TITLE PAGE

AWARENESS, UTILIZATION AND PERCEPTION ON EMERGENCY

CONTRACEPTIVES AMONG WOMEN ATTENDING POST NATAL CLINIC IN

UNIVERSITY OF MAIDUGURI TEACHING HOSPITAL, MAIDUGURI, BRONO

STATE

BY

HYELADI USMAN

M/24/00377

IN PARTIAL FULFILMENT OF THE REQUIREMENT OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF MIDWIFERY

UNIVERSITY OF MAIDUGURI

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 CERTIFICATION PAGE

This is to certify that the project work titled : AWARENESS, UTILIZATION AND

PERCEPTION ON EMERGENCY CONTRACEPTIVES AMONG WOMEN

ATTENDING POST NATAL CLINIC IN UNIVERSITY OF MAIDUGURI TEACHING

HOSPITAL, MAIDUGURI, BRONO STATE was carried out by HYELADI USMAN ID

Number M/24/00377 In the department of Nursing Sciences Faculty of Allied Sciences

University of Maiduguri.

Dr. AMINA ABDULRAHEEM

SIGNATURE: ----------------------------------- DATE: -------------------

SUPERVISOR

Dr. TUKUR BABAYO

SIGNATURE: ------------------------------- DATE: ------------------

HEAD OF DEPARTMENT

CHIEF EXAMINER

NAME: -----------------------------------

SIGNATURE: --------------------------- DATE: -------------------

ii
 DEDICATION

This project is dedicated to God Almighty and Divine family

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 ACKNOWLEDGMENT

First of all my ultimate gratitude goes to the Almighty God for grading the opportunity to write

this project successfully.

I also heartedly express my profound gratitude and appreciation to my project supervisor Dr, Dr.

Amina Abdulraheem for her advice, constructive suggestion and sincere supervision throughout

the period of this study. I also acknowledge the entire academic and non-academic staff of the

Department of Nursing Science, University of Maiduguri for immense contribution to my

educational attainment.

My special appreciation and must grateful acknowledgement goes to my beloved Husband Mr.

Emmanuel Bello Mibwala, daughter Hirhyel Emmanuel and also my son Aklahyel Emmanuel

For their support throughout the period of my study.

My appreciation to my beloved parent in person of Mr. Usman Wakawa (JP), Mrs. Habiba

Usman Wakawa (JP) for their concern for my academic achievement since my primary up to my

tertiary level. And my special thanks also goes to my dear sisters and brother; Mrs. Ruth

Shuaibu, Mrs. Hannatu Hyeladi, Rahila Usman,Yashuwa Usman Alheri Usman, and Idris

Usman.

Also to all my friends, and class mates, thank you for your support.

May Almighty God bless you all and rewards you immensely.

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 TABLE OF CONTENT

Title Page - - - - - - - i

Certification - - - - - - ii

Dedication - - - - - - iii

Acknowledgment - - - - - - iv

Table of Content - - - - - - v

List of Table - - - - - - vi

List of Figure - - - - - - vii

Abstract - - - - - - viii

CHAPTER ONE: INTRODUCTION

1.1 Background of the Study - - - - - - - 1

1.2 Statement of the Problem - - - - - - - 3

1.3 Objectives of the Study - - - - - - - 4

1.4 Significance of the Study - - - - - - - 4

1.5 Research Questions - - - - - - - - 5

1.6 Scope of the Study - - - - - - - - 5

1.7 Operational Definition of Terms - - - - - - 5

CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction - - - - - - - - - 7

2.1.1 Concept of Emergency Contraceptive - - - - - 7

2.1.2 Methods of emergency contraceptive - - - - - - 8

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2.1.3 How emergency contraceptive pills work - - - - - 9

2.1.4 Indications for Emergency contraceptive Pills - - - - - 9

2.1.5 Safety and Effectiveness of Emergency contraceptive - - - - 10

2.2 Emergency Intrauterine Contraceptive Devices (EIUCDs) - - - 12

2.2.1 Available Emergency Intrauterine Contraceptive Device - - - 12

2.2.2 Advantages of using Emergency Intrauterine Contraceptive Devices - - 13

2.2.3 Side Effects Associated with emergency Intrauterine Contraceptive Device - 13

2.3 Perceptions about Emergency Contraceptive - - - - - 13

2.3.1 Awareness of Emergency Contraceptive - - - - - 14

2.3.2 Utilization of Emergency Contraceptive - - - - - 15

2.4 Theoretical Framework - - - - - - - 16

2.4.1 Health Belief Model - - - - - - - - 16

2.4.2 Application of the Model to the Study - - - - - - 16

2.5 Empirical Review - - - - - - - - 22

2.6 Summary of Literature Review - - - - - - 24

CHAPTER THREE: METHODOLOGY

3.1 Study Area - - - - - - - - - 26

3.2 Research Design - - - - - - - - 27

3.3 Target Population - - - - - - - - 28

(a) Sample Size and Sampling Techniques - - - - - 28

3.5 Instrument for Data Collection - - - - - - 29

3.6 Validity and Reliability of Data Collection Instruments - - - 29

3.7 Method of Data Collection - - - - - - - 29

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3.8 Method of Data Analysis - - - - - - - 29

3.9 Ethical Consideration - - - - - - - - 30

CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.0 Introduction - - - - - - - - - 31

4.1 Response Rate - - - - - - - - 31

CHAPTER FIVE: DISCUSSION OF FINDINGS

5.1 Discussion of Findings - - - - - - - 40

5.2 Summary of Major findings - - - - - - - 41

5.3 Limitation of the Study - - - - - - - 41

5.4 Implication for Nursing - - - - - - - 41

5.5 Recommendation - - - - - - - - 42

REFERENCES - - - - - - - - - 43

QUESTIONNAIRE - - - - - - - - - 48

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 LIST OF TABLES

Table 4.1: Socio-Demographic Characteristics of Respondents - - - 36

Table 4.2: Awareness of emergency contraceptives method (N=186, % =100) - 37

Table 4.3: Utilization of Emergency contraceptives (N=200, %=100]- - - 38

Table 4.4 Respondents view on misconception - - - - - 39

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 LIST OF FIGURE

Fig1: Health Belief Model - - - - - - - - 16

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 Abstract

The study assesses the level of awareness and utilization of emergency contraceptive method

among women attending post natal clinic U.M.T.H, Maiduguri, Borno State. Three objectives

and three research questions were formulated for the study. Descriptive survey design was used

for the study. Before processing the responses, the retrieved questionnaire will be checked for

completeness and comprehensibility to ensure consistency. The data were then be summarized,

coded and will be entered into statistical package for social science (SPSS) for analysis to

enable the responses be grouped into various categories. The finding on awareness of emergency

contraceptive shows that majority 86(46.2%) got their information via media. Finding on

utilization, indicated that majority utilizes pills (43%),followed by injectable (35%),then

IUCD(21.5%)in that order. Finding on misconception of emergency Contraceptives shows that

84% of despondent believed emergency Contraceptives causes infertility very often. Based on the

findings of the study it is recommended that developing continuing education programmes on

emergency contraception specifically geared toward nurses and midwives as well as printed

material for providers to share with patients/client may also be effective.

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 CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Emergency contraceptive (EC) is a method to prevent pregnancy in women who have had

unprotected sex or when birth control methods have failed (Prine,2022). According to Weis

(2018) Emergency contraceptive is an emergency birth control that uses either Emergency

Contraceptive Pills (ECPs) or a copper T – intrauterine contraceptive device (IUCD) to prevent

pregnancy following unprotected vaginal intercourse. Emergency contraceptive is usually

effective up to five days following unprotected sexual intercourse.

