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In collaboration with Futures Without Violence and the National Sexual Violence Resource Center, ASEC is proud to share our latest resource - Emergency Contraception: A Guide for Sexual and Domestic Violence Advocates. Emergency contraception (EC) provides a last chance to prevent an unintended pregnancy and is an important option for survivors of sexual and domestic violence. This fact sheet was created for anyone who works with survivors.

Emergency Contraception (EC): 

A Guide for Sexual and Domestic Violence Advocates

LOGOS for American Society for Emergency Contraception, Futures Without Violence, 

and National Sexual Violence Resource Center 

September 2023

 

Emergency contraception (EC) provides a last chance to prevent an unintended pregnancy and is an important option for survivors of sexual and domestic violence. This fact sheet was created for anyone who works with survivors. 

  

EC Basics1

  • EC is contraception used as soon as possible up to 5 days after unprotected sex, contraception fails, or when sex is coerced or forced. EC is sometimes called the morning-after pill or Plan B. 

  • EC prevents pregnancy before it happens. EC is not the same as the abortion pill.

  • Some types of EC are available over-the-counter without a prescription at pharmacies.

  • Time is of the essence with EC. The sooner EC is taken, the more likely it is to work.

  • EC is safe for people of all ages to use. There are no age restrictions for the use of EC. 

 

EC is an essential tool for survivors. It is crucial that advocates are knowledgeable about EC and how to provide survivors with information. By offering EC and information about EC to all survivors, domestic and sexual violence advocates play an important role in helping survivors get timely access.

 

EC options available in the US1

  • Progestin-only EC oral pills (Plan B One-Step and generics like AfterPill): Available over-the-counter (OTC). Progestin-only EC should be taken as soon as possible within 5 days after sex. 

  • Ulipristal acetate EC oral pills (ella): Available by prescription only. Ella should be taken as soon as possible within 5 days after sex. Ella is more effective than progestin-only EC oral pills because it works closer to the time of ovulation.

  • Intrauterine devices (IUD): A copper IUD inserted by a healthcare provider after unprotected sex is the most effective option for EC and it has the added benefit of providing long-term pregnancy prevention. Some research shows that a levonorgestrel 52mg IUD (like Mirena) may also be an effective EC method.

 

How EC pills work

  • EC pills prevent pregnancy by delaying or inhibiting ovulation (release of an egg from the ovary). If there’s no egg, there’s nothing for sperm to fertilize and pregnancy cannot occur. If someone is already pregnant, taking EC pills will not harm or end the pregnancy.2

 

Effectiveness 

  • The copper IUD is by far the most effective option for EC, followed by ulipristal acetate pills (ella) and progestin-only pills (Plan B One-Step)1,3

  • Some studies show that EC pills may be less effective depending on your weight or body mass index (BMI)4

    • If you weigh 165 lbs or more (or have BMI of 26 or more), progestin-only EC may not work. In this case, ella or a copper IUD may be a better choice.  

    • If you weigh 195 lbs or more (or have BMI of 35 or more) ella may not work. In this case, a copper IUD may be a better choice.

    • This research is not 100% certain, but it’s important to let people know about the possibility that EC pills may not work depending on weight. 


Safety & Side Effects

  • Taking EC – even multiple times within the same month or year – does not affect one’s ability to get pregnant in the future.5

  • EC is extremely safe.6–8 The FDA has approved EC for unrestricted over-the-counter access. EC is safer than many OTC drugs, such as Tylenol.

  • Side effects (such as nausea, headache, and changes to the next period) are generally mild and go away on their own.6–8 Many people do not experience any side effects at all.

 

Urgency of EC Right Now

  • EC is an important resource to prevent unintended pregnancy. With increasing abortion restrictions in many states, now is an important time to ensure EC access.  

  • EC is not the same as the abortion pill and will not work if someone is already pregnant.9 For more information on how to access abortion, please see https://www.plancpills.org/ and https://www.ineedana.com/

 

How Advocates Can Help

  • It is important for advocates to provide non-judgmental information about EC. Survivors/clients may be feeling a wide range of emotions and need unbiased support.

  • EC can also be used as a safety planning measure and as a back-up or primary contraceptive in instances of reproductive coercion or birth control sabotage. It may be useful for survivors to have access to multiple doses.

  • Ideally, domestic violence and sexual violence centers should have free OTC progestin-only EC on site and available for survivors, along with other OTC items. For more information and guidance, please see the American Society for Emergency Contraception’s fact sheet, Distribution of Emergency Contraception (EC) By Organizations: Legal Issues at https://www.americansocietyforec.org/reports-and-factsheets10

  • Sample script: “We let all clients know in the bathroom there is a ‘Take What You Need’ cabinet that has emergency contraception, tampons, condoms, lube, pregnancy tests, Advil, first aid and more.”

  • Organizations can access free EC to distribute directly from Plan B (https://www.planbdonations.com/Home/EntryForm) or SIRUM (https://www.cognitoforms.com/SIRUM3/EmergencyContraceptiveAccessInitiativeRequestForm.) 

