Knowledge and Practice of Emergency Contraceptives among Students at Ambo Techniques College, Ethiopia

Abstract

Background: In Ethiopia, particularly, in the study area data on knowledge, attitude and practice of emergence contraceptives among youth in school and college level is lacking. This could be evidenced by the high rates of unwanted pregnancies as well as sexually transmitted infections in these age groups. Therefore, in this study, we are meant to fill such gap in the study area. Methods: A cross-sectional survey was conducted among 305 female students at Ambo Technique College in Ethiopia from March to September 2013. Results: In this study, 80.7% of the respondent had ever heard about Emergence Contraceptives (EC). Yet majority of the respondent (84.6%) had not used the method despite the significant sexual practice they made. About 77.4% of the students have positive attitude towards EC. Conclusion: The respondents in this study had high level of knowledge and positive attitude about EC yet very low level of utilizing the method. Therefore, much work need to be done to identify the reasons behind this lower utilization rate and prompt addressing to increase its up take to the acceptable degree. Lastly, responsible stakeholders have to device structured reproductive health education at college level as one of the tool to achieve the country’s millennium development goal related to family planning.

Full text

Knowledge and Practice of Emergency Contraceptives among Students at Ambo
Techniques College, Ethiopia
Jimma Likisa Lenjisa1*, Dinkinesh Ulfina2, Ebissa Tamme2, Gemechu Kaba2, Hadas Berehe2, Netsanet Lemma2 and Minyahil Alebachew Woldu1
1College of Medicine and Health Sciences, Department of Pharmacy, Clinical Pharmacy Research and Course Team, Ambo University, Ethiopia
2College of Medicine and Health Sciences, Department of Nursing and Midwifery, Ambo University, Ethiopia
*Corresponding author: Jimma Likisa Lenjisa, College of Medicine and Health Sciences, Department of Pharmacy, Clinical Pharmacy Research and Course Team,
Ambo University, Ethiopia, Tel: +251917305585; E-mail: jimmapharm@gmail.com
Received: April 10, 2014; Accepted: July 16, 2014; Published: July 23, 2014
Copyright: © 2014 Lenjisa JL, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: In Ethiopia, particularly, in the study area data on knowledge, attitude and practice of emergence
contraceptives among youth in school and college level is lacking. This could be evidenced by the high rates of
unwanted pregnancies as well as sexually transmitted infections in these age groups. Therefore, in this study, we
are meant to fill such gap in the study area.
Methods: A cross-sectional survey was conducted among 305 female students at Ambo Technique College in
Ethiopia from March to September 2013.
Results: In this study, 80.7% of the respondent had ever heard about Emergence Contraceptives (EC). Yet
majority of the respondent (84.6%) had not used the method despite the significant sexual practice they made.
About 77.4% of the students have positive attitude towards EC.
Conclusion: The respondents in this study had high level of knowledge and positive attitude about EC yet very
low level of utilizing the method. Therefore, much work need to be done to identify the reasons behind this lower
utilization rate and prompt addressing to increase its up take to the acceptable degree. Lastly, responsible
stakeholders have to device structured reproductive health education at college level as one of the tool to achieve
the country’s millennium development goal related to family planning.
Keywords: Emergence contraceptives; Knowledge; Attitude;
Practice; Ambo TVET
Introduction
Ethiopia has one of Africa’s youngest populations at the beginning
of the 21st century. About one out of every four females in Ethiopia is
16-24 yrs old. This is the largest group of young people ever in the
region to inter adulthood. Helping Ethiopian youth to make a healthy
transition to adulthood is critical to the countries development and
prosperity of its future population. Worldwide young women and men
suffer a disproportionate share of unplanned pregnancies, Sexually
Transmitted Diseases (STD) including HIV and other serious
reproductive health problems. To alleviate this problem, increasing
accessibility and awareness of contraception methods including
emergency contraception’s to these vulnerable young population is a
critical step to be implemented [1,2].