Glasier (2018) defined emergency contraceptive as any device or drug that is used as

emergency procedure to prevent pregnancy after unprotected sexual intercourse. Emergency

contraceptive acts by inhibiting ovulation, prevention of fertilization, if fertilization occurs it will

prevent the implementation of the product of conception. There are several emergency

contraceptives in use today. However, their side effects convenience of use, safety and efficacy

profiles vary, (Nelson, 2011).

Good knowledge and favourable attitude towards emergency contraceptive is necessary among

postnatal mothers, to avoid unintended pregnancies. Hence future pregnancies can be delayed

and planned accordingly. However, there is lack of information regarding knowledge and

attitude about emergency contraceptive in developing countries like India. In this context, the

present study was taken up to assess the knowledge and attitude of postnatal mothers towards

emergency contraceptive and to find out the association between socio-demographic variables,

parity and previous planned delivery with awareness of emergency contraceptive. Due to the

1
effort of numerous agencies the availability of emergency contraceptive has increased and

specific products are registered in more than hundred countries (Hapiparsad, 2017).

By 2005, at least 50 detected products for emergency contraceptives were registered in 109

countries, in Africa, America, Asia, Europe and Oceanic. Access to emergency contraceptive can

be beneficial to millions of women and families in the world that may suffer the consequences of

unwanted pregnancy encourage abortion, thus improving reproductive right (Hapiparsad, 2017).

In spite of misconception generated by the introduction of emergency contraceptive almost

everywhere, majority of countries have registered emergency contraceptive products, have

included it in National guideline for family planning and management of sexual violence, and

made it available to public health services, clinics and throughout social marketing or pharmacies

(Takar, 2018).

Even specialist physicians were not aware about the appropriate dosages, timing of use,

and mechanism of action or availability of emergency contraceptives.

Emergency contraceptive pills is use when a woman is not using any birth control

method, force to have unprotected sex (rape), forget to take birth control pills, condom breakage,

partner do not pull in time. The hormonal emergency contraceptive pills reduce the risk of

pregnancy by up to 95%, and emergency contraceptive intrauterine device insertion reduce such

risk by 99%, (Bacher, 2011).

The full potential of emergency contraceptive can be realized only when women are

made aware of the existence of these methods and the need to use them within the short time

frame of their efficacy. Such awareness is still limited in many developing countries. In India, a

survey of 4000 women aged 18-35 years in the state of Delhi revealed very low (3.2%)

awareness about emergency contraceptive (Goel, 2017)., and awareness in rural areas was less

2
than 2%. Evaluation of knowledge and views of doctors about emergency contraceptive revealed

poor knowledge among women (Kumar, 2016)

1.2 Statement of the Problem

One of the major global concerns is the health of mothers and children. Results from past

researches have proved that perinatal, neonatal and under five as well as maternal mortality rates

remain high in most developing countries. Strategies have been employed by various

governments in improving these indices amongst which is the use of emergency Contraceptives.

Despite employing this strategy, the contraceptive prevalence is relatively low in most

developing countries with values ranging from 6-14.6%. In relation to the non-utilization of

modern contraceptive, the major obstacles include fear of side effects, poor quality of services

and opposition from family members or influential members of the community. The likelihood

of infants dying before their first birth day has been demonstrated to be far greater if the infant

was born less than one year after the end of their mothers' last pregnancy than those born after a

longer interval. Improved outcome of infants are noted to be better, if the mothers waited for 18

to 23 months, after a full term birth and before conceiving again. This highlights the requirement

for contraceptive use immediately after the postpartum time as this period characterizes the

beginning of return of fertility in most females.

An estimated 80 million unintended pregnancies has occurred in 2012 in the developing

world, resulting in 30 million unplanned births, 40 million abortions and 10 million miscarriages

(WHO, 2012). A considerable proportion of these abortions or unplanned pregnancy can be

prevented by the timely use of emergency contraceptive

High population growth hampers poor countries’ economic development as their

expanding populations compete for limited resources such as foods, housing, schools and jobs.

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Rapid and unstable population growth renders societies more unstable and can lead to greater

civil unrest.

Helping women avoid becoming pregnant too early, too late or too often benefits them

and their children. Meeting the unmet need for contraceptives would further reduce global rates

of maternal mortality by 35%, and a three-year interval between births in developing countries

would further lower rates of infant mortality by 24% and rates of child mortality by 35%.

(Busery and Sisa, 2016).

This incidence of unintended pregnancy and abortion, increased maternal mortality,

population boom, and poverty drew the attention of the researcher to carry out study on

awareness and utilization of emergency contraceptive among women of child bearing age

attending post natal clinic in U.M.T.H, Borno state.

1.3 Objectives of the Study

The main aim of this study was to assess the level of awareness utilization and perception

on emergency contraceptive method among women attending post natal clinic of U.M.T.H

The study achieve the following specific objectives:

1. Assess the level of awareness on emergency contraceptive among women attending post

natal clinic of UMTH.

2. Determine utilization of emergency contraceptive among women attending post natal

clinic of UMTH.

3. Find out perception on emergency contraceptive among women attending post natal

clinic of UMTH

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1.5 Research Questions

1. What is the level of Awareness of Emergency Contraceptives among women attending

post natal clinic of UMTH?

2. What is the level of utilization of emergency contraceptive among women attending post

natal clinic of UMTH?

3. What is the perception of women attending post natal clinic Of UMTH on emergency

Contraceptives?

1.4 Significance of the Study

This study when completed will be of immense benefit to researchers and students who

will want to venture in to similar topic of study. It will also add to the existing literature on

awareness utilization,and misconception of emergency contraceptive method among women. It

will be of great benefit to policy makers and government agencies like World Health

Organization who are directly in charge of formulating policies on awareness utilization and

misconception on emergency contraceptive method among women.

1.6 Scope of the Study

This research is delimited to U.M.T.H and it will aim at assessing the level of awareness,

utilization and perceptions on emergency contraceptive among women attending post natal clinic

in the hospital only.

1.7 Operational Definition of Terms

Emergency contraceptive: Emergency Contraceptive (EC) is a birth control that is used after

unprotected sex, contraceptive failure and rape. Terms used to describe EC include post-coital

contraceptive and the morning after pill. Emergency contraceptive are intended to provide

5
second chance to prevent pregnancy for women who have been exposed to unprotected sexual

intercourse and who don’t wish to become pregnant.

Post Natal Care: This is the health care services rendered to women after delivery.

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 CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

2.1.1 Concept of Emergency Contraceptive

Emergency contraceptive or postcoital contraceptive provides an additional support

whenever there is a breach in the regular contraceptive use. A number of studies are available

from the west regarding the use of emergency or Postcoital contraceptive (Foster et al, 2008).

The main reasons for needing emergency or Postcoital contraceptive are the non use of condoms,

condom breakage and missing an oral contraceptive pill (Pyett, 2006). The department of family

welfare, ministry of health and family welfare has introduced emergency contraceptive pills in

the family welfare program, as a contribution to achieving the National population policy goals

(Consortium, 2003). It is also a very critical option for preventing an unwanted pregnancy in

case of sexual assault.

Emergency contraceptive refers to contraceptive methods than 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.

According to weismiller, (2006) Emergency contraceptive is an emergency birth control

that uses either emergency contraceptive pills (ECPs) or a copper T – intrauterine contraceptive

device (IUCD) to prevent pregnancy following unprotected vaginal intercourse. Emergency

contraceptive is usually effective up to five days following unprotected sexual intercourse.

Glasier, (2008) defined emergency contraceptive as any device or drug that is used as

emergency procedure to prevent pregnancy after unprotected sexual intercourse. Emergency

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Contraceptive (EC) should not be used as a regular family planning method but be used in an

emergency back up (Ethiopian Society of Obstetricians and Gynecologists, ESOG, 2007).

