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.

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

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.

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

Among Issues, Voters See Health Reform As Top Priority for New Congress But Reject Major Overhaul of System For More Modest Approach

Embargoed for release: 12:00 p.m. EST Tuesday, November 15, 1994

For further information contact: Matt James or Tina Hoff

National Election Night Survey Also Finds: Voters Support Spending Cuts to Reduce Deficit in Theory, But Not in Practice When Specific Budget Areas Are Proposed

Menlo Park, CA — A Kaiser/Harvard election night survey of Americans nationwide who voted in the 1994 election has found that health care continues to be a key concern, but the voters are rejecting a major overhaul of the system. Instead, they strongly favor approaches to solving this national problem that are incremental and do not significantly expand government control of the health system.

When voters cast their ballots, candidates’ stands on issues are just one of many factors that determine their votes. Economic insecurity, values and ideology, attitudes about government and incumbents, and the perceived personal qualities of the candidates themselves all also play a major role. Among issues, however, health care (33%) was number one for voters in deciding who to vote for in the Congressional election, ahead of crime (29%) and taxes (23%). In addition, it was named as the top priority issue for the next Congress to deal with. [Tables 1 and 2]

In the survey, the voters also made it clear that they want Congress to take the lead in health reform next year, rather than the White House. [Table 3]

The survey shows that the voters’ vision of health care reform has shifted toward that held by many moderate Republicans and Democrats. Thirty-one percent of those surveyed said they were less supportive of major health reform than six months ago, with half of those citing as their reason that they did not think the government would do it right. More voters now want Congress to make modest changes in the health care system (41%), rather than enacting a major reform bill (25%). In addition, one in four voters favor leaving the system as it is. [Tables 4 and 5]

“These results say that voters want the new Congress to place health care high on their legislative agenda,” said Dr. Robert Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University. “But what the public means by health reform now comes closest to a more moderate vision: one which is more limited in scope, incremental, and that involves a much more limited role for government.”

A majority of voters (55%) believe that it is better to have the health insurance system run by private health insurance companies than by the government. This is especially the case among those who voted for Republican House candidates (66%). [Table 6]

When asked what worries them most about health care reform, a plurality said they worry that there will be too much government bureaucracy (36%) or quality will decline (22%). When asked who they would like to take the lead in health care reform, more than one half indicated a preference for state leadership (54%), a change from previous surveys. [Tables 7 and 8]

Voters are split over whether the priority should be guaranteeing universal coverage or making an incremental start. Republican voters favor starting with coverage for some groups who do not have health insurance, but not attempting to cover everyone at this time (45%). Democrats more strongly favor guaranteeing health insurance coverage for all Americans as part of whatever legislation is passed (52%). [Table 9]

If health insurance can not be provided to all Americans, voters favor covering children first (40%) and working people who are uninsured (24%). When asked how the Congress might improve the private insurance system, 29 percent favor requiring employers who offer insurance to provide a choice of at least three health plans, and 27 percent favor requiring all employers to contribute part of the cost of health insurance for their employees. [Table 10 and 11]

In order to see these changes made in the health care system, a slight majority (51%) of voters are willing to pay more in health insurance premiums or taxes. [Table 12]

The Deficit, Taxes, and Entitlements

The survey shows that the outcome of the election was also affected by the federal deficit and voters’ desire not to have their taxes increased. These were named as the third and fourth highest priorities for the next Congress. When asked what Congress should do about the federal deficit in the next session, two thirds of voters (67%) preferred cuts in major spending programs to raising taxes (10%) or “not dealing with the deficit problem now” (10%). [Tables 13 and 14]

Survey results reveal a dilemma for the new Congress. Voters support general cuts in government spending in principle, but not in practice when they relate to specific current government spending programs. When presented with a list of 25 selected policies to reduce the deficit, a majority of voters supported only four:

1. Having people over age 65 who earn more than $50,000 a year pay more for Medicare than other seniors (71% favor);

• Decreasing spending on food stamps (55%);
• Decreasing agricultural price supports (53%); and
• Decreasing defense spending (53%).

