Socio-Demographic Characteristics		Frequency (n=424)	Percentage (%)
Age (years)	≤ 19	196	46.23
	> 19	228	53.77
Sex	Male	164	38.68
	Female	260	61.32
Residence	Urban	306	72.17
	Rural	118	27.83
Religion	Hindu	302	71.22
	Christian	94	22.16
	Muslim	16	3.77
	Others	12	2.83
Education	Illiterate	20	4.72
	Primary and middle school	22	5.19
	Secondary and Higher secondary	224	52.83
	Graduate and above	158	37.26
Marital Status	Unmarried	206	48.59
	Married	211	49.77
	Divorced/ separated	5	1.17
	Widowed	2	0.47
No of children	None	281	66.27
	One	60	14.16
	Two	75	17.69
	More than two	08	1.88
Profession/ studies	Medical	170	40.09
	Nursing / Physiotherapy	130	30.67
	Other staff	64	15.09
	Not related to health care services	60	14.15
Income	I	12	2.83
	II	93	21.93
	III	141	33.26
	IV	110	25.94
	V	68	16.04

The study was conducted amongst youth of age 15-24 years where near about 50% subjects were above and below 19 years of age, outnumbering females (61.32%). Near about ¾ th of subjects were belonged to urban area who were mostly Hindu by religion followed by Christian. Among all 51.41% subjects were married and 33.73% subjects having one or more than one children. Only 14.15% subjects were not related to profession or studies related to health care services. More number of subjects were belonged to class III, IV and V of B. G. Prasad classification of socio-economic status.

 

Table 2: Status of awareness and usage pattern of emergency contraception

*- multiple choices were allowed.

Among all 56.13% were received sex education during schooling or college and 58.96% subjects were aware about at least one method of emergency contraception. Major sources of information first time received were health care personnel and audio visual media. More number of subjects was aware about Yuzpe method and LNG pills whereas around 11 % subjects were aware about Mifepristone and IUCDs. Among the aware subjects, 86.27% subjects knew about timing of usage of LNG pills but only 57.89% knew about timing of IUCD insertion as EC. About 61.2% subjects were having knowledge about side effects of emergency contraception. Among the aware ones, 52.8% subjects used emergency contraception. There were 1.41% subjects who were not aware of emergency contraception but utilized it due to various reasons. The total percentage of usage of contraception was 55.2%. Mostly they used LNG pills followed by Yuzpe method. Combined usage rate of Mifepristone and IUCD was less than 11%. Public health facilities, private hospitals and pharmacy played near about equal role in providing ECs to these aware subjects. More than ¾^th subjects used ECs for prevention of unintended pregnancy. Near about 37% subjects used ECs more than once in last year.

 

Table 3: Association between various factors and awareness of emergency contraception (n=424)

Age more than 19 years, male sex, persons related to profession or studies related to health care, urban residence, education more than middle school level was significantly associated with awareness regarding emergency contraception.

Table 4: Association between various factors and usage of emergency contraception (n=424)

State of awareness, age more than 19 years, male as decision maker for use of contraception, Sex education during schooling/college, high income, no misconception about EC and no fear of social stigma about EC were the factors which revealed statistically significant association with use of emergency contraception.

