Use Emergency Contraception When Necessary

The statistics are truly stunning. In the United States, about half of all pregnancies are unintended. Four out of 10 unintended pregnancies are terminated by abortion. Of the women who have these abortions, 54 percent used a method of contraception during the month that they became pregnant. ¹

Emergency contraception is useful for a number of different situations. These include the incorrect use or failure of birth control, the failure to use birth control while sexually active, the breakage of a condom, and as a victim of sexual assault or rape. All of these situations increase the risk of becoming pregnant. The use of emergency contraception pills appears to work by delaying the release of an egg from the woman’s ovaries and prevents the sperm from fertilizing an already released egg.

There are two types of emergency contraception that may be purchased without a prescription. They contain a synthetic form of the hormone progesterone called levonorgestrel. Plan B One-Step is a single tablet of 1.5 mg levonorgestrel; Next Choice, also known as Plan B, is taken as two doses. Each dose is .75 mg of levonorgestrel. These doses may be taken together or 12 hours apart, up to five days after sex. These pills prevent a pregnancy from occurring, but they do not terminate a pregnancy that has already implanted. They are most effective when used within 24 hours of sex. Emergency contraception should not be used if a teen may be pregnant for several days or when there is vaginal bleeding. There is a prescription medication, ulipristal acetate (Ella), which is taken as a single tablet. It works by delaying ovulation. It requires a prescription from a medical provider. It may be taken up to five days after unprotected sex.

A copper intrauterine device (IUD) is the most effective method of emergency contraception, and it may also be used for regular contraception. It may be inserted into the uterus by a medical provider up to five days after unprotected sex. It may work by inhibiting sperm movement or by other mechanisms that inhibit fertilization and implantation.

In a study published in 2014 in the journal Biology of Reproduction, researchers from China examined the effect on the physical and mental development of children born after the failure of emergency contraception. The researchers compared a group of 195 children exposed to emergency contraception to a matched group of 214 children who were never exposed to emergency contraception. Over a two-year period, the physical and mental health of the two groups were evaluated. The researchers found no statistically significant differences between the two groups of children in weight, height, head circumference, and intelligence scores. “The values of all parameters of both groups were similar to those of the national standards.” The researchers concluded that emergency contraception had “no effect on the physical growth, mental development, or occurrence of birth defects in children born from pregnancies in which EC [emergency contraception] failed.” ³

In a study published in 2015 in the Indian Journal of Community Medicine, researchers from New Delhi interviewed a number of experts in the field of emergency contraception to determine some of the reasons that it is so infrequently used. In addition, the researchers conducted a review of the literature on the topic. A number of key barriers emerged. The vast majority of the sales of emergency contraception are in the cities. In fact, 71 percent of the total sales are in urban areas, but urban areas comprise only 29.8 percent of the population of India. And, emergency contraception does not appear to be readily available in many rural areas. Moreover, many physicians have incorrect information about emergency contraception. For example, though it has proven to be untrue, some physicians believe that these products may trigger an ectopic pregnancy or an abortion. Some gynecologists have negative views of women who use emergency contraception. For example, they thought that these women have multiple sexual partners and/or risky sexual behaviors. There is also the issue of cost. Some of the most popular brands are expensive, and all women may not find them to be affordable. The researchers recommended an educational campaign involving the media and improvements in access to emergency contraception, with the ultimate goal of “mainstreaming” these treatments. ⁵

In a study published in 2011 in Contraception, researchers from Scotland; Bethesda, Maryland; and Paris noted that emergency contraception does not always work. To learn why this occurs, they examined data from a meta-analysis of two randomized controlled trials. When compared to women with normal body mass index (BMI), the risk of pregnancy after using emergency contraception was three times higher in women who were obese. This is a very important finding for overweight and obese women who want to avoid pregnancy. The second finding was more anticipated. Even after taking emergency contraception, the risk of pregnancy was highest when sex took place near ovulation. When compared to women who had sex outside the fertile times of the month, the women who had sex the day before the estimated day of ovulation had a fourfold increase risk of pregnancy. According to the researchers, women who are overweight or obese and women who have unprotected sex near ovulation should have a medical provider insert a copper intrauterine device. ⁶ While this may appear to be a readily available solution, an emergency appointment with a medical provider is not necessarily available, especially to a teen who may have little experience navigating medical systems.

In a study published in 2014 in Contraception, New York City researchers wanted to learn more about the ability of males to purchase emergency contraception in the three New York City neighborhoods of Washington Heights, East Harlem, and the Upper East Side. In July 2012 three male research assistants, aged 19, 25, and 28 years, were sent to ask about purchasing these products. (Because of a lack of resources, they did not actually purchase the items.) In each of the 158 pharmacies that they visited, the research assistants explained to the pharmacist or pharmacy technician that the condom had broken during sex with their partner, and the partner now required emergency contraception. Of the 128 pharmacies, 81 percent indicated that emergency contraception was available for sale. Although this represented a very solid majority, the researchers noted that young men had a one in five chance of not having emergency contraception available. Also disturbing was the fact that the research assistants were, on occasion, given incorrect information. One pharmacist noted that emergency contraception caused miscarriages and abortions. Another pharmacist said that it was associated with birth defects. The researchers added that the costs associated with emergency contraception may be high for those living in lower socioeconomic areas, and the pharmacies may not have extended hours on the weekend, when unprotected sex is more likely to occur. An even more serious concern is the possibility that some pharmacists may be finding ways to refuse to dispense emergency contraception because of their own personal beliefs. “Cost and timely access are still important issues that remain today.” ⁷

1. Pelin Batur, “Emergency Contraception: Separating Fact from Fiction,” Cleveland Clinic Journal of Medicine 79, no. 11 (2012): 771-76.

2. Suneeta Mittal, “Emergency Contraception: Potential for Women’s Health,” Indian Journal of Medical Research 140, Supplement (2014): 45-52.

3. Lin Zhang, Weiping Ye, Wen Yu et al., “Physical and Mental Development of Children After Levonorgestrel Emergency Contraception Exposure: A Follow-Up Prospective Cohort Study,” Biology of Reproduction 91, no. 1 (2014): 27.

4. Laura M. Miller, “College Student Knowledge and Attitudes Toward Emergency Contraception,” Contraception 83 (2011): 68-73.

5. Anvita Dixit, M. E. Khan, and Isha Bhatnagar, “Mainstreaming of Emergency Contraception Pill in India: Challenges and Opportunities,” Indian Journal of Community Medicine 40, no. 1 (2015): 49-55.

6. Anna Glasier, Sharon T. Cameron, Diana Blithe et al., “Can We Identify Women at Risk of Pregnancy Despite Using Emergency Contraception? Data From Randomized Trials of Ulipristal Acetate and Levonorgestrel,” Contraception 84 (2011): 363-67.

7. David Bell, Elvis J. Camacho, and Andrew B. Velasquez, “Male Access to Emergency Contraception in Pharmacies: A Mystery Shopper Survey,” Contraception 90 (2014): 413-15.