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The best-kept secret in birth control

What if some hot fun in the summertime has you nervously counting the days to your next period? Maybe you went on vacation and didn't pack condoms because there's no way you'd ever sleep with a perfect stranger--or so you thought. Or maybe your husband's condom ripped, or your IUD was expelled, or you forgot to take your Pill. How much worse if you were forced into unprotected intercourse during a date rape or other sexual assault. If you were careless, you could just slap yourself! If you weren't, you're still pleading with the heavens not to let you get pregnant.

Good news: There is something you can do to avoid unwanted pregnancy--after you've had intercourse but before you actually get pregnant. It's called emergency contraception (EC) and "it's been a well-kept secret for decades," says Julia Scott, R.N., past-president and CEO of the National Black Women's Health Project.

What Is Emergency Contraception?

If you've heard the term morning-after pill, you've heard of emergency contraception. For some 25 years, doctors have been able to prescribe effective postcoital methods of preventing pregnancy. They'd either give you extra doses of ordinary birth-control pills, or insert a copper IUD (intrauterine device) up to five days after either intercourse or the estimated day of ovulation.

Surprisingly, experts aren't certain about exactly how emergency contraceptive pills work; they just know they do. Studies indicate that they may delay ovulation and inhibit fertilization. They may also interfere with implantation of a fertilized egg--like other birth-control methods and even breasffeeding. With the IUD, copper is toxic to the sperm.

Misunderstood Method

The "morning-after pill" is never just one pill but usually a number of birth-control pills taken in two doses 12 hours apart. For some pills, you might take two doses of 20 tablets each. (Sounds alarming, but it's safe.) Your doctor will prescribe it for you.

And it's not just for the morning after. "it can be used immediately and is more effective the earlier it's used," says James Trussell, Ph.D., a professor at the Office of Population Research at Princeton University. It can be used up to 72 hours after unprotected sex.

These methods are not the same as the controversial "abortion pill" (Mifepristone, also known as RU-486). The morning-after pill won't end an established pregnancy, which doctors define as beginning once the embryo is implanted in the lining of the uterus (about seven days after the sperm fertilizes the egg). In fact, even if a woman takes emergency contraceptive pills when she's pregnant, the developing fetus is safe.

Emergency contraception's biggest problem: Women don't know it exists. "It's a catch-22 situation," explains Tina Hoff, vice-president of Public Health Information and Partnerships at the Kaiser Family Foundation. "Physicians assume that patients will come to them when they need emergency contraception, but many women have never heard of it, so they don't know enough to ask."

Exploring Other Options

Today you don't have to pop 40 pills. There are two products being marketed specifically as emergency contraception--Preven and Plan B--and they're basically repackaged birth-control pills.

Preven, on the market since 1998, contains both estrogen and progestin and cuts the chance of pregnancy by about 75 percent. The discomfort you might experience from the two-time, four-pill dose is nausea, vomiting, breast pain or headaches. In 1999 the FDA approved Plan B, a progestin-only emergency contraceptive. Only two pills reduce your pregnancy risk by about 88 percent. It's more effective, less likely to cause nausea or vomiting, and safer for women with other health issues.

As an emergency contraceptive, the copper IUD is most effective against pregnancy. "If one hundred women use emergency contraceptive pills, about two of them will become pregnant," explains Felicia H. Stewart, M.D., adjunct professor, Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California, San Francisco. "With IUDs only one in a thousand become pregnant." The IUD's added benefit: It may remain in place as regular birth control for up to ten years. However, it must be inserted by a doctor, so if you have unprotected sex on, say, Friday night, you're sweating bullets until your appointment.

Nothing's Foolproof

Don't toss out your condoms or diaphragm in favor of emergency contraception. It's not nearly as effective as correctly using any other method of regular birth control.

"I don't want women to think that emergency contraception is 100-percent effective. It's not," warns Anne Moore, R.N.C., M.S.N., professor of nursing at Vanderbilt University School of Nursing. If you're fertile and repeatedly use this method, you'll be pregnant before you can say "Oops!" That's a special concern among Black women, who have higher rates of unintended pregnancies than White women, as well as higher HIV rates. And these methods don't protect you from sexually transmitted diseases such as HIV. But in a real emergency, it's a whole lot better than slapping yourself until your period comes.

FOR MORE INFORMATION

* The Emergency Contraception Hotline ([888] NOT-2-LATE) and the Emergency Contraception Web Site (not-2-late.com): Educational information and contact information for emergency-contraception providers in your area. Available around the clock in English and Spanish.

* The Emergency Contraceptive Connection ([877] ECPILLS): Through Planned Parenthood of Georgia, this service allows state residents to be screened by telephone then receive a prescription for emergency contraceptive pills called in to a nearby pharmacy.

* Because emergency birth control is most effective the sooner you use it, some doctors give their patients a "just in case" prescription--so they'll have it as soon as they need it. If you're sexually active, ask your doctor about this emergency insurance.

-- R.C.D.

To find out which birth-control method is best for you, take our quiz on essence.com.

Rachel Christmas Derrick writes frequently about health and fitness.

Next month: The Abortion Pill.

"If more women knew about emergency contraceptives, there'd be far fewer unintended pregnancies," says Rachel Christmas Derrick about her report "In Case of Emergency"