In favour of the pill

Emergency contraceptives are a better means to reduce the chances of pregnancy
In favour of the pill

emergency contraception is a safe and effective method to protect women from induced abortions, according to American researchers.

At present, steroid hormone pills and copper releasing intrauterine devices ( iud s) are the two emergency contraceptives mainly used by people. Among the steroidal preparations, high dose oestrogens, oestrogen-progesten combinations and progesten pills are available in many countries. Their use after unprotected sex can substantially reduce the incidence of pregnancy.

The copper iud s offer a more effective method of preventing pregnancy in comparison to hormonal methods. The iud method also helps women if they use the device on a long-term basis. In India, only 19 per cent of married women in the age group of 15-24 years use contraceptives. As a result, nearly 17 per cent of teenagers are exposed to the risk of pregnancy. This contributes substantially to 1-4.4 million abortions every year in developing countries. About 70,000 deaths occur annually in India because of unsafe abortions.

Despite the availability of the drugs for the last 20 years, emergency contraceptives have not been widely used. Stanley Zinberg of the American College of Gynaecologists ( acog) says that many physicians and health care providers even in the us are unaware of the safety and efficacy of oral contraceptives that could prevent at least 75 per cent of all unwanted pregnancies provided the medication is taken in proper time ( Journal of American Medical Association , Vol 278, No 2).

In the us, there are nearly 1.7 million pregnancies and 800,000 abortions each year. The acog campaign aims at educating physicians and people about the safety and efficacy of contraceptive drugs. It has recommended the use of 'Yuzpe' method of emergency contraception, discovered by obstetrician and gynaecologist A Albert Yuzpe in the 1970s. Women are required to take four tablets containing 0.05 mg of dl -norgestrol - the first two 72 hours after sexual intercourse, followed by two tablets 12 hours later.

The use of copper iud s as a method of contraception is known since the 1970s. The effectiveness of these iud s is due to their ability to prevent implantation as a result of changes in the tissue of the womb, due to the presence of copper ions. This is a highly effective method of contraception with the failure rate as low as 0.1 per cent. The upper limit of inserting iud s is five days after unprotected sex, which is 48 to 72 hours more than the time required for hormonal pills. The other advantage of using iud s is that they can be used for a long time.

The acog is also advising physicians and health care centres about minor side-effects noticed in patients taking these pills. Vomiting and nausea (women suffering from severe morning sickness) occur in 12 to 22 per cent of patients. Such people should be advised to take an antiemetic (a medicine used to prevent vomiting) one hour before taking the emergency contraceptive.

Studies have also shown that in more than 98 per cent of women taking these pills, regular period starts in 21 days. Over 90 per cent of these periods are of normal duration for the patients. If the menstrual period does not start within 21 days, the acog advises that such women seek medical advice and go for a check up.

Though their efficacy has been known for a long time, the mechanism of oral contraceptives in preventing pregnancy is still not clear. No investigations have been undertaken to determine whether the small number of women who conceive after the failure of emergency contraceptive give birth to children with birth defects. However, studies have shown that no abnormalities were found in children whose mothers used oral contraception, even with very high dose steroidal preparations.

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