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

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.

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.

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)

Survey Shows “Two Faces” Of Public Opinion On Welfare Reform

Americans Support Time Limits and Tough Work Requirements, But Reluctant to Abandon Those In Need

Public Defines Welfare Broadly Understands Key Details of Welfare Programs

Embargoed for release: 9:00 a.m. EST, Thursday, January 12, 1995

For further information contact: Matt James or Tina Hoff

Menlo Park, CA — A new Kaiser/Harvard survey of Americans nationwide has found that the public supports strong welfare reform measures, such as time limits and work requirements, but is reluctant to simply cut people off and leave them without some means of basic support.

The survey identifies four core beliefs that shape the public’s policy preferences. Two lead the public to support time limits and other strong welfare policies: the belief that welfare causes more harm than good because it discourages work and causes family break up, and the belief that welfare costs the taxpayer too much money. But two other core beliefs make the public concerned that these same strong policies will leave low income people without basic support: the belief that lack of economic opportunity as much as personal responsibility is the reason people need welfare, and the belief that both government and people themselves have a shared responsibility for ensuring that people have a minimum standard of living.

Two-thirds (68%) of Americans favor ending welfare payments after two years for all able-bodied welfare recipients, including women with pre-school children, and requiring them to take a job. But support for cutting off payments drops to 26 percent if the job pays low wages that would make it difficult to support a family, and to only 16 percent if the person is unable to find a job.

Large majorities favor government providing job training (87%) and public service jobs (74%) for people on welfare, and providing child care to low-income mothers who work or are in job training (85%). After education, training, health and child care benefits have been provided, 56 percent believe welfare recipients should be required to do community service work in exchange for continued benefits or have benefits cut off after a specified period of time. Only 10 percent believe the government should end all aid under these circumstances, and 25 percent believe the government should cut recipients off only after guaranteeing they have a job.

The public’s desire to “do something” about welfare is also reflected in support for limits on welfare. Majorities favor requiring mothers to report the name of a child’s father before they can receive welfare (81%), setting limits or denying welfare to non-citizens, including most legal immigrants (64%), denying additional benefits to women who have more children while on welfare (59%), and government limiting how fast welfare programs can grow, regardless of how many people may need assistance (capping welfare) (57%).

Nearly equal proportions of Americans say: 1) “We shouldn’t let people who can’t get or hold a job go hungry or homeless, and we need to continue welfare payments to these people” (44%), and 2) “We should have a firm limit on how long people can stay on welfare, regardless of the consequences, in order to get them to work” (43%).

“The jury is still out on what the public will support on welfare reform. At the moment they want four things that may be incompatible — get people off welfare within two years, get them jobs that provide a minimum standard of living, don’t let families suffer severe hardship, and don’t raise taxes or cut government programs to do these things,” said Drew Altman, Kaiser Family Foundation president and former welfare commissioner in New Jersey under Governor Tom Kean.

Two-thirds of Americans (66%) oppose a proposal that would end welfare benefits for unmarried women and their children if that meant some of the children would have to be cared for in group homes or orphanages. If such a proposal were enacted, the public overwhelmingly prefers having the government pay for group homes where mothers and their children live together (56%), rather than providing orphanages for the children (8%) or doing nothing (8%). A fourth of respondents said none of the above.

One important caveat should be added. The public is not prepared to sacrifice very much to see reforms enacted. Only about half are willing to pay more taxes or see other programs cut to provide job training (53% willing to 40% unwilling) and public service jobs (47% to 45%).

Awareness of Reform Proposals

At this early stage, the public is not yet following the welfare reform debate closely. In sharp contrast to the 47% who said in October 1993 that they were following news stories and other information about health care reform very closely (Kaiser/Harvard Survey, October 1993), only 13% say in this survey they have been following stories about welfare reform very closely.

Only three in ten Americans say they understand President Clinton’s welfare proposals very (5%) or fairly well (25%). A similar proportion understand the Republican proposals very (7%) or fairly well (24%).

