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The Alaska Emergency Contraception Project
In December 1998, the Alaska Emergency Contraception Project was formed. It is a coalition of women's health care providers from the private and public sectors. The project is modeled after the Northwest Emergency Contraception Coalition, which was launched in 1997.
What is emergency contraception?(download Powerpoint)
Emergency Contraception, often referred to as "the morning after pill" can reduce the risk of pregnancy after unprotected vaginal intercourse. Emergency contraception pills (EC) can reduce the risk of pregnancy up to 120 hours after unprotected sexual intercourse. They work best when taken within 72 hours - within 72 hours of unprotected sexual intercourse, the pills are 75 to 99 percent effective at preventing pregnancy. They work by preventing ovulation or fertilization of an egg. If fertilization already has occurred, they prevent the egg from implanting into the uterus -- the medical definition of pregnancy (1).
If you have had unprotected sex within the last five days and want to prevent pregnancy, call 1-888-NOT-2-LATE for a list of providers in your area.Oral Contraceptives Used as Emergency Contraception - (To be used within 120 hours (5 days) of unprotected intercourse)
Brand Name
# of Pills to swallow as soon as possible (1st dose)
2nd dose: # of Pills to swallow 12 hrs after 1st dose
1 white pill
1 white pill
Ovral
2 white pills
2 white pills
Lo/Ovral
4 white pills
4 white pills
Levlen
4 light orange pills
4 light orange pills
Nordette
4 light orange pills
4 light orange pills
Tri-Levlen
4 yellow pills
4 yellow pills
Triphasil
4 yellow pills
4 yellow pills
Alesse
5 pink pills
5 pink pills
Levlite
5 pink pills
5 pink pills
Ovrette
20 yellow pills
20 yellow pills
According to a 1997 Kaiser Family Foundation Survey only 10% of providers routinely discuss emergency contraception (ECP) with their patients. Most people are unaware of its availability and only 1% of women have ever used it. Despite being described and available since 1967, it's use has been relatively limited to college health centers, family planning clinics, (2) and emergency rooms for use with rape victims (3).
How does emergency contraception work?
Clinical studies have shown that emergency contraception pills can delay or inhibit release of the egg. There is no clinical data to support theories that ECPs interfere with normal cervical mucous, fertilization, or tubal transport of sperm, egg, or embryo (1). It is not clear how emergency IUD insertion prevents pregnancy. Depending on when the IUD is inserted, it may interfere with sperm transport or fertilization.Is emergency contraception safe?
No serious or long-term complications have been associated with ECPs in Europe, where they are widely available. If ECPs are taken inadvertently during early pregnancy, there is no known risk of birth defects. (4) Similarly, if taken in early pregnancy, there is no higher risk of miscarriage. In 1997, The FDA removed warnings about adverse effects of oral contraceptives on a developing pregnancy. (5) An IUD should be immediately removed if pregnancy is diagnosed. There is a higher risk of miscarriage, infection, and preterm labor if an IUD is worn through pregnancy.Why is emergency contraception needed?
No contraceptive method is fail safe and few couples can use their method perfectly every time they have intercourse. Women are victims of rape. In Alaska and nationwide, 50% of pregnancies are unintended. Nationwide, 47% of unintended pregnancies end in voluntary abortion. 53% of all unintended pregnancies occurred while women were using contraception.Why is emergency contraception important?
The Institute of Medicine reported in 1995 that "unintended pregnancies are associated with poorer prenatal care, lower birth weights, higher substance abuse rates, and infants more likely to be victims of abuse and neglect." Emergency contraception could substantially reduce medical costs associated with unintended pregnancy, birth, spontaneous or induced abortion. It would also have a positive impact on the physical and emotional well being of the women and men facing an unintended pregnancy.Innovative Ways of Increasing Access to Emergency Contraception
while Maintaining Safe Use
Advance Distribution
Clients receive ECPs or a prescription along with counseling about correct use at the time of their annual exam
Planned Parenthood has implemented ECP prescription by phone for new and established clients who are unable to get to the clinic within the 120 hour treatment timeframe. Medical history is taken by phone and informed consent documented.
Prescription through Allied Health Professionals Washington State has pioneered an innovative program in which women receive ECPs from pharmacists under protocol from a licensed prescriber. Public Health Nurses are modeling this program elsewhere. What can I do to help improve access to this method in Alaska?
Tell clients about ECPs during routine visits (what it is, why they might need it, 3-day timeframe for treatment, and how to get it).
Provide an "ECP Kit" to all sexually active clients in advance of need (kits contain pills or a prescription, information on correct use, and condoms).
Sign up to be a provider of emergency contraception (either call the hotline number or check the website). Currently there are 62 listed Alaskan providers of emergency contraception in 35 communities statewide.
For further information on the Alaska Emergency Contraception Project, please call: (907) 351-7332
To order Emergency Contraception Hotline materials (wallet cards, posters, and telephone protocol cards), please call Kandra Strauss at (202)-530-2900 or kstrauss@basshowes.com (while supplies last)
1. Trussell, J, Stewart, F,: Dialogues in Contraception Fall 1998,Vol 5 , No 96
2. Harper C, Ellertson, C. Knowledge and Perceptions of emergency contraceptive pills among a college age population: a qualitative approach. Family Planning Perspectives 1995;27 (4):149-54.
3. Glover D, et al, Diethylstibesterol in the treatment of rape victims. Western Journal of Medicine 1976; 125:331-4
4. Food and Drug Administration (FDA). Prescription drug products; Certain combined oral contraceptives for use as postcoital emergency contraception; Notice. Federal Register 62:8610-8612, February 25, 1997.
5. American College of Obstetricians and Gynecologists (ACOG). Emergency Contraception, ACOG Practice Pattern 3. Washington, DC, December 1996.
6. Planned Parenthood Federation of America (PPFA). Manual of Medical Standards and Guidelines. March 1997.
