A Survey among the General Public and Licensed Pharmacists in New Jersey and Oregon
Conducted on Behalf of RHTP

 

 

 

 

January 2000

  

 

 

 

Peter D. Hart Research Associates

1724 Connecticut Avenue, NW

Washington, DC  20009

 


Results of General Public Survey

 

From November 17 to 23, 1999, Peter D. Hart Research Associates conducted a poll among 506 New Jersey voters and 503 Oregon voters to assess their awareness of and familiarity with emergency contraception, their feelings about emergency contraceptive pills? being widely available to women, and their attitudes toward collaborative drug therapy agreements and so-called ?conscience clauses.?  The margin of error for each poll is 4.5%.  The following memo presents the key findings of these polls.

 

 

Overview

 

The research findings provide valuable insight into voters? approach to the topic of emergency contraception (EC).  As the results of both polls demonstrate, emergency contraception is not a subject with which most voters are familiar; however, once they learn more about the subject, they are generally positive to the idea of emergency contraception and its being widely available to women. 

Perhaps somewhat surprisingly, voters have mixed reactions to the concept of collaborative drug therapy agreements between doctors and pharmacists, and their reservations about these arrangements significantly affect their feelings about making EC available through these types of agreements.  Finally, while voters are largely unaware of the discussion of so-called ?conscience-clause? legislation in their states, they express strong opposition to these exemptions.

 

Knowledge of and Familiarity with Emergency Contraception

 

Many voters have a general sense that a medical treatment exists for preventing pregnancy after unprotected sex, but almost unanimously, voters know very little about emergency contraceptive pills?from whether EC is even available in the United States to how long EC pills are considered effective in preventing pregnancy.  About half (47% in New Jersey, 51% in Oregon) of voters in each state say that they know of a product or drug that has been proven effective in preventing pregnancy after unprotected sex, but they admit that they are not particularly familiar with the particular drugs.  A slightly higher proportion of voters in each state believe that they are very or fairly familiar with the term ?morning-after pill? (23% NJ, 25% OR) than with the term ?emergency contraceptive pills? (14% NJ, 17% OR). 

Voters? lack of knowledge of emergency contraception stems from their lack of personal experience with EC:  just one in 20 (5%) New Jersey voters and one in ten (9%) Oregon voters know of a family member or friend who has taken emergency contraceptive pills.  Even among the population whom one might expect would have the most personal experience with EC?women age 18 to 44?only about one in ten (8% NJ, 11% OR) say that they know someone who has taken emergency contraceptive pills.  In both states, barely one in ten (7% NJ, 9% OR) 18- to 50-year-old women say that they have discussed EC with their doctors or other health care professionals. 

In fact, emergency contraception remains such a remote topic to most of the general public that a majority of voters are not even aware that emergency contraceptive pills are available in the United States:  just about one in three (30% NJ, 33% OR) voters in each state know that EC is available in this country, compared with one in four (28% NJ, 25% OR) who do not; the remainder admit that they simply do not know whether the drug is available in America.  Even among voters who know that emergency contraceptive pills are available in America, one in four (25%) New Jersey voters and one in three (34%) Oregon voters do not know that these pills are available only by prescription. 

 

Reaction to Emergency Contraception

 

Despite their lack of familiarity with and knowledge of emergency contraception, voters generally react favorably to the idea of emergency contraception?s being widely accessible to all women.  After hearing a short description of emergency contraceptive pills, to clarify voters? misperceptions and provide them with some context, approximately six in ten (62% NJ, 64% OR) voters say that they feel very or fairly positive toward the idea of EC?s being widely available.  In fact, this sentiment is so widespread that a majority of voters in almost all demographic groups?including Catholics?describe their reaction to the idea as positive; Oregon Republicans are the exception, and even a large plurality (49%) of them feel positive toward the idea.

 


 

 

 

 

 

The positive aspects of emergency contraceptive pills? being widely accessible are similar to many of the values that voters bring to the debate surrounding other reproductive rights issues; for example, about one in five (23% NJ, 19% OR) voters talk about EC as a ?personal decision? and a ?woman?s choice.?  They also volunteer that emergency contraceptive pills would prevent unwanted pregnancy (12% NJ, 14% OR) and that the pills are a better alternative to abortion (6% in both states).  In fact, when read a series of statements about why emergency contraceptive pills should be widely available to women, voters in both states identify reducing the number of abortions as the most convincing reason to support the accessibility of EC.

