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1 PILL VS 2 PILLS: ALL YOU NEED TO KNOW ABOUT EMERGENCY CONTRACEPTIVE PILLS IN GHANA

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Have you ever used emergency contraceptive pills? What do you think about the ones that come as one pill and the ones that come as two pills? Do you think one is more effective than the other? Why?

Emergency contraception is a birth control method that works to prevent pregnancy after unprotected sex or when other contraceptives used failed – it could be a condom bursting or the woman missing 3 or more days of taking her daily contraceptive pill. It comes in three forms: the emergency contraceptive pills, the combined oral contraceptive pills, and the IUD (the intrauterine device that can be inserted in the uterus within 5 days after unprotected sex to prevent pregnancy). The IUD can be left in the uterus for up to 10 years and it is said to be the most effective form of emergency contraception (99% success rate). It can also be removed right after the woman’s next period or any time she wants it removed. 

THE EMERGENCY CONTRACEPTIVE PILLS (ECPs)

The emergency contraceptive pills are safe and up to 95% effective in preventing pregnancy within 120 hours after unprotected sex, but they are more effective when you take them sooner. They are also called post-pills, emergency pills, and morning-after pills. Even though they are called morning-after pills, you don’t need to wait till the next morning to take them. You can take them right after sex and the earlier you take them, the more effective they are. 

Here are some reasons why anyone would have to take emergency contraceptive pills after sex: 

  1. If the woman wasn’t on any form of contraceptive during the intercourse 
  2. After sexual assault or rape 
  3. If the condom breaks, tears or slips off during sex
  4. If the cervical cup or diaphragm slips out of place during sex 
  5. If the woman misses 3 or more days of taking her daily contraceptive pills or birth control pills 
  6. If there’s an expulsion of an inserted IUD or implant 
  7. If there is a possibility of a contraceptive failure

THE TYPES OF EMERGENCY CONTRACEPTIVE PILLS 

Emergency contraceptive pills are either available as a single dose (one pill or tablet) or a double dose (two pills or tablets). Interestingly, there’s some confusion about the two and a widely held assumption that the 2-pills ECPs are more effective than the 1-pill ECPs. I’m here to tell you that that assumption is FALSE! 

Initially, companies only made and sold the 2-pill drugs until research showed that combining both in one pill would still be as effective as the 2-pill drugs in preventing pregnancy after unprotected sex. Since then, most emergency contraceptive pill companies have made available the 1-pill drugs and others have made available both 1-pill and 2-pill drugs because they are both effective.

I mean, they wouldn’t be approved by WHO (World Health Organization) if they weren’t effective. Both types contain the right amount of ingredients necessary to prevent pregnancy and although there are factors that affect the efficacy of the pills, they are in no way related to the number of pills that come with each type. 

HOW DIFFERENT IS THE SINGLE DOSE ECP FROM THE DOUBLE DOSE ECP? 

Based on the ingredients they contain, there are two different types of emergency contraceptive pills:

  • ECPs That Contain UPA (Ulipristal Acetate) – 1 PILL
  • ECPs That Contain Levonorgestrel – 1 PILL & 2 PILLS
    • The single-dose: one pill that contains 1.5mg of levonorgestrel (examples are: Back-Up Emergency Contraceptive Pill, 1 Tablet Lydia Postpil, Plan B One-Step & Next Choice One Dose) 
    • The double dose: 2 pills that contain 0.75mg of levonorgestrel each and can be taken together or 12 hours apart. 0.75mg + 0.75mg = 1.5mg – combining (the sum of) both pills in the double dose = The single dose

ECPs containing UPA are not sold in Ghana. Only the ECP containing levonorgestrel is available in Ghana; they are common and can be purchased in any pharmacy without a prescription. The main ingredient, levonorgestrel, is a synthetic form of progesterone that stops or delays ovulation in order to prevent pregnancy. They can be taken within 72 hours after sex but need to be taken earlier because the longer you wait, the more the effectiveness declines. 