Voters expressed very low levels of support for spending cuts in Social Security (17%), Medicaid (17%), Medicare (8%), and veterans’ benefits (7%). Even when told that one in three dollars spent by the federal government go to Social Security, Medicare, and Medicaid, two thirds of voters (65%) stillprefer to see the biggest spending cuts come from other areas, while only 10 percent believe the biggest cuts should take place in these three major spending areas. [Tables 15 and 16]

These results point to a major obstacle facing the new Congress in its effort to reduce the federal deficit. Voters want Congress to address the deficit, but they do not want their taxes raised. They want spending cuts in principle, but are not willing to support major cuts in the programs that made up the largest part of the non-defense budget.

The poll results show sharp contrasts between Democrat and Republican voters. Democrat voters are willing to cut defense spending further in years ahead while Republicans are less willing. Republicans are more willing to cut AFDC (welfare payments); Democrats are less so. Voters in both parties are willing to cut spending on food stamps and agricultural price supports, and support asking those seniors who earn more than $50,000 per year to pay more for Medicare. [Table 15]

This situation is not aided by voters’ general lack of knowledge of what makes up the federal budget. They know what entitlement programs are, but they do not have a very good idea of what are major areas of spending in the federal budget. Asked which of five areas consumed the largest area of federal spending, only 15 percent correctly named Social Security and 30 percent named defense. One in four voters (27%) thought the most federal money was spent on foreign aid, which accounted for only 2% of the 1993 Federal Budget. [Tables 17 and 18]

“The public’s misconceptions about the Federal Budget is the Achilles heel in deficit reduction,” said Matt James, Vice President, Kaiser Family Foundation. “What the public is willing to embrace will not result in meaningful spending reductions. Policymakers need to do a better job in explaining which areas need to be addressed to achieve real savings or there will be a political price to pay when small-time reductions fail to result in big-time savings.”

Methodology

The Kaiser/Harvard Election Night Survey was a random-sample, telephone survey of adults nationwide who said they voted in the November 8, 1994 election. The national sample consisted of 1,200 voters. 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 Kaiser Family Foundation, based in Menlo Park, California, is an 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 reform, reproductive health, HIV, and health and development in South Africa. The Foundation also maintains a special interest in health care in its home state of California. The Foundation does not support any particular proposal or approach to health reform.

Medicare: Holes in the Safety Net

This report discusses findings from focus groups that consisted of those individuals who interact with the Medicare program, including beneficiaries, health professionals, caretakers, and program management staff. A press release summarizing the findings of 15 focus groups conducted nationwide on public attitudes toward and understanding of the Medicare system in the United States is available.

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.

A review of the progress toward the goal of universal coverage in six states — Florida, Hawaii, Massachusetts, Minnesota, Oregon, and Washington. The study found that while most states had put the many mechanisms in place to achieve universal coverage, there have been significant delays in their reform efforts, and there are serious financial constraints to state efforts in the absence of federal assistance. This report was released as part of the Foundation’s new national initiative to identify, analyze, and disseminate information on leading state health reform activities — “Innovations in State Health Reform.”

• Report: Keeping the Promise? Achieving Universal Health Coverage in Six States

California Election Night Survey On Ballot Initiatives

Anti-government Mood Defeats Proposition 186

A Perception That Undocumented Persons Use Costly Services Drives Vote For Proposition 187

Embargoed for release: 12:00 p.m. EST, Tuesday, November 15, 1994

For more information contact: Matt James or Tina Hoff

Menlo Park, CA — A Kaiser/Harvard survey of Californians in the 1994 election has found that the principal reason voters rejected Proposition 186, the state single payer initiative, was their concern that it would give government too much control of the health care system. These findings echo results from national surveys, which show a broad anti-government mood in the country.

The Kaiser/Harvard survey also looked at California voters opinions on Proposition 187, a proposal to limit services to undocumented persons and Proposition 188, a proposal to override local anti-smoking laws funded primarily by tobacco interests.

