Health Care Provider Practices Around Emergency Contraception: An Analysis of a Nationwide Survey

Of U.S. pregnancies each year, 45% are unintended and approximately one-third are conceived within 18 months of a previous live birth. Unintended pregnancy can be prevented by the use of contraceptive methods before or after sexual intercourse. Most unintended pregnancies are attributable to nonuse, inconsistent or incorrect use of current contraceptive methods, while only 5% of pregnancies are due to contraception method failure. Emergency contraception (EC) effectively prevents pregnancy after unprotected sexual intercourse, yet there are barriers to EC use in the United States. The purpose of this study is to assess health care provider’s practices around EC. Specifically, this study will evaluate how often health care providers provide an advance prescription for EC to a woman not specifically seeking EC, provide an advance supply of EC to a woman not specially seeking EC, provide or prescribe a contraceptive at the same time they provided EC, and provide Cu-IUD as EC. The survey was mailed to a random sample of 6,000 private-sector office-based physicians (n=2,000) and public-sector health center providers (n=2,000 from Title X health centers and n=2,000 from non-Title X health centers). We analyzed 2013–2014 questionnaire data from 2,055 providers practicing family planning in the private and public sector using SAS-callable SUDAAN to adjust for the complex sampling design and correct for non-response. Using multivariable logistic regression, adjusted odds ratios and 95% confidence intervals were estimated for the associations between EC practices and provider characteristics. Overall, respondents reported providing EC infrequently, however practices varied by setting and provider specialty. Clinical specialty/setting was a variable that was significantly associated in our study across all the EC questions which may indicate that the frequency of provision an advance prescription, supply, contraception with an EC, or a Cu-IUD as an EC is based on clinical specialty or setting of the health care providers. Understanding provider barriers to EC provision is important to improve women’s access to EC