Volume 201, Issue 1 , Pages 22.e1-22.e7, July 2009
Characteristics of women who sought emergency contraception at a university-based women's health clinic
Article Outline
Objective
The purpose of this study was to identify unique characteristics for seeking emergency contraception (EC) among sexually active unmarried women who attended a university-based women's health clinic (WHC).
Study Design
Three hundred nine consecutive women who attended the women's health clinic for 3 months of the 2006 spring semester completed an anonymous self-administered questionnaire. Fisher exact and Student t tests were used to assess bivariate associations, and step-wise regression was used to determine independent associations.
Results
Women who requested EC were more likely to have previously used EC (P < .001), to have had unprotected sex in the past 6 months (P < .001), to have experienced an unintended pregnancy in the past year (P = .009), and to perceive the need for EC use in the next 3 months (P < .001) but were less likely to use hormonal contraception or an intrauterine device (P < .001).
Conclusion
Our findings support the need for increased education that would include the use of and access to effective primary contraceptive methods in conjunction with EC awareness.
Key words: contraception, emergency, risk, student, women's health clinic
Despite large efforts to increase the use of contraception, approximately 50% of all pregnancies in the United States are unintended.1, 2 Among the college population, it is estimated that 80-90% of all students are sexually experienced, many of whom are practicing unsafe sexual activities.3, 4 Data from the University of Hawaii (UH) at Manoa campus, in 2004, revealed that the average number of coital partners among women was 1.16, and approximately 3% of the women reported an unintended pregnancy. Eleven percent of UH students reported using emergency contraception (EC) within the last year.5
Theoretically, EC has the potential to impact the burden of an estimated 1.5 million unintended pregnancies and 700,000 abortions through widespread availability.6 Much of the literature surrounding EC addresses the debate of increasing access to EC and the resulting behaviors with increased use.6, 7, 8, 9, 10 In August 2006, the US Food and Drug Administration approved the nonprescription status for EC for women > 18 years old to allow for increased access.11 Currently, little is known about the effect this increased access will have on overall unintended pregnancies and abortion rates.12, 13, 14
This study was undertaken to identify differences in characteristics between women who seek EC at a university-based women's health clinic (WHC) and women who visit the WHC for other services, in an effort to identify possible areas for specific educational interventions and to assist with the development of targeted sexual health and contraceptive programs at the UH Manoa campus WHC.
Materials and Methods
Data collection was carried out at the University Health Services' Manoa WHC on the UH campus at Manoa. The WHC offers a wide range of medical services and programs (eg, family planning services, screening and treatment for sexually transmitted diseases [STDs], pregnancy testing, and counseling). The primary service population (approximately 75%) are students of UH Manoa, but many services are available to faculty, staff members, and students from other UH campuses. Because the WHC receives Title X funding, it is not limited to UH students.
From September 1, 2005, to November 30, 2005, the university health services at Manoa treated 7661 patients, with 4605 female patients (60.1%). During this same timeframe, the WHC had almost 400 visits. Based on these numbers, all women who visited only the WHC during the first 3 months of the spring semester 2006 (January 19-April 7) who were ≥ 18 years (and who had not completed the survey previously) were recruited. This timeframe was chosen to capture accurately a representative sample of the WHC patients during a semester. In consecutive order, women who attended the WHC were asked by a nurse to participate in the study (except for a few instances when staffing or other logistical problems occurred). Potential participants were asked to complete a 2-page, anonymous self-administered survey while waiting for services. No information was taken or available to the researcher from the actual medical records to confirm EC use/request; hence, all information was self-reported. The study was not advertised to avoid influencing the natural attendance numbers at the WHC over the semester.
Our survey instrument was patterned after the American College Health Association's National College Health Assessment. Some questions were taken verbatim, and some questions were modified to incorporate different time intervals for reported behaviors (eg, although the National College Health Assessment asks about the number of sexual partners in the past year, we explicitly focused on number of penile-vaginal sexual partners in the past 6 months; although the National College Health Assessment asks about unprotected sex in the past 30 days, we asked about unprotected penile-vaginal sexual intercourse in the past 6 months). Sociodemographic categorizations (specifically ethnicity) were also modified to better capture the ethnic make up of the UH student population. Questions were developed through an extensive literature review, consultation with professionals who work in the field of women's health in college populations, and a review of medical form questionnaires at WHC. This included a critical review of the questionnaire by health educators from the WHC and the UH School of Medicine, staff physicians from the WHC and UH School of Medicine, a health psychologist, an academic epidemiologist and biostatistician, and a nurse practitioner. The original survey instrument was piloted with 25 female public health graduate students and 5 health professionals. Revisions that were made based on feedback that was received included explicitly defining sex as penile-vaginal sexual intercourse. One question regarding forced sexual penetration and another regarding personal religious practices were removed from the questionnaire because of sensitivity concerns. The final survey incorporated 27 total questions that addressed basic demographics, contraceptive and sexual practices, EC use and knowledge, and drug and alcohol use.
