Sunday, February 25, 2007

More Emergency Contraception Research

The current issue of the journal Contraception has two articles on emergency contraception availability and awareness, and the journal Women's Health Issues has an article on California women's knowledge of emergency contraception.

1) Schwarz EB, Reeves MF, Gerbert B, Gonzales R. Knowledge of and perceived access to emergency contraception at two urgent care clinics in California. Contraception. 2007 Mar;75(3):209-13.

For this study, the researchers recruited adult (18-45) English-speaking women from two urgent care clinics in San Francisco from Mar-Jul 2005. They excluded women who were currently pregnant, had had a hysterectomy or tubal ligation, had an IUD in place or a partner who had had a vasectomy, were over 45, or who planned to relocate or did not have a telephone. Women completed a computerized survey while they waited for their appointments. The 10-question survey asked about their knowledge of emergency contraception (EC), which was made available without a prescription in California in 2002. 446 women completed surveys that were analyzed. Younger women (<30) and women who had had a prior abortion were more likely to know that EC is currently available in California. Overall, women scored poorly, averaging only 4 correct answers out of 10.

  • Only 39% knew that emergency contraception is effective in the 3-5 days after intercourse.
  • Only 27% knew that EC is very or extremely safe, and only 39% knew it is very or extremely effective at preventing pregnancy.
  • 50% knew that EC poses no risk to future fertility, but only 19% knew it does not cause birth defects or miscarriage.
  • 84% knew that EC offers no protection from sexually transmitted infections.
  • Only 19% reported a personal or religious objection ot abortion, and only 7% reported a personal or religious objection to EC.

    Despite the low levels of knowledge of EC found by this survey, the authors note that their design may have actually overestimated knowledge of EC, as it excluded women who did not speak English, 47% of participants had college degrees, and women with less knowledge of EV may have elected not to complete the survey more frequently than those with some knowledge.

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    2) Shacter HE, Gee RE, Long JA. Variation in availability of emergency contraception in pharmacies. Contraception. 2007 Mar;75(3):214-7.

    The researchers conducted telelphone surveys of EC availability in Boston, MA, Philadelphia, PA, and Atlanta, GA. At the time of the study, state policy required MA pharmacists to fill all valid prescriptions, GA law allws pharmacists to legally refuse to fill the prescriptions, and PA had no policy regarding pharmacist refusals. A prescription was required for emergency contraception in all three states at the time the calls were made. 1085 pharmacies were included in the analysis: 268 in Boston; 427 in Philadelphia; 390 in Atlanta.

  • 23% of pharmacies could not dispense EC within 24 hours, including 4% in Boston, 23% in Philadelphia, and 35% in Atlanta. 18% of these reporting being willing to but unable to dispense within 24 hours due to not carrying the drug.
  • Atlanta had the highest rate of refusal to dispense, at 9% (34) of pharmacies.
  • Large chains (20 or more stores in the city) were least likely to be unable to dispense EC within 24 hours (27%), followed by small chains (4 or fewer stores in the city, 32%), and medium chains (5-20 stores in the city, 46%).
  • No refusals occurred in Boston, where pharmacists are required to fill valid prescriptions.

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    3) Foster DG, Ralph LJ, Arons A, Brindis CD, Harper CC. Trends in knowledge of emergency contraception among women in California, 1999–2004. Womens Health Issues. 2007 Jan-Feb;17(1):22-8.

    The authors took 6 years of data from the California Women's Health Survey, an annual telephone survey of ~4,000 rnadomly selected adult women in California. Two questions about emergency contraception were added to the survey in 1999 and were asked of women who had ever had sexual intercourse but had not had a hysterectomy.

  • In 1999, 48% of women knew there was something they could do in the 3 days after unprotected intercourse to prevent pregnancy; by 2004, 65% of women knew this.
  • Women who answered "yes" to the first question (about whether something could be done to prevent pregnancy in the 3 days after intercourse) were asked what could be done. 3% in 1999 and 4% in 2004 explicitly named emergency contraception in response. 66% in 1999 and 65% in 2004 referred to the "morning after pill" (indicating that they were aware of EC) or some other correct response such as having an IUD inserted or taking a modified dose of birth control pills.
  • Incorrect responses included RU-486, abortion, douche, injection, and herbal remedies.
  • Younger women (<25) and college-educated women were more likely to know about EC in both 1999 and 2004.
  • Racial/ethnic disparities were found, with Hispanic and South/Southeast Asian women having the lease knowledge of EC, and significant differences in EC knowledge between native and foreign-born Hispanic women.
  • Foreign-born Hispanic women, women with incomes below the poverty level, and women who did not complete high school had the lowest levels of EC knowledge in 2004.
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