As India eyes new warnings for morning-after pill, what women must know
India’s morning-after pill may soon come with much more prominent warnings. The Union ministry of health and family welfare has proposed that levonorgestrel emergency contraceptive pills—commonly sold in 0.75 mg and 1.5 mg doses—carry boxed warnings saying these are for emergency use and not regular contraception, do not cause abortion, and do not protect against HIV or other sexually transmitted infections. The proposal is still in draft form.
The challenge is ensuring that stronger warnings correct misuse without frightening women away from a method that experts say remains an important and generally safe back-up after unprotected sex or contraceptive failure.
Levonorgestrel works by delaying or preventing ovulation—stopping an egg from being released before fertilisation can occur. It cannot terminate an established pregnancy and is, therefore, not an abortion pill.
The World Health Organization (WHO) says emergency contraception can prevent more than 95 per cent of expected pregnancies when an appropriate method is used within five days, although effectiveness varies by method and timing. Studies of levonorgestrel emergency pills report pregnancy rates of about 1.2 per cent to 2.1 per cent after use.THE EARLIER THE BETTER
Experts say the most important rule is not to wait. WHO recommends levonorgestrel emergency contraception be taken as soon as possible after unprotected intercourse. It can be used within 120 hours, but effectiveness declines with delay. It may be needed after sex without contraception, condom breakage or slippage, missed contraceptive pills, failure of withdrawal or sexual assault where contraception was not in place.
This is where the conversation needs nuance. Emergency contraceptive pills are not designed to replace regular contraception, but repeated use is not the same as being dangerous.
A 2025 systematic review of repeated emergency contraceptive pill use within the same menstrual cycle found only six eligible studies. The evidence was rated very low certainty, but researchers did not identify a clear increase in serious adverse events and concluded that women should not be discouraged from taking emergency contraception again if another episode of unprotected sex occurs in the same cycle.
What is better documented is menstrual disruption. In a prospective study of 544 women taking a single 1.5 mg dose of levonorgestrel, about 21 per cent had their next period delayed by more than a week. Spotting, bleeding between periods, nausea, dizziness, headache, breast tenderness and abdominal pain were also reported. WHO says repeated use poses no known health risks and does not harm future fertility, although more frequent use can lead to increased side effects, particularly menstrual irregularities.
Indian data also shows that repeat use is not uncommon. A meta-analysis of 33 Indian studies found that among women who had used emergency contraception, repeat use ranged widely, from about 12 per cent to 69 per cent. Experts say the right approach is not to scare women away from the pill but to recognise when emergency contraception is becoming a routine habit. Someone needing it frequently should consider a regular method that is more reliable for ongoing protection.
Taking the pill once does not protect against sex that happens later. Experts recommend starting or resuming regular contraception and using condoms where appropriate. Emergency pills also offer no protection against HIV or other sexually transmitted infections. If a period is significantly delayed, unusually abnormal or pregnancy symptoms develop, experts advise taking a pregnancy test and seeking medical advice.
The message behind the new warnings, therefore, should not be ‘don’t take the pill’. It is simpler: use it when needed, take it early and do not mistake emergency contraception for everyday contraception.