2.1.2 Methods of emergency contraceptive

The following are emergency contraceptives that are currently used:

 Combine oral contraceptive pills (COCPs): An increased dose of combined oral

contraceptives containing ethinylestradiol and levonorgestrel (Yuzpe’sRregimen).

 Progesterone only pills (POPs): High dose progesterone only pills containing

levonorgestrel.

 Intrauterine contraceptive devices (Copper Releasing Intrauterine Contraceptive devices),

(ESOG, 2007).

1. Emergency Contraceptive Pills Regimen

As mentioned above, there are two types of ECP regimen in use. Treatment with both

regimens should not decline over time.

2. Combined Oral Contraceptive Pills: Contain ethinylestradiol and lavonorgestrel or

comparable formulations. This regimen is known as the Yuzpe’s method, and it has been

used since the 70s.

o When high dose pills containing 50mcg of ethinylestradiol and 0.25mg of lavonorgestrel

are available, two pills should be taken as the first dose as soon as convenient, but not

later than 3 days (72 hours) after unprotected intercourse. The second two pills should

follow 12 hours later.

o When low dose pills containing 30mcg ethinylestradiol and 0.15 of lavonorgestrel are

available, four pills should be taken as the first dose as soon as convenient but not later

8
 than 3 days (72 hours) after unprotected intercourse to be followed by another four pills

12 hours later.

3. Progesterone Only Pills

o When pills containing 0.75mg of levonorgestrel are available, one pill should be taken as

the first dose as soon as convenient but not later than 3 days (72 hours) after unprotected

intercourse to be followed by another one pill 12 hours later.

o When pills containing 0.03 mg of levonorgestrel are available, twenty (20) pills should be

taken as the first dose as soon as convenient but not later than 3 days (72 hours) after

unprotected intercourse to be followed by another 20 pills 12 hours later (Emergency

Contraceptive Guideline, 2005)

2.1.3 How emergency contraceptive pills work

Studies have shown that EC pills can:

 Delay or inhibit ovulation.

 Prevent implantation by making the inner lining of the uterus (endometrium) unstable for

implantation.

 Prevent transport of the sperm and ovum.

The mechanism that is active in a particular case depends on the time of the menstrual cycle

when emergency contraceptives are used. ECPs do not interrupt or abort an established

pregnancy. They can only help in preventing unwanted pregnancy. Once implantation

(pregnancy) has occurred, ECPs are not effective. ECPs, thus, do not cause any form of abortion

or bring about menstrual bleeding.

2.1.4 Indications for Emergency contraceptive Pills

 When no contraceptive has been used.

 Condom rupture, slippage or misuse, and IUCD expulsion.

 Two OCPs missed consecutively, and late for contraceptive injection by two weeks or

more.

 Failure of a spermicidal tablets or film to melt before intercourse.

 Failure to abstain on a fertile day of the cycle in women who uses the calendar method.

 Failed coitus interuptus (withdrawal).

 In case of sexual assault (Emergency Contraceptive Guideline, 2005)

2.1.5 Safety and Effectiveness of Emergency contraceptive

Emergency contraceptive pills (ECPs) are considered very safe.

 In more than 20 years no deaths or serious medical complication s have been reported.

 The COCs used as emergency contraceptive pills have not been associated with fetal

malformation or congenital defects in the event if EC fails to prevent pregnancy.

 Available data suggest the ECPs do not increase the possibility that a pregnancy

following use will be ectopic (Emergency Contraceptive Guideline, 2005)

Emergency contraceptive pills are fairly effective in preventing pregnancy from unprotected

sexual intercourse during the second or third week of their menstrual cycle, 8 would become

pregnant.

 If the same 100 women use combined oral pills as ECPs, instead of 8 women only 2

would become pregnant.

 If the same 100 women used progestin – only ECPs, instead of 8 women only 1 would

become pregnant.

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  These estimates suggest that the use of ECPs could reduce the probability of becoming

pregnant from unprotected sexual intercourse by roughly 75% in the case of combined

ECPs, and 85% in case of combined progestin only pills (ESOG, 2007).

2.1.6 Side Effects of Emergency Contraceptive Pills and their Management

The following are common side effects of ECPs:

4. Nausea – It is the most common in ECPs, but COC user experience more nausea than

POP users. It usually does not last more than 24 hours.

o Management of nausea – Take the pill with food or at bed time to reduce nausea. A

woman who has previously experienced nausea while using hormonal methods including

ECPs could need prophylactic anti – emetic.

5. Vomiting – occurs in 20% of women using COCs and 5% of women using POPs as

ECPs.

o Management of vomiting – If vomiting occurs within 2 hours, the dose should be

repeated.

6. Irregular vaginal spotting or bleeding – Some women many experience irregular

vaginal bleeding or spotting following ECPs use.

o Management – Inform women that ECPs do not bring menses immediately a common

misconception among ECP users. If the menstrual period is delayed for more than two

weeks from the expected date, the possibility of pregnancy should be considered and a

pregnancy test should be done. If you can not provide the test, refer to facilities where the

service can be provided.

7. Other problems – Breast tenderness, headache, dizziness and fatigue, do not generally

last more than 24 hours.

the discomfort of headache and breast tenderness (ESOG, 2007).

2.2 Emergency Intrauterine Contraceptive Devices (EIUCDs)

An intrauterine device (IUCD) is a safe, effective long – acting reversible contraceptive

(LARC) option. IUCDs are small devices made of flexible plastic that contain copper or a natural

hormone, progestin. IUCDs works primarily by preventing fertilization of the egg. The copper

IUCD, Paragard, works by blocking sperm from reaching the egg and is effective at preventing

pregnancy immediately after insertion. The hormonal IUCD, mirena, works in various ways by

keeping the ovaries in various ways by helping cervical mucus to form to block the opening of

the uterus and/ or affecting the ability of the sperm to move towards the egg. It takes about 7

days for hormonal intrauterine devices to begin preventing pregnancy (Hatcher, 2012).

2.2.1 Available Emergency Intrauterine Contraceptive Device

Two IUCDs are currently available; Paragard, a plastic T – shaped device wrapped in

copper wire and Mirena, a progestin – releasing IUCD. Mirena is effective for up to 7 years and

Paragard is effective up to 12 years.

Effectiveness of Emergency Intrauterine Contraceptive Devices

Current data shows that both mirena and Paragard IUCDs are 99% effective at preventing

pregnancy. Fewer than 1 in 100 women using the IUCD experience accidental pregnancy during

the first year of use (Centre for Disease Control, 2012).

Paragard is use as a form of emergency contraceptive and may be inserted to prevent

pregnancy up to 5 days following unprotected sex. When inserted within several days of

unprotected sex, it reduces a women’s risk of pregnancy to 1 in 1000 (Hatcher, 2011).

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2.2.2 Advantages of using Emergency Intrauterine Contraceptive Devices

Once the IUCD is in place, it is very convenient, there is no daily pill, and there is

nothing to insert before intercourse. Paragard has no effect on hormone levels in the body.

Mirena may reduce cramps; make menstrual periods lighter and some women stop getting

periods altogether while using IUCD. Fertility returns soon after the IUCD is removed (Brown

University Health Education, 2012). Due to the length of time the IUCD can be used, it is one of

the most cost effective methods of contraceptive in the market.

2.2.3 Side Effects Associated with emergency Intrauterine Contraceptive Device

Side effects associated with the IUCD insertion procedure include mild pain, cramping,

and backaches. After Mirena insertion, the menstrual cycle may become shorter, lighter, or stop

altogether and women may experience spotting between periods within the first few months of

use. An increase in menstrual cramping and heavier bleeding is common after Paragard insertion.

