1. Session II, Slide #1 Levonorgestrel (LNG) Emergency Contraceptive Pills Session II: Indications for Use and Screening Clients

2. Session II, Slide 2 Indications for use of ECPs A couple recently had sex without using contraception. A condom broke or slipped. A woman using oral contraceptive pills missed three or more pills or started later in the month than instructed. A woman using contraceptive injections was late for her next shot. A woman experienced an IUD expulsion or could not locate the IUD string.

3. Session II, Slide 3 Indications for use of ECPs (continued) Sex was forced (rape). Failed coitus interruptus (e.g., ejaculation in vagina or on external genitalia). Miscalculation of the periodic abstinence method or failure to abstain on a fertile day of the cycle. Failure of a spermicide tablet or film to melt before intercourse. Diaphragm or cap dislodgment, breakage, tearing, or early removal.

4. Session II, Slide 4 Screening customers for ECP use The most important screening question for ECP use is: Did you have unprotected sex within the last 5 days (120 hours)? If “yes” then the client is eligible for ECPs. Effectiveness will be lower the longer a woman waits to take ECPs.

5. Session II, Slide 5 Screening questions for ECP use (continued) You can also ask questions to determine if the woman is pregnant. ECPs will not work if she is pregnant. ‒ Was your last menstrual period less than 4 weeks ago? If “No,” the client may be pregnant. ‒ Was this period normal for you in both its length and timing? If “No,” the client may be pregnant. ‒ Is there reason to believe you may be pregnant? If “Yes,” the client may be pregnant. If the client is not pregnant, ECPs may be given. If the client’s pregnancy status is unclear, ECPs may still be given, with the explanation that the method will not work if she is already pregnant. You can also ask about other drugs the woman is taking: Are you taking the any of these drugs: rifampicin, griseofulvin, Saint John’s Wort, anticonvulsant drugs or ritonavir? ECPs may be less effective if you are taking any of these medications. But ECPs should still be given, as there are no contraindications to ECPs.

6. Session II, Slide 6 ECP Screening Flow Chart 1. Did you have unprotected sex in the last 120 hours (5 days)? Yes 2. Are you pregnant? 4. Do you want to prevent pregnancy? Recommend ECPs. If your next period does not come within 7 days of when you would normally expect it, see a health care provider to determine pregnancy status. ECPs are not right for you. If your last menses was over 4 weeks ago, see a health care provider to determine next steps. No Yes Don’t know No Yes No 3. Was your last menses was over 4 weeks ago? Yes Don’t knowNo