King Edward Memorial Hospital - Department : Obstetrics and Gynaecology

Obstetrics and Gynaecology

KNOWLEDGE, ATTITUDE AND PRACTICES OF EMERGENCY CONTRACEPTION

An interview-based survey was carried out on

Beneficiaries (n= 450)	Providers (n= 78)
Women of reproductive age group in Antenatal and Family Welfare OPDs., MTP clinic and Post-partum centre of Dept. of Obs/Gynae., KEM Hospital	Gynaecologists, Medical Officers of Medical Colleges, District Hospitals. Paramedical staff of Primary Health Centres and Sub-centres

The concept of emergency contraception was explained to those unaware of it during the interview and they were given an idea of its methods.

Questions were aimed to elicit information from both beneficiary and provider on their knowledge and practice of/advice on

Existing methods of contraception.
MTP & related morbidity.
Opinion and attitude towards abortion.

What are the contraceptive methods that you know?

By whom are they used?

What is their efficacy?

100% effective, Can fail rarely, Can fail sometimes

Is follow up needed Why?

How long can they be used?

What is your opinion regarding their safety?

Can they cause - Health Problem, Mental problem, Social problem, None of the above?

Can one become pregnant after discontinuing their use?

PROVIDERS:

Doctors 28
Paramedics 50 (from PHC + SC)

Awareness of family planning methods 100% in all.

Awareness of emergency contraception 100% in doctors, NIL in paramedical staff who were then expalined about concept and methods of EC.

Can Emergency contraception be used as a substitute for regualr contraception?

If there is a risk of conception after unprotected sex 67 (86%) would recommend EC 11(14%) would decide on merits of each case.

Best methods of communicating

Counseling	41 (52.6%)	Group Discussion	36 (46.2%)
Media TV/Radio	38 (48.7%)	School/College curricula	20 (25.6%)
Paper Magazine	12 (15.4%)	Posters & charts	15 (19.2%)

PROVIDERS:

	Yes	No	Undecided
Should EC be told to general population	72 (92.3%)	6 (7.7%)	-
Should EC be told to adolescent girls	71 (91%)	-	7 (9%)

If Yes Why

General Population	Adolescents
They can ask for it in time 20 (25.6%)	Can avoid abortion & unwanted preg 23 (29.5%)
Prevent unwanted pregnancy 16 (20.5%)	Part of sex education 16 (20.5%)
Part of sex education 13 (16.7%)	To improve the awareness and knowledge regarding this issues as it is an important part of sex education 12 (5.4%)
Prevent abortion & keep family small 11 (14.1%)	Prevent over - & mis-use of EC (if they know exactly what to do) 11 (14.1%)
Improve health by avoiding MTPs 8 (10.3%)	Can ask for EC in time 9 (11.5%)
Control population 4 (5.1%)

Best Route of EC:	Paramedics	Let doctor decide
	Doctors	Depends on merits of each case

BENEFICIARIES

Did you face such a situation in the past?

Yes	No	Don't Know
192 (42.67%)	255 (56.67%)	3 (0.67%)

What did you do?

Waited for missed period 32(7%)		MTP from recog. Source 138 (31%)
Took treatment from doctor 2(0.48%)		Illegal abortion 1 (0.22%)
Could not do anything, Conceived & continued pregnancy		19 (4.22%)
In case you meet such an Emergency in future could you use Emergency Contraception?	Yes	No	Don't Know
	405 (90%)	21 (47%)	24 (47%)

Where would you go for it?

Govt. Hospital	386	85.77
Private Hospital	11	2.44
Chemist	2	0.44
Do not know	6	1.33

What are the advantages and disadvantages of Emergency Contraception?

Advantages	Disadvantages
Helps avoid unwanted pregnancy. No tension of pregnancy 199 (44.22%)	May have side effects & Reproductive morbidity 28 (6.22%)
Helps avoid need of abortion 164 (36.44%)	May not be successful 49 (10.89%)
Can't say 84 (18.68%)	Do not know 233 (51.78%)
Easy confidential respectful 2 (0.44%)	Young girls can beSpoiled by licence to permissive sex-Misuse 18 (4%)
Unmarried can be rescused by it 1 (0.22%)	No disadvantage 122 (27.15%)

Is Emergency contraception Safe & effective?			Should couples know about it?
200	(44%)	Yes	420	(93%)
1	(0.22%)	No	2	(0.4%)
249	(55.8%)	Don't know	28	(6.6%)

Should EC be made available to adolescent girls?

Yes	No	Can't Say
392 (87.11%)	25 (5.56%)	33 (13.1%)

If a woman is in need of EC, the need should be met like any other health emergency

Yes	No	Can't Say
388 (86%)	4 (0.9%)	58 (13.1%)

If Yes, why?

Strictly couples reproductive right	162 (36%)
One's private affair	50 (11.11%)
Socially acceptable	4 (0.89%)
Ethical	4 (8.89%)
All of the above	230 (61.11%)

Choice of EC method & route
Injection	119 (26%)
Oral	220 (49%)
IUCD	60 (13%)
Don't know	51 (12%)

What is abortion?	Yes	No	Don't know
It is a process by which pregnancy is got rid off.	414 92%	3 0.7%	33 7.3%
It should be done by 8-12 weeks	327 72.7%	17 3.8%	106 23.5%
It is a surgical procedure requiring instrumentation	323 71.8%	8 1.8%	119 26.4%

Can abortion cause problems?

Yes	No	Don't'know
276 61.33%	28 6.22%	146 32.44%

Given an alternative to abortion would you like to opt for it?			-	Where would you go for abortion?
Yes	419	93%		Doctor	424	94.22%
No	11	2.4%		Nurse	0	0
Don't know	20	4.6%		Trained Dai	1	0.22%
-				Any other	3	0.66%
-				Continue pregnancy.	22	4.88%

What is this alternative?

Some contraception	129	28.7%
Emergency contraception	260	57.8%
Others (continue preg.)	4	0.9%
Don't know	57	13.0%

If you ran the risk of conceiving due to unprotected sex would you like to have EC?

Yes	No	Depends
391 (87%)	21 (4.6%)	38 (8.4%)

Amongst beneficiaries awareness of family planning method was almost universal but awareness of Emergency Contraception was practically nil.

EC emerged as an unknown commodity to beneficiaries and paramedical providers.

However, the concept of EC took very well with both the above groups

Women were very concerned with their reproductive health, what was lacking was an opportunity to gain knowledge about and access to the product.

Aggressive Marketing is called for. Improve IEC on E.C. for users and providers (all the cadres of paramedical staff.)

The IEC should extend to all current and potential clients.

Eligible couples must be edcuated so also the adolescents.

Emergency Contraception does deserve a place in sex education.

If they do not know about it how can they ask for it?

And ask for it well in time?

You can't dig a well after the fire has started.

Emergency contraception must become the right of all women of reproductive age group in all strata of life in all urban rural & slum areas, it should be available with all levels of health providers.

It must not be allowed to remain the prerogative of the already privileged educated women of the metropolises.