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Guidelines for
Administration of
Emergency Contraceptive
Pills for Medical Officers
2. Counselling
Counselling is one of the critical activities when
administering ECPs for the following reasons.
I. Counselling would help to provide emotional
support to a client/couple who is worried about a pregnancy due to
unprotected sexual intercourse.
II. It establishes rapport and confidence in the
provider as the provider is helping the client/couple to meet a critical
need, which is prevention of an unwanted pregnancy.
III. It provides an opportunity to help the
client/couple start using regularly a contraceptive of their choice as well
as ensure sustained correct use of the same.
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Every client should be counselled to help decide
to plan her family and to choose a method based on informed choice.
Wherever possible spouse/ partner should be counseled.
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2.1 Counselling for ECPs
The following are the critical steps:
I. Building a rapport with the client by greeting
the client as this is critical in finding out accurate information for
effective use of ECP such as the timing of first unprotected intercourse. It
is also important for acceptance of a regular contraceptive.
II. Make the client feel comfortable
psychologically as well as physically. The former is extremely important, as
she may be very anxious. In case of sexual assault, the effort has to be
greater as the woman would be emotionally distraught.
III. Be supportive and non-judgemental especially
in cases of sexual assault.
IV. Identify the reason for wanting ECP and when
the first unprotected sexual intercourse happened. In case of a contraceptive
accident, ask the client to describe the use of the method.
V. Identify the client's needs by asking relevant
questions: personal, social, family, medical, reproductive health including
reproductive tract infections/ STIs, family planning goals and past/current
use of family planning methods (if not found out earlier).
VI. Using simple language, provide information on
the following:
 What is ECP
Timing of use
Mechanism of action
Effectiveness in preventing pregnancy
(especially if implantation is likely to have taken place or if more than one
act of sexual intercourse has taken place
Effectiveness in causing abortion
Effect on the foetus if pregnancy continues
Advantages and disadvantages
Effect on preventing future pregnancies
Importance of regular use of a contraceptive
Various contraceptive methods including
mechanisms of action of methods, their benefits and disadvantages and timing
for initiation of the method and whereto obtain the services
VII. Once the client/couple is sure about using the
ECP; do a client assessment as described in Section 4, and if found eligible,
provide the ECP. Record
VIII. Instruct the client about taking the ECP, emphasising
the need for second dose, likely side effects and what to do in such
situations (as described under section b)
IX. Discuss when to return for follow up and for
initiating the use of a regular contraceptive
X. Provide a packet of condoms if at risk of
STIs/HIV (if condoms have not been chosen as the method)
XI. Maintain confidentiality and privacy must be
ensured at all counselling sessions
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Confidentiality and privacy should be maintained
during counseling.
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2.2 Method-Specific Counselling
If the client has chosen a method during the first
visit or during follow up visit; use the following steps to counsel the
client. Ensure that privacy and confidentiality are maintained all the
time.
I. Establish rapport with the client
II. Ask the client what she knows about the method
chosen, rumours (if any) and past experience with the method (especially in
case of contraceptive accidents).
III. Provide information as relevant using simple
language and clarify doubts. If the client is new, repeat the information on
the following.
Show the model chosen or a model/diagram incase of
sterilizations
Mechanism of action
Effectiveness
Advantages, disadvantages
When to start taking the contraceptive/return
in case of clinical services such as Cu-T and sterilizations (in relation to
menstrual period)
Reconfirm the client’s decision to use the
method chosen and do an assessment as prescribed in the national guidelines
for the method. Record the findings
I. If found eligible, demonstrate the use of the
method/explain the method of insertion/surgery. In case of condoms and oral
contraceptive pills, ask the client to repeat the instructions. Record the
supply/procedure.
II. Repeat the likely problems/side effects in the
first few months and what to do in such situations.
III. Tell the client when to return for follow up.
IV. Provide a packet of condoms for use if at risk
of STIs/HIV (if condoms have not been chosen as the method). Explain the use
of condoms (if not explained before).
2.3 Counselling on Return Visit after ECP
I. When a client returns for follow-up, it is
important to counsel her.
II. Ask the client about any side effects
III. Ask about her last menstrual period: flow,
duration
IV. If not pregnant, counsel about family planning
methods as described in the earlier sections
V. If pregnant, counsel and advise appropriately
VI. Record
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