 

Reasons Why Emergency Contraception
Should Be Widely Available

(% very/fairly convincing)

 

NJ Voters
%

OR Voters
%

EC is a better alternative to reducing unintended pregnancies than abortion is


69


73

EC is more effective the sooner it is taken; therefore, women need to be able to get it quickly and easily


63


66

Half of all pregnancies in the United States are unintended; EC is the safest way to reduce this


56


59

EC pills are just a higher dose of regular birth control pills and therefore should be just as easily available


50


48

While voters have a generally positive reaction to emergency contraception, they do express concern about two distinct aspects of EC?s being widely available:  the potentials for encouraging risky, unprotected sex, and abusing EC as a regular, ongoing method of birth control.  More than four in ten voters in each state?including a significant proportion of voters who describe themselves as being positive toward EC?say that these concerns are very or fairly convincing reasons why EC should not be widely available to women.

 

Collaborative Drug Therapy Agreements

 

Voters are ambivalent toward the idea of collaborative drug therapy agreements between pharmacists and doctors.  In New Jersey, 47% of voters describe these agreements as a bad idea, while only 33% describe them as a very or fairly good idea; in Oregon, reactions are more evenly divided?40% think the agreements are a bad idea, as opposed to 38% who believe they are a very or fairly good idea.  While men in both states are more likely than women to see these arrangements as a positive step, New Jersey and Oregon voters both seem reluctant to diminish the role of doctors in prescribing drugs.  And because voters have mixed reactions to the pros and cons of collaborative drug therapy agreements, they are not particularly enthusiastic about adding emergency contraceptive pills to the protocol of drugs that fall under these arrangements.  In New Jersey, 39% support adding EC to the list of medications that pharmacists could prescribe directly to patients; 56% oppose this measure.  In Oregon, however, 51% favor adding EC to collaborative drug therapy agreements, while 44% oppose this extension.

 

?Conscience-Clause? Legislation

 

Legislative proposals in New Jersey and Oregon that would allow pharmacists to refuse to fill prescriptions or provide medications because of religious or moral objections?so-called ?conscience clauses??are not a topic with which voters are familiar.  In Oregon, about half (52%) of voters say that they have heard nothing at all about these proposals, whereas in New Jersey, three in four (74%) say the same.  Despite their low levels of awareness of these legislative initiatives, voters express strong and consistent opposition to these measures:  eight in ten (79%) in New Jersey oppose this type of legislation, while seven in ten (69%) in Oregon feel similarly.  Conscience-clause legislation is rejected by sizeable majorities of every demographic group of voters in both states.

 

 

 

 

 

 

 

 

 

 

In explaining their opposition to these legislative measures, voters cite pharmacists? ?professional obligation to provide patients with any drug or medication that has been legally prescribed for them? as the most compelling reason to reject these measures:  70% of voters in New Jersey and 62% of voters in Oregon rate this as a very convincing reason to oppose conscience-clause legislation.  At the same time, just about one in three (33% NJ, 35% OR) say that the argument ? . . . it is the responsibility of the pharmacy?not the pharmacist?to make sure that patients have access . . . to the drugs and medications that they need? is a very convincing reason to support the legislation.

In the end, a majority (60% NJ, 53% OR) of voters maintain that pharmacists should never be allowed to refuse medications to patients because of their own religious or moral objectives?even when they are presented with the alternative of allowing pharmacists to refuse prescriptions as long as the pharmacy has a procedure for ensuring that patients are not denied care.

   


 

 

 

 

 

 

 

 

 

Results of Pharmacists Survey

 

From November 20 through December 3, 1999, Peter D. Hart Research Associates conducted a poll among licensed pharmacists, 105 in New Jersey and 103 in Oregon, on their knowledge of and feelings about emergency contraception, as well as their attitudes toward collaborative drug therapy agreements and so-called ?conscience clauses.? Only pharmacists who work for an independent, chain, or supermarket pharmacy were interviewed in this survey.  The following memo presents the key findings.

 

 

Overview

 

While general familiarity with emergency contraception is widespread among pharmacists, their actual knowledge of EC is inconsistent and, in some cases, based on erroneous information.  Despite reporting a fair amount of expertise on the subject, a significant proportion of pharmacists do not recognize some basic facts about EC, including how effective it is, the time frame during which it can be taken, and how the pills work to prevent unintended pregnancy. 

The overwhelming majority of pharmacists do not object to emergency contraception.  And although some voice concerns about this method, most report that these concerns do not interfere with their willingness to fill EC prescriptions for patients.

Unlike the general public, pharmacists have a decidedly positive view of collaborative drug therapy between doctors and pharmacists.  And also in contrast to public sentiment, pharmacists in both states express strong support for so-called ?conscience-clause? legislation.

