Want to avoid looking like the Duchess of Cambridge? Don't cross your fingers

It seems they're all at it. As well as the Duchess of Cambridge, Kim Kardashian, Peaches Geldof and a host of other celebrities are showing off their pregnancy bumps.

But not all pregnancies are welcome - termination rates have been on the rise for 40 years. Overall, they've been about stable for the last five years, with just under one in 50 of women aged 15-44 having terminations each year between 2007 and 2011. That's still more than twice as many as in the 1970s. But women in their early 20s have the highest rate of all, and their rates of termination continue to go up, from 1% a year in the mid-1970s to 2.2% a year in the mid-1990s to 3.3% a year today (ref 1).

When I first became a GP over 20 years ago, the 'morning after pill' was widely believed to be just that - a tablet that reduced your risk of getting pregnant after a contraception accident as long as you got it the next day. The name may have been catchy - after all, it was the first time women could do anything practical 'after the event'. But actually, it's not accurate - emergency contraception, as doctors all call it, doesn't just work in the first 24 hours after unprotected sex. The pill which is most widely available, Levonelle®, works for up to three days after unprotected sex and the other pill available, ellaOne® , works for up to five days. Although there have been sensational headlines about 'the abortion pill', both pills work mainly by delaying ovulation - so there's no egg to be fertilised and no 'abortion' to be induced. Neither is completely fail-safe - the average woman has about a 5.5% chance of getting pregnant from a single episode of unprotected sex, which is reduced to 2.2% by taking Levonelle® in the next 72 hours and to 1.4% by taking ellaOne® (ref 2). Much of the superior performance of ellaOne® comes in the first 24 hours, where unwanted pregnancy rates are 2.5% with Levonelle® and 0.9% with ellaOne® (ref 2).

The other effective method of emergency contraception is coil-fitting. It's actually the most effective method of all - almost 100% effective and can be fitted up to five days after unprotected sex. It has the added advantage of providing long-term contraception as well - although hormonal contraception, like the oral contraceptive pill, can be started at the same time as giving ellaOne®.

Levonelle®, ellaOne® and sometimes coil-fitting are available from GPs, and family planning clinics or family planning organisations, like the British Pregnancy Advisory Service or Brook.

Levonelle® is also available to buy from many pharmacists, without prescription and without seeing a doctor. They may not be a perfect solution - and they're certainly not an alternative to using regular, reliable contraception - but they are a LOT more effective than hoping for the best!


1) Department of Health. Abortion Statistics, England and Wales: 2011 published May 2012

2) Glasier A et al. Ulipristal acetate versus levonorgestrel for emergency contraception: a randomised non-inferiority trial and meta-analysis. Lancet 2010; 375: 555-62

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