One in four pregnancies worldwide is an unwanted pregnancy, according to a study published in June 2019 by the World Health Organization (source 1). Following unprotected or poorly protected intercourse, two emergency contraception, allow to react before fertilization. If a pregnancy is already in progress, women can resort to voluntary termination of pregnancy (Medical or surgical abortion), up to 14 weeks of amenorrhea.
The morning after pill (hormonal emergency contraception)
Within a few days after unprotected sex or poorly protected, it is possible to take a morning-after pill. Objective: to prevent fertilization of the egg by a sperm. Two such contraceptives exist, both over the counter in pharmacies, without a prescription:
- The first is a high dose progestin based on levonorgestrel (Norlevo), to be taken at most within three days (72 h) following intercourse.
- The second contains the active ingredient ulipristal acetate (EllaOne), to be taken at most within five days (120 h) following intercourse. This is why it is also called day after pill.
Hormonal emergency contraception comes in the form of a single tablet. It can be taken at any time of the cycle and is all the more effective when it is taken quickly after intercourse: 95% when taken within 24 hours, 85% when taken between 24 and 48 hours and 58% when taken between 48 and 72 hours.
Emergency contraception can be issued free of charge to minors, anonymously, in pharmacies, family planning and school infirmaries (middle and high schools). Refusal of dispensing by a pharmacist is illegal.
It is safe and without serious side effects. However, it is advisable to remain vigilant in the event of risk or history of ectopic pregnancy. If menstruation does not occur within five to seven days following the expected date, you must take a pregnancy test.
Emergency contraception by IUD (intrauterine device or IUD)
The copper intrauterine device is considered the most effective method of emergency contraception. After unprotected or poorly protected intercourse, placing a Copper IUD significantly reduces the risk of getting pregnant: less than 0.2%, or 2 pregnancies per 1,000 users, regardless of the time of the cycle.
Inserting a copper IUD in effect makes the uterus unsuitable for implantation of the egg. Between the moment of intercourse and the implantation of an egg, there are at least five days. In the event of poor or unprotected intercourse, it is therefore possible to insert an IUD up to five days after the date of unsafe sex.
This method is more difficult to implement, because it requires the availability of practitioners (doctors, midwives). It will then serve as permanent contraception for several years.
Drug abortion to end an unwanted pregnancy
The voluntary termination of a drug pregnancy can be performed by a doctor or a midwife, in the hospital, in a health or family planning center or in a city office. If it is carried out in city medicine, she is authorized only until the seventh week of amenorrhea (no periods), i.e. the end of the fifth week of pregnancy. If it takes place in the hospital, it can be used up to the ninth week of amenorrhea. Beyond that, it is recommended to resort to surgical abortion.
In April 2020, to limit the consequences of the measures taken to deal with the Covid-19 epidemic, the deadline for use of medical abortion in town increased to 9 weeks, instead of 7 weeks (decree published on November 7, 2020 in the Official Journal – source 2). The Haute Autorité de Santé is calling for this measure to be made permanent (source 3).
Two cpreliminary onsultations (and possibly a psychological support interview) make it possible to carry out the necessary examinations, to take stock of the motivations and risks of this intervention. Then the medical abortion takes place in two stages:
- Making mifepristone, an antiprogesterone which stops pregnancy;
- 36 to 48 hours later, taking another type of medicine, misoprostol (two available: Gymiso and MisoOne; Cytotec used for a long time in this indication, but out of its marketing authorization, was withdrawn from the market in March 2018). This medicine helps cause the egg to expel. A few hours later, bleeding and uterine contractions occur.
Uborn follow-up consultation, 14 to 21 days after the operation, allows the doctor or midwife to check that the pregnancy has been terminated. A contraceptive pill will then be administered for one month, the day after the abortion, and a gynecological examination in the following month will be scheduled.
Surgical abortion to end an unwanted pregnancy
The voluntary termination of pregnancy (by aspiration) is performed in a health facility (hospital or clinic authorized to perform abortion). “Under certain conditions (abortion performed only under local anesthesia, suitable premises, availability of an anesthesiologist …), it can take place in an authorized health center having established a cooperation agreement with a nearby hospital center” , states Health Insurance (source 4).
In France, it is practiced before the end of the fourteenth week of amenorrhea (no period) and takes place in the hospital under general or local anesthesia. In the first case, hospitalization lasts nearly three hours. In the second, it lasts almost six hours.
The intervention consists of aspirate the embryo by means of a cannula introduced into the previously dilated cervix. Once performed, this abortion must be carefully monitored. A control visit takes place within 14 to 21 days.
Since April 2016, abortion and all associated medical procedures (consultations, ultrasounds…) Are 100% covered by Social Security.
Recall : abortion is not a method of contraception. It must remain exceptional and lead to an in-depth reflection on long-term contraception.
Emergency contraception: morning after pill or copper IUD, Haute Autorité de Santé, March 18, 2020
(1) High number of unintended pregnancies linked to lack of family planning services, new WHO study finds, WHO, October 25, 2019
(2) Order of November 7, 2020 amending the order of July 10, 2020 prescribing the organizational and operating measures of the health system necessary to deal with the covid-19 epidemic in the context of the state of health emergency
(3) Medicated abortion up to 9 weeks: perpetuating this right for women, Haute Autorité de Santé, April 12, 2021
(4) The two methods of abortion and the follow-up, Health Insurance