Two New Surveys of American Public and Physicians:

American Women Are Misinformed About Emergency Contraceptive Option; Once Explained, Many Say Would Be Likely to Use

–Ethical and Safety Concerns Not Major Factors In Stated Likelihood to Use “Morning-After” Pills —

OB/GYNS Consider “Morning-After” Pills to be Safe and Effective; While Most Have Prescribed Within LastYear, Only to Handful of Patients

— Most Physicians Who Do Not Perform Abortions State No “Objections or Concerns” Prescribing Emergency Contraceptive Pills —

Embargoed for Release Until: Wednesday, A.M., March 29, 1995

For further information contact: Matt James or Tina Hoff (415) 854-9400

Although nearly half (47%) of adult American women with the potential of facing an unplanned pregnancy say they would be likely to use “morning-after” pills, many are uninformed or misinformed about this emergency contraceptive alternative and few have ever used it, according to a new national survey on public knowledge and attitudes on contraception and unplanned pregnancy conducted by the Kaiser Family Foundation and Louis Harris & Associates, Inc.

Six out of ten women with the potential of facing an unplanned pregnancy say they have “heard of” emergency contraceptive pills (ECPs), also referred to as “morning-after” pills. Yet, only a third indicate that they, in fact, know if “anything” can be done within a few days after unprotected sex to prevent pregnancy.

ECPs are high-dose oral contraceptives known for approximately 20 years to be effective in preventing pregnancy if taken within 72 hours after unprotected sex. (Nausea and vomiting are common side-effects among women using emergency contraceptive pills. Contraindications for oral contraceptives, such as history of stroke or heart attack, also apply to potential ECP users, although clinicians may make exceptions for some women for one time use.) Although oral contraceptives have not been approved by the Food and Drug Administration (FDA) for emergency contraception purposes, doctors and other health providers who can write prescriptions may use any drug licensed by the FDA for unlabeled purposes — that is, oral contraceptives may be prescribed as an emergency contraceptive.

Health professionals are identified by most women (83%) as a source they rely on for information on “birth control.” However, preliminary findings from a new survey by the Kaiser Family Foundation and Fact Finders, Inc. indicate that obstetricians/gynecologists have made only a handful of their female patients “aware of” ECPs and do so, generally, in response to an emergency situation rather than during routine contraceptive counseling. Because ECPs are intended to be used as a back-up method for contraceptive emergencies — such as failure of a regular method or failure to use any method — their potential use relies heavily on an informed public: an individual must be aware that something is possible to prevent pregnancy after unprotected sex to seek the care of a clinician in the first place.

Furthermore, most women who have heard of ECPs are misinformed about the time period during which they are effective: nearly half (48%) believe the pills must be taken 24 hours or sooner after intercourse to prevent pregnancy and 10% are not sure. Only 20 percent know that the method is effective up to 72 hours after unprotected sex. (To avoid confusion about how soon after intercourse the pills must be taken to prevent pregnancy, reproductive health experts now prefer the term “emergency contraceptive pills” instead of the more commonly known label “morning-after” pills.)

Physicians’ Views and Practices

The Kaiser/Fact Finders survey indicates that obstetricians/gynecologists are “familiar” with emergency contraceptive pills (77.5% say “very familiar” and 22% “somewhat familiar”) and most do not have “objections or concerns” about prescribing ECPs (72%). Among those who say they are “very familiar” with the method, the overwhelming majority consider ECPs to be “very safe” (88%) and “very effective” (85%). Overall, seven out of ten the obstetricians/ gynecologists surveyed say they have prescribed ECPs within the last year, but on a very infrequent basis: more than three quarters (77%) of those who prescribed ECPs did so five or fewer times.

The survey also indicates that physicians make a distinction between abortion and emergency contraception. Of the two-thirds of obstetricians/ gynecologists who say in their own practice they do not “ever perform abortions as elective terminations of pregnancy,” a majority (64%) say they have no “objections or concerns” about prescribing ECPs for their patients and, in fact, 65 percent did prescribe ECPs at least once in the last year. Among the more than half (56%) of physicians who cite ethical, moral, or religious objections as a main reason why they do not perform abortions, the vast majority — 84 percent — do not have the same objections about prescribing ECPs. Nearly half (48%) of physicians who do not perform abortions for ethical, moral, or religious reasons prescribed ECPs at least once in the last year.

“Our surveys indicate that many American women are interested in emergency contraceptive pills if faced with a potential pregnancy they want to prevent and most obstetricians/gynecologists find ECPs to be a safe and effective contraceptive alternative. Clearly, this option merits a closer look by both providers and policymakers,” said Mark D. Smith, executive vice president, Kaiser Family Foundation.

Views of American Women Most Likely to Experience An Unplanned Pregnancy

This section reports survey results for women considered most likely to experience an unplanned pregnancy, defined as those who are sexually active, fertile (and whose partners are fertile), and not pregnant or trying to get pregnant. According to the Alan Guttmacher Institute, at any given point in time, two-thirds of American women of reproductive age — some 39 million women — have the potential to experience an unplanned pregnancy. Ninety percent of these women use some method of birth control. And, while slightly more than half of unplanned pregnancies in the United States occur among the 10 percent of women who do not use any contraception, 47 percent occur among women who experience contraceptive failure or improperly use contraceptives.