The study and survey instrument were approved by the UH's institutional review board.
Excluded from the analysis were women who reported zero coital interactions and married women. Our target population for this study was single sexually experienced women who attended a university-based WHC. Although married women also experience unintended pregnancies, key factors that relate to contraceptive usage, coital frequency, and number of partners are linked to marital status,15 and the vast majority of college students and clinic patients were unmarried (> 90%). Contraception methods were categorized in 4 groups: “best,” which includes hormonal and intrauterine devices; “good,” which includes condoms; “poor,” which includes withdrawal, spermicide, and other self-identified practices; and “nothing.”
Tests of association between binary variables and EC use were performed with the Fisher exact test. Student t tests were used to compare means of quantitative variables. Odds ratios and exact 95% CIs were calculated to assess strength of the association for EC characteristic variables. All tests for bivariate comparisons, except t tests, were calculated with Stat Xact (version 4.0.1; Cytel Software Corp, Cambridge, MA). χ2 test for linear trend to assess EC seeking behavior by day of visit was performed WITH the Statcalc program of EpiInfo (version 3.1.2; Centers for Disease Control and Prevention, Atlanta, GA).
Multivariate analyses were conducted with the use of logistic regression models, with the elimination of nonsignificant variables by backwards stepwise regression. The variables in the initial model included those variables that demonstrated statistical significance in bivariate analyses and variables that were based on relevant information from the literature to ensure inclusion of variables, regardless of bivariate effect size or probability value (eg, age, college status, race, and other demographic and behavioral indicators). Student t tests and multivariate logistic regression analyses were conducted with R software (version 2.1.0; R Foundation for Statistical Computing, Vienna, Austria). Probability values less ≤ .05 were considered statistically significant. All tests were 2-tailed.
Results
Three hundred thirty-three of the 339 women who were invited to participate in the study completed a survey (98% participation rate). A total of 24 women were excluded because they either never had vaginal sex (n = 12) or were married (n = 12), which left 309 surveys for analysis. The sample population represents approximately 10% of the average total annual WHC visits.
Within this population, 17% of the women (54/309) requested EC, and 83% of the women (255/309) visited the WHC for other reasons. Among those who visited the WHC for reasons other than to request EC, 41% of the women were seeking to renew or start birth control methods; 33% of the women were requesting a routine annual examination; 12% of the women wanted an STD check, and < 10% were visiting for some other reasons. Among the women who stated the primary reason for visiting the WHC was to request EC, 35% of the women were also requesting to renew/start birth control; 19% of the women were requesting an STD check, and 17% of the women were requesting an annual examination. Women who were requesting EC were on average younger than EC nonrequestors (P = .006). Almost 43% of the women identified themselves as Caucasian/white; 17% of the women identified themselves as Japanese, and all other races or ethnicities comprised < 10% of the total sample. One person (1.9%) who requested EC and 11 women (4.4%) who did not request EC were identified as not being a currently enrolled student (approximately 4% of the total).
Of women who visited the clinic and requested EC, the largest percentage (37%) attended on Monday, which followed a decreasing trend as the week progressed (χ2 for linear trend, P = .012; Table 1).
