Dr. Sushma P Desai. M.D, D.C.H.  Practicing Paediatrician And Adolescent Counsellor  President: Adolescent Health Academy - Surat Branch  National Trainer : Mission Kishore Uday Programme  Resource Person : ‘ Sexual and Reproductive Health of Young People ’  ( Surat Municipal Corporation Project )

Emergency Contraception How Routine?

Definition  It is a contraception used in emergency to prevent pregnancy.  It is to be used within 72 hours of unprotected sexual intercourse.

Types 2 Methods : 1. EC Pills ( ‘Morning After’ Pills ) 2. Copper bearing IUD Plan A : Combination pills 100 mg Ethinyl estradiol and 0.5 mg Levonorgesterol 2 doses taken 12 hours apart, 1 st dose within 72 hours of exposure. Plan B : High dose progestin only pill 1.5 mg Levonorgesterol Single Dose within 72 hours of exposure. Popular Indian Brands : I-Pill, Unwanted 72, Preventol, Option 7.

 Does not disrupt existing pregnancy / not terratogenic.

Indications Should be used only in an emergency situation like :  Sexual assault : sex against her will/force to have sex ( rape )  Contraceptive accidents : Condom breaks/dislodgement of I.U device  Unplanned Sexual intercourse : Without Contraception e.g. heat of the moment  Missed regular dose of contraceptive : O.C.P for 2 or more days / Dex Medroxy progesterone injection

Pre Prescription Evaluation  Youth friendly clinic :  Comprehensive team approach :  History : * Detail menstrual history * HEADSSS : H/O high risk behavior ( mental health disorder, substance abuse, past history of unsafe abortions, multiple partners ), Home environment and parenting style  WHO Medical Eligibility Guidelines : If History of stroke, migraine, coagulopathy-Plan B Preferred

Pre Prescription Evaluation ( Contd. )  Clinical Examination : Look for evidence of Pregnancy or abortion / STI, HIV / Trauma (Sexual Assault)  Investigations : r/o STI, HIV, Pregnancy * Hematological investigation * urine test * pelvic U.S.G * Vaginal swabs

Follow up  After 2 weeks of prescription : * r/o pregnancy/abortion * h/o acute pain in abdomen : r/o ectopic pregnancy * serology for STI, HIV  Guidelines : Regarding safe sexual behavior, different methods of contraception, harmful effects of unprotected sex, Interpersonal relationship.  Life Skill Education : assertive and negotiation skills, goal setting, personality development  Parental counseling  HPV vaccination

 Simple  Highly Effective (Failure rate < 5% Depending on the time of consumption)  Minimal Immediate Side Effects ( Nausea, vomiting, dizziness, breast tenderness : > with plan A)  Do not offer any protection against STI, HIV  Menstrual irregularities : Early/Delayed cycles, irregular bleeding, menorrhagia  If used repeatedly within the same cycle :Loses efficacy, > chances of harmful effects on reproductive health of the young female  Can not be used as only protection if sexually active Advantages Disadvantages

Current Indian Scenario  Opportunity for premarital sexual activity is increasing as : * Age Of puberty is falling, Age of marriage is rising * “Sexarche” is happening earlier : ( 17.2 Yrs. B, 18.3 Yrs. G ) * influence of media, westernization.  Lack Of comprehensive sexuality education : * conservative attitude of Indian society ( parents, teachers, government) * Adolescent lack knowledge of harmful effects of unsafe sexual encounters, different methods of contraception.  Prevailing social taboos * Extra marital pregnancy and abortion : shameful and traumatic  High incidence of unsafe abortions ( quacks/untrained doctors ) : 5 millions annually, 20,000 women die of complications

Current Indian Scenario ( Contd. ) The other side of the coin :  The sell of E.C pills increased up to 250% in past 3 years. NFHS : 83 m E.C pills v/s 16 m condoms.  E.C pills are largely misused : the reasons are * Easy availability : O.T.C without prescription * Young couples find it easy way out for unprotected frequent sexual activity : increased risk of STDs/HIV. * Lack of knowledge about : 1.) Indications, limitations and harmful effects of E.C pills, 2.) Other methods of contraception * E.C pills are used multiple times a month as a replacement for the low dose OC pills * Massive, misleading advertisement * Fear of pregnancy / ‘just to be on safe side’  The result : Increased risk of STDs/HIV, harmful effects on reproductive health of young women.

Conclusion  E.C is an effective means of preventing unwanted pregnancy but Should be used only in emergency situation ( should not be used frequently/should not replace low dose OC pills)  We should empower the adolescents with 1.) sexuality education and life skills to promote responsible sexual behavior. 2.)Knowledge of other safe methods to avoid pregnancy i.e abstinence, non penetrative sex, condoms, spermicides, O.C pills  Harmful effects of : 1.) Unprotected sex like S.T.Ds/H.I.V 2.) High dose hormones on the reproductive health must be stressed upon.