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From Research to Practice

Emergency Birth Control Pills:
The Role of Educators and Youth-Serving Professionals

Also available in [PDF] Format.

Research shows that young people need medically accurate, comprehensive education about their sexual health – education that includes information about abstinence and contraception,[1,2,3,4,5,6] including emergency birth control pills. This medication, often known as emergency contraception ®(EC), morning-after pills, and/or Plan B, is a method that young women can use after unprotected sex in order to prevent pregnancy. Research shows that sexually active young women do not use emergency birth control pills in place of their regular birth control.[7,8,9] Instead, they use the medication in emergency situations – when they forgot to take some of their regular pills or their contraceptive injection was late; when a condom was used incorrectly or, for some other reason, their contraception failed; when no protection was used; or when they could not protect themselves from rape or sexual assault.

This document includes a brief summary of the importance of emergency birth control pills as a pregnancy prevention method for adolescent and young adult women in South Carolina. It reviews findings from surveys that assessed knowledge and awareness of emergency birth control pills among young South Carolina women. It provides suggestions for actions that educators can take to improve youth’s knowledge of and access to emergency birth control pills, including a lesson plan with leader’s resource. It concludes with resources for educators about emergency birth control pills.

Section I. Adolescent and Young Adult Women in South Carolina Need Access to Emergency Birth Control Pills.

  • According to the most recent data available, South Carolina’s adolescent pregnancy rate in 2000 (89 per 1,000 women ages 15 to 19) was slightly higher than the national rate (84 per 1,000).[9,10]
  • South Carolina’s non-Hispanic black and Latina teens had lower pregnancy rates (116 and 126 per 1,000, respectively) than their non-Hispanic black and Latina peers in the United States as a whole (153 and 138 per 1,000, respectively). White teens in South Carolina, by contrast, had a higher pregnancy rate (71 per 1,000) than did their white peers in the United States as a whole (55 per 1,000).[9]
  • Emergency birth control is particularly important for survivors of sexual assault or rape. Women ages 15 through 24 suffer the overwhelming majority of the approximately 300,000 rapes and sexual assaults that occur each year in the United States.[11,12] Experts estimate that, in the United States, at least 25,000 pregnancies occur each year as a result of reported rapes and sexual assaults.[13] Experts also estimate that 22,000 of these pregnancies could be prevented with the timely use of emergency birth control pills.[13]

Section II. Young Women in South Carolina Have Little Knowledge of Emergency Birth Control Pills.

Surveys show that many young women in South Carolina have never heard of emergency birth control pills, and also that many believe myths and misinformation about the pills. In 2006, surveys among young white, African American, and Hispanic women, ages 16 through 24 in South Carolina, found that:

  • Few respondents knew how emergency birth control pills work. Only 29 percent knew that the pills are stronger doses of regular birth control pills, and only 25 percent were aware that emergency birth control pills are not as effective in preventing pregnancy as is regular hormonal contraception.
  • Few respondents knew the timeframe for the effectiveness of emergency birth control pills. In fact, only 12 percent knew that they could take emergency birth control pills later than 24 hours after unprotected sex.
  • Most respondents were unaware that emergency birth control pills have few side effects and that these side effects are only temporary. Only 14 percent knew that the pills have no long-term side effects.
  • Few respondents knew that emergency birth control pills are safe if the woman taking them is already pregnant. Only eight percent were aware that the pills will not harm a woman or her pregnancy. Additionally, only 25 percent knew that the pills will not cause abortion.

Other surveys have shown that most young women, once they are educated about emergency birth control pills, would take the medication in an emergency to prevent unintended pregnancy.[9,10]

Section III. The Role of Educators and Youth Serving Professionals in Raising Awareness and Improving Access to Emergency Birth Control Pills for Young Women in South Carolina

Educators and youth serving professionals can make a significant difference in helping young women to prevent both unplanned and unwanted pregnancy and also abortion.