TABLE 1. Characteristics of women who visited the University Women's Health Clinic
| Variable | Total (n) | Request for emergency contraception (n) | P value | |
|---|---|---|---|---|
| Yes (n = 54) | No (n = 255) | |||
| DAY OF VISIT | ||||
| Monday | 71 (23.0%) | 20(37.0%) | 51(20.0%) | .111a (χ2 test for linear trend; P = .012) |
| Tuesday | 74(23.9%) | 12(22.2%) | 62(24.3%) | |
| Wednesday | 61(19.7%) | 10(18.5%) | 51(20.0%) | |
| Thursday | 69(22.3%) | 8(14.8%) | 61(23.9%) | |
| Friday | 34(11.0%) | 4(7.4%) | 30(11.8%) | |
| AGE (y) | ||||
| Mean ± SD | 22.84 ± 4.09 | 21.57 ± 3.41 | 23.11 ± 4.17 | .006b |
| RACE/ETHNICITY | ||||
| White | 132(42.8%) | 19(35.2%) | 113(44.5%) | .086c |
| Chinese | 16(5.2%) | 0 | 16(6.3%) | |
| Filipino | 19(6.2%) | 7(12.9%) | 12(4.7%) | |
| Hawaiian/part Hawaiian | 19(6.2%) | 3(5.5%) | 16(6.3%) | |
| Hispanic | 11(3.6%) | 2(3.7%) | 9(3.5%) | |
| Japanese | 53(17.2%) | 11(20.4%) | 42(16.5%) | |
| Pacific Islander (not Hawaiian) | 16(5.2%) | 1(1.9%) | 15(5.9%) | |
| Mixedd | 27(8.7%) | 7(13.0%) | 20(7.9%) | |
| Othere | 15(4.9%) | 4(7.4%) | 11(4.3%) | |
| CURRENT COLLEGE STATUS | ||||
| 1st y | 36(11.9%) | 8(15.1%) | 28(11.2%) | .140a |
| 2nd y | 49(16.2%) | 14(26.4%) | 35(14.1%) | |
| 3rd y | 56(18.5%) | 8(15.1%) | 48(19.3%) | |
| 4th y | 54(17.9%) | 12(22.6%) | 42(16.9%) | |
| ≥ 5th y | 27(8.9%) | 2(3.8%) | 25(10.0%) | |
| Graduate | 68(22.5%) | 8(15.1%) | 60(24.1%) | |
| Not currently a student | 12(4.0%) | 1(1.9%) | 11(4.4%) | |
aFisher exact test, 2-tailed; |
bt test, 2-tailed; |
cFisher exact test, 2-tailed, probability value was obtained with Monte Carlo approximation that was set at 1 million simulations; |
dindividuals who self-identified as “mixed”; |
eall races that were ≤ 2% of the data set (includes Alaskan native, Korean, black or African American, American Indian, Taiwanese, and Vietnamese). |
Of the women who requested EC, 85% had previously used EC vs only 43% for women who did not request EC (P < .001). Women who sought EC were also more likely (39% vs 5%) to report multiple use of EC (≥ 2 times) within the past year (P < .001). In addition to past use of EC, 47% of the women who requested EC perceived that they may use it again within the next 3 months, as opposed to only 12% among nonrequestors (P < .001).
Women who requested EC reportedly believed that they were at risk for pregnancy because of having had unprotected sexual intercourse, as opposed to a perceived problem or need for “backing up” their existing birth control method. Approximately 82% of the women who requested EC admitted having unprotected sexual intercourse in the past 6 months at least once, compared with 48% of women who did not request EC (P < .001). Women who requested EC had significantly greater odds of using less effective contraceptive methods or no method at all (Table 2).
TABLE 2. Sexual history characteristics among women who visited the University Women's Health Clinic
| Request for EC | |||||
|---|---|---|---|---|---|
| Variable | Total (n) | Yes (n) | No (n) | Odds ratio (95% CI) | P value |
| EC USE | |||||
| Ever used emergency contraception (n = 309) | |||||
| Yes | 155(50.2%) | 46(85.2%) | 109(42.7%) | 7.70(3.40-19.56) | <.001a |
| No | 154(49.8%) | 8(14.8%) | 146(57.3%) | ||
| Frequency of EC use in past year (n = 309) | |||||
| 0 timesb | 202(65.4%) | 8(14.8%) | 194(76.1%) | 1 | |
| 1 time | 74(23.9%) | 25(46.3%) | 49(19.2%) | 12.37(4.97-33.36) | <.001a |
| ≥ 2 times | 33(5.2%) | 21(38.9%) | 12(4.7%) | 42.44(14.10-131.60) | <.001a |
| Perceived need for EC in 3 mo (n = 305) | |||||
| Yes | 55(18.0%) | 25(47.2%) | 30(11.9%) | 6.61(3.22-13.43) | <.001a |
| No | 250(82.0%) | 28(52.8%) | 222(88.1%) | ||
| SEXUAL HISTORY | |||||
| Perceived risk of pregnancy (n = 216)c | |||||
