UK Contraception: Morning After Pill & Abortion Info

HI. So, at a big feminist coffee meeting with Emily, we talked about how woeful sex education is in this country. We never really got any useful advice or information about emergency contraception or abortion, so I thought I’d take the time to compile basically a list of what’s available, how it works, and where you can get it from in England, Scotland & Wales (Nothern Ireland, very very sadly, doesn’t allow abortions unless they’re in exceptional circumstances - most people in NI travel to England for a private abortion).

The Morning After Pill/Emergency Contraceptive Pill

First stop if you’ve had unprotected sex and you might be pregnant. The brand most commonly used in the UK is called Levonelle. It’s a progesterone pill and it works (we think) by either preventing or delaying ovulation (the release of an egg) or by preventing a fertilised egg from settling in the womb.

You need to take the pill within 72 hours (three days) of unprotected sex and it’s more effective the sooner you take it. If you take it within 24 hours it’s 95% effective, and this drops to 58% at 72 hours.

Levonelle is free on the NHS. You can get it from your GP surgery (make an appointment with your doctor), contraception clinics, sexual health clinics, GUM (genitourinary medicine) clinics or walk in centres. See List One at the bottom to find your nearest clinic which offers these services.

If you’re over sixteen you can buy the pill at most pharmacies (ie. Lloyds pharmacy, Boots pharmacy. There’ll probably be one near your GP surgery). It usually costs around £25.

There is another method of emergency contraception, which we’ll look at next.

Inter-Uterine Device (IUD)

The IUD works both as a method of emergency contraception and as a more long term method. You can use it as either, or as both.

An IUD can work as emergency contraception if it’s fitted within five days of having unprotected sex. It’s a little plastic and copper coil which sits in your uterus. It stops sperm from surviving in your uterus/cervix/fallopian tube. It may also stop fertilised eggs from implanting in the womb, and this is how it works as emergency contraception.

There’s a lot of positives to the IUD. Depending on the type, you can leave it in for five or ten years - or remove it sooner. Other medicines don’t effect it and your fertility will return to normal as soon as it’s removed. On the downside, if you use it as a method of long term contraception rather than an emergency, and you’ll need two physical examinations: one to check it’s suitable to fit, and then the fitting itself (which is nothing to be scared about).

It’s available from the same places as the emergency contraceptive pill and is free on the NHS (see links below) although obviously you can’t buy this one over the counter, as you need a trained medical practitioner to fit it.

If you’ve had unprotected sex it’s a very good idea to also be tested for infections.

This is basic good sense. Remember that having a sexually transmitted infection (STI) doesn’t make you a bad person, or a “slut”, or any of those other delightful words we like to hurl at sexually active women. There’s no shame in taking care of your sexual health, and getting tested is very important. If you do have an STI, you need to deal with it quickly before it does you any long lasting harm. Most STIs can be cured with some simple antibiotics.

You can get sexual health screenings free at the same places as an IUD or Emergency Contraceptive Pill (see links).

What to do if it’s too late for emergency measures:

We’re all human and nobody is perfect, and sometimes mistakes happen (maybe your condom spilt, maybe you didn’t use one). However it happened, don’t feel ashamed. At least next time you’ll hopefully be a little safer. If you skip a period, then there is a possibility that you might be pregnant. You need to do a test and we’ll take it from there.

Pregnancy Tests

You can buy pregnancy tests for a heap load of places, including pharmacies and even supermarkets. The most common brand is called Clear Blue and their basic test costs around £10, sometimes slightly under. It’s really simple - you pee on a stick and it’ll measure the hormones in your urine and tell you if you’re pregnant or not. You can take a test any time after the first day of your missed period (the day you’re due to start your period). Some fancy pants tests let you do them BEFORE your missed period, but these are occassionally a little inaccurate as you need to give the hormones enough time to build up in your body.

If your periods are irregular, then you can take one 21 days after the last time you had unprotected sex.

Alternatively you can have a pregnancy test free on the NHS (see links), although not all GUM clinics and walk in centres offer them and some pharmacies may charge you. Marie Stopes will charge you about £5.

If you are pregnant, then you have three options. Continue with the pregnancy and keep the baby, continue with the pregnancy and offer it up for fostering or adoption, or have a termination/abortion.

I’m going to talk extensively about option 3, a termination, but look at the links below if you want to continue with the pregnancy. Remember that it is your body and your choice exclusively what you do - don’t let anyone make the decision for you, although you need to think carefully and practically about it and there are plenty of people to give you advice and support. Don’t think you have to go through ANY of this alone. This can be a very tough choice to make, but the sooner you make it the better as terminations are easier the sooner in the pregnancy you have them, and arrangements about fostering/adoption need to be taken as soon as possible.

