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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 8  |  Issue : 3  |  Page : 235-239  

Emergency contraception: Knowledge and attitude toward its use among medical students of a medical college in North-West India


1 Department of Community Medicine, GMC, Jammu and Kashmir, India
2 Department of Community Medicine, Dr. RPGMC, Tanda, Himachal Pradesh, India

Date of Submission06-Sep-2015
Date of Decision06-Oct-2015
Date of Acceptance29-Dec-2015
Date of Web Publication22-Jun-2016

Correspondence Address:
Sunil Kumar Raina
Department of Community Medicine, Dr. RPGMC, Tanda, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.175974

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   Abstract 

Context: Emergency contraception (EC) is use of drug or device to prevent pregnancy after unprotected sexual intercourse. Unlike other regular methods of contraception which are taken prior to the sexual act, EC is used after the unprotected sex. Aim: To assess the knowledge and attitude toward use of emergency contraceptives among medical students. Setting and Design: A cross-sectional questionnaire based study was conducted among all the medical students in the Government Medical College in North-West India. Subjects and Methods: A questionnaire seeking information on knowledge and attitude of undergraduate medical students was administered over a period of 4 weeks in the month of February and March 2014. Statistical Analysis: The data were entered in MS excel and expressed using percentages. Chi-square test was used as a test of statistical significance. Results: About 61.6% (247/401) of the participants were aware about the timing of use of EC. Audio visual media (76.6%; 307/401) was the most common source of information for of these medical students. Conclusions: The lack of appropriate in-depth knowledge of EC among future health care professional should alarm the medical teaching system as EC is the only method that can be used to prevent pregnancy after unprotected sex or contraceptive accident.

Keywords: Attitude, emergency contraception, knowledge, medical students


How to cite this article:
Gupta RK, Raina SK, Verma AK, Shora T. Emergency contraception: Knowledge and attitude toward its use among medical students of a medical college in North-West India. J Pharm Bioall Sci 2016;8:235-9

How to cite this URL:
Gupta RK, Raina SK, Verma AK, Shora T. Emergency contraception: Knowledge and attitude toward its use among medical students of a medical college in North-West India. J Pharm Bioall Sci [serial online] 2016 [cited 2019 Dec 12];8:235-9. Available from: http://www.jpbsonline.org/text.asp?2016/8/3/235/175974

Emergency contraception (EC) is defined as the use of a drug or device to prevent pregnancy after unprotected sexual intercourse.[1] It has been shown to be both safe as well as effective.[1] Unlike other regular methods of contraception which are taken prior to the sexual act, EC is used after the unprotected sex. There are two methods of EC: Emergency contraceptive pills (ECPs) and copper-bearing intrauterine devices (IUDs). The progestin only method uses the progestin levonorgestrel in a dose of 1.5 mg, typically up to 72 h after intercourse. This is given either as two 750 μg doses 12 h apart, or as a single dose pill. On the other, the combined or Yuzpe regimen uses large doses of both estrogen and progestin. This regimen recommends taking two doses at a 12 h interval. Levonorgestrel prevents pregnancy by preventing or delaying ovulation. ECPs may also work to prevent fertilization of an egg by affecting the cervical mucus or the ability of sperm to bind to the egg.[2]

Across the world, some additional methods are being used in EC. In addition to progestin only and combined methods, ulipristal acetate has been approved as an ECP in Europe in early 2009 and in the US in August 2010[3] whereas mifepristone is generally used as either EC or as an abortifacient in Russia and China.

