Emergency Contraception’: Facts and Myths

Emergency Contraception has been with us for over 3 decades now. The intended user is a woman who wishes to prevent unplanned pregnancy following unanticipated sexual intercourse or failure of a barrier method of contraception such as a ruptured condom.

Emergency contraception is supposed to be very effective if taken in the recommended period. The success is traditionally quoted at 95% if taken in the first 24 hours, falling to a shade over 50% if taken on the third day, that is 49-72 hours after having sex.

The ‘Morning After’ Pill

Emergency contraception is more popularly known as the Morning After Pill. If the use actually lived up to the letter and spirit of this moniker, then we would expect it to be very effective. What is the reality? We shall see shortly.

What is Emergency Contraception

At risk of stating the obvious, it is important to explain that self-administered Emergency contraception comes in the form of a progestogen hormone pill taken as soon as possible after (usually unplanned) sexual intercourse to prevent pregnancy. It is meant to do this mainly by preventing or delaying the release of the egg (ovulation) or implantation of a fertilized egg.

Emergency contraception is also available in the form of an intrauterine device (IUD or ‘coil’) which das to be inserted in the same 72 hour window. This is more effective but is used much less partly because it cannot be self-administered and inevitably involves the input of a health professional.

Availability of Emergency Contraception:

In the UK, the ‘Morning After Pill can be bought over the counter, without a prescription, by anybody over the age of 16. It is also available (free) from GP surgeries, Family Planning clinics, GUM clinics and Brook Clinics.

In Australia, in 2004 the Emergency Contraceptive pill was re-classified as a Schedule 3 drug meaning it is now available without a prescription.

France had been there well before with the approval of over the counter Emergency Contraception pill (NorLevo®) without prescription in 1999.

Many other countries have since removed this restriction including developing countries such as South Africa and India. This is to make the availability as easy as possible.

In America...

In the USA, in 2005, Steven Galson, acting director of the Food and Drug Administration's drugs division rejected the advise of the FDA advisory panel to make the Morning After Pill available without a prescription. In 2006, the so-called Plan B Emergency Contraception Pill got approval for over the counter sale without prescription to women over the age of 18. Younger women need a prescription.

There is slightly more choice of emergency contraception in the United States with a combined Progestogen and Estrogen pill also available to be taken for up to 5 days after having sex. It is slightly less effective.

Plan B

This is the name given to the emergency contraception pack available in the USA. it was first approved by the FDA in 1999. It contains two pills of the hormone Levonorgestrel (a progestogen). These are to be taken within 72 hours of having unprotected sex . The tablets are taken 12 hours apart.

Planned Parenthood is the one of the leading providers of emergency contraception in the United States and over 1.2 million women used this service from the organization’s centers throughout the country in 2005.

Safety

The emergency contraceptive pill is safe for the baby should it fail and the woman becomes pregnant. There is no increased risk of birth defects. The pill does not prevent sexually transmitted infections.

How really effective

There is no doubt as to the effectiveness of emergency contraception if used appropriately by the individual. However, what continues to trouble many public health experts is the fact that wider and easier availability of emergency contraception does not appear to be reducing unplanned and unwanted pregnancies. In fact, the rate of conception among the under-18s in England and Wales was reported to be almost static between 2004 and 2005 at just over 42,000 in each of those years. Most of these are unplanned. This followed a 3 year stint in which rates were falling steadily. Similarly, in 2006, there were 200,000 terminations of pregnancy in England and Wales, a new record and over 6,000 more than the previous year. Almost a third of terminations are a repeat. The windfall from freely available emergency contraception has therefore not materialized.

All that is accompanied by even more worrying statistics of ever increasing levels of STIs among teenagers, a sure sign of continuing risky sexual behavior. The rate of genital herpes went up almost 16% between 2005 and 2006 for girls aged 16-19 years. There does appear to be a link between alcohol, drug use and risky sexual behavior in this age group.

Education, Education, Education.

The figures mentioned here, which are mirrored in many countries across the globe (to varying degrees), would tend to indicate that more efforts in educating our young people about matters of sexual health are required.

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