Emergency contraceptives (ECs) need to be available and used appropriately as a backup in case regular contraception is not taken by people like university students. This study was conducted to assess emergency contraception use and its associated factors among female undergraduates of Arba Minch University. A cross-sectional study was conducted among 515 undergraduates using a structured questionnaire. Respondents were selected by the stratified random sampling technique and data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression models were fitted to identify associated factors. The adjusted odds ratio with a 95% confidence interval was used to present the identified risk factors. The prevalence of emergency contraception use among Arba Minch University students was 78.0% (95% CI: 71.5%, 84.5%). Better information about emergency contraceptives (AOR = 6.3; 95% CI: 2.4, 9.7), good approach of EC service providers (AOR = 9.3; 95% CI: 2.4, 11.6), and positive attitude about ECs (AOR = 2.4; 95% CI: 1.5, 7.2) were factors significantly associated with EC use. The prevalence of emergency contraceptive use noted in this study was comparatively higher than the results found by previous studies conducted in Africa and Ethiopian universities. Continuing support for and wider dissemination of the class are recommended. The fact that the students/participants readily accepted the preceding provisions made such positive findings possible and sustainable.
Over 100 million acts of sexual intercourse take place each day in the world, resulting in around 3 million conceptions of which 50% are unplanned and 25% definitely unwanted [
A systematic review of the causes of maternal mortality estimated that unsafe abortion accounted for 13% of all maternal deaths in Africa [
Adolescent girls face a high risk of unintended pregnancies and unsafe abortions with devastating consequences on their health and life [
The Ethiopian Parliament amended the penal code on abortion in 2005. The new law has improved access to safe abortion care by expanding the legal indications [
Emergency contraceptive is a type of modern contraception administered after unprotected sexual intercourse which plays a vital role in preventing unintended pregnancy, unsafe abortion, and unintended childbirth which are the major problems of maternal health [
In Ethiopia, the most common method of EC involves taking postcoital pills as soon as possible, optimally within 72 hours after unprotected sex. A second dose is taken 12 hours later. The insertion of an intrauterine device (IUD) within 5 days of unprotected sex is another less frequently used method of ECs [
Previous studies conducted in Nepal, Ghana, South Africa, and Nigeria showed that the level of EC utilization among female undergraduates was 8.4% [
International and national evidences regarding factors associated with EC use showed that age [
Evidence further showed that university students have history of different risky sexual behaviors that exposed female undergraduates to unintended pregnancy [
The institution based cross-sectional study was carried out to assess the prevalence of and factors associated with EC use among female undergraduates of AMU. The study was conducted on Arba Minch University female undergraduate students in October 2015. Arba Minch University is one of the most well-established universities found in Southern Nations, Nationalities, and People’s Region. It is located in Arba Minch town 500 km south of Addis Ababa. The main campus of the university is situated at the eastern foot of Gamo mountain ranges adjacent to the vast lowland stretching towards lakes Abaya and Chamo which are part of the East African Rift Valley system. In the 2014/2015 academic years, a total of 16, 520 students were enrolled in the regular programs of which 4,741 (28.7%) were females. In the undergraduate programs, women constitute 12.4% of the student population at the moment [
All AMU undergraduate female students and all such students who were available on campus during data collection were the source and the study population of this work. Students who were sick and unable to communicate during data collection were excluded.
