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Oregon PRAMS: Presentations

Improving Access to Emergency Contraception

Kenneth D. Rosenberg, MD, MPH, Erica Dale, Alfredo S. Sandoval, MS, MBA
Oregon Department of Human Services, Office of Family Health, Portland, Oregon
Background. Unintended pregnancy is associated with late initiation of prenatal care, low birthweight, domestic violence and poor child health and development. Emergency contraception ("the morning-after pill") has been used (as a combination of oral contraception pills) since the 1970s to prevent unintended pregnancies. New dedicated emergency contraception pills have increased the ease of use for all women. Emergency contraception could potentially prevent half of unintended pregnancies.

Methods. Oregon PRAMS surveys a stratified random sample of women 2-6 months after a live birth. In 1998-99 we interviewed 1867 women (64.0% response rate). Women were asked "Before you got pregnant...had you read or heard about emergency birth control (the "morning-after" pill)?". The responses were weighted for oversampling, nonresponse and noncoverage.

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 emergency contraception (in multivariate analysis) were mothers with less than a high school education (compared to $12 years: ORa=3.23; 95% CI 2.17, 5.00), annual family income below $30,000 (compared to $$30,000: ORa=2.04; 95% CI 1.39, 3.03), and whose pregnancies were unintended (compared to intended: ORa=1.47; 95% CI 1.03, 2.08).

Conclusions. Emergency contraception is an important method for preventing unintended pregnancy. Thirty percent of women have never heard of it. Women of low socioeconomic status are relatively likely to not know about emergency contraception.

Public Health Implications. Emergency Contraception is a valuable tool in the effort to decrease unintended pregnancy. Public health programs should educate women about the existence and use of emergency contraception and decrease barriers to access. Providers should be encouraged to write advance prescriptions for sexually active women. States should be encouraged to set up programs like those of Washington State and California, where pharmacists can evaluate a woman's need for emergency contraception and provide counseling, referrals and emergency contraception.

Submitted for presentation at CDC Maternal and Child Health Epidemiology Workskop, December 2002.