Emergency contraception is a kind of contraception method that is
used in the prevention of pregnancy following an episode of
unprotected intercourse during the fertile period. It has the potential,
as the last resort, to avoid unwanted pregnancy and therefore abortion;
a desirable goal especially when abortion is illegal. Oral contraceptive
pills and Intrauterine Contraceptive Devices (IUCDs) are mainly used
as emergency contraceptives. When used within 72 hours after sexual
intercourse, pills have the capacity to prevent pregnancy by 75-85%
and with the use of IUCDs unwanted pregnancy can be prevented by
as much as 99% [3].
Statement of the problem
Unwanted pregnancy leading to unsafe abortion is one of the most
important causes of maternal morbidity and mortality. Unsafe
abortion is a major medical and public health problem in Ethiopia [4].
Ethiopia has a high incidence of unwanted pregnancies and
incomplete and unsafe/septic abortions, particularly among
adolescents. For this reason, it is reported that about four million
adolescents experience induced abortion each year [5].
Moreover, Ethiopia is the second most populous country in Africa,
with an estimated population of 93,877,025 despite the substantial
increase in the use of modern contraceptives from 6% in 2000 to 27.3%
in 2011. One of such method is Emergence Contraceptives (EC) which
was introduced in Ethiopia in 1997. There is no national data exist on
the percentage of Ethiopian women who have used EC. However,
studies in different parts of the country show very low utilization rate
(as low as 10%) of the method despite the significant proportion of
youth have ever had sex in their life time. The most frequently
reported reasons for the non-use of the method are fear of side effect
and lack of information (knowledge). The knowledge of sexually active
unmarried women, in this regard it is found to be 41% nationally
which is very much lower than what is expected to be [6-9].
Reproductive System & Sexual
Disorders Lenjisa et al., Reprod Syst Sex Disord 2014, 3:3
http://dx.doi.org/10.4172/2161-038X.1000136
Research Article Open Access
Reprod Syst Sex Disord Male Reproduction & Infertility ISSN:2161-038X RSSD, an open access journal
: Current Research

The potential of EC to prevent unintended pregnancy is well
documented but the awareness & use of the method in our country is
poor. Scientific evidences shows that three fourth of unplanned
pregnancy can be prevented by using emergency contraceptives after
unprotected sexual intercourse [10]. However, the problem of
unintended pregnancy still exists despite the fact that different modern
contraceptives exist worldwide. This could be attributed to the lack of
information and negative attitudes towards the method [11,12]. In
light of this, we are interested in examining problems concerning
knowledge, attitude and practice of emergency contraceptives among
Ambo TVET female students.
Significance of the study
The study is searching for facts and information’s on the
knowledge, attitude and practice of emergency contraceptives which is
believed to be the second opportunity to prevent unintended
pregnancy after unprotected sexual intercourse among female
adolescent and young adult. Therefore, the findings can benefit
governmental and non-governmental organization working to provide
reproductive health service of these populations. Furthermore, Ambo
health office and non-governmental organization found around the
study area and also in Ethiopia like family guidance associations which
are providing emergency contraceptive service can utilize the result of
this study as a base line data in planning awareness creation programs
for female college students.
Methods and Materials
Study design
A descriptive cross sectional study was used to assess knowledge,
attitude and practice of students in the study area.
Study area and period
The study was conducted from March to September 2013 at Ambo
Technical and Vocational Educational Training College (TVETC) in
Ambo town. Ambo town is located at about 116 kilometers to the west
of the capital city; Addis Ababa. Ambo Technical and Vocational
Educational Training College (TVETC) was established in 1994. There
are a total of 2043 (1028 male and 1015 female) regular students
enrolled in the academic year 2012/13. The students attending this
college are selected from different locations giving an opportunity for
the generalizability of the findings to versatile population groups. All
Female regular students of age 15 years or more were included. We
excluded those who are absent from class on the day of data collection
and not willing to participate in the study.
Sampling and data collection procedure
Simple random sampling techniques were applied to select 305
from 1015 female regular students enrolled to Ambo TVET College in
2012/13 academic year. List of students from all departments was
prepared and given a number from 1 to 1015 then the study unit is
selected by using table of random numbers. Data collection was
carried out by trained four clinical nurses up on supervision of the
principal investigators. Self-administered questionnaires were used as
the tool for data collection. In order to minimize bias due to language
barriers, the questionnaires which originally prepared in English was
translated to local language of the study participants called Afan
Oromo version. This tool contains three important parts:
sociodemographic information, sexual history and questions that
accesses knowledge about, attitude towards and practice of emergency
contraceptives. To assure true responses by the student, collage
teachers and authorities didn’t involve in administering the
questionnaires.
