An Indian experience with intrauterine device-CuT 200B and oral
levonorgestrel (LNG) as emergency contraception
L.N. Gaur, Malabika Roy, N.K. Gupta, C. Shekhar, S. Datey, N.C.
Saxena Division of Reproductive Health and Nutrition, Indian Council of
Medical Research (ICMR), New Delhi, India
Objectives: To study the profile and perception of women seeking
emergency contraception (EC) and to evaluate the efficacy & side effects of
0.75mg oral LNG (2 doses) and CuT200 B for EC.
Design and Methods: Women requesting for EC after single act of
unprotected intercourse in the current menstrual cycle were offered 0.75 mg LNG
(2 doses) 12 hours apart within 72 hours and CuT 200B inserted within 120 hours
of unprotected intercourse as EC. A total of 632 women who fulfilled the
selection criteria and gave informed written consent were enrolled in the study
at 8 Human Reproduction Research Centers of ICMR. The subjects were followed up
at one week after the expected date of next menstrual bleeding to elicit the
information on pregnancy, side effects and perception about EC. The efficacy was
assessed by crude pregnancy rate as well as percent pregnancy averted.
Results: Of the 632 acceptors, 46.8% sought EC due to non-use of any
family planning method, 10.8% forgot to use condom, 26.1% women sought due to
condom breakage /slippage, 6.8% sought due to IUD expulsion/displacement. Forced
sex was the reason given by only 0.9% of women. The average age and parity were
27.3 years and 2.2 respectively. Nulliparous/unmarried/ widow constituted 5.7 %
of women. The relative acceptances of the two methods were 36.1% of IUD and
63.9% of LNG. Majority (82.2% and 73.2%) of women sought LNG and IUD within 48
and 72 hrs respectively. Six pregnancies were reported in the LNG group (3 user
failure and 3 method failure) giving a typical use failure rate of 1.66 %. The
percent pregnancies averted with LNG was 76.9 which is comparable with the WHO
study which reported a failure rate of 1.7 % and percent pregnancy averted as
77.0 with the LNG 0.75 mg two dose schedule. There was no pregnancy reported
with CuT 200B in the present study. Side effects with LNG were nausea, headache
and dizziness that ranged between 10–14% and with IUD low abdominal pain
(49.1%) and irregular bleeding (13.2%) were the major complaints. Women’s
perception of EC in the study indicated that majority (93.2%) would like to
consult a doctor before use. 62% women expressed that adolescents should be made
aware of EC.
Conclusions: 0.75 mg LNG (two doses) is an efficacious and acceptable
method for EC as the pregnancy rate was 1.66% and it averted 77.0% of the
excepted pregnancies in Indian women on typical use. CuT 200B in the study
averted all the expected pregnancies. Most women in the study indicated
preference of availing LNG pills from a health facility after consulting a
doctor.