They are up to 95% effective in preventing pregnancy and are sold under several brand names like Postinor 2, Levonelle, Lydia postpil, and many others.

Combining (the sum of) both pills in the double dose = The single dose

Hence, whichever one you take works effectively. Studies have also shown that taking a single dose of 1.5mg is as effective as taking a double dose of 0.75mg each (12 hours apart).

WHERE CAN YOU BUY ECPS IN GHANA?

Emergency contraceptive pills that contain levonorgestrel can be purchased in all pharmacies in Ghana without a prescription. The prices range from GH₵5.00 to approximately GH₵10.00 for Lydia postpil and GH₵30.00 for postinor 2. To purchase back-up emergency contraceptive pill, contact Marie Stopes by calling this number: 0800222333

To learn more about where and how to access emergency contraception in Ghana, click this link: ECPs in Ghana

WHAT AFFECTS THE EFFICACY OF EMERGENCY CONTRACEPTIVE PILLS? 

A number of things can make emergency contraceptives less effective. These will require you to take another dose if you want to prevent pregnancy:

  1. Throwing up within 3 hours after taking the pill(s)
  2. Waiting too long (over 12 hours) to take the second dose of the 2-pill emergency contraceptives. If you don’t take both pills at the same time, you are required to take the second one within 12 hours after taking the first. 

Secondly, some medications or drugs react with emergency contraceptive pills to decrease their effectiveness. For this reason, you should use other contraceptives if you are taking any of such medications. 

Such medications include: 

  1. Some drugs used to treat HIV and/or tuberculosis  
  2. Omeprazole and other drugs that work to make the stomach less acidic
  3. Some antibiotics like rifampicin and rifabutin
  4. St John’s Wort
  5. Some drugs used to treat epilepsy like Carbamazepine and phenytoin

NB: You need to let your doctor or health care provider know what drugs you are taking or what medication you are currently on in order to decide if you can still go ahead and use emergency contraceptive pills. If you can’t, you can opt for IUD or other birth control methods. 

AVOID REGULAR OR PERSISTENT USE 

From its name, it is important to note that the emergency contraceptive pill is not and shouldn’t be used as a regular contraceptive. This is because the side-effects are worsened and uncomfortable when you take them frequently (WHO, 2018). Secondly, even though the same type can be used more than once in one menstrual cycle (if you have to/on rare occasions) and it won’t make you infertile, it isn’t as effective in preventing pregnancy as other birth control methods. For this reason, choosing to use it as a regular contraceptive method might result in failure and cause pregnancy. 

So, if you have an active sex life and you don’t want to get pregnant anytime soon, it’s best to explore other contraceptives to choose the best one for you. Visit findmymethod.org to explore your options and get help/guidance in choosing the best contraceptive method for you. 

To learn more about emergency contraceptive pills, the side effects, myths, frequently asked questions and how to use them, click this link: Emergency Contraception

Don’t risk getting pregnant if you are in no place to keep a pregnancy! Know the options available to you, know the side-effects, and learn the right way to use them. Remember, whether the emergency contraceptive pill comes in a single dose or a double dose, it can still prevent pregnancy. It is not and shouldn’t be used as a regular contraceptive

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MENTAL HEALTH ADVOCATE, WRITER, SEX AND RELATIONSHIP EXPERT

Ami Shikah is a sex educator and mental health advocate. She is passionate about sex education and is working towards making her website/blog a place where people come to for knowledge and information that will help them make healthy decisions about sex and sexuality. Mental health isn't treated with much importance in her part of the world (Ghana, Africa) and as someone who has had to deal with depression and suicidal thoughts, she hopes to share her experiences with the world and help other people like her. She has in-depth knowledge about sex, sexual health, sexuality, vaginal health, pregnancy and abortion and is working to share it all with the world. She has also made it possible for people to ask questions and get answers to them anytime.

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