| No contraception used | 101(46.8%) | 33(63.5%) | 68(41.5%) | 2.45(1.23-4.96) | .009a |
| Birth control problem (contraception used) | 115(53.2%) | 19(36.5%) | 96(58.5%) | ||
| Unprotected sexual intercourse in past 6 mo (n = 302) | |||||
| Yes | 164(54.3%) | 44(81.5%) | 120(48.4%) | 4.69(2.19-10.89) | <.001a |
| No | 138(45.7%) | 10(18.5%) | 128(51.6%) | ||
| Age at first sexual intercourse(n = 305) | |||||
| ≤ 16 y | 105(34.4%) | 16(30.8%) | 89(35.2%) | 1.51(0.48-5.62) | .627a |
| 17-19 y | 153(50.2%) | 31(59.6%) | 122(48.2%) | 2.13(0.75-7.47) | .192a |
| ≥ 20 yb | 47(15.4%) | 5(9.6%) | 42(16.6%) | ||
| Mean no. of partners within last year(n = 309) | 2.22 | 2.78 | 2.11 | .016d | |
| Frequency of vaginal intercourse in past 6 mo (n = 298) | |||||
| ≤ 10 timesb | 96(32.2%) | 15(28.3%) | 81(33.1%) | 1 | |
| 11-20 times | 66(22.2%) | 13(24.5%) | 53(21.6%) | 1.33(0.53-3.25) | .640a |
| ≥ 21 times | 136(45.6%) | 25(47.2%) | 111(45.3%) | 1.22(0.57-2.65) | .715a |
| Primary birth control (n = 309)e | |||||
| Best (hormonal or intrauterine device)b | 178(57.6%) | 12(22.2%) | 166(65.1%) | 1 | |
| Good (condoms) | 94(30.4%) | 30(55.6%) | 64(25.1%) | 6.48(2.98-14.70) | <.001a |
| Poor (withdrawal)f | 22(7.1%) | 8(14.8%) | 18(7.4%) | 6.15(1.89-18.79) | .002a |
| Nothing | 15(4.9%) | 4(7.4%) | 11(4.3%) | 5.03(1.00-20.36) | .05a |
| Marijuana use at last sexual intercourse (n = 296) | 2.16(0.76-5.61) | .153a | |||
| Yes | 26(9.0%) | 8(14.8%) | 18(7.4%) | ||
| No | 270(91.0%) | 46(85.2%) | 224(92.6%) | ||
| Any alcohol at last sexual intercourse (n = 305) | |||||
| Yes | 79(25.9%) | 19(35.2%) | 60(23.9%) | 1.72(0.86-3.37) | .09a |
| No | 226(74.1%) | 35(64.8%) | 191(76.1%) | ||
| No. of drinks at last sexual intercourse (n = 79)g | |||||
| ≥ 4 | 27(34.2%) | 11(57.9%) | 16(26.7%) | 3.78(1.13-12.81) | .029a |
| 1-3 | 52(65.8%) | 8(42.1%) | 44(73.3%) | ||
| MOST RECENT PARTNER | |||||
| Length knew last partner (n = 302) | |||||
| Knew last partner < 1 y | 143(47.4%) | 33(62.3%) | 110(44.2%) | 2.09(1.09-4.05) | .025a |
| Knew last partner ≥ 1 y | 159(52.6%) | 20(37.7%) | 139(55.8%) | ||
| Describe last partner (n = 304) | |||||
| Casual | 59(19.4%) | 14(26.4%) | 45(17.9%) | 1.64(0.76-3.41) | .223a |
| Exclusive | 245(80.6%) | 39(73.6%) | 206(82.1%) | ||
| SEXUAL OUTCOME | |||||
| Sexually transmitted disease (n = 309) | |||||
| Yes | 62(20.1%) | 10(18.5%) | 52(20.4%) | 0.89(0.37-1.94) | .920a |
| No | 247(79.9%) | 44(81.5%) | 203(79.6%) | ||
| Abortion (n = 307) | |||||
| Yes | 34(11.1%) | 11(20.4%) | 23(9.1%) | 2.56(1.04-5.93) | .04a |
| No | 273(88.9%) | 43(79.6%) | 230(90.9%) | ||
| Unwanted pregnancy in last year (n = 309) | |||||
| Yes | 14(4.5%) | 7(13.0%) | 7(2.7%) | 5.28(1.49-18.40) | .009a |
| No | 295(95.5%) | 47(87.0%) | 248(97.3%) | ||
aExact 2-tailed probability values and 95% CIs from 2 binomial sample calculations; |
breference group; |
cwomen who responded to ever feeling at risk of unwanted pregnancy after intercourse (compared those women who believed that they were “at risk” because of not using any form of birth control with those women who did use some form of birth control); |
dt test, 2-tailed; |
edetermined by the most effective method used in preventing pregnancy; |
falso included fertility awareness and spermicide; |
gonly those who reported alcohol use at last intercourse. |
No significant differences were detected between EC requestors and nonrequestors for marijuana use or any drinking at last sexual intercourse. However, limiting the analysis to only women who drank at their last sexual intercourse revealed that, among those women who requested EC, 58% (26% of all EC requestors) drank ≥ 4 drinks, as opposed to only 27% (0.6% of all non-EC requestors) among the nonrequestors (P = .029).