DISCUSSION

Though the present study was carried out in a private medical institution in rural area, respondents were from urban as well rural areas were there. We could find many Indian studies regarding knowledge, attitude and practices but those studies were carried out exclusively among medical professionals, medical or nursing students or only females studying in colleges or working women. As present study was carried out among male as well as female subjects which were also a mix of from medical/ paramedical staff and students, interns, other hospital staff/ non-medical staff and patients in the hospital, the results of the present study will not be directly comparable to any of those studies. Worldwide there is variation of awareness status, knowledge and usage pattern of EC amongst youths. In the present study, the level of awareness about emergency contraception was lower (58.96 %) as compared to college students which was (94%)¹³ and in the study carried out by Zeteroglu et al¹⁴ among health care providers including nursing staff, 74%. Studies in the United States of America (USA) and United Kingdom (UK) conducted in 2008 and 1996 respectively have reported more than 90% awareness.^15-16 In a study conducted among college students in Puducherry¹⁷, 23.1 % were aware of emergency contraception. Takkar et al¹⁸ conducted a study among staff nurses, ministerial staff and other educated working staffs in a Government teaching hospital in Chandigarh in north India also reported low awareness (11.2%) of EC among health care providers. This variation seems to be due to the difference in the education level, which can have an influence on the awareness level of EC. In this study, Media like internet, TV, Radio was found to be the main source of information for EC. In a study conducted in Nigeria among undergraduate college students, the main source of information was through friends/peers.¹⁹ In another study conducted in female students of Makerere University of Uganda, only 45.1% had ever heard of EC; their main source of information were also via friends 34% followed by Media 24.8%.²⁰ Present study revealed that only 7.60% knew Cu-T can be used as EC which is similar to study conducted by Rahaman et al¹¹ where it was 6% only but was less when compared to the study done in Ethiopia (23.2%).²¹ In present study, 79.89% answered that after ECP has to be taken within 72 hrs of unprotected sexual intercourse which was higher than 11.3% reported by Delbanco et al (9%)²² Present study revealed that 61% subjects answered about side effects of EC which was lesser than the study done in Chandigarh (88.9%) by Puri S et al.²³  In present study 52.8% used emergency contraception who were already aware about EC whereas few others (n=6) used it due to reasons like forced by partener or suggested by peers ; though they were not aware about EC. Total 55.20% have used emergency contraception. There seem to be low usage of EC in the study population also due to the high proportion of sexually inactive participants. The most utilized EC was LNG Pills (63.04%) and least utilized (5.07%) was Mifepristone. Public health facilities, private hospitals and pharmacy played near about equal role in providing ECs to these aware subjects. More than ¾ th subjects used ECs for prevention of unintended pregnancy. Near about 37% subjects used ECs more than once in last year. In present study, age more than 19 years, male sex, persons related to profession or studies related to health care, urban residence, education more than middle school level has shown statically significant association with awareness regarding emergency contraception. In a study conducted by Dorairajan et al ¹⁷ bivariate analysis showed that males [OR (95% CI): 3.26 (1.9-5.4); P=0.001], exposure to sex education [OR (95% CI): 2.3 (1.4-3.75); P=0.04] and students of medical college [OR (95% CI): 2.2 (1.3-3.5); P=0.002] were significantly more aware about emergency contraception. On applying multivariate model for influence of these factors on awareness about emergency contraception, male sex, awareness of regular contraceptive methods, exposure to sex education and higher age group emerged as significant predictors. Similar observations were also made in a study conducted in Kathmandu, Nepal.²⁴ In present study, state of awareness, age more than 19 years, male as decision maker for use of contraception, Sex education during schooling/college, high income, no misconception about EC and no fear of social stigma about EC were the factors which revealed statistically significant association with use of emergency contraception. In the study conducted by Dorairanjan et al¹⁷ the factors that emerged as significant predictors for potential use of emergency contraception were male sex [adjusted OR (95% CI): 3.245 (1.04-10.08); p<0.05] and awareness of emergency contraception [adjusted OR (95% CI): 3.48 (1.19-10.11); p<0.05]. In this study, the absence of significant association between urban residence and profession /study related to health care and the use of emergency contraception can be explained by the fact that now a days ECs are available in government setups at peripheral level also, people related with health care profession/studies are more aware about EC and will take care of their health in adequate manner. Number of children also has no statistically significant association with use of emergency contraception, may be more number of people who were mainly using it to prevent unintended pregnancy which can be at any time and which is not dependent on number of children they have. The ECP use was not associated with the marital status in the present study, indicating that the reach of the t EC in both the groups is similar.

 

LIMITATIONS

1. The study was conducted in a single private institution only.
2. There were no means to verify the truthfulness of responses.
3. There is a need to do further planned studies preferably community based, involving both sexes, all types of people from rural as well urban areas with large sample and preferably including domains to explore the sexual practices and actual EC use.

 

CONCLUSION

To conclude, the awareness about emergency contraception amongst youth studied was 58.96 per cent. Out of total aware youth; 52.8% utilized emergency contraception. Awareness about emergency contraception, age more than 19 years, male as decision maker for use of contraception, Sex education during schooling/college, high income, no misconception about EC and no fear of social stigma about EC were found to be the significant correlates for usage of EC.

RECOMMENDATIONS

1. Increase the IEC activities among age group of 15-19 years, low income group people, where social stigmas and misconception about EC is more prevalent.
2. Impart health education to general public through public health care delivery system particularly in rural areas.
3. Include topics related to sex education, contraception and emergency contraception in academics from secondary school onwards.
4. Methods of emergency contraception like Mifepristone and IUCD should be publicised more intensively through audio visual media and internet with due focus on its actual indications.
5. IEC activities to promote gender equality also in decision making for use of contraception and emergency contraception in target population.

 

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