Abortion/Termination

If you’ve decided to have an abortion then you have two options; go private, or have it for free on the NHS. Some women choose to go private as the waiting lists are shorter, but be aware that this will cost a lot and is probably a more sensible consideration if you’re more advanced in your pregnancy and therefore aren’t in a position to wait too long.

Which type you have will be determined by consultation with a medical professional, but generally it will be decided according to how advanced you are in the pregnancy. How many weeks you are will be determined by the first day of your last period, so count from then.

In the UK (excluding Northern Ireland) it is legal to have an abortion up until 24 weeks into the pregnancy. Abortions may be performed after that but only if doctors have determined there is a serious medical risk in carrying on the pregnancy.

The best first step in obtaining an abortion is visiting your GP. You need a referral from two doctors to obtain an abortion and a GP is normally the first, although you can go to a GUM clinic or local family planning services. If nobody there is able to refer you for an abortion, they’ll put you in contact with a doctor who can.

You can also self refer using the British Pregnancy Advisory Services (see below for contact details).

Before a termination

Most terminations can be carried out in a day and no overnight stay is required. You can only have a termination in a hospital or a specially licensed clinic.

When you arrive you’ll have a consultation where they’ll give you the opportunity to talk about your choices. Then you’ll have a medical history taken and a blood test to determine which blood group you are. The doctor or nurse will inform you about the different types of abortion, which one is best suited to your pregnancy, and then the risks involved. Finally, you’ll be given a consent form to sign.

Early Medical Termination (up to 9 weeks)

No surgery is involved, only the taking of some pills. You’ll have three appointments: an assessment, and then two different visits on different days where you’ll take some pills.

The first dose of medicine is called mifepristone. It blocks the hormones needed to continue with the pregnancy. Your second dose will taken during the third appointment, usually 1-3 days after taking the mifepristone. You’ll take prostaglandin tables - made up of misoprostol (taken orally or vaginally) or gemeprost (which can only be taken vaginally). This causes the lining of your womb to break down, and you’ll bleed and may suffer pains. It’s akin to a heavy period and you can also for pain killers to deal with the cramps. You lose the pregnancy similarly to an early miscarriage. This normally happens within 4-6 hours of your second dose. You might be able to go home, or you might have to stay at the clinic/hospital.

If you have this done privately rather than on the NHS, expect to pay upwards of £450 (all price estimates are taken from Marie Stopes).

Medical Termination (9-20 weeks)

The same drugs are used as above, but as the pregnancy is more advanced there will be a higher dose of prostaglandin. This is similar to a late miscarriage. While usually you can return home the same day, you may have to stay overnight.

Surgical Abortion - Vacuum Aspiration (up to 15 weeks)

This procedure can be performed either manually or with an electronic pump. It’s not as scary as it sounds. A small tube is inserted into the vagina and through the cervix, and the pregnancy is removed by suction. You’ll be given pain relief, and you can return home a few hours after the procedure (which only lasts around ten minutes).

Done privately, with conscious sedation (so you’re awake but feel nothing) this will cost you upwards of £600.

Surgical Dilation and Evacuation (D&E) - (after 15 weeks)

If you’re having a late abortion, this will probably be the method used. You’ll be given a general anaesthetic, so you’ll be unconscious and feel no pain. The cervix is slowly dilated and special forceps are used to remove the pregnancy in little pieces. Any leftover tissue is removed with suction, like in vacuum aspiration. This process will take around 15-20 minutes and you’ll probably be able to go home the same day, if you’re healthy and there are no complications.

Done privately, with conscious sedation this will cost you around £760.

Abortion after 21 weeks

Abortion after 21 weeks is very uncommon. It will either be done via D&E or medically. Whichever method, the doctor will stop the heart of the fetus so it is not born alive. You’ll basically have to go through labour in order to deliver the fetus (which understandably can be very distressing and upsetting). You may have to stay overnight in the hospital or clinic.

You’ll need a general anaesthic for this so done privately it will cost you upwards of £1700.

Links

Find your local clinic/GP with contraceptive services (clickable link).
Advice for continuing with your pregnancy (clickable link).
Marie Stopes price list (clickable link).
FPA abortion advice & information (PDF, clickable link).
British Pregnancy Advisory Services Actionline, 08457 30 40 30.
Marie Stopes Abortion, Contraception & Sexual Health Services for uterus owners (clickable link).
NHS website, ‘How Abortions are Performed’ (clickable link).
NHS abortion clinic finder (clickable link).
NHS emergency contraception information (clickable link)
Brooke Advisory Services - free sexual health advice for under 25s (clickable link)