Of the total sample, approximately 5% of the women reported an unintentional pregnancy within the past year. Thirteen percent of women who requested EC had experienced an unintentional pregnancy within the last year, compared with only 3% among nonrequestors (P = .009). In addition, 20% of women who requested EC reported ever experiencing an abortion, as opposed to only 9% among the nonrequestors (P = .04). Ever testing positive for an STD was similar for EC requestors and nonrequestors (Table 2).
In the final multivariate model, the independent significant variables were requesting EC on Monday (P = .009), frequency of EC use in the past year (P < .001), unintentional pregnancy in the last year (P = .0123), method of contraception used at last sexual intercourse, how one described her most recent partner (casual vs exclusive), and perceived need for EC in the next 3 months. Variables that were removed from the model during the stepwise analysis were age, length of time participant knew her last partner, number of partners in the last year, experiencing an STD, marijuana use at last intercourse, alcohol use at last intercourse, ever experiencing an abortion, age at first intercourse, and race/ethnicity (Table 3). The difference in log likelihood between the complete model and the reduced model was not significant (likelihood ratio χ2, 8.3 [8 degrees of freedom]; P > .25), which indicated that deleting the set of variables did not significantly worsen the fit of the model.
TABLE 3. Multivariate analysisa assessing independent associations with requesting EC
| Variable | Odds ratio (95% CI) | P value |
|---|---|---|
| DAY OF THE VISIT | ||
| Tuesday-Fridayb | 1 | |
| Monday | 3.90(1.39-10.92) | .009 |
| FREQUENCY OF EC USE IN PAST YEAR | ||
| 0 timesb | 1 | |
| 1 time | 9.04(3.08-26.54) | <.001 |
| 2 times | 46.04(11.89-178.34) | <.001 |
| UNINTENTIONALLY PREGNANT IN THE LAST YEAR | ||
| Nob | 1 | |
| Yes | 14.37(1.76-117.32) | .0123 |
| FREQUENCY OF VAGINAL SEXUAL INTERCOURSE (PAST SIX MONTHS) | ||
| ≤ 10b | 1 | |
| 11-20 | 2.70(0.82-8.90) | .103 |
| ≥ 20 | 2.70(0.87-8.53) | .085 |
| METHOD OF CONTRACEPTION USED AT LAST SEXUAL INTERCOURSEc | ||
| Best (hormonal or intrauterine devise)b | 1 | |
| Good (condoms) | 9.30(3.14-27.54) | <.001 |
| Poor (withdrawal)d | 2.91(0.64-13.37) | .169 |
| Nothing | 10.52(1.48-74.88) | .019 |
| DESCRIBED MOST RECENT PARTNER | ||
| Exclusiveb | 1 | |
| Casual | 3.70(1.20-11.42) | .023 |
| SELF-PREDICTED USE OF EC IN THE NEXT 3 MO | ||
| Unlikelyb | 1 | |
| Likely | 6.96(2.54-19.04) | <.001 |
aBackwards stepwise logistic regression model: Variables excluded from the model through this procedure were age, race/ethnicity, college status, age at first sexual intercourse, number of partners in the last year, length of time most recent partner known, marijuana use at last intercourse, alcohol use at last intercourse, ever experiencing an abortion, and ever testing positive for an sexually transmitted disease; |
breference group; |
cdetermined by the most effective method reported in preventing pregnancy; |
dalso included fertility awareness and spermicide. |
Comment
This study was undertaken to assess whether characteristic differences exist between women who seek EC and women who visit the university WHC for other purposes. Among those who request EC at the time of the visit, approximately 85% of the women had previously used EC ≥ 1 time within the past year, and nearly one-half of the women perceived the need for future EC use in the next 3 months. They were also significantly more likely to have used a less effective contraceptive method during their most recent intercourse. Approximately 82% of women who requested EC indicated having had unprotected sex at least once in the past 6 months, were significantly more likely to have believed that they were at risk for pregnancy because of unprotected sexual intercourse as opposed to a birth control failure or mishap, and were more likely to have experienced an abortion or unwanted pregnancy in the last year.
