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18 September 2006

Expert questions impact of emergency contraception

Giving women the morning-after pill makes no difference to either the pregnancy rate or the abortion rate, a family planning expert has written in the British Medical Journal.

Professor Anna Glasier, director of family planning at the Lothian primary care NHS trust in Edinburgh, writes that because of difficulty in using the pills correctly, several studies - including one that she herself led - have shown that even giving women packets of emergency contraceptive pills (ECP) to keep at home in case they need them does not reduce the proportions having unplanned pregnancies or terminations.

‘When reasons for not using emergency contraception, despite having a supply at home, were documented, three out of every four women said they did not realise they had put themselves at risk of pregnancy,’ she argues in a BMJ editorial. But the evidence for the pill’s efficacy are not strong, says Professor Glasier, as there has never been a placebo-controlled trial of the morning-after pill for ethical reasons. The estimates of efficacy could well be skewed by the inadequacy of the information researchers are given by some women using the pill. ‘Many women using emergency contraception have recently had unprotected intercourse more than once, many are vague about the date of their last period, and a few were too drunk to be sure they had even had sex’.

For woman who have had unprotected sex the pill is still very important, ‘because emergency contraception will prevent pregnancy in some women some of the time’. But, she continues: ‘If you are looking for an intervention that will reduce abortion rates, emergency contraception may not be the solution, and perhaps you should concentrate most on encouraging people to use contraception before or during sex, not after it.’

The fpa said that emergency contraception was an important method for women whose contraception had failed or who had had unprotected sex. ‘Emergency contraception is no substitute for correct, regular use of contraception. It is not, and was never intended to be, a panacea for abortion,’ said Toni Belfield, of the fpa. ‘Preventing unplanned pregnancy is a complex issue that encompasses attitudes towards risk taking behaviour, knowledge of contraceptive methods, ability to negotiate the use of contraception with partners and discuss sex openly.’

In a press statement Ann Furedi, Chief Executive of bpas, said:

‘Everyone deserves a second chance to prevent an unintended pregnancy. If taken in time, the emergency contraceptive pill (ECP) prevents around 75 per cent of pregnancies that would otherwise have occurred. It is a safe option, and crucially, is maximally effective in the first 12 hours after contraceptive failure or unprotected sex. Because of the time-sensitivity, access to this treatment needs to be fast. However, women may struggle to get a GP or clinic appointment in time, or to get to a pharmacy to buy it over the counter. That’s why bpas have pioneered prescribing this treatment in advance, allowing our doctors give this to women to keep at home in case of emergency. This also allows doctors to discuss with the woman the most effective time within which to take the pill.

‘Studies show that women need more awareness about exactly when they should take ECP in order for it to stand the most chance of working. More must be done to help women understand what puts them at risk of pregnancy, how to use regular contraception effectively to reduce the risk- and what to do if that fails. We would welcome more research into this area.’

Emergency contraception: is it worth all the fuss? Glasier, A. British Medical Journal. 2006 Sep 16;333(7568):560-1.

Morning-after pill has not cut abortion rate, says expert, Guardian, 15 September 2006

Advance supplies of Emergency Contraceptive pill crucial in preventing unwanted pregnancy’, say bpas doctors, bpas media release, 15 September 2006