The morning after the night before - what makes getting emergency contraception hard?
Emergency contraception, is a 'last resort' contraception for when, for whatever reason, you have unprotected sex. It can be a pill, taken up to 3 days after unprotected sex (the sooner the better), or a coil, fitted up to 5 days after.
In my work in teenage pregnancy I have come across loads of barriers that young women face when they need to get emergency contraception. One of the main ones is embarrassment.
I heard young mum’s say that they didn’t get emergency contraception because they were too worried that they’d be judged by health professionals or that they were too embarrassed to get it - talking to a stranger, however professional they are, about the fact you had unprotected sex can be something that many people find hard. Sometimes, it's OK the first time, but going back to a doctor to get it for a second or third time can feel too embarrassing for someone. I have heard of someone who travelled to a different town to go to a different clinic the second time they wanted the morning after pill, as they didn't want to go to the same doctor again.
This fear of being judged is made even more difficult if a young woman does not understand what the morning after pill does or how it works. Some women mistakenly think that it causes an abortion (in fact, it prevents an egg being released or, in some cases, stops a fertilised egg from implanting in the womb in the first place) and may think they will be judged for this – by those they are talking to or sometimes within their religion or family.
We do a lot of work trying to lessen this embarrassment and make it easier for young women to access it. Something that works quite well are discretion cards. These are a bit like business cards which you hand over to your pharmacist or the doctors receptionist to explain what you want, without you having to say a word. These can be good in a crowded pharmacy or surgery, especially in small towns where there might be someone you know there. Other things that I have heard people say helps them is thinking “this might be embarrassing and difficult but not as embarrassing and difficult as telling everyone I am pregnant”. Which seems like quite a good thing to repeat to yourself if you get nervous. Something else I've heard works is always telling the doctor the condom broke – it could be less embarrassing than admitting to unprotected sex for some people. However, for me, I think the most important thing for people to remember is that most doctors and pharmacists would be pleased you are taking control of your contraception and avoiding the risk of an unplanned pregnancy by getting emergency-contraception.
Another barrier, which I have touched upon already, is lack of knowledge. As someone who works in with teenage mothers, many of whose pregnancies were unplanned, finding out that it was lack of knowledge that led to them not getting emergency contraception is really sad and frustrating. Sometimes this is that people think they are too young to get it. This isn't helped by the fact that some pharmacies refuse to give the morning after pill to under 16s. It also isn’t helped by the fact that, to buy the pill from a pharmacy without a prescription costs about £28 (not something your average 15 year old has to hand)while many younger women are scared to go to their doctors to get a free prescription because they are worried that the doctor will tell their parents.Other things that I have heard people say helps them is thinking “this might be embarrassing and difficult but not as embarrassing and difficult as telling everyone I am pregnant”.
Another thing that not everyone knows is that, while getting emergency contraception as soon as possible is best (I have known cases of young women who delayed getting the morning after pill for 24 hours because they were so hungover and, while they did take it in the end, still ended up pregnant), if you do miss the three day window, you can still get an IUD fitted as a form of emergency-contraception.
Something else that really shocked me recently is that there is even lack of knowledge within the NHS itself. I recently spoke to a nurse who didn't realise that you often had to pay to get the pill straight from a pharmacy! If the NHS themselves don't know the details, is it surprising that young women aren’t always clear themselves!
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