http://doi.org/10.33698/NRF0035 -Suksham Chopra, Indarjit Walia, Karobi Das
Abstract : Emergency Contraceptive Pills (ECPs) are considered to be safe and effective method of postcoital contraception. But lack of public awareness and lack of easy access to ECPs are found be the main reasons for their underutilization. In the present study, a group of 112 women attending one of the family welfare clinics of Chandigarh were randomly selected and interviewed during 2004-2005 to assess their knowledge, attitudes and practices related to ECPs. Only 10.7 percent of the respondents had heard about ECPs. Majority of them stated that they were willing to use ECPs in future and would even recommend their use to friends and relatives. More than seventy percent had favoured an advance supply of ECPs to women but 56.8 percent were of the view that ECPs should be prescribed by doctor only so as to minimise the side-effects. Thus to enhance women’s knowledge about ECPs, it would be necessary to make them aware of both positive and negative aspects of ECPs through a balanced presentation of information.
Key Words :
Emergency Contraceptive Pills (ECPs)
Correspondence at :
Dr. Inderjit Walia,
National Institute of Nursing Education, PGIMER, Chandigarh, India.
Throughout the world, health care providers are concerned about providing safe and effective methods of contraception to women of child-bearing age. Today, Emergency Contraceptive Pills (ECPs) are considered to be safe and effective method of postcoital contraception. This form of contraception was described as early as thirty years ago. Yet, the physicians had little experience of prescribing it.1-3 It is assumed that the potential use of ECPs would reduce the burden of unwanted pregnancies and, consequently, unsafe abortions. It has been reported that half of the 3.5 million unintended pregnancies that occur every year in the United States could have been averted if ECPs were made easily accessible and used.4
Though it is established that ECPs can substantially reduce the burden of unintended pregnancies, their use, so far, has been limited. This low usage has been reported from countries where ECPs are not available over the counter. In addition, limited knowledge, shame associated with procuring of ECPs and problems of access to ECPs were responsible for their underutilization.5-6
In the present setting, ECPs are available at the family planning centres, where women can use them more effectively, in consultation with the doctors. Not many studies have been conducted about women’s knowledge and attitudes about Emergency Contraceptive Pills (ECPs). This had motivated the investigators to undertake the present study in one of the family welfare clinics of the Union Territory of Chandigarh.
Materials and Methods
The study was carried out during 2004- 2005 in one the urban family welfare clinics of the U.T., Chandigarh. Those women who were seeking services for family welfare were selected randomly. But only those women were included in this study who showed their willingness to participate in it. A total of 112 women were finally included in the study after they were explained the objectives of the study. The study was carried out with the following objectives
(i) To assess women’s knowledge and attitudes about Emergency Contraceptive Pills (ECPs); and (ii) to describe various practices related to the use of Emergency Contraceptive Pills (ECPs). Data was gathered by a trained female researcher with the help of a semi-structured interview schedule, which was thoroughly pretested.
Findings of the study
- Socio-Demographic Characteristics
As mentioned earlier, a group of 112 women were included in the study, and of these, a majority of them were below thirty years of age (74.1%). Education wise, only 9.8 percent of them were illiterate and nearly one-third of them (32.2%) were either graduates or postgraduates. Four of them had acquired additional qualification in management and commerce. It was interesting to note that despite attaining degrees in art or commerce, more than ninety percent (93.7%) of them were not working to supplement their family income. As regard their family income, nearly one-fourth of them had a monthly income of more than rupees ten thousand and 47.3 percent of them had an income of rupees 5001 to 10,000 (Table – 1). Keeping in view, their family income, one could conclude that a majority of them belonged to the upper strata of the society. It has been recently reported that the city of Chandigarh has the highest per capita income, as compared to other metropolitan cities including – Mumbai, Delhi, Bangalore and Hyderabad.7
Table – 1 : Socio-demographic Characteristics of the Respondents
|Age Group (in years)
(i) Less than 25
|(iv) 36 and above||8||7.1|
|(ii) Upto Middle||18||16.1|
|(iii) Upto 12th Standard||47||41.9|
|(iv) Graduates and Postgraduates||36||32.2|
Family Income (per month)
(i) Less than Rs. 5000
(ii) 5001 – 10,000
(iii) 10,001 and above
|(ii) Not working (Housewives)||105||93.7|
- Number of living children, desire for additional child and use of last contraceptive method
As regard their number of living children, ninety percent of them had one to two living children, while 9.9 percent had three or more living children. On being asked whether they would like to have another child in the family, nearly forty-percent of them stated that they had no desire to have another child. Of those, 53 (47.3) percent who desired to have another child more than forty percent (41.5%) showed their preference for a male child and nearly fifty percent of them did not seem to bother about the sex of the child. At the time of data collection, more than seventy percent of the respondents (71.4%) were relying on a modern or traditional method of family planning. Of these, 43.7 percent were relying on condom, and 22.5 percent had got CuT inserted. Among those 27.5 percent, who were relying on natural methods expressed a desire to use a more reliable method of birth
control. This reflected their state of awareness about the need of contraception (Table – 2).