More serious side effects include the IUCD slipping out of place, infection of the uterus, and

these serious events are rare (Planned Parenthood, 2012).

2.3 Perceptions about Emergency Contraceptive

Emergency contraceptive is not the same thing as an abortion because most people can

not differentiate between ECPs and abortion pills (Salvatierra, 2011). These two medications

serve two different purposes and work completely different from one another. Emergency

contraceptive can not end a pregnancy. Scientific and medical authorities are in agreement that

emergency contraceptive reduces the risk of pregnancy and helps prevent the need for abortion

(Brache, 2008).

During conference in the united state (2012), one representative of NGOs said her friend

told her that she took ECPs after that blood spilled out of her and the death of the fetus,

13
(American College of Obstetricians and Gynecologists (ACOG), 2012). However, we know that

EC does nothing to a pregnancy that has already begun. If the egg has implanted in the uterus,

taking those two pills will do absolutely nothing. There will be no flood of blood, because there

is nothing in there to expunge. The biggest side effect that a woman may have is short term cause

by many medications (ACOG, 2012).

2.3.1 Awareness of Emergency Contraceptive

The full potential of emergency contraceptive can be realized only when women aware of

the existence of these methods and the need to use them within the short time frame of their

efficacy. Such awareness is still limited in many developing countries. In Indian, a survey of

4000 women aged 18 – 35 years in the state of Delhi revealed very low (3.2%) awareness about

emergency contraceptive (Kumar, 2006), and awareness in rural areas was less than 2%.

Evaluation of knowledge and views of doctors about emergency contraceptive revealed poor

knowledge among general practitioners (Goel, 2005).

In comparison, a survey in United States showed that 36% of respondents relealized

anything could be done to prevent pregnancy after unprotected sex (Delbanco, 2005). AS

Swedish study by Aneblom et al and (McDonald, 2006) showed that awareness about emergency

contraceptive was 83 and 80%, respectively. In the present study the awareness about emergency

contraceptive was 11.2% which was higher than that reported by Tripathi et al. This could be due

to the study population included only educated and working women in a hospital setting. There

was no difference in the awareness about emergency contraceptive in nursing staff as others;

however, the number of those who were aware is too small to come to a definitive conclusion.

Another encouraging observation of the study was that 81% of women were willing to

use emergency contraceptive if educated about it. A three year program of training for health

14
care providers and multifaceted information campaign for general public from 1999 to 2003 in

Mexico City showed that emergency contraceptive increased significantly from 13 to 32%

(Heimburger et al, 2005). Awareness of emergency contraceptive was low and there is an urgent

need to promote it.

2.3.2 Utilization of Emergency Contraceptive

Utilization of emergency contraceptive is to make use of emergency conception for a

purpose of preventing pregnancy after unprotected vaginal intercourse. However, awareness and

knowledge of emergency contraceptive is limited in many developing countries not to talk about

utilization. It is evident from a study that knowledge and utilization of emergency contraceptive

was very poor (7.3%).

In Ghana also, Frank et al. found utilization regarding emergency contraceptive to be

11.9% among women (Baiden& Elizabeth, 2004). However, the utilization level reported in the

study is low as compared to the situation in developed countries. Glei et al, studied a “General

Practice” – based population of 1,290 women aged 17 – 50 years in California, of whom 28%

had use emergency contraceptive pill (Smith et al, 1999). Graham found the utilization level

about EC in teenagers in southeast Scotland to be 53% (Graham, 1999). A study in USA

revealed that only 23% (Belzer et al, 2006).

A survey conducted in united state by National Survey of Family Growth; women aged

15 – 44 roughly one in nine (11% or 5.8 million) women had ever used emergency contraceptive,

up from 4.2% in 2002. Most women who had ever use EC had done so once (59%) or twice

(24%),(Daniel et al, 2013. Young adult women age 20 -24 were most likely to have ever used

EC, about one in four had done so women (19%), 1 in 7 cohabiting women (14%), and 1 in 20

currently or formerly married women (5.7%) had ever used emergency contraceptive. About one

15
in two women reported using emergency contraceptive because of fear of method failure (45%)

and about one in two reported use because they had unprotected sex (49%), (Daniel et al, 2013).

Similar findings from a study done by Cynthia (1998) showed the utilization to be 55% in

Princeton university students. Such differences in level of utilization levels in different countries

with respect to contraceptive may be due to their cultural differences and government policies

(Cynthia, 1998).

2.4 Empirical Review

A study was conducted bySrivastav , Khan and Chauhan, (2014) to assess the awareness

and practice of contraception among child bearing women attending tertiary care hospital. Study

design used isCross-sectional.it was conducted at the outpatient department of Gynecology and

Obstetrics Liaquat National MedicalCollege and Hospital Karachi, from May 2008 to July

2008.Two hundred women of child bearing age were interviewed regarding their

awareness,attitude and practices of contraception. The inquiries were recorded by pre designed

questionnaire. Questions regarding methods of contraception known and source of knowledge

and their practices were recorded. Convenient sampling was used to distribute questionnaire.

Mean age of the patients was 29.88 years (SD 6.38 years). 73% of the women were educated,

and majority of them were Muslims. Awareness was seen regarding contraceptionin 81% of the

women interviewed but only 49% practiced any method. Barrier method of contraception was

the most popular method known and practiced. Media seemed to be the major source of

information (64.5%). In response to the reason for non use, majority feared side effects (56.8%).

Major reason for use of contraception was spacing (47.9%).Majority (77.5%) of women had

assertive attitude towards contraception study concluded that there is a gap between awareness

16
and practice of contraception. Despite having knowledgethe compliance is low. One of the major

factors among reasons of non use of contraceptionis fear of side effects.

A cross-sectional study was conducted by Arora, Bajpai and Srivastava, (2013) on

contraceptive methods use was conducted among 314 women and 20 service providers in ten

wards from ten health facilities at Kahama district. Data were collected using structured and in-

depth interview questionnaires. Information gathered included socio-demographic, socio –

cultural characteristics, accessibility of contraceptive methods, current use and access to

information. Thirty five percent of women in stable marital relations reported to be using

contraceptive methods. Highest (58%) use of contraceptives was reported among women in

formal employment. Factors found to be significantly associated with contraceptive use were:

education level, occupation, traditional cultural beliefs, and support from husband/partners and

access to information while religion, decision maker on desired number of children in the family

were not found to be significantly associated with the use of contraceptive methods. Prevalence

of contraceptive use among women in stable marital relations is 34.5% than that in the general

population of women with the age of 15 -49 years in Kahamadistrict . Socio-demographic factors

like education level and occupation were found to influence the use of contraceptive methods

among women in stable marital relations. Moreover, socio-cultural factors like religious beliefs

and husband/partner support were also crucial in influencing the use of contraceptive methods.

Olamijuloand Olorunfemi, (2012) carried out a study to examined the awareness and

utilisation of emergency contraceptives among married women in the traditional core areas of

Ibadan, Oyo State. Data was collected through the administration of 136 copies of structure

questionnaire to married women in five selected traditional core areas. Result showed that the

utilisation of Emergency Contraceptives methods was low among married women in OpoYiosa

17
(9%) and Ayeye (11.2%), but high in Mapo, Oja Oba and Inalende with utilisation rates of

31.5%, 29.2% and 19.1% respectively. Oral contraceptive pills, injectable contraceptives and

IUCD were mostly used, while implant was not widely used. Fear of infertility, associated side

effects and husband’s influence were major barriers to women use of Emergency Contraceptives

measures. Logistic regression result showed that the socioeconomic characteristics of married

women were responsible for 12.6 per cent of the use of Emergency Contraceptives.The Wald

criterion showed that monthly income of N10,000 – N20, 000 (X2 = 5.317, p<0.05) exerted

significant influence on the prediction of the use of Emergency Contraceptives, while other

socioeconomic variables did not exert significant influence on the prediction of the use of

Emergency Contraceptives (p>0.05). EXP (B) value further indicated that the monthly income

(N10, 000 – N20, 000) of married women in the traditional core areas of Ibadan was 3 more

times likely to predict the use of Emergency Contraceptives. The study recommends the need to

increase the campaign on the use of Emergency Contraceptives methods in the traditional core

areas of Ibadan mostly in OpoYiosa and Ayeye where the level of utilisation is still low.

