1. Planning, Protection, Prevention: Reducing Unintended Pregnancy in Colorado Situating Teen Pregnancy and STI Prevention Efforts and Support for Pregnant and Parenting Teens within Coordinated Efforts to Promote the Reproductive Health of Colorado Women and Girls

2. Why Focus on Unintended Pregnancy? Using the 4 out of 10 ratio, $92 MILLION of that total was spent on unintended pregnancies

3. Critical Question What prevents women from using contraceptives consistently and correctly when they do not want to become pregnant?

4. Prevention First Colorado Coalition Member Organizations Colorado Coalition for Girls Colorado Organization for Latina Opportunity and Reproductive Rights Colorado Organization on Adolescent Pregnancy, Parenting and Prevention Denver Women’s Commission Girls Incorporated of Metro Denver NARAL Pro-Choice Colorado Foundation National Council of Jewish Women, Colorado Section Planned Parenthood of the Rocky Mountains Republican Majority for Choice – Colorado Chapter Women’s Health (Boulder Valley Women’s Health Center) Women’s Lobby of Colorado

5. Scope of Research Clinic Research –Distributed more than 4,500 print surveys in fall 2006 to health care clinics throughout the state –1,324 surveys were returned, of which 1,027 were from eligible women Teen Research –77 written surveys collected in spring 2007 from teens who used one of two clinics in the Denver- metropolitan area Random Telephone Survey –Placed more than 2,100 calls in fall 2007 to yield 801 completed surveys of eligible women –Audience sampled included over-representation of Hispanic women Focus Groups –Four focus groups conducted in spring 2008 with low-income women in the Denver-metro area –Two groups consisted of women aged 18 to 30 and two groups consisted of women aged 30 to 44 –Women were selected who were currently on Medicaid or had been on Medicaid in the last three years Individual Interviews –Prevention First Colorado staff conducted 40 interviews in fall 2008 with low-income women in the Denver- metro area –50 percent of interviewees were aged 18 to 30 and 50 percent were aged 31 to 44 –Both pregnant and non-pregnant women were interviewed; sterilized women were not –All interviewees were currently on Medicaid or had been within the last year

6. Key Findings: Women 18-44 Identified attitudinal barriers to contraceptive use psychological barriers that kept women from thinking about contraception partner communication or interaction issues planning or lack of planning for contraceptive use Planning appeared to be the most important factor in contraceptive use: Women who scored highly on the planning section of the survey were more likely to use effective birth control methods, less likely to experience unintended pregnancy, and less likely to report having had sex without contraceptives when trying to not get pregnant

7. Key Findings: Women 18-44 (cont’d) Populations of Women Most At-Risk to Have Sex WITHOUT Birth Control When Not Desiring Pregnancy Populations of Women Most At-Risk to Experience Unintended Pregnancy Caucasian women on Medicaid, Caucasian women living in rural or small town communities, and Caucasian women in their 20s Women on Medicaid and Caucasian women living in small towns and rural areas generally with low educational attainment (less than a bachelor’s degree) 57% of Caucasian women on Medicaid had had sex without contraceptives when not desiring pregnancy compared to 39% of all Caucasian women Caucasian women in their 20s were more likely to have reported having sex without contraception when not desiring pregnancy Percent of Women Who Reported Their Primary Contraceptive Method as “NO METHOD”

8. Key Findings: Teens Aged 15-19 (cont’d) Social Norms Respondents who believed that most of their peers used contraceptives were 80 percent less likely to have had sex without contraceptives than those who believed that most of their peers did not use contraceptives Education Teens who had taken a sexuality education class were 14.4 percent more likely to report always using birth control and 12.5 percent more likely to report sometimes using birth control than those who had not taken a sex education class More than 1/4 of teens surveyed believed certain myths about sex and contraceptives, including: a woman cannot get pregnant if she is “on top” during sex birth control can make getting pregnant in the future difficult using birth control pills can cause cancer Contraceptive Method at Last Intercourse

9. Key Findings: Teens Aged 15-19 Consistency: Teens who reported sometimes using contraceptives were 8 times more likely to be pregnant than teens who reported that they always used contraceptives. Those who reported never using contraceptives were 9.3 times more likely to be pregnant than those who always used contraceptives Transportation: Teens who reported having no trouble getting transportation to a doctor or clinic where they can obtain contraceptives were 76 percent less likely to have had an unintended pregnancy than those who reported having transportation difficulties

10. Data-Based Recommendations for Systemic Change Declare the reduction of unintended pregnancy a public health priority in Colorado Streamline access to and use of family planning services provided through Medicaid Ensure all FDA-approved contraceptive drugs, devices and related outpatient services are covered by all insurance products offered in Colorado Evaluate barriers to condom access in pharmacies and grocery stores throughout Colorado Provide preventive family planning services through mobile health clinics that serve rural and small-town communities Allow advanced practice nurses with prescriptive authority to distribute and administer prescription contraceptives Revise state statute regarding mandated, comprehensive planning for cities and counties to include health care and family planning care Develop social marketing and public education campaigns to increase contraceptive use and knowledge of the impacts of unintended pregnancy

11. Recommendations Specific to Adolescent Health Provide preventive reproductive health care services and dispense contraceptives on-site through school-based health centers that deliver health care to adolescents in Colorado Opportunities Community interest/demand Established experts Programs in progress Challenges Community objection Long-term Funding

12. Recommendations Specific to Adolescent Health Expand access to programs that have been proven to help pregnant and parenting teens finish high school Opportunities Colorado Dropout Initiative Political will, existing expertise Existing programs Challenges Funding Limited data

13. Recommendations Specific to Adolescent Health Aggressively Implement Colorado House Bill 07-1292 Opportunities Healthy Colorado Youth Alliance Change in political, funding climates Content standards review process National and other states can be used as models Challenges Political, philosophical disagreements over content and role of public school system in providing sex education Funding and training for educators Lack of clarity about curricula that adhere to statute

14. Operating Environment Constitutional fiscal formulas State and local revenue shortfalls Local control Multiple cooks in the kitchen –Parents –Educators –Medical community –Students –Advocacy groups –Trade associations –Local government –State government (Legislature, CDE, CDPHE)

15. Related Research & Resources From Accessing Contraceptives: Barriers to Access for Colorado Women 5.5% of pharmacies do not fill prescriptions for birth control and 9.5% do not sell emergency contraception. Of the pharmacies that carry Plan B®, 6.2% have at least one pharmacist that would refuse to sell it. 22.3% of clinics do not prescribe or provide contraceptives and 39.6% do not provide access to emergency contraception. 16% of Colorado counties do not have clinics where women can obtain emergency contraception. Full report available at the Prevention First Web site: www.PreventionFirstColorado.org

16. Related Research & Resources Reproductive Health in Colorado: A State Profile Baseline metrics reveal the need for a comprehensive reproductive health care agenda NARAL Pro-Choice Colorado researched and compiled a collection of reproductive health care indicators by state legislative district as an educational resource to enable policymakers to examine baseline heath care needs and disparities by geographic location. Full report available at www.prochoicecolorado.org/politicalupdates/districtprofile.shtml NARAL Pro-Choice Colorado: www.ProChoiceColorado.org

17. Thank You Toni Panetta Political Director, NARAL Pro-Choice Colorado (303) 394-1973 ext 17 tpanetta@ProChoiceColorado.org Prevention First Colorado www.PreventionFirstColorado.org NARAL Pro-Choice Colorado www.ProChoiceColorado.org