  • Educate youth about emergency birth control pills. Use the lesson plan and leader’s resource following in Section IV.
  • Educate parents, school administrators, and other advocates about emergency birth control pills. Visit www.morningafterinfo.org for the facts, information about writing letters to the editor and op eds, talking points on emergency birth control pills, resources, myths and facts, and other resources.
  • Encourage local pharmacies to stock Plan B® – the only pre-packaged emergency birth control product currently available in the United States. The medication is now available without prescription for women ages 18 and older. Visit www.morningafterinfo.org for information about pharmacy access in South Carolina.
  • Because women under age 18 are only able to obtain Plan B® with a prescription, encourage health care providers to supply advance prescriptions to sexually active women under age 18 so that they can get and use emergency birth control pills as quickly as possible, should the need arise. See Section IV for resources and a guide to area providers who will write prescriptions for women under age 18.
  • Provide students with information about the national emergency contraception hotline and Web site. See Resources, Section V, for more information, including reliable Web sites by and for teens.
  • Encourage students to be proactive in educating their peers and families about emergency birth control pills.

Section IV. Lesson Plan

Facts about Emergency Birth Control Pills—True or False

Purpose: To educate young women ages 16 through 24 about the existence, safety, and effectiveness of emergency birth control pills and to empower them to increase awareness of and access to emergency birth control pills in their community

Materials: Newsprint; markers; tape; two signs—one that says "Myth" and another that says "Fact"; Leader's resource; for each student, a copy of the fact sheet and/or the brochure for young women about emergency birth control pills.

Time: 50 minutes

Planning Notes: Read the fact sheet and the leader's resource to prepare to lead this session. Tape the "Myth" and "Fact" signs at opposite ends of the room.

Procedure:

  1. Ask the group if anyone knows of a method to prevent pregnancy after a couple has had unprotected sex, if they have a problem with their contraceptive method, or if a young woman has been raped.
  2. Explain that many people, even adult women and some health care providers, do not know about emergency birth control or may believe myths about it. Ask the group to stand. You are going to read a series of statements about emergency birth control pills. If they believe the statement is true, ask them to stand under the sign that says 'Fact.' If they believe the statement is false, ask them to stand under the sign that says 'Myth'. Check to see if there are any questions.
  3. Read the statements on the Leader's Resource. Ask the group standing under the incorrect sign first to explain why they chose that answer. Then ask the group standing under the correct answer to explain why they chose their answer. Be sure to gently dispel any continuing myths and stress that the goal of the activity is to become more educated about the topic, not to embarrass anyone.
  4. After the activity, ask everyone to take a seat again. Ask what they learned about emergency birth control pills that surprised them. Do they know anyone in their family, or school, or community that knows about emergency birth control pills or where to get them?
  5. Brainstorm the benefits of emergency birth control pills and also some of the concerns about them. See if the group can reach consensus that emergency birth control pills could be an important resource for all young people to know about.
  6. Divide the group into smaller groups of 5 or 6. Give each group a sheet of newsprint and a marker and ask them to come up with ways to raise awareness about emergency birth control pills among young women and ways to increase access to the pills.
  7. After all groups have reported their suggestions, you may want to ask if anyone is interested in implementing any of the ideas. If so, what would the necessary steps be to make it happen in their school, clinic, or community? Small Action Teams can be formed, and the groups can report on progress they make toward their goal at a future meeting.

Discussion Points:

  1. What did you learn about emergency birth control pills that surprised you?
  2. Do you think it is important for all young women to have accurate information about emergency birth control pills? Why or why not?
  3. Do you think, considering what you have learned, that emergency birth control pills should be available as over-the-counter medication to young women under 18? Why or why not?