“Americans do not yet know the consequences of the various welfare reform proposals,” said Dr. Robert J. Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University. “As the debate continues and begins to focus on the implications of particular proposals — whether they be severe negative consequences for individuals and families or increased taxes or cuts in other government programs — the public is likely to become more cautious.”

Welfare Spending

Asked to choose from a list of six areas which two consumed the largest share of federal spending, only 14 percent correctly named Social Security and 37 percent named defense as one of the top two. Four-in-ten Americans (40%) thought welfare was one of the two largest areas of federal spending.

When asked to define welfare, the public identified the following six major federal government programs from a list of nine as being welfare programs: food stamps (93%), AFDC (Aid to Families with Dependent Children) (85%), public housing (85%), WIC (the Women, Infants, and Children program) (72%), the school lunch program (62%) and Medicaid (60%). Most did not regard Supplemental Security Income (SSI), the federal cash assistance program for the aged, blind, and disabled, as welfare. These six major programs labelled by the public as welfare make up 10.2 percent of the 1993 budget, ranking behind defense (21%) and Social Security (21%), and equal to Medicare (10.2%).

State and Federal Roles

The public wants to see the states play a major role in welfare reform. Given four choices, a majority (52%) thought government officials should experiment with reform at the state level, compared to 29 percent who preferred reform at the national level, 7 percent who wanted to leave welfare as it is, and 6 percent who would prefer to eliminate all welfare benefits.

But Americans are wary of letting states determine their own policies without some federal guidelines. While 36 percent thought each state should determine the best way to aid poor people, 50 percent believed the federal government needs to set guidelines when it gives money to states, in order to assure they will treat everyone fairly and do the right thing for poor people.

A majority of Americans (58%) also favor a “swap” proposal, where states would be in charge of welfare and the federal government would take responsibility for paying for the health care of poor people, instead of both responsibilities being shared as they are now. Twenty-four percent are opposed, and 18 percent said they didn’t know.

Core Beliefs and Values

Americans’ beliefs about what policies and reforms should be enacted can be related back to four core values they hold about welfare and poverty:

1. Americans see the welfare system as doing more harm (56%) than good (33%) because they believe it encourages the breakup of the family and discourages work.

The overwhelming majority (81%) think that most welfare recipients are able to work. The idea that welfare discourages people from working was identified by half of Americans (49%) as what bothers them most about the current welfare system ranking far ahead of concerns such as costing taxpayers too much (14%) and causing families to break up (13%). Two-thirds (68%) say that welfare encourages women to have more children than they would have if they were not able to get welfare.

• Most Americans believe the country spends too much (64%) or the right amount (17%) rather than too little (12%) on welfare.They are somewhat divided in their willingness to pay more taxes or see other programs cut to provide job training (53% willing to 40% unwilling) and public service jobs (47% to 45%). The public is also split nearly evenly on whether people who receive money from welfare could get along without it (46%) or really need this help (44%).
• Americans perceive a variety of reasons for people being on welfare, some rooted in individual responsibility and others in social conditions and lack of economic opportunities.When questioned about possible reasons people are on welfare, most often rated as major reasons were: welfare pays better than some jobs do (71%); people choose not to work (65%); poor education (64%); and women having babies in order to collect additional welfare benefits (62%). Americans are split on whether welfare recipients really want to work (40%) or choose not to (47%). More broadly, 38 percent believe lack of personal effort is the main reason for poverty in the U.S.; 42 percent lack of opportunities and jobs.But the public also sees economic and social obstacles that prevent people from leaving welfare. The vast majority of Americans (72%) believe there are jobs for most welfare recipients who really want to work. But only 22 percent believe that most of these jobs pay enough to support a family. While 42 percent say “It’s important for a mother with young children to stay at home even if it means having to provide her with welfare,” 35 percent believe “We should not pay welfare to mothers with young children because it’s so important that people work.” The survey suggests that because Americans believe that both individuals and society share in the responsibility for people being on welfare, Americans’ support for reform proposals may decline if they think that the reform will not lead to a minimal standard of living or will create severe hardship for families.
• Most Americans believe that government and welfare recipients have a shared responsibility for ensuring that people have a minimum standard of living.Asked who should be primarily responsible for making sure that non-working low-income people have a minimum standard of living, a majority (57%) said that responsibility should be shared between government and people themselves, friends, and voluntary agencies; 26 percent said people themselves and friends and voluntary agencies; and only 14 percent said government should be primarily responsible. Significantly, however, most of those who believe in shared responsibility want government’s role to last only for a limited time (71%). Only 25% said government responsibility should last “as long as it takes.” The theme is clear: the public believes that able-bodied people have an obligation to help themselves, but also that government has a role in maintaining a safety net for a reasonable but not unlimited period of time.

