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Guidelines for
Administration of
Emergency Contraceptive
Pills for Medical Officers
1. Introduction
Emergency Contraceptive Pills (ECPs)
are hormonal contraceptives that can be used to prevent pregnancy following
‘an’ unprotected act of sexual intercourse within the past 72 hours. It
provides an important option to women who have had unprotected intercourse
within the past 72 hours. It provides an important option to women who have
had unprotected intercourse due to non-use of contraceptive or a
contraceptive accident. It is a very critical option for preventing an
unwanted pregnancy in case of sexual assault.
India’s
current contraceptive prevalence rate of 48.2% (NFHS-2) is not adequate to
achieve the desired goal of reaching the replacement fertility level by 2010.
The percentage of unwanted/ unplanned pregnancies is about 13% (NFHS-2), with
the majority due to unprotected sexual intercourse and a small percentage due
to contraceptive accident. Consequences of an unwanted pregnancy, most
importantly unsafe abortions, are well known. ‘Complications of abortions’ is still a leading cause of material mortality and is a
major contributor to maternal morbidity. An unwanted preganacy
also has emotional, social and financial implications. The objective of
achieving the National Population Policy goals of reduction in maternal
mortality and of replacement fertility levels by 2010 in the context of
current demographic, social and gender scenario in India warrants the introduction
of ECPs in the reproductive and child health programme.
The ECPs by preventing an
unwanted pregnancy, after a recent act of unprotected sexual intercourse,
prevents a consequent unsafe abortion and maternal mortality as well as
emotional trauma especially in case of sexual assault. These contributions to
woman’s life open the window of opportunity to initiate an effective method
of contraception as well as other reproductive health services.
1.1 Emergency
Contraceptive Pills
All the hormonal oral contraceptive pills (combined
as well as single) in varying doses can be used as ECPs.
However, the Drug Controller of India has approved only Levonorgestrel
(LNG) (progestogen-only) for use as ECP. LNG is
available in 0.75 mg. tablets. LNG is the ‘dedicated product’ for emergency
contraception as it will be specially packaged at the correct dosage for use
as ECP. The Guidelines are for administration of LNG.
1.2 Mechanism
of Action
The exact mode of action of ECPs
is not known, but probable mechanisms include prevention of ovulation,
fertilization and/ or implantation, depending on the phase of menstrual cycle
when it is used. The probable mechanisms are:
i) Inhibition or delay of ovulation
ii) Thickening of cervical mucus
iii) Direct inhibition of fertilization
iv) Histological and biochemical alteration in endometrium leading to impaired endometrial receptivity
to implantation of fertilized egg
v) Alteration in transport of egg, sperm and
embryo
vi) Interference with corpus luteum
function and luteolysis
The mechanisms for prevention of pregnancy are
thought to happen before implantation takes place.
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ECPs
(LNG) are not effective once the process of implantation has taken place.
They will not cause as abortion
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1.3 Effectiveness
When used correctly (time and dose as prescribed)
after ‘a single’ act of unprotected sexual intercourse, the ECPs fail to prevent pregnancy in about 2% of women (the
chances of pregnancy after a single act of unprotected sexual intercourse is
7-8%). In multiple acts of sexual intercourse, the risk of pregnancy is
higher unless it is ensured that the ECPs are taken
within 72 hours of the first act of sexual intercourse. Since ECPs are used only once, it can not be directly compared
to the failure rates of regular oral contraceptives based on use during a
full year.
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Regular use of ECPs is not recommended due to the following reasons:
·
Overall ECPs are
less effective than regular contraceptives.
·
With frequent use of ECPs,
the failure rate, the side effects and costs would be more than that of
regular hormonal contarceptives
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1.4 Advantages
and Disadvantages of LNG
1.4.1 Advantages
i) Effective if taken correctly as prescribed
ii) Sale
for all women including those who have conditions, that are listed as
precautions in case of other hormonal contraceptives
iii) Does not affect lactation
iv) Use not associated with foetal
malformation or congenital defects
1.4.2 Disadvantages
Has to be used within 72 hours of the
first act of sexual intercourse
i) Has to be used within 72 hours of the first
act of sexual intercourse as use of the ECP beyond this period increases
the risk of pregnancy
ii) Effectiveness decreases with frequent use
iii) Does not protect STIs/
HIV
iv) Side effects; Nausea, vomiting, irregular
bleeding per vagina, breast tenderness, headache, dizziness, fatigue
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