This document provides information on emergency contraception (EC), including types of EC, how EC works, effectiveness, safety, side effects, instructions for clients, and follow-up care. It discusses EC options like emergency contraceptive pills containing levonorgestrel or the Yuzpe regimen, and copper IUDs. EC is very safe and reduces risk of pregnancy by 75% or more. Common side effects include nausea, vomiting, and irregular bleeding. Proper use and follow-up guidance is outlined. Post-abortion and postpartum family planning is also summarized.

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By Mulualem S. (MSc)

2. Objectives
By the end of this module, you will be able to:
 To describe the different EC and their regimens
 To explain mechanism of action and
effectiveness of EC
 To describe benefits and side effects of EC
 To describe options for post abortion and post
partum FP
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What is EC?
 A type of contraception that is used as an
emergency to prevent unintended pregnancy
following an unprotected sexual intercourse.
 Sometimes referred to as the “morning-after pill” or
“post-coital contraception”.

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Types of EC
 Emergency contraceptive pills (ECPs):
COC or
POP
 Copper-releasing IUDs.

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Who can use EC?
When no contraceptive has been used
When there is a contraceptive accident/ misuse
Condom rupture, slippage or misuse
IUCD expulsion
Three COC missed consecutively & late for DMPA
injection by > 4 weeks
POP contraceptive pill taken 3 or more hours late
Failure of a spermicidal to melt before intercourse
Failed coitus interruptus (withdrawal)
Diaphragm dislodgement or early removal.
Miscalculation of the safe period when using a fertility
awareness based method.
In case of Rape

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Not eligible for EC
 Client who is already pregnant

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ECP regimen
Can be used up to five days following unprotected
sexual intercourse.
1. Progesterone only pills
 Pills containing 0.75mg levonorgestrel such as
postinor-2, Optinor.
 1 pill as soon as possible after unprotected intercourse
followed by a same dose taken 12 hours later.
 Pill containing 1.5mg levonorgestrel:
 1 pill only as soon as possible after unprotected
intercourse
 Pills containing 0.03mg levonorgestrel (microlute,
norgeston, ovrette)
 20 pills for the 1st & 2nd dose 8

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ECP regimen …
2. Combined OCP/ Yuzpe's method
 High dose pills containing 50 µg of
ethinyl oestradiol & 0.25mg
levonorgestrel (neogenon, ovran,
eugynon)
 1st dose: 2 pills as soon as possible after
unprotected with in 5 days
 2nd dose: 2 pills 12 hours later
 Low dose pills containing 30 µg ethinyl
oestradiol & 0.15 mg of levonorgestrel
(microgynon, nordate, lo/femenal)
 4 pills for the 1st & 2nd dose
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How does EC work?
Delay or inhibit ovulation
 Is the principal mechanism
Prevent implantation
Prevent transport of the sperm & ovum
* Emergency contraceptives are not effective once
implantation has occurred.
*ECPs do not interrupt or abort an established
pregnancy

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Safety and effectiveness
Safety
 ECP are considered very safe
 In > 20 yrs no death or serious complication
reported
 ECP is not associated with fetal malformation/
congenital defect
 ECP do not increase the possibility of ectopic
pregnancy
Effectiveness
 ECP reduce probability of becoming pregnant
 By 75% in case of COC &

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Side effects
Nausea
Most common
More in COC user than POP users
 In about 50% of clients using combined
ECPs and in 20% of women using
progestogen-only ECPs
Usually does not last > 24 hrs
Management:
 Take the pill with food/ at bed time
 Prophylactic anti -emetic may be
considered in women who had nausea in
previous ECP use

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Side effects …
Vomiting
 In 20% of women using COC &
 In 5% of women using pops as ECP
 Management- if vomiting occurs with in 2
hours, the dose should be repeated
Irregular vaginal bleeding or spotting
 Inform that ECP do not bring menses
immediately
 If the menstrual period is delayed for >1
week from the expected date, consider the
possibility of pregnancy
Breast tenderness, headache, dizziness &

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Instructions to the client
Explain the correct use of the method
Advise that emergency contraception does not
protect against STIs including HIV.
Counsel on regular contraception then after.
Advise the client to drink milk or eat a snack
with the pills to reduce nausea.
Advise her to use a barrier method until her next
menstruation if she has sexual intercourse.
Explain that after the use of ECPs most women
will have the next menstrual period early or on
time.
If the menstrual period is delayed for more than
1 week the possibility of pregnancy should be

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Follow-up care
If the client adopted a method of contraception for
regular use no follow-up should be required in
relation to the use of EC
During the follow-up contact discuss suitable
contraceptive options
Oral contraception can be started the day after
ECP is taken.
Injectables, implants and IUCD can be given
within 7 days of the beginning of the next
menstrual cycle.
In case of failure of ECP
 If the client decides to continue the pregnancy,
reassure her that there is no risk of teratogenic

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Copper-bearing IUCD
A copper-bearing IUCD can be used within 7
days of unprotected intercourse as an EC.
Failure rate: <1% of women become pregnant.
Indications: in addition to those for EC
 The client is considering using an IUCD for
continuous, long-term contraception.

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Unsafe Abortion & Contraception
Globally, approximately 500,000 maternal deaths
each year
Nearly 70,000 are from unsafe abortion
A way to end unsafe abortion is through
contraception

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Post-abortion FP
Timing of counseling: Before or after treatment for
abortion
Safe methods to prevent pregnancy are available
 Most contraceptive methods can be used
immediately following abortion
Inform the client that she could become pregnant
again within 10 days if not using contraception
Provide or inform how she could obtain
contraceptive services
After abortion, the recommended minimum
interval to next pregnancy is at least six months
 In order to reduce risks of adverse maternal and
perinatal outcomes

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Post abortion FP Methods
Uncomplicated abortion:
 Uterine Size up to 12 Wks: All methods can be
used
 Uterine Size Greater > 12 Wks
 Most methods can be used immediately, IUCD
can also generally be used (Category 2)
Abortion with Complications:
 Infection or genital trauma
o Delay female sterilization and IUCD insertion
 Severe bleeding:
o Sterilization should be delayed

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Unmet need for PP FP
Only 3-8% of post partum woman want
pregnancy with in 2 years
Only 40% of post partum woman use FP
After a live birth, the recommended interval
before attempting the next pregnancy is at least
24 months.

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PP FP counselling
Timing of counseling could be at any of the
following visits:
 Preconceptional
 During antenatal care
 During the latent phase of labor
 Early in the postparum period
 During late postpartum period

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Breast-feeding- Contraception
Breast-feeding (Lactational amenorrhea method/
LAM)can only be considered as a method of
contraception if
The women is amenorrheic
Wtihin the first 6 months postpartum and
Exclusively breast-feeding
Even in women who are breast-feeding properly
12% will ovulate within the first 6 months and
2% will get pregnant

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Thank