When emergency contraceptive pill fails

Monday, October 21st, 2019
Dr Grace Kanyi

What happens when this emergency pregnancy preventive pill that is meant to curb cases of unwanted pregnancies fail?

Nancy Onyancha was only 22 years old when she got pregnant, despite using the Postinor 2 emergency contraceptive. Known to many as P2. Still in college and not in a position to take care of a baby, pregnancy was out of the question. Oblivious to her, the pill did not prevent conception; she found out she was pregnant a month later.

“I was shocked when I found out that I was pregnant even after taking the pill the next day after I had had unsafe sex. My boyfriend did not want to use condoms and so I went along with his request. He also forbid me from taking the pill, which was a ridiculous demand, I never wanted to have a child because I was still enrolled in college. When I realized that I was pregnant, I told him about the outcome of our sexual encounter and he refused to take responsibility. Everything changed that day for me, I felt betrayed and dejected. I had complete trust in the pill and I had read the instructions properly and so I believed that it would work,” she says

For Nancy, getting pregnant at 22 was devastating. Things escalated when her significant other did not want anything to do with her and her unborn child. Within weeks of realising she had conceived, she was so stressed that she could not eat or attend classes. As the feeling of desperation crept in, she weighed up abortion but could not go ahead with it because she didn’t know anyone who would perform a safe procedure.

“For weeks, I could not eat properly or attend classes, I was so stressed leaving my room was a difficult task, I called and texted my then-boyfriend so many times my thumb would hurt. He somehow managed to ignore me like I never existed. That’s when thoughts of abortion crossed my mind but I was scared of having an unsafe abortion and I did not know anyone who would perform a safe abortion on me, considering that termination of pregnancy is illegal in Kenya,” she recounts.

Nancy's case is not an isolated one: her story is one that some Kenyan women can identify with. Dorcas Wambui suffered an almost similar fate, she had been dating her boyfriend, now husband, for four years when she got pregnant with her girl even after taking the P2 contraceptive pill immediately after having unsafe sex. She says they had talked about not having children until they were financially stable, so to say they were shocked when they realised they were expectant is an understatement.

“News of unexpected pregnancies can be traumatising especially if it was not on the table for couples. I was with my boyfriend when I swallowed the pill so when I broke the news to him, he thought that it was a prank. He was still struggling to find a job and I was a recent graduate with an entry-level job. Shocked and in utter disbelief, we had to seek the second and a third opinion, all confirming that indeed I was pregnant, “ narrates Dorcas.

There are several brands of the oral emergency contraceptive pill readily available over the counter in Kenya including ECEE 2, EMCOM, LEVO-72, which work by triggering the creation of cervical mucus that renders it impenetrable to sperms. Having dominated the Kenyan Pharmaceutical sphere for many years, women have heavily relied on these pills and especially the Hungarian Postinor 2.

Postinor 2 comes packed with two pills. A genuine drug comes in a green pack with a white scratch area on the reverse side. When scratched, it reveals the word 'original' as well as the company’s logo. Whereas the fake pill comes in a similar package, only that the scratch-to-reveal spot is not available or does not contain the word ‘original’.

Dr Grace Kanyi, an obstetrician and gynecologist, says several factors come into play for an emergency pill to backfire, one of them being counterfeit.

“For an emergency contraceptive pill to take effect, it has to be taken within 72 hours of unprotected coitus. It is actually advisable to take it within 24 hours for maximum effect. It is important to stress that one does not need doctor's prescription and they are normally readily available over the counter in pharmacies. However, women should be very vigilant when purchasing these pills since the market is flooded with fakes that are sold to unsuspecting customers,” explains Dr Kanyi.

Today, these pills are visibly absent in most pharmacies possibly due to the numerous reports that the authorities confiscated them for camouflaging as the original ones.  

In 2015, following an alert received from World Health Organisation about the discovery of the fake pills in Kampala, Uganda, the ministry of health through the pharmacy board put the general public, health workers and health facilities like chemists and pharmacies on high alert following the discovery of fake Postinor-2 drug.

In 2018, The Kenya Anti-Counterfeit Agency confiscated about 31,000 pieces of fake morning-after pills estimated to be worth Sh7 million at the Embakasi Inland Container Depot.

Dr.Kanyi stresses that oral emergency contraceptives are essential in eradicating unwanted pregnancies cases, of unsafe abortion, relating it to morbidity and mortality. Such emergency contraceptives are highly used in post-rape care, but one can use them if the condom breaks or if one is not on any family planning method.

“Millions of unwanted births are averted annually by use of by use of contraceptive, averted pregnancies reduce the size of maternal and infant mortality rate. Maternal disability due to complications of unsafe abortions from unintended pregnancies can be tackled by use of emergency contraceptive, “explained Dr. Kanyi.

 Dr. Kanyi, explain that an emergency pill is not an abortion drug and should not be used as such. She encourages girls and women to sign up for a family planning method

There are other methods of emergency contraceptives such as increasing the number of daily pills and Copper T Intra Uterine Device, which is normally inserted within five days of unprotected sex. However, after using P2, a woman might experience transient side effects such as heavier menses with more abdominal discomfort.

Other effects of taking the fake pill is unnecessary bleeding, breast cancer, liver disease, delay in the next menstrual period and vomiting