Emergency contraception: A solution or a problem?

Emergency contraception is a quick and effective way to prevent pregnancy after exposure to unprotected sexual intercourse. To be clear, emergency contraceptive methods do not induce an abortion. It is meant for occasional use and to reduce the incidence of unwanted pregnancies. It is also not meant to replace the other regular methods of contraception.

In this article, the concept of emergency contraception is well explained in the following aspects;

• Epidemiology
• Target population of use
• How effective emergency contraception is
• When to use emergency contraception
• Different methods available for taking emergency contraception
• Risks and benefits of emergency contraception
• Emergency contraception; a solution or a problem?

Having outlined a definite meaning to emergency contraception, it is imperative to understand its epidemiology. By epidemiology, we mean the branch of science that deals with the spread and control of diseases and the subject in question by extension. Research has shown that the use of emergency contraception is more prevalent among older and more educated females.

This is not a surprise because taking emergency contraception shows a level of awareness that is most likely common among older sexually active females that are educated.

The study by Mishore et.al on “Emergency contraceptives: knowledge and practice among Ethiopian female college students” shows that, indeed, females of older age and higher educational status had higher knowledge and practice of emergency contraception.

The target population for emergency contraception includes all adolescents and sexually assaulted girls or women. Other categories of women include the immediate post-partum women, and any other woman of reproductive age group.

Depending on the most effective one for the time of the cycle they present in, it is important that every female of childbearing age knows when and how to access emergency contraception. Medically, it is advisable to avoid the use of intrauterine device in cases of sexual assault because of a high risk of Sexually Transmitted Infections (STI).

How effective is emergency contraception?

All things being equal, about 95% of pregnancies can be prevented using emergency contraception especially when taken within three days after unprotected sexual intercourse. To achieve better results, most emergency contraception work optimally when taken earlier than later. This is to say that the chances of emergency contraception preventing pregnancies is higher the earlier they are taken. Hence, it is advisable to take emergency contraception in a matter of hours after intercourse. This is why it is important to make up one’s mind on time whether to use them or not as it requires immediate or urgent action.

When can someone use emergency contraception?

There’s a reason it is called ’emergency’ contraception. Therefore, it is meant to be taken when there is an urgent risk of unwanted pregnancy to occur. The following  are situations where using emergency contraception is most needed:

• After unprotected sexual intercourse
• Failure of other contraceptive methods (such as condom tear or leakage)
• Incorrect use of other contraceptive techniques.

As earlier stated, emergency contraception should never take the place of regular contraceptive methods like the use of good condoms, oral contraceptive pills, Intrauterine Device (IUD), contraceptive injections or implants, diaphragm, etc. It is meant to be taken seldomly or for emergency purposes.

You can read more from our article on  Safe Sex Practices and Sexual Responsibility.

Different methods of taking Emergency Contraception

The available methods include:

• Intrauterine Device with copper (Cu IUD) – This is the gold standard method as it is the most effective emergency contraceptive method available.  As a matter of fact, copper IUD is the only emergency contraceptive method that is effective even after ovulation. What it basically does is to change the environment in the uterus to make it toxic to sperm. However, care must be taken to insert the IUD within 5 days of the exposure to unprotected intercourse. This is important because emergency contraception does not mean abortion, hence the rule to  do this on time in order to prevent an inadvertent dislodgement of an already implanted and established pregnancy. It works by reducing the motility of sperm cells and also causing a sterile inflammation in the endometrium which makes the environment hostile for implantation. It provides effective on-going contraception and the body mass index has no effect on it.

• Oral Emergency Contraception – This is a quite popular method and could also be called morning after pill or post pill. It works by ingesting a pill which helps to delay ovulation. It has no effect after ovulation has taken place. Therefore, depending on what point in a woman’s cycle it is taken, this method is not 100% effective. Morning after pills are also not effective if taken after 120 hours of exposure.

Emergency contraception, a solution or a problem?

The blessings of emergency contraception cannot be overemphasized as it confers benefits on sexually assaulted women, others who have used their regular contraception technique incorrectly or with failures of the methods used. This is also of great advantage for post-partum women with less strict lactational guideline adherence. Women who are vomiting or on enzyme inducer drugs along-side their regular hormonal contraceptive would find emergency contraception useful.

