Emergency Contraception

By Dr Caitriona Henchion, IFPA Medical Director, September 2009

This summer the first ever TV advertisement for emergency contraception was beamed into Irish living rooms via Channel 4 and Sky. IFPA Medical Director Dr Caithriona Henchion takes a closer look at emergency contraception and the many myths surrounding it.

The emergency contraceptive pill is available over the counter in 16 countries in the EU. Most recently, the Spanish government announced plans to make emergency contraception available in pharmacies without prescription.The emergency contraceptive pill (also known as the morning-after pill or ECP) is unique; it is the only contraceptive method a woman can easily use post-coitally. In Ireland, however, this contraceptive method is available on a prescription-only basis.

At IFPA we firmly believe that there is no good reason why ECP should not be available over-the-counter in pharmacies in Ireland. Furthermore, it should be available without age restrictions and at a reduced cost.

The emergency contraceptive pill is a very safe and responsible method of preventing pregnancy when regular contraception has failed, no contraception was used or in the case of sexual assault. As there are no serious side effects with it and no contra-indications there is no medical reason why it shouldn’t be more readily available.

The first dedicated emergency contraception product in Ireland was licensed by the Irish Medicines Board in 2002. Prior to that doctors prescribed high doses of the contraceptive pill to patients. This was administered in two doses and often resulted in nausea for the patients.

While ECP can be taken for up to 72 hours after unprotected sex, the sooner a woman takes it the more effective it is. ECP does not cause an abortion, does not cause any harm to existing pregnancies and has no capacity to induce miscarriage. It is made out of the same hormones as regular contraception and works in a similar way.

Among the many myths surrounding ECP is the notion that it is predominantly taken by young women. This is not the case. Yes, we do see women aged 16 and 17 looking to access emergency contraception, but we also have women in their early and mid 40s looking to access it.

Another myth is that serial use of the emergency contraceptive pill reduces efficacy. There is also no evidence to support this and there is no basis for the claim that repeated use impacts on fertility.

Research in the UK indicates that changing access to ECP from prescription-only to over-the-counter did not increase uptake – the same number of women took it, but access was much more straight forward.

Taking all this into account, there is no reason why ECP should not be more readily available. Given that the emergency contraceptive pill is most effective when it is taken early, the requirement of visiting a doctor to get prescription causes an unreasonable delay in timely use, resulting in an increased risk of unplanned pregnancy.

Requiring women to visit a doctor to get a prescription also unnecessarily increases the costs. A woman will have to pay €60 to see a doctor and pay €15 for the drug itself. For young people this cost is particularly prohibitive. Added to this is the fear that the GP will send a bill to their family home.

If ECP becomes available over-the-counter it is important that pharmacists supply clients with an information pack about sexually transmitted infections and what to do if menstruation does not commence.

*Picture: Emergency Contraception Advert from US-based Women’s Emergency Network