Proposition 186

By a margin of almost three to one (73 percent against and 27 percent in favor), Californians voted against the single payer plan. Fifty-seven percent of those who voted against Proposition 186 cited too much government involvement as the primary reason for their vote. Approximately one third of those who voted against the plan thought that the proposal would decrease the quality of their medical care (15 percent) or would increase the cost of their health care (14 percent).

“The themes struck by the opponents of the single payer initiative resonated loud and clear with California voters,” said Matt James, Vice President, Kaiser Family Foundation. “With the anti-government mood so strong, the timing for Proposition 186 could not have been worse.”

“Results of California voters show very definitively that though Americans see many things wrong with the health care system, they are ultimately not willing to turn the solution over to public sector agencies. Arguments about the success of either Medicare or our neighbors to the north fall on deaf ears in a climate where Americans have such little faith in their government,” said Dr. Robert Blendon, Professor and Chairman of the Department of Health Policy and Management at Harvard University.

Among those who voted for Proposition 186, most said they did so because everyone in the state would have health insurance (39 percent). The next highest reason provided was because they believed the “health care system would be fairer” (16 percent). Only 15 percent gave “eliminating the role of insurance companies,” a major theme in the proponents’ campaign, as the reasoning behind their vote.

Republicans (95 percent), conservatives (82 percent) and business people (80 percent) were among the groups who most strongly opposed Proposition 186. Hispanics (64%), those uninsured (58 percent) and Democrats (54 percent) were among the groups who most strongly supported the single payer initiative.

Proposition 187

Californians passed Proposition 187 (59 percent in favor and 41 percent against), a proposal to limit services for undocumented persons. What has not been available to date is what voters’ principal reasons were for supporting this measure. The poll shows that the most important reason (61 percent) given by those who voted for this proposition was the belief that undocumented persons use services that cost citizens too much money. The second most important reason (27 percent) were those who believed that “we have to do something to stop the flow of illegal immigrants into our country.”

As reported, a minority of voters cast their ballots against this measure. Of those, 38 percent said that the fact that it would have been unfair was the primary reason they voted against 187. The second most important reason among opponents (25 percent) was a concern about the potential problems the children of undocumented persons may face if they were excluded from public schools.

Our survey showed that Republicans (73 percent) and business people (64 percent) were among the groups most in favor of Proposition 187, and that Hispanics (94 percent) and Democrats (71 percent) were among the groups most opposed to the proposal. Women (56 percent), liberals (85%) and National Public Radio listeners (63 percent) also opposed the proposal, while men (67 percent), conservatives (76 percent) and Rush Limbaugh listeners (72 percent) generally supported the proposition.

Proposition 188

Californians rejected Proposition 188 (70 percent against and 30 percent in favor), a proposal to override local anti-smoking laws by a statewide provision. Among those most strongly opposed to Proposition 188 were people in households in which someone worked in the health care field (77 percent), liberals (73 percent) and women (68%). Those most strongly in favor of the provision were Hispanics (53 percent), Rush Limbaugh listeners (46 percent), and those with lower incomes (44 percent).

Our survey found that 77 percent of Californians had seen or heard advertisements in favor of Proposition 188. Of these respondents, 85 percent correctly stated that tobacco interests had put up the most money to support this proposition.

Methodology

The Kaiser/Harvard Election Day Survey was a random-sample, telephone survey of adults in California who said they voted in the November 8, 1994 election. The sample consisted of 1,000 California voters. 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 is plus or minus 3.5 percent.

The Kaiser Family Foundation, based in Menlo Park, California, is an 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 reform, reproductive health, HIV, and health and development in South Africa. The Foundation also maintains a special interest in health care in its home state of California. The Foundation took no position for or against Proposition 186.

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Statewide Surveys of Californians:Press Release Survey

Warning: Inadequate Low-Income Subsidy Design Can Cause Problems for Health Care Reform

This report examines potential adverse consequences of low-income subsidy systems contained in the leading health care reform approaches including: work disincentives as a result of high marginal taxrates; employer incentives to drop coverage; and loss of coverage due to budgetary control mechanisms.

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