 

Knowledge of Emergency Contraception

 

Overwhelmingly, pharmacists report that they are aware of an established medical treatment for preventing pregnancy after unprotected sex?about nine in ten (90% in New Jersey, 89% in Oregon) pharmacists in each state know of a product or drug that is effective in this area.  They also are familiar with specific products to combat unintended pregnancy:  80% of pharmacists in New Jersey and 74% in Oregon say that they are very or fairly familiar with ?emergency contraceptive pills,? while 78% of pharmacists in New Jersey and 70% in Oregon say the same about the ?morning-after pill.?

Despite these claims, pharmacists still have many misperceptions of EC.  For example, 59% in each state say that emergency contraceptive pills are not considered safe for most women who have been advised not to take regular birth control pills, despite scientific evidence to the contrary.  In addition, a majority in each state incorrectly identify the time period during which emergency contraceptive pills are considered effective, and a significant minority underestimate the effectiveness of EC in preventing unintended pregnancy.  Another common misperception with potentially important implications concerns how emergency contraceptive pills actually work in preventing pregnancy:  more than half of pharmacists in each state erroneously report that EC can interrupt an established pregnancy by disrupting a fertilized egg that already has become implanted.  On the other end of the spectrum, pharmacists know some basic facts about EC, including its greater effectiveness when the pills are taken at an early stage and the frequency of potential side effects associated with EC, such as nausea. 

Pharmacists? inconsistent knowledge of EC probably stems from their lack of significant, direct experience with filling prescriptions for these pills.  Three in ten (29%) pharmacists in New Jersey and more than four in ten (44%) in Oregon say that they have not filled a prescription for these pills in the past year, and among those who report having filled such prescriptions in the past year, the vast majority report handling ten or fewer. 

 

Reaction to Emergency Contraception

 

Like the general public, pharmacists have a generally favorable reaction to emergency contraception?s being broadly accessible to women:  63% of pharmacists in New Jersey and 69% in Oregon describe their reaction as positive.  While strong majorities of pharmacists in both states say that they do not have any moral or religious objections to emergency contraceptive pills, some pharmacists do express such reservations?about one in four (26%) pharmacists in New Jersey and about one in five (19%) in Oregon say that they have concerns about EC.  Among pharmacists who report having objections to emergency contraceptive pills, however, the overwhelming majority say that these reservations are personal (89% NJ, 70% OR), rather than professional.  In the end, concern about widespread refusal by pharmacists to dispense emergency contraceptive pills is more theoretical than practical, as only one in 20 (4%) New Jersey pharmacists and one in ten (10%) Oregon pharmacists say that their feelings about EC would prevent them from actually filling prescriptions for patients. 

Even though pharmacists are amenable to the idea of emergency contraception?s being widely available to women, they do not believe that EC should be available over the counter, without a prescription:  73% of pharmacists in New Jersey and 65% in Oregon oppose making EC available in this way.  Pharmacists in both states also oppose making regular oral contraceptive or birth control pills available to women without a prescription. 

 

Collaborative Drug Therapy Agreements

 

Pharmacists are enthusiastic about the idea of collaborative drug therapy agreements between pharmacists and doctors.  Unlike the mixed reaction these agreements receive from voters in each state, a strong majority of both New Jersey (71%) and Oregon (79%) pharmacists characterize collaborative drug therapy agreements as a very or fairly good idea.

In keeping with their favorable view of collaborative drug therapy agreements, a majority of pharmacists support adding EC to the protocol of drugs that could be prescribed under these arrangements:  56% of pharmacists in New Jersey and 67% in Oregon favor such an expansion.

 

?Conscience-Clause? Legislation

 

In contrast to public opposition to legislative initiatives allowing pharmacists to refuse to fill prescriptions because of religious or moral objectives, pharmacists in both New Jersey and Oregon embrace so-called ?conscience-clause? proposals.  Six in ten (59%) pharmacists in New Jersey and seven in ten (68%) in Oregon support such measures; in New Jersey, 79% of voters oppose them, while in Oregon, 69% of voters reject them.  Pharmacists in Oregon report being the most aware of discussions of this type of legislation in their state legislature:  52% of pharmacists in Oregon say that they have heard a great deal or quite a bit about these proposals, compared with only 29% of pharmacists in New Jersey who say the same. 

In the end, pharmacists? enthusiasm for conscience-clause legislation is tempered somewhat by their support for a compromise solution allowing pharmacists to refuse to fill prescriptions because of religious or moral objections only if the pharmacy where they work has established procedures for ensuring that patients are not denied access to these drugs as a result:  about half (48% NJ, 54% OR) of pharmacists in each state select this option as their preferred position.