JIMMA UNIVERSITY

COLLEGE OF PUBLIC HEALTH AND MEDICAL SCIENCES

DEPARTMENT OF NURSING AND MIDWIFERY

ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICE TOWARD

EMMERGENCY CONTRACEPTIVE METHODS AMONG JIREN HIGH SCHOOL
FEMALE STUDENTS, JIMMA TOWN, JIMMA ZONE, OROMIA REGINAL STATE
JIMMA SOUTH WEST ETHIOPIA

By

DESALECH BILO

A RESEARCH PAPER SUBMITED TO DEPARTMENT OF NURSING AND

MIDWIFERY COLLEGE OF PUBLIC HEALTH AND MEDICAL SCIENCE JIMMA
UNIVERSITY IN PARTIAL FULLFILMENT OF THE REQUIREMENT FOR THE
BACHELOR OF SCIENCE DEGREE IN NURSING.

JUNE, 2014

JIMMA, ETHIOPIA

1
 JIMMA UNIVERSITY

COLLEGE OF PUBLIC HEALTH AND MEDICAL SCIENCES

DEPARTMENT OF NURSING AND MIDWIFERY

AKNOWLEDGE, ATTITUDE AND PRACTICE TOWARD EMMERGENCY

CONTRACEPTIVE METHODS AMONG JIREN HIGH SCHOOL FEMALE STUDENTS,
JIMMA TOWN, JIMMA ZONE, OROMIA REGINAL STATE JIMMA SOUTH WEST
ETHIOPIA

Advisor:-

Ato Fekadu Yadassa (Msc)

JUNE, 2014

JIMMA, ETHIOPIA

2
 ACKNOWLEDGEMENT
It is not exaggeration to state that without the help of the almighty God, this research paper would
not have been in a position to finalize successfully, so praised for ever.
First and most, I would like to thank my advisor Ato Fekadu Yadassa for his, encouragement and
necessary guidance and support through this paper development.
I am deeply grateful to my family members who gave me continuous support and inspiration to
develop this proposal.
I greatly acknowledge Jimma University College of Medical Sciences and Public health
department of Nursing for providing me this opportunity.
Additionally I would like to give my special thanks to Jimma Jiren High School Directors
Offices for their hurtful assistance in providing different data and also kindly helping students
during questioner (data) collection time and students who presented and family that Given true
information of data to be collected has facilitated my proposals not only by kindly putting at my
disposal relevant documents. Thus, a considerable amount of archival material from the
community of Jiren high school area to be utilize in this work. Relevant documents has be
consulting

I
3
 ABSTRACT
Background:- Despite the availability of highly effective methods of contraception, many
pregnancies are unplanned and unwanted. These pregnancies carry a higher risk of morbidity and
mortality, often due to unsafe abortion. Many of these unplanned pregnancies can be avoided by
using emergency contraception. Literature reveals that there is existence of knowledge, attitude
and practice gaps on EC in the world including Ethiopia.

Objective:- To assess the knowledge, attitude and practice towards emergency contraception among
female students of Jiren high school, south west, Ethiopia
Methods: A descriptive cross-sectional study was conducted on 254 female students in Jiren high
school, Jimma town, south west of Ethiopia, from May 1-15, 2013. Simple random sampling was
employed to each grade framed students to select number of study subjects from each class.
Then the data was tallied, edited and analyzed using SPSS for widow version 16.0. Then the data
was presented in graphs and frequency tables. Association of variables was seen using chi-square
test and significant association was declared at p-value of <0.05 with 95%CI.
Result: From 251 respondents about 154(61.4%) have ever heard about emergency contraception
of which 65.7% has good knowledge about emergency contraceptive and about 56.9% has
favorable attitude towards emergency contraceptive; and only 20.8% of those who have practiced
sex were used emergency contraceptive. Oral contraceptive pill was the most widely used
10(100%). Health professionals were the main source of information 109 (70.8%)
Conclusions and Recommendations: Even though there is high awareness, there is a problem on
timely using of the service and utilization of emergency contraceptive methods and unfavorable
access to the service for high school female students.
Hence there is a need for collaborative effort to improve service quality and prevent female
students from life threatening behaviors.
Key words:- Emergency contraceptive, knowledge, attitude

II

4
Table of contents

ACKNOWLEDGEMENT............................................................................................................................3

ABSTRACT..................................................................................................................................................4

IV.................................................................................................................................................................. 6

ACRONYMS................................................................................................................................................7

V CHAPTER ONE: INTRODUCTION........................................................................................................8

1.1. Background of the study........................................................................................................................8

1.2. Statement of the problems......................................................................................................................9

1.3. OBJECTIVE of the study.....................................................................................................................10

1.3.1: General objective..............................................................................................................................10

1.4. Significance of the Study.................................................................................................................11

CHAPTER TWO: LITERATURE REVIEW..............................................................................................12

3.3: study design.........................................................................................................................................17

3.4.1. Source population..............................................................................................................................17

3.4.2. Study population...........................................................................................................................17

3.5. Inclusion and exclusion criteria........................................................................................................18

3.6. Sample size and sampling technique/procedure...................................................................................18

3.6.2. Sampling procedure...........................................................................................................................19

3.7. Study variables:......................................................................................................................................3

3.8. Operational definition............................................................................................................................3

3.9. Procedure for data collection (instrument).............................................................................................3

3.10. Data quality control..............................................................................................................................3

3.11. Data Analysis and Presentation............................................................................................................4

3.12. Ethical consideration............................................................................................................................4

3.13. Dissemination of the study results........................................................................................................4

CHAPTER FOUR:........................................................................................................................................5
5
RESULT AND DISCUSSIONS...................................................................................................................5

RESULTS.................................................................................................................................................5

DISCUSSIONS.............................................................................................................................................6

CONCLUSIONS AND RECOMMENDATION.........................................................................................7

Annex I: REFERENCES...............................................................................................................................9

Annex II: QUESTIONAIRRES…………………………..………………………………………10

IV

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ACRONYMS
ACOG: American College Of Obstetricians and Gynecologist

AIDS: Acquired Immune- Deficiency Syndrome

CBD: Community Based Distributors

COC: Combined Oral Contraceptives

EC: Emergency Contraception

ECP: Emergency Contraceptive Pills

ICEC: International Consortium for Emergency Contraception

IEC: Information, Education and Communication

IUCD: Intra-Uterine Contraceptive Device

JU: Jimma University

KAP: Knowledge, Attitude &Practice

MOH: Ministry Of Health

NCHS: National Center for Health Survey

OCPs: Oral Contraceptive Pills

POP: Progesterone Only Pills

SNNP: Southern Nations, Nationalities and People

SRP: Student Research Program

STI: Sexually Transmitted Infections

UK: United Kingdom

UNFPA: United Nation Family Planning Association

USA: United State of America

WHO: World Health Organization

7
 V CHAPTER ONE: INTRODUCTION
1.1. Background of the study
Emergency contraception is a method of contraception used after intercourse and before the
potential time of implantation, offers women a last chance to prevent pregnancy after unprotected
intercourse (1, 2).

Since it is difficult to determine the infertile time of the cycle with certainty emergency
contraceptive better be provided for any women who is concerned about her risk of pregnancy,
regardless of the cycle day of exposure (3).