  • If storing EC, store it in a safe place and in accordance with the manufacturers’ instructions (between 68-77°), check product for tampering, and keep in mind the expiration date on the box. 

  • Advocates can help survivors overcome common barriers to EC and make it more accessible by providing EC for free and providing information on other places to access it. Health center and pharmacy hours may be limited, especially on nights and weekends, when people may need EC the most. Pharmacy prices can be high ($40-50). EC is not always stocked on the shelf - people buying EC may need to ask pharmacy staff for it, which can feel like a violation of privacy. Some pharmacies still ask for proof of ID, based on outdated age restrictions.11 Advocates should be honest with survivors about potential barriers to accessing EC and how they can overcome them. 

 

Accessing EC

  • In addition to providing EC to survivors directly, advocates should know where survivors can access EC in the community. Learn which providers in the community provide ulipristal acetate (ella) or IUDs as EC as these methods may be needed if the survivor has higher weight or it’s been a longer time period.

  • Advocates should call their local hospital to learn what types of EC are available if survivor/client goes to get a sexual assault forensic exam (SAFE). 

  • In addition to accessing EC at DV/SA programs, survivors can access EC in multiple ways: 

    • At pharmacies, over-the-counter: Progestin-only EC (Plan B One-Step and generics) is sold on shelves at pharmacies without age or gender restrictions. Anyone of any age can buy it and no one should be asked for ID.12 

    • At pharmacies, with a prescription: Ulipristal acetate EC (ella) is prescription-only. Users should see a healthcare provider or go to a clinic for a prescription. 

    • Online: Both types of EC pills can be ordered through online services such as Pandia Health, Nurx, or Planned Parenthood Direct. Due to shipping time, EC should be ordered online ahead of time, before it is needed. 

    • Free or low-cost EC can be accessed at local Planned Parenthood clinics (https://www.plannedparenthood.org/) or local family planning or health department clinics. Local abortion funds and mutual aid groups may provide free EC. School clinics, peer-to-peer support networks, and vending machines at some college campuses may also provide free or lower cost EC. 

    • Clinic or medical practice: Healthcare providers may be able to provide all forms of EC. IUD insertion requires a trained provider.

ADDITIONAL RESOURCES ON EMERGENCY CONTRACEPTION:

  • Additional Suggested Scripts for How to Offer EC:

    • “We tell everyone calling the hotline that if you have questions about emergency contraception and where to get it, we can share information about that and help you.”

    • “We always like to check with clients to share info about  emergency contraception, which can stop a pregnancy from happening before it starts. Clients might choose to use emergency contraception if they don’t want to become pregnant, but in the last five days had sex without a condom, were coerced or forced to have sex without a condom, or were worried that someone had messed with their birth control.”

Emergency Contraception Resources:

Resources for EC after SA/DV:

 

REFERENCES

1. Emergency Contraception for Every Campus. Emergency Contraception Basics [Internet]. 2023; Available from: https://www.ec4ec.org/ec-101/

2. American Society for Emergency Contraception. Mechanism of Action of Levonorgestrel Emergency Contraceptive Pills, [Internet]. 2022;Available from: https://www.americansocietyforec.org/_files/ugd/7f2e0b_60b64d14bc4445d29c70aad73618950b.pdf

3. Cleland K, Zhu H, Goldstuck N, Cheng L, Trussell J. The efficacy of intrauterine devices for emergency contraception: a systematic review of 35 years of experience. Hum Reprod 2012;27(7):1994–2000. 

4. American Society for Emergency Contraception. Efficacy of emergency contraception and body weight: Current understanding and recommendations [Internet]. 2022;Available from: www.americansocietyforec.org/reports-and-factsheets

5. Raymond EG, Cleland K. Clinical practice. Emergency contraception. NEnglJMed 2015;372(14):1342–8. 

6. Faculty of Sexual and Reproductive Healthcare. FRSH Guideline: Emergency Contraception. 2020. 

7. Haeger KO, Lamme J, Cleland K. State of emergency contraception in the U.S., 2018. Contracept Reprod Med 2018;3:20. 

8. Jatlaoui TC, Riley H, Curtis KM. Safety data for levonorgestrel, ulipristal acetate and Yuzpe regimens for emergency contraception. Contraception 2016;93(2):93–112. 

9. Li HWR, Gemzell-Danielsson K. Mechanisms of action of emergency contraception pills. Eur J Contracept Reprod Health Care 2019;24(1):11–2. 

10. American Society for Emergency Contraception. Distribution of Emergency Contraception by Organizations: Legal Issues [Internet]. Available from: https://www.americansocietyforec.org/reports-and-factsheets

11. American Society for Emergency Contraception. “This is much harder than I thought it would be.” Access to over-the-counter emergency contraception in America [Internet]. Available from: www.americansocietyforec.org/reports-and-factsheets

12. American Society for Emergency Contraception. Emergency contraception: A guide for pharmacies and retailers [Internet]. 2016;Available from: http://americansocietyforec.org/uploads/3/4/5/6/34568220/pharmacy_ec_access_overview.pdf

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