Context: Emergency contraception (EC) offers women a last chance to prevent pregnancy after unprotected intercourse. Nursing personnel are both service providers and health educators to the community and their understanding can influence the contraceptive behaviour.Aim: To find out the understanding of emergency contraception among nursing personnel.Settings and design: Descriptive cross-sectional study.Material and methods: A predesigned questionnaire was used to collect the responses of nurses regarding their understanding of Emergency Contraception.Statistical analysis used: Mean &amp; Percentages.Results: Eighty (80%) of the respondents had heard about EC. Majority (88.75%) responded in favour of Levonorgestrel. Most (76.25%) opined incorrectly that EC pills are abortifacient. All the participants showed positive attitude towards EC. However, only three participants came out to be EC users.Conclusion: Nurses with a complete knowledge and positive attitude towards EC can act as effective counsellors to the public to create awareness, improve their understanding and change their attitude towards EC.Keywords: Understanding; Nurses; Emergency contraception; Levonorgestre

Sharma, Charu

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Understanding of Emergency Contraception among Nursing Staff ina Tertiary Care Hospital of Andaman and Nicobar Islands, IndiaCharu Sharma*Charu Sharma, All India Institute of Medical Sciences Jodphur, Jodhpur, Rajasthan, IndiaReceived date: May 10, 2017; Accepted date: Jul 20, 2017; Published date: Jul 20, 2017ABSTRACTContext: Emergency contraception (EC) offers women a last chance to prevent pregnancy after unprotected intercourse.Nursing personnel are both service providers and health educators to the community and their understanding can influencethe contraceptive behaviour.Aim: To find out the understanding of emergency contraception among nursing personnel.Settings and design: Descriptive cross-sectional study.Material and methods: A predesigned questionnaire was used to collect the responses of nurses regarding theirunderstanding of Emergency Contraception.Statistical analysis used: Mean & Percentages.Results: Eighty (80%) of the respondents had heard about EC. Majority (88.75%) responded in favour of Levonorgestrel. Most(76.25%) opined incorrectly that EC pills are abortifacient. All the participants showed positive attitude towards EC. However,only three participants came out to be EC users.Conclusion: Nurses with a complete knowledge and positive attitude towards EC can act as effective counsellors to the publicto create awareness, improve their understanding and change their attitude towards EC.Keywords: Understanding; Nurses; Emergency contraception; LevonorgestrelKey MessageNurses with a complete knowledge and positiveattitude towards EC can act as effective counsellors tothe public.INTRODUCTIONEach year approximately 210 million women becomepregnant worldwide and 80 million pregnancies areunplanned. About 46 million (22%) end in inducedabortion and 68,000 women die because of unsafeabortion [1]. In India, complications of unsafe abortionaccount for an estimated 9% of all maternal deaths [2].Emergency Contraception (EC) promises to be useful insuch cases by preventing unwanted pregnanciesfollowing unprotected sex. It is a safe and extremelyeffective method with a failure rate of 0.2-3%. In spite ofbeing introduced in the National Programme in 2003 andlater declared as an over the counter (OTC) product in2005, EC still remains a grossly under-utilized option inthe prevention of pregnancy [3]. Nursing personnel act asboth health educators and service providers. Theirunderstanding about contraception can grossly influencethe contraceptive practices of the community. Therefore,this study aims at assessing the level of knowledge,attitude and practice of EC among the nurses working ina tertiary care hospital. This study was the first of its kindin Andaman & Nicobar group of Islands, situated in Bay ofBengal, about 1200 km from mainland India.www.jbcrs.orgResearch ArticleCorresponding Author:Charu Sharma, All India Institute of Medical