Young women under 24 years are more likely than older ones to experience unwanted pregnancy, even when contraceptives were readily available. Several factors explain this situation. Sex between young adults may be occasional and not prévus.1 Young married and unmarried are often inefficient users of contraceptives because they just started sexual practices and regulatory naissances.2 Often, they are misinformed on sexuality and reproductive health. Perhaps they are authentic to some myths, for example that a woman can not get pregnant the first time she has sex.
The emergency contraceptive pills (ECPs), a contraceptive that can be used up to 72 hours after unprotected sex, can be very useful for young adults. Since the PCU avoid unwanted pregnancy, it also helps to avoid abortion and the maternal morbidity and mortality. The PCU helps sexually active young people to realize that it is perhaps time for them to start using a regular contraception.3 It is important that young men and women, know the PCU because they have unprotected sex and pregnancy may not soubaitée with all health and social consequences that entails, they know there is still time to do something to prevent this situation.
What the emergency contraceptive pill and how does it work?
The PCU contains a special dose of the same hormones as the pill normal. It is reserved for emergencies that may arise, for example if a condom breaks or a diaphragm did not remain in place or no use of contraception or rape. A woman who uses the PCU takes two doses to twelve hour intervals, with special strengths of regular oral contraceptives containing estrogen normally and progestatifs.4 Another progestin pills, as effective as combined oral contraceptives but with a lower incidence of side effects is also available in some countries. Whatever the protocol, the first is taken as quickly as possible after unprotected sex but no later than within 72 hours.
The PCU decreases by about 75% risk of pregnancy. This rate is calculated using estimates that if 100 women have one unprotected sexual intercourse during the second or third week of their menstrual cycle, only two fall pregnant if they use ECPs compared to the eight who normally fall pregnant without the use of this contraceptif.5
The instructional material such as training guide Pathfinder International provides detailed information on the formulation, dosage and clinical management of the emergency contraceptive pill .6 Some women have nausea and vomiting for one or two days following the capture of the PCU. Under other side effects, there is the saignotements a temporary sensitivity breasts, headaches, dizziness and fatigue.
Next at what point in its cycle, a woman uses the PCU act in different ways. Studies show that if ovulation has not yet occurred, ECPs can stop or postpone ovulation. The mechanism of delaying ovulation is probably the only mode of action or the main mode. Some researchers believe that ECPs can also act in other ways but there are few facts to support their hypothèse.7 If a woman has ovulation, ECPs can prevent fertilization, prevent the transport of a fertilized egg in the tube Fallopian making it reaches the uterus at the wrong time or they may prevent implantation in the uterus .8 Additional research is needed to determine which of these mechanisms actually contributes to the effectiveness of CEP.
ECPs can not cause an abortion. According to the definition of the medical community and regulatory agencies like the U.S. Administration for food and medicine, pregnancy begins after implantation of an egg fécondé.9 ECPs have no effect on an embryo implanted . If used in early pregnancy, the facts indicate that they have no harmful effect for the mother or foetus.10
What are the benefits of the PCU for young people?
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The CEP offers a substantial because it is a method in case of non-sexual protégées.11Pour young people who are not prepared for a sexual encounter or have unintended reports, the CEP offers a second chance to use a contraceptive.
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The PCU is for the young who had not yet seen an introduction of services to health care reproductive.12
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Family planning programs can provide ECPs and advice to young sexually active before they may need to use them in an emergency or within 72 hours after unprotected sex. A distribution in advance with the advice and monitoring requirements are especially important for young people using methods barriers whose failure rates are higher than those of hormonal contraceptives. Some experts of the reproductive health of young advocates to distribute a leaflet PCU with condoms and vice versa.13
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ECPs help sexually active young people while they make the transition and move to a sustainable use of contraceptifs.14 ECPs should be seen as a transitional contraceptives because regular rates much higher efficiency. For example, the rate of unwanted pregnancy for condoms, as commonly used, is about 14% of women during the first year of use .15
What are the disadvantages of the PCU?
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Like all hormonal methods, the PCU does not protect against STDs, including HIV.
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Considering that many women probably n'agiront if they do not have their next period, they miss the opportunity to use the PCU to prevent grossesse.16
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Since the PCU is only effective within 72 hours after unprotected sex, it should be clear to young people a means of contraception is necessary for future sex. The CEP offers no protection for the remainder of the menstrual cycle a woman.
What are the experiences of ECPs distributing the programs for youth?
