Volume 33, Number 1, January/February 2001
Many Women at High Risk for Unintended Pregnancy Are Unaware of Emergency Contraception or How to Use It
Among women at high risk for unintended pregnancy, only 36% have heard of emergency contraception, 19% can name or describe emergency contraceptive pills and 7% know the correct timing for the method's use, according to a survey of 371 mostly Hispanic, low-income postpartum women at a public hospital in San Francisco.1 To learn how efforts to educate women about emergency contraception could be better targeted, the researchers examined predictors of women's knowledge of and willingness to use the method. Compared with women who have just given birth to their first child, women who have had previous births have reduced odds of knowing about emergency contraception. However, among women who know of emergency contraception, those with previous births have elevated odds of being willing to use the method.
From September 1998 to March 1999, researchers interviewed English- or Spanish-speaking women who had had a live birth. The majority of the women in the sample (72%) were Hispanic, and two-thirds of this group spoke only Spanish. Sixty-six percent of participants had a household income less than $20,000, and only 3% had private insurance. Almost one in five study participants were teenagers; the average age of the participants was 25.6 years.
The women participated in 10-minute interviews with bilingual interviewers in the hospital on the day of their discharge. To assess women's familiarity with emergency contraception, interviewers asked them if they had ever heard of "morning-after" pills or emergency contraceptive pills. To determine if women had further knowledge of the method, interviewers asked them whether a woman who has just had sex and thinks she might become pregnant can do anything in the next few days to prevent pregnancy. The interviewers recorded an affirmative response only if a woman could name or describe "morning-after" or emergency contraceptive pills. If women were aware of the method, the interviewers asked them about the timing for its use, whether it is available, how to obtain it and whether they had ever used it. To determine women's willingness to use emergency contraception in the future, the interviewers asked, "If a pill existed which a women could take after unprotected intercourse to prevent pregnancy, would you ever consider using it?"
Forty-five percent of the women said that prior to their current pregnancy, during a time when they did not want to conceive, they had had unprotected intercourse all or most of the time. Thirty-eight percent had previously had an unwanted pregnancy, and 17% had had an abortion; 63% said that their current pregnancy had been unplanned.
Three percent of the women had used emergency contraception, and 36% had heard of it. Just 19% correctly named or described emergency contraceptive pills in response to the question regarding what a woman could do if she had had sex and thought she could become pregnant, and only 7% were aware that the method must be used within 72 hours after intercourse. Eighteen percent of participants objected to the use of emergency contraception for moral or religious reasons. Finally, 64% said they would be willing to use emergency contraception in the future.
Fewer than half (44%) of the women who had heard of emergency contraception believed that it is safe, and just 20% knew the correct timing for its use. A third (32%) believed that the method induces abortion. Approximately two-thirds of those familiar with emergency contraception knew that it is effective, that it is available in the United States and that one needs a prescription to obtain it (65-67%). Eighty-one percent knew that emergency contraception does not prevent sexually transmitted infections.
In univariate analyses, the investigators found that a wide range of factors relating to women's background characteristics (ethnicity, age and socioeconomic factors) and contraceptive and reproductive histories were associated with whether women were familiar with emergency contraception. However, few of these factors were associated with whether women were willing to use the method.
In a series of multivariate logistic regression analyses, the researchers found that teenagers and women older than 30, those who have used condoms, those who have had an abortion and those who object to emergency contraception for moral or religious reasons had elevated odds of knowing about emergency contraception (odds ratios, 2.0-2.4). Hispanic women who spoke only Spanish, Asian and Pacific Islander women and women who had given birth before all had reduced odds of being familiar with emergency contraception (odds ratios, 0.2-0.5).
Depending on whether women were familiar with emergency contraception, different factors were predictive of their willingness to use a pill that prevents pregnancy after unprotected intercourse. Therefore, the researchers analyzed the responses about participants' willingness to use such a pill according to whether women were familiar with the method. Among women who were unfamiliar with emergency contraception, married women and women who objected to the method for moral or religious reasons had reduced odds of being willing to use such a pill in the future (0.4-0.5), while women who had previously used oral contraceptives had elevated odds of being willing to do so (1.8).
Among participants who said they were familiar with emergency contraception, women with family incomes of more than $20,000 and those who morally objected to emergency contraception had reduced odds of being willing to use it in the future (odds ratio, 0.3), while women who had given birth before had elevated odds of being willing to do so (3.0). In addition, women who had accurate information about its safety and whether it causes an abortion had elevated odds of being willing to use it in the future (2.4 and 2.5, respectively).
The researchers note that although the women who participated in the study were mostly Hispanic and low-income, and therefore not representative of all women in the United States, these women are a population at high risk for unintended pregnancy. Educational efforts on emergency contraception targeted to these women could therefore have a significant impact on reducing unplanned pregnancies, according to the researchers. The investigators also say that their findings indicate a need for emergency contraception education efforts targeted to women who have had multiple births, as well as to Asian women and monolingual Spanish-speaking women, who need educational materials in their languages. The researchers conclude that to increase women's willingness to use emergency contraception, "it is insufficient to educate women about the existence of [the method]; we must reassure them that it is safe and that it does not induce abortion." --B. Brown
1. Jackson R et al., Knowledge and willingness to use emergency contraception among low-income post-partum women, Contraception, 2000, 61(6):351-357.