The morning after

In January 2001 the progestogen-only emergency pill became available over the counter to women aged 16 and over. The Family Planning Association explains how it works and the alternatives

Organisations like the FPA, have long campaigned for emergency contraception to be readily available through pharmacies. Contraception isn't 100% effective, it's not always used well and sometimes we take risks, so unplanned pregnancies are a fact of life.

In 1999, 800,000 women used emergency contraception, many of them were married or in long-term relationships. Having said that, the UK has the highest rate of teenage pregnancies in Europe, and emergency contraception has to be one way of addressing that problem.

To be effective, you need emergency contraception within 72 hours of unprotected sex. Waiting over the weekend, or for a doctor's appointment during the week, makes it less effective.

A vociferous minority believe that over the counter availability of the emergency pill is a step too far. Fearing that promiscuity will increase and morals decline, Baroness Young took her crusade to the House of Lords in January 2001 to try to halt sales of the pill, but her motion was defeated by a pragmatic majority.

Pharmacists now sell Levonelle, he emergency contraceptive, all over the country for about £20 a pack, or you can get it free from your GP, Family Planning Clinic or NHS walk in clinic.

Emergency contraception (EC) isn't new

It's been available since the mid 1970s and has been shown to be safe and effective. However, it shouldn't be used in place of regular ongoing contraception such as the Pill, condoms, the cap or IUD.

There are two methods of EC:

  1. Emergency hormonal pills (better known by the misnomer 'morning after pill')
  2. The copper IUD
Emergency hormonal pills

There are two different types:

  • Progestogen-only pills - a packet of two pills
  • Combined (oestrogen and progestogen) - a packet of four pills.
Today, women seeking hormonal emergency contraception should always be given progestogen-only EC (known as Levonelle in the UK). In some parts of the country and abroad, the combined hormonal method (known as Schering PC4) may still be prescribed, but this will probably be discontinued in the UK sometime during 2001.

Is it effective? Emergency pills must be taken within 72 hours of unprotected sex. They are more effective the sooner they are taken. Research shows that progestogen-only pills are more effective than combined pills.

What's involved? Both types of pill are taken in the same way. The first dose (one pill, if taking progestogen-only pills, or two pills, if taking combined pills) should be taken as soon as possible. The second dose is taken twelve hours later.

How do they work? They work by stopping or delaying ovulation (egg release) or by preventing a fertilised egg settling in the womb (implanting). Opponents of EC continually state that these pills cause an abortion. However, the medical and legal standpoint on this is clear; abortion can only take place after a fertilised egg has implanted in the womb. EC prevents pregnancy and is not abortion. People who believe life begins at fertilisation may not wish to use EC.

Are there any risks? No. Most women can use emergency pills. They are safer than being pregnant and having an unplanned baby. If you are taking any drugs or medicines or have any illness, you need to mention this so the right method can be used.

The main disadvantage is feeling sick or vomiting, and this nasty side effect is much less likely with progestogen-only pills. Emergency pills are so safe that, even if you take them not realising you are pregnant, they will not affect the pregnancy or harm the baby.

The copper IUD

Many women are not aware of this option. If you don't want to use emergency pills or you have missed the 72-hour limit, you can use a copper IUD. It works by stopping an egg being fertilised or from implanting in your womb.

A doctor or nurse can fit the IUD within five days of unprotected sex or within five days of the earliest time you could have ovulated. An IUD is never fitted if there is any doubt about these dates, because if a woman is pregnant already, it might result in miscarriage. The IUD is otherwise very safe and extremely effective. It has the added advantage that it can be left in place for use as a long-term method of contraception. If you want it removed, this can be done during your next period.

Where can I get EC?

You can get EC free from:

  • Any GP who provides contraceptive services
  • Any family planning clinic
  • Any young person's clinic or Brook clinic
  • Most genito-urinary medicine (GUM)/sexual health clinics
  • Most NHS walk-in centres (in England only)
  • Some hospital accident and emergency departments (phone first)
  • Some pharmacies.
You can buy emergency contraception from:
  • Most pharmacies if you are sixteen years old or over
  • Some privately run clinics, such as British Pregnancy Advisory Service (BPAS).
Importantly, all the advice and treatment you receive is confidential - wherever you receive it.

For information and advice on all methods of contraception visit: The Family Planning Association website or ring their helpline on 0845 3101334