Emergency contraception: Knowledge and attitude toward its use among medical students of a medical college in North-West India

摘要

Context: Emergency contraception (EC) is use of drug or device to prevent pregnancy after unprotected sexual intercourse. Unlike other regular methods of contraception which are taken prior to the sexual act, EC is used after the unprotected sex. Aim: To assess the knowledge and attitude toward use of emergency contraceptives among medical students. Setting and Design: A cross-sectional questionnaire based study was conducted among all the medical students in the Government Medical College in North-West India. Subjects and Methods: A questionnaire seeking information on knowledge and attitude of undergraduate medical students was administered over a period of 4 weeks in the month of February and March 2014. Statistical Analysis: The data were entered in MS excel and expressed using percentages. Chi-square test was used as a test of statistical significance. Results: About 61.6% (247/401) of the participants were aware about the timing of use of EC. Audio visual media (76.6%; 307/401) was the most common source of information for of these medical students. Conclusions: The lack of appropriate in-depth knowledge of EC among future health care professional should alarm the medical teaching system as EC is the only method that can be used to prevent pregnancy after unprotected sex or contraceptive accident. KEY WORDS: Attitude, emergency contraception, knowledge, medical students Emergency contraception (EC) is defined as the use of a drug or device to prevent pregnancy after unprotected sexual intercourse.[ 1 ] It has been shown to be both safe as well as effective.[ 1 ] Unlike other regular methods of contraception which are taken prior to the sexual act, EC is used after the unprotected sex. There are two methods of EC: Emergency contraceptive pills (ECPs) and copper-bearing intrauterine devices (IUDs). The progestin only method uses the progestin levonorgestrel in a dose of 1.5 mg, typically up to 72 h after intercourse. This is given either as two 750 μg doses 12 h apart, or as a single dose pill. On the other, the combined or Yuzpe regimen uses large doses of both estrogen and progestin. This regimen recommends taking two doses at a 12 h interval. Levonorgestrel prevents pregnancy by preventing or delaying ovulation. ECPs may also work to prevent fertilization of an egg by affecting the cervical mucus or the ability of sperm to bind to the egg.[ 2 ] Across the world, some additional methods are being used in EC. In addition to progestin only and combined methods, ulipristal acetate has been approved as an ECP in Europe in early 2009 and in the US in August 2010[ 3 ] whereas mifepristone is generally used as either EC or as an abortifacient in Russia and China. IUD is an effective alternative to ECPs for EC. Among the IUD's, copper-T IUD can be used up to 5 days after unprotected intercourse.[ 3 ] The copper-bearing IUD primarily prevents fertilization by causing a chemical change that damages sperm and egg before they can meet.[ 2 ] As per the World Health Organization estimates, 210 million pregnancies occur annually, out of which, 38% are unwanted and 22% end up with abortion worldwide. In India, about 11 million abortions take place annually and around 20,000 women die every year due to abortion-related complications.[ 2 ] It is being realized that the unwanted pregnancy and need for induced abortion could be reduced by optimum use of EC as they prevent women's risk of becoming pregnant from a single act of intercourse by 79–99%.[ 4 ] Government of India approved the dedicated regimen of emergency contraceptives in year 2001 and the same was introduced in the National Family Health Welfare Program in 2003.[ 5 ] It was approval as over the counter for adults aged 18 and above by the Government of India in 2005. This was done to reduce the rates of unwanted pregnancy and unsafe abortion.[ 6 ] However, the fear of its use and improper use has failed to achieve the objective. It was in this context that this study was conducted in medical students of a medical college in North-West India with the aim to assess the knowledge and attitude toward use of emergency contraceptives among medical students.