Information for users:
The emergency contraception pill, often called “the morning after pill”, “Plan B” or “ECP”, is a method of preventing pregnancy after unprotected sexual intercourse has occurred. Emergency contraception can be used when a condom breaks, after a sexual assault, when a woman has skipped two or more birth control pills in a row or any time unprotected sexual intercourse has occurred. Emergency contraception can be effective if taken up to five days after unprotected sexual intercourse. However, the earlier the pill is taken the more effective it is. Emergency contraception does not protect you from getting a sexually transmitted infection. If you have had unprotected sex with someone whose sexual background you do not know, it is advisable to get tested for possible infections.

The form of ECP available directly from pharmacists in Canada is made of Levonorgestrel and is commonly sold as Plan B, although there are generic versions available in Canada now, like NorLevo. It is a safe, effective and easy-to-use method consisting of two levonorgestrel pills. Levonorgestrel is a progestin, which means that it is a steroid that is absorbed like the body’s naturally produced hormone, progesterone. It does not contain any estrogen. Plan B should be taken as soon as possible after unprotected intercourse. Its effectiveness decreases significantly if taken after 24 hours. Although Plan B can be taken up to 3 days after sex, by this time it will only be 58% effective as opposed to having a 95% effectiveness rate if taken within the first 24 hours. The price ranges from $20 to $50, depending on the province you live in and depending on the pharmacy that you go to.

Alternatively, ECP is available for free or at a nominal cost from many health clinics and sexual health centres, women’s centres/clinics, community health clinics, birth control clinics, university health centres and emergency hospital rooms. Click here for a list of Canadian Federation for Sexual Health members in your area. Consider having a package of Plan B or other ECP at home for emergency situations.

ECP works differently depending in which stage of your menstrual cycle you are when you take it. Most of the time, the pills either stop or delay the release of an egg (ovulation). Sometimes, if you have already released an egg and it became fertilized, ECP prevents it from implanting on the uterus wall thereby preventing you from getting pregnant. If you are already pregnant, taking ECP will not cause a miscarriage and will have no negative effect on the embryo.

Since there is no law requiring that all pharmacies offer emergency contraception, be aware that some pharmacists who are anti-choice may refuse to provide you with it. In this case, try going to another pharmacist at another pharmacy.

However, according to the code of ethics to which Canadian pharmacists are bound, your pharmacist should provide you with a referral to another pharmacist that can dispense ECP to you. If they refuse to refer you, you can find other pharmacies in your area using a phone directory or online listing. Be sure to call ahead to see if they will dispense ECP. You can also report a pharmacist for refusing to refer you by contacting the College of Pharmacists in your province.

If you are sexually active or are planning to become sexually active, do not use emergency contraceptives as your only protection against pregnancy. They are not as effective as an ongoing contraceptive method such as the birth control pill or condoms. They are also more expensive than the majority of contraceptives. Although emergency contraception does not have permanent or long-term side effects, for some women, taking the emergency contraception pill can cause nausea, vomiting, diarrhoea or spotting. If vomiting occurs within one hour of taking the ECP, the dosage must be retaken. As stated above, emergency contraception does not protect against sexually transmitted infections.

Emergency contraception is different from RU-486, also called the “abortion pill”, which is used for medical abortion but is not available in Canada. In Canada, medical abortion is provided with a combination of two drugs, methotrexate and misprostol given either orally or by injection. While the prescription drugs used in medical abortion provoke the termination of a pregnancy, emergency contraceptive pills will not terminate an existing pregnancy. It does not prevent pregnancy from occurring due to acts of unprotected intercourse later in the same menstrual cycle either.

If you require additional information on emergency contraception or where to access it, the Canadian Federation for Sexual Health has a national emergency contraception toll-free information line. The number is 1-888-270-7444.







