Emergency Contraception (EC)

Information: Part 1. Types. How it works. Self
medication. Abortion numbers. Effectiveness, etc.

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About Emergency Contraception:

There will always be a need for such post-coital medication to prevent pregnancy -- at least for women who wish to regulate their fertility. Condoms can tear; women sometimes forget to take their birth control pills; diaphragms will occasionally slip; rape and forced incest happens. Sometimes, in the rush of the moment, people will not use a condom. As one physician stated: "As people's sex drive goes up, their IQ goes down." Or, as one comedian said: "God provided men with a brain and a penis, but only sufficient blood to run one at a time." (paraphrased)

Types of emergency contraception:

	An emergency contraceptive pill (ECP), a.k.a. the Yuzpe regimen. This contains an elevated dose of oral contraceptives containing estrogen (ethinyl estradiol) and a progestin (levonorgestrel or norgestrel) is taken within 72 hours of unprotected intercourse. This is followed by a second dose 12 hours later. This method has been in use for over 20 years. Gravol pills are often given in addition to the ECP, to reduce nausea -- a common  side-effect.
	An alternative ECP contains a high dose of either estrogen or a progestin alone, without estrogen. There is less clinical experience with this medication.
	An intra-Uterine Device (IUD) is sometimes inserted within 5 days of unprotected intercourse. The IUD changes the environment of the uterus in ways that are not entirely clear; the result is that a fertilized ovum will not be able to attach itself to the endometrium, the lining of the uterus.

Emergency contraceptives have been approved for use as a regular post-coital method in over 20 countries - including Canada, England, New Zealand, the Netherlands, and the United States. Research is ongoing by the World Health Organization, the Population Council. In 1997-FEB, it was declared safe and effective by the US Food and Drug Administration. It is available over the counter without a prescription for women 17 years-of-age or older. The pills are sold specially packaged for emergency use in some countries.

How the pills work:

	If an ovum has not been recently released from an ovary, the medication will usually prevent it from being released.
	If an ovum has recently been released, ECP may prevent it from being fertilized.
	If the ovum has already been fertilized, it was once believed that the pills would "alter the lining of the uterus inhibiting the implantation of the embryo. 1 Most pro-life groups still believe this. However, medical research has shown that this is extremely unlikely or impossible.
	If pregnancy has begun (i.e. the ovum has developed into an embryo which has already attached itself to the uterine wall), researchers have shown that the pills will have no effect. The pregnancy will continue normally.

There are two common and unpleasant side-effects to these pills. About 50% of women develop nausea; 20% vomit. Some women experience headache, dizziness, cramping, tender breasts, and/or irregular bleeding. These do not generally last more than a day. "Advocates argue that the side effects are minor compared with the consequences of the estimated 2.7 million unwanted pregnancies every year in the United States." ₂

In the very unlikely chance that a woman takes the pills and still remains pregnant, one source states that "there is no reason to suspect that one time emergency use of the pills would be associated with birth defects." ₃

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Self Medication:

Unfortunately, some women have learned the exact dosages of birth control pills required for emergency contraception, and are engaging in self-medication. The New York Times published an article in 1997 containing precise ECP dosages using various contraceptive pills. The Feminist Women's Health Center currently publishes a dosage and color of regular birth control pills to take in order to have similar results to EC pills. ₄ This is not a safe technique. The procedure should be taken under the direction of a physician or pharmacist because of the slim possibility of serious side-effects.

Impact on abortions:

One source, the Alan Guttmacher Institute estimates that there are about 6.3 million unintended pregnancies each year. ₅ The FDA predicted that if doctors and women adopt ECP, emergency contraception could prevent up to 2.3 million of these pregnancies every year in the U.S., and thus prevent up to one million abortions. This change would reduce the level of abortions to a small fraction of their present levels. A conference in India indicated that ECP could make a major impact at reducing that country's 11 million legal and illegal abortions each year. ₆

Some argue that schools, public health agencies etc. should undertake a massive educational program promoting EC in the event of contraceptive failure or lack of use. The goal would be to reduce accidental pregnancies and the subsequent abortions. Some suggest that pharmacies make EC freely available to persons aged 16 and older without prescription. This would make it easier for people to obtain EC on evenings and weekends, and thus be able to take the pills within 72 hours of unprotected sex. However, Dr Gene Rudd, associate executive director of the Christian Medical Association, a pro-life group, suggested that if EC is available to teens then they might skip regular visits to their gynecologist. He said: "They're not going to get their pap smears; they're not going to get screened for sexually transmitted disease." ₇ It is unclear to us what the relationship is between EC and pap smears.

