ORIGINAL ARTICLE

EMERGENCY CONTRACEPTION:
KNOWLEDGE AND ATTITUDE AMONG
FEMALES
SHAISTA NAZ, SUBHANA TAYYAB, LUBNA ALI, ROZINA YASIR

ABSTRACT

Objective To assess women’s knowledge of emergency contraception.

Study design Descriptive study.

Place & Gynaecology Unit IV, Lyari General Hospital Karachi, In January 2009.
Duration of
study

Patients and Women aged between 18 to 45 years visiting Gynaecology OPD at Lyari General Hospital
Methods Karachi were interviewed and responses entered in a specially designed questionnaire of
knowledge and attitude about emergency contraception.

Results Of the 300 respondents, 129(43%) had practiced contraception while 9(3%) admitted to having
an induced abortion. Only 144(48%) had heard of emergency contraception (EC). 123(41%)
knew only about hormonal method of EC. Only 6(2%) knew the correct timing of EC. Six
requested for EC previously.

Conclusions Many women were uninformed about the action and timing of EC. Health facilitator should
educate masses about EC, emphasizing available methods and correct timing of use.

Key words Emergency contraception, Abortion, Family planning.

INTRODUCTION: by the year 2050. It has a total fertility rate in excess of

Unintended pregnancy posses a major challenge to the five births per woman.2
reproductive health of young adults in developing
countries. Some young women with unintended The economic implication of this rapid growth is enormous
pregnancies obtained abortion, many of which are and translates into poor quality of life and health for an
performed in unsafe conditions and others carry their average Pakistani.3 Family planning can improve women’s
pregnancies to term, incurring risks of morbidity and health in child bearing years. Regulating fertility is as
mortality higher than those for adult women. 1 Pakistan important as controlling morbidity and mortality. It is an
is the 7th most populous country in the world with over essential component of personal, social and economic
40% of its citizens under the age of 15 years. According development.4 The international conference of population
to UN projection, it will become the 4th most populous and development (ICPD) estimated that 350 million
couples worldwide lack access to the full range of modern
Correspondence: family planning methods.5
Dr. Shaista Naz
Pakistan was a pioneer in developing countries in
Department of Gynaecology Unit IV
supporting family planning activities,6,7 but Pakistani
Lyari General Hospital, Karachi
families have been slower to adopt family planning

