POLICYTHE FACTS BRIEF After Unprotected Sex Safe andEffective Options for Preventing Emergency Contraception • TYPES OFECANDHOW THEY WORK of theiroptions. shouldbeaware wish tobecomepregnant, sex orbeensexuallyassaulted,anddonot Young womenwhohavehadunprotected consulting ahealthcareproviderfortesting. so thosewhoneedECshouldalsoconsider transmitted infections(STIs)includingHIV– EC offersnoprotectionagainstsexually it isnotaseffectiveothermethods. a primarymethodofbirthcontrolbecause experts agreethatitshouldnotbeconsidered of times a womancan safely use EC, most pregnancy, andthere is nolimittothenumber reduces thechanceofanunintended Although emergencycontraception significantly not coveredundertheACAruling. because over-the-countermedicationsare must paythefullcostofPlanBOne-Step covered byinsurance. prescription methodsofbirthcontrolbe significant barrier, byrequiringthat cost, Care Act(ACA)partiallyaddressesanother prescription (see Table 1). The Affordable (“behindthecounter”)orby ages. for purchasebywomenandmenofall Step PlanBOne- (FDA) ruledthatoneECproduct, in 2013,theFood andDrugAdministration science, severelyrestrictedteenaccess.But ideological opposition to EC, not medical Until recently, legal barriersbasedon be usedforemergencycontraception. medications, as well as the Copper IUD, can hormonal Several sex. of unprotected most effective when taken within 12 hours Itis up to120hours (five days)aftersex. emergency contraception canbeeffective term is misleading because some forms of to as the “morning-after pill,” but this Itissometimesreferred or sexualassault. preventing pregnancyafterunprotectedsex Emergency contraception (EC)isameansof number ofways,including: unprotected sexorsexual assaultina A womancanpreventpregnancy after ® 2 , would be available on store shelves Other methods are available from Othermethodsareavailablefrom 3 Young womenstill 3 1 1

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• • • effective than PlanB Research hasfoundthat ella women whoweigh166pounds orabove. Plan BOne-Step -only EC products, like that found have studies Recent inserting anIUD. provider mustruleoutpregnancybefore effect onadevelopingfetus. there islittleinformationaboutella used asEC,willnotharmapregnancy, but only pills,andregularbirthcontrolpills progestin- that found has work. Research she isalreadypregnantbecauseitwillnot . Emergency contraception doesnotcause from implantingintheuterus. an egg,andbypreventingafertilizedegg works bypreventingspermfromfertilizing after theegghasbeenfertilized.TheIUD that eitherPlanBOne-Step from fertilizingtheegg.Thereisnoevidence release anegg);andbypreventingthesperm preventing (whentheovaries Medication formsofECworkprimarilyby ------Many brands ofregular birthcontrol normally worksinthebody. the waythathormoneprogestin contain ulipristalacetatewhichchange ella as such pills Anti-progestin require twopillstakenoverdays. Step Some ofthese,includingPlanBOne- pills butusedinlargeramountsasEC. foundinregularbirthcontrol contain the hormone progestin, a Step Progestin-only pills, like Plan B One- ten years. birth controlandmaybeusedforupto one ofthemosteffectivemethods Itis to fivedaysafterunprotectedsex. prevents pregnancywheninsertedup The copperIUD(calledParaGard learn moreaboutbrands anddosage. contraception. Visitec.princeton.eduto pills alsocanbeusedasemergency ® ® , require only one pill, while others , Next Choice 1 A woman should not use EC if AwomanshouldnotuseECif 1 6 ® , maynotbeeffectivein ® forwomenover 166 ® , and others, which , and others, which ® , orella 5 1

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pounds, but it too may lose effectiveness WITH INCREASED ACCESS, MORE YOUNG in women with a Body Mass Index (BMI) PEOPLE ARE USING EC of over 25. (Learn more about BMI and • Teens and young adults are increasingly how to calculate it here: http://www.cdc. using EC as a pregnancy prevention gov/healthyweight/assessing/bmi/) The method. Fourteen percent of sexually copper IUD’s efficacy is not affected by experienced women ages 15-19 have used weight or body mass.6 EC. Twenty-three percent of sexually experienced women ages 20-24 have 14 EC IS SAFE AND EFFECTIVE used EC. • The FDA states that EC is safe and • In 2002, only 4.2 percent of sexually effective.1,2,5,6 Leading professional