraception has been widely available as a backup for decades. In Finland, early evidence suggests that abortion rates among teenagers have dropped following the spread of information about emergency contraception.
In many developing countries, where abortion remains illegal, unsafe abortions are a leading cause of death among women of reproductive age. Abortions are also a major drain on scarce medical resources. In these settings, the availability of emergency contraception could prevent much needless death and suffering. It could also reduce the growing pressure on hospital beds, nursing staff, blood supplies, and medications needed to treat the life-threatening medical complications of abortions performed by untrained practitioners under insanitary conditions.
How many women have used emergency contraception?
Rates of emergency contraceptive use appear to be highest in those European countries where emergency contraceptive pills come specially packaged in the proper dosages with instructions for doctors and patients. These products make emergency contraception easier to prescribe and use.
Women in most developed countries have heard something about a morning after pill. But most do not know exactly what the treatment is or how long after unprotected sex they can use it. In the United States, for example, a 1994 survey by the Henry J. Kaiser Family Foundation showed that only about one percent of American women have ever used emergency contraception and only about one-quarter of gynaecologists regularly prescribe it. Experts assume levels of knowledge and use in developing countries are quite low.
Will access to emergency contraception encourage promiscuity and sexual irresponsibility among young people?
There is no evidence to suggest that knowledge of emergency contraception increases sexual activity among young people. What is clear is that the need for emergency contraception often brings sexually active young people into family planning clinics, where they can receive other services and counseling, including help in learning how to say no when they choose to be abstinent. For adolescents who are already sexually active, emergency contraception provides a bridge to effective birth control and disease prevention.
Will women stop using other forms of contraception if emergency contraception becomes too easily available?
Emergency contraceptives can have unpleasant side-effects, including nausea and sometimes vomiting. A few women also experience headaches, breast tenderness, or fluid retention. These side-effects, although not serious from a medical standpoint, do discourage over-reliance on emergency contraception for routine birth control.
Emergency contraception is less effective in preventing pregnancy and more expensive than most forms of regular contraception, two additional disincentives against routine use of the method.
If they know their partners can use emergency contraceptives, will men be less likely to use condoms?
Couples use condoms both to avoid pregnancy and to prevent the spread of disease. Emergency contraception provides no protection against sexually transmitted diseases, including HIV/AIDS. For individuals at risk of STDs, condom use remains critical. Women and men may, on the other hand, feel more confident about relying on condoms for birth control if emergency contraception is available as a backup, in case a condom slips or breaks.
Will adding emergency contraception to existing reproductive health care systems be costly?
Definitely not. Emergency contraception is highly cost-effective. With a moderate amount of training, any health care provider qualified to distribute oral contraceptives can provide emergency contraceptive pills. With appropriate instruction, supplies can also be given to women during routine family planning visits, to keep at home in case of an emergency.
Although the cost of commercial products is roughly equivalent to the cost of a full cycle of pills, these dedicated products help ensure safe and appropriate use. Moreover, the savings to the health system of averting unwanted pregnancy or unsafe abortion more than cover the cost of emergency contraceptive supplies and services. Health care providers can also produce lower-cost emergency contraceptives by cutting up monthly cycles of appropriate pill brands. The most expensive part of expanding access to emergency contraception may be educating women about their options.