“Morning-after pill” or “post-coital contraception” are terminologies used interchangeably, but

confusing since methods are not only pills and can be used within 5 days after un protected
intercourse and not merely the morning after. Hormonal ECs originated in the mid-1920s and
developed since the mid-1960s (1, 3).

The general indications for EC are when no contraceptive has been used; when there has been a
contraceptive accident or misuse and when the woman is a victim of sexual assault (1, 4).

Consequences of unprotected sex, such as unintended pregnancy and unsafe abortion, can be
prevented by access to contraceptive services including emergency contraception. Oral pills and
intrauterine contraceptive devices (IUCDs) are mainly used as emergency contraceptives when
used within 72 hours after sexual contact pills have the capacity to prevent pregnancy by 75-85%
and with the use of IUCDs unwanted pregnancy can be prevented by as much as 99%. This is
especially significant for those Young couples that opt not to use a long-term regular
contraceptive method and their sexual behavior is rather unplanned, erratic and irregular (5, 6, 7).
Such behavior could usually happen to high school students who probably might lack knowledge,
favorable attitude toward EC, and practicing it. Thus, this study is aimed at assessment of KAP of
emergency contraceptive methods among Jiren High school female students (17).

8
 1.2. Statement of the problems
Unintended pregnancy can carry serious consequences for women, their families and countries.
To list some of them are denying a fundamental human right to control one’s own fertility,
Limits economic growth, Negative environmental impact, High maternal mortality and morbidity,
High infant mortality; impact on child health and development(8).

Despite the fact that highly effective methods of contraception (birth control) are available to
prevent unintended pregnancy, each year, there are about 26 million legal and an estimated 20
million illegal abortions or in other word 126.000 abortions every day worldwide due to
unintended pregnancies(9) , almost half of all pregnancies are unintended in USA(10) . The
planning status of births is estimated using nationally representative and small-scale surveys of 80
countries shows that of the 208 million pregnancies that occurred in 2008,41 percent were
estimated as unintended(11).

The annual number of induced abortions, in Africa rose between 2003 and 2008, from 5.6 million
to 6.4 million. In 2008, the most abortions occurred in Eastern Africa (2.5 million), followed by
Western Africa (1.8 million), Northern and Middle, Africa (0.9 million), and Southern Africa (0.2
million) (12) , in Ethiopia In 2008, 101, unintended pregnancies occurred per 1,000 women aged
15–44, and 42% of all pregnancies were unintended(13).

For over a decade, advocates have sought to improve access to emergency Contraception (EC)
across the world. These efforts have been highly successful in Europe and North America, where
EC is now widely available over the counter, have generated much debate in Latin America, and
are beginning to take hold in Asia. In Africa, however, the success of EC programs remains
limited. Even in countries where the regulatory environment is favorable, resource constraints
within the public sector limit the ability to provide consistent and quality EC services at low
cost. In a growing number of African countries, the private sector has emerged to fill these gaps,
increasing access primarily among young, affluent urbanites. Low knowledge levels among the
general population ultimately undermine the impact of such provision strategies, with as few as
10% of women in Senegal and Zambia reporting having ever heard of EC, and in the majority of
African countries, less than one percent of all women have reported ever using it(14).

9
The rate of unplanned pregnancies varies around the world. The number is particularly high
among teenagers and poor sectors of the population, but it is also seen among women over 35,
both single and married. While the total number of unplanned pregnancies has diminished over
the past few decades, the percentage remains high among teenagers (15) who could be due to gap
in awareness, negative attitudes towards contraception, low accessibility or as a result of sexual
assault. At times, the knowledge and practice might be there but no contraceptive is 100%
effective, and it is always very vital to have EC as a backup method (16).

A cross-sectional study conducted on KAP emergency contraception among graduating female

students of Jimma University in 2010 only 41.9% of them heard about and 6.8% used EC (17)
even though 28.9% of the student practices sexual intercourse (18).

Thus, understanding of knowledge, attitude and practice of high school students on EC is critical
at for local health planners and organizations to prevent the occurrences of unwanted pregnancy
and its complications. Therefore, this study is aimed to examine the knowledge, attitude and
practice of Jiren High school female students regarding emergency contraception.

1.3. OBJECTIVE of the study

1.3.1: General objective

To assess knowledge, Attitude and practice toward emergency contraception among Jiren High
school female students
1.3.2: Specific objectives
 To determine the knowledge level of Jiren High school female students on emergency
contraception
 To determine the attitude of Jiren High school female students toward emergency
contraceptive methods
 To determine the practice of emergency contraceptives among Jiren High school female
students

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1.4. Significance of the Study
Emergency contraception is up to 89 percent effective in preventing pregnancy, depending on
how quickly a woman begins the methods, the type of methods taken used, and when the sex
occurred during the woman’s menstrual cycle (19).

If it used correctly, it can help adolescents to prevent unintended pregnancy and its consequences.
In addition, providing ECs can provide adolescents with a bridge to other reproductive health
services. But this needs important information on the area of knowledge, attitude and practice of
students/adolescents.

Despite limited studies were conducted on the issue of EC in the Ethiopia, the existing
information’s were only focused on female students at University level and the level of high
school students in general and Jiren female students KAP toward EC is yet not known. Thus this
study will come up with information related to KAP of Jiren High school female students which
could be used as base line information for researchers, local health planners and identifying
factors that hinders the utilization of EC when necessary and suggests possible solution that
enhances EC utilization.

Hence knowing the level of knowledge, attitude and practice towards EC will help policy and
decision makers to implement program tailored to female students need concerning EC method
use.

The study will also help as base line data for further studies to be conducted and to make possible
recommendation.

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 CHAPTER TWO: LITERATURE REVIEW
2.1 The Concept of Emergency Contraception

Despite the availability of highly effective methods of contraception, many pregnancies are
unplanned and unwanted. These pregnancies carry a higher risk of morbidity and mortality, often
due to unsafe abortion. Many of these unplanned pregnancies can be avoided using emergency
contraception (21).

Emergency contraception refers to contraception methods that can be used by women following
unprotected intercourse or if the women had a contraceptive accident such as leakage or slippage
of condom to prevent an unwanted pregnancy (22, 10).

There are two types of emergency contraception: hormonal methods and the insertion of
intrauterine device (IUD). Hormonal emergency contraception consists of combined oral
contraceptive a pill has been used since the 1970s, which contain 200mcg of ethinyl estradiol and
1.0 mg of Levonorgestrel. And the other one is Progesterone only pills containing 0.75 mg (one
tab) or 0.03mg of levonorgestrel (20tabs) should take within 72 hours of unprotected intercourse
and then 12 hours Later(22,24).

The non-hormonal method of emergency contraception involves insertion of a copper intrauterine

contraceptive device (IUD) into the uterus. They are most appropriate for women in stable
relationships who wish to retain the IUD for long-term contraception and who meet the screening
requirements for regular IUD use (10, 25).

The exact mode of action of ECPs in any given case cannot be known. ECPs have been shown to
inhibit or delay an egg from being released from the ovary when taken before ovulation. They
may also prevent sperm and egg from uniting or stop a fertilized egg from attaching to the uterus.
ECPs do not interrupt or abort an established pregnancy. They can only help in preventing
unwanted pregnancy. ECPs play a crucial role in family planning programs as a backup method to
avoid unwanted and unplanned pregnancy as well as a bridge to continuing use of family planning
methods (21, 22, 10, and 26).

