As of June 2022 when the United States Supreme Court issued its ruling in Dobbs v. Jackson, the right to an abortion in the United States is no longer constitutionally protected at the federal level. The ruling is significant and means the inevitable loss of safe and legal abortion access for countless people, particularly people of color, people with low incomes, adolescents, and others who have historically faced systemic barriers to care.
This new landscape has left many people rethinking their contraceptive choices and underscores the importance of Upstream’s work in increasing equitable access to the full range of contraceptive options, including emergency contraception. Despite emergency contraception being available in the US for many decades, confusion persists about what it is and how it works. Providers can clear up this confusion by utilizing evidence-based guidelines for counseling and prescribing, and continuing to offer patient-centered care that is free of coercion and bias.
What is Emergency Contraception?
Emergency contraception is a contraceptive method that is used to prevent pregnancy after an episode of unprotected intercourse, a contraceptive failure (such as a broken condom or a missed pill), or a sexual assault. Emergency contraception is not the same as abortion because emergency contraception is used to prevent pregnancy. Emergency contraception is not effective after implantation and will not end a pregnancy. Medical abortion (the abortion pill) acts after there is a confirmed pregnancy.
Emergency contraception provides people with a final opportunity to use contraception for pregnancy prevention. It is available in both oral forms and as an intrauterine device (IUD).
Emergency Contraception Pills
Plan B (and other generics) and ella® are emergency contraception pills. Plan B contains levonorgestrel, a progestin, and ella® contains ulipristal acetate, a progesterone receptor modulator. They both work by delaying or preventing ovulation.
Plan B is most effective when taken within 72 hours after unprotected intercourse (but can be taken up to 5 days after) and ella® is effective within five days after unprotected intercourse. Because emergency contraceptive pills are most effective the sooner they are taken after unprotected intercourse, it’s a good idea for people to have these on hand ahead of time in case they are needed. Plan B can be purchased without a prescription, while ella® requires a prescription from a healthcare provider.
Ella® is the more effective of these two options for all people. This is especially important for anyone who weighs more than 165lbs or has a body mass index (BMI) of 30 or over. In this case, Plan B may be less effective and ella® would be the preferred oral option. Ella® may be less effective in anyone who weighs over 196lbs or has a BMI of 35 or greater.
After use of ella®, wait 5 days before starting or restarting a hormonal contraceptive method. Progestins in hormonal contraception can interfere with ella®’s ability to delay ovulation. This is not a concern with Plan B.
Intrauterine Devices (IUDs) for Emergency Contraception
IUDs are the most effective form of emergency contraception. IUDs work primarily by preventing fertilization. When used as emergency contraception, they may also sometimes prevent implantation of a fertilized egg. There are no weight limitations associated with the use of IUDs.
The Copper IUD is a non-hormonal contraceptive that has a long history of use for emergency contraception. It has historically been considered effective when used within five days after unprotected intercourse. New research suggests that the Copper IUD can be effective for up to 14 days after unprotected intercourse and can be used anytime a pregnancy test is negative.
Additionally, emerging evidence demonstrates that some of the hormonal IUDs (specifically the levonorgestrel 52mg IUDs with the brand names Mirena and Liletta) are as effective as Copper IUDs for emergency contraception.
Strategies for increasing access to emergency contraception:
- Use shared decision-making with your patients to determine which EC method is best for them.
- Prescribe oral EC ahead of time so patients have it on hand when they need it.
- Stock Plan B and ella® in clinic pharmacies to reduce barriers to obtaining oral EC.
- Know which pharmacies in your local community stock ella®, which can be harder to find than Plan B.
- Provide scheduling options that allow for same-day IUD placements for EC.
- Train front office and call center staff on all EC options including IUDs.
- Increase patient awareness about EC through educational initiatives and patient education materials.
If you are interested in learning more about Upstream’s training and technical assistance please visit https://upstream.org/contact-us/.
Additional Resources on Emergency Contraception
American Society for Emergency Contraception
https://www.americansocietyforec.org/reports-and-factsheets
American College of Obstetricians and Gynecologists
https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2015/09/emergency-contraception
Reproductive Health Access Project
https://www.reproductiveaccess.org/wp-content/uploads/2014/12/2021-03-EmergencyContraception-english.pdf
https://www.reproductiveaccess.org/wp-content/uploads/2014/12/difference.pdf
Journal Articles
Contraception, Cleland K, Kumar B, Kakkad N, Shabazz J, Brogan NR, Gandal-Powers MK, Elliott R, Stone R, Turok DK.
Contraception, Gemzell-Danielsson K, Berger C, P G L L.
Emergency contraception — mechanisms of action.
Contraception, Thompson I, Sanders JN, Schwarz EB, Boraas C, Turok DK
Copper intrauterine device placement 6–14 days after unprotected sex.
