Introduction

Emergency contraceptive pills (EC) have become more available in many developing coun¬tries. However, limited provider knowledge and negative attitudes, as well as poor user awareness and access, have hindered adolescents in learning about and using EC. Studies have found a delay of about one year on average between starting sexual activities and first use of modern contraceptives¹.

In 1995, worldwide, woman experienced over 300 million unwanted pregnancies resulting in over 700,000 of them to death because of pregnancy related cases. World Health Organization (WHO) estimated that 84 million unwanted pregnancies occur annually world wide. A worldwide study conducted by the WHO to assess the reproductive needs of the population found unexpected discrepancy between the young peoples familiarity with modern contraception and on the other hand the high levels of unwanted pregnancy and unsafe abortion experienced. Millions of women who could benefit from emergency contraception have never heard of it^2,3. In India, where quite a number of pregnancies are unplanned, the need for EC is substantial. Infact, in various studies use of EC has emerged as a starting point for regular use of contraceptive in young adolescents^4,5,6. Various countrywide outreach activities have been launched to increase the awareness regarding EC however acceptance of this method is limited by lack of awareness and access to EC. Hence, this study was undertaken to fill the information gap regarding EC and to be useful in determining the effectiveness of the educational messages and secondly to define the target audience for future campaigns.

The objective of the study was to determine the knowledge, attitude and practices relating to hormonal

EC among college going girls and their mothers.

Material And Methods

This was a observational study conducted among 100 undergraduate female students and their mothers. The study conformed to the declaration of Helsinki and all participants were enrolled after obtaining informed consent, after obtaining clearance from ethics committe and the institute. The study population was subdivided into two groups i.e. 100 undergraduate college girls and their mothers in role of chief care providers. Participants were interviewed using a pre-structured questionnairre. Answers were noted and analysed. All participants were given a short talk on EC. Then their concerns and perceptions on future availability were enquired.

Results

A total of 200 women were included in study subdivided in two study groups: 100 college girls and 100 mothers. Mean age of study population was 41.2 + 2.57 years ( range 38-47 years) for mothers and 19.4+1.9 (range 18-23 years) for college girls. Among mothers, use of contraception was as follows: 16% of them had tubal ligation done. Of the rest 84%, 52% used contraception methods: IUCD –10%, condom-34%, oc pills- 8%.Only 34% had heard of EC and 4% of these had used the EC pills once.70% of them had heard about EC through television, 30% through friend. 38 % of the mothers had MTP done once or more and 14% had given birth to unwanted pregnancy.

Figure 1

Table 1: Contraception practices among mothers and girls

60% mothers said it was a good thing for female health and should be available over the counter but only to adults >18 years old (as for tobacco sale). Only 28% felt they would discuss it with their daughters; 5.6% with their friends and only 8% said they will talk about EC to their female domestic help. 60% of the mothers thought the knowledge of EC should be promoted. All agreed it will increase casual sex rate. 80% mothers thought the promotion campaign should include college girls to prepare them for marriage. No mother thought it should be promoted in school age girls.

Among the college going girls- 40% of the girls had heard of EC: 50% through television, 10% from their mothers while 40% through friends.

Figure 2

Table 2: Knowledge source of Emergency Contraception pill

8% of them were married / sexually active, 4 (50%) of whom had heard of EC, 2 (25%) has used EC once.4 (50%) of the married girls used o.c. pills regularly.70% girls thought it was good for female health and should be freely available to all in medical shops. 24% girls said they would now discuss it with their mother; 70% with friends. Only 2% were willing to discuss it with their teachers in college. 75% girls said promotion of knowledge of EC should be done at college level but only 20% of these said it should include all girls above 14 years age(Table-3). 58% thought it will increase the casual sex but decrease the unwanted pregnancy rate.