experienced women aged 15-44 reported associations such as the American they had ever used EC. In 2006-2010, 11 College of Obstetricians and Gynecologists, percent reported that they had ever the American Academy of Pediatrics, used EC.14 and Society for Adolescent Health and Medicine all support women’s access to • Under the , private EC, regardless of age.9,10,11 health plans are required to cover all FDA- approved, prescribed contraceptive drugs • EC pills are approximately 74 to 85 percent and devices – including prescription effective in preventing pregnancy, forms of emergency contraceptive pills depending on how promptly a woman and the copper IUD. Women who obtain uses them, when during her cycle she EC over the counter will have to pay full had sex, and the kind of EC she takes.1 retail price.12 Some studies show EC is most effective when taken as soon as possible after • In 26 states, covers over-the- unprotected sex.1 Progestin-only pills counter EC. In many states, a doctor must are more effective than combination prescribe EC in order for Medicaid to pills (containing both and cover it, making access in a timely manner progestin).1 The most effective EC pill is more difficult.15 ella® (antiprogestin ). • Plan B One-Step® is now available over-the- • Some women experience side effects when counter after FDA approval in 2013. Generic taking EC. For those who take progestin- versions of Plan B One-Step® are expected only pills, side effects include headaches to be available soon.2 (20 percent of women experience) and 1 (11-12 percent experience). Side CONCLUSION effects are more common among women who take pills containing both estrogen A variety of emergency contraception and progestin and include nausea (in 50 methods are available to young people. percent of women taking it) and Evidence shows that increased access (in 20 percent).12 Other less common side to or advanced provision of emergency effects include , breast tenderness, contraception pills (in advance of need) headache, , and dizziness.1 does not increase risky sexual behaviors or These side effects are significantly more disrupt currently consistent contraceptive 10,16 common for combination pills than use. But young people face cultural, for progestin-only pills.1 Side effects financial, psychological, and social barriers associated with antiprogestin pills include to accessing contraceptive information and headache in 18 percent of users, nausea in services, especially EC-related information 12 percent of users, and abdominal pain and services. Health care providers, in 12 percent of users.1 Side effects of the educators, youth-serving professionals, copper IUD can include an increase in and parents can all play a role in supporting menstrual pain, and pain upon insertion.13 young people’s access to EC and putting their worries about unwanted pregnancy to rest. • The Society for Adolescent Health and Medicine supports increasing awareness of and improving timely access to EC for teens, Written by Sarah Horn and Emily Bridges, MLS including recommending that teens be counseled about emergency contraception.11 Advocates for Youth © January 2014 TABLE 1: TYPES OF EC AND THEIR CHARACTERISTICS1,5,6,7,8,13

ANTI- PROGESTIN-ONLY REGULAR BIRTH COPPER IUD PROGESTIN CONTROL PILLS BRAND NAME ella® Plan B®, Next Choice®, and others Various brands of ParaGard® pills ACTIVE Ulipristal acetate Levonorgestrel Combination of N/A INGREDIENT levonorgestrel and ethinyl astradiol TIMEFRAME FOR Up to five days Most effective within 12 hours of Most effective Must be inserted USE after sex. sex; effective up to three days (72 within three days within 5 days hours) after sex. (72 hours) of sex; (120 hours) of somewhat effective unprotected sex. up to five days (120 Continues to hours) after sex. prevent preg- Taken in higher nancy for up to doses than regular ten years. birth control. HOW IT WORKS Prevents the Prevents the ovary from Prevents the ovary Prevents sperm ovary from releasing an egg; prevents sperm from releasing from fertilizing releasing an egg from fertilizing an egg an egg; prevents an egg; prevents sperm from fertilized egg fertilizing an egg. from implanting in the uterus. WHERE AND Requires Plan B One-Step® is available on Prescription Must be inserted HOW TO GET IT prescription pharmacy