For the purpose of the present study, we had defined Knowledge as
a study subject who responded correctly to more than four out of six
emergences contraceptive awareness related questions. Attitude as a
subject of study who had a favorable response to more than 3 out of 5
attitude statements and Practice implies subjects who had ever used
emergence contraceptive once or more in their life time. Sexually
active when sexual intercourse is practiced in the past six weeks. Lastly,
ever had sexual intercourse was defined as an individual who had
practiced sex once or more in her life time.
Data processing and analysis
Data was analyzed using SPSS version 20.0. Then descriptive
statistics are performed. Finally, the results were organized in number
and percentage for categorical data while as mean and range for
continuous variables and presented using narrative statements and
tables.
Ethical consideration
Ethical clearance was obtained from Ambo University, College of
Medicine and Health science research and technology transfer team.
Then informed consent was obtained from each and every study
participant before data collection began. Participants filled the
questionnaire privately and all necessary precautions’ were taken to
maintain the confidentiality of the information to be collected.
Results
Socio-demographic characteristics
We had got 100% response rate in this study. As shown in Table 1,
the age of study participants mostly (73.1%) falls in the range of 15 to
35 years. Most of the respondents (59%) were followers of Orthodox
Christianity followed by Protestants who accounted for 20.6%. Again,
majority (86.5%) of the respondents were not married and almost all
Oromo in ethnicity.
Characteristics Number Percent
Age in years
15-19 223 73.1
20-35 82 26.9
Marital status
Married 41 13.5
Unmarried 264 86.5
Religion
Orthodox 183 60.0
Protestant 63 20.6
Muslim 59 19.4
Citation: Lenjisa JL, Ulfina D, Tamme E, Kaba G, Berehe H, et al. (2014) Knowledge and Practice of Emergency Contraceptives among
Students at Ambo Techniques College, Ethiopia. Reprod Syst Sex Disord 3: 136. doi:10.4172/2161-038X.1000136
Page 2 of 5
Reprod Syst Sex Disord Male Reproduction & Infertility ISSN:2161-038X RSSD, an open access journal

Ethnicity
Oromo 303 99.3
Other 2 0.7
Year of study
Level II 92 30.2
Level III 209 68.5
Level IV 4 1.3
Table 1: Socio-demographic characteristics of the respondents, Ambo,
Ethiopia, 2013.
Sexual history and pregnancy related issues
As it can be seen from Table 2, history of recent sexual intercourse
of the respondents was very low (1.6%). Surprisingly, all of them who
had sex during the survey responded that they have not used condom.
A total of 26 respondents replied that they had been pregnant at least
once previously of which unwanted or unplanned pregnancy
constituted 76.9%.
Characteristics Number Percent
Ever had sex during this month
Yes 5 1.60
No 300 98.4
Ever used condom at this time
Yes 0 0
Ever been pregnant
Yes 26 8.5
No 279 91.5
Unwanted pregnancy (n=26)
Yes 20 76.9
No 6 23.1
Induced abortion (n=26)
Yes 2 7.4
No 24 92.6
Table 2: Sexual and reproductive health characteristics, Ambo,
Ethiopia, 2013.
Knowledge about EC
Table 3 shows that in this study, 80.7% of the respondents have
heard about products that can be used for emergency contraceptives.
Among those who heard about the products, they report that the
major reason to use those products is rape (41.1%). More than half of
respondents (52.9%) reported that the correct time interval to use
emergency contraceptives was 72 hours. When asked about specific
types of emergency contraceptives, 54.4% mentioned pills and 25.2%
mentioned injectable while 16.4% mentioned IUCDs. The major
source of information that is known by the respondents was
government health institutions (about 60%) followed by media (radio/
television) as depicted on Figure 1.
