The morning after

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Nepal, March 22, 2004 – The Himalayan Times

She is raped on the street or at home. She has sexual encounter and uses contraception, but the oral contraception fails or the condom breaks. She does not want a pregnancy. She faces health risks as a result of pregnancy. In a country like Nepal talking about sex is also taboo, and yet more and more young teenage girls are getting pregnant as they have very little knowledge about the subject. Untimely pregnancy leads to abortion.

According to Demographic Health Survey (DHS), Nepal has one of the highest maternal death rates among all the SAARC countries and over half of the deaths are due to unsafe abortions. Women facing unintended pregnancy are at greater risk of depression and physical abuse. The child born of an unintended pregnancy is at a greater risk of being born at low birth weight, dying in the first year of life, not receiving resources necessary for healthy development and being abused or neglected. To avoid all these problems, emergency contraception is being introduced in Nepal.

What is emergency contraceptive?

Emergency contraception (EC) is not the bortion pills, informs Renuka Gurung, programme manager of Centre for Research on Environment Health and Population Activities (CREHPA). According to World Health Organisation (WHO): Emergency contraception refers to contraceptive methods that work after unprotected sex but before pregnancy. It is often referred to as the morning after pill or post-coital pills.

Emergency contraception must be taken within 72 hours after unprotected intercourse, which is well before a pregnancy can be established. It prevents pregnancy, often by delaying or inhibiting ovulation. They will not cause an abortion if a woman is already pregnant at the time she takes the pills. Emergency contraception can play a much stronger role in reducing unintended pregnancy and unnecessary abortion in our nation according to Gurung.

What are the various methods?

Two methods of emergency contraception are common,a says Gurung. Since the Prostinor pills are not available in the country, ordinary oral contraceptive pills, Nilocon white, could be a good substitute, she says. The first dose of four pills should be taken within 72 hours of intercourse, followed by a second dose of four pills again 12 hours later.

Copper-T (intrauterine device) is another effective method to stop fertilisation. It must be inserted up to five days after unprotected intercourse. However, it is more viable in a married woman than an unmarried teenager.

Poonam Yadav, programme officer at CREHPA is of the opinion that if a woman is not able to procure the pills within 72 hours then she can opt for Copper-T, which is equally effective.

Things to be kept in mind If a woman is already pregnant then EC or any other contraception pills should not be taken. Though this proves to be useful it should not be taken on a regular basis. EC does not prevent sexually transmitted diseases (STD) such as HIV/AIDS or syphilis. Therefore should not be mistaken as pills that prevent STD.

How safe and effective is it?

Yadav says that various studies have proved that the pills are very safe for women. According to a WHO report, she says, that if the pills are taken within or before 72 hours of unprotected sex then it will prove to be very effective.

Side effectsWomen complain of nausea and vomiting after starting the Morning After Pill”, according to Yadav. Despite these symptoms, it is very important to complete the entire dose to ensure that the treatment is successful she says. If nausea becomes unbearable then a doctor or health provider should be contacted.

It is advisable for women to take pills which stops vomiting before taking the EC,” she adds. Using this emergency birth control method may also delay start of menstruation but not

all women experience this, she informs.