Public Knowledge

With some significant exceptions, the public is reasonably well informed about the welfare system. For example:

• the public (90%) knows that more women and children are on welfare than men. (In 1992, two-thirds of AFDC recipients, or 9.2 million, were children);

• a majority of the public (57%) knows responsibility for running welfare is shared between federal and state governments. (Federal funds pay on average 55% of AFDC benefits plus 50% of administrative costs);
• a plurality (32%) knows how much public assistance mothers are receiving each month. (The average benefit in 1993 was $399 per month for a family of three);
• seventy-one percent say that they know what Medicaid is and 43 percent know that it pays not only for hospital and doctor services for poor adults and children, but also for services for the elderly in nursing homes and the blind and disabled. (The public was least knowledgeable about Medicaid financing for the blind and disabled, the program’s fastest rising major cost).
• the public overwhelmingly believes most people on welfare are minorities. (In 1992, 39 percent of AFDC recipients were white, 37 percent black, 18 percent Hispanic, 3 percent Asian, 1 percent Native American, and 2 percent unknown);
• when asked how long people stay on welfare, 43 percent said continuously until their children grow up, 26 percent said on and off until their children grow up, and 15 percent said a few years before leaving welfare for good. (Thirty-four percent stay on welfare less than one year and another 44 percent for up to five years. A majority of those who leave welfare return later to the welfare rolls. Welfare dependency is characterized more by repeat spells of dependency than continuous dependency on public assistance.)

Methodology

The Kaiser/Harvard Survey was a random-sample, telephone survey of adults nationwide. The national sample consisted of 1,200 adults and was conducted between December 27 and 29, 1994. The survey was designed by the Harvard University School of Public Health’s Department of Health Policy and Management and the Kaiser Family Foundation, and was conducted by KRC Communications Research, a national opinion research firm located in Newton, Massachusetts. The margin of error in the national sample is plus or minus 3 percent. The survey is the first conducted under a new program, the Kaiser/Harvard program on the Public and Health/Social Policy, designed to monitor public knowledge, values and beliefs on health and health-related issues.

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. The Foundation does not support any particular proposal or approach to welfare reform.

Note: This publication is not available on our website. However, the data from these surveys is still available through the Public Opinion and Media Research Group. Please email kaiserpolls@kff.org for more information.

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:

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.

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

Attitudes And Practices With Regard To Abortion

Conducted by Fact Finders, Inc. of Albany, New York, this 1995 survey on contraception and unplanned pregnancy concerned Obstetrician/Gynecologists’ attitudes and practices regarding the issues.

The three separate random-sample telephone surveys of adults ages 18 and older living in the United States, Canada, and the Netherlands, designed by the Henry J. Kaiser Family Foundation in association with Louis Harris and Associates, Inc and conducted in 1995. The surveys were conducted to assess differences in public knowledge, opinions, and practices related to pregnancy and birth control, hoping to help explain some of the variation in unplanned pregnancy rates between the U.S. and other developed nations.