Ankomah, Anyanti, Adebayo and Giwa, (2013) conducted a study to determine pattern

of contraceptives use among female undergraduates in the University of Ibadan, Nigeria. A

descriptive cross- sectional study was conducted among female undergraduates resident on

campus using self administered questionnaires Overall, 425 female undergraduates between the

ages of 15 and 30 years were interviewed. Only 28.7% of the respondents were sexually active

and mean age at sexual debut was 19 years ±2.31 years. About 63.9% of the sexually active

respondents had ever used some form of contraceptives mainly the condom and pills. Only

(26.7%) of the sexually active respondents used a contraceptive at their last sexual encounter and

contraceptive use was significantly higher (p<.05) among the older females. Contraceptive use

18
among the sexually active female undergraduates of the University of Ibadan was not optimal

although knowledge of various methods was high. Appropriate interventions are needed to

encourage contraceptive use among sexually active female undergraduates.

Arowojulu and Adekunle, (2000) survey 1500 students in post-secondary institutions in

southwest Nigeria showed that the concept of emergency contraception (EC) was well known.

Respectively, 32.4%, 20.4% and 19.8% knew that combined pills, progesterone only pills and

intrauterine contraceptive device (IUCD) were usable for EC, while 56.7% mentioned the use of

traditional methods. Only 11.8% had ever used either pills or IUCD and 10.7% had used a

traditional method. Few students (11.5% and 2.3% respectively) knew the correct timing of EC

pills and IUCD. The respondents reported varying circumstances under which EC was indicated

but the majority cited condom breakage and sexual assault. The popular media represent the

commonest source of information while hospitals/clinics were the commonest sources of

procurement. About 37% of the respondents planned to use EC in future while 58% would not

and 4.7% were uncertain. Reasons for these responses were explored.

A study was conducted by Thapa and Rani, (2014) to investigate the knowledge, attitude

and practices of contraception in women of reproductive age. This descriptive cross-sectional

survey was carried out from January to June 2011, at Gynae/Obs Unit, Women & Children

Hospital, Kohat. A convenient sample of 900 was selected from reproductive age group (15-49

years), attending the outdoor. Data was collected on a questionnaire. Likert 3 point and 5 point

scale was used about the knowledge and attitude of contraceptive respectively. SPSS version 16

and Statistic 9 were used to analyze the data. The mean age of respondents was 30.76±7.641

years. The mean age at marriage was 18.19±2.982 years, literacy rate 37.8%, 95.2% women

were house wives and 56.2% respondents had heard of some method. While enquiring their own

19
attitude, 589(65.4%) gave positive response regarding the use of contraceptives and 734(81.6%)

declared emergency Contraceptive as prohibited in the religion. Use of contraceptive was

(30.8%). However, it was more common in grand multipara p35 years old ladies p<0.001.

Husband education did not show significant difference on contraceptive use p=0.162.Frequency

of contraceptive use is comparatively low in our set-up despite high level of awareness. desire

for larger family, pressure from husband, religious concerns and fear of side effects are the main

factors responsible.

A study was conducted by Omoteso, (2006) with the objective to determine the

prevalence of emergency contraceptive use among students of tertiary institutions in Osun State

and to assess the knowledge and attitude towards emergency contraception. It was a descriptive

cross-sectional study using self administered, structured questionnaire. The study population was

students of State Polytechnic Iree and ObafemiAwolowo University, Ile Ife. Data were entered

and validated, and statistical analysis was performed using SPSS version 11 software. The Study

revealed that majority of the respondents 241 (80.3%) had poor knowledge of emergency

contraception. Majority of them 160 (55.3%) were sexually active while 32.6% of the sexually

active respondents used contraceptives. Condom was the most used contraceptive. Among those

using contraception, 86 (28.7%) were current users. Among the people surveyed, only 47

(15.7%) of them had used emergency contraception. Overall, there was a limited knowledge and

use of emergency contraception by the students in this study. Evidently, there is a need for

carefully designed educational programmes and promotion of EC in existent student health care

centres on campuses.

A study was conducted by Rahaman, Renjhen and Kumar , (2010) in an urban slum of

Delhi to highlight the contraception perception & practices of the women. Data were gathered

20
from a total of 201 pregnant women (belonging to lower income group) enrolled from a

government run maternity clinic by the interview technique . Data revealed that, at the time of

conception, as high as 34% of the pregnancies were unwanted. Although the subjects had

knowledge of contraception, the usage was very low (33%); and they considered contraception

only as a means of limiting the family size which should be adopted once the family is

complete‘. Son preference, ignorance regarding importance of child spacing, limited control over

personal lives and inhibitions/ fallacies regarding contraception were the main reasons behind far

lower usage of the contraceptives. Also, lack of knowledge regarding the appropriate methods of

contraception, their side-effects (if any), and the authentic source of obtaining also emerged as

the hindering factors. It seems that education, even the basic family life education, is the key to

solve many of the problems relating to reproductive behaviour of women as it will empower

them to make decisions governing their lives. Efforts to change the behaviour, knowledge and

attitude of men are also integral to the reproductive health status of women.

A study was conducted by Kang, & Moneyham, (2008) to assess contraceptive

knowledge, perceptions and use among adolescents in selected Senior High Schools in the

Central Region of Ghana. A cross-sectional study was carried out in the Cosmopolitan city of

Cape Coast of the Central Region of Ghana. Three mixed, one female and one male senior high

school were conveniently identified for the study. A self-administered questionnaire was given to

350 students in the schools out of which 300 were retrieved and used, representing a response

rate of 85.7%. The Statistical Package for the Social Sciences (SPSS) programme software

(version 15.0) was used for data entry, and descriptive statistics tests were conducted for the

items which were summarised by frequencies and percentages. Results showed that almost 21%

of 244 students with knowledge of contraception are users, 82% of sexually active respondents

21
were non-users while condom is the most common contraceptive method used. Also, 60% and

30% of respondents obtained knowledge about contraception from the media (TV/Radio) and

peers (friends) respectively. However, almost 32% of the study participants thought

contraceptives are for only adult married persons. They believe that there is a need for aggressive

advocacy and dissemination of information on Adolescent Reproductive Health (ARH) and

family planning methods before initiation of sexual activity among the adolescent population in

Ghana.

2.5 Theoretical Framework

The theory adopted for this study is the health belief model.

2.5.1 Health Belief Model

The health belief model is derived from a psychological and behavioral theory with the

foundation that the two components of health-related behavior are

1. The desire to avoid illness, or conversely get well if already ill; and,

2. The belief that a specific health action will prevent, or cure, illness.

Ultimately, an individual's course of action often depends on the person's perceptions of the

benefits and barriers related to health behavior. There are six constructs of the HBM. The first

four constructs were developed as the original tenets of the HBM. The last two were added as

research about the HBM evolved.

1. Perceived susceptibility - This refers to a person's subjective perception of the risk of

acquiring an illness or disease. There is wide variation in a person's feelings of personal

vulnerability to an illness or disease.

