Emergency contraception – a neglected option for birth control

Eka R. Gunardi, Darrell Fernando

DOI: https://doi.org/10.13181/mji.v22i4.609


Emergency contraception (EC) is any method of contraception which is used after intercourse and before the potential time of implantation, in order to prevent pregnancy after an unprotected or inadequately protected sexual intercourse, or cases of rape. Use of emergency contraception could halve the number of unintended pregnancies and the consequent need for abortion, but unfortunately many medical professionals and the public are not aware of it. Two methods are available for emergency contraception, namely emergency contraception pills (ECPs) and copper-bearing intrauterine devices (Cu-IUDs). There are two regimens of ECP, the levonorgestrel regimen and combined regimen. The levonorgestrel regimen is preferred as it is more effective and causes less side effects. ECPs should be administered as soon as possible after unprotected or inadequately protected sex, being most effective if initiated within 24 hours. Cu-IUDs can be inserted up to 5 days after unprotected sexual intercourse. Emergency contraception mainly works by preventing fertilization, and does not interrupt and established pregnancy. Emergency contraception is very safe, therefore can be offered to women who have had unprotected intercourse and wish to prevent pregnancy. It must only be used as a backup method of birth control. (Med J Indones. 2013;22:248-52. doi: 10.13181/mji.v22i4.609)

Keywords: Birth control, copper-IUD, emergency contraception, emergency contraceptive pills, levonorgestrel

Full Text:



  1. Dunn S, Guilbert E. Emergency contraception. J Obstet Gynaecol Can. 2012;34(9):870-8.
  2. Sadler TW. Langman's medical embryology. 11th ed. Philadelphia: Wouters Kluwer/Lippincott Williams & Wilkins; 2010.
  3. Armstrong C. ACOG Recommendations on Emergency Contraception. Am Fam Physician. 2010;82(10):1278.
  4. World Health Organization [Internet]. Emergency contraception [updated 2012 July; cited 2013 October 10]. Available from: http://www.who.int/mediacentre/factsheets/fs244/en/
  5. Ellertson C. History and efficacy of emergency contraception: beyond Coca-Cola. Fam Plann Perspect. 1996;28(2):44-8. http://dx.doi.org/10.2307/2136122
  6. Dirjen Bina Kesehatan Ibu Kementerian Kesehatan RI [Internet]. Factsheet: kontrasepsi darurat [updated 2013]. Available from: http://www.kesehatanibu.depkes.go.id/wp-content/uploads/downloads/2013/01/Factsheet_Kondar.pdf. Indonesian.
  7. Trussell J, Jordan B. Mechanism of action of emergency contraceptive pills. Contraception. 2006;74(2):87-9. http://dx.doi.org/10.1016/j.contraception.2006.03.028
  8. Task Force of Postovulatory Methods of Fertility Regulation. Randomised controlled trial of levonorgestrel versus the Yuzpe regimen of combined oral contraceptives for emergency contraception. Lancet. 1998;352(9126):428-33. http://dx.doi.org/10.1016/S0140-6736(98)05145-9
  9. Gemzell-Danielsson K, Berger C, P GLL. Emergency contraception -- mechanisms of action. Contraception. 2013;87(3):300-8. http://dx.doi.org/10.1016/j.contraception.2012.08.021
  10. Committee on Health Care for Underserved W. ACOG Committee Opinion Number 542: Access to emergency contraception. Obstet Gynecol. 2012;120(5):1250-3.
  11. National Intitute for Health and Clinical Excellence [Internet]. Contraception – emergency [cited 2011]. Available from: http://cks.nice.org.uk/contraception-emergency - !topicsummary.
  12. Kulier R, O'Brien PA, Helmerhorst FM, Usher-Patel M, D'Arcangues C. Copper containing, framed intra-uterine devices for contraception. Cochrane Database Syst Rev. 2007;4:CD005347.
  13. Cheng L, Che Y, Gulmezoglu AM. Interventions for emergency contraception. Cochrane Database Syst Rev. 2012;8:CD001324.
  14. Ortiz ME, Croxatto HB, Bardin CW. Mechanisms of action of intrauterine devices. Obstet Gynecol Surv. 1996;51(12 Suppl):S42-51. http://dx.doi.org/10.1097/00006254-199612000-00014
  15. Gemzell-Danielsson K, Marions L. Mechanisms of action of mifepristone and levonorgestrel when used for emergency contraception. Hum Reprod Update. 2004;10(4):341-8. http://dx.doi.org/10.1093/humupd/dmh027
  16. Wanggren K, Stavreus-Evers A, Olsson C, Andersson E, Gemzell-Danielsson K. Regulation of muscular contractions in the human Fallopian tube through prostaglandins and progestagens. Hum Reprod. 2008;23(10):2359-68. http://dx.doi.org/10.1093/humrep/den260
  17. Cleland K, Raymond E, Trussell J, Cheng L, Zhu H. Ectopic pregnancy and emergency contraceptive pills: a systematic review. Obstet Gynecol. 2010;115(6):1263-6. http://dx.doi.org/10.1097/AOG.0b013e3181dd22ef
  18. Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception. 2007;75(6 Suppl):S16-30. http://dx.doi.org/10.1016/j.contraception.2007.01.020
  19. Center for Disease Control and Prevention. US medical eligibility criteria for contraceptive use. MMWR. 2010;59(No.RR-4):1-85.

Copyright (c) 2013 Eka R. Gunardi, Darrell Fernando

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

All articles and issues in Medical Journal of Indonesia have unique DOI number registered in Crossref.