SciencesJodphur, Jodhpur, Rajasthan, India, E-mail:sharma.charu651@gmail.comDOI:10.4103/2278-960X.194494© 2017 Journal of Basic and Clinical Reproductive SciencesThis is an open access article distributed under the terms of the Creative CommonsAttribution-NonCommercial-ShareAlike 3.0 License,which allows others to remix,tweak,and build upon the work non-commercially,as long as the authoris credited and the new creations are licensed under the identical terms.For reprints contact: editor@jbcrs.orgCopyright: © 2017 Sharma This is an open-access article distributed under theterms of the Creative Commons Attribution License, which permits unrestricteduse, distribution, and reproduction in any medium, provided the original authorand source are credited.133SUBJECTS AND METHODSThis was a cross-sectional study conducted in a tertiarycare hospital of the island in December 2015 to assessthe knowledge, attitude and practice of EmergencyContraception among the 100 staff nurses working there.After obtaining the ethical committee approval, randomlyselected nurses, who gave verbal consent, were invited toparticipate in this study. A pre-designed, structuredquestionnaire was given to them, which includedquestions on socio–demographic variables, knowledge,attitude and practice towards EC. Questions on practiceof EC were optional as the study included both marriedas well as single nurses. Confidentiality of informationprovided was assured and maintained. For evaluation ofknowledge and attitude, participants had to answerYes/No/Do not know. Data was analyzed using SPSSsoftware. Descriptive analysis using percentages, meanand standard deviation (SD) was used.RESULTSA total of 100 staff nurses participated in the study. Ofthese, 91% were married. The mean age was 37.29 ±8.20 years [Table 1] depicts the socio-demographic profileof the study participants.Characteristics Number(n=100)Percent (%)Age (yrs) 20-29 16 1630-39 44 44≥ 40 40 40Residence area Urban 83 83Rural 17 17Religion Hindu 69 69Christian 23 23Muslim 8 8Duration of work ≤ 10 53 53Experience (yrs) Nov-20 29 29>20 18 18Table 1: Socio-demographic characteristics of participants.The mean duration of work experience was 12.08years. Most of them (80%) did diploma in General nursingand Midwifery and the rest did Bachelor of Science (BSc.)in Nursing.Majority of the participants (45%) had a parity score oftwo with unplanned pregnancy experienced in 10%. Whenasked leading questions, 87% nurses felt that the problemof unintended pregnancy is a major problem in ourcountry. All the staff nurses were aware of some methodof contraception. Condom was the most popular methodused. The most common source of information about ECwas from mass media (100%) followed by doctors andhealth personnel (56.2%; 45/80) and friends, relatives &spouse (13.7%; 11/80).Regarding methods that could be used as EC, 88.75%(71/80) responded in favor of Levonorgestrel (LNG). Allhad the correct knowledge that EC should not be used asa regular method of contraception [Table 2] but at thesame time most of them (42.5%; 34/80) wronglyconsidered that contraindications such as hypertensivedisorders, heart diseases, diabetes and thyroid disordersassociated with oral contraceptives are also applicable forE- Pills. Majority of them (76.25%; 61/80) opinedincorrectly that EC pills are abortifacients [Figure 1]. Allthe participants had a positive attitude towards EC [Table3].Figure 1: Mechanism of action of emergency contraception.Statement CorrectResponseIncorrectResponseDo NotknowIndication for using EC 9 71 -LNG as EC 71 5 4High dose OCP as EC 65 5 10IUCD as EC - 12 68Mifepristone as EC - 8 72Mechanism of action 19 61 -Appropriate time of takingLNG*78 2 -Number of tablets to be taken(Two)**37 42 1Interval for repeat dose (12hours)35 45 -LNG is available as an OTCdrug (Yes)54 20 6Common Side effects 21 43 16Contraindications to EC(Pregnancy)- 34 46EC protects against STDs(No)72 7 1Citation: Sharma C.Understanding of Emergency Contraception among Nursing Staff in a Tertiary Care Hospital of Andaman and Nicobar Islands, Indiadoi: 10.4103/2278-960X.194494134 Journal of Basic and Clinical Reproductive