- Approximately half of the 6.4 million pregnancies occurring each year in the
United States are unintended (Finer & Henshaw, 2006). Unintended pregnancies, defined
as pregnancies not wanted at the time conception occurs, regardless of contraceptive use
(Chandra, Martinez, Mosher, Abma, & Jones, 2005) can have serious repercussions on
women, children, and society. For decades, women facing the possibility of an
unintended pregnancy following unprotected intercourse, birth control method failure, or
sexual assault, have had no choices outside of abortion. Since 1997 however, another
option has become available to American women making unintended pregnancy
decisions – emergency contraceptive pills (ECPs).
Research has indicated that widespread use of ECPs has the potential to prevent
1.5 million of the approximate 3 million unintended pregnancies occurring each year in
the US, including as many as 700,000 pregnancies that now result in abortion (Trussell,
Stewart, Guest, & Hatcher, 1992). Although 84% of American women have heard of
ECPs, only 6% claim to have ever used them (Hoff, Miller, Barefoot, & Greene, 2003).
Despite their effectiveness and the public’s awareness of them, ECPs still remain
underutilized in many high-risk populations. Explanations for this discrepancy are not
readily available. In particular, young adult women attending college are at risk for
unintended pregnancy yet we know little about their relationship with ECPs.
Although extensive ECP use could have a profound effect on unintended
pregnancy rates, we have limited information about the factors that influence a woman's
decision to use ECPs. Furthermore, with the US Food and Drug Administration's
approval of behind the counter status for the emergency contraceptive Plan B on August
24, 2006, one of the last major external hurdles for women accessing emergency
contraceptive pills appears to have been removed. However, it is unknown whether
prescription-free availability will be the final factor in women's predisposition to use
ECPs or if other intrinsic factors, may in fact, override use.
The purpose of this study was to determine the nature and extent of college
women's knowledge, self-efficacy, attitudes, perceived social norms, and use related to
emergency contraceptive pills. Additional goals included: using a conceptual framework
to determine which social and behavioral constructs suggested by the contraceptive
literature best predict intention to use ECPs and ECP use.
Data were collected via an online survey designed by the lead author. A sample
of 4,219 female students was drawn from a directory list of students enrolled at Oregon
State University during the Spring Quarter of 2004. A total of 1718 women returned
usable questionnaires. Key findings were that the majority of sexually active participants
(68%, n = 871) had experienced a pregnancy scare in the past yet only 28.3% (n = 362)
had ever used ECPs. Further, women had insufficient knowledge about ECPs in order to
make informed decisions. Male partners were the most influential social reference in
ECP decision-making. Although prescription-free access to ECPs is an historical
milestone for reproductive health in the US, this policy change may not be the final step
in ensuring that women access and use ECPs when they need them. Intrinsic factors
including: knowledge that ECPs prevent pregnancy by interfering with ovulation,
knowledge that ECPs are not a form of abortion, and confidence in accessing ECPs in
time if needed seem to influence ECP use. In order for ECPs to impact unintended
pregnancy rates to the extent research has demonstrated, strategies addressing these
internal factors are warranted and must target both women and men.