Emergency Contraceptive Pills

Fact Sheet on Youth Reproductive Health Policy

By taking a special dose of oral contraceptive pills within 72 hours of unprotected intercourse, women can prevent pregnancy in the majority of cases. While not recommended as a routine form of contraception, emergency contraception gives women an important second chance to prevent pregnancy when a regular method fails, no method was used, or sex was forced.

Its Importance as a Youth Reproductive Health Issue

• Younger women are more likely than older women to have unplanned and sporadic sex, use contraception ineffectively, and lack information on contraceptive methods, thus increasing their chances of having an unplanned pregnancy.
   
• By preventing such unplanned pregnancies, emergency contraceptive pills help avert abortion and pregnancy-related illness and death, to which young women are more susceptible than older women.
   
• Use of ECPs can give young people an entry point into reproductive health care services, promote their access to effective contraception and other needed services, and ultimately reduce the likelihood that they will need ECPs in the future.
   

Before defining youth-specific policies on ECPs, countries should develop general policies that apply to all age groups. Ideally, the Ministry of Health would incorporate such a general policy into its service delivery guidelines. Another important policy step is for the health ministry to designate a specific product and register it for use as an ECP or for the health ministry to issue a recommendation on using an existing oral contraceptive for emergency situations. To ensure that youth have access to ECPs, policies should:

• Define the age-appropriate use of ECPs, and that ECPs should be available for persons of any age. National Ministry of Health guidelines are the proper vehicle for such a policy.
   
• Allow providers to distribute ECPs to clients in advance. Such provisions should apply to all potential users, but are especially important for youth, who are more likely to use condoms and other barrier methods of contraception, which have higher failure rates than do other methods.
   
• Support pharmacy provision of ECPs to youth. Endorsement by groups such as the national association of pharmacists is important in assuring acceptance of ECP provision to youth by individual pharmacists and in stimulating interest in staff training and information provision.
   
• State that pharmacies can distribute ECPs without prescription and that they provide appropriate counseling. Again, the health ministry should incorporate this into its guidelines. Ideally, the national association of pharmacists should also issue similar guideline to its members.
   
• Promote availability of ECPs through non-health outlets, in the same way that condoms are available. This approach is particularly important for young people, since many do not go to the "traditional" government maternal and child health services. Although incorporated into national health ministry guidelines, such policies are also important at the local level and for secondary schools and universities that may have the means to distribute ECPs through school clinics.
   
• Encourage informing youth about ECPs and where to obtain them. Such information is important even for teens that are not yet sexually active, given the incidence of rape, incest, and coerced sex among young people."
   
• Encourage education for health workers on provision of ECPs and on counseling of young people.
   

Currently, very few countries have policies that explicitly address provision of emergency contraception for youth. A great deal of work is still needed to ensure that countries put in place appropriate policies that make this important contraceptive option more widely available for young people.

Search for policies related to ECP in the policy database.

Research Findings to Support Policy Development

Pharmacists' Knowledge and Perceptions of Emergency Contraceptive Pills in Soweto and the Johannesburg Central Business District, South Africa.(430kb) Blanchard, K., Harrison, T., and Sello, M. International Family Planning Perspectives. 2005;31(4):172-178.

Recent research not available online:

Emergency Contraception in Zambia: Setting a New Agenda for Research and Action. Ahmed Y, Ketata M, Skibiak J. Nairobi, Kenya: Population Council, 1998;

Perception and practice of emergency contraception by post-secondary school students in southwest Nigeria Arowojolu AO, Adekunle AO. Afr J Reprod Health 2000;4(1):56-65;

Knowledge and practice of emergency contraception among Nigerian youths.Arowojolu AO, Adekunle AO. Int J Gynaecol Obstet 1999;66(1):31-32;

Emergency contraception among university students in Kingston, Jamaica: a survey of knowledge, attitudes, and practices. Sorhaindo A, Becker D, Fletcher H, et al. Contraception 2002:66(4):261-68.

From Rhetoric to Reality: Implementation Tips

Pay attention to marketing and pharmacist training. Policy should encourage distribution of ECPs through pharmacies but successful implementation depends on knowledgeable staff and informed youth. Information campaigns should make youth aware that ECPs are available at pharmacies. Programs also need to target pharmacy staff to interest them in provision of ECP and provide them training and materials for appropriate distribution and counseling on young people.

Watch Out For...

Misinformation. Although ECPs are now registered in over 90 countries, the vast majority of women and many doctors and other health workers are not fully familiar with the method or have misperceptions about its appropriate use. For instance, health workers and others often believe that provision of ECPs promotes promiscuity or that the availability of ECP discourages use of contraception. Various studies have shown this is not true. For more information, see facts about ECP, from the Family Health International web site

Related Links and Resources

International Consortium for Emergency Contraception. This web site contains the latest information on ECPs.

Expanding Contraceptive Options and Access for Youth (148kb). FHI, 2004. This YouthLens publication discusses how education, services, and products can help protect youth against unintended pregnancy and sexually transmitted infections, including HIV.

Facts about Emergency Contraception from Family Health International's web site.

Emergency Contraceptive Pills: An Important Option for Young Adults. 1998. A 4-page fact sheet from Focus on Young Adults.

FAQs

Q. Will access to emergency contraception encourage promiscuity and sexual irresponsibility among young people?
There is no evidence to suggest that knowledge of emergency contraception increases sexual activity among young people. What is clear is that the need for emergency contraception often brings sexually active young people into health services, where they can receive a range of care, including help in learning how to say "no" when they choose to be abstinent. For adolescents who are already sexually active, emergency contraception provides a bridge to effective prevention of disease and unwanted pregnancy. (Adapted from the web site of the International Consortium for Emergency Contraception)

Q. Is it safe to provide ECPs without a prescription?
Yes. ECPs meet all the customary criteria for over-the-counter use, including low toxicity, lack of potential for overdose or addiction, no teratogenicity, no need for medical screening, self-identification of the need, uniform dosage, and lack of drug interactions. For more information, see facts on ECPs on the Family Health International web site.