Reproductive Health Technologies Project - Contraception - Frequently Asked Question About Emergency Contraception

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What is emergency contraception?
Emergency contraception is a safe, effective back-up birth control method that can prevent pregnancy after unprotected intercourse or contraceptive failure — like a broken condom. The most common form of emergency contraception is emergency contraceptive pills, which contain high dosages of the same hormones found in daily birth control pills — estrogen and progestin. When taken within days of unprotected intercourse, emergency contraception can reduce the risk of pregnancy by up to 89%.¹

Emergency contraception is not a substitute for correct use of regular contraceptives. It is less effective than regular contraception, and provides no protection from HIV/AIDS or sexually transmitted diseases.

Is emergency contraception the same drug as the "morning-after pill"?
Because emergency contraception can help reduce the risk of pregnancy after sex, some people like to call it the "morning-after pill." Actually, labels for the FDA approved products say emergency contraception should be used within 72 hours of unprotected intercourse and recent research shows this window can be extended to 120 hours, or 5 days.² However, there is no reason to delay treatment; the sooner, the better.

Is emergency contraception the same drug as the "abortion pill"?
Emergency contraception should not be confused with mifepristone (brand name, Mifeprex), also known as RU-486. Emergency contraception and mifepristone are completely different drugs. Emergency contraception helps to prevent pregnancy, while mifepristone terminates an early pregnancy. In fact, emergency contraception helps to reduce the need for abortion. Researchers estimate that roughly half of the unintended pregnancies in the U.S. could be prevented by widespread awareness and use of emergency contraception. In 2000 alone, use of emergency contraception prevented more than 50,000 abortions.³

Why would a woman need emergency contraceptive pills?
There are about 3 million unintended pregnancies each year in the United States. Just over half of these happen to women who are using a regular method of contraception.⁴ Despite the many highly effective birth control options women have to choose from, none is 100% perfect. And sometimes, mistakes happen — a condom breaks, a diaphragm slips, a woman misses a pill. Or she has sex when she didn’t plan to or want to.

Sadly, one of the most compelling reasons a woman might need emergency contraception is in the case of rape. Each year, thousands of American women are the victims of this violent crime. By offering a woman the option of emergency contraception, health care providers can help to eliminate at least one trauma associated with rape — the prospect of an unwanted pregnancy. However, most hospitals do not yet treat this as the standard of care. Several states, including California, New Mexico, New York, South Carolina, and Washington, require this by law.

How do emergency contraceptive pills work?
Emergency contraception prevents pregnancy the same way that the daily pill does: by delaying or inhibiting ovulation, inhibiting fertilization, or preventing implantation of a fertilized egg in the uterus.⁵ ⁶ All of these events occur before the beginning of pregnancy, which medical science defines as the implantation of a fertilized egg in the lining of a woman’s uterus. Implantation typically begins five to seven days after fertilization. Emergency contraception does not interrupt a pregnancy. In fact, it will not work if a woman is already pregnant.

What kinds of emergency contraceptive pills are available in the United States?
Plan B, a progestin only product, was approved by the FDA in July 1999. There are also about a dozen brands of daily birth control pills that can be used as emergency contraception (see www.not-2-late.com for a complete list).

Where can a woman obtain emergency contraception?
Emergency contraceptive pills are available in the United States only by prescription. A woman can get emergency contraception – or a prescription for the pills – from any physician and many other reproductive health care providers. Most clinicians require a woman to come in for an office visit before prescribing emergency contraception. In several states, women are able to obtain EC directly from a pharmacist without having to visit a clinic or health care provider first. In Alaska, California, Hawaii, Maine, New Mexico, and Washington, there are collaborative drug therapy agreements between individual physicians and pharmacists to provide emergency contraception. For more information about pharmacy access to emergency contraception, visit www.go2ec.org.

In addition, an application to make Plan B available over-the-counter is currently under review at the United States Food and Drug Administration (FDA). A decision on the application was due in January 2005, but the FDA issued a "pocket veto," declining to act by the anticipated deadline.

How should a woman take emergency contraception?
Each packet includes a single course of treatment and consists of two tablets, each containing 0.75 mg levonorgestrel. According to FDA-approved labeling, the first tablet should be taken as soon as possible within 72 hours (3 days) of unprotected intercourse. The second tablet must be taken 12 hours later. Recent research shows that one 'double dose' (1.5mg) is as effective as two doses taken 12 hours apart. These data show that emergency contraception can still reduce the risk of pregnancy when taken on days 4 and 5, but the sooner the better. One study also shows that emergency contraceptive pills taken 24 hours apart work just as well as pills taken 12 hours apart.

How effective is emergency contraception?
Emergency contraception reduces the risk of pregnancy among users about from 8%, on average, to about 1 %. In other words, when used correctly, it reduces the risk of pregnancy by 89% after a single act of unprotected sex. Effectiveness declines as the interval between intercourse and the start of treatment increases. In the first 24 hours after intercourse, progestin-only emergency contraceptive pills, like Plan B, can prevent 95% of expected pregnancies. Combined estrogen-progestin pills reduce the risk of pregnancy by 75 percent.

Are there any side effects associated with emergency contraceptive pills?
Some women experience one or more side effects after taking emergency contraception. Side effects include nausea, vomiting, cramping, fatigue, headache, dizziness, breast tenderness, and menstrual changes. Combined estrogen-progestin pills have a slightly greater occurrence of side effects than progestin-only pills. No serious complications have been associated with emergency contraception. When used as directed, emergency contraception is safe for most women.

How many women have used emergency contraception in the United States?
Recent surveys estimate that only 6% of women have ever used emergency contraception. One reason for the low use rates is historically low awareness of the product and lack of information about where to access it. Since 1996, the Reproductive Health Technologies Project (RHTP) has been working to increase awareness and access through media campaigns and grassroots activism. Click here for more information about RHTP's emergency contraception campaigns.

Where can a woman get more information about emergency contraception?
There is an automated, 24-hour-a-day, toll-free hotline (1-888-NOT-2-LATE or in Spanish, 1-866-en-3-dias) and an Emergency Contraception Website www.not-2-late.com. Both also provide guidance about where to get emergency contraception in a given area.

¹ Task Force on Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. The Lancet 1998, 352: 428-433.

² von Hertzen, H. et al. Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial. The Lancet, 7 December 2002: 1803-1810.

³ Jones RK, Darroch JE, Henshaw, SK. Contraceptive Use Among U.S. Women Having Abortions in 2000–2001. Perspectives on Sexual and Reproductive Health 2002, 34: 294-303.

⁴ Glasier A. Emergency postcoital contraception. New England Journal of Medicine 1997, 337:1058-1064 .

⁵ Trussell J and Raymond EG. Statistical evidence concerning the mechanism of action of the Yuzpe regimen of emergency contraception. Obstetrics and Gynecology, 1999, 93: 872-876.

⁶ The United States Code of Federal Regulations, Title 45, Part 46, Subpart B, Section 46.202, Subsection (f) states "Pregnancy encompasses the period of time from implantation until delivery."