2. Perceived severity - This refers to a person's feelings on the seriousness of contracting an

illness or disease (or leaving the illness or disease untreated). There is wide variation in a

22
 person's feelings of severity, and often a person considers the medical consequences (e.g.,

death, disability) and social consequences (e.g., family life, social relationships) when

evaluating the severity.

3. Perceived benefits - This refers to a person's perception of the effectiveness of various

actions available to reduce the threat of illness or disease (or to cure illness or disease).

The course of action a person takes in preventing (or curing) illness or disease relies on

consideration and evaluation of both perceived susceptibility and perceived benefit, such

that the person would accept the recommended health action if it was perceived as

beneficial.

4. Perceived barriers - This refers to a person's feelings on the obstacles to performing a

recommended health action. There is wide variation in a person's feelings of barriers, or

impediments, which lead to a cost/benefit analysis. The person weighs the effectiveness

of the actions against the perceptions that it may be expensive, dangerous (e.g., side

effects), unpleasant (e.g., painful), time-consuming, or inconvenient.

5. Cue to action - This is the stimulus needed to trigger the decision-making process to

accept a recommended health action. These cues can be internal (e.g., chest pains,

wheezing, etc.) or external (e.g., advice from others, illness of family member, newspaper

article, etc.).

6. Self-efficacy - This refers to the level of a person's confidence in his or her ability to

successfully perform a behavior. This construct was added to the model most recently in

mid-1980. Self-efficacy is a construct in many behavioral theories as it directly relates to

whether a person performs the desired behavior.

23
Fig1: Health Belief Model

2.5.2 Application of the Model to the Study

The Health Belief Model's adaptability and holistic nature facilitate applications in

diverse contexts like family planning and with complex behaviors like contraceptive behavior.

Family planning is a dynamic and complex set of services, programs and behaviors towards

regulating the number and spacing of children within a family. Contraceptives, one form of

family planning, refers to activities involved in the process of identifying and using a

contraceptive method to prevent pregnancyand can include specific actions such as contraceptive

initiation (to begin using a contraceptive method), continuation or discontinuation (to maintain or

stop use of a contraceptive method), misuse (interrupted, omitted or mistimed use of a

contraceptive method), nonuse, and more broadly compliance and adherence (general terms

often used to denote any or all of the former contraceptive behavior terms).

Awareness and utilization of Emergency contraceptives, viewed through the Health Belief

Model, is motivated by an individual's:

1. Desire to avoid pregnancy and value placed on not becoming pregnant;

2. Non specific, stable differences in pregnancy motivations and childbearing desires;

3. Perceived ability to control fertility and reduce the threat of pregnancy by using

contraceptive. Sufficient motivation must exist to make prevention of pregnancy salient

and relevant and to support the contraceptive behavior decision-making process.

2.6 Summary of Literature Review

The literature reviewed that contraceptive methods can be used by women following

unprotected intercourse or if the women had a contraceptive accident such as leakage or slippage

24
of condom to prevent an unwanted pregnancy. Also it was reviewed that current data shows that

both mirena and Paragard IUCDs are 99% effective at preventing pregnancy.

The study also reviewed that the full potential of emergency contraceptive can be realized

only when women aware of the existence of these methods and the need to use them within the

short time frame of their efficacy. Such awareness is still limited in many developing countries.

The literature also reviewed that another encouraging observation of the study was that 81% of

women were willing to use emergency contraceptive if educated about it.

The literature reviewed that utilization of emergency contraceptive is to make use of

emergency conception for a purpose of preventing pregnancy after unprotected vaginal

intercourse. However, awareness and knowledge of emergency contraceptive is limited in many

developing countries not to talk about utilization. It is evident from a study that knowledge and

utilization of emergency contraceptive was very poor (7.3%).

25
 CHAPTER THREE

METHODOLOGY

This chapter detailed the methodology that will be employed for the study. The

methodology is presented under the following sub-heading; research design, setting, target

population, sample and sampling technique, instrument for data collection, validity/reliability of

instrument, method of data analysis and ethical consideration.

3.1 Study Area

The city of Maiduguri, capital ofBorno State is an ancient city located in North-Eastern

Nigeria and inhabited mainly by Kanuri, Shuwa and Hausa. Present day Maiduguri is a

cosmopolitan city which is inhabited by various ethnic groups from the entire country and from

neighbouring countries of Cameroon, Chad and Niger. It is endowed with agricultural resources

with supply of professionally skilled, semi-skilled and unskilled manpower from other states in

Nigeria and from neighbouring countries of Chad, Cameroon and Niger. Relative to other

industrialized cities such as Kano and Kaduna in the north, Lagos and Port Harcourt in the south,

Maiduguri is of lower economic and social activity than the other states, but still has its own

share of economic and social activities, being known for its fish trade (Banda trade) with fish

being brought from Baga on the shores of Lake Chad. It has a Federal University, the University

of Maiduguri, and a Federal Secretariat both of which attract personnel from other parts of the

country and from outside of the country. There has been increasing number of banks, hotels,

schools and Federal Government Ministries, departments and agencies within the metropolis.

The University of Maiduguri Teaching Hospital, (UMTH) is located in the metropolitan

city of Maiduguri. It is a tertiary hospital established with the tripartite mandate of service

26
delivery, training, and research and as a referral center for primary and secondary public health

institutions as well as for neighbouring states (Koroma, 2004).

The Teaching Hospital established by the Federal Government, and was commissioned

by former President ShehuShagari on July 23, 1983 (UMTH Annual Report, 1997). Since then

UMTH has been offering a combined service of teaching, research and provision of medical care

to the North-Eastern states. The UMTH was designated as “Centre of Excellence in immunology

and infectious diseases” and as a National Referral centre for HIV/AIDS research, diagnosis and

management by the Federal Government in 1986. It has a World Health Organization (WHO)

Polio laboratory for diagnosis and management of polio with the ultimate goal of polio

eradication. The hospital presently has many bed facilities, and several wards. A sizeable number

of the patients who patronize the hospital are said to be foreigners who come from Cameroon,

Chad and Niger Republics.

The Department of Obstetrics and Gynaecology under study was established to provide

obstetrics and gynaecology services, conduct relevant research and train undergraduate and post-

graduate students. Obstetrics and gynaecological services are provided at the Antenatal Clinic

(ANC), Post-Natal Clinic (PNC), Gynaecological Clinic (GNC), Family planning Clinic (FPC)

and Labour Ward (LW). The department was classified as `Centre of Excellence’ in reproductive

health.

3.2 Research Design

The research design for this study was cross – sectional descriptive survey because it

involves description of existing phenomenon, systematic collection and presentation of data to

give a clear picture on the particular situation.

27
3.3 Target Population

The target population consists of women attending postnatal clinic of UMTH monthly

totaling 400 as estimated by Medical Record UMTH.

3.4 Sample Size and Sampling Techniques

The sample size for this study was two hundred (200) women attending post-natal clinic,

two hundred (200) respondents each was picked from women attending to post-natal. This was

necessary so as to ensure the validity of the judgment or outcome of the research. Yaro

Yamane’s model (1967) was applied for selecting the sample.The formula was thus;

n=

where

n = Sample size

N = Population

1 = Constant

e = Level of significance (0.05)

n = N/1+N(0.5)2

= 400/1+400(0.0025)

= 400/1+1

= 400/2

= 200

n = 200

Using the above method, the sample size wasl be 200 women to be selected randomly from the

postnatal clinic in UMTH Maiduguri

Questionnaire developed by this researcher was used to collect data from the research

respondents. The questionnaire was divided into three section; Section A elicit Socio-

demographic Information, Section B elicited information on level of awareness on emergency

contraceptive among women attending post natal clinic of UMTH, Section C elicit information

on utilization of emergency contraceptive among women attending post natal clinic of UMTH

and Section D. elicit information on the perceptions about emergency contraceptive in the study

area.