Characteristics Number Percent
Ever heard of product for EC
Yes 246 80.7
No 59 19.3
Perceived reasons to use those products
(n=246)
Condom breakage/slippage 60 24.4
Intercourse without contraceptive 60 24.4
Rape 101 41.1
Others 25 10.0
Time interval to use EC
12 hrs 18 7.3
24 hrs 29 11.8
48 hrs 32 13.0
72 hrs 130 52.9
1 week 8 3.2
Other 29 11.8
Type of EC ever heard
Pills 136 54.4
Injectable/Depo 63 25.2
IUCD 41 16.4
Others 10 4
Do you know where to get information
about EC
Yes 262 85.90
No 43 14.10
Do you know where EC is available
Yes 265 88.33
No 35 11.67
Table 3: Knowledge about EC of the respondents, Ambo, Ethiopia
2013.
Utilization of EC
As it is shown in Table 4, only 12.5% respondents reported that they
had used emergency contraceptive methods previously. All
participants who had used emergency contraceptive methods reported
that the methods were effective in protecting unwanted or unplanned
pregnancy. Majority of the respondent (73.7%) also indicated that they
got the service of emergency contraceptives from the government
health institutions followed by family guidance Ethiopia (13.2%).
Citation: Lenjisa JL, Ulfina D, Tamme E, Kaba G, Berehe H, et al. (2014) Knowledge and Practice of Emergency Contraceptives among
Students at Ambo Techniques College, Ethiopia. Reprod Syst Sex Disord 3: 136. doi:10.4172/2161-038X.1000136
Page 3 of 5
Reprod Syst Sex Disord Male Reproduction & Infertility ISSN:2161-038X RSSD, an open access journal

Figure 1: The main sources of information about emergency
contraceptive.
Characteristics Number Percent
Ever used EC
Yes 38 12.5
No 267 87.5
Result of using EC (n=38)
Effective/no pregnancy 38 100
Not effective/pregnancy 0 0
Where did you get service EC (n=38)
Government health institutions 28 73.7
Family guidance Ethiopia 5 13.2
Private clinic 3 7.9
Community pharmacy 2 5.2
Table 4: Utilization of EC by respondents, Ambo, Ethiopia, 2013.
Attitude toward EC
Table 5 shows that 77.4% of the respondents have positive attitude
towards emergency contraceptives. Majority of the respondents (about
69.8%) do not belief that emergency contraceptive help to induce
abortion. About 85.6% of the respondent agreed to advice the future
use of emergency contraceptives. During unprotected sexual
intercourse. However, a significant proportion of respondents (33.1%)
reported that induced abortion is preferred than using emergency
contraceptive.
Characteristics Number Percent
Positive attitude about EC
Yes 236 77.4
No 69 22.6
Do you support EC
Yes 244 80
No 50 16.4
No response 11 3.6
Do you belief EC help induce abortion
Yes 92 30.2
No 213 69.8
Do you advice to use EC
Yes 261 85.6
No 44 14.4
Induced abortion is preferred to EC
Agree 101 33.1
Disagree 204 66.9
Table 5: Attitude toward EC of the respondents, Ambo, Ethiopia, 2013.
Discussion
The present study has generated data of considerable importance
regarding the knowledge of college students on EC, their attitude
toward the method and the extent to which they have utilized it since
they started sexual intercourse. The findings will be valuable input for
policy makers and other stakeholders working on sexual and
reproductive health services in the region for planning and provision
of EC services for the youth with unmet need of the method under
consideration. Accordingly, these findings are discussed below in view
of national and international data previously available to further
consolidate the applicability of the findings.
In Ethiopia, it is indicated that only 19% of all women (41%
unmarried) had knowledge about ECs [7]. In previous work
conducted by Jimma et al. on Ambo University female students, it was
found that 62.5% of the students have information about the method.
The present study showed even higher knowledge for the respondents
than our previously published work [13] regardless of the fact that
university students are believed to have better overall knowledge than
college students. This is similar to the findings of other studies
conducted in among the biggest and oldest universities of Ethiopia like
Hawassa University, Addis Ababa University and Jimma University
[8,14-17]. In India it is reported that 90.3% college students have ever
heard about EC [18]. These findings highlight the need for further
study to find out the attributes of college students that could
responsible for increasing their knowledge.
