Christmas is upon us, and it is a time when excess will prevail. Within another four weeks, there will be a sharp increase in the number of women who go to pharmacies to request pregnancy-test kits. Many women who receive a positive test result will be devastated. By early February, there will also be an increase in the number of women who go to medical doctors requesting an abortion.
To reduce abortion rates, the key is to reduce the number of unintended pregnancies. Abstaining from sex is one way to prevent unintended pregnancies. Using regular contraceptives, including condoms, is another option. However, there is a contraceptive available in Jamaica which may be taken after sex to prevent a woman from getting pregnant. This is post-coital (after-sex) contraception. It costs between $600 and $900 to buy one course of these tablets. The packet contains two tablets, each containing 750 micrograms of levonorgestrel, a female hormone. These tablets are known as emergency contraceptives (EC) or 'morning-after' pills.
No prescription required
EC is available at the pharmacy without a prescription. The female who requires EC will be confidentially interviewed by the registered pharmacist, who will determine whether EC is indicated for the circumstances presented, based, for example, on the day in the menstrual cycle when sex occurred, or whether the woman is already pregnant from a previous act.
Emergency contraception is used when there is failure to use any contraceptive method, or when there is failure of the method itself, and the woman does not want to become pregnant:
Contraceptive failure (the condom slipped or broke); the diaphragm or female condom dislodged, broke or was used incorrectly
The woman was late for a dose of contraceptive injection
The woman missed two doses of her oral contraceptive pills
No contraception was used during sex
Error occurred in practising the withdrawal method
To be effective, the first dose of this high-dose contraceptive must be taken less than 72 hours (3 days) after sex. One tablet is taken as soon as possible after unprotected sex (but no later than 3 days). It is more effective the sooner it is taken after sex. The second dose is taken 12 hours after the first one.
So the first dose of the 'morning-after' pill does not have to be taken the morning after unprotected sex, but may be taken preferably immediately after sex or up to three days later. When taken correctly, it is effective 75 per cent to 90 per cent of the time. This means that it has a higher failure rate than regular oral contraceptives. It does not protect the user from STIs, including HIV/AIDS.
Not for regular use
The health consequences of pregnancy are greater than any individual risk from the use of EC. Nausea, vomiting and changes in menstrual bleeding during the next cycle are common side effects. If vomiting occurs under two hours after taking EC, another tablet should be taken quickly and the pharmacist consulted.
When taken before an egg is released, EC works by slowing it down. It may slow the transport of the sperms or an embryo through the womb, and may prevent the fertilised egg from being implanted into the womb. EC will not disrupt an existing pregnancy (if one assumes that pregnancy starts after a fertilised egg is implanted into the lining of the womb), and does not interfere with the woman's future fertility.
Due to the relatively high failure rate and high dosage of the hormone in EC, it is not advisable to use it as a regular ongoing contraceptive.
Dahlia McDaniel is a pharmacist and final-year doctoral candidate in public health at the University of London; email: firstname.lastname@example.org.