1. Knowledge of Emergency Contraception in California Recent Trends and Persistent Disparities May 24, 2005 San Francisco, California UNIVERSITY OF CALIFORNIA, SAN FRANCISCO

2. Collaborators Felicia Stewart, M.D. Abigail Arons Diana Foster, Ph.D. Diana Foster, Ph.D. Cynthia Harper, Ph.D. Heather Gould, M.P.H.

3. Acknowledgements This analysis and meeting are funded by a grant from The California Wellness Foundation (TCWF). This analysis and meeting are funded by a grant from The California Wellness Foundation (TCWF). Created in 1992 as an independent, private foundation, TCWF’s mission is to improve the health of the people of California by making grants for health promotion, wellness education and disease prevention programs.

4. California 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.

5. Survey 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

6. Survey Population Responses from 12,000 California women between 1999 and 2004 Women were excluded from analysis if they were over age 44, had never had intercourse, had had a hysterectomy or refused to answer the EC questions

7. Women answering EC questions

8. Emergency Contraception Question 1: 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

9. EC Question 2: What can she do? 1999-20012002-2004 N=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

10. EC Question 2: What can she do? 1999-20012002-2004 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 1999-20012002-2004 N=3,265 yes’s N=3,747 yes’s

11. EC Question 2: What can she do? 1999-2001 2002-2004 N=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

12. Knowledge of EC among Women in California Source: California Women’s Health Survey N=12,000

13. Knowledge of EC among Women in California Source: California Women’s Health Survey N=12,000

14. Trends in EC knowledge by race/ethnicity Hispanics have lowest level of knowledge, followed by S/SE Asians Gap between race/ethnic groups narrowing slightly over time

15. Trends in EC knowledge by place of birth among Hispanic women 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.

16. Trends in EC knowledge by age Young women exhibit higher levels of knowledge than older women

17. Trends in EC knowledge by education Women with less than a high school diploma are less than half as likely to know about EC than women with a college degree Women with just a high school diploma are two thirds as likely to know about EC as women with a college degree.

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

19. Trends in EC knowledge by time since last family planning visit 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.

20. Trends in EC knowledge by poverty status 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.

21. Trends in EC knowledge among women at risk of unintended pregnancy 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.

22. Knowledge of EC in CA, by county 1999-2004 We 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.

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

24. Data 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.

25. Contact Diana Greene Foster greened@obgyn.ucsf.edu Bixby Center for Reproductive Health Research & Policy University of California, San Francisco 2356 Sutter Street, Suite 200, UCSF Box 1744 San Francisco, CA 94143-1744 (415) 502-7370 or (510) 635-5153