IUD is an effective alternative to ECPs for EC. Among the IUD's, copper-T IUD can be used up to 5 days after unprotected intercourse.[3] The copper-bearing IUD primarily prevents fertilization by causing a chemical change that damages sperm and egg before they can meet.[2]

As per the World Health Organization estimates, 210 million pregnancies occur annually, out of which, 38% are unwanted and 22% end up with abortion worldwide. In India, about 11 million abortions take place annually and around 20,000 women die every year due to abortion-related complications.[2] It is being realized that the unwanted pregnancy and need for induced abortion could be reduced by optimum use of EC as they prevent women's risk of becoming pregnant from a single act of intercourse by 79–99%.[4]

Government of India approved the dedicated regimen of emergency contraceptives in year 2001 and the same was introduced in the National Family Health Welfare Program in 2003.[5] It was approval as over the counter for adults aged 18 and above by the Government of India in 2005. This was done to reduce the rates of unwanted pregnancy and unsafe abortion.[6] However, the fear of its use and improper use has failed to achieve the objective. It was in this context that this study was conducted in medical students of a medical college in North-West India with the aim to assess the knowledge and attitude toward use of emergency contraceptives among medical students.


   Subjects and Methods Top


This was a cross-sectional study conducted among all the medical students in a Government Medical College in North-West India. The study was carried over a period of 4 weeks in the month of February and March 2014. There are 100students in each class except for 1st year which has 150 students totaling to 550 students in the entire college.

A questionnaire was constructed to assess knowledge and attitude regarding use of EC among medical students based upon a review of literature and similar studies conducted elsewhere.[7],[8],[9],[10],[11],[12],[13] Thus a predesigned, pretested, and self-administered multiple response questionnaire was provided to students. The questionnaire consisted of a total of 8 questions and was divided into three parts; (1) knowledge part: Included question number 1–5; (2) attitude component: Question number 6 and (3) practice component: Question number 7–8. The details are available in [Table 1].
Table 1: Knowledge and attitude of participants about emergency contraceptives

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Phases of questionnaire construction

Initial work-up The work-up was conducted by group of public health experts. The aim was to develop a series of questions for the questionnaire to be administered to medical students.

The experts worked on the possible alternatives to each questions after sitting together. This was done to arrive at a consensus in development of questions. A question was accepted for inclusion in the questionnaire only when agreed upon by all the members of the group.

Prepilot and questionnaire layout The prepilot centered on information gathering on the suitability of the questionnaire developed. For this purpose, we sat down with 25 subjects of age 18 years and above and went through the questions together to identify potential problems in their applicability. We amended the questionnaire before piloting with another group of 25 testers age 18 and above. These 50 testers were not medical students and therefore were not a part of our study sample. The amended version was again based on unanimous decision by the expert group. This process was aimed at arriving at a questionnaire wherein questions were unambiguous, appropriate and acceptable to respondents of the age group under study. We also tested the layout at this stage to ensure that the investigator could navigate their way easily through the questionnaire.

Pilot phase After the appropriate modifications were made to the questionnaire, a semester stratified random sample of 25 subjects from the medical college was drawn from the institution rolls for a pilot study. The subjects were selected by simple random technique. The selected students from the pilot phase were excluded from study sample.

Methods All students were informed about the objectives of the study and assured that the information collected would be treated as confidential and used only for research purposes. Only those students who gave a written informed consent were administered the questionnaire. The questionnaire was administered to the student in their class rooms. The students were adequately spaced during the questionnaire administration to avoid any communication. Due clarification was provided to students who asked for it regarding any of the item in the questionnaire. No names or other identifying information were included except the gender on the self-administered questionnaire to ensure anonymity.

The study has been approved by the Institution Ethics Committee.


   Results Top


Of the total students approached in the medical college, 401 out of a total of 550 students agreed to participate in the study giving us a response rate of 73%. Females contributed to 53.1% (213/401) of the study population. The demographic characteristics of the participants are shown in [Table 2]. It is seen that 31.9% (128/401) participants had a rural background, 64.8% (260/401) having annual family income <50,000 rupees, and 58.1% (233/401) were Muslim by religion.
Table 2: Demographic characteristic of study population

