265 Availability of Emergency Contraception in the Emergency Department: A National Survey

Abstract

Emergency contraception accessibility was deemed a human right by the World Health Organization in 1968. However, even given the de jure over-the-counter availability of levonorgestrel-only emergency contraception in the United States, accessibility of emergency contraception remains imperfect. Emergency departments are disproportionately used by populations of women at increased risk for unintended pregnancy, including women of lower socioeconomic status and those who have been sexually assaulted; as such, they can serve as an important access point to these medications. This study will conduct a telephone-based “mystery shopper” study of a wide sample of hospitals throughout the United States. We will report the likelihood of a female layperson obtaining information and access to emergency contraception, and what additional steps (if any) were required to qualify for a prescription. This study hypothesizes that emergency contraception will be less accessible in hospitals that are smaller, rural, non-teaching, and/or faith-based as compared to larger, urban, and teaching hospitals without religious affiliation. Data collection is ongoing as of abstract submission. Data is collected by phone by an investigator or other trained member. Calls are placed to the public number of an emergency department and the caller, introducing themselves as a general member of the public, follows a premade conversational script containing the survey questions. Calls to emergency departments are made solely on weekends to simulate times of limited access to non-emergency department health care providers. Our data will compare emergency contraception availability between 960 hospitals based on geographic region, size, rurality, teaching status, and faith affiliation. Our list of hospitals was obtained from a publicly available listing of all hospitals in the United States, sorted to exclude children’s hospitals, VA hospitals, tribal hospitals, hospitals in US territories, and hospitals that did not have emergency departments. Prior to randomization, teaching hospitals were separated and block randomization was utilized to ensure adequate sampling. Collected data is a combination of qualitative and quantitative data points including size of hospital, rural/urban status of hospital, religious affiliation of hospital, academic vs. nonacademic hospital, availability of emergency contraception, and sexual assault services. Analysis will include comparing if emergency contraception is available without restrictions, available with restrictions, or unavailable, and if valid or invalid referrals to another facility are obtained. Results will also be compared with the 2005 national availability of emergency contraception in emergency departments as studied in Availability of Emergency Contraception: A Survey of Hospital Emergency Department Staff (Teresa Harrison, 2005). Pending data analysis. Results of this study will provide insight into reasonable accessibility of emergency contraception in emergency departments around the country; this information will be of particular use given the changing legal landscape surrounding pregnancy and abortion in the United States.