The sample size was calculated using the single population proportion formula, assuming a 95% level of confidence interval, 0.05 margin of error, and the proportion of emergency contraception use to be 72.0% [
The outcome variable of this study was EC use, and the independent variables were students grouped under sociodemographic characteristics, knowledge, practice, and attitude towards emergency contraceptives. The dependent variable was dichotomized as “yes” or “no.” Sociodemographic variables were collected using questions about the following: the age of the students which is divided into three groups as 18–20, 21–25, and >=25 years; religion as Orthodox, Protestant, Muslim, and others; campus as health science and non-health science; year of study as first year, second year, third year, and fourth year; residence as on campus and out of campus; history of previous residence as urban or rural; ethnicity as Amhara, Oromo, Tigray, and others; sexual and reproductive health history as age (in years) at menarche; age at first sex and history of sexual exposure as yes or no; history of condition of first sexual exposure as wanted (with consent) or unwanted; history of contraceptive use at first sex as “yes” or “no”; history of previous exposure to pregnancy as “yes” or “no”; history of previous EC use as “yes” or “no”; history of approach by EC service provider as “yes” or “no”; history of induced abortion as “yes” or “no”; marital status as married, divorced, separated, and widowed; mother’s and father’s educational status as being illiterate, primary school graduate, high school graduate, and higher education graduate; cultural acceptance of EC use as “yes” or “no”; religious acceptance of EC use as “yes” or “no”; information about EC as “yes” or “no”; students' attitudes towards “EC free of charge could increase the rate of its utilization” as “yes” or “no”; students' attitudes towards “EC is much better than the regular contraceptive methods for preventing unintended pregnancy.” We determined knowledge about ECPs using four multiple-choice questions. Each correct answer was worth corresponding 1 point, that is, 4 points for the four questions. Students were considered to have enough knowledge if they scored above the mean. They were considered not to have enough knowledge if they scored below the mean. The students’ attitudes were measured using seven items rated on a three-point Likert scale as (1) agree, (2) neutral, and (3) disagree. Students were considered to have positive attitude if they scored above the mean and negative attitude if they scored below the mean.
A pretested semistructured and self-administered questionnaire written in English was used to collect data. A pretest was administered on 5% of the calculated sample and appropriate modifications were made. Four female B.S. graduate nurses facilitated the process. Additionally, one male supervisor was recruited to supervise the data collection process. The instructors of the colleges were requested to allow us to use the last 20 minutes of their respective classes administering the questionnaire. After obtaining the written consent of respondents, then data were collected by the facilitators from October 15–30, 2015, under the follow-up of a trained supervisor and the principal investigator for accuracy and completeness. The questionnaire was distributed to the students randomly after proportionally stratifying them as health science and non-health science groups. The supervisor explained points that needed clarifications in the process of completing the forms and checked copies to correct errors on the spot.
In addition to the checkups by the supervisor, all data were manually cleaned, checked, and coded by the principal investigator, in order to maximize the quality of the research. Data from the survey was entered into Epi info version 3.5 and exported to Statistical Package for Social Sciences (SPSS) version 20 software for further analysis. Descriptive statistics were presented using tables, graphs, charts, and frequencies. Variables with <0.2
Ethical clearance was obtained from the Institutional Review Board (IRB) of UoG, College of Medicine and Health Sciences (CMHS), Institute of Public Health. Research permission was obtained from AMU and respective colleges before data collection. The participants were informed about the purpose of the study and the importance of their participation. Respondents were told that they could skip a question/s that they did not want to answer fully or partly and to quit the process at any time they wanted and that their participation was voluntary. After assuring confidentiality of and obtaining the informed consent of participants, copies were distributed to the undergraduate female students in their respective classes under strict secrecy. Participants' privacy was insured by avoiding personal identifiers, by separate seats, and by locking copies to limit data accessibility to a third party.
A total of five hundred and fifteen female students from Arba Minch University participated in the study with a response rate of 96.4%. The majority of the respondents, 372 (72.2%), were from urban areas, while Amhara and Oromo, the major ethnic groups, were 191 (37%) and 113 (22%), respectively. Three hundred and eleven (60.4%) of the participants were Orthodox Christians, the majority, 449 (87.2%), are unmarried at the moment, and 444 (86.2%) belonged to non-health science fields. Four hundred and seventy-four (92%) of the students were living on campus; 154 (29.9%) and 152 (29.5%) were first- and third-year students, respectively. Regarding parental educational status, 166 (32.2%) of the respondents’ mothers attended primary school, while 135 (26.2%) of the fathers had higher education (Table
Sociodemographic characteristics of female undergraduates of Arba Minch University, 2015.