Table – 2 : Number of living Children, desire of additional child and use of last family planning
Number of living children / desire for additional child
|I. Living children
|Three and above||11||9.9|
|II. Desire for additional child
|III. Sex of the desired child*
|IV. Use of last Birth Control method
|Birth Control Method used**
|* Percentage from 53 respondents.|
|** Percentage from 80 respondents|
- Knowledge and attitudes towards emergency contraceptive Pills (ECPs) and their impact on other Birth Control methods
Review of studies from different settings have clearly shown that lack of awareness about ECPs was responsible for their underutilization.5-9 In the present study,
Figure – 1: A wareness about ECPs
only eleven percent of the respondents had heard about this method (Fig. I). They did so either through their friends or read about ECPs in the newspapers. Only four of them had mentioned that they had ever used ECPs. Majority of them were also not aware of their mode of action, effectiveness and duration of use. Thus they had limited awareness about these aspects of the ECPs. Majority of them who showed their awareness were below 30 years of age and they were either graduates or postgraduates. Economically too, they represented a better strata of the society.
It was interesting to note that while nearly eleven percent of them were aware of ECPs, nearly eighty percent of them (79.5%) expressed their desire to use ECPs in the future. Besides 81.1 percent of them were even inclined to suggest their use to their friends and relatives. However, 67.8 percent showed their concern about various side- effects, not only regarding their immediate use but also in the future. More than fifty percent of the respondents (56.3%) were of the view that ECPs should be prescribed by the doctors only so as to minimise their side- effects. But nearly one-fourth of them (26.8%) favoured their free availability with the general practitioners and at the chemists’ shops so that those in need could use them conveniently. It may be emphasized here that the ECPs are widely used in countries where these are readily available. In Australia, ECPs can be obtained from family planning clinics, sexual health clinics, general health practitioners and emergency departments.10 At the same time, health care providers in Mexico, had reported some negative health effects of ECPs and they favoured their controlled distribution.11 In New Zealand also, doctors had shown resistance to their over- the-counter prescription as they felt that this would reduce interest of women in other Birth control methods.12 In the present study, nearly sixty percent of the respondents were of the view that the use of ECPs would not affect the use of other Birth control methods as majority of them knew that “it is a one- time method’. The findings of this study also revealed that more than seventy percent (71.3%) of the respondents were of the view that women should be given an advance supply of ECPs (Fig. 2). Some studies have also shown that where women are given an advance supply of ECPs, they are more likely to use them judiciously.13-14 Few studies, carried out in India, have shown the divided
Would like to use Recommend useWorry about side- ECPs should be
Use of ECPs
ECPs in future of ECPs to effects with use of prescribed by given in advancewould reduce use friends/relatives ECPs doctor only supply of other family planning methods opinion of doctors over the dispensing strategy of the ECPs on ‘prescription only’.15-16 In view of these, currently several medical organizations are involved in preparing guidelines for routine counseling and advance prescription for the ECPs.17-18Figure – 2 : Attitudes towards to ECPs
Public awareness about ECPs and their easy access can certainly enhance their use among those women who are in need of avoiding unwanted pregnancies. In the present study, only 10.7 percent of the respondents were aware of ECPs but their knowledge about them was inadequate. Studies from Kenya, Mexico and Ghana19,20,21 have also reported that though more women were aware of ECPs, their knowledge about ECPs was superficial. In Kenya 48 percent of the women were aware of ECPs but only 2.6 percent could describe them spontaneously.19 Latino women were also found to be more aware of ECPs. In a recent survey, where 25 percent of Latino women had heard about ECPs, English-Speaking women were found to be more aware of ECPs than Spanish- Speaking women.22 In the present study, nearly seventy percent of the respondents were in favour of giving an advance supply of ECPs to women so that they could use them in time. This will help them to be free from anxiety. Similar views have been expressed from Ghana.23 No doubt, an advance supply of ECPs is gaining popularity. This may be the best way to increase their timely and appropriate use.24
But in order to increase popularity of ECPs in our settings, it would be necessary to enhance public awareness about them and the physicians should also be better informed about all those aspects related to the use of ECPs. Women should be made aware of both the positive and negative aspects of ECPs through a balanced presentation of information. In this regard, a WHO – sponsored study, carried out in four countries, had highlighted the importance of offering a balanced presentation on both positive and negative aspects of contraceptives being provided to the clients. Reportedly, this has yielded a good response in the selection and use of appropriate bir th control methods.25-26 Thus, provision of adequate information along with contraceptive counseling, should become an integral part of the strategy of offering family welfare services.