Ninety-nine percent of women who have heard of ECPs say they have never used them, although four out of ten (44%) say they would if faced with a potential pregnancy they wanted to prevent. Women who had not heard of ECPs were told “‘morning-after’ pills (ECPs) are a particular kind of birth control pills that are taken after sexual intercourse [and that] if several of the pills are taken at the same time within 72 hours of sex, they may reduce the chance of pregnancy by up to 75 percent,” and then were asked: “would you be very likely, somewhat likely, or not at all likely to take them if you had unprotected sex and wanted to prevent pregnancy?” More than half of the women who had never previously heard of ECPs responded that they would be likely to use them to prevent a potential unplanned pregnancy (25% say “very likely,” 27%, “somewhat likely”).

The women are almost evenly divided as to whether or not emergency contraception poses “ethical concerns” for them: a slight majority (51%) say it does not vs. 47 percent who say it does. The survey found, however, that ethical concerns do not always translate into resistance to using ECPs. More than a third (37%) of the women who expressed an ethical concern about ECPs still say they would be likely to use the method if faced with a potential pregnancy they wanted to prevent. Likewise, almost equal proportions of women expressing concerns about the safety of “the pill,” as those who have none, say they would use ECPs.

Among all groups of women — including those citing no ethical problems with ECPs — there remain at least 40 percent who say they are “not at all likely” to use ECPs. And, most women (66%) think ECPs should continue to be available by prescription, as opposed to being “widely available, like condoms.”

Previous research has indicated that ECPs are widely available on college campuses through student health services. The results of the Kaiser/Harris survey find, in fact, that among women of all ages, races, and income levels, a higher degree of education corresponds to a greater level of awareness about emergency contraception and ECPs. A majority (51%) of college-educated women know pregnancy can be prevented after sex and have heard of ECPs. By comparison, only 11 percent of those who did not graduate from high school are equally informed. The majority of those who did not graduate from high school (58%) neither know anything is possible to prevent pregnancy after unprotected sex, nor have heard of ECPs.

Women who had heard of ECPs were more likely than those who had not to list sources of information on contraception in addition to health professionals. For example, more than three quarters (78%) of women who had heard of ECPs listed “magazines” as a source of information on contraception as compared with fewer than a quarter (22%) of those who were not aware of the method.

The survey results are being presented Wednesday, March 29, at a briefing for journalists on emergency contraception sponsored by the Kaiser Family Foundation and the Washington Journalism Center.

The Kaiser/Harris Survey on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy was a random-sample, telephone survey of adults nationwide. The national sample consisted of 2,002 adults, 18 years and older, and was conducted between October 12 and November 13, 1994. The margin of error in the national sample is plus or minus 2 percent. The margin of error among the sample referenced throughout this release — 270 American women most likely to experience an unplanned pregnancy — is plus or minus 6 percent. Reports have been released from data collected in this survey on public knowledge and attitudes about abortion rates and teen sexuality. Future reports will be issued on talking with children about sexuality and other sensitive issues, men and contraception, and other aspects of contraception and reproduction.

The Kaiser/Fact Finders Survey on Obstetricians/Gynecologists’ Attitudes and Practices Related to Contraception and Family Planning was a random-sample, telephone survey of obstetricians/gynecologists drawn from the American Medical Association’s Physicians Masterfile. The national sample consisted of 300 obstetricians/gynecologists, and was conducted between February 1 and March 21, 1995. The margin of error ranges from plus or minus 3.4 and 5.7 percent. A companion survey of physicians in Family Practice is also being conducted. Future reports will be issued on physician attitudes and practices on other aspects of contraception and family planning, including preferred contraceptive methods, RU-486, abortion, teen sexuality, and general findings on contraceptive counseling and patient-physician communication.

The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation’s work is focused on four main areas: health policy, reproductive health, HIV, and health and development in South Africa.

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Topline: Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy in the US, Canada and the Netherlands 1995

HIV and Managed Care, Special Supplement to JAIDS

Health policy and public health experts examine the politics, practice, and special considerations of providing AIDS/HIV care under a managed care health system. This work was published as a special supplement to JAIDS, the Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, and produced as part of the Kaiser Forums program, an ongoing series of issue-specific briefings at which policy makers, health experts, practitioners, and others discuss and debate controversial topics related to the Foundation’s core areas of interest.

Note: This publication is no longer in circulation. However, a few copies may still exist in the Foundation’s internal library that could be xeroxed. Please email order@kff.org if you would like to pursue this option.

An analysis of the electorate and health reform that considers how American voters’ values influenced their support or opposition toward health reform proposals and how those attitudes shifted over the course of the debate. The study uses a novel typologyof the American people developed by the Times Mirror Center for the People and the Press that divides voters into ten groups of which three are pro-Republican, four are pro-Democrat, and the remainder are Independents. Among the values determined to be most significant in assessing public opinion on health reform were: attitudes toward government, attitudes toward the poor and needy, and attitudes toward business. Economic and political variables were also relevant. Times Mirror found similar values among different groups and differing values within the same group.