Sciences • January-June 2017 • Vol 6 • Issue 1EC can be used regularly(No)80 - -Effectiveness of EC inpreventing pregnancy (85%)[5]50 30 -*within 72 hours of unprotected sexual intercourse; **0.75mg LNGTable 2: Knowledge of emergency contraception.Statement Yes No Do notKnowEC is safe for its users 80 - -Will recommend EC to others 80 - -Should Paramedical staff dispenseEC19 61 -Should EC be more widelyadvertised80 - -Willing to attend awarenessprogramme80 - -Using EC is better than abortion 80 - -EC will encourage high risk behavior 80 - -EC would discourage consistent useof condom70 10 -Does EC use discourage regularcontraceptive70 10 -Purchase of EC as OTC will beembarrassing49 31 -Table 3: Responses regarding attitude towards emergencycontraception.DISCUSSIONUnplanned pregnancy poses a major public healthchallenge in women of reproductive age and is associatedwith unsafe induced abortion and its consequencesEmergency contraception offers women a last chance toprevent pregnancy after unprotected intercourse. Thebiggest hurdle in practice of EC is lack of knowledge.Nursing personnel form a vital component of the healthsystem that shoulders major responsibilities in creatingawareness regarding EC. Their skills and devotion bringthem close to the patients and communities so that theycan clear their misconceptions about the chosen method.In the present study, only 11.25% (9/80) had correctknowledge about EC. Similar findings were observed byTakkar et al. [4]. LNG as EC was known to only 71% of ourparticipants. None of them knew about Mifepristone andIUCD as a method of EC. This was comparable to thatobserved by Zeteroglu et al. [5]. In a study done by Thapaet al. it was found that there was a positive co relation(co-efficient of correlation=0.537) between nurses’knowledge and attitude towards EC [6]. In another studydone in Vietnam, it was observed that the providers whoreceived training and proper information aboutEmergency Contraception were ready to include EC intheir cafeteria approach to the clients seekingcontraceptive advice. They also concluded that healthpersonnel including pharmacists and druggists shouldalso get proper training regarding the advantages,disadvantages and side-effects of EC so that they canconfidently prescribe them [7].Khan et al. in his study reported that 96% of thedoctors incorrectly believed that EC pills act bypreventing implantation [8]. In the present study also,there is a common misconception that EC pills act as anabortifacient. This view negatively influenced thedecision to use or provide EC in the future. Emergencycontraception, thus, need to be positioned as an optiondistinct from abortion. It is, in fact, a way to prevent theneed for abortion.The correct timing of administration of EC was knownto 78% of our respondents which was better than thatobserved in a Nigerian study where only 10% were awareof it [9].No medical reasons indicate that EC pills should beprescription-only products. These can be dispensed bydoctors, nurses, pharmacists as well as community healthworkers [10]. No serious complications have been linkedto EC. Common side effects include nausea, vomiting,abdominal pain, breast tenderness, headache, dizzinessand fatigue. These usually do not occur for more than afew days after treatment and they generally subsidewithin 24 hours. Among nurses with awareness of EC,only 26.25% (21/80) were aware of these side effects.In a study carried out in Delhi, 90% participants saidthat EC should not be used on a regular basis [11]. Similarresponse was given in our study also. Majority of thenurses had a positive attitude and showed theirwillingness to encourage their friends and relatives to useEC if needed. About 61.25% felt that purchasing EC fromOTC will be embarrassing; however, all of them believedthat using EC is better than abortion. All the participantsresponded affirmatively regarding promotion ofpromiscuity but actually this is not correct because this isa behavioral problem. Similar findings have beenreported in other studies too [12-14].Inspite of having a positive attitude towards EC, theactual usage was very low (3.75%). This