Leader’s Resource for the Lesson Plan

Facts about Emergency Birth Control Pills—True or False

  1. Several types of emergency birth control pills are available.
    A: True. Plan B® is the only specifically packaged product of emergency birth control pills. Yet, it is also possible to use different doses of many regular brands of oral contraceptives.
  2. Emergency birth control is a type of birth control that must be used before a person has sex.
    A: False. Emergency birth control pills are used after a person has unprotected sexual intercourse.
  3. Emergency birth control pills can reduce a woman's risk of pregnancy by up to 89 percent when taken within 72 hours (three days) of unprotected sexual intercourse.
    A: True. Emergency birth control pills are up to 89 percent effective in preventing a pregnancy, depending on the type of emergency birth control used, how quickly the pills are begun, and when during a woman’s menstrual cycle the sex occurred. Emergency birth control pills are most effective when taken within the first 24 hours after sex. But they are still effective, although somewhat less so, when taken up to 120 hours after sex.
  4. There are several reasons why a young woman might use emergency birth control pills.
    A: True. Emergency birth control pills may be used if a couple has had unprotected sexual intercourse. They also work if a condom breaks; if a woman didn’t take her regular birth control pills or was late for a shot; or if her diaphragm slips out of place during sex. Women can also use emergency birth control pills if they have been raped or sexually assaulted.
  5. Plan B® is the same medication as RU-486, 'the abortion pill.'
    A: False. Women take RU-486 (also called mifepristone or the “abortion pill”) to end a pregnancy. It is an entirely different medication from Plan B®.
  6. If you take emergency birth control pills when you’re already pregnant, they can cause abortion.
    A: False. Emergency birth control pills work by preventing pregnancy, not by causing abortion. They will not harm an existing pregnancy.
  7. Plan B® is now available without a prescription from a doctor for all women.
    A: False. The U.S. Food and Drug Administration recently approved the sale of Plan B® without a prescription for women (and men) ages 18 and over. Women under age 18 still need a prescription.
  8. Emergency birth control pills don’t cause any side effects.
    A: False. Some women taking emergency birth control pills may feel nauseous, dizzy, or tired. Some women vomit and/or have a headache or sore breasts. These side effects are temporary and should last less than a day or two. There are no medical risks in taking emergency birth control pills.
  9. Emergency birth control pills may be harmful to teenage women.
    A: False. Emergency birth control pills are a safe and effective option for teenage women. In fact, research shows that emergency birth control pills are safer than aspirin. Furthermore, they do not cause birth defects or abortion if a woman is already pregnant when she takes them.
  10. Emergency birth control pills protect against sexually transmitted infections (STIs), including HIV, the virus that causes AIDS.
    A: False. Emergency birth control pills only prevent pregnancy, not STIs. Using condoms every time a person has intercourse is the best way to prevent STIs.
  11. A 16-year-old has the legal right to obtain emergency birth control without her parent's permission.
    A: True.
    In South Carolina, teens age 16 and older have the right to obtain emergency birth control without parental consent or notification. Most Planned Parenthood and health department clinics offer confidential services to all teens.
  12. Prescriptions for emergency birth control pills can only be obtained from a doctor.
    A: False.
    There are many ways to obtain a prescription. Call the National EC Hotline at 1-800-NOT-2-LATE to locate the nearest doctor or health clinic; call 1-800-230-PLAN to find the nearest Planned Parenthood health center. To find the nearest health care provider who will provide prescriptions for emergency birth control pills to young women under 18, visit www.not-2-late.com.

Section IV. Resources for Educators

Professional Resources regarding Emergency Birth Control Pills

American Society for Emergency Contraception: ASEC is a collaboration of organizations working to improve women's access to emergency contraception, especially in the United States. ASEC serves as: a source of information on emergency birth control pills for the media and others; a watchdog for inaccurate or biased articles in the press; a support to other organizations willing to endorse the medication; and a source of information, primarily through a semi-annual electronic newsletter on recent events related to EC.

Association of Reproductive Health Professionals: ARHP offers an entire Web section devoted to emergency contraception, including professional and consumer health information, news coverage, fact sheets, and training materials.

International Consortium on Emergency Contraception PDF document: A valuable guide to the research on emergency birth control pills: Emergency Contraceptive Pills: Medical and Service Delivery Guidelines, 2nd ed. New York: Author, 2004;

Not-2-Late.com: Operated by the Office of Population Research at Princeton University and by the Association of Reproductive Health Professionals, the site offers accurate information – for both consumers and health care providers – about emergency birth control pills, including: a nationwide (but not comprehensive) directory of medical professionals who will prescribe emergency contraception and pharmacies that will fill prescriptions; current information about the brands of oral contraceptives that can be used as emergency contraception; and a summary of current research.

South Carolina Emergency Contraception Initiative: The Initiative offers research summaries, talking points, myths and facts, resources, and much more regarding emergency birth control pills and young women in South Carolina.

Position Statements on Emergency Birth Control Pills

American Academy of Pediatrics, Committee on Adolescence. Emergency contraception: policy statement. Pediatrics 2005; 116:1038-1047; http://aappolicy.aappublications.org/cgi/content/full/pediatrics;116/4/1026

American College of Obstetricians & Gynecologists. Emergency contraception. ACOG Practice Bulletin: Clinic Management Guidelines [No. 69]. Washington, DC: Author, December 2005; members can access this document at http://www.acog.org/

American Medical Association, Council on Medical Service. Access to Emergency Contraception [H-75.985] Chicago, IL: AMA, 2006; http://www.ama-assn.org/apps/pf_new/pf_online?f_n=browse&doc=policyfiles/HnE/H-75.985.HTM.