To gather early insights and timely information for state and federal policymakers concerning how the movement to managed care is affecting the poor and their access to care, the Henry J. Kaiser Family Foundation and The Commonwealth Fund are jointly sponsoring case studies and population surveys in five states that are currently restructuring their health care systems for the low-income population: California, Minnesota, New York, Oregon,and Tennessee. TennCare represents one of the most ambitious state-level efforts to restructure Medicaid and expand insurance coverage to the uninsured. The case study shows that the rapid change caused considerable confusion for patients, providers, and health plans. The TennCare experience provides early insights into the issues that states will face as they move to enroll more of their low-income populations into managed care arrangements.

Report (.pdf)

Nationwide surveys have explored public opinion on these issues, but few surveys have measured the public’s knowledge of unplanned pregnancy, abortion, contraceptive methods and other related topics. The Kaiser Family Foundation commissioned a survey of Americans to identify where the gaps and misperceptions exist in the public’s knowledge of reproductive health issues, in an effort to help dispel the myths and provide Americans with the facts. The national household survey of 2,002 Americans was designed and analyzed by the Kaiser Family Foundation and Louis Harris and Associates, Inc. and conducted by Louis Harris and Associates, Inc.

This paper analyzes changes in insurance coverage that have occurred at the national level between 1988 and 1994.

• Report: The Changing Composition Of Health Insurance Coverage In The United States

G. Emergency Contraceptive Pills, or Morning-After Pills

G1. If a woman has just had sex and thinks she might become pregnant, is there anything that she could do in the next few days to prevent pregnancy, or not?

Asked only in the U.S. USA18+ Yes, there is something 36% No, there is not anything 47% Too late to prevent pregnancy (Vol.) 1% Not sure/Refused 17% G2. Have you ever heard of morning-after pills, also called emergency contraceptive pills, or not?

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, have heard of it 54% 53% 71% 96% No, have not heard of it 45% 47% 28% 4% Not sure/Refused * 1% * * G3. How soon after sexual intercourse do morning-after pills have to be taken — immediately, within 12 hours, within 24 hours, within 72 hours, or within one week?

Based on those who have heard of emergency contraceptive pills.

USA18+ USA18-44 CAN18-44 NETH18-44 Immediately 10% 10% 9% 4% Within 12 hours 31% 28% 30% 34% Within 24 hours 28% 32% 36% 49% Within 72 hours 9% 12% 11% 6% Within one week 5% 6% * * Not sure/Refused 16% 12% 13% 6% G4. (Ask Females: Have you/ Ask Males: Has your current or most recent partner) ever usedmorning-after pills, or not?

Based on those who have heard of emergency contraceptive pills.

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, have taken 1% 2% 9% 11% No, have not taken 98% 98% 86% 82% Not sure/Refused 1% 1% 5% 7% G5. Morning-after pills are a particular kind of birth control pills that are taken after sexual intercourse. If several of the pills are taken at the same time within 72 hours of sex, they may reduce the chance ofpregnancy by up to 75%.

From what you know about morning-after pills, would you say (you/your current or recent partner) would be very likely, somewhat likely, or not at all likely to take them if you had unprotected sex and wanted to prevent pregnancy?

USA18+ USA18-44 CAN18-44 NETH18-44 Very likely 23% 21% 19% 33% Somewhat likely 20% 24% 23% 17% Not at all likely 47% 52% 47% 31% Not applic. (Vol.) 7% 3% 7% 11% Not sure/Refused 3% 1% 5% 9% G6. Do you think morning-after pills should be widely available, like condoms or tightly controlled like drugs that require a prescription from you doctor?

USA18+ USA18-44 CAN18-44 NETH18-44 Widely available 37% 33% 27% 26% Tightly controlled 58% 64% 64% 71% Not sure/Refused 5% 3% 9% 3% G7. Would a method of birth control that is taken soon after intercourse, such as morning-after pills, pose ethical concerns for you, or not?

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, would pose concerns 36% 43% 31% 21% No, would not 61% 55% 65% 74% Not sure/Refused 3% 2% 5% 4% H. Abortion

H1. Of every 100 pregnancies in the United States, how many do you feel end in abortion?

Asked only in the U.S.

USA18+ Mean: 35 pregnancies Not sure/Refused 5% H2. Do you feel that the number of abortions per every 100 women in the United States is increasing, decreasing, or staying about the same each year?

Asked only in the U.S. USA18+ Increasing 49% Decreasing 8% Staying about the same 41% Not sure/Refused 2% H3. Of every 100 abortions that occur in the United States, how many do you feel occur among (Read each item — Do not rotate)?

Asked only in the U.S.

USA18+ Mean Not sure/Refused a. Teenagers 49 pregnancies 4% b. Lower income women 46 4% c. Minority women 42 6% H4. Of all women between the ages of 12 and 50, what percentage do you feel has had an abortion?

Asked only in the U.S. USA18+ Mean: 31% Not sure/Refused 7% H5. Is the percentage of women in the United States who have had an abortion higher, lower, or about the same as the percentage of women who have had an abortion in other developed countries like Canada, Great Britain or Germany?

USA18+ USA18-44 CAN18-44 NETH18-44 Higher in the U.S. 49% 57% 10% 16% Lower in the U.S. 16% 14% 43% 67% About the same 28% 24% 32% 7% Not sure/Refused 6% 5% 15% 10% I. Factuals

Now, I have just a few factual questions for the purpose of classification.