The use of the PCU is limited in many countries, although the medical community known for thirty years the effectiveness of the pill in an emergency .17 Despite these limitations, more and more women hear about the PCU and ask their provider to provide them. In most countries, women can obtain ECPs only through the service, although in some countries, platelets pill can be obtained without a prescription at pharmacies or from the community.
Some European countries, such as the United Kingdom, selling plates of pills packaged specifically for use in an emergency .18 Women commonly use the PCU in the UK and the Netherlands where the pill is part of integrated reproductive health reimbursed by social security pays.19 The experience of the Netherlands demonstrates the acceptability of the PCU among young people: in 1991, 70% of Dutch women receiving PCU their general were less 25 years and 34% had less than 20 ans.20
Cost data from the United Kingdom indicate that the provision of the PCU with advice costs between $ 19 and $ 74, depending on prestataire.21 In developing countries, we think the price will be about 25 cents for non-governmental organizations, NGOs and marketing social.22
What are the barriers to the use of ECPs by young adults?
Despite the importance and effectiveness of the PCU, young people who need emergency contraception face many barriers to get it. Many young people are not aware of the PCU as a means of preventing unwanted pregnancy. The health care providers are often themselves as poorly informed about emergency contraception and the argument often put forward by the PCU encourages promiscuity as a reason not to distribute to young then that is not coming back this reason.
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Most providers in a study in Viet Nam have overestimated the incidence and severity of side effects and cited indications against incorrect. Some providers said they did not propose the PCU to their patients given the lack of research results known and most thought that the distribution should be strictly contrôlée.23
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Some confusion still surrounds the PCU and abortion and this confusion may block efforts to prevent an unwanted pregnancy, as we saw in Malaisie.24
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Some recommend to provide the PCU combined with condoms but a study of university hospitals in the United States shows that some providers are concerned about this approach. These providers believe that tell students to use condoms to prevent pregnancy and STDs and then provide them with the PCU as the condom may tear is an ambiguous message about the effectiveness of condoms.25
PCU programs are underway in developing countries?
Despite such barriers, family planning programs involved in seeking international awareness of the PCU and make them available. For example, the organization affiliated to the International Federation for Family Planning in Colombia, PROFAMILIA organizes daily educational activities for youth, their parents and teachers. Educators give information on the PCU in their meetings on reproductive health. Young people want to know what is in the PCU, how it works, causes Does abortion, what are the risks or side effects and is permitted by law. The staff PROFAMILIA shows young people how to use ECPs only for emergencies and encourages them to share information on PCU with their camarades.26
But most programs that distribute the PCU youth in developing contexts are still at the pilot stage. They do not emit enough information or data on their experience. But the examples of these new programs will remain.
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The research unit on fertility at the Faculty of Medicine of Ibadan in Nigeria began a three-year pilot project in six centers for family planning and reproductive health. The clinic Youth Association for reproductive health and family (ARFH) is one of those sites. Grace Delano ARFH the pill called "saving" 27dans its support to the project's purpose is to broaden access to ECPs, especially among young people aged 15 to 24 ans.28 Even young men come to consult the clinics to receive ARFH PCU for their partner. Counselors ARFH advantage of the opportunity to tell young people that we should not rely on this method of emergency, it is better to avoid anxiety about a possible pregnancy and sexually young assets should adopt a regular contraceptive method.
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The Medical Association of Women of Kenya and the Program for Appropriate Technology in Health (PATH) wrote a short story, "What young people need to know about emergency contraception." The story begins with a young woman who cares about being pregnant after having the first sexual intercourse. Fortunately, the mother of the girl discovers what happened and give her daughter the necessary information on ovulation and fertilization. At the insistence of his mother, the girl went to a doctor for the PCU and avoid a possible pregnancy and promises not to have sex until marriage. The story ends by encouraging young people to spread the news about emergency contraception with their friends who have had unprotected sex protégés.29
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The Medical Center in Mexico City as part of the National University of Mexico has a pilot project with the Population Council offering students advice and medical services necessary for PCU.30 In addition, the Mexican Foundation for Family Planning (MEXFAM) and the Mexican Institute for research on family and population (IMIFAP) brought together information materials in Spanish for young people dealing with the PCU and communicated via publications and the Internet .31
What is the final message?
The CEP is an important option for emergency contraception for young people who are sexually active. Given the barriers surrounding the issue of youth sexuality and the confusion between the PCU and abortion, the PCU is underused. When the PCU is available and accessible to young, it is well accepted. It helps reduce the incidence of unwanted pregnancies and abortions, especially if its distribution is good advice. It also helps young people to realize the significance of contraception and encourages them to use a more reliable method on a regular basis.
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