This is also helpful for women who are just commencing their regular contraception with failure to use additional contraceptive precautions, or barrier method failures. In the occasion of late or missed pills, emergency contraception comes in very hanndy if unprotected sexual intercourse has occurred. It is also useful if there has been spontaneous expulsion of intrauterine device or removal within 7 days after unprotected sexual intercourse.

All adolescents and sexually assaulted women must be offered emergency contraceptive method, depending on the most effective one for the time of the cycle they present in.

However, the frequent and repeated use of emergency contraception may cause more harm than good, and if care is not taken, may be a source of a problem itself.

Case in point is the alarming abuse of an emergency contraceptive pill popularly known as Postinor 2, a morning-after pill taken within 24 – 72 hours after unprotected sexual intercourse. As an over-the-counter drug in Nigeria, this contraceptive pill is reportedly taken indiscriminately leading to more harm than good. What a lot of consumers do not understand is that the drug is not to be taken if the person has certain health conditions such as heart disease, diabetes, high blood pressure, diarrhoea or indigestion. It is also harmful to take Postinor 2 when having vaginal bleeding. It is highly NOT recommended for girls below 17 years of age.

Furthermore, taking Postinor 2 alongside other drugs can affect its effectiveness and it is not advisable to take it without a physician’s attention. Taking the drug outside the recommendation or supervision of a physician is potentially dangerous to one’s hormonal and reproductive health.

Since there are no systems in place to monitor the consumption of this drug in Nigeria, the risk of abuse is high. As have been established over and again in this article, emergency contraceptive pills are not made to be a regular form of birth control, thus the frequent use of Postinor 2 can weaken the walls of the womb and damage the uterus leading to miscarriages in the future.

Aside from the abuse of emergency contraceptive drugs, other  risks associated with the use of emergency contraception include failure of the method. Oral hormonal methods used after ovulation has been found to be ineffective. Again,  the insertion  of an intrauterine device after 120 hours of unprotected sexual intercourse has also been found to be ineffective. Oral contraceptives taken after 72 hours of exposure are also not very effective.

 Women with higher weight and Body Mass Index might also experience failure with hormonal methods. Further risks associated include;

•  higher transmission of sexually transmitted diseases
•  ectopic pregnancy
•  menstrual disturbances or irregularities
• perforation of the uterine walls with intrauterine devices.
• women with severe asthma controlled by glucocorticoids cannot use the ulipristal acetate (UPA ECPs) as well as women with hepatic impairments.
•  the hormonal emergency contraceptive methods are not exactly safe for lactating mothers as they are excreted in breastmilk.

Emergency contraception; a plus or a minus?

From the foregoing, evidence supports that the provision of Emergency Contraception (EC) may not increase sexual risk taking. However, it has been shown that it increases the likelihood of women avoiding their regular contraceptive methods. The conventional regular contraceptives have still been found to be more effective, healthier and safer. Thus it is imperative that health providers should continue to advocate for the use of long-acting contraceptive methods over emergency methods.  Emergency contraceptive method provision in advance of demand is not scientifically proven to be effective in reducing pregnancy rates.

Emergency contraception has been found to be cost effective compared with an unwanted pregnancy, but an increase in Emergency Contraception supply has not been proven to reduce unplanned pregnancies though. According to a Scottish study, abortion rates have also not reduced.

Finally, Emergency Contraception (especially oral) does not provide on-going contraception and risk of pregnancy increases if exposure continues in same cycle without mitigating against it. This is however the opposite for an intrauterine device.

Conclusion 

The advent of emergency contraception has greatly improved the overall success of contraceptive methods.  The emergency contraceptive methods are not meant to substitute the regular contraceptive methods, but to potentiate their effects. Having a good knowledge about the types and modes of action would help in correctly deploying the right method in preventing an unwanted pregnancy. It is therefore imperative for providers to adequately educate the public on their proper use.

Medical Disclaimer: KompleteCare aims to improve the quality of life for everyone with fact-based content about the nature of diseases, preventive care, behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.