title: Emergency contraception for newly arrested women: evidence for an unrecognized public health opportunity.
abstract: Incarceration affords an opportunity to provide health care to populations with limited access to care. Women in this population are at high risk for experiencing unintended pregnancies. It is not known what proportion of these women engage in unprotected intercourse in the days prior to incarceration and therefore may benefit from being offered emergency contraception upon their arrest to decrease their risk of unintended pregnancies. We sought to describe the proportion and characteristics of newly arrested women who are eligible for and interested in taking emergency contraception by conducting a cross-sectional study in an urban county jail booking facility. A 63-item survey was administered to women ages 18-44 within 24 h of being arrested in San Francisco. Eighty-four (29%) women were eligible for emergency contraception. Of these, 48% indicated a willingness to take emergency contraception if offered. Half of the women eligible for emergency contraception expressed ambivalent attitudes about pregnancy. Women who had taken emergency contraception in the past were more likely to say they would accept it (45%) than women who had never used it (25%, p = .05). The strongest predictor of willingness to take emergency contraception was not having a misperception about its safety, efficacy, or mechanism of action (RR = 1.9, 95% CI 1.2-3.0). Seventy-one percent of all women indicated that they would accept an advance supply of emergency contraception upon release from jail. Emergency contraception counseling and provision should be offered to newly arrested women as a key reproductive and public health intervention for a traditionally marginalized, high-risk population.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. sufrinc@obgyn.ucsf.edu.
authors.forename: Carolyn B
authors.initials: CB
authors.lastname: Sufrin
authors.affiliation: Department of Internal Medicine, San Francisco General Hospital and University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Jacqueline P
authors.initials: JP
authors.lastname: Tulsky
authors.affiliation: San Francisco Department of Public Health, Jail Health Services, University of California, San Francisco, San Francisco, CA, USA.|Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Goldenson
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Winter
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Deborah L
authors.initials: DL
authors.lastname: Cohan
mesh_terms: D000293:Adolescent; D000328:Adult; D044363:Contraception, Postcoital / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D010342:Patient Acceptance of Health Care; D011329:Prisoners / Q000523:psychology*; D011634:Public Health; D012495:San Francisco; D055815:Young Adult