Similar survey done among students of Addis Ababa University and Unity University College
showed 43.5% of students have heard about EC, but lesser proportion (10%) of those who have
12
heard about EC could tell the correct timing of administration and only 5% of the respondents
have used emergency contraception. In the same study, 19.5% were sexually active and 51.7%
have ever used regular modern contraceptives. Of those who were sexually active 35.1% have
experienced pregnancy one or more times and 73.5% of these pregnancies were unwanted. More
than 71.7% of unwanted pregnancy had induced abortion and 29% were under unsafe condition.
About 53% of the students have positive attitude towards the importance of emergency
contraceptives (34).

A cross-sectional study by Tilahun.D on 660 regular undergraduate female students of Adama

University showed that (46.8% of the students had heard about emergency contraceptives and
from those who heard emergency contraceptives, 27.2% had good knowledge, 62.9% of the
students had positive attitude towards EC 4.7% had used emergency contraceptive methods(23).

A study in Jimma university female students showed that among a total of 389 volunteered
graduating female students participated in the study , 41.9% were ever heard of Emergency
Contraceptive, 6.8% used the method, 36.5% informed by friends 22.8% radio ) and 12.3%
heard from television and (71.2% agreed to use Emergency Contraceptive when they practice
unintended sexual intercourse(17) 11.6% knew the correct timing for EC(35).

In this study almost one-third of the subjects reported that they are already sexually active. This
result is similar to the study conducted among high school female students in Assella (6). The
result is also higher than similar study conducted on higher education students in Addis Ababa
(8). But it was lower than the finding of studies conducted on South Africa Secondary School
female students and Nigerian female undergraduates’ students (1, 9). In this study nearly one-
third of ever sexually active respondents gave history of at least one pregnancy, of which 92%
were unwanted pregnancies. But, the prevalence of unwanted pregnancy among the total study
participants was 8.8 %, which is lower than reported by other studies conducted in the Jimma
Jiren high school female students , which ranged between 15-50% (4, 8, 11).This study showed
overall low rate of induced abortion. Of those with induced abortions, nearly two-third inflicted
themselves and almost one-six by untrained abortionists. Similar Study conducted in Addis Ababa
showed higher rate of unwanted pregnancy (73.5%), high rate of induced abortion (71.7%) and
lower rate of safe abortion (29%) (8). The possible explanation for low rate of safe abortion and
13
high rate of unwanted pregnancy in this study could be attributed to fear of parents and family,
and economic problems made the respondents to take measures that could threaten their life or
darken their future career. Less than one-third of the respondents had good knowledge about EC
on overall summary index for knowledge in this study which is comparable with studies
conducted in other parts of Ethiopia, Nigeria, and Cameron (8, 9, 13). This finding reveals that
comprehensive knowledge about EC methods is lacking among university female students. The
positive attitude of respondents towards EC is slightly higher than report from Addis Ababa (8)
though a considerable proportion reported their concern on using it. Majority of the respondents
got the service from pharmacy and only less than a quarter from government institution which is
similar to the study done in Uganda (2).

This study showed that use of EC is low which is similar to the findings of studies in different
areas of Ethiopia (8,10) but less than the report from studies conducted in South Africa and
Nigeria (1, 9). The low EC practice rate in this study could be due to the fact that less proportion
(29%) of them were sexually active compared to the report from South Africa and Nigeria where
57% and 63%, respectively were sexually active. The low awareness about EC could contribute.
The fact that this study was institution-based; our findings might not be generalized to the general
population. However, it may represent female students of higher learning institutions of Ethiopia.
The ever use of contraceptive in this study was comparable to a study conducted among South
Africa Secondary school students (11%) and Addis Ababa Higher Education students (10%) and
Ethiopian DHS (17.4%) (1,8,12). Though nearly half of the respondents have heard about EC in
this study, only 15% of them had identified the correct timing of administration of the pills after
unexpected sexual contact. Several studies conducted in higher institutes in Uganda, Nigeria,
South Africa, Cameron, and other developing countries reported similar findings (2, 9,13). This
study has tried to show the sexual behaviors as well as patterns of perception and practice on
contraception; with a special emphasis on emergency contraception in students at higher
education level in Ethiopia. The limitations in this study could be the fact that other colleges and
segments of adolescents were not included and especially the knowledge, attitude and practice of
emergency contraceptives among care providers and health institutions were not assessed; which
could have been equally important to identify the problem in addition to approaching clients.
Almost one-fifth of the total number of study subjects reported that they are sexually active in
14
their lifetime. Similar results were reported by different studies among Nigerian university
students, and female medical school students in Mexican university (16, 17). Among unmarried
students who were sexually active, about 27% Knowledge, attitude, and practice on Emergency
Contraceptives among female student 115 gave history of at least one pregnancy, of which 73.5%
were unwanted pregnancies. On the other hand, among the total study participants, the
prevalence of unwanted pregnancy was 4.7%, which is lower than reported by some studies
conducted in the country, which ranged between 15-50% (1). The prevalence of induced abortion
in this study was 4.9%. Unwanted pregnancy was the main reason given for undergoing induced
abortion (about 95%). The result was relatively higher as compared to a study done by Tadesse et
al (1) The result of this study has shown that two thirds (64.1%) of the total respondents were
aware of the existence of EC. This figure is much higher than those reported by Ammanuel from
Jimma, Ethiopia (50.1%) (8) , 23% from USA and 18% from Mexico, but it was lower than those
reported from a UK (85%) high school adolescent’s study (9) . Similar to what many other studies
have shown; our young female students also lack specific details like dose and time frame of the
method (19%). This is low when compared with the study done in UK, 30 % 9. The prevalence of
EC usage was 2.8%, which is quite very low when compared to a study done in UK, 62% and
even in Ethiopia 11.5%(8). This study has shown no significant association of EC use with level
of education which was contrary to many other studies. The commonest source of information
about EC in this study were school teachers and health professionals followed by friends and
family and was consistent with USA and Scotland studies which have shown 39% school, 22.6%
friends 17.5% family and 9.2% health professionals(9). Given a high prevalence of sexual activity
16%, very low awareness of EC and lack of an appropriate knowledge on the specifics of the
method among the study group; it was not surprising to find a 4.7% past pregnancy rate and a
higher tendency to practice unsafe abortion (60%). When source of information about EC in this
study was explored, health institution (mainly FGAE and Marie Stops) took the lead followed by
partner neighborhood radio and school, respectively
2.2. Effectiveness (benefits) of Emergency Contraception

Among the various forms of contraception, emergency contraceptives are the only one that can be
used after sexual intercourse, offering a second chance to prevent unwanted pregnancy. Various
studies have shown that the levonorgestrel only regimen reduces the risk of pregnancy by 60

15
percent to 93 percent or more after a single act of intercourse and combined (Yuzpe) . Regiment
reduces it by 56 percent to 89 percent. In direct comparison, the levonorgestrel regimen has been
shown to be substantially more effective than the combined regimen. Both regimens appear
to be more effective the sooner after intercourse (with in 72 hours) they are used.
Emergency contraceptive pills are not as effective as consistent and correct use of most modern
contraceptive methods (ICEC, 2008; Ellertson, 1996; Remez, 2009 & Olenick, 1999).