Journal of Surgery Pakistan (International) 14 (2) April- June 2009 89

Emergency Contraception: Knowledge and Attitude Among Females

practices than their South Asian neighbours.8,9 More less likely than all other respondents to have heard of
than one third of Pakistani women wish to space next post coital contraception while barrier methods users
birth or limit family to its current size, but are not using were most likely to know about emergency contraception.
any contraceptive method.10 A total of 90(30%) respondents got their information
about emergency contraception from doctors, 102(34%)
Total fertility rate in Pakistan has declined slowly, from from lady health visitors (LHVs) and 30(10%) from
about 6.0 lifetime births per woman in 1984-85 to 5.4 friends (table I).
in 1990-91.11 Funded by United States Agency for
International Development, PDH provides the first update DISCUSSION:
in fourteen years on the national maternal mortality ratio The findings of this study reflect lack of correct
for Pakistan. The survey found that current maternal information on emergency contraception available in
mortality rate (MMR) is 276 maternal deaths per 100,000 Pakistan. A pattern of misinformation or partial knowledge
births nationwide with a higher ratio in rural area. ran through out the responses to the questionnaire.
Pakistan’s millennium development MMR goal is to Many women believed that EC can be taken until one
reach less than 140 by the year 2015.¹² Only 20% of missed period. Many women did not know that EC can
women are assisted by a trained providers during be used as a back up when the other methods are
delivery.9 About 200,000 maternal deaths per year can known to have failed or after unexpected sex.
be attributed to the lack or failure of contraceptive
services.13 It was hoped that women using barrier methods of
contraception would be better informed than those using
Among the various forms of the contraception, other methods, but it was not so. This suggests that
emergency contraceptives are the only one that can be health professionals are not telling women about the
used after sexual intercourse offering a second chance use of EC. Same was found in an other study from
to prevent unwanted pregnancies.14 The aim of this England. In our study 41% knew only about EC and
study was to determine the knowledge and perception out of them only 2% had the knowledge of correct timing
of emergency contraception among the females. which differs from another study conducted in the London
East Family Health Services Authority Area where the
PATIENTS AND METHODS: rate was 53%.15
This descriptive study was conducted over a period of
two weeks in January 2009 at Gynaecology OPD at This study showed that less than half of the women
Lyari General Hospital, Karachi. Randomly selected knew about the availability of EC but were poorly
women of age 18-45 years in OPD were interviewed informed regarding its use. Women in our Gynaecology
face to face and a questionnaire was filled about their OPD differed from women interviewed in an abortion
demographic information, sexual history and knowledge clinic who were more likely to heard of emergency
of emergency contraception. Women were asked, when contraception (65%16 compared to 41% in the present
emergency contraceptive must be used to be effective, study). In an other study of 178 women only 38% knew
which drug can be used as emergency contraception the action of EC. Some women believed that antibiotics
and the source from where they can obtain the and antimalarial medicines can also be used as
information on emergency contraceptives. emergency contraceptive. Same was found in another
Nigerian study but to a lesser extent (11.4% 17 as
RESULTS: compared to our study - 20%). Another drug mistakenly
Three hundred women were interviewed. Forty two thought to be an emergency contraceptive was
(14%) were < 20 years of age, 156 (52%) were between gynaecosid, which is recommended for the treatment
21 to 30 years and 72(24%) > 31 years of age. Among of amenorrhoea, not related to pregnancy. The use of
these 261(87%) had less than 10th grade education, these drugs as emergency contraceptive agent is
27(9%) had obtained such level of education and only dangerous.
6(2%) had graduate qualification. Emergency
contraception was heard of by 144(48%) women. Among In order to strengthen and promote EC services, health
these respondents 123(41%) knew only about hormonal care providers should spend more time to educate
method of EC. None of them were aware of intra uterine couples instead of educating women only. It should be
contraceptive device and mifepristone as an emergency stressed that the use of EC is not against religion.
contraceptive. Only 6(2%) respondents gave the correct Awareness should be created among women to have
(72 hours) time during which post coital contraception their rights and opinions about the extent of family size.
could be used safely. Six women had requested for EC There should be an introduction of opportunistic
previously. counselling among health professionals at community
level. This education should not be limited to obstetrics
Respondents using no contraception were significantly departments.

90 Journal of Surgery Pakistan (International) 14 (2) April- June 2009

 Shaista Naz, Subhana Tayyab, Lubna Ali, Rozina Yasir

Table: 1 Characteristics and Responses of Participants

AGE: Percentage Numbers

< 20 Years 14% 42

20 – 25 Years 19% 57

26 – 30 Years 33% 99

> 36 Years 24% 72

PARITY:

1 12% 36

2+ 23% 69
5+ 65% 195

EDUCATION:

< 10 Grade 87% 261

10 Grade 09% 27

Intermediate 02% 06

Graduate 02% 06

METHOD OF CONTRACEPTION:
Progesterone only / Combined Oral Contraceptive pills 41% 123
Safe period or withdrawal 02% 06

Condom 12% 36

Intra uterine contraceptive device 02% 06

Norplant 01% 03

Not having sexual intercourse 01% 03

Diaphragm 00% 00

Trying to get pregnant 08% 24

PREVIOUS REQUEST FOR POST COITAL CONTRACEPTION:

Yes 02% 06

No 98% 294

Unless we concentrate on this issue as a team it will CONCLUSIONS:

be difficult to control growth rate to a desired limit and There is an urgent need to educate women about
the dream of economic stabilization and raising living emergency contraceptives with emphasis on available
standards will be difficult to achieve in developing methods and correct timing of use. Our findings suggest
countries. that correct knowledge of this methods is lacking among
women. Advanced provision and promotion of

Journal of Surgery Pakistan (International) 14 (2) April- June 2009 91

Emergency Contraception: Knowledge and Attitude Among Females

emergency contraceptives would very likely enhance state of world population , the right to choice
its use as in developed countries reproductive rights health, 1997.

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92 Journal of Surgery Pakistan (International) 14 (2) April- June 2009