Slide 1

Dr. Sushma P Desai.
M.D, D.C.H.
 Practicing Paediatrician And
Adolescent Counsellor
 President: Adolescent Health
Academy - Surat Branch
 National Trainer : Mission Kishore
Uday Programme
 Resource Person : ‘ Sexual and
Reproductive Health of Young People ’
 ( Surat Municipal Corporation

Project )


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Emergency Contraception
How Routine?


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Definition

 It is a contraception used in emergency to
prevent pregnancy.
 It is to be used within 72 hours of
unprotected sexual intercourse.


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Types
2 Methods :
1. EC Pills ( ‘Morning After’ Pills )
2. Copper bearing IUD
Plan A : Combination pills
100 mg Ethinyl estradiol and 0.5 mg Levonorgesterol
2 doses taken 12 hours apart, 1st dose within 72 hours
of exposure.
Plan B : High dose progestin only pill
1.5 mg Levonorgesterol
Single Dose within 72 hours of exposure.
Popular Indian Brands : I-Pill, Unwanted 72, Preventol
, Option 7.


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 Does not disrupt existing pregnancy / not terratogenic.


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Indications
Should be used only in an
emergency situation like :
 Sexual assault : sex against her
will/force to have sex ( rape )
 Contraceptive accidents :
Condom breaks/dislodgement
of I.U device
 Unplanned Sexual intercourse :
Without Contraception e.g. heat
of the moment
 Missed regular dose of
contraceptive : O.C.P for 2 or
more days / Dex Medroxy
progesterone injection


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Pre Prescription Evaluation
 Youth friendly clinic :
 Comprehensive team approach :
 History :
* Detail menstrual history
* HEADSSS : H/O high risk behavior ( mental health
disorder, substance abuse, past history of unsafe
abortions, multiple partners ), Home environment and
parenting style
 WHO Medical Eligibility Guidelines : If History of
stroke, migraine, coagulopathy-Plan B Preferred


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Pre Prescription Evaluation ( Contd. )
 Clinical Examination : Look for evidence of
Pregnancy or abortion / STI , HIV / Trauma (Sexual
Assault)
 Investigations : r/o STI, HIV, Pregnancy
* Hematological investigation
* urine test
* pelvic U.S.G
* Vaginal swabs


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Follow up

 After 2 weeks of prescription :
* r/o pregnancy/abortion
* h/o acute pain in abdomen : r/o ectopic pregnancy
* serology for STI, HIV
 Guidelines : Regarding safe sexual behavior,
different methods of contraception, harmful
effects of unprotected sex, Interpersonal
relationship.
 Life Skill Education : assertive and negotiation
skills, goal setting, personality development
 Parental counseling
 HPV vaccination


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Advantages
 Simple
 Highly Effective
(Failure rate < 5% Depending
on the time of consumption)
 Minimal Immediate Side
Effects
( Nausea, vomiting, dizziness,
breast tenderness : > with plan
A)

Disadvantages
 Do not offer any protection
against STI, HIV
 Menstrual irregularities :
Early/Delayed cycles, irregular
bleeding, menorrhagia
 If used repeatedly within the
same cycle :Loses efficacy, >
chances of harmful effects on
reproductive health of the
young female
 Can not be used as only
protection if sexually active


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Current Indian Scenario

 Opportunity for premarital sexual activity is increasing as :
* Age Of puberty is falling, Age of marriage is rising
* “Sexarche” is happening earlier : ( 17.2 Yrs. B, 18.3 Yrs. G )
* influence of media , westernization.
 Lack Of comprehensive sexuality education :
* conservative attitude of Indian society ( parents, teachers,
government)
* Adolescent lack knowledge of harmful effects of unsafe sexual
encounters, different methods of contraception.
 Prevailing social taboos
* Extra marital pregnancy and abortion : shameful and traumatic
 High incidence of unsafe abortions ( quacks/untrained doctors ) :
5 millions annually, 20,000 women die of complications


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Current Indian Scenario ( Contd. )
The other side of the coin :
 The sell of E.C pills increased up to 250% in past 3 years. NFHS
2010-11: 83 m E.C pills v/s 16 m condoms.
 E.C pills are largely misused : the reasons are
* Easy availability : O.T.C without prescription
* Young couples find it easy way out for unprotected frequent
sexual activity : increased risk of STDs/HIV.
* Lack of knowledge about : 1.) Indications, limitations and harmful
effects of E.C pills, 2.) Other methods of contraception
* E.C pills are used multiple times a month as a replacement for the
low dose OC pills
* Massive, misleading advertisement
* Fear of pregnancy / ‘just to be on safe side’
 The result : Increased risk of STDs/HIV, harmful effects on
reproductive health of young women.


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Conclusion
E.C is an effective means of preventing unwanted
pregnancy but Should be used only in emergency
situation ( should not be used frequently/should not
replace low dose OC pills)
We should empower the adolescents with 1.) sexuality
education and life skills to promote responsible sexual
behavior. 2.)Knowledge of other safe methods to avoid
pregnancy i.e abstinence, non penetrative sex,
condoms, spermicides, O.C pills
Harmful effects of : 1.) Unprotected sex like S.T.Ds/H.I.V
2.) High dose hormones on the reproductive health
must be stressed upon.


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