Emergency Contraception Explained to Africans
By: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). Medically reviewed by: Tii Ngwachi Munghieng, MD.
Alt text: Picture showing contraceptive pill packs and a pregnancy test strip placed side by side Image credit: Pexels
Susan closed her mother's shop by 8:30 p.m. and was rushing home to cook dinner. She decided to take a lonely but shorter route to her house. Unfortunately, she was accosted by a group of boys who raped her in turns. Her cry attracted a bystander who took her to a nearby health centre, where she was treated with painkillers and antibiotics and then discharged. Two weeks later, she missed her period and started feeling sick. She visited a nearby health centre, where a pregnancy test was done, and it was positive.
When unprotected sexual intercourse happens around the ovulation period, pregnancy is likely to occur. In such cases, using a method of pregnancy prevention (contraception) after intercourse may help prevent pregnancy.
Apart from unprotected sex, some African women have poor access to effective contraception and rely on methods like condoms and natural family planning. These may fail and require emergency contraception as a backup.
In addition, due to poor living conditions (such as slum dwelling), armed conflict, displacement, and insecurity, some young girls like Susan are exposed to sexual assault. They risk unintended pregnancies, especially when emergency contraception is not accessible.
Evidence indicates growing awareness of emergency contraception (EC) among African women [1]. However, significant disparities persist between countries, particularly among poor and uneducated rural populations. As a result, unplanned pregnancies remain common, often leading to unsafe abortions and related complications, including maternal deaths.
The missing link in Susan’s post-rape experience is emergency contraception, and that’s the focus of this article. We will explore the different types of emergency contraception and how they are used.
According to the World Health Organization (WHO), emergency contraception refers to methods of contraception that can be used to prevent pregnancy after sexual intercourse. It is also known as post-coital contraception.
It is aimed at preventing an unwanted pregnancy after unprotected or underprotected sex.
There are many options for emergency contraception, ranging from oral drugs (taken by mouth) to intrauterine devices (inserted into the womb). The oral medications are also known as the morning-after pills.
Consistent with the World Health Organization recommendations, emergency contraception is required when: [2, 3]
Chart depicting the effectiveness of emergency contraception. Click on image to enlarge.
Generally, emergency contraceptives are up to 95% effective. However, their effectiveness depends on how soon they are taken after intercourse, especially for oral contraceptives. Emergency contraception is less effective in obese individuals [4].
Emergency contraception is typically used for short-term situations and is considered to be safe. There are no restrictions on its use. Any woman of reproductive age, including adolescents and breastfeeding women, can use it.
There are four main methods (See table 1 for a comparison of their features):
Table 1: A comparison of the features of common emergency contraceptives.
How Do Emergency Contraceptives Work?
These are how emergency contraceptives work:
Introduced by Yuzpe, AA, this regimen contains both estrogen (ethinyl estradiol) and progesterone (levonorgestrel). These are artificial forms of the female reproductive hormones.
It delays or prevents ovulation.
It contains two doses taken by mouth, 12 hours apart. Each dose contains 100 mcg of ethinyl estradiol and 500 mcg of levonorgestrel. The first dose must be taken within 72 hours of intercourse. This method is less popular today due to its high estrogen content. It is used only when other methods are unavailable.
The Yuzpe regimen prevents up to 75% of pregnancies and is less effective than other emergency methods. Effectiveness decreases the longer the delay in taking it.
It may cause nausea and vomiting.
This pill contains the hormone levonorgestrel (a type of progesterone). Brand names include Postinor, Plan B, etc. It is available over the counter in Africa.
It delays or prevents ovulation.
The first dose must be taken within 72 hours of intercourse.
It prevents about 89% of pregnancies.
May cause irregular periods, breast pain, and headaches.
Also known as EllaOne, Ulipristal acetate is newer than the other pills [6]. It is available over the counter in Africa, though often expensive. It was introduced into the European and United States of America markets in 2009 and 2010, respectively
UPA is a progesterone receptor modulator. It affects progesterone’s action and delays ovulation.
