by Doctor Henry Madzorera

There are many reasons why emergency contraception may need to be used. Abortion on demand is not permitted by law in Zimbabwe, so we all must work hard to prevent unwanted pregnancies. The unmet need for modern contraception in Zimbabwe is 13%, which means there are many women out there who need contraception but do not have access to it. Today we want to look at emergency contraception following unprotected sex or failure of a contraceptive method you were using, such as a burst condom. Missing a dose or two of your regular contraceptive pill makes you vulnerable to an unwanted pregnancy, and this is another indication for emergency contraception.

There are two types of emergency contraception, and these are 1) the morning after pill, and 2) the intrauterine contraceptive device (IUCD).

The morning after pill should be taken within 72 hours of unprotected sexual intercourse. The earlier the better. Here in Zimbabwe we use either the combined oral contraceptive pill (COC), or the progestogen only pill (POP). They both work equally well. Two doses of the pill are taken 12 hours apart.

There are two strengths of the COC pill, the low dose oestrogen and the high dose oestrogen pills. They are taken differently. The low dose COC has 30-35 micrograms of ethinyloestradiol, and you should take 4 tablets within 72 hours of unprotected intercourse, repeated once after 12 hours. The high dose pill has 50 micrograms of ethinyloestradiol, and two tablets should be taken within 72 hour of sexual intercourse, to be repeated after 12 hours. That gives adequate protection.

The POP contains 750 micrograms of levonorgestrel, and a single dose of two tablets should be taken. Alternatively, one may choose to take one tablet at once, and a second dose after 12 hours. There are other pills for emergency contraception in other countries, but let’s stick to what is available here.

The IUCD should be inserted within 5 days of unprotected sex.  The IUCD (copper T) contains copper which inhibits pregnancy.  This method works much better than the hormonal methods mentioned above, and it has a less than one percent failure rate. If you want to keep the IUCD for long term use, that is perfectly permissible. You get 10 years of protection from copper-T IUCD.

There are no serious long term adverse effects from taking the emergency contraceptive pill, though it may cause minor side effects such as headache, abdominal pain, and changes to your next period which may come earlier or later, and may even be more painful than usual.

If you vomit within two hours of taking your morning after pill, you need to visit your clinic or doctor. They may repeat the pill or insert an IUCD, whichever you prefer. Medications for epilepsy, too much acid in the stomach (eg omeprazole), and others may reduce the effectiveness of the morning after pill.

The morning after pill should not be used as a regular form of contraception. While there are no known serious side effects from taking the morning after pill more than once in any cycle, you are highly encouraged to go onto regular contraception if you need it. It is important to note that emergency contraception will not prevent sexually transmitted infections (STI’s). If therefore you have survived sexual assault, you need examination and possibly post exposure prophylaxis for HIV and treatment of other infections you may have acquired.

For any questions about emergency contraception please visit your clinic or doctor.