Although no statistical difference was found between alcohol use and no use at most recent sexual intercourse, when limiting the analysis to only women who consumed alcohol at most recent intercourse, those women who requested EC were at 3.78 greater odds of drinking ≥ 4 alcoholic beverages.
EC was most often requested on Monday and followed an orderly trend of diminished requests as the week progressed. Varying factors could explain this association, the most apparent being that the clinic is closed on the weekend and that Monday is the first open day. It is related possibly to increased risk-taking behaviors over the weekend.16, 17 Extended clinic hours and education programs that address weekend behaviors and locations to access EC during closed hours should be made readily available and advertised to reduce barriers for accessing EC quickly.
A few aspects of sexual histories were similar between EC requestors and nonrequestors. We found that almost one-half of study subjects identified previous EC use and had engaged in unprotected sexual intercourse in the past 6 months at least once. Less than 5% of study subjects reported an unintended pregnancy; > 20% of study subjects reported ever experiencing an STD, which suggested a need for targeted STD intervention and prevention programs for all women who visit the WHC. This population in general could benefit greatly from more effective long-term forms of birth control and STD prevention.
Strengths of this study include high participation rate (98%) and large sample size. Seventeen per cent of the women who completed the questionnaire requested EC. A sample size of 300 with frequencies of 52 women (17% of 300) who requested EC and 148 women (83% of 300) who did not request EC would generate 80% power to detect a difference in responses of roughly 0.2 (eg, proportions of 0.64 and 0.43 or 0.2 and 0.39, respectively). Concerning the description of the study population, for characteristics with proportions lying in the 0.4-0.6 range, the standard error with 300 subjects would be 0.0289, which would generate a reasonably narrow 95% CI of approximately ±0.057. Previously published clinic-based studies that described EC requestors or differentiated EC requestors from nonrequestors included substantially smaller study populations.18, 19, 20 Because of the high participation rate, participants likely are a representative sample of women who visited the WHC. Because women were allowed to participate only once, the frequency of clinic visits per participants should not have affected the results.
One limitation of the study is the self-reported nature of the information. Another limitation is the external generalizability of the findings. Although this study was conducted at the university WHC, this sample may not be representative of the general campus population nor visitors to the general campus health clinic. The study sampled sexually active, unmarried women who visited the WHC, and caution should be taken in extrapolating these results beyond the study group.
Although EC-seeking characteristics of unmarried sexually active women who attend university-based WHCs have not been investigated in depth, our finding that EC requestors (compared with nonrequestors) were more likely to have engaged in unprotected sexual intercourse is consistent with findings that were reported from family planning clinics19, 20 and urban high school-based clinics.21 Our additional findings that EC requestors were more likely to have used EC in the past year and that they are more likely to perceive the need to use them in the future clearly elucidate a pattern of unsafe sexual practices for which interventions may be addressed.
Our findings support that an increase in access and education about EC should be provided in conjunction with information about contraceptive methods and behaviors to reduce the need for future use of EC. This should include primary contraception education that emphasizes the adoption of a consistent and effective primary method, substance use and risk-taking behavior reduction, and practical and relevant STD prevention information. In addition, both access to EC and more efficacious primary birth control methods should made more readily available, especially on the weekends. More research that is focused on identification of the barriers to primary contraception and EC use among this population is needed for more targeted and effective interventions.
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Authorship and contribution to the manuscript is limited to the 5 authors indicated. There was no outside funding or technical assistance with the production of this article.
Cite this article as: Parrish JW, Katz AR, Grove JS, et al. Characteristics of women who sought emergency contraception at a university-based women's health clinic. Am J Obstet Gynecol 2009;201:22.e1-7.
PII: S0002-9378(09)00267-1
doi:10.1016/j.ajog.2009.03.012
© 2009 Mosby, Inc. All rights reserved.
Volume 201, Issue 1 , Pages 22.e1-22.e7, July 2009