3.6 Validity and Reliability of Data Collection Instruments

The questionnaire constructed was submitted to the project supervisor for face and

content validity. Necessary correction was made after vetting by the supervisor. To ensure

reliability of the instrument.

3.7 Method of Data Collection

Data was collected by face to face administration of questionnaires to the respondents

who consented to participate in the study. Respondents were briefed on how to answer the

question and assistance was provided when necessary. The respondents were seen during their

clinic days which are on Mondays and Wednesdays. The completed questionnaires was retrieved

on the spot of administration.

3.8 Method of Data Analysis

Before processing the responses, the retrieved questionnaire was checked for

completeness and comprehensibility to ensure consistency. The data were then summarized,

29
and entered into statistical package for social science (SPSS) for analysis to enable the responses

be grouped into various categories.

The data was presented by the use of percentage and frequency tables to ensure that the

information gathered was clearly understood.

3.9 Ethical Consideration

In order to carry out this research, approval was given by relevant authorities which

include, Department of Nursing science University of Maiduguri. consent will be obtained from

each respondent before administration of the questionnaires. All data collected from the research

was kept with utmost confidentiality.

30
 CHAPTER FOUR

DATA PRESENTATION, ANALYSIS AND INTERPRETATION

4.0 Introduction

This chapter presents the analysis of data collected provided by the respondents through

the questionnaires. It is organized into Socio demographic description of respondents, Awareness

of emergency contraceptives method of respondents, utilization and perception on emergency

contraceptives of the respondentsData were analyzed using The Statistical Product for Service

Solution (SPSS) version 20.0. Frequencies and percentages were used to describe the data

collected from respondents.

4.1 Response Rate

A total number of 200 questionnaires were administered and 186 were retrieved.

Table 4.1: Socio-Demographic Characteristics of Respondents

Occupation Frequency Percentage

House wife 85 42.6

Civil servant 50 26.8

Business 30 16.4

Others 21 11.2

Total 186 100

Age groups Frequency Percentage

18-25 years 20 10.0

31
26-30 years 65 34.9

31-35 years 40 21.5

36-40 years 30 16.4

41 years and above 31 16.7

Total 186 100

Marital status Frequency Percentage

Married 110 59.3

Single 61 32.7

Divorced 10 5.3

Widow 5 2.7

Total 186 100

Educational level

Primary 32 17.3

Secondary 70 37.6

Tertiary 44 23.6

Non-formal education 40 21.5

Total 186 100

Religion

Islam 126 67.7

Christianity 60 32.3

Others 0 0.0

Total 186 100

Source: Field Survey, (2019)

of 26 - 30 years while the least 20(10%)are between the age of 18 – 25 years. It furthermore

illustrates that 126(67.7%)of the respondents practice Islam while 60(32.3%)are Christians. The

result shows that 85(42.5%) respondents are house wives,50(26.8%) are civil servant,30(16.4%)

are business women and 21(11.2%)have different occupation not mentioned. Majority 70(37.6%)

of respondents have attained secondary level of education and 44(23.6%) attain tertiary level of

education while the least 32(17.3%) are those that attain only primary school level of education.

33
Table 4.2: Awareness of emergency contraceptives method (N=186, % =100)

Variables Frequency Percentage (%)

Source of Information about EC

Media 86 46.2

Clinic 61 32.8

Friends 39 30.1

Total 186 100

About emergency contraceptive

They can prevent pregnancy up to five days post natal 58. 31.2

They come inform of pills 48 25.8

Copper T is use as EC 12 6.5

All women can use emergency contraceptive 30 16.1

EC should not be used more than 2 times in a cycle 38 20.4

Total 186 100

In what situation is emergency contraceptive used

When no contraceptives has been used 56 30.1

When you are not married 53 28.5%

When you have several children 11 5.9

contraceptives used has been compromised or not used 86 46.2

Total 186 100

Which of the following contraceptive do you know as

34
emergency contraceptive

Pills 66 35.0

Intra uterine contraceptive device 43 23.1

Implant 27 14.5

Injectable 50 26.9

Total 186 100

Side effect of emergency contraceptives

Irregular vaginal spotting and bleeding 60 32.3

Nausea and Vomiting 22 11.8

Alteration in menstrual cycle 76 40.9

Breast tenderness 28 15.1

Total 186 100%

Source: Field survey, 2019

The table above shows that majority of the respondent 58(31.2%)are awarded that EC

can prevent pregnancy up to five days post natal while 48(25.8) they come inform of

pills,61(32.8%) heard about EC from the family planning unit/clinics, 86(46.2%)from the media

and 39(20.98%) from their friends. 56(30.1%) of the respondents chose when no contraceptive

has been used as situations when emergency contraception can be used,53(28.5%)chose When

you are not married, 11(5.9) chose When you have several children,86(46.2%) chose

Contraceptives used has been compromise.66(35.0) of the respondents knows pills as emergency

contraceptive method 43(23.1) know Intra uterine contraceptive device (IUCD), 27(14.5) know

implant and 50(26.9%) know injectables. 60(32.3%) chose Irregular vaginal spotting, bleeding as

35
side effects of emergency contraceptives,22(11.8%)chose nausea and vomiting nausea, and

76(40.9%)also chose alteration in menstrual cycle ,28(15.1%) of the respondents chose Breast

tenderness.

Table 4.3: Utilization of Emergency contraceptives (N=200, %=100]

Variables Frequency Percentage (%)

List of Emergency Contraceptive used

Pills 80 43.0

IUCD 40 21.5

Injection 66 35.5

Total 186 100

Time of taking the first dose

Immediately after intercourse 80 43.0

Within 3 days after intercourse 106 56.9

Whenever 0 0.0

Total 186 100

Source of getting EC

Pharmacist 40 21.5

Chemist 28 15.1

Hospital 63 33.8

Clinic 43 23.1

Others 12 6.5

Total 186 100

36
Time of taking the second dose

12 hours after the first dose 52 27.9

24 hours after the first dose 94 50

72 hours after the first dose 40 21.5

Total 186 100

The table above shows that 80(43.0%) have used pills, 40(21.5%) have used IUCD while

66 (35.5%) had use injectables. 80(43.0%) respondents take emergency contraceptive pills

immediately after intercourse,106(56.9%) take it within 3 days of intercourse. 40 (21.5%) of the

respondents get their EC from pharmacists, 28(15.1%) of the respondents do get their supplies

from chemist and 63(33.8%) of the respondents do buy their EC from hospital and 43(23.1%) do

buy from clinic while 12(6.5%) of the respondents do source their EC from other options.

Also52(27.9%) of the respondents take their second dose 12 hours after the first dose,94(50%)

take it 24 hours after the first dose and 40 (21.5%) take it 72 hours after the first dose.

Table 4.4 Perceptions on emergency Contraceptives

37
Variables Frequency Percentage (%)

Information about EC

Irregular vaginal bleeding, 52 27.9

Alteration in menstrual cycle, 78 41.9

Breast tenderness 30 16.1

Nausea and Vomiting 10 5.4

Headache 16 8.6

Total 186 100

Do EC have effects on breasts milk production

very often 27 14.5

Often 79 42.5

sometimes 32 17.2

not at all 48 25.8

Total 186 100

How do you experience menstruation after use

Heavier 58 31.2

Long and heavier 83 46.6

Short 27 14.5

Very short 18 9.7

Total 186 100

Do EC causes infertility

Very often 84 45.2

Often 47 25.3
38
Sometimes 40 21.5

Not at all 15 8.1

Total 186 100

Source: Field survey, 2019

The result shows that 52 (27.9%) experience Irregular vaginal bleeding, 78 (41.9%)

experience alteration in menstrual cycle reduction, 30(16.1%)experience breast tenderness, while

10 (5.4%) of the respondents indicated nausea and vomiting and 16 (8.6%) of the respondents

indicated headache. The result on EC have effects on breasts milk production shows that, 27

(14.5%) said very often, 79(42.5%) said often, 32(17.2%) sometimes, and 48(25.8%) said not at

all. On experience menstruation after use, 58(31.2%) said heavier, 83(46.6%) said long and

heavier, 27(14.5%) short while 18(9.7%) said very short. The findings on EC causes infertility

84(45.2%) said very often, 47(25.3%) said often, 40(21.5%) said sometime while 15(8.1%) of

the respondent said not at all.

