What if a condom slips off, or a divorced couple is unexpectedly intimate (for "old time’s

sake") without birth control, or a couple runs out of condoms and uses only foam, or

a woman is raped while trying to walk to her car after a night class, or a woman is two

days late starting a new pack of pills, or a woman drinks too much at a party and has

unprotected sex, or a woman leaves her NuvaRing in longer than 5 weeks, or a couple

with a new baby have intercourse before they restart birth control? What if a woman is

one of the 54% of single, nonmonogamous women who do not use birth control every

time (Beil, 2009)? Studies indicate that each night more than one million women in the

United States who do not want to get pregnant have unprotected sex (G. Harris, 2010).

Fortunately, in these and numerous other situations, a possible pregnancy can be

emergency contraception prevented by using emergency contraception (EC). After unprotected intercourse,

H°rm°ne pills or an IUD that can be a hormone pill, packaged as Plan B or Next Choice (I Figure 10.8); a nonhormonal used after unprotected intercourse to

K pill, Ella; or insertion of a ParaGard IUD are options for emergency contraception.

prevent pregnancy.

The IUD is the most effective in preventing pregnancy and can be inserted up to 7 days after unprotected intercourse. If the ParaGard IUD is inserted up to 5 days after unprotected intercourse, it is over 99% effective in preventing pregnancy (Golden et al., 2001). It is appropriate for women who plan to use the IUD as an ongoing method of

chapter 10

contraception, but its use is limited to women who are at low risk of sexually transmit­ted infections and pelvic inflammatory disease (Long, 2002).

Plan B or Next Choice is the most commonly used method and is most effective taken within the first 24 hours after intercourse, typically 95% effective in preventing pregnancy. Within 72 hours both are 75% effective, and even within 120 hours, they can provide a small degree of protection from pregnancy (G. Harris, 2010; Piaggio et al., 2011). Any woman or man, 17 years of age or older, can get Plan B or Next Choice by asking a pharmacist (Wood et al., 2012). However, a pharmacist is not required by law to dispense emergency contraception, and one study found that one in five pharmacists may refuse to give emergency contraception to young women (Szalavitz, 2012). Search the website http://ec. princeton. edu for a pharmacy in your area that dispenses EC, or call the telephone hotline at 1-888-668-2528.

In 2010 the FDA approved another emergency contraceptive, Ella, that works up to 5 days after unprotected sex. Ella, available only by prescription, is a nonhormonal pill and contains ulipristal, a drug that blocks the effects of key hormones necessary for conception.

As shown in ■ Table 10.7, two or more oral contraceptives can be substituted if the emergency contraceptive treatment is not available. These hormone treatments work primarily by inhibiting ovulation (Population Council, 2005). They may also provide secondary protection by altering cervical mucus and the lining of the uterus. When a woman uses EC, she should also be aware of and watch for side effects similar to those related to birth control pills.

Increased knowledge and use of EC could prevent an estimated 2.3 million unin­tended pregnancies each year in the United States. A study of college students found that only 16% knew EC was available at their college health center (Miller, 2011). Most women are not aware that an IUD is a possibility for emergency contraception (Wright et al., 2012). Studies at abortion clinics indicate that 50 to 60% of the patients would have been treatable with and would have wanted to use emergency contraception rather than have an abortion if they had known about it and had had access to it (Speroff & Fritz, 2005). Women in London, England, can order emergency contraception over the Internet, and a courier will deliver it within two hours (Hope, 2012).