I1. Are you single, married, living as a couple with someone, widowed, separated, or divorced?

USA18+ USA18-44 CAN18-44 NETH18-44 Single 19% 29% 33% 24% Married 56% 53% 49% 55% Living as a couple 6% 9% 13% 17% Widowed 1% 1% 1% * Separated 2% 2% 2% * Divorced 7% 3% 3% 3% Not sure/Refused * * * * I2. Are you covered by any form of health insurance including Medicaid or Medicare, or not?

Asked only in the U.S.

USA18+ Yes 84% No 16% Not sure/Refused * I3. What is the highest level of school you have completed or the highest degree you have received? (Probe: If respondent says just “High School:” What was the highest grade youcompleted? If 12th Grade, code “Graduate.” If 11th Grade or less, code “Less Than.”)

The U.S. and Canada: USA18+ USA18-44 CAN18-44 Less than high school (grades 1-11, grade 12 but no diploma) 12% 7% 16% High school graduate or equivalent (e.g., GED) 42% 44% 26% Some college but no degree 25% 28% 20% College graduate 14% 15% 24% Postgraduate 6% 6% 15% Not sure/Refused * * 8% The Netherlands:

NETH18-44 Primary school 3% Lower technical and vocational education 16% Lower secondary school 14% Middle technical and vocational education 29% Higher secondary school 10% Higher technical and vocational education 21% University 7% Not sure/Refused * I4. Are you of Hispanic or Latino origin or descent, or not?

Asked only in the U.S.

USA18+ USA18-44 Yes 8% 10% No 90% 88% Not sure/Refused 2% 1% I5. Do you consider yourself white, (Rotate: Black or African-American), Asian or Pacific Islander, Native American or some other race?

Asked only in the U.S.

USA18+ USA18-44 White 80% 77% Black or African-American 12% 13% Asian or Pacific Islander 1% 2% Native American 2% 2% Other race 4% 5% Not sure/Refused 1% 1% I6. Which of the following income categories best describes your total 1993 household income? Was it (read list)?

USA18+ USA18-44 CAN18-44 NETH18-44 $7,500 or less 9% 7% 4% 7% $7,501 to $15,000 11% 10% 6% 8% $15,001 to $25,000 17% 18% 14% 27% $25,001 to $35,000 17% 17% 15% 21% $35,001 to $50,000 19% 21% 18% 7% $50,001 to $75,000 12% 13% 21% 4% $75,001 to $100,000 5% 5% 7% * $100,001 to $125,000 2% 2% 3% * Over $125,000 2% 3% 3% * Not sure/Refused 6% 4% 9% 25% I7. Did you vote in the 1992 presidential election, when about half of the American public voted, or not?

Asked only in the U.S.

USA18+ Yes 71% No 29% Not sure/Refused * I7a. Did you vote for George Bush, Bill Clinton, or Ross Perot?

Based on those who voted in the 1992 presidential election. Asked only in the U.S.

USA18+ George Bush 38% Bill Clinton 41% Ross Perot 14% Other 1% Not sure/Refused 5% I8. How frequently do you attend religious services? Would you say at least once a week, at least once a month, a few times a year, or never?

USA18+ USA18-44 CAN18-44 NETH18-44 At least once a week 37% 30% 18% 10% At least once a month 16% 18% 14% 10% A few times a year 28% 33% 38% 24% Never 18% 19% 30% 55% Not sure/Refused 1% * 1% 1% I9. Language interview was conducted in.

USA18+ USA18-44 CAN18-44 NETH18-44 English 99% 98% 71% * Spanish 1% 2% * * French * * 29% * Dutch * * * 100%

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Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy:Survey Part One Part Two Part Three

Kaiser Family Foundation Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy in the United States, Canada, and the Netherlands1995

Unplanned pregnancy is a major problem facing Americans today. Approximately 3.5 million unplanned pregnancies occur each year in the United States. Women in the United States are almost twice as likely as women in Great Britain and three times as likely as women in the Netherlands to face an unplanned pregnancy.

Research has explored public opinion on these issues, but none has measured public knowledge. Hoping to help explain some of the variation in unplanned pregnancy rates between the U.S. and other developed nations, the Kaiser Family Foundation commissioned telephone surveys with adults in Canada, the Netherlands, and the U.S. to assess differences in public knowledge, opinions, and practices related to pregnancy and birth control. Canada was selected for comparison because it represents a culture similar to that of the United States, but has an unplanned pregnancy rate two-thirds that of the U.S. The Netherlands was selected because its culture is considered very different in its attitudes toward sexuality than the U.S. and it has an extremely low unplanned pregnancy rate — only one-tenth of the U.S. rate.

The three national telephone surveys were designed and analyzed by the Kaiser Family Foundation and Louis Harris and Associates, Inc. and conducted by Louis Harris and Associates, Inc. (A complete methodology is on the opposite page.) The surveys examined public knowledge of and attitudes toward issues related to unplanned pregnancy and contraception, including emergency contraception. Survey respondents were asked, for example, about such things as their perceptions about the magnitude of the problem of unplanned pregnancy in their country and their awareness of different contraceptive options.