CHAPTER FIVE

DISCUSSION OF FINDINGS

39
 This chapter involves the discussion of Major findings of the study, Summary of the

major findings, limitation of the study, nursing implication and recommendation.

5.1 Discussion of Findings.

The findings of the study show that majority of respodant,70(37.6%) have attained

secondary school, 85(42.6%) are house wives and 126(67.5%)are Muslims. This is in line with

study conducted by Srivastva, Khan and Chauhan (2014) that 73% of the women were educated

and majority are Muslims.

The finding on awareness of emergency contraceptive shows that majority 86(46.2%) got

their information via media, this is in line with Srivastav, Khan and Chuham(2014) which said

media seems to be the major source of information with (64.5%). 60(32.3%) are also aware of

irregular vagina spotting and bleeding as side effect of emergency Contraceptives. This is in line

with Srivastav, Khan and Chauham (2014) that there is gap between awareness and practice of

contraceptive one of the major factor he said among reasons for non-use of emergency

Contraceptives is fear of side effect.

Finding on utilization, indicated that majority utilizes pills (43%),followed by injectable

(35%),then IUCD(21.5%)in that order. This in line with Olamijulo and Olorunfemi (2012) that

said pills is highly utilized, then in injectable and IUCD in that order.

Also on utilization, source of getting emergency Contraceptives, hospital (33.8%) have

the highest followed by clinic. This is in agreement With Ankomah, Anyanti, Adebayo and Giwa

(2013) finding that said, the media represent the commonest source of information, while

hospital/clinic were the commonest source of procurement.

Finding on perception on emergency Contraceptives shows that 84% of despondent believed

emergency Contraceptives causes infertility very often. This agrees with Olamijulo and

40
Olorufemi(2012) that carried out a study to determine awareness and utilization of emergency

Contraceptives among married women in traditional core areas of Ibandan, result shows that

Utilization of Emergency Contraceptives was low to be (9%), which is said to be due to fear of

infertility associated side effect and husband influence.

5.2 Summary of Major findings

By observing the major percentages of respondents ,findings shows that the level of awareness

of emergency Contraceptives was good, utilization was good too not bad, but the timing of

taking the contraceptives affect the effectiveness and also fear of side effect of emergency

Contraceptives also affect utilization level, as most women believed it causes infertility.

5.3 Limitation of the Study

The study is limited due inadequate resource and timefactor.

5.4 Implication for Nursing

The issue of low level of awareness,utilization and perceptions on emergency contraception

is challenging to nursing profession, because nurses are responsible for providing essential and

quality care to meet the need of the patient/client. Therefore nurses have a lot of roles to play

such as:

 Nurses can help to narrow the clinical gap in women health care by increasing awareness

of emergency contraception.

 They should also play a role in correcting wrong perceptions about EC and potential

adverse effects, and facilitating client access.

 Nurses should provide routine counseling on a variety of health promoting behaviours to

child bearing and potential mothers.

41
  Nurses should improve clients understanding and educating them on the method by

explaining to both partner how it works at every visit to family planning.

 Nurses need to be knowledgeable to help women attending post natal clinic aware of their

options and access to emergency contraception.

5.5 Recommendation

The following recommendations were made from this study;

1. Developing continuing education programmes on emergency contraception specifically

geared toward nurses and midwives as well as printed material for providers to share with

patients/client may also be effective.

2. Government should ensure continued supply of emergency contraception commodities

through periodic cross checking of commodity data against service statistics.

3. Government should increase the proportion of publicly and funded family planning

clinics that offer emergency contraception.

42
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 QUESTIONNAIRE

The researcher is a final year student of the department of Nursing science University of

Maiduguri, currently carrying out a research on “Determination of the Level of

Awareness ,Utilization and Perceptionon Emergency Contraceptives among women

attending Post Natal Clinic, University of Maiduguri Teaching Hospital (UMTH).

Please kindly provide the necessary information as your responses will be treated with

confidentiality.

Instruction: please tick [√] appropriately.

Section A: Socio-demographic Information

1. Age

(a) 18 – 25 years [ ] (b) 26 – 30 years [ ] (c) 31 – 35 years [ ]

2. Marital status

(a) Single [ ] (b) Married [ ] (c) Divorced [ ] (d) Widow [ ]

3. Religion

(a) Islam [ ] (b) Christianity [ ] (c) Traditional worshiper [ ]

4. Ethnic group

(a) Kanuri [ ] (b) Marghi [ ] (c) Bura [ ] (d) Others [ ]

5. Occupation

(a) Housewife [ ] (b) Civil servant [ ] (c) Business [ ] (d) Others [ ]

6. Educational level

(a) Primary [ ] (b) Secondary [ ] (c) Tertiary [ ]

48
Section B: Awareness of Emergency Contraceptive method

7.Are u aware of EC?If yes, where is your source of information?

(a) In family planning unit/clinic [ ]

(b) In the media [ ]

(c) Through a friend [ ]

8. About Emergency Contraceptives

(a)They can prevent pregnancy up to five days post natal

(b) they come in form of pills

(c) Copper T is used as EC

(d) All women can use EC

(e) EC should not be used more than 2 times in a circle

9. In what situations is emergency contraception used?

(a) When no contraceptives has been used

(b) When you are not married

(c) When you have several children

(d) contraceptives used has been compromised.

10. Which of these contraceptive method do you know as emergency contraceptives?

(a) Pills

(b) Intra uterine contraceptive device (IUCD)

(c) Implant

(d) Injectables

49
11 Which of these are side effects of emergency contraceptives

(a) Irregular vaginal spotting, bleeding,

(b)Nausea and Vomiting

(c) Alteration in menstrual circle

(d) Breast tenderness

Section C: Utilization of Emergency Contraceptivmethood

12. Have you ever used emergency contraceptive? If yes,which have you used?

(a) Copper T

(b) Pills

(c) IUCD

(d) Injectable

13 . When do you normally take the first dose?

(b) Immediately after intercourse [ ]

(c) (b) Within 3 days after [ ]

(c) Whenever is available [ ]

14. When do you normally take the second dose?

(a) 12 hours after the first dose [ ]

(b) (b) 24 hours after the first dose [ ]

50
 (c) 72 Hours after the first dose [ )

15 .where do you normally get EC?

(a)Pharmacist

(b) Chemist

(c) Hospital

(e) Clinic

(f)Others

SECTION D. : Perception on Emergency Contraceptives

16. Which of the following is true about EC?(Tick as many as possible)

(a)Irregular vaginal bleeding

( b) Alteration in menstural cycle

(c) Breast Tenderness

( d) Nausea and vomiting

(e)Headache

17. Does EC have effect on breast milk production?

(a) Very often

(b)Often

51
 ( c) sometimes

( f) not at all

18. How do you experience menstruaton after used?

(a). Heavier

(b) long and heavier

(C) Short

(d) very short

19. Does emergency Contraceptives causes infertility?

(a) very often

(b). Often

(c) Sometimes

(d) Not at all

52