shelves to women and usually required. by a healthcare men of all ages. Generic versions provider of Plan B One-Step® are not yet on shelves as of December 2013 but should be soon. Two-pill versions of Plan B® and generics are available behind the counter for those 18 and older. Those 17 and younger must have a prescription to get these products. SIDE EFFECTS Fifty percent or Twenty percent or fewer Twenty percent An increase in fewer experience experience nausea, headaches, or fewer cramping or nausea, painful menstruation. experience nausea, bleeding after headaches, painful headaches, painful insertion is menstruation. menstruation. common; usually goes away after a few months. OTHER NOTES If a woman is Recent studies have found that If a woman uses N/A pregnant and has levonorgestrel/progestin-only EC her supply of taken ella®, she products, like Plan B One-Step®, birth control pills, should consult may not be effective in women she should visit her health care who weigh 166 lbs. or above. her healthcare provider. Research has found that ella® is provider as soon as more effective than Plan B® for possible to refill it. women in this weight range, but it too may lose effectiveness in women with a Body Mass Index (BMI) of over 25. (Learn more about BMI and how to calculate it here: http://www.cdc.gov/ healthyweight/assessing/bmi/) The copper IUD’s efficacy is not affected by weight or body mass. REFERENCES 9. American College of Obstetricians and Gynecologists. The Limits of Conscientious Refusal in Reproductive Medicine. 1. Trussel J, Raymond EG. Emergency contraception: a ACOG Committee Opinion No. 385. 2007. last chance to prevent unintended pregnancy. Office of Population Research, 2013. 10. Committee on Adolescence, The American Academy of Pediatrics. Emergency Contraception. Pediatrics 2012; 130(6): 2. Food and Drug Administration.”FDA approves Plan B 1174-1182. One-Step emergency contraceptive for use without a prescription for all women of child-bearing potential.” 11. Society for Adolescent Health and Medicine. Provision of Accessed 1/10/2014 from http://www.fda.gov/newsevents/ emergency contraception to adolescents: position paper of newsroom/pressannouncements/ucm358082.htm. the Society for Adolescent Medicine. Journal of Adolescent Health 2004; 35:66-70. 3. U.S. Department of Health and Human Services. “Affordable Care Act Expands Prevention Coverage for 12. Kavanaugh ML, Williams SL, Schwarz EB. Emergency Women’s Health and Well-Being.” Accessed 1/10/2014 from contraception use and counseling after changes in United http://www.hrsa.gov/womensguidelines/ States prescription status. Fertility and Sterility 2011; 95(8): 2578-2581. 4. Government Printing Office. Prescription drug products: certain combined oral contraceptives for use as postcoital 13. Hubacher D, Pai-Lien C, Park S. Side effects from the emergency contraception: notice. Federal Register 1997 copper IUD: do they decrease over time? Contraception. (February 25); 62:8609-12. 2009;79:356–362. 5. Food and Drug Administration. “Highlights of Prescribing 14. Daniels K, Jones J, Abma J. Use of emergenc­y Information: ELLA (ulipristal acetate) tablet.” Accessed contraception among women aged 15-44: , 1/10/14 from http://www.accessdata.fda.gov/drugsatfda_ 2006-2010. National Center for Health Statistics Data docs/label/2012/022474s002lbl.pdf Brief 2013; 112: 1-7. 6. ParaGard. ParaGard T 380A Intrauterine Copper 15. Guttmacher Institute. State policies in brief: Contraceptive. Prescribing Information. Accessed 1/10/14 emergency contraception. New York: 2013; http:// from http://www.paragard.com/images/ParaGard_info.pdf www.guttmacher.org/statecenter/spibs/spib_EC.pdf; accessed October 23, 2013. 7. Glasier A, Cameron ST, Blithe D, Scherrer B, Mathe H, Levy D, Gainer E, Ulmann A. Can we identify women at risk 16. Kaiser Family Foundation. Emergency Contraception. of pregnancy despite using emergency contraception? Menlo Park, CA: The Foundation, 2013, http://kff.org/womens- Data from randomized trials of ulipristal acetate and health-policy/fact-sheet/emergency-contraception/. levonorgestrel. Contraception. 2011;84:363-7. Accessed October 21, 2013. 8. Moreau C, Trussell J. Results from pooled Phase III studies of ulipristal acetate for emergency contraception. Contraception. 2012;86:673-680.