P2-S9.03 The sex lives of emergency contraception users in the USA, 2006–2008
Authors: Habel M , Leichliter J S 
Published: July 2011

Background

Previous research indicates that emergency contraception (EC) users are less likely to have visited a gynaecologist in the past 12 months, and are more likely to report ever having an STI compared to non-users; however, studies examining this unique population have been outside of the USA Given FDA-licensure of EC behind-the-counter, this is the first US study to use a nationally representative sample of reproductive aged women (15–44) to explore whether EC users represent a missed opportunity for STI counselling and screening.

Methods

Data were collected through in-person interviews and through audio computer-assisted self-interview. Using a sample of 7356 women, sexual behaviour variables for which there were significant bivariate differences (p<0.10) for lifetime EC users were examined in a multiple logistic regression model controlling for demographics often associated with sexual behaviour including age, race/ethnicity, marital status, poverty level, and geographic location.

Results

Overall 10% (704) of the sample had ever used EC; less than 3% had used it within the past 12 months. Most women had only used EC once (62%). Primary reasons for use were not using a birth control method (46%) and worry that birth control would not work (42%). Most EC users had received EC from a family planning clinic (51%). More EC users obtained EC from a drug store drug store (23%) than a private doctor's office (17%); most received EC without a prescription (69%). Demographic factors associated with lifetime EC use included: age 20-24/25-29 years (AORs=3.3; 2.4), never married (2.1), income 150% above the poverty level (1.6), and living in an urban-suburban area (1.6). Lifetime EC users were almost twice as likely to have had >4 lifetime partners. In bivariate analyses lifetime EC use was associated with receiving STI services in the past 12 months and having had a pap, but in the model became insignificant.

Conclusions

Contrary to previous findings, EC users were no more likely than non-users to have received STI counselling or screening, despite greater numbers of sex partners. However, with licensure of behind-the-counter ECs, this research indicates that some women are accessing ECs without a prescription at drug stores rather than a provider's office, representing a missed opportunity for screening. These findings suggest future research on EC access and possible expansion of STI screening programs into real world settings, such as pharmacies.

Abstract P2-S9.03 Table 1

Prevalence of lifetime emergency contraception (EC) use

n(%) SEPopulation total (weighted n)Ever used EC (n=6326) Yes704(9.7) 0.95,1171,887 No5623(90.2) 0.948,055,234Used EC in past 12 months (n=6327) Yes175(2.1) 0.31,156,443 No6151(97.8) 0.952,068,403No of times ever used (n=703) 1431(61.9) 3.63,180,161 2160(24.3) 2.41,248,453 3+112(13.8) 3.0709,209Primary reasons for EC use*(n=703) Worried birth control method would not work271(42.3) 4.32,188,726 Didn't use birth control that time345(45.8) 3.52,369,367 Other reason87(11.8) 1.3610,641Where received EC (n=449) Private doctors/HMO74(16.5) 1.2905,108 Community Clinic/FP clinic/school-based Clinic232(50.8) 4.32,228,311 Hospital facility or urgent care29(6.2) 1.1342,076 Friend, partner, or spouse13(2.3) 0.6123,784 Drug store95(23.1) 2.51,266,920 Other place6(1.0) 0.257,439Obtained EC with a Rx (n=144) Yes49(31.4) 2.3764,194 No95(68.6) 2.31,645,951*

First reason mentioned for the last (or only) time used EC.

†Population totals reflect US women age 15–44 years.