Ever wondered why morning-after pills are not available over-the-counter in Singapore? The health authority and a doctor clue us in on the types of emergency contraception available here, and how to obtain them.
It’s a familiar movie trope most commonly seen in American rom-coms: Boy meets girl. Boy and girl have unprotected sex (either that, or the condom broke). Girl rushes down to the pharmacy immediately for some Plan B, which is also known as the morning-after pill or emergency contraception.
In Singapore, however, the events do not play out like that. Unlike the movies, you can’t actually get morning-after pills over the counter here. To get your dosage of emergency contraception in Singapore, you actually have to go to a clinic or hospital with an obstetrics and gynaecology department.
While you can get emergency contraception over the counter in other countries, our regulations here are quite strict about this. You should also note that you must be at least 16 years old and that only women can get the prescription—so that means your boyfriend can’t head down to the clinic on your behalf.
“Emergency contraception medicines contain potent active ingredients and may not be suitable for some people, such as those with certain underlying medical conditions,” says a spokesperson from the Health Sciences Authority (HSA), which regulates health products in Singapore, including medications.
“They also require adherence to specific instructions on how to take the medication in order for it to be effective… these medicines are only available from a doctor or a pharmacist upon a doctor’s prescription as they require appropriate medical supervision,” the spokesperson adds.
Certain emergency contraception pills might not be suitable for those with drug allergies, liver problems, or those who are currently on certain medications. HSA noted that companies that have applied to carry these medications have also requested for them to be registered as prescription-only medicine.
Can a doctor refuse to give you emergency contraception?
Yes, but only for medical reasons.
“While doctors, like any human being, may have their own beliefs or conscientious objections to certain clinical requests, it is also important to abide to the Singapore Medical Council Ethical Code and Ethical Guidelines,” says Dr Susan Logan, consultant at National University Hospital’s Women’s Clinic.
The code and guidelines state that:
“Personal moral bias or prejudices about patients’ habits or lifestyles should not influence decisions on treatment. Any clinical decisions must be based on an objective assessment of clinical needs and the likely effectiveness of treatment options.”
If a doctor cannot provide medical services that are “necessary or most beneficial” for their patients, the code and guidelines state that they must offer to refer you to other healthcare service providers who can give you the appropriate services. You should also be informed of the medical reasons for the referral, and provided with relevant information about the other doctors.
There might be some cases where certain emergency contraception options are not available at the clinic you went to. In that case, it’s within your rights to obtain a prescription or a referral from your doctor, and head down to another clinic or hospital for your emergency contraception.
Types of emergency contraception in Singapore
Currently, there are three types of emergency contraception here. Dr Susan Logan explains the difference between the options:
- Copper intrauterine device (Cu-IUD)
It’s the most effective method of emergency contraception, and can last up to twelve years. This birth control device needs to be placed in your uterus, and insertion should only be performed by a qualified medical practitioner. There’ll also be a procedure charge for the insertion if you opt for this.
It’s an oral emergency contraception that’s effective up to 120 hours (5 days) after unprotected sexual intercourse. Dr Logan says that this is more effective than levonorgestral EC (Postinor) and should be considered first line for oral treatment.
It’s another oral emergency contraception that’s effective up to 72 hours (3 days).
The side effects
Most women will get their next period within a week of the expected day, and don’t report anything unusual in terms of flow and cramps. A minority of women have reported slight bleeding before their actual period.
If your period is more than a week late after taking emergency contraception, it’s recommended that you take a pregnancy test, advises Dr Logan.
Both oral emergency contraception options in Singapore can be used more than once in a menstrual cycle, but it’s advisable to abstain from sex until your next period if you’ve taken emergency contraception.
Oral contraception does not affect long-term fertility, but Dr Logan notes that there’s a study that reported that the repeated use of Postinor can cause irregular and frequent bleeding.
There is also no evidence of emergency contraceptions causing adverse pregnancy outcomes (such as premature birth and low birth weight) or fetal abnormality if pregnancy occurs despite their use. However, the data relating to ellaOne is limited because it’s a newer product.
If you go with the copper IUD option, you may have heavier, longer, and more painful menses in the initial period, but this should improve after three to six months. There’s also a very rare chance that your long-term fertility would be affected if a bad pelvic infection develops. Most of these infections occur within three weeks of insertion, and symptoms include pain in the lower belly or abdomen, fever and chills, and heavy vaginal discharge with an unpleasant odour.
But at the end of the day, just remember that, as its name suggests, emergency contraception should only be used if you unexpectedly had unprotected sex, or if your normal method of contraception had failed (i.e., condom breaking).
“Regular contraception is generally more effective as compared to emergency contraception,” says Dr Logan. For example, condoms are about 98 percent effective at preventing pregnancy and acts as a barrier against STIs. While the effectiveness rate for ellaOne is similar (its website states that out of 100 women who use it, approximately two will become pregnant), it offers no protection against STIs.
On the pill but missed your dose?
“You should speak to your doctor if you are taking the combined oral contraceptive pill such as Diane-35, Yasmin, YAZ, Microgynon but have missed a dose or some doses,” says Dr Grace Huang, a resident doctor at DTAP.
“If there is a need for you to take emergency contraception, you may have to hold off restarting your regular pill for up to five days to prevent interactions between the different medications. Your doctor will advise you accordingly.”
She adds that condoms should be used during this period and for seven days after restarting your combined pill.
TL;DR: it’s better to be safe than have an unplanned pregnancy, so please use condoms when having sex, and only use emergency contraception as it is intended – for emergencies only.
Image: Artinun Prekmoung/123RF