Your Questions Answered
What are emergency contraceptive pills and how can I get them?
Emergency contraception (EC) is needed when a woman’s method of birth control has failed or if there was no birth control used, or if a woman was sexually assaulted. Emergency contraceptive pills are oral contraceptives which are taken within 3 days after unprotected intercourse to reduce the chance of a pregnancy. The pills should be taken as soon as possible after intercourse, and for this reason are commonly referred to as the “morning after” pill. However, this is misleading, because although it is best if they are taken within hours after intercourse, they can be taken up to 3 days after unprotected intercourse. The oral contraceptives work in one of three ways: by preventing or delaying ovulation (which is the release of an egg from the ovary), by preventing fertilization, or by stopping a fertilized egg from attaching to the uterus.
There are two prescription pills which are packaged exclusively for this use. They are simply concentrated doses of the same hormone found in ordinary birth control pills. Plan B contains 1.50 mg levonorgestrel and Preven has a combination of estrogen and progestin. These specific packages are relatively new to the market, but physicians have been using combinations of oral contraceptives for this purpose since the 1960’s.
Emergency contraceptives will not be effective if a woman has an already established pregnancy. In fact, EC should not be confused with RU – 486 or mifepristone, which are medicines which could end an established pregnancy, and are taken after a woman misses her period.
Emergency contraceptives are effective in preventing pregnancy between 75- 85% of the time. Research from the Alan Guttmacher Institute has established that in the year 2000, emergency contraceptives averted over 100,000 unintended pregnancies, including an estimated 51,000 abortions.
The primary side effects of the pill are nausea and vomiting. A small percentage of women report headache, breast tenderness, irregular bleeding, and cramps. EC’s do not protect you from sexually transmitted infection.
Because of the low level of hormones found in these pills and because of the short duration of exposure to the hormones they are considered safe for nearly every woman, including adolescents. A physical exam is not required prior to receiving emergency contraceptive pills.
After a woman takes EC she should have her period within one week of her expected date of menses. If she does not have her period within 3-4 weeks she should have a pregnancy test. If a woman is pregnant, all available evidence indicates that the EC’s will not have harmed the pregnancy.
ACCESSIBILITY OF EMERGENCY CONTRACEPTION
Many women are familiar with the fact that no contraceptive is 100% effective. And in fact, in half of the unintended pregnancies each year, women do report using a method which apparently failed. Because EC is most effective the closer it is taken to unprotected intercourse, the delay of a weekend or a holiday can have a significant impact on an individual woman.
Currently, EC’s are prescription only. According to one study, 50% of all pregnancies are unintended and 28% of these end in abortion, and the primary reason emergency contraceptives are not used more is because there is not enough access to the pills. Advocates for women’s health were greatly disappointed this spring when the FDA did not approve over-the-counter status for EC’s. Non prescription status has overwhelmingly been recommended by the FDA’s own advisory committee, and by more than 70 of the nations’ leading medical and public health organizations. These organizations include American Academy of Pediatrics, the American College of Obstetricians and Gynecologists and the American Public Health Associations. However, the proposal has been resubmitted to the Food and Drug Administration to make Plan B available over the counter for women over the age of sixteen.
There are a few states that are finding ways to make EC’s more accessible, like California and Maine--which have a state-approved protocol allowing for a pharmacist to dispense the EC. In Maine, details are being worked out with the state’s pharmacy board. However some pharmacies and their corporate owners will not stock emergency contraception due to a misconception regarding the way the medication works. Another way to make EC’s more accessible for all women, is advance prescriptions. In order to improve the chances of a woman having emergency contraception when she needs it, some health care providers may consider writing an advance prescription so that women may keep EC in their medicine cabinet.
It is hoped that emergency contraceptives will be readily accessible to all women who need it and when they need it. Advance prescriptions and state initiated collaborative efforts between providers and pharmacists are two ideas to improve accessibility until over-the-counter status is approved.
It is not felt that EC will be used as an actual birth control method, because there are side effects which can be bothersome, and it simply is not as effective as a regular birth control method-like condoms, oral contraceptives, or IUD’s.
Resources
Alan Guttmacher Institute www.agi-usa.org
Planned Parenthood of Northern New England www.ppnne.org
Laura Detwiler, CNM