Emergency Contraception: America's Best-Kept Secret

Medically Reviewed by Traci C. Johnson, MD on March 09, 2023
3 min read

Do you watch the television show "ER"? During an episode in 1997, Nurse Hathaway (Carol) offered the option of emergency contraception pills to a young woman who had just been forced to have sex against her will. It's possible that between 5 and 6 million people learned about emergency contraception that day.

According to the Kaiser Family Foundation, almost 3 million unintended pregnancies happen each year in the United States. You can imagine why -- a condom tears, a diaphragm slips out of position, a woman misses two birth control pills in a row. Or, a couple has gotten "swept away" in the momentum of lovemaking and has neglected to use birth control. Perhaps a rape has occurred. Without treatment, eight in 100 women who have had one act of unprotected intercourse during the second or third week of their cycle are likely to become pregnant. With emergency contraception, only two women in 100 would be in the same situation.

There are two types of emergency contraception pills (ECPs). One is a combination of estrogen and progestin, and the other is a progestin-only pill. Depending on when they are taken during the menstrual cycle, ECPs can inhibit or delay ovulation; inhibit transport of the egg or sperm; or alter the lining of the uterus to prevent implantation of a fertilized egg.

Another option, which is actually the most effective, is a copper IUD. This has to be inserted by a medical professional within 5 days of unprotected sex. It can prevent the implantation of a fertilized egg.

ECPs, sometimes called the morning after pill, must be taken within 72 hours of the unprotected intercourse. The pills are more effective the earlier a woman takes them within the 72-hour time period.

Pills are taken in two doses, with the second dose taken 12 hours after the first. Each dose is one, two, four or five pills, depending on the brand. You need a prescription to get ECPs, although some medical providers are now writing prescriptions in advance.

L evonorgestrel/ethinyl estradiol (Preven) is packaged especially for emergency-contraceptive use. It contains both hormones, estrogen and progestin, and reduces the chance of pregnancy by 75 percent. About 50 percent of women who take this feel nauseous and another 20 percent vomit.

Levonorgestrel ( Plan B ) is progestin-only and has been on the market since July of 1999. It's more effective than Preven and has fewer side effects associated with it.

The copper IUD prevents a fertilized egg from being implanted in the uterus. About 80% of women keep the IUD inserted as birth control for up to 10 years. 

Although the Food and Drug Administration declared ECPs to be safe and effective in 1997, only 10 percent of health professionals discuss emergency contraception on a routine basis with their patients, according to a survey that same year by the Kaiser Family Foundation.

Forty-one percent of Americans are still unaware of the existence of ECPs. In fact, only 11 percent of women aged 18 to 44 have both heard of ECPs and know that the pills need to be taken within 72 hours of unprotected intercourse.

Remember that we all make mistakes. Unintended pregnancy crosses all boundaries -- age, race, ethnicity, social class. Experts estimate that as many as 1.7 million of the over 3 million unintended pregnancies that happen each year in the United States could potentially be prevented by the use of ECPs. This includes as many as 800,000 pregnancies that now result in abortions. Wouldn't you rather keep a supply on hand, just in case? Ask your doctor about emergency contraception at your next visit.