Correct timing is the single most important determinant of EC
effectiveness; the shorter the time between unprotected intercourse
and utilization of EC, the better will be its effectiveness. In this study,
52.9% of the respondents mentioned the correct time (maximum 72
hrs) since the unsafe sex which is comparable to our previous work
and Hiwot et al. [13, 14]. However, this is higher than that of Anteneh
et al. (35%) and lower than the 68.8% obtained by Vijender et al. [18].
Different studies identified different sources providing information
on EC. Accordingly, the most commonly stated sources of information
for this type of contraception include media [13], health institutions
[3], school [14], and friends as well as media [15], TV, magazine and
Citation: Lenjisa JL, Ulfina D, Tamme E, Kaba G, Berehe H, et al. (2014) Knowledge and Practice of Emergency Contraceptives among
Students at Ambo Techniques College, Ethiopia. Reprod Syst Sex Disord 3: 136. doi:10.4172/2161-038X.1000136
Page 4 of 5
Reprod Syst Sex Disord Male Reproduction & Infertility ISSN:2161-038X RSSD, an open access journal

internet [18]. The present study showed government health
institutions to be the most common source of information stated by
respondents.
These evidences clearly show that method mix (combination of TV,
magazine and the like) has to be used to make EC information as
widely disseminated as possible so as to increase the awareness of
youth and adolescents in universities and colleges as well as the
communities at large about this kind of contraception.
The prevalence of sexual practice among university and college
students is known to be high which is mostly unprotected yet the
proportion of this wing of population found to use EC is very low as
explored by different studies. It ranges from 4.9% to 36.5% for
Ethiopian students [13-15]. Similarly, lower utilization rate of 12.5%
had been obtained in the present study. Among women undergoing
abortion, the utilization is even lower to the level of not existing [3,16].
This very lower utilization rate of the method in all cases is despite the
respondents’ acceptable level of knowledge and high degree of sexual
practices. For this, different scholars put different reasons for EC non-
use including but not limited to fear of side effects, fear of becoming
infertile after use, lack of information, religion, culture, partner
disagreement, fear of being seen by others, inconvenient service
delivery and many more [3,9,17]. Therefore, campus wide well
organized reproductive health education is timely and a must to be
implemented for this group in order to increase the uptake of the
method so as to avoid the high rate of unwanted pregnancy associated
with it.
In contrast to what have mentioned for extent EC utilization, most
studies showed that female students have favorable attitude for the
method. We have come across positive attitude of 53% to 100% during
our literature review [3,13-16]. The finding of this study also falls in
this range. However, this doesn’t mean that we should not have to
work on this issue. This is because there are still many misconceptions
and wrong belief like it increases risky behaviors, fear of misuse,
propagate HIV/AIDS, discourage the use of other methods, causes
birth defect and the like [3,13,14]. Hence all these need to be addressed
to make the knowledge of, attitude toward and utilization of EC to go
side by side to minimize unwanted pregnancy and its complications
among college and university students which are now constituting the
major proportion of world population.
Lastly, as other cross-sectional studies, our study is limited by the
fact that we couldn’t establish causation among any variables.
Secondly, there could be some degree of biasness as the study was
based on self-reported questionnaires.
Conclusion
In general, students in this college have acceptable level of general
knowledge and attitude. However, their utilization of emergence
contraceptives is very low secondary to different myths and
misconceptions that need to be addressed soon by the government and
other responsible stakeholders. Moreover, method mix has to be used
to make EC information as widely disseminated as possible to increase
the awareness of college and university students about the method.
Lastly, campus wide well organized reproductive health education is
timely and a must to be implemented for this group in order to
increase the uptake of the method.
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This article was originally published in a special issue, entitled: "Male
Reproduction & Infertility", Edited by Eric Chung Princess Alexandra Hospital
Australia & Jermane Bond Joint Centre Health Policy Institute USA
Citation: Lenjisa JL, Ulfina D, Tamme E, Kaba G, Berehe H, et al. (2014) Knowledge and Practice of Emergency Contraceptives among
Students at Ambo Techniques College, Ethiopia. Reprod Syst Sex Disord 3: 136. doi:10.4172/2161-038X.1000136
Page 5 of 5
Reprod Syst Sex Disord Male Reproduction & Infertility ISSN:2161-038X RSSD, an open access journal