Single dose of 30 mg, taken within 120 hours (5 days) of intercourse.
It is more than 95% effective, with studies showing a pregnancy rate of 1.2% (1 in 100 women)
May include headache, abdominal pain, vomiting, and delayed menstruation.
Mifepristone is a progesterone antagonist, meaning it works against the action of progesterone.
Alters the lining of the womb, making it less receptive to a fertilised egg.
The usual dose is 10–25 mg taken once, though higher doses have also been used. Mifepristone is effective when used within 72 hours of intercourse.
It is more effective than levonorgestrel, with a pregnancy rate of 1-10 per 1,000 women reported by studies.
Mifepristone may cause nausea and vomiting. It may also cause prolonged vaginal bleeding.
This is a small plastic device lined with copper that is inserted into the womb to prevent pregnancy [7]. It does not contain hormones. It is commonly known as the coil or loop.
The copper IUD triggers a reaction in the womb lining to prevent implantation (when a fertilized egg attaches itself to the wall of the womb). Copper also affects sperm function.
It should be inserted within 5 days of unprotected sex and must be done by a health professional.
It is the most effective emergency contraception method, with a pregnancy rate of about 0.1% (1 in 1,000).
Side Effects
Copper IUD may cause abdominal cramps, irregular or heavy periods.
Recently, the levonorgestrel 52 mg IUD has been introduced in the USA as an emergency contraceptive method. However, its use is not widespread. It is more costly and may not be easily accessible to African women.
Unintended pregnancy is a public health concern. It is often the result of unprotected or poorly protected sex and reflects limited access to contraception. Emergency contraception helps bridge this gap. Many emergency contraceptives are available over the counter in urban areas across Africa. However, more should be done to educate rural women and to improve access in remote regions.
If the vomiting occurs within 3 hours, you should take another dose.
Emergency pills (except mifepristone) are not known to harm a developing baby.
No. One dose is enough for multiple sex episodes on the same day.
Yes, but it's best to switch to a more stable birth control method within 1–2 weeks.
Hormonal emergency contraception does not cause abortion. However, mifepristone can cause abortion if taken after pregnancy has already occurred.
1. Awopegba OE, Chukwudeh OS, Owolabi EO, Ajayi AI. Trends in emergency contraception awareness among women and girls in 28 sub-Saharan countries. BMC Public Health. 2021 Nov 3];21(1):1987. Available from here.
2. Upadhya KK, Committee On Adolescence. Emergency contraception. Pediatrics. 2019 Dec;144(6):e20193149. Available from here.
3. Practice bulletin no. 152: Emergency contraception. Obstet Gynecol. 2015 Sep;126(3):e1–11. doi: 10.1097/AOG.0000000000001047. Available from here.
4. Edelman AB, Hennebold JD, Bond K, Lim JY, Cherala G, Archer DF, et al. Double dosing levonorgestrel-based emergency contraception for individuals with obesity: a randomized controlled trial. Obstet Gynecol. 2022 Jul 1;140(1):48–54, Available from here.
5. Gemzell-Danielsson K, Berger C, P G L L. Emergency contraception -- mechanisms of action. Contraception. 2013 Mar;87(3):300–8. Available from here.
6. Sullivan JL, Bulloch MN. Ulipristal acetate: a new emergency contraceptive. Expert Rev Clin Pharmacol. 2011 Jul;4(4):417–27. Available from here.
7. Goldstuck ND, Cheung TS. The efficacy of intrauterine devices for emergency contraception and beyond: a systematic review update. Int J Womens Health [Internet]. 2019 Aug 21 [cited 2025 Jul 9];11:471–9. Available from here.
Related:
Why family planning is essential to Nigerian women of reproductive age?
Family planning options for men and women
Birth control pills in Nigeria: Common myths and misinformation
Published: August 10, 2025
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