- Chung CH, Waldman IJ, Freund KM, Ash Emergency contraception prescribing practices of general internists compared with other primary care physicians. Contraception 2004; 69: 43-45.
- Grossman RA, Grossman How frequently is emergency contraception prescribed? Fam Plann Perspect 1994; 26: 270-271.
- Beckman IJ, Harvey SM, Sherman CA, Petitti DB. Changes in providers’ views and practices about emergency contraception with Obstet Gynecol 2001; 97: 942- 946.
- russel J, Stewart F, Guest F, Hatcher RA. Emergency contraceptive pills: a simple proposal to reduce unintended pregnancies. Fam Plann Perspec 1992; 24: 269-263.
- Free C, Lee RM, Ogden Young women accounts of factors influencing their use and non- use of emergency contraception: in-depth interview study. British Medical Journal 2002; 325: 1393.
- Trussell J, Dwian V, Shochet T, Moore K. Access to emergency Obstet Gynecol 2000; 95: 267-270.
- Indo-Asian News Service: City has the highest per capita income. Chandigarh Hindustan Times 6.2005.
- Delbanco SF, Manldon J, Smith Little knowledge and limited practice: emergency contraceptive pills, the public, and the obstetricianb– gynecologist. Obstet Gynecol 1997; 89: 1006-
- Shaban DW, Palan PR, Emerson M, Mikkail Lack of adequate knowledge of hormonal emergency contraception in minority women. Obstet Gynecol 2003; 101: S 15.
- Fox J, Weerasinghe D, Mindel Emergency contraception: who are the users? International Journal of STD and AIDS 2004; 15: 309-313.
- Langer A, Harper C, Garci BC et Emergency contraception in Mexico city. What do health care providers and potential users know and think about it. Contraception 1999; 60: 233- 241.
- William C. New Zealand Doctors Resist Emergency British Medical Journal 1996; (News) 312 (7029) 463.
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- Raine T, Harper C, Leon K, Dorney Emergency Contraception: Advance provision in a Young High Risk Clinic Population. Obstet Gynaecol 2000; 96: 1-7.
- Mondal AK, Chakroborty AK, Kalsar PK, Bose Providers’ concept of emergency contraception: Report and recommendations of consor tium on national consensus for emergency contraception, organized by WHO- CCR in human reproduction, AIIMS, New Delhi in collaboration with WHO, Ministry of Health and Family Welfare and ICMR, Jan 10.11;2001;96.
- Bhatt Emergency contraception: Experience from Baroda. Repor t and recommendations on consortium on national consensus for emergency contraception, organized by WHO-CCR in human reproduction at AIIMS, New Delhi in calibration with WHO and Ministry of Health and Family Welfare and ICMR, New Delhi. Jan. 10-11; 2001;90.
- American College of Obstetricians and Gynecologists, ACOG practice bulletin: emergency and Washington (DC) American College of Obstetricians and Gynecologists 2001.
- American Medical Association. H-75. 985 access to emergency Chicago. American Medical Association; 2002.
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- r A, Dolores GA, Schivan R et al. Emergency contraception in Mexico city: knowledge, attitude and practices among providers and potential clients after a 3 year introduction Contraception 2002; 66: 321- 329.
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- Romo LF, Abey B, Helen The role of misconceptions on Latino women’s acceptance of contraceptive pills. Contraception 2004; 69: 227-235.
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- Kakar DN. Women and Family Planning. 1984 Sterling Publishers, New Delhi.
- Christian BB, Kakar DN, Chung KK, Toker FM, Santiago CE, et Preference for contraceptive methods and personnel in India, Korea, The Philippines and Turkey. Studies in Family Planning 1980; 11, 9-10.