Press releases have been issued from the data collected in the U.S. survey on public knowledge and attitudes about emergency contraceptive pills, abortion rates, men and contraception, teen sexuality and pregnancy, and other aspects of contraception and reproduction. To obtain the press releases and additional information on these topics, call the Kaiser Family Foundation’s publications request line at 1-800-656-4533.

The Kaiser Family Foundation, based in Menlo Park, California, is a non-profit, independent national health care philanthropy and is not associated with Kaiser Permanente or Kaiser Industries. The Foundation’s work is focused on four main areas: health policy, reproductive health, and HIV policy inthe United States, and health and development in South Africa.

Methodology

The Kaiser Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy are three separate random-sample telephone surveys of adults ages 18 and older living in the United States, Canada, and the Netherlands. The survey was designed by the Henry J. Kaiser Family Foundation in association with Louis Harris and Associates, Inc.

The sampling procedure was designed to produce representative samples of adults in telephone households in all three countries. Random digit selection was used to assure equal representation ofpeople in households that are listed and “unlisted” in telephone directories. An effort was made to match interviewers of the same sex as the randomly selected respondents. Interviews were conducted in English and Spanish in the United States. For the Canadian and Dutch surveys, the survey instrument was translated into French and Dutch, using culturally appropriate wording, and back-translated into English for verification.

The U.S. sample consisted of 2,002 adults in the 48 contiguous United States (excluding Alaska and Hawaii) and was conducted between October 12 and November 13, 1994. The margin of error in the nationwide U.S. sample is plus or minus 2 percent and plus or minus 3 percent for respondents of “reproductive age,” that is men and women age 18-44 (1,140 respondents). The Canadian sample consisted of 1,002 adults and interviews were conducted between December 9, 1994 and January 3, 1995. The margin of error for the Canadian sample is plus or minus 3 percent and plus or minus 4 percent for respondents of reproductive age (594 respondents). The Dutch sample consisted of 1,001 adults and interviews were conducted between December 15, 1994 and January 19, 1995. The margin of error for the Dutch sample is plus or minus 3 percent and plus or minus 4 percent for respondents of reproductive age (536 respondents).

Questionnaire and Toplines

I. Gender of Respondents

USA18+ USA18-44 CAN18-44 NETH18-44 Male 50% 49% 51% 51% Female 50% 51% 49% 49% II. Age of Respondents

USA18+ USA18-44 CAN18-44 NETH18-44 18-29 21% 18-24 22% 20% 24% 30-49 43% 25-34 40% 42% 39% 50-64 18% 35-44 38% 39% 37% 65 and over 17% A. Talking with Your Doctor

Now I’d like to ask you a few questions about your discussions with health care professionals. (If Necessary: If any question is not applicable to you, please say so, and we’ll move past it.)

A1. In the past two years, have you discussed birth control such as the use of condoms or birth control pills with your doctor or another health professional, or not?

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, discussed 21% 33% 34% 25% No, did not discuss 71% 63% 65% 73% Not applicable (Vol.) 9% 4% 1% 2% Not sure/Refused * * * * A2. Have you ever discussed birth control with a doctor or another health professional, or not?

Based on those who did not discuss or were not sure whether they discussed birth control with a doctor in the past two years.

USA18+ USA18-44 CAN18-44 NETH18-44 Yes, discussed 38% 40% 45% 36% No, never discussed 61% 60% 55% 62% Not applic. (Vol.) 1% * 2% * Not sure/Refused * * * * A3. Has a doctor ever been the one to raise the subject of birth control, or not?

Based on those who have discussed birth control with a doctor. Asked only in the U.S.

USA18+ Yes, doctor raised subject 32% No, doctor did not 67% Not sure/Refused 1% B. Information Sources

B1. People can get information about birth control from a variety of sources. What sources would you say that you most typically rely on for information about birth control? What else? (Do Not Read List — Multiple Record)

USA18+ USA18-44 CAN18-44 NETH18-44 1. Health care professionals 63% 64% 68% 79% 2. Magazines 20% 23% 15% 13% 3. Your friends or peers 12% 14% 6% 5% 4. Television 11% 13% 8% 9% 5. Your family 9% 10% 5% 5% 6. Health and sex education courses in school 8% 10% 5% 3% 7. Reference books/medical journals/library 5% 5% 5% 3% 8. Church, clergyman 2% 2% * * 9. Newspaper 2% 2% * * 10. Planned Parenthood/ family planning agencies 2% 2% * * 11. Your spouse or partner 2% 2% 1% 1% 12. Pamphlets 1% 2% 2% 2% 13. Nowhere — don’t want/need/get any information 1% * 2% * 14. Other 3% 5% 13% 16% 15. Not sure/Refused 13% 9% 3% 8% C. Knowledge of Unplanned Pregnancy Problem

C1. Unplanned pregnancy is a pregnancy that a woman is not actively trying to have. It could be unintended, a mistake, unwanted, or not at the right time. Do you think unplanned pregnancies are a very big problem, a somewhat big problem, not a very big problem, or not a problem at all in your country?

USA18+ USA18-44 CAN18-44 NETH18-44 Very big problem 60% 60% 36% 6% Somewhat big problem 30% 33% 45% 35% Not a very big problem 5% 4% 13% 49% Not a problem at all 2% 2% 3% 4% Not sure/Refused 3% 1% 3% 5% C2. Compared with 10 years ago, do you feel the percentage of women in the your country who have unplanned pregnancies is now much higher, higher, about the same, lower or much lower?

