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Emergency Contraception: a "Second Chance" -- July 16, 2001

Emergency contraception offers women a "second chance," preventing pregnancy after unprotected intercourse or when a couple's regular method of contraception is used incorrectly or fails to work properly. Unprotected intercourse may include coerced sex, as well as situations when no method is used.

"Emergency contraception can help reduce unplanned pregnancies, many of which result in unsafe abortion and take a large toll on women's health," says Dr. Paul Van Look of the World Health Organization (WHO), former chair of the international Consortium for Emergency Contraception steering committee, a group of health experts who are promoting public awareness of this important family planning option.

Every year, unintended pregnancies lead to at least 20 million unsafe abortions, resulting in the death of some 80,000 women, according to WHO. Still other maternal deaths result from unintended pregnancies that do not involve an abortion, according to the current issue of Network, a health bulletin published by Family Health International (FHI).

The most widely used emergency contraception involves pills containing the same hormonal ingredients found in regular oral contraceptives but in higher doses. In fact, regular birth control pills can be used for emergency contraception if enough pills are taken to equal the right dosage (the number of regular oral contraceptive pills needed varies, depending upon the brand involved).

Emergency contraceptive pills do not affect a fertilized egg that has been implanted in the uterus. Hence, it cannot cause an abortion.

Using this method is convenient:

• Pills that are manufactured for emergency contraception or the proper number of regular oral contraceptive pills should be started as soon as possible after unprotected intercourse, ideally no later than 72 hours. (Research is examining whether this time frame can be extended.)

• After 12 hours, an identical dose is taken. Each of the two doses must contain the proper amount of hormones.

However, emergency contraception should not be used as regular contraception because it is less effective than regular pill use and can result in unpleasant side effects, such as nausea.

Like other non-barrier methods of contraception, emergency contraceptive pills provide no protection against HIV or other sexually transmitted infections. Condoms remain the best method for protection against these diseases.

In some countries, emergency contraception is referred to as "the morning-after pill," which can be misleading because a woman does not need to wait until morning to begin use -- she should begin use as soon as possible after unprotected intercourse. Some research has shown that the sooner she takes the pills, the more effective they will be in preventing pregnancy.

Improvements

Efforts to improve emergency contraceptive pills include making them easier to use by eliminating the need for a second dose, reducing side effects, and investigating whether the recommended time limit of 72 hours for starting use might be extended.

In some countries, unnecessary requirements for a prescription make it difficult for women to obtain the pills, even when they know they are available. "Prescription status is a major barrier to access," says Dr. David A. Grimes of FHI, who is among experts advocating the elimination of prescriptions. "Removing the prescription requirement and allowing women to purchase pills directly is the most expedient way to ensure that women can obtain and use them whenever the need arises."

Many women are likely to need emergency contraception outside regular clinic hours, particularly during weekends and holidays. The lack of time to make and keep an appointment to get emergency contraception from a health-care provider can be a major obstacle to proper use.

Even where prescriptions are required, simply eliminating an office or clinic visit can greatly reduce the time needed to obtain emergency contraception, says Dr. Grimes.

FHI is a nonprofit research organization based in the United States that seeks to improve reproductive health worldwide, with an emphasis on developing countries. Network is provided free to family planning providers and others worldwide.