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[Table 1] provides information on knowledge, attitude and practice of the participants. About 20.4% (82/401) of all subjects had knowledge about use of both oral contraceptive pill (OCP) and Intra Uterine Contraceptive Device (IUCD) being as EC. Out of these 82, 39% were students of final professional of MBBS. Further, 69.8% (280/401) were aware that only OCP is used as an EC and 20.4% (82/401) said both OCP and IUCD can be used. Knowledge about the timing of use of EC is in 61.6% (247/401) as knowing it to be used within 72 h of intercourse. All the situations under which an EC can be taken were known to 88.3% (354/401) of the participants. The batch wise difference in knowledge and attitude component of knowledge, attitude, and practice was statistically significant (P < 0.05). The same is not true for the attitude component wherein the difference between batches was not found statistically significant. Importantly, five participants had a sexual experience and three out of these five had used an EC.


   Discussion Top


The Government of India launched the family planning program in 1952 with the objective of reducing birth rate.[14] Under the family planning program, temporary and permanent methods of contraception were introduced by the Department of Family Welfare, Government of India.[14] However, contraceptive failure and unwanted pregnancy lead to high abortion rate.[3] EC or postcoital contraception prevents unwanted pregnancy after unprotected sexual intercourse and failure of regular contraception.[3]

An Indian Council of Medical Research study in India documented 6.1/1000 legal abortions and 13.5/1000 illegal abortions performed in country.[15] One of the causes of illegal pregnancy is unplanned pregnancy due to multiple reasons.[16] Emergency contraceptive gives a second chance at prevention in cases of unanticipated sexual activity.[17] So one of the strategies to avoid unintended pregnancy is increased awareness and use of EC.[9] Keeping this in view, the current study was planned. The study population chosen for this purpose was the medical students. The idea was to assess the level of awareness among future health care providers. It is these health care providers, who will be main drivers of our health care delivery.

The correct knowledge in this study about both IUD and OCP being used as EC was present only among 20.4% participants. Further 70% of study participants reported that only OCP's can be used as EC. Study on female graduates in Chandigarh revealed similar findings with 73% reporting OCP's as the only method of EC.[9] Majority (77%) of participants were aware that EC drug composition has higher dose of hormones as compared to regular contraceptives.

In our study, preventing implantation as a mechanism of action of EC was known to 45.1% students and awareness of EC preventing ovulation and implantation was known to 44.9%. Similar studies in Delhi conducted on doctors showed that 50% of doctors were aware of EC action of blocking implantation of the fertilized ovum.[18] Similar information was known to 41.43% doctors of Kashmir Valley.[10] Further 26% of doctors in Delhi and 57.15% of doctors in Kashmir Valley mentioned that EC interferes with fertilization. Only 6.8% of respondents in Delhi and 8.58% of respondents in Kashmir Valley knew that it prevents ovulation.[10],[18]

Seven students (1%) in our study said EC induces abortion. This was much lower than 51.2% reported by the University students of Buea,[13] 25.8% reported by the university students of Ghana. The difference in percentage could be ascribed to the difference in the education backgrounds of the study participants. Further 25.5% of medical students from central India,[11] 22% of gynecologists of Nagpur,[19] 49% nursing students of Nairobi,[20] 8.58% of doctors of Kashmir Valley,[10] and 8.1% of doctors of Delhi reported a higher percentage that participants from our study.[18]

All the indications of EC usage was known accurately to 88.3% of students. The percentage increased as we moved toward higher semester 100% of 5th semester and final professional student knowing the EC usage accurately.

The importance of awareness regarding EC among medical students cannot be emphasized more and therefore unawareness about proper method of use of EC may serve as a deterrent to our family welfare programs. This will not only lead to unwanted pregnancy but also may create health hazards. The lack of appropriate in-depth knowledge of EC among these future health care professional should alarm the medical teaching system. EC is the only method that can be used to prevent pregnancy after unprotected sex or contraceptive accident.[21] Acquiring knowledge by remembering has been a part of medical education, but if integrated with skill based learning from early years of medical school can prove beneficial for health care system.