American Medical Women’s Association. Emergency Contraception. Arlington, VA: Author, 2005; http://www.amwa-doc.org/index.cfm?objectId=0EF88909-D567-0B25-531927EE4CC23EFB

Association of Reproductive Health Professionals. Position Statement; http://www.arhp.org/healthcareproviders/resources/ecresources/arhpposition.cfm

Physicians for Reproductive Choice & Health: Policy Statement, http://www.prch.org/advocacy_policy/ECinfomation.shtml

Society for Adolescent Medicine. Provision of emergency contraception to adolescents: position paper of the Society for Adolescent Medicine. Journal of Adolescent Health 2004; 35:66-70; http://www.adolescenthealth.org/PositionPaper_Emergency_Contraception.pdf PDF document

Consumer Health Information on Emergency Birth Control Pills

1.888.NOT.2.LATE or 1.866.EN.TRES.DIAS: English and Spanish (respectively) language hotlines, operating 24/7, to direct women to an health care provider near them

Advocates for Youth: This site provides comprehensive information for parents, youth, and professionals about emergency contraception. They also have a campaign targeted around access to emergency contraception.

Back Up Your Birth Control: The Campaign encourages young women to get emergency birth control pills from their health care provider before they need the medication.

Emergency Contraception Web Site: By putting in a zip code, the user can find the names and addresses of area clinicians willing to provide emergency contraception.

Go Ask Alice: Produced by Columbia University's Health Education Program, this site has questions and answers on all kinds of relationship, sexuality, and sexual health issues.

Planned Parenthood Federation of America: This site offers informative papers on emergency contraception, its history, barriers to access, and the difference between emergency contraception and abortion. The site also offers referral to local clinics.

Sex, Etc: By teens and for teens, this site helps youth stay healthy, including avoiding unintended pregnancy.

Teenwire: This Planned Parenthood site offers great information on sexuality and relationships as well as referral to local clinics.

Written by Sue Alford, MLS
New Morning Foundation and Advocates for Youth © 2006.

References:

  1. Baldo M, Aggleton P, Slutkin G. Does Sex Education Lead to Earlier or Increased Sexual Activity in Youth? Presentation to the Ninth International Conference on AIDS, Berlin 6-10 June, 1993. Geneva: World Health Organization, 1993.
  2. Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy, 2001.
  3. UNAIDS. Impact of HIV and Sexual Health Education on the Sexual Behaviour of Young People: A Review Update [UNAIDS Best Practice Collection, Key Material] Geneva: Author, 1997.
  4. Alford S, Huberman B, Moss T, Hauser D. Science & Success: Sex Education and Other Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2003.
  5. Alford S, Cheetham N, Hauser D. Science & Success in Developing Countries: Holistic Programs that Work to Prevent Teen Pregnancy, HIV & Sexually Transmitted Infections. Washington, DC: Advocates for Youth, 2005.
  6. Alford S, et al. Science & Success [3rd edition]. Washington, DC: Advocates for Youth, in press 2006.
  7. American Academy of Pediatrics, Committee on Adolescence. Emergency contraception policy statement. Pediatrics 2005; 116:1038-1047.
  8. Gold MA, Wolford JE, Smith KA, Parker AM> The effects of advance provision of emergency contraception on adolescent women’s sexual and contraceptive behaviors. Journal of Pediatric & Adolescent Gynecology 2004; 17:87-96.
  9. Harper CC, Cheong M, Rocca CH, Darney PD, Raine TR. The effect of increased access to emergency contraception among young adolescents. Obstetrics & Gynecology 2005; 106:483-491.
  10. Petitti DB, Harvey SM, Preskill D, Beckman LJ, Postlethwaite D et al. Emergency contraception: preliminary report of a demonstration and evaluation project. Journal of the American Medical Women’s Association 1998; 53(Supplement 2):251-254.

New Morning Foundation and Advocates for Youth use reasonable efforts to provide accurate information for personal education. Nothing contained herein constitutes medical, legal, or other professional advice nor does it represent an endorsement of any treatment, and the reader is encouraged to seek advice from a qualified professional regarding her particular needs.

Information contained herein is provided without warranty of any kind, express or implied, including warranties of merchantability or fitness for a particular purpose. Neither New Morning Foundation nor Advocates for Youth shall be liable for any direct, indirect, incidental, consequential, or any other damages resulting from use of the information contained herein.

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