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	Closing the Effectiveness Gap
June 2007 Issue No. 13	The INFO Project • Johns Hopkins Bloomberg School of Public Health • Center for Communication Programs • 111 Market Place, Suite 310 • Baltimore, Maryland 21202, USA • 410-659-6300 • 410-659-6266 (fax) • www.infoforhealth.org • infoproject@jhuccp.org

Key Points Achieving Contraceptive Effectiveness How Programs Can Improve Contraceptive Effectiveness How to Explain Contraceptive Effectiveness Figure 2: Comparing Effectiveness of Family Planning Methods Figure 3: Counseling Aid: Explaining Effectiveness of Injectable Contraceptives Counseling for Effective Use Feature: Emergency Contraception: A Second Chance Table 2: Client Educational Materials: Tips for Using Contraceptives Effectively Subscription and Ordering Information Bibliography Credits Bibliography

FEATURE

Emergency Contraception: A Second Chance

 

Figure 4. Effectiveness of Emergency Contraception Pills (ECPs) Using progestin-only or combined estrogen-progestin ECPs can dramatically reduce pregnancies after unprotected sex compared with not using ECPs.

If 100 women each had unprotected sex once during the second or third week of the menstrual cycle and then used:

Source: World Health Organization and Johns Hopkins Bloomberg School of Public Health 2007 (136) INFO Reports

People tend to think of emergency contraceptive pills (ECPs) as a second chance to prevent pregnancy after having sex without contraception, or after sex was forced or coerced. But ECPs also give women a second chance in the event of a contraceptive mistake or an obvious contraceptive failure. If a woman wants an IUD as her continuing contraceptive method, she can have a copper-bearing IUD inserted, and that, too, will provide emergency contraception (60).

Emergency contraception, whether pills or the IUD, can help women avoid unintended pregnancy in the event of such contraceptive mistakes as:

• Condom slipped, broke, or was otherwise used incorrectly.
• Fertility awareness method was used incorrectly (for example, failed to abstain or to use another method on a fertile day).
• Using withdrawal as a family planning method, man failed to withdraw before he ejaculated.
• Woman missed three or more combined oral contraceptive pills or started a new pill pack three or more days late.
• Woman is more than 2 weeks late for her repeat progestin-only injection or more than 7 days late for her repeat monthly injection.
• IUD has come out of place (60, 136).

How emergency contraceptive pills work. ECPs contain the same hormones used in oral contraceptives but in higher one-time or two-time doses. ECPs work primarily by preventing or delaying the release of eggs from the ovaries. They do not disrupt an existing pregnancy (60). All women can safely use ECPs, even women who cannot use hormonal contraceptives on an ongoing basis, because the treatment is brief and the hormonal dose is low (136).

What are the regimens? Progestin-only oral contraceptives and combined oral contraceptives can act as emergency contraceptives. Also, special emergency contraceptive pills that contain either only the progestin levonorgestrel or both estrogen and levonorgestrel can be used, if available. Progestin-only emergency contraceptives are taken in a single dose. Combined estrogen-progestin emergency contraceptives are taken in two doses.

The number of pills a woman has to take for emergency contraception for each dose depends on the type of pills she is using. It ranges from 1 or 2 pills with special progestin-only or combined estrogen-progestin ECPs to 40 or 50 pills with progestin-only oral contraceptives.

How effective are emergency contraceptive pills? The sooner ECPs are taken after unprotected sex, the better they prevent pregnancy. ECPs can prevent pregnancy when taken any time up to five days after sex (34, 85, 95, 130). ECPs should be used only in the event of a contraceptive mistake, however, or after having had sex without contraception.

WHO does not recommend regular use of ECPs as an ongoing contraceptive method (140). ECPs are less effective than nearly all regular contraceptive methods when used correctly and consistently over the long term (60).

Progestin-only ECPs are more effective than combined estrogen-progestin ECPs, and they cause fewer side effects. Progestin-only ECPs reduce the risk of pregnancy by an estimated 88%, while estrogen-progestin ECPs reduce the risk by about 75% (114, 121) (see Figure 4).

Providing ECPs. Women are more likely to use ECPs if they already have them on hand, studies show (12, 33, 45, 62, 76, 90, 99). Providers can give women, or men, a prescription for or supply of ECPs in advance so that the woman can have them on hand to be able to take them as soon as possible if needed (141).

Research shows that women who receive ECPs in advance are not more likely to have unprotected sex than women who only receive information about ECPs. Also, women who receive ECPs in advance are not more likely than other women to rely on ECP use repeatedly, and not less likely to use regular contraception (12, 33, 45, 62, 93, 99).

Moreover, they are not more likely to make contraceptive use errors with their regular method (33, 45, 62). In fact, women who have ECPs on hand in advance, as well as women who are given information about ECPs, are likely to use more effective contraception after receiving the advance supply of or information about ECPs (45, 46, 62).

For more information about emergency contraception, including specific pill formulations and dosing, consult the publication Family Planning: A Global Handbook for Providers (136) or the International Consortium for Emergency Contraception (http://www.cecinfo.org/), a group of international organizations formed to expand access to and ensure safe and appropriate use of emergency contraception.

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