Contraception Confusion

As campus debates have played out over whether and to what extent student health centers should provide access to emergency contraception such as Plan B, opponents of the idea often point out that students can easily obtain it elsewhere -- that all they have to do is walk down the street to the local pharmacy.

But a new study suggests that when the health center is not a viable resource, many students might not know how to go about getting emergency contraception -- which could be problematic, since in the event of a potential pregnancy, time is of the essence.

Examining students’ ability to find information about emergency contraception online, researchers found that many of the students could not -- in fact, one in three students could not find any relevant information about the preventive pills, and the majority could not identify the most efficient way to acquire the contraception when they needed to.

“This is one of those instances where it could really make a huge difference if you get the right information and you get it in time, and despite it being that kind of important information, many students couldn’t figure it out,” said Eszter Hargittai, a co-author of the study and associate professor of communication studies at Northwestern University. “If it could be available easily on campus, I would think that would make a huge difference to quite a few people.”

Emergency contraception pills reduce the risk of pregnancy when taken up to five days after unprotected sex, but are more effective when taken sooner; they are recommended to be taken within three days. The pills, which are available without a prescription to anyone 17 and older, are not abortion mechanisms; rather, they halt ovulation and make it more difficult for the sperm to fertilize the egg. But the study’s authors note that studies have found that half of students conflate emergency contraception with the abortion pill, RU-486, and confusion about how the former works “frequently discourages” women who have moral qualms from seeking it out.

Hargittai and her co-author Heather Young, who is pursuing her Ph.D. in Northwestern’s media, technology and society program, surveyed more than 200 18- and 19-year-old students in 2007-8 (several years ago, which is relevant for reasons discussed below) at two Midwestern college campuses, one urban public and one suburban private. In addition to surveying the students about their Internet uses and demographic background (57 percent were white, 28 percent Asian, 11 percent Hispanic and 3 percent black; most had at least one parent with a college degree but close to a third did not), the authors made in-person observations to see how students searched for and evaluated content online.

During the in-person observation sessions, students explored a hypothetical scenario: “You are at home in the middle of summer. A friend calls you frantically on a Friday at midnight. The condom broke while she was with her boyfriend. What can she do to prevent pregnancy? Remember, neither of you is on campus. She lives in South Bend, Indiana.”

The researchers set the hypothetical over the summer and in a town without a Planned Parenthood to rule out the possibility of a student simply suggesting the friend go to campus health services, and with the foresight that many would immediately recommend Planned Parenthood (which they did -- more on that below).

Emergency contraception pills had just been made available at the time of the study, the authors said, so visiting a pharmacy to purchase the pills without a prescription was “the ideal solution to the task,” because obtaining them that way is much faster than visiting a hospital or clinic. Even so, the researchers considered a student’s answer “successful” if it simply suggested the friend take emergency contraception pills.

Two in three students gave successful final answers, and 40 percent of those gave the “ideal” answer -- that the friend should go to the pharmacy and purchase the pills over the counter. But 34 percent gave “unsuccessful” answers that made no mention of emergency contraception. Nineteen percent, meanwhile, simply suggested that their friend “should seek medical care.” Three percent arrived at no conclusion at all.

“Most students did not seem to have prior knowledge of the drug and many were unable to learn about it during their search,” they wrote. “The proportion of correct responses is even less encouraging if we consider that several of the people who arrived at the ideal solution had prior knowledge about ECPs…. These findings suggest that despite the availability of quality health information on the Web, many students are unable to find accurate information about important health matters online.”

But it’s difficult to use the findings as evidence that campuses should provide Plan B, said James Trussell, faculty associate of Princeton University’s Office of Population Research and creator of its educational emergency contraception website Not2Late (which, as it happens, was accessed by 8 percent of students in the study).

“There’s a huge sort of disconnect between the study question as posed and the real world,” Trussell said. In most cases, a university health center would be available, he said, and even if it didn’t offer Plan B, it would likely direct the student to somewhere that did. He also speculated that students are better informed now about emergency contraception, since it has been available over the counter for several years.

“However, there are still going to be some college students who clearly are not going to know about emergency contraception, either because they’re on a college campus where it’s easily available but they don’t know that,” Trussell said (adding that that’s unlikely given that the topic is usually covered in pre-freshman health education classes), “or, far more likely, they’re in a place in a small town where there really aren’t many options.”

Notably, 31 percent of students landed on a website of Planned Parenthood, the widely used agency that has been targeted for defunding by numerous legislators and the presumptive Republican presidential nominee, Mitt Romney, because it provides abortions to a small percentage of clients. One in 10 students accessed morningafterpill.org, which is sponsored by the pro-life American Life League and showed up as the first link when students entered “morning after pill” or “emergency contraception” into a search engine -- but “very few” students ended up relying on the site for information.

Many students had a hard time finding relevant information because they didn’t understand all the terminology. One student, for example, searched for “morning after pill” and landed on a page with an “emergency contraception” link, but scrolled right past it.