   Conclusions Top


The lack of appropriate in-depth knowledge of EC among medical students is a cause of concern. It should alarm the medical teaching system as EC is the only method that can be used to prevent pregnancy after unprotected sex or contraceptive accident.

Limitations

The study has been limited to medical students of a single institution only. The study could have been extended to other medical college in the area. This was avoided because the other medical college in the area belonged to the private sector.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

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Trussell J, Koenig J, Ellertson C, Stewart F. Preventing unintended pregnancy: The cost-effectiveness of three methods of emergency contraception. Am J Public Health 1997;87:932-7.  Back to cited text no. 1
    
2.
WHO. Emergency Contraception – World Health Organization. Available from: http://www.who.int/mediacentre/factsheets/fs244/en. [Last accessed on 2015 Oct 10].  Back to cited text no. 2
    
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4.
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5.
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6.
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Renjhen P, Kumar A, Pattanshetty S, Sagir A, Samarasinghe CM. A study on knowledge, attitude and practice of contraception among college students in Sikkim, India. J Turk Ger Gynecol Assoc 2010;11:78-81.  Back to cited text no. 7
    
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Raina S. Assessment of knowledge, attitude, and practice in health care delivery. N Am J Med Sci 2013;5:249-50.  Back to cited text no. 8
    
9.
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11.
Giri PA, Bangal VB, Phalke DB. Knowledge and attitude of medical undergraduate, interns and postgraduate students in India towards emergency contraception. N Am J Med Sci 2013;5:37-40.  Back to cited text no. 11
    
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Kishore V, Misro MM, Nandan D. Providers' knowledge, attitude and dispensing practices of e-pills in government dispensaries of South district in Delhi, India. Indian J Community Med 2010;35:46-51.  Back to cited text no. 12
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Kongnyuy EJ, Ngassa P, Fomulu N, Wiysonge CS, Kouam L, Doh AS. A survey of knowledge, attitudes and practice of emergency contraception among university students in Cameroon. BMC Emerg Med 2007;7:7.  Back to cited text no. 13
    
14.
Park K. Park's Textbook of Preventive and Social Medicine. 23rd ed. Jabalpur: M/s Banarsidas Bhanot; Medicine and Social Sciences; 2011. p. 518.  Back to cited text no. 14
    
15.
Government of India. Annual Report 2011-2012. New Delhi: Ministry of Health and Family Welfare; 2012. Available from: http://www. Planningcommission.nic.in/Reports/genrep/ar_eng1112.pdf. [Last accessed on 2015 Aug 20].  Back to cited text no. 15
    
16.
Amin F, Howden P, Peyman NA. Risk factors of unplanned pregnancies in a group of Iranian and New Zealander women. Eur J Sci Res 2009;26:108-21.  Back to cited text no. 16
    
17.
Gold MA, Wolford JE, Smith KA, Parker AM. The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors. J Pediatr Adolesc Gynecol 2004;17:87-96.  Back to cited text no. 17
    
18.
Singh S, Mittal S, Anandalakshmy PN, Goel V. Emergency contraception: Knowledge and views of doctors in Delhi. Health Popul Perspect Issues 2002;25:45-54.  Back to cited text no. 18
    
19.
Bhatt R. Emergency Contraception: Experience from Baroda; Report and Recommendations of Consortium on National Consensus for Emergency Contraception, Organized by WHO-CCR in Human Reproduction, All India Institute of Medical Sciences, New Delhi, in 53 Collaboration with WHO, Ministry of Health and Family Welfare and Indian Council of Medical Research, January 10 and 11; 2001. p. 90.  Back to cited text no. 19
    
20.
Gichangi PB, Karanja JG, Kigondu CS, Fonck K, Temmerman M. Knowledge, attitudes, and practices regarding emergency contraception among nurses and nursing students in two hospitals in Nairobi, Kenya. Contraception 1999;59:253-6.  Back to cited text no. 20
    
21.
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