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Oregon PRAMS Presentation
Oregon PRAMS: Presentations

Improving Access to Emergency Contraception


Kenneth D. Rosenberg, MD, MPH (1,2)
Erica Dale (1,3)
Alfredo P. Sandoval, MS, MBA (1)


(1) Oregon Office of Family Health, Portland, Oregon
(2) Oregon Health & Science University, Portland, Oregon
(3) Columbia University School of Public Health, New York, NY

American Public Health Association, 130th Annual Meeting, November 11, 2002

BACKGROUND

Emergency contraception (EC), "the morning-after pill," has been used (as a combination of oral contraception pills) since the 1970s. New dedicated EC pills have increased the ease of use for women to prevent unintended pregnancy.


EC is important because its use has the potential to decrease the incidence of unintended pregnancy. Unintended pregnancy is a significant health, social, and economic problem. About half of all pregnancies occurring in the U.S. are unintended and about half of all unintended pregnancies end in abortion. An unintended pregnancy carried to term can be a significant cause of health and developmental problems for both mother and baby. If EC is taken within 72 hours of unprotected intercourse, it can decrease the risk of pregnancy by 75-89%.

METHODS

The Oregon Pregnancy Risk Assessment Monitoring System (PRAMS) is an ongoing population-based survey of postpartum women conducted by the state health department. We survey Oregon resident mothers 2-6 months after a live birth. These mothers are identified using a stratified random sample of birth certificates. Mothers who do not respond to a mailed survey receive a second mailed survey and telephone follow-up. Responses are then weighted for oversampling, nonresponse and noncoverage to be representative of all Oregon live births.


We analyzed the first year of data from Oregon PRAMS: monthly cohorts selected November 1998 through October 1999. The babies were born from August 1, 1998 through August 9, 1999. Women were asked, "Have you ever heard of emergency contraception ("the morning-after pill)?" Of the 2919 women selected, 1867 women responded (response rate = 64.0%).

RESULTS

In 1998-99, 70.3% of new mothers said that they had heard of emergency contraception. The women most likely to have not heard about EC (in multivariate analysis) were mothers with less than a high school education, with an annual family income below $30,000, and whose pregnancies were unintended.


Risk Factors For Not Having Heard of Emergency Contraception, multivariate analysis, Oregon PRAMS, 1998-99

Risk Factor Multivariate ORa (95% CI)
Maternal education <12 years (A) 3.23 (2.17, 5.00)
Annual family income <$30,000 (B) 2.04 (1.39, 3.03)
Unintended pregnancy (C) 1.47 (1.03, 2.08)
(A) compared to > =12 years
(B) cf > =$30,000
(C) compared to intended pregnancy



DISCUSSION I

How Public Health Professionals Can Increase Access to EC


Emergency Contraception is an important way to prevent unintended pregnancy. There are several ways in which public health professionals can help increase women's access to EC. They can educate providers and women of the availability of EC. They can encourage providers to prescribe advance prescriptions for EC. They can encourage state medical and pharmacy associations to collaborate (and state legislators to pass laws) to allow pharmacists to evaluate a patient's need for EC and provide counseling, referrals, and EC pills if appropriate.


DISCUSSION II

Emergency Contraception in Oregon


One barrier to increased use of emergency contraception in Oregon has been that very few retail pharmacists were stocking emergency contraception. This analysis of PRAMS data was published in the state health department newsletter to providers to encourage advance prescriptions of EC. Advance prescription might lead to retail pharmacies stocking EC so that EC would also be available for emergency use. Since the publication of the article CD Summary (Web Link (pdf) 42K), there has been an increase in orders from Oregon retail pharmacies for EC pills.


DISCUSSION III

Emergency Contraception in Washington State and California


In 1998, the Washington State Board of Pharmacy, the Washington State Pharmacists Association, the University of Washington School of Pharmacy, and PATH (Program for Appropriate Technology in Healthcare), a private non-profit organization, launched a pilot project to explore the possibility of allowing pharmacists, under the aegis of a collaborative drug therapy agreement, to evaluate a patient's need for EC and provide counseling, referrals and EC pills if appropriate. The Washington State Medical Association added their endorsement to the project shortly after the pilot began. This program has met with enormous success statewide. California enacted a similar law in 2000. Several countries have recently made EC available over-the-counter or available directly from pharmacists.

CONCLUSIONS

1. Many women would benefit if more states passed laws allowing pharmacist counseling, referral and prescription of emergency contraception.


2. The Food and Drug Administration should consider over-the-counter dispensing of emergency contraception.


3. Providers should educate their patients about emergency contraception. This is particularly true for low-income women and women with less than a high school education. Emergency departments should make EC easily accessible for all rape victims.