USA18+ USA18-44 CAN18-44 NETH18-44 Much higher 27% 30% 14% 1% Higher 42% 42% 32% 13% About the same 20% 19% 28% 29% Lower 8% 7% 15% 45% Much lower 1% * 1% 5% Not sure/Refused 2% 1% 10% 6% C3. Do you feel that (Rotate: married women or unmarried women) are more likely to haveunplanned pregnancies?

Asked only in the U.S.

USA18+ Married women 9% Unmarried women 82% No difference (Vol.) 6% Not sure/Refused 2% C4. Do you feel that (Rotote: teenagers or women over the age of 19) are more likely to haveunplanned pregnancies?

Asked only in the U.S.

USA18+ Teenagers 86% Women over the age of 19 11% No difference (Vol.) 2% Not sure/Refused 2% C5. Do you think that (Rotate: Women in the United States or women in other developed countries, such as Canada, Great Britain or Germany) are more likely to have unplanned pregnancies?

Asked only in the U.S.

USA18+ United States 69% Other developed countries 11% Same (Vol.) 7% Not sure/Refused 13% C6. Would you say that (read each item) contributes to unplanned pregnancies very much,somewhat, or not at all?

Very Much Somewhat Not At All Not Sure/Refused a. A decline in moral standards USA 18+ 53% 36% 10% 1% USA 18-44 48% 40% 12% * CAN 18-44 29% 39% 28% 4% NETH 18-44 15% 33% 39% 12% b. Lack of education in general USA 18+ 48% 39% 12% 1% USA 18-44 46% 41% 13% * CAN 18-44 41% 38% 20% 1% NETH 18-44 16% 38% 44% 2% c. Lack of understanding about how to use birth control USA 18+ 27% 50% 22% 2% USA 18-44 26% 51% 22% * CAN 18-44 25% 45% 28% 2% NETH 18-44 14% 36% 47% 3% d. An inability to get birth control USA 18+ 21% 45% 33% 2% USA 18-44 21% 45% 34% * CAN 18-44 15% 36% 47% 2% NETH 18-44 13% 20% 64% 3% e. The cost of birth control USA 18+ 14% 40% 45% 2% USA 18-44 12% 40% 47% 1% CAN 18-44 14% 32% 49% 5% NETH 18-44 5% 29% 59% 7% f. A genuine desire to have children USA 18+ 12% 48% 37% 4% USA 18-44 11% 52% 36% 2% CAN 18-44 15% 37% 41% 7% NETH 18-44 8% 32% 42% 17%

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Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy:Survey Part One Part Two Part Three

D. Knowledge of Teen Pregnancy

D1. Now I’m going to ask you some questions about teenagers, that is, young women between the ages of 12 and 19. Do you think that the percentage of teenagers in the United States who engage in sexual intercourse is increasing, decreasing, or is it about the same as ten years ago?

Asked only in the U.S.

USA18+ Increasing 73% Decreasing 9% Same 17% Not sure/Refused 1% D2. What percentage of (read each item) do you feel have had sexual intercourse? (Rotatewithin each group)

Asked only in the U.S.

USA18+ a. 14 year old females Mean: 44% b. 14 year old males Mean: 47% c. 18 year old females Mean: 70% d. 18 year old males Mean: 75% D3. What percentage of young women in the United States do you feel become pregnant before the age of twenty?

Asked only in the U.S. USA18+ Mean: 44% D4. What percentage of teen pregnancies do you feel end in abortion?

Asked only in the U.S. USA18+ Mean: 41% D5. Generally speaking, if a woman under 20 has a child in the United States, will she be more likely to (Read each item; Rotate), less likely, or will it have no effect?

Asked only in the U.S.

MoreLikely LessLikely No Effect Not Sure/Refused a. Complete her education USA 18+ 8% 84% 7% 1% b. Earn a good salary USA 18+ 4% 83% 12% 2% c. Go on welfare USA 18+ 85% 6% 7% 2% d. Get married USA 18+ 21% 43% 34% 2% D6. What percentage of all teenagers who have children in the United States do you think are (Read each item; Rotate)?

Asked only in the U.S.

USA18+ a. White Mean: 41% b. In the middle or upper class Mean: 37% E. Overall Knowledge about Reproduction and Birth Control

Now I have a few questions about pregnancy and birth control.

E1. When do you think a woman is most likely to get pregnant — about one week before her period starts, during her period, or about two weeks after her period starts?

USA18+ USA18-44 CAN18-44 NETH18-44 About one week before her period starts 35% 33% 30% 17% During her period 3% 4% 3% 2% About two weeks after her period starts 55% 60% 57% 71% Not sure/Refused 8% 4% 10% 11% E2. If 100 women who are not using birth control engage in sexual intercourse regularly, whatpercentage do you feel will get pregnant during one year?