Another form of emergency contraception works by the insertion of a copper intrauterine device (IUD). An IUD is a small T-shaped device that is placed inside your uterus and reduces your risk of pregnancy by 98-99%. A copper IUD can be inserted by a doctor up to seven days after unprotected intercourse and will prevent a fertilized egg from implanting in the uterus, thus preventing you from becoming pregnant. It can then be left in as a long-term method of contraception. The copper IUD can be ideal for women who cannot or choose not to take hormonal medication and who want a very effective, long-term method of contraception. The IUD is not recommended as a form of emergency contraception if there is the possibility that you may have a sexually transmitted infection, like chlamydia or gonorrhoea, at the time of the insertion. Copper IUDs can be more difficult to access than emergency contraceptive pills as they need to be inserted by a doctor. They can cost between $30 - $100 and are available through most health care providers, health clinics and some sexual health clinics.

Access problems
In Canada, we often take for granted the fact that we have access to the quality reproductive health supplies that we need. However, the failure rates for regular contraceptives and the high rates of unintended pregnancies highlight the fact that having access to reproductive healthcare supplies does not mean that everyone uses them. In Canada, at least 40% of all pregnancies are unplanned (Delbanco, Lundy, Hoff, Parker & Smith, 1997). Many argue that the percentage is even higher for adolescent pregnancies (SOGC). Emergency contraception is just one example of many barriers faced by Canadian women trying to access reproductive health supplies.

Up to April 2005, women needed a doctor’s prescription in order to access emergency contraception pills. In April 2005, Health Canada made emergency contraception pills (ECP) available in drugstores without a prescription and without the need for a consultation with a pharmacist (PHAC). Therefore, you can now get ECP over the counter (CFSH). It is recommended that you call the pharmacy beforehand to ensure that they have ECP in stock. ECP is also available at sexual health centres, women’s centres/clinics, community health clinics, birth control clinics, public health departments, university health centres and emergency hospital rooms. However, ECP is not as accessible as one would hope.

Access to ECP is still limited in part because pharmacists can refuse to sell it according to their personal beliefs. There have been many cases where women, old and young, married and unmarried, have been denied the morning after pill because the pharmacist judged that they should let the pregnancy continue or because the pharmacist was opposed to a woman’s right to choose when she wants to be pregnant.

Vulnerable populations such as aboriginal people, youth, people living with disabilities, people with a lower income and people living in rural areas find many more challenges than the general public in accessing ECPs. In rural areas where there are often a limited number of pharmacists, refusal to sell ECP can lead to women having to travel to a neighbouring town to access it. This can be time consuming, expensive, and can conflict with work and childcare.

In order to obtain the drug, many women are subject to ad-hoc counselling that requires them to reveal unnecessary personal information. Pharmacists often charge for this counselling fee, which increases the cost of accessing the ECP. The ECP itself is usually sold for around $25. The counselling fee can be as much as $20, bringing the cost of the ECP to be around $40 to $50. This is an amount many women simply cannot afford.

Taboos on youth sexuality can also challenge access to ECP because some pharmacists can be judgmental, intimidating or can threaten to warn parents or family members of their adolescents’ behaviour. This can be a bigger barrier in rural areas where there are only a few pharmacies in the same region and where people do not have a choice about where they can buy the pills.

Misinformation also plays a key role in challenging access. Many Canadian women do not even know that emergency contraception is available, especially in regions where abstinence-only education is common or where sexuality education is taboo. The anti-choice movement is spreading inaccurate information on ECP by saying that it is an abortion or that it causes infertility. The truth is that ECP prevents a pregnancy from happening and will not stop a pregnancy from continuing if it has already occurred. It does not have any long-term consequences on a woman’s health.

Possible solutions?
In order to make ECP more accessible, we must dedicate efforts to improve the quality and quantity of sexual education provided in schools so that young people know how to adequately use contraceptive methods, how to avoid unplanned pregnancies, and how to use emergency contraception. Information on the availability of contraceptives and of the ECP should also be made available to the general public.

 

Contrary to some beliefs, a recent University of California study showed that having better access to ECP does not result in women abandoning traditional contraception methods, nor does it encourage adolescents to engage in promiscuous sex (Hyman, 2005). Increasing access to ECP will contribute to reducing unintended pregnancies.