Effectiveness:

Various sources indicate that their efficiency is 74% or more; one study found 89% effectiveness.  However, most women who take emergency contraceptive pills would not have become pregnant anyway. The number of women who take the pills and still become pregnant is only about 2%. One essay quotes a study which showed a pregnancy rate of only 1.2% for ECP, if the treatment is started within 12 hours of sexual intercourse. ₈ Effectiveness rates of 99.4 and 99.9% have been reported for the two main IUD types. ₉

Safety Considerations:

The medication appears to be safe when taken by active (i.e. not bedridden) women. ₁₀The Consortium for Emergency Contraception suggests that women who are:

"... at risk of stroke, heart disease, blood clots, or other cardiovascular problems -- should not use combined oral contraceptives on a regular basis. [However] medical experts believe one time emergency use of birth control pills does not carry the same risks." ₃

The "progestin only" pills might be a better choice for such women. No deaths or serious complications have been reported in the approximately 25 years that the pills have been used. The World Health Organization, International Planned Parenthood Federation, and the U.S. Food and Drug Administration have all found ECP to be safe and effective.

Other EC factors:

Some groups claim that if the ECP were generally available, that some women would stop using her regular birth control technique and rely on the ECP instead. This is unlikely, because:

	EC costs much more than regular birth control pills,
	They are less convenient, since they require a trip to the doctor or pharmacist each time they are used
	They produce unpleasant side effects.
	EC is much less reliable than some other contraceptive methods.
	EC is useless at preventing the transmission of sexually transmitted diseases (STD)

A study in Finland showed that "No respondents reported using emergency contraception as their only contraceptive method." ₁₁

This topic is continued in Part 2

References used:

The following information sources were used to prepare and update the above essay. Many of these URLs are no longer accessible.

1. A "Provider Attitudes towards ECPs" survey was at: http://www.path.org/
2. Paul Koring, "Drug gets go-ahead for sale in the U.S.," Globe and Mail, Toronto ON, 1998-SEP-3
3. "Questions and Answers for Decision Makers," by the Consortium for Emergency Contraception website was at: http://www.path.org/
4. "Morning-after pill spreading out of control in Spanish schools," Catholic News Agency, 2006-MAY-30, at: http://www.catholicnewsagency.com/
5. Julie Severens Lyons, "Law makes morning-after pill available without prescription: PHARMACIES WILL BE ABLE TO DISPENSE EMERGENCY CONTRACEPTIVES," The Mercury News, 2001-OCT-16, was at: http://www0.mercurycenter.com/
6. Report of a national meeting on emergency contraception held in Lucknow, India in 1996-DEC, was at: http://www.path.org/
7. Martha Irvine, "FDA weighs morning-after pill for teens," Yahoo! News, 2004-OCT-18, at: http://news.yahoo.com/
8. Jo Ann Rosenfeld, "Post-Coital Contraception," was at: http://www.wwilkins.com/
9. "More Women Opting For IUD Contraception. IUDs Improved Substantially Since Dalkon Shield," WXII12, at: http://www.wxii12.com/
10. "Emergency Contraceptive Pills" at: http://opr_princeton.edu/ec/ecp.htm gave an overview of ECP.
11. Reports on Britain and Finland were at: http://www.path.org/

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Copyright © 1999 to 2011, by Ontario Consultants on Religious Tolerance
Originally published on 1999-JAN-13
Latest update: 2011-DEC-07
Author: B.A. Robinson

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