USA18+ USA18-44 CAN18-44 NETH18-44 10% or less 5% 4% 4% 6% 11%-20% 6% 5% 4% 5% 21%-30% 10% 10% 7% 10% 31%-40% 8% 8% 6% 6% 41%-50% 18% 16% 19% 18% 51%-60% 9% 10% 8% 10% 61%-70% 8% 9% 9% 6% 71%-80% 18% 20% 18% 14% 81%-90% 7% 8% 7% 5% 91%-100% 7% 8% 9% 3% Mean 57 59 61 53 Standard error in mean 1 1 1 1 Median 59 60 61 52 Don’t know 4% 2% 9% 17% E3. What different methods of birth control have you heard of? What others? (Open-Ended — all responses were volunteered and multiple responses could be given)

Based on those under 65 years old. Asked only in the U.S. USA18+ a. Abortion 3% b. Abstinence 27% c. Birth control pills or oral contraceptives 85% d. Condoms or rubbers or female condoms 85% e. Contraceptive foams, creams, jellies, and suppositories 41% f. Contraceptive implant, or Norplant, or capsules under the arm 31% g. Depo-Provera (contraceptive injections in the arm/shots) 15% h. Diaphragms, sponges or cervical caps 50% i. Female sterilization such as tubal ligation, tubes tied or hysterectomy 16% j. IUDs 39% k. Male sterilization (vasectomy) 14% l. Rhythm method or natural family planning or calendar method 20% m. Withdrawal 5% n. None 2% o. Other 2% p. Not sure/Refused 3% E4. I would like to get your opinion about how effective various methods of birth control are at preventing pregnancy. Do you think that (read each item) is/are very effective at preventing pregnancy, somewhat effective, or not very effective?

Based on those under 65 years old.

VeryEffective SomewhatEffective Not Very Effective Not Sure/Refused a. Sterilization (such as vasectomy/tubal ligation, tubes tied or hysterectomy) USA 18+ 86% 10% 2% 1% USA 18-44 87% 9% 2% * CAN 18-44 83% 13% 2% 3% NETH 18-44 90% 7% 1% 1% b. Birth control pills USA 18+ 64% 29% 4% 1% USA 18-44 64% 31% 4% * CAN 18-44 73% 23% 3% 1% NETH 18-44 90% 9% * 1% c. Condoms USA 18+ 36% 53% 9% * USA 18-44 38% 53% 7% * CAN 18-44 40% 52% 7% 1% NETH 18-44 52% 44% 3% 1% d. Diaphragms USA 18+ 30% 57% 8% 4% USA 18-44 29% 59% 7% 3% CAN 18-44 18% 50% 19% 14% NETH 18-44 19% 43% 12% 26% e. Withdrawal USA 18+ 12% 26% 56% 4% USA 18-44 12% 26% 57% 3% CAN 18-44 9% 15% 69% 6% NETH 18-44 3% 8% 86% 3% f. Contraceptive foams, creams, jellies, and suppositories USA 18+ 10% 60% 24% 4% USA 18-44 9% 62% 24% 4% CAN 18-44 6% 42% 36% 16% NETH 18-44 5% 36% 37% 21% g. The rhythm method (also called natural family planning, or calendar method) USA 18+ 9% 43% 42% 4% USA 18-44 9% 42% 44% 3% CAN 18-44 7% 29% 57% 6% NETH 18-44 6% 16% 73% 5% E5. Would you say that (read each item) is/are very safe, somewhat safe, somewhat unsafe orvery unsafe for the health of the user?

VerySafe SomewhatSafe SomewhatUnsafe VeryUnsafe Not Sure/Refused a. Birth control pills USA 18+ 18% 49% 23% 7% 1% USA 18-44 17% 50% 24% 7% 1% CAN 18-44 21% 46% 23% 8% 3% NETH 18-44 40% 34% 20% 3% 3% b. Condoms USA 18+ 53% 34% 7% 3% 1% USA 18-44 56% 33% 7% 2% * CAN 18-44 66% 26% 5% 2% 2% NETH 18-44 82% 14% 3% * 1% c. Contraceptive foams, creams jellies, and suppositories USA 18+ 17% 49% 20% 8% 4% USA 18-44 16% 52% 20% 7% 3% CAN 18-44 16% 35% 21% 9% 19% NETH 18-44 15% 22% 25% 6% 32% d. Diaphragms USA 18+ 25% 43% 20% 7% 4% USA 18-44 24% 44% 21% 6% 3% CAN 18-44 21% 37% 21% 9% 13% NETH 18-44 26% 27% 18% 3% 26% e. IUDs USA 18+ 5% 33% 32% 18% 10% USA 18-44 4% 34% 33% 18% 9% CAN 18-44 9% 31% 25% 20% 16% NETH 18-44 21% 33% 29% 6% 11% f. Female sterilization (tubal ligation, tubes tied or hysterectomy) USA 18+ 41% 35% 14% 5% 2% USA 18-44 35% 39% 17% 5% 2% CAN 18-44 40% 33% 14% 6% 7% NETH 18-44 59% 21% 11% 3% 8% g. Male sterilization (vasectomy) USA 18+ 53% 29% 9% 4% 2% USA 18-44 48% 33% 10% 4% 2% CAN 18-44 53% 28% 9% 4% 5% NETH 18-44 66% 20% 7% 2% 5% F. Personal Experiences

Now I’m going to ask you some questions about your personal experiences. Once again, I want to reassure you of the complete confidentiality of all of your responses. Researchers will analyze this information in summary form and will never associate you with any of your responses.

F1. Have you had sexual intercourse in the last twelve months, or not?