2.3. Side Effects Associated with Emergency Contraception and its Contraindications

No deaths or serious complications have been causally linked to emergency contraception.

Side Effects that are medically minor but trouble some to clients do occur, however, side effects
of both regimens include nausea, vomiting abdominal pain, fatigue, headache, dizziness,
breast tenderness, and irregular vaginal bleeding. The levonorgestrel only regimen is
associated with significantly lower chance of nausea and vomiting than the combined regimen. In
most women, menses following treatment will occur within a week before or after the expected
time. No evidence exists to indicate that ECPs are dangerous under any known circumstances or
in women with any particular medical condition (ICEC, 2008 & ESOG,).

16
 CHAPTER THREE: METHODOLOGY

3.1. Study Area and Period

Jiren High School is found in Jimma Zone, Southwest Ethiopia. The zone is one of the 18 zones
in Oromia Regional State; the Capital City Jimma is located 335kms south west of Addis Ababa.

The school organized in three different groups: Administration Staffs 7 are male and 4 are
females; Teachers Staffs 52 are males and 21 are females and student committee. Also my study
is on student group. it divided in to two group that is grad 9 th student and grad 10th student .The
study concern on both grad 9th and grad 10th female students in Jiren high school. So Grad 9 th
Classes starting from A-X a No of 800 female students and Grad 10 th classes has starting from A-
T. Have No of 400 Female students. So together both 9th and 10th classes have 1200 female
students in jimma jiren high school the school has a total of 2396 students among which 1196
are males.

3.2. Study Period

The study period was from January, 1-30 /2014.

3.3: study design

A descriptive cross-sectional study was employed to determine the knowledge, attitude and
practice of emergency contraceptive methods among female students in Jiren high school.
3.4. Population
3.4.1. Source population
Source populations was all female students attending their education during study period at Jiren
High school female students

3.4.2. Study population

Study populations were all female students of Jiren High school.

17
3.5. Inclusion and exclusion criteria
3.5.1. Inclusion criteria
All female students enrolled in Jiren High school (9-10) female students.
3.5.2. Exclusion criteria
Female students who were absent during data collection period and involuntary to participate.
3.6. Sample size and sampling technique/procedure
3.6.1. Sample size determination
Since data is not available on KAP of emergency contraception among high school female
students in the area, 50% of population proportion formula to determine sample size based on
single population proportion and the level of precision (d) is (0.05).
n= (za ) 2 pq q= (1-p)
2
d2
or

n= (Za)2 pxq = 384

d2
Where
n= minimum sample size of the study subjects
z=is standardized normal distribution curve/value for the 95%
confidence interval (1.96)
p=proportion of population with KAP of emergency contraception among secondary school
students (50%)
d=the margin of error taken (0.05)

n= (Za)2 pxq = 384

d2

Since the source population is <10,000, population correction formula is used determine to adjusted
minimum sample size as follows

nf= ni
1+ ni
N
18
Where
n=a minimum sample size (384)
N=total number of female students (1200)
Nf= minimum final sample size
Since the total population is less than 10,000, I was use the correction factor formula.

19
 231

Including 10% none response rate 254

3.6.2. Sampling procedure

The required numbers of samples was allocated proportionally among each grade students using
stratified sampling technique. A Sampling frame of female students from each grade was made
and simple random sampling was employed to each grade framed students to select number of
study subjects from each class.

1
 Stratified sampling of Jiren High school female students

Jimma Jiren
high school
students

Jimma Jiren high school

Grad 9and 10 students

Jimma jiren high school Jimma Jiren high school

Grad 9 students Grad 10 students

G.9 A 32 F.stud G.9 P 32 F.stud

G.9 B 34 F.stud G.9 Q 35 F.stud G.10 A 21 F.stud G.10 P 23 F.stud
G.9 C 31 F.stud G.9 R 31 F.stud G.10 B 19 F.stud G.10 Q 11 F.stud
G.9 D 35 F.stud G.9 S 27 F.stud G.10 C 18 F.stud G.10 R 29 F.stud
G.9 E 27 F.stud G.9 T 39 F.stud G.10 D 22 F.stud G.10 S 14 F.stud
G.9 F 39 F.stud G.9 U 40 F.stud G.10 E 17 F.stud G.10 T 26 F.stud
G.9 G 28 F.stud G.9 V 26 F.stud G.10 F 23 F.stud
G.9 H 38 F.stud G.9W 40 F.stud G.10 G 15 F.stud
G.9 I 26 F.stud G.9 X 31 F.stud G.10 H 25 F.stud
G.9 J 40 F.stud G.10 I 16 F.stud
G.9 K 29 F.stud G.10 J 24 F.stud
G.9 L 37 F.stud G.10 k 18 F.stud
G.9 M 30 F.stud G.10 L 22 F.stud
G.9 N 36 F.stud G.10 M 10 F.stud
G.9 O 34 F.stud
G.10 N 30 F.stud
G.10 O 17 F.stud

All Grade 9 female students No 800 All Grade 10 female students No 400

All Grade 9 grade 10 Jimma Jiren

high school female students No 1200

23
3.7. Study variables:
3.8. Operational definition
Knowledge: Awareness of existence of EC, its importance and effectiveness, ability to
identify when EC should be used after unprotected sex and its side effects.
Attitude: Attitude is the study subjects opinion, outlook, position and ideas towards EC
methods..
Practice: A study subjects who have knowledge about emergency contraception and who
have ever used it to prevent unplanned pregnancy after unprotected sex, or method failure
were classified as having practiced ECs and those who didn’t used ECs were regarded as not
practiced ECs.

3.9. Procedure for data collection (instrument)

Structured questionnaire prepared in English and arranged according to particular objective they
can answer. Data was collected by trained data collectors through face to face interview of the
study subjects.

Randomly selected Students from each class room and from each grade (grade 9 and 10) of study
was taken to one classroom, where they were informed about the purpose of the study,
importance of their participation and verbal consent was ensured. Based on their willingness to
participate in the study, they were interviewed and the questionnaires were filled by the data
collectors.

3.10. Data quality control

Data collection instrument was pre-tested on 27(10%) from Jimma preparatory school female
students to check internal validity and reliability. Based the finding possible amendments were
made. In addition, data collectors were adequately trained for one day on the administration and
checking of completeness of the questionnaire. Supervision by the principal investigator
throughout the data collection period was carried out.

23
3.11. Data Analysis and Presentation
After data collection each questionnaire was checked for completeness and consistency. Then the
data was analyzed manually by using scientific calculator. For descriptive statistics the results
were presented in terms of proportions or percentages and association between variables were
calculated using chi-square test and p-value of <0.05 were considered as significant.
3.12. Ethical consideration.
The proposal of the study was first submitted to Jimma university department of Nursing and
letter of permission was taken from Jimma University SRP office and given to Jiren High school
female student’s administrative office to get permission and cooperation. The respondents were
informed about the objective and purpose of the study and verbal consent was taken from each
respondents. Also they were informed about their right of not participating in the study or
withdrawing at any time. Confidentiality of the information was assured and collected
anonymously.

