Emergency Contraception: America’s Best Kept Secret

Do you watch the TV show “ER”? During an episode in 1997, Nurse Hathaway (Carol) offered the option of taking emergency contraceptive pills to a young woman who had just been forced to have sex against her will. It is possible that between 5 and 6 million people had heard of emergency contraception that day.

According to the Kaiser Family Foundation, nearly 3 million unintended pregnancies occur each year in the United States. You can imagine why – a condom tears, a diaphragm slips out of position, a woman forgets two birth control pills in a row. Or, a couple got “swept away” in love and neglected to use birth control. Maybe a rape took place. Without treatment, eight out of 100 women who have had unprotected sex in the second or third week of their cycle are likely to become pregnant. With emergency contraception, only two women out of 100 would be in the same situation.

What is emergency contraception?

There are two types of emergency contraceptive pills (ECPs). One is a combination of estrogen and progestin, and the other is a progestin-only pill. Depending on when they are taken during the menstrual cycle, ECPs can inhibit or delay ovulation; inhibit ovum or sperm transport; or alter the lining of the uterus to prevent implantation of a fertilized egg.

Another option, which is actually the most effective, is a copper IUD. This must be inserted by a healthcare professional within 5 days of unprotected sex. It can prevent implantation of a fertilized egg.

How it works?

ECPs, sometimes called the morning after pill, must be taken within 72 hours of unprotected sex. The pills are most effective the earlier the woman takes them in the 72 hour period.

The pills are taken in two doses, with the second dose taken 12 hours after the first. Each dose is one, two, four or five tablets, depending on the brand. You need a prescription to get ECPs, although some providers now write prescriptions in advance.

Evonorgestrel/ethinyl estradiol (Preven) is packaged specifically for emergency contraceptive use. It contains both hormones, estrogens and progestins, and reduces the chances of pregnancy by 75%. About 50% of women who take it feel nauseous and 20% vomit.

Levonorgestrel (Plan B) is progestin-only and has been on the market since July 1999. It is more effective than Preven and has fewer side effects associated with it.

The copper IUD prevents a fertilized egg from implanting in the uterus. About 80% of women keep the IUD inserted as a form of contraception for up to 10 years.

Why haven’t you heard of ECPs?

Although the Food and Drug Administration declared ECPs safe and effective in 1997, only 10% of healthcare professionals regularly discuss emergency contraception with their patients, according to a survey conducted the same year by the Kaiser Family Foundation.

Forty-one percent of Americans are still unaware of the existence of ECPs. In fact, only 11% of women aged 18-44 have both heard of ECPs and know that the pills must be taken within 72 hours of unprotected sex.

Remember that we all make mistakes. Unwanted pregnancies cross all borders — age, race, ethnicity, social class. Experts estimate that up to 1.7 million of the more than 3 million unintended pregnancies that occur each year in the United States could potentially be prevented through the use of ECPs. This includes up to 800,000 pregnancies that now result in abortions. Wouldn’t you rather keep a supply on hand, just in case? Ask your doctor about emergency contraception at your next visit.