If you have a story to share about your experience of accessing and using emergency contraception, please send it to us at info@canadiansforchoice.ca or by fax at 613-789-9960. All information will be used anonymously.





Myths and Misconceptions

There is a lot of information available about ECP, but unfortunately not all of it may be accurate. Here are a few myths and misconceptions that are repeated often and reappear frequently online.

 

Is using ECP safe?

Yes. If used as directed, ECP has very few risks. Like most medications, there are some minor side effects that you may experience, but the occurrence of serious side effects is very rare. The most common side effect from taking ECP is nausea, so it is a good idea to eat something and take anti-nausea medication an hour before you take the ECP. There are no known long-term or serious side effects from using ECP. If you are currently take medications or have health concerns, you should discuss them with a pharmacist when purchasing your ECP. If you don’t feel comfortable talking about your medical history in the pharmacy, you could call a pharmacist beforehand to ask their advice.

 

Will taking ECP make it more difficult for me to get pregnant later?

The chemicals in ECP leave your body completely within a few days of taking it. It has no effect on a woman’s ability to get pregnant at a later time; in fact it is possible for women who have taken an ECP to get pregnant from any subsequent sexual intercourse, even within the same menstrual cycle. That means it is important to continue to use contraception to prevent unwanted pregnancy, even between taking ECP and your next menstrual period. Neither ECP nor regular oral contraceptives have a long term effect on a woman’s ability to conceive in the future (Liskin & Rutledge, 1984).

 

Does ECP cause cancer?

No. IUDs containing levonorgestrel, the same chemical as ECP, are even recommended as a preferable form of contraception for women who have survived some forms of cancers. Medications containing estrogen, like some forms of hormone replacement therapies, have been linked to cancer in some studies. However many birth control pills and all emergency contraceptive pills in Canada contain only progestins, no estrogens, and are not linked to causing cancers (Shwarz, Hess, & Trussell, 2009).

 

If I’m already pregnant, will ECP cause an abortion/miscarriage?

No, emergency contraception is NOT the same as the abortion pill. Emergency contraceptive pills prevent pregnancy by preventing a woman’s ovaries from releasing an egg so that it won’t become fertilized; therefore, pregnancy does not happen. In some cases, ECP works by altering the lining of the uterus to make it more difficult for fertilized ova to implant; thus preventing you from becoming pregnant. If you are already pregnant, taking ECP will not cause an abortion or miscarriage.

 

If you are already pregnant and you are seeking a medication for an abortion (called medical abortion and sometimes referred to as the ‘abortion pill’) you can click here or phone our Information and Referral Access Line at 1-888-642-2725 for more information about what is available to you.

 

If I’m already pregnant and I take ECP will it harm the embryo or fetus?

No, studies show that women who accidentally take ECP while already pregnant had no higher risk of birth defects than those who didn’t take ECP at all. Some studies also suggest that ECP is safe to take while breastfeeding (Trussell & Raymond, March 2011).

 

Does taking ECP cause ectopic pregnancies?

No, because emergency contraceptives are effective in lowering your risk of pregnancy, they also lower the risk that an ectopic pregnancy will occur. The rate at which ectopic pregnancies occur after ECP fails is the same as for those who did not use ECP at all (Cleland, Raymond, Trussell, Cheng, & Zhu, 2010).

 

 

References

  • Liskin L, Rutledge AH. After contraception: Dispelling rumors about later childbearing. Pop­ulation Reports, 1984 Sept–Oct; Series J (28).
  • Shwarz, E., Hess, R., Trussell, J. (2009). Contraception for Cancer Survivors. Journal of General Internal Medecine. 24(Supplement 2), 401-406.
  • Trussell, J & Raymond, E. (March 2011). Emergency Contraception: A last chance to prevent unintended pregnancy. Princeton Review Online.
  • Cleland, K., Raymond, E., Trussell, J., Cheng, L., Zhu, H. (2010). Ectopic Pregnancy and Emergency Contraceptive Pills: A Systematic Review. Obstetrics & Gynecology. 115(6), 1263-1266.