Knowledge of Emergency Knowledge of Emergency Contraception in CaliforniaContraception in California

Recent Trends and Persistent DisparitiesRecent Trends and Persistent Disparities

May 24, 2005May 24, 2005San Francisco, CaliforniaSan Francisco, California

UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

CollaboratorsCollaborators

Felicia Stewart, M.D.Felicia Stewart, M.D.

Abigail AronsAbigail Arons

Diana Foster, Ph.D.Diana Foster, Ph.D.

Cynthia Harper, Ph.D. Cynthia Harper, Ph.D.

Heather Gould, M.P.H.Heather Gould, M.P.H.

AcknowledgementsAcknowledgements

This analysis and meetingThis analysis and meeting are funded by a grant are funded by a grant from The California Wellness Foundation from The California Wellness Foundation (TCWF).  (TCWF). 

Created in 1992 as an independent, private Created in 1992 as an independent, private foundation, TCWF’s mission is to improve the foundation, TCWF’s mission is to improve the health of the people of California by making health of the people of California by making grants for health promotion, wellness education grants for health promotion, wellness education and disease prevention programs.and disease prevention programs.

California Women’s Health SurveyCalifornia Women’s Health Survey

The California Women’s Health Survey (CWHS) is an annual telephone survey, conducted in English and Spanish, that collects data on health-related behaviors, knowledge and attitudes from a random sample of adult women.

The CWHS is a collaborative effort between the California Department of Health Services, the California Department of Mental Health, the Department of Alcohol and Drug Program, CMRI, the Department of Social Services, and the Public Health Institute.

Questions on knowledge of EC have been included in the surveys from 1999-2005.

Survey QuestionsSurvey Questions

Question 1: If a woman has unprotected sex is there anything she can do in the 3 days after intercourse that will prevent pregnancy

Question 2: What can she do? (open-ended)

asked of those who said ‘‘yes’’ to question 1

Survey PopulationSurvey Population

Responses from 12,000 California women Responses from 12,000 California women between 1999 and 2004between 1999 and 2004

Women were excluded from analysis if they Women were excluded from analysis if they were over age 44, had never had intercourse, were over age 44, had never had intercourse, had had a hysterectomy or refused to answer had had a hysterectomy or refused to answer the EC questionsthe EC questions

Women answering EC questionsWomen answering EC questions

2,121 2,040 1,910

202149 157 345 322 380

1,9251,9672,037

0

500

1,000

1,500

2,000

2,500

Women underage 44 withoutEC dataWomen 18-44with EC data

Emergency Contraception Question 1:

48% 51% 58% 63% 64% 65%

41% 37%31%

30% 29% 27%

11% 12% 11% 7% 6% 8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1999 2000 2001 2002 2003 2004

Don’t know

No

Yes

If a woman has unprotected sex is there anything she can do in the three days following intercourse that will prevent pregnancy?

Source: California Women’s Health Survey N=12,000

EC Question 2: What can she do?

66

3

3

2

0

5

2

0 20 40 60 80

65

1

4

2

0

2

10

0 20 40 60 80

1999-2001 2002-2004N=3,265 yes’s N=3,747 yes’s

Responses among women who said “yes” to Q1 Those who know EC or gave an ambiguous response

Seek medical help

Pill, don’t know name

Have an IUD inserted

Take birth control pills

Use emergency contraception

Take high dose/extra birth control pills

Take the morning after pill

EC Question 2: What can she do?

8.9

6.2

1.1

0.9

1.1

0.6

0.1

0.1

0 5 10

6.3

6.7

0.8

1

0.5

0

0.1

0.3

0 5 10

1999-2001 2002-2004

Responses among women answered “yes” to Q1 Those who do not know EC

Herbal remedies

Pray

Have an abortion

Injection

Douche

Other

Don’t know/not sure

Take RU486

1999-2001 2002-2004N=3,265 yes’s N=3,747 yes’s

EC Question 2: What can she do?

1999-2001 2002-2004N=3,265 52% of respondents N=3,747 60% of respondents

Does not know EC 19%

Ambiguous 7%

Knows EC 74%

Does not know EC 16%

Ambiguous 12%

Knows EC 72%

Summary of responses of women who said “yes” to Q1

Knowledge of EC among Women in Knowledge of EC among Women in CaliforniaCalifornia

39 37 40 44 48 48

1 3 7 7 7 97 10

12 13 9 852 49 42 37 36 35

0%

20%

40%

60%

80%

100%

1999 2000 2001 2002 2003 2004

"nothing one can do to prevent pregnancy"

guessed wrongambiguous response

knows EC

Source: California Women’s Health Survey N=12,000

Knowledge of EC among Women in Knowledge of EC among Women in CaliforniaCalifornia

