O.O. Ogunbode1, R. Takpe2, A. Adeniyi2, A.M. Ogunbode3, A. Agboola2
- Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan.
- Department of Obstetrics & Gynaecology, University College Hospital, Ibadan.
- Department of Family Medicine, University College Hospital, Ibadan, Ibadan.
Background: Unintended pregnancies contribute to the high burden of unsafe abortion, maternal deaths and morbidities among undergraduates.
Objective: To assess the determinants of good knowledge and evaluate the trends in the practice of Emergency Contraception (EC) among female undergraduates.
Method: This was a cross sectional study involving four hundred and twenty female undergraduates from two universities in Ibadan, Nigeria. Participants were recruited from their hostels and classrooms. Data collection was done using self-administered questionnaires and good knowledge was defined as three correct answers to five questions testing knowledge. The questionnaires also addressed their practices of EC. The data was stored on the computer, cleaned and analyzed using the Statistical Package for the Social Sciences (SPSS) version 22. Statistical significance was set at p <0.05.
Results: Two hundred and fourteen (51.0%) participants were aware of EC and the common sources were friends (43.4%), media (42.9%) and pharmacies (42.0%). One hundred and sixty-four participants (39.1%) had good knowledge of EC. Participants in the age group 20-24 years, second year of study, those who were aware of EC and had ever used EC were associated with good knowledge. Less than half (48%) of the sexually active participants used EC in the past six months and Levonogestrel (51%) was the commonest EC used. Menstrual irregularity and abdominal pain were the major side effects of EC.
Conclusion: The practice of EC is poor and with poor knowledge demonstrated among female undergraduates. There is therefore the need to improve information and access to EC in the university community.
Keywords: Emergency contraception, Determinants, Knowledge, Practice, Female undergraduates
Dr. A. Agboola
Dept. of Obstetrics and Gynaecology,
University College Hospital,
Date of Acceptance: 31st Dec., 2022
Unintended pregnancies account for approximately forty percent of all pregnancies worldwide.1 With this growing scourge, it is no surprise that over 44 million pregnancies end in abortion annually. In Africa, many of these abortions being unsafe, are major contributors to maternal and infant mortality.2 It is common knowledge that youths have risky sexual behaviours and constitute a high-risk group for these unwanted pregnancies.3-5 Despite the social and cultural importance of childbearing in African societies, unwanted pregnancies are a source of concern in most families. This problem is magnified in unmarried youths and those who follow through with the pregnancies have higher unmet social needs and obstetric risks.5-7
Contraceptive use is an important strategy for the prevention of unwanted pregnancy and consequently reduces the incidence of induced abortion. In developing countries where the fertility rates are high, contraceptive use will guarantee human and socioeconomic development.2 Furthermore, the rate of induced abortion is an appropriate indicator of the current state of medical care and family planning in any country.8
Studies have shown varying levels of knowledge, attitude and practice of contraception among adolescents in Nigeria.9,10 The Nigeria Demographic and Health Survey in 2018 revealed that contraception prevalence rates in the country were low while modern contraceptive use was higher among sexually active unmarried women (28%) than among currently married women (12%). 11 The promotion of emergency contraception (EC) may be a ‘second chance method’ or an ‘option B’ in preventing pregnancy in adolescents with an unmet need,improper and/or inconsistent use of contraception and those who have experienced coerced unprotected sex or in cases of sexual assault.12
EC is defined as any drug or device which when used after intercourse will prevent pregnancy. Since the first description of EC in 1960, its popularity has increased but knowledge is still limited globally13. Generally, a lack of awareness restricts access to the use of EC and increased access is generally associated with increased use. It has also been shown that good knowledge of EC does not translate to adequate uptake.14
Currently, there are several options for EC, including progestin only pills (ECPs) which contain Levonorgestrel, progesterone modulators (Ulipristal cetate), anti-progesterone synthetic steroids (Mifepristone), and the copper intrauterine device (IUD).15 In many countries, Levonorgestrel is the most available, accessible and acceptable of the lot.1
Youths in Nigeria have poor awareness, knowledge and practice of EC12,16. Ajayi et al. revealed that some female undergraduates erroneously use non-emergency contraceptive pills and concoctions as EC in Nigeria14 . It is important to study the awareness, practice and knowledge of females to EC as these should be the major drivers of its uptake since the available options are tailored to their use and females bear the brunt of the consequences of unwanted pregnancies.
This study aimed to assess the awareness and knowledge of emergency contraception among young females with undergraduates as a case study. The results from this study will help develop strategies necessary in reducing morbidities and mortalities from unwanted pregnancies and achieving universal access to sexual and reproductive health.
MATERIALS AND METHODS
This was a cross sectional study involving four hundred and twenty female undergraduates from two Nigerian Universities in Ibadan, namely University of Ibadan (UI) and Lead City University (LCU), Ibadan. The UI, Ibadan, Oyo State, Nigeria is a public university and the oldest degree-awarding institution in Nigeria which is made up of ninety-two academic departments organised into 17 faculties. LCU, Ibadan, on the other hand, is a private university founded in 2005 and is made up of seven faculties.
Ethical approval was obtained from the UI/University College Hospital (UCH), Ibadan, Institution Research Board. The sample size was calculated using the Kish and Leslie formula for cross-sectional studies, assuming 95% level of confidence and 5% margin of error. The proportion of sexually exposed undergraduates of 48.2% from a previous similar study was used in the sample size calculation.
The five institutions in Ibadan namely Ajayi Crowther University, LCU, Kola Daisi University, Dominion University and UI were allocated numbers from 1-5, folded and put in an opaque envelope and two sample institutions were selected by simple random sampling techniques, while participants were recruited from their halls of residence and classrooms. Four research
personnel were trained to collect the data using selfadministered, pre-tested questionnaires. Good knowledge of EC was defined as three correct options in a five-item questions testing knowledge. The confidentiality of participants was ensured throughout the study.
The data was stored on the computer, cleaned and analyzed using Statistical Package for the Social Sciences (SPSS) version 22. Data analysis was summarized using descriptive statistics and charts. Test of associations was done using Chi square and Yates correction, while statistical significance was set at p <0.05.