3.13. Dissemination of the study results

The final report of the study was submitted to in Jimma University department of nursing office,
defended in front of public auditorium. Result of the study was disseminated to Jiren high
School, Jimma University public health and medical sciences CBE office.

3.14. Limitations of the study

The data was collected only from youth in one high school, which is small proportions of youth
in the study area and for this reason the result has limited power to be generalized to all youth in
the study area and may overestimate the result.

23
CHAPTER FOUR: RESULT

4.1. Socio -demographic characteristics of respondents

The response was obtained from 251 students from which 181 (72.1%), 70(27.9%) were grade
nine and grade ten respectively, making the response rate 98.8%. Some of the reasons for the
non-respondents were grade ten students are near to take the national examination. Out of the
respondents 233 (92.8%) were within the age group of 15-19 years, 116 (46.2%) were followers
of Islam followed by orthodox Christianity which account for 88 (35.1%) and protestants
accounts for 44(17.5%). (Table-2).

Table 1: Socio-demographic & academic characteristics, knowledge, attitude and practice

towards emergency contraception among female students of Jiren high school May, 2014

S.No Characteristics Number %

1 Age 15-19 233 92.8
20-24 18 7.2
>25 0 0
2 Religion Muslim 116 46.2
Orthodox 88 35.1
Protestant 44 17.5
Others 3 1.2
3 Number of None 235 93.6
children One 15 6
Two or more (>2) 1 0.4
4 Class of study Grade nine 181 72.1
Grade ten 70 27.9

Figure 1 : Marital status of female students of Jiren high school, May, 2014

23
As shown to the above figure of the total respondents of female students of Jiren high school 214
(85.5%) is single where as 37(14.7%) is married.

Figure 2: Ethnic distribution of female students of Jiren high school May, 2014

As shown on the above figure from the respondents 146 (58.2%) were from Oromo ethnic group
followed by Amhara and Gurage which accounts 46(18.3%) and 31(18%) respectively and the
rest are from Tigrie, Kulo and Kafa which accounts for 28(11.2%).

4.2. Sexual and reproductive characteristics of respondents.

As it is indicated in the following table, 139 (55.4%) of the respondents were reported to have
had menarche by the age of 14-16 years and the others had seen by the age of 11-13 years. About
48(19.15) of the respondents have had sexual intercourse in their life time; of those who ever had
sexual intercourse, about 64.6 were by their consent and about 17(35.4) were forced. Of those
who had forced sex, student peers 12(70.5%), unknown persons 2(11.8%) were committing for
majority of forced sex. Of those practiced sexual intercourse 9(18.8%) are faced unwanted
pregnancy. Of those who had unwanted pregnancy 7(77.8%) were resulted from forced sex and
the rest were from inappropriate use of contraception. From those who had unwanted pregnancy
5(55.6%) were resulted in induced abortion (Table 3).

Table 1: Age at menarche, sexual reproductive characteristics and patterns of sexual intercourse
among female students of Jiren high school May, 2014

S.N Characteristics Number %

o

23
 1 Age at menarche 11-13 112 44.6
>14 139 55.4
2 Ever had sexual inter course Yes 48 19.1
No 203 80.9
3 Practiced sex by : Consent 31 64.6
Forced 17 35.6
4 Forced sex performed by Peers/students 12 70.5
A relative in the parents 1 5.9
Unknown person 2 11.8
No response 2 11.8
5 Every faced unwanted Yes 9 18.8
pregnancy in life ( N= 48) No 39 81.2

6 Outcome of unwanted Gave birth 4 44.4

pregnancy Induced abortion 5 55.6
7 Ever used contraception Yes 32 66.7
( N= 48) No 16 33.3

8 Pregnancy while using co. Yes 2 22.3

( N= 9) No 7 77.7

4.3 Respondents’ practice of Emergency contraceptives utilization

From those who had practiced sexual inter course 48 (19.1%), only 10 (20.8%) of them had used
emergency contraception and oral contraceptive pills were the only emergency contraception
used. Of those who have used ECs half of them used with correct time and half of them was
advised by the male partner. Some of the reasons for not using emergency contraception were
fear of social stigma 14 (36.8%), not knowing the availability of ECs 6 (15.8) not knowledge the
place to get ECs 5 (13.2%) and accessibility of health care facility in 5(13.2%), (Table-4).

Table 2: Practice of emergency contraceptive methods among female students of Jiren

high school May, 2014

S.N Characteristics Numbe %

o r
1 Ever used emergency Yes 10 20.8
contraception No 38 79.2

2 Emergency OCPs 10 100

contraception used (N= IUCD - -
10)
23
 Do not know/remember - -
3 Time when emergency Correct time used 5 50
contraception used Incorrect time used 3 30
Do not know 2 20
4 Advice for EC usage Friends female/peers 3 30
Male friends/partner 5 50
Health worker 2 20
Parent
- -
Other
- -
5 Reasons for not using I don’t know from where to 5 13.2
EC (N=38) get 4 10.5
Drugs un available 5 13.2
Health institute is far to get 14 36.8
services 6 15.8
Fear of social stigma 4 10.5
I don’t know its availability
Privacy not kept

4.4 Respondents Knowledge on emergency contraceptive methods.

Of those who have heard about EC 154 (100%) replied OCPs (POPs and COC,) and 34 (22.1%)
IUCD were the methods they know used as emergency contraceptives. From the respondents
who have heard about emergency contraception 127 (81.2%) were replied that ECs is obtained
from health institutions and the others were responded that private clinic (51.3%) and pharmacy
(31.8%) can also be the alternative place to obtain ECs. About 73(47.4%) of them knows that
ECs can be used after unprotected sexual intercourse and about 34(22.1%) knows that ECPs can
be used with in 72 hrs and 24(15.6%) knows IUCDs can be used with in 120hr/ 5 days after
unprotected sex (Table-5).

Table 3: Knowledge of EC methods among female students of Jiren high school May, 2014

S.N Characteristics Number %

o
1 Ever heard about Yes 154 61.4
contraception No 93 37.0
Not respond 4 1.6
2 Place where to obtain ECs From health institutions 127 81.2
[YES =150] From private clinic 79 51.3
From pharmacy 49 31.8
Do not know 85 55.2
Not respond 16 10.4
23
3 Time when ECs can be After unprotected sexual 73 47.4
used intercourse
When unwanted pregnancy 13 8.4
occurred
As an ongoing contraception 15 9.7
Do not know 53 34.4
4 Methods used as EC ( N= OCPs 154 100
154) IUCDs 34 22.1
Others ( wrong answers) 52 33.8
5 Time when ECPs is Within 72 hrs 34 22.1
effective ( N= 154) Within 120hrs / 5 days 24 15.6
Do not know the time 96 62.3
6 Time when IUCS is Within 72 yrs 16 47.1
effective ( N= 34) Within 120 hrs / 5 days 7 20.6
Do not know 11 32.3

23
Figure 3: Source of information about emergency contraceptive method among female students
of Jiren high school, May, 2014

As shown to above figure of those who have had heard of emergency contraceptives 154
(61.4%), the source of information about emergency contraceptives 109 (70.8%) were from
health information given by health workers, from teachers in the schools in 103 (66.9%), from
mass media 63 (40.9%) and from school club 39 (25.3%)

4.5 Respondents attitude towards emergency contraceptive methods

Out of 154 (61.4%) respondents who knew about ECs, 99(64.3%) agreed to use ECs when they
practice unintended sexual intercourse, 119 (77.35) gave their opinions to advice their friends to
use ECs, 78(50.6%) of respondents were replied to agree with increment of prevalence of
HIV/AIDS and other STIs when emergency contraceptive use in the society increases. Worries
with the use of ECs includes, ECs will promote promiscuity 39(25.3%) and fear of side effects in
using ECs 69(44.8%). As it was replied by 76(49.4%) unplanned sexual intercourse is the
problem of all young females (Table-6).

23
Table 4: Attitude of female students of Jiren high school towards emergency contraceptive
method May, 2014

S.No Agree Neutral Disagree

No % No % No %
1 If I have unintended sexual intercourse 99 64.3 38 24.7 17 11
I would use ECPs.
2 If a close friend have unintended 119 77.3 26 16.9 9 5.8
sexual intercourse I would advise her
to use ECPs.
3 Widespread use of ECPs will increase 78 50.6 29 18.8 47 30.6
the risk of STIs including HIV/AIDS.
4 Emergency contraception promote 39 25.3 49 31.8 66 42.9
promiscuity
5 Emergency contraception is one way 49 31.8 41 26.6 64 41.6
of abortion
6 I don’t want to use emergency 69 44.8 44 28.6 41 26.6
contraception for fear of side effects
7 Unplanned sexual intercourse is a 76 49.4 42 27.3 36 23.3
problem of all young females

4.6 Factors associated with knowledge of EC methods among high school female students.

Chi square test was carried out to determine the association between socio- demographic factors
with knowledge, attitude and practice of EC among study participants. As shown on table 7,on
this particular study students in the age range of 20 and above years were high likely (X 2 = 6.26,
P= 0.0123) to have knowledge of EC than those age between 15- 19 students; learning at grade
ten were more likely to have knowledge of ECs than those learning in grade nine (X 2 = 4.23 , P=
0.0379). Respondents who are ever married have good knowledge about ECs than those who
never married (X2=3.9, P= 0.0483) (Table 7).

23
Table 5: Association between socio-demographic factors and the levels of knowledge of
emergency contraceptive method among female students of Jiren high school May, 2014

23
 Variables Knowledge towards EC

Good Poor Total

No. (%) No. (%) No. (%) X2 df P-value

Age 15-19 117 (50.2) 116(49.8) 233(92.8) 6.26 1 0.0123

20-24 15 (83.3) 3(16.7) 18(7.2)

Total 132 119 251(100)

Religion Orthodox 58 (50) 58(50) 116(46.2) 1.16 3 0.7626

Muslim 49 (55.7) 39(44.3) 88(35.1)

Protestant 24 (54.5) 20(45.5) 44(17.5)

Others 1 (33.3) 2(66.7) 3(1.2)

Total 132 119 251(100)

Ethnicity Oromo 79 (54.1) 67(45.9) 146(58.2) 0.42 2 0.8106

Amhara 24 (54.5) 22(45.5) 44(17.5)

Others 29 (49.2) 30(50.8) 59(23.5)

Total 132 119 251(100)

Marital Single 107 (50) 107(50) 214(85.3) 3.9 1 0.0483

status
Ever 25 (67.6) 12(32.4) 37(14.7)
married

Total 132 119 251(100)

Urban 101 (57.7) 74(42.3) 175(69.7)

23
 Total 132 119 251(100)

Class of Grade 9 88 (48.6) 93(51.4) 181(72.1) 6.24 1 0.0125

study
Grade 10 47 (67.1) 23(32.9) 70(27.9)

Total 132 119 251(100)

4.7 Factors associated with attitude of EC methods among high school female students.

As it was indicated on the following table there was a significant statistical association between
place of origin and attitude of the respondents towards emergency contraceptive methods in
which, those students who came from from Amhara ethnic group has favorable attitude towards
emergency contraceptive than other respondents from other ethnic group (X 2=8.52, P=0.0141)
(Table-8).

Table 6: Association between socio - demographic factors and the attitudes towards emergency
contraceptive method among female students of Jiren high school May, 2014

23
Variables Attitude towards EC

Favorable Unfavora Total X2 df P-value

ble

No. (%) No. (%) No. (%)

Age 15-19 95 (66.4) 48 (33.6) 143(92.9) 0.01 1 0.9203

>20 8 (72.7) 3 (27.3) 11(7.1)

Total 103 51 154(100)

Religion Muslim 52 (73.2) 19 (26.8) 71(46.1) 2 3 0.4862

Orthodox 33 (61.1) 21 (38.9) 54(35.1)

Protestant 16 (61.5) 10 (38.5 26(16.8)

Others 2 (66.7) 1 (33.3) 3(2)

Total 103 51 154(100)

Ethnicity Oromo 60 (67.4) 29 (32.6) 89(57.8) 8.52 2 0.0141

Amhara 20 (71.4) 8 (28.6) 28(18.2)

Others 23 (62.2) 14 (37.8) 37(24)

Total 103 51 154(100)

Marital Single 83 (64.8) 45 (35.2) 128(83.1) 0.93 1 0.3349

status
Married 20 (76.9) 6 (23.1) 26(16.9)

Total 103 51 154(100)

Urban 83 (77.6) 24 (22.4) 107(69.5)

Total 103 51 154(100)

23
 Class of Grade 9 73 (67) 36 (33) 109(70.8) 0.62 1 0.8875
study
Grade 10 30 (66.7) 15 (32.3) 45(29.2)

Total 103 51 154(100)

4.8 Factors associated with the practice of EC methods among high school female students.

As it shown to the following table there is no significant statistical association between the use of
emergency contraception and the socio- demographic factors of respondents (Table-9).

Table 7: Association between socio- demographic factors and practice of emergency

contraception among female students of Jiren high school May, 2014

Vables ECs practice

Every used Never used Total X2 df p-value
ECs ECs
No (%) No (%) No. (%)
Age 15-19 4 (14.3) 24 (85.7) 28(58.3) 1.75 1 0.186
>20 6 (30) 14 (70) 20(41.7)
Total 10 38 48(100)
Religion Muslim 5 (50) 16 (42.1) 21(43.8) 0.323 3 0.956
Orthodox 3 (17.6) 14 (82.4) 17(35.4)
Protestant 1 (16.7) 5 (83.3) 6(12.5)
Others 1 (25) 3 (75) 4(8.3)
Total 10 38 48(100)
Ethnicity Oromo 3(13.6) 19 (86.4) 22(45.8) 2.31 2 0.316
Amhara 4 (36.4) 7 (63.6) 11(22.9)
Others 3 (20) 12 (80) 15(31.3)
Total 10 38 48(100)
Marital Single 4 (40) 6 (60) 10(20.8) 2.81 1 0.093
status Married 6 (15.8) 32 (84.2) 38(79.2)
Total 10 38 48(100)
Urban 7 (21.2) 26 (78.8) 33(68.7)
Total 10 38 48(100)
Class of Grade 9 4 (16) 21 (84) 25(52.1) 0.739 1 0.390
study Grade 10 6 (26.1) 17 (73.9) 23(47.9)
Total 10 38 48(100)

23
 CHAPTER FIVE: DISCUSSION

This study has tried to show the knowledge, attitude and utilization of emergency contraceptive
methods and perception of unintended sexual intercourse and unwanted pregnancy among Jiren
high school female students, in Oromia regional state, south west Ethiopia. This study also
assesses the sexual and reproductive characteristics (ever had sex, age at menarche, number of
children…) of the respondents. Almost one fifth (19.1%) of the total number of study
participants have practiced sexual intercourse in their life time. This result is somewhat lower
than similar study conducted on higher education students in Addis Ababa which (19.5%) of the
study participants were sexually active (34).This variation could be due to high number of study
participants for the study in Addis Ababa (833) and only 251 female students for this study . The
result was lower than the result of study conducted in Nigerian female undergraduates from wom
43% of the respondents were sexually active (29). This variation might be due to age difference,
marital status and possibly from level of education.

Among respondents who have practiced sexual intercourse 35.4% of them have had sex without
the permission of the females (forced sex). Of the forced sex 52.9% resulted in unwanted
pregnancy from which 44.4% of the pregnancies were continued to delivery while 55.6% have
gone to induced abortion. Similar study in Addis Ababa showed high rate of unwanted pregnancy
(73.5%) higher rate of induced abortion (71.7%) from which 29% where under unsafe condition
(34). The possible explanation for low rate of unwanted pregnancy, low rate of induced abortion
and high rate of delivery in this study could be provision of health information by students from
Jimma University through a community based education as CBTP, TTP, and SRP. Health
workers can also provide information on the sexual and reproductive concernsof adolescents and
youth. On the other hand health extension worker were providing Health information and family
planning service by going home to home and by giving school health service. The possible
reasons for high rate of delivery after unwanted pregnancy were, some of them were from the
rural area and most of them did not know the presence of safe abortion care.

23
The result from this study revealed that only 61.4% of the respondents had ever heard about
emergency contraception’s. This is somewhat higher than the reports from Kenya (Nairobi), on
female who come for family planning service (20%) (30), Adama University on undergraduate
female students (46.8%) (35) Jimma University on undergrad female students (41.9%) (36).This
variation could be due to the high promotion of family planning service including EC in the
study area and the presence of clubs in the school which works on prevention of HIV/AIDs and
unwanted pregnancy among youth.

However from those who have heard about EC, 65.7% of them had good knowledge and 56.9%
had favorable attitude toward EC. The result from Adama University reports 27.2% had good
knowledge and 62.9% of the respondents had positive attitude toward ECs. In this study pills are
the most widely known EC method almost by all respondents who knows EC. The most common
source of information was from health workers education (70.8%), from mass media 40.9%, peer
discussion 30.5%. The study done at Jimma University revealed that the most common source of
information were friends and peer discussion in 36.5%, mass media 22.8% and about 23% were
from health institutions (36). The variation in this study is probably from, most of the study
participants were from urban, provision of information and service by HEWs by home to home
service and by provision of information by students from JU through community based
education program.

Even from those who had basic awareness of EC they lacked detailed knowledge about the
regimen, how it is taken and its effectiveness in reducing the chance of pregnancy. As revealed
by this study about half of them have identified the correct timing of administration of pills after
unprotected sexual contact which is higher than report from Kenya, Nairobi 20%. The variation
could be due to provision of health information by students of Jimma University through
community based education. With regard to the place where to get the service, 81.2% from
health institution ,51.3% from clinics and 31.8% from pharmacies which is almost similar with
the study done at Kenya Nairobi which is 84% from hospital, 48% from pharmacies and 30%
from clinics (30).

23
As it was revealed from this study 56.9% of the respondents who ever heard about EC had
favorable attitude towards ECs and 33.1% has unfavorable attitudes. The result from Adama
University showed that 62.9% of the respondents had positive attitude towards EC (35), and this
variation could be due to classification of respondents.

This study finding showed that about two thirds (64.3%) of students who know about EC
believed that they would use EC after unprotected sexual intercourse and about 77.3% of them
agreed to advice friends or relatives to take EC after unprotected sexual intercourse; which
agrees with the study done at Jimma University in which 71.2% of the respondents were agreed
to use EC when the need arises (17).

From those respondents who know about ECs only 6.5% of the respondents had ever used it
Which agrees with similar studies done in south Africa (27,28) , Kenya Nairobi (30), Addis
Ababa University (34) Adama University (35) and Jimma University (36) showed the practice of
EC as 9.1% ,16%,5%,4.7% and 6.8% respectively.

23
CHAPTER SIX

CONCLUSION AND RECOMMENDATION

6.1 CONLUSION

 There is inadequate knowledge on the correct time of using EC.

 Favorable attitude of the respondents could be an indication of fertile environment for
possible interventions and reduction of maternal morbidity and mortality resulting from
unwanted pregnancies.

 Some of the reasons for not using contraceptives among youths were fear of social
stigma, inadequate knowledge from where and how to get the service and not trusting the
health professionals for their privacy.

 Nearly one third of sexual – intercourse were by forced sex, which resulted in to high
number of unwanted pregnancy. This could be prevented if the respondents have
adequate knowledge of contraceptives including EC. In the same way unsafe abortion
was high which could have been prevented by provision of EC after unintended sexual
intercourse.

23
6.2 RECOMMENDATION

 Health profession of Jiren kebele and teachers of Jiren high school should collaborate to
provide health information to increase awareness about correct timing of emergency
contraceptive method among Jiren high school students.
 School club should Strength IEC in the area on sexual and reproductive health, with
special emphasis to ECs including different family planning methods will be a life saving
procedure for youth, females and providing continuous education to the community.

 As the rate of unintended sexual intercourse and unwanted pregnancy were high HEW
should give a considerable attention in family planning counseling as a backup service to
solve short coming problems of females.

 School health service provider should provide health education in the catchment area, by
giving special emphasis on the prevention of unwanted pregnancy and its consequences
by providing both health information and emergency contraceptive service.

 Further research on knowledge and attitude of providers and male partner will be needed
to make EC service assessable for all youths.