indicates thatparticipants had many misconceptions and apprehensionregarding its use. Low practice of EC was also noted intwo other studies [4,15].The reason for lack of detailed information about ECmay be linked to the source of information. Theadvertisements on television stress only on theaccessibility of EC pills and use fancy phrases such as‘Tension Free,’ but they lack complete information aboutthe product. Hence, it is the health care providers whocan give correct and desired information to their clientsand this is possible only when they themselves arethoroughly clear in their concepts.Citation: Sharma C.Understanding of Emergency Contraception among Nursing Staff in a Tertiary Care Hospital of Andaman and Nicobar Islands, Indiadoi: 10.4103/2278-960X.194494Journal of Basic and Clinical Reproductive Sciences • January-June 2017 • Vol 6 • Issue 1 135CONCLUSIONKnowledge gaps among the nursing personnelregarding EC need to be bridged as this could negativelyimpact on prescribing habits and future promotion ofemergency contraception. It is therefore essential to givethem adequate knowledge and training aboutcontraception and also regularly updates their knowledgewith recent advances in the field so that they can spreadthe right message to the right person.CONFLICT OF INTERESTAuthors report no conflict of interest.ACKNOWLEDGEMENTNoneREFERENCES1. Alan Guttamacher Institute. Sharing responsibility. Women societyand abortion worldwide. 1999; New York, The Ala GuttmacherInstitute.2. Stillman M, Frost JJ, Singh S, Moore AM, Kalyanwala S. Abortion inIndia: A literature review, New York, Guttmacher Institute 2014.3. Nivedita K, Fatima Shanthini N. Knowledge, attitude and practiceof emergency contraception on nursing personnel. J Clin DiagnRes 2014;8:OC20-22.4. Takkar N, Goel P, Saha PK, Dua D. Contraceptive practices andawareness of EC in educated working women. Indian J MedicalSci. 2005;59:143-49.5. Zeteroglu S, Sahin G, Sahin H, Bolluk G. Knowledge and attitudestowards emergency contraception of health-care providers in aregion with a high birth rate. Eur J Contracept Reprod Health Care2004;9:102-6.6. Thapa B. Knowledge and attitude regarding EC among nursingpersonnel. JCMC 2013;3:46-507. Ngoc NTN, Ellertson C, Surasrang Y, Loc LT. Knowledge andattitudes about emergency contraception among health workersin Ho Chi Minh City, Vietnam. Int. Fam. Plann. Perspect1997;23:68-72.8. Khan ME, Anvita D, Isha B, Martha B. Medical barriers to EC: Across sectional survey of doctors in North India. Glob HealthScience Pract 2014;2:210-18.9. Ebuehi OM, Ebuehi OA, Inem V. Health care providers’ knowledgeof, attitudes toward and provision of emergency contraceptives inLagos, Nigeria. International family planning perspectives2006;32:89-93.10. Ministry of Health and Family Welfare. Guidelines foradministration of emergency contraceptive pills by health careproviders. 2008.11. Vertika K, Misro MM, Nandan D. Providers’ knowledge, attitudeand dispensing practices of E pills in Government dispensaries ofSouth District in Delhi, India. Indian J Community Med2010;35:46-51.12. Lawrence RE, Rasinki KA, Yoon JD, Curlin FA. Obstetrician-gynecologist physicians’ beliefs about emergency contraception: Anational survey. Contraception 2010;82:324-30.13. Oriji VK, Omietimi JE. Knowledge, attitude and practice ofemergency contraception among medical doctors in PortHartcourt. Niger J Clin Pract 2011;14:428-31.14. Burton R, Savage W. Knowledge and use of postcoitalcontraception: A survey among health professionals in TowerHamlets. Br J Gen Pract 1990;40:326-30.15. Gichangi PB, Karanja JG, Fonck KK, Temerman M. Knowledge,attitudes and practices about emergency contraception amongnurses and nursing students in two hospitals in Nairobi, Kenya.Contraception 1999;59:253-6. 

Understanding of emergency contraception among nursing staff in a tertiary care hospital of Andaman and Nicobar Islands, India

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Understanding of emergency contraception among nursing staff in a tertiary care hospital of Andaman and Nicobar Islands, India

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