Written by Lizzie, RSEI Educator | Published April 26th, 2022

Period. Yet this common misunderstanding around how emergency contraception actually works is shared amongst youth and adults alike. Emergency contraception (also known as the morning after pill) prevents pregnancy from happening in the first place, while the medication abortion (the abortion pill) ends an already existing pregnancy. We need to understand the difference.

Currently, we are teetering on the edge of a post-Roe future, as state after state pass increasingly strict abortion bans. And it is likely that stricter access to other reproductive services, like birth control, could follow. With this in mind, it is especially important and timely that we support the young people we work with in understanding what emergency contraception actually does, how to use it most effectively, and the difference between emergency contraception and medication abortion, because they are not the same.

Pregnancy does not happen immediately following sex. 

In fact, sperm can live inside of the uterus and fallopian tubes for up to 6 days after sex, just waiting for ovulation (the process in which the ovaries release an egg). If a sperm fertilizes an egg, it still can take up to a whole other week for the fertilized egg to travel from the fallopian tubes and implant in the uterine lining. More often than we realize, eggs may become fertilized, but never make it to implantation.

Medically speaking, pregnancy begins at implantation, not fertilization. All in all, it can take nearly 2-3 weeks after sex for someone to become pregnant! 

Emergency contraception works best when taken as soon as possible after sex. 

Emergency contraception pills work by delaying ovulation and preventing an egg from releasing. This is why someone can still prevent pregnancy even days after having had sex. However, it will only work when taken before ovulating. Most people don’t know exactly when they ovulate, which is part of why emergency contraception tends to be less effective than other birth control methods. [Read our blog on Fertility Awareness Methods to learn more about tracking ovulation].

If the ovaries have already released an egg, the emergency contraception pills may thicken the cervical fluid, making it more difficult for sperm to find and fertilize an egg. Emergency contraception does not harm or impact an already existing pregnancy, so if a person is already pregnant by the time they take this pill, they will still be pregnant.

There are a few different types of emergency contraception.

The emergency contraception pill (AKA the morning-after pill) is a single pill taken as soon as possible, or within 3-5 days after having unprotected sex. 

The most effective EC pill contains ulipristal acetate and is by a brand called ella

ella is:

  • most effective when taken within 5 days but works best when taken as soon as possible
  • only given with a prescription! Someone can get a prescription for ella from a doctor’s office, certain pharmacies, or online with next day delivery
  • usually costs $50 or more at the pharmacy, but can be covered by health insurance
  • it costs $90 to order online (with medical consultation and overnight shipping included)
  • available without age restrictions
  • weight dependent and may work less effectively for people 195 lbs or more

The other EC pills contain levonorgestrel (brands like Plan B One-Step, My Way, AfterPill, EContra, and more). These EC pills are:

  • most effective taken within 72 hours (3 days) but work best when taken as soon as possible
  • can be taken up to 5 days after
  • available over the counter at most pharmacies and online, and do not require a prescription
  • can cost $11-$50 depending on the brand
  • available without age restrictions
  • weight dependent and may work less effectively for people 155 lbs or more

When it comes to the emergency contraception pill, timing is everything! EC can be purchased well in advance of being needed, by anyone, of any gender. 

Finally, certain IUDs also work as emergency contraception! The Paragard copper IUD, as well as the Mirena and Liletta hormonal IUDs all, work as EC, and actually are the most effective types! 

These IUDs:

  • work up to 5 days after unprotected sex, and are just as effective on day one as on day 5
  • does not have any weight limitations
  • Can cost $0-$1,300 depending on the IUD and if someone has health insurance
  • can be used for up to 7-12 years as birth control
  • must be inserted and removed by a health care professional

Scheduling an IUD insertion can often take longer than the 5-day window, so getting an IUD as emergency contraception may not always be the most feasible option for people. 

Emergency contraception will only prevent pregnancy, not end an already existing one.

Medication abortion, sometimes known as the “abortion pill”, however, is a safe and effective way to end a pregnancy up to 77 days or 11 weeks into the pregnancy. Medication abortion involves a series of two medications, plus antibiotics, taken over the course of a few days. 

The first medication, mifepristone, is taken during a health center appointment and stops the pregnancy from continuing to develop. The second round of medication, misoprostol, is taken within 48 hours of the healthcare visit, as instructed by the provider. This medicine will induce cramping and bleeding, similar to a miscarriage. Collectively, these medications will end a pregnancy, and an ultrasound will be needed to ensure the procedure is complete about two weeks after.

As a reminder, emergency contraception prevents someone from getting pregnant, and only a medication abortion can end an already existing pregnancy.

* * * * * * * * * *

We are watching an ever-growing attack on reproductive rights and abortion access play out both in the Supreme Court and across this country. This means the experience and ability of many young people to access reproductive services are changing, and uncertain. The Responsible Sex Education Institute is the education branch of Planned Parenthood of the Rocky Mountains. Planned Parenthood has been around for over a hundred years and will continue for hundreds more. Planned Parenthood is a proud abortion provider. 

Young folks need access to accurate and comprehensive information about their sexual health in a shame and stigma-free environment. They need to understand how emergency contraception works, that taking it is time-sensitive, and that it is one of many different methods of birth control available to them. And, more pointedly, our youth need to know that emergency contraception is different from a medication abortion. With this information, young people deserve to be supported in making the best choices for themselves and about their bodies. We, as teachers, trusted youth-serving adults, families and communities, can support them in making healthy and informed decisions