The Scandal of Emergency

Dr Duncan Shrewsbury II  30 NOV 2016

A recent news item reports on campaign work calling for an end to ‘patronising and insulting consultations’ for the morning after pill, otherwise known as emergency contraception. The article claims that the process is outdated and undermining to women, 'deliberately chastising' them for their choices and asserting some level of 'moral judgement.

Where is the scandal?

The campaign raises some valuable points that the health profession ought to consider, including how easy it is to access all forms of contraception, and the way patients feel during consultations when seeking contraception. However, they also call for emergency contraception to be down-regulated, so that it can be bought ‘over-the-counter’ (without a prescription, or without needing to see a healthcare professional).

They also draw on suggestions that the cost of emergency contraception (when bought through a consultation with a pharmacist) is set higher in the UK, compared to other European countries, as an intentional dissuader to regular use. These are all valid points and demand consideration.
Should women have to pay so much and undergo ‘scrutiny’ for the right to manage their own bodies?

Emergency contraception, the facts

Emergency contraceptive tablets (based on progesterone) are believed to work by preventing the release of an egg from the ovaries. There is also some suggestion that they may affect the lining of the womb, and how a fertilised egg may implant. There are three main forms of emergency contraception available, two kinds of progesterone tablets and one metallic implant.

Of the tablets, one works if it is taken within the first 72 hours after unprotected sex. The other works up to 5 days afterwards. The latter is only licensed for use in women over the age of 18 years.
These methods are believed to be about 97-98% effective, although they are more effective if taken sooner within the their treatment window. We do not fully understand how they work at different points in a woman’s menstrual cycle.

The most effective form of emergency contraception is a copper coil (a tiny devise that is introduced into the womb, and can stay there for up to 5 years). This is about 99% effective, and also has the benefit of providing on-going contraceptive cover, whilst it remains in place.

Concerns and limitations 

I realise the irony (or potential controversy) that I would offer an opinion, as a man. I wholeheartedly believe in a woman’s right to choice. However, as a future GP, I also believe that choice should be informed. To suggest that emergency contraception is a safe alternative to regular contraception, and that it should be available over-the-counter, is misleading.

It is true that the side-effects and risks of the emergency contraceptive tablets are few. This does not, however, mean that they are safe for unregulated sale. The British Pregnancy Advisory Service suggest that ‘‎There is no clinical reason for a woman to consult with a healthcare professional before she obtains emergency contraception, unless she wishes to’. I would agree that this is often the case. But not always, as it often isn’t possible for the woman to tell (or tell us) whether she needs further help or not.
This is one limitation of assuming knowledge, which often require years of specific training to gather.

When discussing emergency contraception, health professionals have a duty to check the welfare of their patient.  It isn’t unusual, as a GP, to be approached by women as young as 14 or 15 years for emergency contraception. Sadly, some women are forced into sexual intercourse, or seeking contraception against their will.

It is in these cases that healthcare professionals have a duty to ensure that a woman’s safeguarding needs are met. Moreover, the consultation serves as an opportunity to educate about other forms of (regular) contraception, and sexual health matters.  The benefits are clear when considered independently.

For more information on contraception, or emergency contraception, see NHS Choices, or book an appointment to see your GP or practice nurse.  If you, or someone you know is need of help, or more information regarding forms of sexual abuse or assault, see SafeLine.

Any opinions above are the author's alone and may not represent those of the NHS or Mind and Medicine. Any comment is based on the best available evidence at the time of writing.  All data is based on externally validated studies unless expressed otherwise. Novel data is representative of sample surveyed. Online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice.

4. Faculty of Sexual and Reproductive Healthcare Clinical Guidance. (2012) Emergency Contraception. FSRH Clinical Effectiveness Unit.