Emergency contraception (EC), sometimes referred to as "the morning-after pill," is a back-up birth control method that is used within days of unprotected sex or in the event of a known contraceptive failure, such as a condom breaking. It is not intended for use as a regular contraceptive method. EC prevents a pregnancy from occurring, and should not be confused with medical abortion drugs – mifepristone (RU-486) or methotrexate – that end an established pregnancy.
Four decades after introduction of the pill, more women than ever are using it. Today's low-dose oral contraceptives are safer and just as effective as earlier pills. Taken regularly, the pill prevents pregnancy almost without fail. Pill users benefit in other ways, too, such as less anemia and protection from certain cancers. Lower doses have reduced the circulatory disease risks of the pill.
Four decades after introduction of the pill, more women than ever are using it. Today's low-dose oral contraceptives are safer and just as effective as earlier pills. Taken regularly, the pill prevents pregnancy almost without fail. Pill users benefit in other ways, too, such as less anemia and protection from certain cancers. Lower doses have reduced the circulatory disease risks of the pill.
This issue of Population Reports is a user friendly guide to understand the process of counseling clients about oral contraceptives (OCs). Anyone who counsels clients should use the guide to best suit his/her needs and those of clients. The guide uses the word GATHER to assist counselors to remember the 6 steps of family planning counseling for new clients. "G" indicates that counselors should greet clients cordially. "A" means that they should ask clients about themselves and the reason they came to the family planning clinic. "T" reminds counselors to tell clients about every family planning method available at the clinic especially those that interest them. "H" prompts the counselor to help clients choose the best method for them. "E" informs the counselor to explain to clients how to use the chosen method and assist them to plan to use it. "R" means return for follow up by securing an agreed time to meet. For continuing clients the most important steps are "A" "H" and "E". The guide dedicates considerable space to each step to help counselors cover all important aspects of each step. For example step "H" involves asking clients questions such as do you smoke and have you ever had blood clots. It also provides special sections on the different types of OCs AIDS breast feeding and how to counteract rumors. It furthers helps counselors by including a self test on knowledge of OCs and a checklist for new clients and a checklist for continuing OC users. The guide emphasizes the 3 major messages for al OC clients to know: take 1 pill each day begin the next packet as scheduled and contact a family planning provider anytime problems or questions arise. The guide is free.
As of 1980-81 over 50 million women around the world use oral contraceptives (OCs). In developing countries users increased from 14 million in 1977 to 18 million in 1980. Sales in developed countries fell from a peak of 287 million cycles in 1975 to 253 million in 1979 and have remained stable. Sales in Latin American countries increased by 50% since 1975. Between 1976-80 the number of new acceptors provided with OCs through government programs increased in several Asian countries. Highest use based on sales is Australia Austria Belgium France West Germany the Netherlands and New Zealand with over 20% of all women of reproductive age using OCs. Main government suppliers are the U.S. Agency for International Development (100 million cycles annually) the Pathfinder Fund the International Planned Parenthood Federation and the UN. Knowledge of beneficial effects of OCs has recently grown. They include protection against: 1) pelvic inflammatory disease 2) ectopic pregnancy 3) endometrial cancer 4) benign breast diseases and 5) menstrual disorders. In February 1982 the U.S. Food and Drug Administration recommended that instructions on each pill package list OC benefits. The greatest risk associated with the pill is circulatory system disease among women over 35 who smoke. OC use has been found to increase the risk of venous thromboembolism ischemic heart disease cerebrovascular disease and hypertension. No increase in breast cancer has been demonstrated nor has greater incidence of cervical cancer melanoma or pituitary tumors. Return of fecundability is delayed after discontinuation. Doubts about the applicability of OC test results to all women exist especially regarding developing countries. OCs may reduce the volume of milk in breastfeeding mothers but use of OCs with 50 mcg or less of estrogen has not been shown to effect infant growth. Findings conflict about effects of OCs on urinary tract infections gallbladder disease nutrition acne and some endemic diseases. OCs have been found to protect against rheumatoid arthritis. New OCs being researched are: 1) low-dose OCs 2) biphasic and triphasic pills 3) morning after pills 4) natural vs. synthetic estrogens 5) new progestins 6) paper pills 7) once a week pills and 8) slow release pills. For most women in developing countries using OCs for a year is less dangerous than using no contraception and risking pregnancy even if they are over 35 and smoke. Family planning programs must encourage older women who smoke however to use alternate methods. Greater effort is needed to make OCs more widely available and to be sure they are used correctly.
