Emergency Contraception Survey Shows Slow Start for California's New "Pharmacy Access" Program


News Release

Embargoed for release until:
February 18, 2004, 9:00 a.m. EST

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Rob Graham and Heidi Hess at (650) 854-9400

Emergency Contraception Survey Shows Slow Start for California’s New “Pharmacy Access” Program

Only one in 10 women in California ages 15 to 44 know about the new program
Four in 10 don’t know that emergency contraception is available in the U.S.

Menlo Park, CA – As the Food and Drug Administration (FDA) continues to deliberate whether emergency contraception will be made available "over-the-counter" without a prescription, a new Kaiser Family Foundation survey finds very few (9%) California women ages 15 to 44 are aware of the statewide, emergency contraception "pharmacy access" program. Emergency contraceptive pills are a form of birth control that can be used to prevent unintended pregnancy in the first few days following unprotected sex or contraceptive failure, according the FDA. This new program, started in January 2002, permits women to obtain emergency contraception directly from participating pharmacists without first contacting a physician, while "over-the-counter" would allow people to obtain emergency contraception off-the-shelves at participating retailers without a pharmacist consultation or a physician's prescription.

Of the 8% of women surveyed last summer who had used emergency contraception in California, only a tiny fraction report that they obtained the pills directly from a pharmacist under this new program. To date, approximately 18% of all pharmacies in California are providing emergency contraception directly to women, according to the Pharmacy Access Partnership -- an organization that trains pharmacists to participate in this program.

"Even in California, a state that has enacted polices to make access to emergency contraception easier, actual knowledge and use is still quite low," said Alina Salganicoff, Ph.D., vice president and Director of Women's Health Policy, Kaiser Family Foundation and the lead author of the report. "It is too soon, however, to assess how much this new pharmacy program will ultimately affect awareness of and access to emergency contraception."

Overall, there is also considerable confusion about emergency contraception. While recognition of the term "emergency contraception" is high, with over three-quarters (81%) of California women ages 18 to 44 saying they have heard of it, over four in ten women (46%) had heard the term but do not have knowledge of a contraceptive method that is used after sex. Furthermore, four in ten (39%) of the women surveyed do not know that emergency contraception is available in the U.S. and half (49%) of adult women who had heard of emergency contraception, mistakenly thought that it was the "abortion pill," also known as RU-486 (which is used to terminate a pregnancy, unlike emergency contraception which prevents a pregnancy from occurring).

When emergency contraception is accurately explained, however, the survey finds a large majority of Californians (74%) say they approve of using emergency contraception when birth control fails, with only 18% saying that they have a religious or moral objection to its use. Two-thirds of the women surveyed (65%) also say they would be more likely to take emergency contraception to prevent unintended pregnancy if they already had a pack at home in advance of needing it.

Few people learn about emergency contraception from their health care providers. In fact, television news is the leading source of information about emergency contraception. While only one in ten (12%) women who had heard of emergency contraception say their doctor or health care provider had discussed it with them, over eight in ten (84%) say that they would turn to a health care professional to learn more about this birth control option.

The report, Emergency Contraception in California, is based on the findings of a survey designed and analyzed by the Kaiser Family Foundation with Princeton Survey Research Associates (PSRA). It was conducted from April 29 to September 2, 2003 and included interviews with 1,151 females and males ages 15 to 44 living in California. Parental consent was obtained for respondents under 18.

Key California Findings

Knowledge about emergency contraception is limited

One in ten (9%) women ages 15 to 44 know that in California, women can obtain emergency contraceptive pills directly from a pharmacist without having to contact a physician.
Two-thirds (65%) of those surveyed know that there is something a woman can use after sex to reduce the risk of unintended pregnancy. Awareness was the same for men and women.
Young adults are more likely to know of an option compared to older adults (77% of those 18 to 24 compared to 62% of those 25 to 34 and 64% of those 35 to 44).
Four in ten (39%) adult women incorrectly say that emergency contraception isn't available in the U.S. or that they are not sure.
49% of adult women ages 18 to 44 incorrectly state that emergency contraception is the same as the "abortion pill" or RU-486. An additional 26% state that they do not know if they are the same.

Few have had experience with emergency contraception

One in ten women (8%) and men (10%) in California report that they or their partners have used emergency contraception.
Almost one-quarter (23%) of sexually active adults ages 18 to 24 report that they or their partners have used emergency contraception, compared with 8% of those ages 25-34 and 2% of those ages 35 to 44.
Among teens ages 15 to 17, 10% of those who are sexually active state that they or their partners have used emergency contraception.
Half of the respondents (52%) who have experience with emergency contraception obtained the pills from a health care clinic.

Television news – not doctors -- is major source of information about emergency contraception

One in ten (12%) adult women surveyed have discussed emergency contraception with a doctor or other health care professional. Physician communication is just as low (13%) among women who received a gynecological exam in the previous year.
Among adults who know about emergency contraception, they typically learned about it from TV news (46%), friends (14%), and school (12%).
Two-thirds of Californians (65%) say that if a doctor informed them about emergency contraception, they would be more likely to take it or recommend it to their partner if needed. Teens in particular say this would increase the likelihood that they would use or recommend this option (87%).

Emergency Contraception

According to the FDA, emergency contraceptive pills are a form of contraception that can be used following unprotected sexual intercourse to prevent unintended pregnancy. This method is designed to be used in cases of unprotected sex or possible birth control failure, and not as a regular form of contraception. Emergency contraception prevents pregnancy from occurring by preventing ovulation, disrupting fertilization, or inhibiting implantation of a fertilized egg in the uterus. Emergency contraceptive pills are not effective if a woman is already pregnant (in contrast to mifepristone, also known as RU-486). Research finds that emergency contraceptive pills reduce the risk of pregnancy by up to 89% if taken with 72 hours of intercourse.

The California Emergency Contraception Pharmacy Access Program

This California program was implemented in January 2002, following the October 2001 passage of SB 1169 in the California legislature. The program allows pharmacists, under a standing collaborative agreement with a physician, to provide emergency contraception directly to a woman without requiring her to contact a physician first. To date, 18% of pharmacies are participating in this new program. In order to participate in the program, pharmacists must receive emergency contraception training in accordance with California law. Each woman who receives emergency contraception directly from a pharmacist must receive a standardized fact sheet that includes the "indications" for use of the drug, the appropriate method for using the drug, and the need for medical follow up. As opposed to "over-the-counter" status by which a woman could simply buy emergency contraception off the shelf at a retail outlet, the California program requires a woman to obtain the pills directly from an eligible pharmacist.

Methodology

This report is based on data collected from a telephone survey of 1,151 females and males ages 15 to 44 living in California. The interviews were conducted in English and Spanish by Princeton Data Source, LLC under the guidance of Princeton Survey Research Associates (PSRA), from April 29 to September 2, 2003. Before interviewing respondents under age 18, a parent or guardian first completed a short survey and gave consent for their child to be interviewed.

The margin of sampling error is ±3.2% for the total sample, ±6% for teens ages 15 to 17, and may be larger for subgroups.

The survey report and an emergency contraception fact sheet are available online at http://www.kff.org/womenshealth/whp021804pkg.cfm.

The Kaiser Family Foundation is a non-profit, private operating foundation dedicated to providing information and analysis on health care issues to policymakers, the media, the health care community, and the general public. The Foundation is not associated with Kaiser Permanente or Kaiser Industries.