When Emergency Contraception (EC) Was Introduced

When the FDA approved the use of Emergency Contraception (EC), and Planned Parenthood began to make it available, my supervisor and I met to define my changing role.  It was only available by prescription then, so I had no direct role in distributing it, but my role in providing education—timely education—could potentially be significant in preventing unwanted pregnancies. Many people had never heard of it yet, or if they had, many had misinformation, so I needed to be thorough in my approach.

When it first became available, EC could be taken up to 72 hours after unprotected sex.  (It later changed to 120 hours, or 5 days).  I was to explain how it worked, preventing pregnancy after unprotected sex, and that if someone was already pregnant when they swallowed EC they would still be pregnant; it would not end, or terminate, an existing pregnancy.  It is completely different from a medical abortion, but many people were unaware of the differences.

Prior to EC, if anyone came to me concerned that they might be pregnant, my job was to stress the importance of getting a pregnancy test as soon as appropriate, keeping in mind that it usually takes 2 weeks for a pregnancy to show up on a urine test, but that the sooner the better after those first 2 weeks.  So for several years, my timeframe assessment had been straightforward.

Now it was going to change.

Now, if someone approached me concerned that they might be pregnant, I had more to assess than simply when to schedule an appointment for a pregnancy test.  I needed to pause there and get the timeframe: if they had had unprotected sex within 72 hours, they might be a candidate for the new EC.  I could provide general information about it, assess interest, and if they were interested I was to contact the clinic to try to get them in immediately.  The receptionists and nurses were similarly trained to put “Walk-in EC” as a top priority.

So according to my new flow chart, if someone expressed concern over a potential pregnancy, if unprotected sex had happened within 3 days (72 hours) I was to follow the EC line of questioning. If it had been between 3 and 14 days ago, I was to offer to help them schedule a pregnancy test as soon as possible after day 14, and if it had already been more than 14 days, I was to encourage a pregnancy test right away, and offer to schedule it.

Armed with my newly memorized flow chart, during the first weekly teen drop-in after my EC training, I was faced with my first potential EC patients; 2 teen girls came to my office saying, “We think we’re pregnant.”

“Do you wantto be pregnant?” I asked.

“No!” they replied in unison.

“Have you heard about the new EC pills?” I asked.

“Huh?” one of them replied.

“If someone has had unprotected sex and they don’t want to become pregnant, there are new pills called Emergency Contraception, or EC, that can be swallowed up to 72 hours after unprotected sex, to try to prevent pregnancy.  Do you mind if I ask, did either of you have unprotected sex within the last 72 hours, or 3 days?” 

Thinking I was prepared with my flow chart for any answer they might provide, one of them simply looked down at the floor and replied, “Not to the best of my knowledge.”