Emergency contraception in California: Public policy and public health

Since January 1, 2002, pharmacists in California have been allowed to provide emergency contraception (EC) directly to women, without a prescription. In February 2006, Medi-Cal began covering two packs of EC per client per month. The state's family planning program for low-income uninsured women and men, called Family PACT, has a policy of dispensing one pack of EC to each female client on her first visit. Given the now widespread availability of EC in California, researchers examined the levels of knowledge and use of EC in the general population of women. Using data from the California Health Interview Survey (CHIS)(n=42,000 households), they analyzed age, income and race/ethnic differences in knowledge of EC, awareness of California's law regarding pharmacy access, and use of EC in the past 12 months. Findings indicate that adult women were significantly more likely to have heard of EC than adolescent females were (76% v. 58%), but adolescents who had heard of EC were significantly more likely to be aware of the over-the-counter availability (23% v. 12%) and to have used EC compared with adult women (4% v. 2%). There were also significant race/ethnic and income differences in knowledge and use. Findings point to the need for greater publicity regarding EC availability, especially for populations with high teen and unintended pregnancy rates. The analyses also demonstrate the utility of CHIS public use data in analysing reproductive and other health issues in the general population.