morning after the night before: emergency contraception

by Isobel Jacobs and John Illman

Since January 2001, women aged 16 and over have been able to buy emergency contraception at their local pharmacist. The pill, Levonelle, costs £24.99. Women take emergency contraceptives if they have had unprotected sex, or their contraception has failed, and they want to prevent an unplanned pregnancy.

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Levonelle treatment includes two pills. The first should be taken as soon as possible after unprotected sex and the second 12 hours later. They work by delaying or preventing ovulation, or by stopping a fertilized egg settling in the womb lining. Some women experience mild side effects such as nausea, but this is far less common with Levonelle than with previous emergency contraceptive methods.

a long wait

Until 2001, emergency contraception was available by prescription only. This meant that women who wanted to get hold of it had to make an appointment to see their doctor, or go to a family planning or other health clinic, such as Brook. Some A&E departments will supply emergency contraception (but always phone to check first) and some GPs and clinics will also give a prescription in advance, just in case.

The emergency contraceptive pill works for up to 72 hours after unprotected sex. The sooner you take it the better it is. 'I can really identify with the panic of trying to get to a clinic within the shortest time possible!' says Sara. 'I had to wait until the third day to get it as the doctor's surgery was closed due to a bank holiday and my local hospital did not hand them out. I just sat there, knowing that the longer I waited, the less chance there was of it working!'

So you can see why sex advisory groups think that selling the pill at chemists is a good idea.

'We want to see emergency contraception available as widely as possible,' says Toni Belfield, director of information at fpa (Family Planning Association). 'Pharmacy sales are another way to support women who choose to use this method.'

hard to swallow?

Not everyone agrees. Some people argue that making that making emergency contraception available will encourage women, especially younger ones, to have sex without contraception. '[This] sends the wrong message about the need for responsible sexual activity,' says Conservative Party health spokesman Dr Liam Fox.

Other bodies worry that girls feel pressurised to have sex before they're ready. 'Young girls say it's difficult to refuse sex because of the ordinary pill,' says Rose Docherty, of the Society for the Protection of the Unborn Child. 'How much more pressure are kids going to be under if they're told they don't have to worry, because they can just go and get the "morning after" pill?'

But the fpa does not think that putting emergency contraception on sale has changed attitudes. 'Research shows that emergency contraception doesn't affect patterns of sexual behaviour in the long term. So there's no link between providing emergency contraception and an increase in sexual activity,' says Ms Belfield.

think ahead

But bodies such as the anti-abortion group Life are also concerned about the risk of sexually transmitted diseases – which is a frighteningly high level among teenagers. Emergency contraception does not protect against these infections. Ms Belfield stresses: 'Emergency contraception is for emergencies only. The best way to protect yourself from sexually transmitted infection is to use a condom as well as any other method of contraception you may use routinely.'

Less than a third of girls under 16 who are having sex go to family planning clinics to get advice on contraception or sexually transmitted diseases. Sometimes, this is because they don't know if they're allowed to because it is illegal to have sex before you are 16. Other times, they want to talk to someone in private and they're not sure that the service is confidential. But anyone under the age of 16 is entitled to have contraceptive treatment provided the doctor is sure that the young person understands what is involved and the treatment is in their best interests.

If you're 16 or over, there are some things you need to know about buying emergency contraception over the counter. The pharmacist will ask questions about you and any medical conditions you may have. The consultation should take about 10 minutes – in a private area of the pharmacy. If the pharmacist doesn't think the pill is right for you, he or she will refer you to your GP. Always be as honest as possible. If you prefer to get emergency contraception free, or would like the opportunity to talk through your contraceptive choices, remember you can still contact your local GP, family planning clinic or Brook clinic.

We would like to acknowledge the help of Melissa Dear of fpa in the preparation of this article.

help and info

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organisations

British Pregnancy Advisory Service (BPAS)
4th Floor
Amec House
Timothy's Bridge Road
Stratford upon Avon CV37 9BF
Actionline: 08457 30 40 30 (Mon-Fri 8am-9pm, Sat 8.30am-6pm, Sun 9.30am-2.30pm)
Website: www.bpas.org
Provides affordable services to those who wish to prevent an unplanned pregnancy with contraception, or end one by abortion. Offers pregnancy testing, crisis pregnancy counselling, abortion care, after abortion support, sterilisation and vasectomy and emergency contraception. Website contains information for women thinking about having an abortion, information about emergency contraception, pregnancy testing and what to do next.

Brook
Helpline: 0800 0185 023 (Mon-Fri 9am-5pm)
Website: www.brook.org.uk
Provides free and confidential contraceptive advice for anyone under 25. Provides emergency contraception, pregnancy testing and counselling on any sex and relationship problem. To listen to Brook's 24-hour recorded messages on pregnancy, contraception, abortion and sexually transmitted diseases please phone 020 7617 8000. The website has information on the services provided, FAQs and details on how to get in touch with your local Brook centre.

fpa
2-12 Pentonville Road
London N1 9FP
Contraception Education Service Helpline:
England: 0845 310 1334 (Mon-Fri 9am-7pm)
Scotland: 0141 576 5088 (Mon-Thurs 9am-5pm, Fri 9am-4.30pm)
Northern Ireland: 02890 325 488 (Mon-Thurs 9am-5pm, Fri 9am-4.30pm)
Website: www.fpa.org.uk
The fpa's Contraceptive Education Service can advise on all sexual health matters, including contraception, abortion and sexual health, and can give details of local clinics. Single copies of leaflets on all methods of contraception are free with a SAE.

Marie Stopes International
153-157 Cleveland Street
London W1T 6QW
Marie Stopes One Call: 0845 300 8090
Website: www.mariestopes.org.uk
Runs a range of reproductive health services including contraception, abortion counselling, well women screening, gynaecological consultations, vasectomy, and psychosexual and relationship counselling. For abortion and emergency contraception advice, to book an abortion consultation, or to find about other services available near you, call the Marie Stopes One Call number. Their Abortion Help website is aimed at women who are considering an abortion and contains straightforward information and advice, looks at the options available and features answers to FAQs.

(updated December 2002, resources updated February 2005)