40 40 46 51 55 57

60 60 54 49 45 43

0%10%

20%30%

40%50%

60%70%

80%90%

100%

1999 2000 2001 2002 2003 2004

may know EC does not know EC

Source: California Women’s Health Survey N=12,000

Trends in EC knowledge by Trends in EC knowledge by race/ethnicityrace/ethnicity

0%

10%

20%

30%

40%

50%

60%

70%

80%

1999 2000 2001 2002 2003 2004

WhiteHispanicAfrican AmericanN. AsianS/SE Asian

Hispanics have lowest level of knowledge, followed by S/SE Asians

Gap between race/ethnic groups narrowing slightly over time

Trends in EC knowledge by place Trends in EC knowledge by place of birth among Hispanic womenof birth among Hispanic women

0%

10%

20%

30%

40%

50%

60%

70%

1999 2000 2001 2002 2003 2004

Hispanic totalnative born Hispanicforeign born Hispanic

Low levels of knowledge of EC among Hispanic women are driven by the very low levels among foreign born, as opposed to native born women.

Trends in EC knowledge by ageTrends in EC knowledge by age

0%10%

20%30%40%

50%60%

70%80%

1999 2000 2001 2002 2003 2004

18-1920-2425-2930-3435-3940-44

Young women exhibit higher levels of knowledge than older women

Trends in EC knowledge by Trends in EC knowledge by educationeducation

0%

10%

20%

30%

40%

50%

60%

70%

80%

1999 2000 2001 2002 2003 2004

less than high school

high school diploma

some college/technicalschoolcollege diploma

Women with less than a high school diploma are less than half as likely to know about EC than women with a college degreeWomen with just a high school diploma are two thirds as likely to know about EC as women with a college degree.

Trends in EC knowledge by health Trends in EC knowledge by health insurance statusinsurance status

0%

10%

20%

30%

40%

50%

60%

70%

1999 2000 2001 2002 2003 2004

no health insuranceMedi-Calprivate

Women without health insurance and women with Medi-Cal coverage exhibit lower levels of EC knowledge than women with private insurance.

Trends in EC knowledge by time Trends in EC knowledge by time since last family planning visitsince last family planning visit

0%

10%

20%

30%

40%

50%

60%

70%

1999 2000 2001 2002 2003 2004

no visit in past yearvisit in past year

Women who have not had a family planning visit in the past year exhibit lower levels of EC knowledge than women who have had a recent visit.

Trends in EC knowledge by poverty Trends in EC knowledge by poverty statusstatus

0%

10%

20%

30%

40%

50%

60%

70%

1999 2000 2001 2002 2003 2004

below 100%100-200%over 200%

Women with incomes below the federal poverty level have the lowest level of knowledge about EC. However, the gap in knowledge by income is decreasing.

Trends in EC knowledge among Trends in EC knowledge among women at risk of unintended women at risk of unintended

pregnancypregnancy

0%

10%

20%

30%

40%

50%

60%

70%

1999 2000 2001 2002 2003 2004

total women at risk ofunintended pregnancycontracepting

not contracepting

Women who are at risk of an unintended pregnancy and not using any method of contraception are less likely to know about EC than women who are using contraception.Women are considered to be at risk of unintended pregnancy if they are sexually active, neither infertile, pregnant, nor postpartum, and do not want to become pregnant.

Knowledge Knowledge of EC in of EC in CA, by CA, by county county

1999-20041999-2004We find significantly lower levels of knowledge in Los Angeles, the central valley, and southern counties. There is insufficient information on rural northern and eastern counties.

Summary of FindingsSummary of Findings

Overall, knowledge of EC is increasing Overall, knowledge of EC is increasing over time. However, gaps are only very over time. However, gaps are only very slowly narrowing.slowly narrowing.Women who are least likely to know about Women who are least likely to know about EC are also the hardest to reach – women EC are also the hardest to reach – women without a recent family planning visit, poor without a recent family planning visit, poor women, Latina and S/SE Asian women, women, Latina and S/SE Asian women, and women with low educational and women with low educational attainment.attainment.

Data AcknowledgementData Acknowledgement

Data for these analyses were provided by The California Women’s Health Survey (CWHS) Group.

The CWHS is coordinated by the California Department of Health Services in collaboration with the California Department of Mental Health, the California Department of Alcohol and Drug Programs, CMRI, the Department of Social Services, and the Public Health Institute.

Questionnaire development and funding for the survey was provided by the collaborating programs.

Analyses described in this presentation are not necessarily endorsed by the CWHS Group.

ContactContact

Diana Greene Foster greened@obgyn.ucsf.edu

Bixby Center for Reproductive Health Research & PolicyUniversity of California, San Francisco

2356 Sutter Street, Suite 200, UCSF Box 1744San Francisco, CA 94143-1744

(415) 502-7370 or (510) 635-5153