Variables | Frequency | Percent |
---|---|---|
Age (515) | ||
18–20 | 176 | 34.2 |
21–25 | 324 | 62.9 |
>25 | 15 | 2.9 |
Mother’s educational status (515) | ||
Illiterate | 121 | 23.5 |
Primary school | 167 | 32.4 |
High school | 135 | 26.2 |
Higher education | 92 | 17.9 |
Father’s educational status (515) | ||
Illiterate | 75 | 14.6 |
Primary school | 119 | 23.1 |
High school | 119 | 23.1 |
Higher education | 202 | 39.2 |
Cultural acceptance of ECs (515) | ||
Yes | 283 | 55.0 |
No | 232 | 45.0 |
Religion acceptance of ECs (515) | ||
Yes | 184 | 35.7 |
No | 331 | 64.3 |
Over half (58.3%) of the participants reported that they had their periods when they were above 14 years of age. Regarding past sexual history, 200 (38.8%) had sexual intercourse, 175 (87.5%) of them fall in love and desired to practice sexual intercourse, and 32 (16%) were exposed to pregnancy, 16 (50%) of which ended in induced abortions.
More than two-thirds (63%) of the respondents reported that they have heard about emergency contraceptive methods, and 148 (28.7%) and 17 (3%) mentioned oral contraceptive pills and IUDs as EC methods, respectively. Of those who had sexual intercourse, 156 (78.0%) used EC methods. Out of the total participants, 301 (58.4%) had good knowledge about ECs. When participants were asked about the purpose of ECs, 296 (57.5%) said that ECs were used to prevent pregnancy after unprotected sexual intercourse; 265 (51.5%) knew the timing of ECs; 312 (60.6%) knew the side effects of ECs; 37 (70.2%) knew sources of ECs; 301 (58.5%) said ECs should not be used by pregnant woman; and 302 (58.6%) stated that EC pills should not be used regularly like other contraceptive pills.
Out of the total participants, 243 (47.3%) had a positive attitude, while 272 (52.7%) had a negative attitude towards the use of ECs to prevent unintended pregnancy.
Out of the students who used ECs, 52 (33.4%) had the service from pharmacies and 17 (10.9%) from hospitals. Sixty-nine (44.23%) of EC users paid for the service they received. The majority, 349 (67.8%), thought that getting ECs for free would increase the rate of its utilization. Long distance from health facilities and mistreatment by service providers were the two main barriers which prevented getting treatment for 63 (44.5%) and 85 (54.4%), respectively.
Seven variables, such as information about ECs, cultural acceptance of ECs, sexual intercourse by agreement, getting pregnant after sex, treatment by service providers, free ECs, and attitude towards ECs, had
Utilization was higher among participants who had information about ECs than those who had not [AOR (95% CI) = 6.3 (2.4, 9.7)]. Participants who were well approached by EC service providers were nine times more likely to use ECs than those who were mistreated [AOR (95% CI) = 9.3 (2.4, 11.6)]. Those who believed that taking ECs after unprotected sex was much better than the regular use of contraceptive methods to prevent unintended pregnancies were two times more likely to use ECs compared to those who did not believe in that [AOR (95% CI) = 2.4 (1.5, 7.2)] (Table
Showing determinants of EC utilization among female undergraduates of Arba Minch University, 2015.