USA18+ USA18-44 CAN18-44 NETH18-44 Yes 75% 89% 88% 91% No 22% 9% 11% 7% Not applic. (Vol.) 1% * * 1% Not sure/Refused 2% 1% 1% 1% F2. Do you or your partner currently use any type of birth control, or not? (If no current partner, probe: Did you or your most recent partner use any type of birth control?)

Based on those who have had sexual intercourse in the last 12 months.

USA18+ USA18-44 CAN18-44 NETH18-44 Yes 48% 60% 62% 80% No 48% 38% 36% 20% Not applic. (Vol.) 4% 2% 1% 1% Not sure/Refused * * * * F2a. Why don’t you use birth control? (Do not read list — multiple record)

Based on those who do not use birth control.

USA18+ USA18-44 CAN18-44 NETH18-44 Would like to become pregnant 9% 17% 17% 20% Currently pregnant 5% 8% 6% 22% Need to get prescription from doctor * * * * Don’t like contraceptives/uncomfortable 2% 4% 2% 10% Spoils moment/interferes 1% 2% 1% 2% No longer necessary 70% 51% 63% 25% Other 8% 8% 11% 17% Not sure/Refused 5% 8% 4% 5% F3. What form(s) of birth control do you or your partner use? (Do not read list — multiple record)

Based on those who currently use birth control.

USA18+ USA18-44 CAN18-44 NETH18-44 a. Abortion * * * * b. Abstinence * * * * c. Birth control pills or oral contraceptives 34% 38% 43% 65% d. Condoms or rubbers or female condoms 39% 43% 46% 21% e. Contraceptive foams, creams, jellies, and suppositories 4% 3% 3% * f. Contraceptive implant, or Norplant, or capsules under the arm 2% 2% * * g. Depo-Provera (contraceptive injections in the arm/shots) 3% 3% * * h. Diaphragms, sponges or cervical caps 5% 5% 2% * I. Female sterilization such as tubal ligation, tubes tied or hysterectomy 14% 11% 11% 5% j. IUDs 1% 1% 3% 3% k. Male sterilization (vasectomy) 12% 9% 10% 11% l. Rhythm method or natural family planning or calendar method 2% 2% 2% * m. Withdrawal 1% 1% 2% * n. Other * * 3% * o. Not sure/Refused 1% 1% 2% * F4. Who (read each item) — you or your current or most recent partner?

Based on those who currently use birth control.

Respondent Partner Shared Neither Not sure/Refused a. Pays/paid for birth control USA 18+ 40% 22% 30% 7% 1% USA 18-44 38% 23% 31% 7% 1% CAN 18-44 29% 19% 38% 12% 3% NETH 18-44 20% 13% 41% 26% 1% b. Makes/made sure that birth control is/was used USA 18+ 39% 19% 39% 1% 2% USA 18-44 40% 18% 40% * 2% CAN 18-44 24% 21% 49% 3% 2% NETH 18-44 32% 29% 38% 1% * c. Initiates/initiated discussions about birth control USA 18+ 36% 18% 39% 5% 2% USA 18-44 36% 17% 41% 4% 2% CAN 18-44 23% 15% 51% 7% 4% NETH 18-44 27% 14% 51% 6% 3% d. Chooses/chose the type of birth control USA 18+ 43% 23% 31% 2% 1% USA 18-44 42% 23% 33% 1% 1% CAN 18-44 29% 24% 43% 3% 2% NETH 18-44 30% 25% 39% 5% 1% F5. Do you think that (read each item) for preventing unplanned pregnancy, or not? (Do not rotate)

Based on those who are sexually active.

Yes No Not Applic.(Vol.) Not sure/Refused a. Your current or most recent partner was responsible enough USA 18+ 84% 11% 4% 1% USA 18-44 86% 12% 2% * CAN 18-44 87% 7% 4% 1% NETH 18-44 90% 6% 4% 1% All respondents asked. b. Most men are responsible enough USA 18+ 28% 70% * 2% USA 18-44 26% 73% * 1% CAN 18-44 31% 63% * 5% NETH 18-44 39% 44% 1% 16% F6. Why do you think most men are not involved in preventing unplanned pregnancy? (Multiple Record)

Based on those who do not think most men are responsible enough. Asked only in the U.S. USA18+ USA18-44 Female takes responsibility 4% 4% He feels it’s female’s responsibility 26% 28% He doesn’t care 41% 39% He doesn’t think it matters 9% 10% He is not educated 4% 4% He doesn’t become pregnant/not his body 14% 17% He wants to have a baby * 1% He doesn’t think partner needs birth control 1% 1% Other 11% 11% Not sure/Refused 4% 2%

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Surveys on Public Knowledge and Attitudes on Contraception and Unplanned Pregnancy:Survey Part One Part Two Part Three

To gather early insights and timely information for state and federal policymakers concerning how the movement to managed care is affecting the poor and their access to care, the Henry J. Kaiser Family Foundation and The Commonwealth Fund are jointly sponsoring case studies and population surveys in California, Minnesota, New York, Oregon, and Tennessee. This case study describes the first year’s experience of Oregon’s Initiative, the Oregon Health Plan (OHP). It is designed to furnish insights on access issues related to the movement to managed care under the OHP.

• Report: