Ethiopia has one of Africa’s youngest populations at the beginning of the 21^st century. About one out of every four females in Ethiopia is 16-24 yrs old. This is the largest group of young people ever in the region to inter adulthood. Helping Ethiopian youth to make a healthy transition to adulthood is critical to the countries development and prosperity of its future population. Worldwide young women and men suffer a disproportionate share of unplanned pregnancies, Sexually Transmitted Diseases (STD) including HIV and other serious reproductive health problems. To alleviate this problem, increasing accessibility and awareness of contraception methods including emergency contraception’s to these vulnerable young population is a critical step to be implemented [1,2].

Emergency contraception is a kind of contraception method that is used in the prevention of pregnancy following an episode of unprotected intercourse during the fertile period. It has the potential, as the last resort, to avoid unwanted pregnancy and therefore abortion; a desirable goal especially when abortion is illegal. Oral contraceptive pills and Intrauterine Contraceptive Devices (IUCDs) are mainly used as emergency contraceptives. When used within 72 hours after sexual intercourse, 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% [3].

Statement of the problem

Unwanted pregnancy leading to unsafe abortion is one of the most important causes of maternal morbidity and mortality. Unsafe abortion is a major medical and public health problem in Ethiopia [4]. Ethiopia has a high incidence of unwanted pregnancies and incomplete and unsafe/septic abortions, particularly among adolescents. For this reason, it is reported that about four million adolescents experience induced abortion each year [5].

Moreover, Ethiopia is the second most populous country in Africa, with an estimated population of 93,877,025 despite the substantial increase in the use of modern contraceptives from 6% in 2000 to 27.3% in 2011. One of such method is Emergence Contraceptives (EC) which was introduced in Ethiopia in 1997. There is no national data exist on the percentage of Ethiopian women who have used EC. However, studies in different parts of the country show very low utilization rate (as low as 10%) of the method despite the significant proportion of youth have ever had sex in their life time. The most frequently reported reasons for the non-use of the method are fear of side effect and lack of information (knowledge). The knowledge of sexually active unmarried women, in this regard it is found to be 41% nationally which is very much lower than what is expected to be [6-9].

The potential of EC to prevent unintended pregnancy is well documented but the awareness & use of the method in our country is poor. Scientific evidences shows that three fourth of unplanned pregnancy can be prevented by using emergency contraceptives after unprotected sexual intercourse [10]. However, the problem of unintended pregnancy still exists despite the fact that different modern contraceptives exist worldwide. This could be attributed to the lack of information and negative attitudes towards the method [11,12]. In light of this, we are interested in examining problems concerning knowledge, attitude and practice of emergency contraceptives among Ambo TVET female students.

Significance of the study

The study is searching for facts and information’s on the knowledge, attitude and practice of emergency contraceptives which is believed to be the second opportunity to prevent unintended pregnancy after unprotected sexual intercourse among female adolescent and young adult. Therefore, the findings can benefit governmental and non-governmental organization working to provide reproductive health service of these populations. Furthermore, Ambo health office and non-governmental organization found around the study area and also in Ethiopia like family guidance associations which are providing emergency contraceptive service can utilize the result of this study as a base line data in planning awareness creation programs for female college students.

Study design

A descriptive cross sectional study was used to assess knowledge, attitude and practice of students in the study area.

Study area and period

The study was conducted from March to September 2013 at Ambo Technical and Vocational Educational Training College (TVETC) in Ambo town. Ambo town is located at about 116 kilometers to the west of the capital city; Addis Ababa. Ambo Technical and Vocational Educational Training College (TVETC) was established in 1994. There are a total of 2043 (1028 male and 1015 female) regular students enrolled in the academic year 2012/13. The students attending this college are selected from different locations giving an opportunity for the generalizability of the findings to versatile population groups. All Female regular students of age 15 years or more were included. We excluded those who are absent from class on the day of data collection and not willing to participate in the study.

Sampling and data collection procedure

Simple random sampling techniques were applied to select 305 from 1015 female regular students enrolled to Ambo TVET College in 2012/13 academic year. List of students from all departments was prepared and given a number from 1 to 1015 then the study unit is selected by using table of random numbers. Data collection was carried out by trained four clinical nurses up on supervision of the principal investigators. Self-administered questionnaires were used as the tool for data collection. In order to minimize bias due to language barriers, the questionnaires which originally prepared in English was translated to local language of the study participants called Afan Oromo version. This tool contains three important parts: sociodemographic information, sexual history and questions that accesses knowledge about, attitude towards and practice of emergency contraceptives. To assure true responses by the student, collage teachers and authorities didn’t involve in administering the questionnaires.

For the purpose of the present study, we had defined Knowledge as a study subject who responded correctly to more than four out of six emergences contraceptive awareness related questions. Attitude as a subject of study who had a favorable response to more than 3 out of 5 attitude statements and Practice implies subjects who had ever used emergence contraceptive once or more in their life time. Sexually active when sexual intercourse is practiced in the past six weeks. Lastly, ever had sexual intercourse was defined as an individual who had practiced sex once or more in her life time.

Data processing and analysis

Data was analyzed using SPSS version 20.0. Then descriptive statistics are performed. Finally, the results were organized in number and percentage for categorical data while as mean and range for continuous variables and presented using narrative statements and tables.

Ethical consideration

Ethical clearance was obtained from Ambo University, College of Medicine and Health science research and technology transfer team. Then informed consent was obtained from each and every study participant before data collection began. Participants filled the questionnaire privately and all necessary precautions’ were taken to maintain the confidentiality of the information to be collected.

Socio-demographic characteristics

We had got 100% response rate in this study. As shown in Table 1, the age of study participants mostly (73.1%) falls in the range of 15 to 35 years. Most of the respondents (59%) were followers of Orthodox Christianity followed by Protestants who accounted for 20.6%. Again, majority (86.5%) of the respondents were not married and almost all Oromo in ethnicity.

Table 1: Socio-demographic characteristics of the respondents, Ambo, Ethiopia, 2013.

Sexual history and pregnancy related issues

As it can be seen from Table 2, history of recent sexual intercourse of the respondents was very low (1.6%). Surprisingly, all of them who had sex during the survey responded that they have not used condom. A total of 26 respondents replied that they had been pregnant at least once previously of which unwanted or unplanned pregnancy constituted 76.9%.

Table 2: Sexual and reproductive health characteristics, Ambo, Ethiopia, 2013.

Knowledge about EC

Table 3 shows that in this study, 80.7% of the respondents have heard about products that can be used for emergency contraceptives. Among those who heard about the products, they report that the major reason to use those products is rape (41.1%). More than half of respondents (52.9%) reported that the correct time interval to use emergency contraceptives was 72 hours. When asked about specific types of emergency contraceptives, 54.4% mentioned pills and 25.2% mentioned injectable while 16.4% mentioned IUCDs. The major source of information that is known by the respondents was government health institutions (about 60%) followed by media (radio/ television) as depicted on Figure 1.

Table 3: Knowledge about EC of the respondents, Ambo, Ethiopia 2013.

Figure 1: The main sources of information about emergency contraceptive.

Utilization of EC

As it is shown in Table 4, only 12.5% respondents reported that they had used emergency contraceptive methods previously. All participants who had used emergency contraceptive methods reported that the methods were effective in protecting unwanted or unplanned pregnancy. Majority of the respondent (73.7%) also indicated that they got the service of emergency contraceptives from the government health institutions followed by family guidance Ethiopia (13.2%).

Table 4: Utilization of EC by respondents, Ambo, Ethiopia, 2013

Attitude toward EC

Table 5 shows that 77.4% of the respondents have positive attitude towards emergency contraceptives. Majority of the respondents (about 69.8%) do not belief that emergency contraceptive help to induce abortion. About 85.6% of the respondent agreed to advice the future use of emergency contraceptives. During unprotected sexual intercourse. However, a significant proportion of respondents (33.1%) reported that induced abortion is preferred than using emergency contraceptive.

Table 5: Attitude toward EC of the respondents, Ambo, Ethiopia, 2013.

The present study has generated data of considerable importance regarding the knowledge of college students on EC, their attitude toward the method and the extent to which they have utilized it since they started sexual intercourse. The findings will be valuable input for policy makers and other stakeholders working on sexual and reproductive health services in the region for planning and provision of EC services for the youth with unmet need of the method under consideration. Accordingly, these findings are discussed below in view of national and international data previously available to further consolidate the applicability of the findings.

In Ethiopia, it is indicated that only 19% of all women (41% unmarried) had knowledge about ECs [7]. In previous work conducted by Jimma et al. on Ambo University female students, it was found that 62.5% of the students have information about the method. The present study showed even higher knowledge for the respondents than our previously published work [13] regardless of the fact that university students are believed to have better overall knowledge than college students. This is similar to the findings of other studies conducted in among the biggest and oldest universities of Ethiopia like Hawassa University, Addis Ababa University and Jimma University [8,14-17]. In India it is reported that 90.3% college students have ever heard about EC [18]. These findings highlight the need for further study to find out the attributes of college students that could responsible for increasing their knowledge.

Correct timing is the single most important determinant of EC effectiveness; the shorter the time between unprotected intercourse and utilization of EC, the better will be its effectiveness. In this study, 52.9% of the respondents mentioned the correct time (maximum 72 hrs) since the unsafe sex which is comparable to our previous work and Hiwot et al. [13, 14]. However, this is higher than that of Anteneh et al. (35%) and lower than the 68.8% obtained by Vijender et al. [18].

Different studies identified different sources providing information on EC. Accordingly, the most commonly stated sources of information for this type of contraception include media [13], health institutions [3], school [14], and friends as well as media [15], TV, magazine and internet [18]. The present study showed government health institutions to be the most common source of information stated by respondents.

These evidences clearly show that method mix (combination of TV, magazine and the like) has to be used to make EC information as widely disseminated as possible so as to increase the awareness of youth and adolescents in universities and colleges as well as the communities at large about this kind of contraception.

The prevalence of sexual practice among university and college students is known to be high which is mostly unprotected yet the proportion of this wing of population found to use EC is very low as explored by different studies. It ranges from 4.9% to 36.5% for Ethiopian students [13-15]. Similarly, lower utilization rate of 12.5% had been obtained in the present study. Among women undergoing abortion, the utilization is even lower to the level of not existing [3,16]. This very lower utilization rate of the method in all cases is despite the respondents’ acceptable level of knowledge and high degree of sexual practices. For this, different scholars put different reasons for EC nonuse including but not limited to fear of side effects, fear of becoming infertile after use, lack of information, religion, culture, partner disagreement, fear of being seen by others, inconvenient service delivery and many more [3,9,17]. Therefore, campus wide well organized reproductive health education is timely and a must to be implemented for this group in order to increase the uptake of the method so as to avoid the high rate of unwanted pregnancy associated with it.

In contrast to what have mentioned for extent EC utilization, most studies showed that female students have favorable attitude for the method. We have come across positive attitude of 53% to 100% during our literature review [3,13-16]. The finding of this study also falls in this range. However, this doesn’t mean that we should not have to work on this issue. This is because there are still many misconceptions and wrong belief like it increases risky behaviors, fear of misuse, propagate HIV/AIDS, discourage the use of other methods, causes birth defect and the like [3,13,14]. Hence all these need to be addressed to make the knowledge of, attitude toward and utilization of EC to go side by side to minimize unwanted pregnancy and its complications among college and university students which are now constituting the major proportion of world population.

Lastly, as other cross-sectional studies, our study is limited by the fact that we couldn’t establish causation among any variables. Secondly, there could be some degree of biasness as the study was based on self-reported questionnaires.

In general, students in this college have acceptable level of general knowledge and attitude. However, their utilization of emergence contraceptives is very low secondary to different myths and misconceptions that need to be addressed soon by the government and other responsible stakeholders. Moreover, method mix has to be used to make EC information as widely disseminated as possible to increase the awareness of college and university students about the method. Lastly, campus wide well organized reproductive health education is timely and a must to be implemented for this group in order to increase the uptake of the method.