23
 REFERENCES
1. WHO. A tabulation of Available data on the frequency and mortality of unsafe abortion.
2nd Edition, WHO division family health and safe mother hood program, Geneva; 14: 243-
47.
1. Mosher WD, Jones J. National Center for Health Statistics. Vital Health Stat. 2010; 23(29).
Available at: http://www.cdc.gov/NCHS/data/series/sr_23/sr23_029.pdf. Accessed 27 May
2010).
2. Magnus Hirschfeld Archive for Sexology. Worldwide statistics: http://www2.hu-
berlin.de/sexology/ECE2/html/world_wide_statistics.html. accessed on March 10, 2012
3. James Trussell J, Raymond.E: Emergency contraception: A Last Chance to Prevent
Unintended Pregnancy: http://ec.princeton.edu. Accessed on March 10, 2012.
4. Singh S, Sedgh G, Hussain R. Unintended pregnancy: worldwide levels, trends, and
outcomes. Stud FamPlann. 2010 Dec;41(4):241-50
5. Facts on Abortion in Africa. http://www.guttmacher.org/pubs/IB_AWW-Africa.pdf. accessed
on March 10, 2012
6. Facts on Unintended Pregnancy and Abortion in Ethiopia.
http://www.ipas.org/Publications/asset_upload_file440_5002.pdf. accessed on March 10,
2012)
7. Mainstreaming Emergency Contraception in Kenya. Final Project Report 2009.
8. Dray.S: Unplanned Pregnancy Statistics. http://www.ehow.com/about_4611925_unplanned-
pregnancy-statistics.html. accessed on March 10, 2012
9. Mengistu S: Assessment of level of awareness and utilization of emergency contraception
among college female students in Oromia Regional State, Arsi Zone, Assella. Addis Ababa
University Libraries Electronic Thesis and Dissertations: AAU-ETD, Faculty of medicine:
Thesis-public health 2007. [http://etd.aau.edu.et/dspace/handle/123456789/723].
10. Tajure N. Knowledge, Attitude And Practice Of Emergency Contraception Among
Graduating Female Students Of Jimma University, Southwest Ethiopia Ethiop J Health Sci.
Vol. 20, No. 3 November 2010)
11. Ambaw F,Mossie A, Gobena T. Sexual Practices And Their Development Pattern Among
23
 Jimma University Students: Thiop J Health Sci. Vol. 20, No. 3 November 2010)
12. ESOG,. Emergency contraception Guideline. http://WWW.esog. Org.et. Accessed on
accessed on March 12, 2012.
13. Tilahun.D. Knowledge, Attitude and Practice of Emergency Contraceptives among Adama
University Female Students. Ethiop J Health Sci. Vol. 20, No. 3 November 2010
14. ESOG, Emergency contraception Guideline. http://WWW.esog. Org.et. Accessed on March
12, 2012.
15. Suc-san C.Stewart M.D., the latest in emergency contraception,
http://www.thedoctorWillseeyounow.com accessed on March9, 2012.
16. Wegene Tamire ,fiqire inqusilase 111_116_EJHD_Vol_21-2111_116_EJHD_Vol_21-2
Ethiop.J.Health Dev. 2007;21;(2):
17. Dejene Tilahun,(BSC,MPH),Tsion Assefa (BSC,MPH) Ethio.j. Helth Sci vol20,No 3
november 2010
18. Teklebrihan Tema,Tadesse Alemu Ethiopian Jornal of Riproductive Health may 2009 volume
3 suplimentary
19. Zeleke G, Zebenay Z, Weldegerima B. Knowledge Attitude and Practice of Emergency
Contraceptives in Bahir Dar University Female Students. Ethiopian Journal of Reproductive
Health, 2009; 3: 59-64.
20. Seife M. Fikre E. Assessment of level of awareness and utilization of emergency
contraception, among college female students in Oromia Regional state, Arsi Zone, Asella,
South-East Ethiopia. June, 2007, (Master thesis).

23
Annex I: Questionnaire

Jimma University

College of Public health Medical science

Department of Nursing

This questionnaire is designed to assess Knowledge, Attitude, and practice of emergency

contraception among Jiren High school female students. All the respondents are kindly requested
to fill all the questions below. Your genuine answer is of paramount importance to the outcome
of the research and that all the answers and your identity are kept anonymous. Put right mark in
the box eg. “√” . If you need clarification you can communicate with the facilitator if it is
available.

Part-I Socio- Demographic Characteristics of background information

1.Age ______________

2.Marital status

a. Married c. Divorced
b. Single d. Widowed

23
 e. Boyfriend
3. Educational status

a. Grade 9 b. Grade 10

4. Religion

a. Protestant c. Wakefata e. Catholic

b. Orthodox d. Muslim f. Other specify ______

5. Ethnicity

a. Oromo b. Amhara
c. Dawuro d. Yem

e. Gurage

f. Others (specify) ___

23
7. Living condition

a. With parent d. With spouse

b. with relatively e. separately (alone)

c. with friend f. others (specifically) ……………..

Part-II Reproductive History of Respondents

1. At what age you saw menarche? When I was_____years old

2. Do you have any sexual experience?

1. Yes ____ 2. No (skip to Q4) ____

3. If yes to Q2 was your first sexual intercourse by your consent

1. Yes ____ 2. No ____

4. If No to Q2 who forced you to have sexual intercourse?

1. Student friend __ ___

2. Teacher __ ___

3. A relative __ ___

4. Unknown person __ ___

5. Specify if other ____________

Part III knowledge question on Emergency contraceptive

1. Do you know emergency contraceptive

a. Yes b. No

2. Which methods can be used for emergency contraceptive?

A). IUD (intra-uterine device) b. Pills c). DEPO

d). chroiquine e). Progesterone only pills f). Others (specific)

………

3. Where did you get information about emergency contraceptive?

a). school b). Friends c). Mass media

d). Health professional e). Others (specify)…………….

4. What is the correct dose (N=of pills) taken as EC for drug you know?..................

5. What is recommended time take EC to prevent pregnancy effectively?

a). with in 24 hrs after sex c).with In 48 hrs after sex

b). with in 72 hrs after sex d). After missed period

e). I don’t know

6. The recommended No of hrs apart between the doses.

a). 12 hrs a part b). 24 hrs a part c).72 hrs a part d). I don’t know

7. Did you know IUCD or loop can be used as EC?

a). Yes b). No

8. If you answer No 7. Yes what is the recommended time for IUCD or loop insertion
EC?

a). within 24 hr, after sex b). Within 72 hrs after sex

c). within 5 days after sex d). Other (specify)………………

PART IV question to assess the attitude to wards EC. (Emergency contraceptive)
instruction for the following questions you will answer from the following choices put
“√” according to your answer in box.

S.No Agree Neutral Disagree

No % No % No %
1 If I have unintended sexual intercourse
I would use ECPs.
2 If a close friend have unintended
sexual intercourse I would advise her
to use ECPs.
3 Widespread use of ECPs will increase
the risk of STIs including HIV/AIDS.
4 Emergency contraception promote
promiscuity
5 Emergency contraception is one way
of abortion
6 I don’t want to use emergency
contraception for fear of side effects
7 Unplanned sexual intercourse is a
problem of all young females

Part V. Respondent’ practice of Emergency contraceptive utilization

1, have you ever used emergency contraceptive?

Yes

No

2, If no to Q1 why ?

1, Health workers unwilling……………........

 2, I don’t know from where to go ……………

3, Drugs un available ………………………...

4, Time for the service inconvenient …………

5, privacy not kept……………………………..

6, Health institute is far to get services………….

7, fear of social stigma ……………………………

8, I don’t know its availability …………………....

9. If other …………………………………………...

3. if yes to Q 1 which emergency contraceptive method do you have used after

unprotected sexual act?

a). oral pill

b). IUCD

c). I don’t know/remember

4 . in what time have you taken the method in Q3. After unprotected sexual intercourse?

1). Within 72 hours

2). With in 24hours

3). I don’t know

5). How frequent have you used this method after you have started sexual intercross?

1). ……………..times

2).doesn’t remember………..

6. Who told to use emergency contraception?

a).friends female/peer

b).male friends/partner

c). health worker

D).partner

E). specify if other