Factors |
|
COR (95% CI) | AOR (95% CI) | |
---|---|---|---|---|
Yes |
No |
|||
Cultural acceptance of ECs (515) | ||||
Yes | 234 (82.8) | 49 (17.2) | 1 | 1 |
No | 183 (79.0) | 49 (21.0) | 1.3 (0.7, 2.1) | 0.9 (0.2, 3.3) |
Information about ECs (515) | ||||
No | 33 (17.1) | 157 (82.9) | 1 | 1 |
Yes | 307 (94.3) | 18 (5.7) | 0.02 (0.01, 2.60) | 6.3 |
Was the sex performed with consent (wanted sex) (200) | ||||
Yes | 143 (81.7) | 32 (18.3) | 1 | 1 |
No | 13 (52) | 12 (48) | 4.1 (1.7, 9.8) | 4.6 (0.9, 22.4) |
Ever got pregnant after sex (200) | ||||
Yes | 21 (65.6) | 11 (34.4) | 1 | 1 |
No | 135 (81.5) | 33 (18.5) | 0.5 (0.2, 1.0) | 1.9 (0.3, 9.8) |
Had history of well approach by EC service provider (515) | ||||
No | 34 (39.9) | 51 (60.1) | 1 | 1 |
Yes | 260 (60.5) | 170 (39.5) | 0.44 (0.25, 2.4) | 9.3 |
EC free of charge could increase the rate of its utilization (515) | ||||
Yes | 245 (70.2) | 104 (29.8) | 1 | 1 |
No | 150 (90.5) | 16 (9.5) | 0.2 (0.1, 5.0) | 0.3 (0.1, 1.4) |
EC is much better than the regular contraceptive methods in preventing unintended pregnancy (515) | ||||
No | 174 (71.7) | 69 (28.3) | 1 | 1 |
Yes | 228 (83.8) | 17 (16.2) | 0.2 (0.1, 0.9) | 2.4 |
This study assessed the prevalence of and factors associated with EC use among female undergraduate students at Arba Minch University. Of the sexually active students, slightly more than three-fourths used EC methods. Factors like having information about ECs, treatment approach of health care providers, and attitude towards ECs were significantly associated with EC utilization. This finding is similar to that of a study conducted at Addis Ababa University on Ethiopian female undergraduates which reported that 75% used ECs [
This result is higher than those of other studies conducted in African countries, like South Africa 21.2% [
Our finding is greater than those of studies conducted in Ethiopia: Adama University 26.7% [
For instance, when we look at Adama University, the proportion of study participants who had good knowledge on ECs was 27.2% [
The proportion of married participants who had good knowledge about ECs was 58.4% in our work and 21.9% in the study on Arba Minch college students [
The proportion of participants who had sexual intercourse in the study conducted at Arba Minch University was 31.4% which was lower than the 38.8% noted in this work [
In general, the prevalence of EC use in this study is much higher than national and international reports. The possible reasons for this high report of EC use are discussed here. At Arba Minch University SRH is given as a common course to all first-year undergraduates in addition to the activities of youth health clubs and minimedia on campus. Moreover, student clinics were well equipped and service at the clinics was provided by trained nurses with special training on youth-friendly health services. We believe that the reasons above are the main interventions that could raise EC use and the level of knowledge among university students.
This study also showed that EC utilization was around six and half times more common among participants who had information about ECs than those who had not. This finding is consistent with the findings of studies conducted at Adama University [
Participants who believed that taking EC after unprotected sex for the purpose of preventing unintended pregnancy was a better method than using regular contraceptive methods were two and half times more likely to use the method compared to those who did not. This finding is in line with that of a study conducted in Adwa [
The treatment approach of EC service providers was also found to be significantly associated with EC utilization. Those who were well approached by EC service providers were around nine times more likely to use ECs than their counterparts. This finding was in line with that of a study conducted at Adama University [
The prevalence of EC use detected in this study was comparatively higher than those of previous studies conducted in Africa and other Ethiopian universities. Factors found to be associated with EC use were information about ECs, treatment approach of healthcare providers, and attitude towards ECs. Continuing support for and wider dissemination of the class are recommended. The fact that the students/participants readily accepted the preceding provisions made such positive findings possible and sustainable.
Addis Ababa University
Arba Minch University
Adjusted odds ratio
Confidence interval
Emergency contraception
Emergency contraceptives
Ethiopian Society of Obstetricians and Gynecologists
Family Guidance Association of Ethiopia
Intrauterine device
Sexual and Reproductive Health
Statistical Package for Social Science Students.
There are no conflicts of interest regarding the publication of this paper.
Yohannes Ayanaw Habitu, Hedija Yenus Yeshita, Abel Fekadu Dadi, and Desta Galcha were involved in study conception, design, coordination, data collection, data analysis, interpretation, and write-up. Yohannes Ayanaw Habitu prepared the manuscript. All authors read and approved the final manuscript.
The authors would like to acknowledge all the study participants, the data collectors, supervisors, and authorities of AMU, UoG, and IPH for participation in the study and ethical approval.