Figure 3

Table 3: Attitudes and Practices of Discussion about EC Pills

Discussion

Although emergency contraception is not recommended as a routine family planning method, it is a useful method after unprotected sexual intercourse to reduce the chance of unwanted pregnancies. Emergency contraception is most useful when there is failure of barrier methods such as slippage and breakage of condoms, or when sexual intercourse was unpremeditated.However women need to know about emergency contraception and should be willing to use emergency contraception before it can be effective. Surveys among university and postsecondary students in several American and African countries found that while a quarter to three-quarters of youth had heard of emergency contraception, accurate knowledge about its use was minimal^7,8,9. In one study in Nigeria by Arowojolu et al¹⁰, 75 percent of students surveyed were aware of emergency contraception, but only 12 percent knew that the first dose of EC should be taken within 72 hours of unprotected intercourse In a Ghana study by Baiden et al¹¹, only 11 percent of the students surveyed (22 of 196 surveyed) knew the correct timeframe for starting EC.

A study by Tripathi et al¹² in northern India reported that very few of the youth surveyed (women seeking abortions and college students) were familiar with the concept of emergency contraception. In a survey by Ehlers et al ¹³of adolescent mothers in South Africa, 189 out of the 250 respondents (76 percent) did not know about the availability of emergency contraceptives. Aziken et al¹⁴ in a study of female undergraduate students in Nigeria, observed that 58 percent were aware of emergency contra¬ception, but only 18 percent of those women knew the correct timeframe in which ECPs are most effective In addition, misconceptions regarding emergency contraception, such as its side effects, were also a significant finding. This study emphasizes the need for better education and awareness programs.

In our study, 8% of mothers were using oral contraceptives and 32% were not using any contraception as compared to a study by Marafie et al¹⁵ where 30% were using oral contraceptives and 28% were not using any contraception. In the study by Ebuchi et al¹⁶ 96.8% had practiced contraception while 81.1% practiced contraception in the study of Takkar et al.¹⁷

In our study,39% of the mothers and 40% of girls had heard of EC, as compared to 6.1% in the study of Marafie et al¹⁵ and 67.8% in the study of Ebuchi et al¹⁶.In the study of Puri et al¹⁸ 7.3% had knowledge about emergency contraceptive. 4% of mothers had used EC in our study as compared to 2.6% in the study of Takkar et al¹⁷. 56% mothers felt they will discuss it with their friends 28% with their daughters .Quite a number of girls said they will discuss it with their friends (70%) and mothers (24%).In the study of Marafie et al¹⁵, 65.2% felt they would not talk of EC with their friends. Berhanu et al ¹⁹ found that 47% of the university students mentioned that they have ever heard of EC as a means of preventing unwanted pregnancy if used soon after unprotected sexual intercourse. only 25.7% had good knowledge of EC.

60% felt it would be good for women’s health and wanted them to be freely available as compared to Marafie et al¹⁵ in whose study 83.3% felt it was a risk to women’s health 90.9% in their study also wanted the hormonal EC to be freely available. Source of knowledge was mainly television in 70% of the mothers and 50% of the girls, friends in 30% mothers and 40% girls as compared to Ebuchi et al¹⁶ where source was health care providers in 34% and Takkar et al¹⁷ where print and electronic media were the common source of public awareness in 57.7%. According to Berhanu et al¹⁹ most frequently mentioned source of information about EC was TV/Radio (44.1%), followed by female friends (16.9%) and healthcare providers(9.6%).Corbett et al²⁰ in their study of university population concluded that There was an association between advanced prescription for EC and its likelihood of use. Most women would be significantly more likely to use EC if they had a prescription on hand. Of the women who were less likely to choose EC, 100% indicated they would feel embarrassed or judged when asking for it. Only 34% of those women who have had a gynecological exam in the past 12 months had discussed EC with their provider. Similar findings were reported by Vahratian et al²¹; they concluded that advance discussion and provision of EC is underutilized. Only 10% of all female respondents indicated that their current health care provider had spoken to them about EC in a routine health visit and just 5% of female respondents were offered a supply of EC in advance of need.

Conclusion

Knowledge about EC among the college girls and their mothers was poor with some concern for poor availability. One challenge in educating college students and other young adults about EC is the identified lack of information about EC shared by health care providers with this population. The challenge to health care providers is to increase awareness and utilization of such preventive services. It is recommended to continue with awareness programs regarding EC through various channels. Factors influencing the usage and lack of communication among mothers also need attention. EC should be made freely available with some concern regarding their use among the younger women and promotion of casual sex. In developing countries such as India, a sex education program at college level may be introduced to provide at risk population with comprehensive knowledge.

Acknowledgement

The authors want to acknowledge all the people who have contributed significantly to the article.