Abstract
Throughout the world, unplanned pregnancy is a considerable social and public health issue. The majority of cases are unwanted pregnancies and many of these cases result in abortion. Pregnancies in girls between 14 and 17 years rose from 4‰ in 1990 to almost 12‰ in 2006 (Trussell, et.al. 2016). This may have been due to two factors. Firstly, that contraception is either not used or is used incorrectly in many cases. Secondly, that penetrative sexual relations are being initiated at a younger age; and the younger age leads to a decrease in risk perception (Milsom et al.1982). The rate of abortion or voluntary pregnancy termination (VPT) represents an estimate of the number of unwanted pregnancies.
Though oral contraceptive pills are most widely used contraception method for a long time in our country. As it is well accepted that oral contraceptive pills has a long list of side effects and taking a pill every day is troublesome for women, other contraception methods are getting popular day by day.
Thus the objective of this study is to find the real cause why women are using emergency pills, reason behind using everyday pills by the users and attitude towards ECP and everyday pills of its users. Target respondents were University School Students in the Reproductive Age (YOUNG GIRLs) (15- 49 years) for emergency contraceptives and friends of YOUNG GIRLs for everyday pill usage of Benin. We have found that the reasons why emergency contraceptives getting popularity because it is easy to use, hustle free, can prevent unwanted pregnancy taking even after couple of days of having sex. Everyday pill users generally use everyday pills because their partner do not want to take pills. And the second reason was they use everyday pills because it can prevent sexually transmitted diseases.
Though the concept of emergency contraceptive is relatively new. Consumers are getting used to with ECP comparatively faster. Whether using emergency contraceptive pill or everyday pill almost all of the populations were aware of family planning method.
CHAPTER ONE
Introduction
1.1 Background of study
In the second half of the 20th century, the emergence of contraception and its massive use in the developed world represented an effective measure for birth control and the avoidance of unwanted pregnancies. Lately, scientific advances have led to other types of drugs entering the market, known as emergency contraception (EC) or the ‘post-coital pill’. EC use can be defined as taking a contraceptive drug (also known as the ‘morning after pill’) up to 72 hours after unprotected coitus with the aim of preventing an unwanted pregnancy. Its mechanism of action is to impede ovulation or fertilization, but once the fertilized egg is implanted the pill will not have any effect (Melissa, 2015).
The conclusions of clinical trials on the efficacy of these drugs support the use of Progestogen only (total dose of 1.5 mg of levonorgestrel) as the method of emergency contraception of choice due to greater effectiveness and lower incidence of nausea and vomiting (6). The introduction of these drugs to the market considerably raised expectations regarding prevention and reduction of the number of VPT and it has even been argued that its use could prevent up to 95% of unwanted pregnancies (Nearns, J. 2009).
In 2003, 317,670 morning after pills were dispensed, which corresponds to 3% of women of childbearing age, indicating a sharp increase in consumption (Melissa, 2015). From September 2009, the so-called ‘morning-after pill’ could be acquired without a medical prescription in Spanish pharmacies. This measure aims to facilitate access to this pill for all women who require it, at the appropriate time to ensure its efficacy, irrespective of their place of residence and the regional laws in effect.
This deregulation of the pill and improvements in access to it, help to overcome certain obstacles for women such as the shame they may feel in consulting a health professional, as well as facilitating its anonymous purchase at pharmacies.
From another point of view, such a high level of use could be interpreted as a failure, as access to contraception has not prevented the increase in abortions, nor has the availability of everyday pills reduced demands for the morning-after pill. Rather, it seems that these are factors which, taken together, may encourage people to enter into risky situations or remain in them.
Thus, the improvements in EC accessibility have led to the formulation of three more pragmatic concerns: 1) Whether easy access to the EC pill increases early sexual activity, 2) Whether women using this method repeatedly tend to abandon their habitual contraceptives; and 3) Whether these factors expose women and their partners to a greater risk of sexually transmitted diseases.
Emergency contraception is the use of an emergency contraceptive regimen in the first few days following unprotected intercourse, in order to prevent pregnancy.
Types: Three main types of EC are available, namely:
Combined oral contraceptives (COCs) at a higher dose than that used for continuous contraception
Progestogen-only pills (POPs) at a higher dose than that used for continuous contraception Copper intrauterine devices (IUDs).
The first two regimens are referred to as emergency contraceptive pills (ECPs). This approach requires two equivalent doses of ECPs, 12 hours apart, preferably within 72 hours of unprotected intercourse. Each dose of COCs should contain at least 100 μg of EE and at least 300 μg of levonorgestrel (LNG). Each dose of POPs should contain 750 μg of LNG. There are pills specially packaged for EC; however, levonorgestrel pills commonly available for continuous contraception may also be used for this purpose. A copper IUD inserted within five days of unprotected intercourse is another option for emergency contraception. In instances where an adolescent is at low risk for STIs and desires a long-acting contraceptive method, this may be an appropriate emergency contraceptive choice. In most situations, because of the eligibility requirements for IUDs (see IUD section below), ECPs present a more realistic option (WHO, 2014).
The effectiveness of ECPs is estimated by comparing the number of expected pregnancies that would occur if no method were used with the actual number of pregnancies that occur after ECP use. It is estimated that 8 out of 100 women would get pregnant if each had a single act of unprotected intercourse in the second or third week of the menstrual cycle. Recent studies have shown that when correctly used COCs prevent 75% and POPs 85% of the expected pregnancies
Importantly, ECP effectiveness is substantially influenced by the time elapsed after intercourse prior to using the method; ECPs are more effective the earlier they are taken after unprotected intercourse. Copper-bearing IUDs are the most effective form of emergency contraception. When inserted within five days of unprotected intercourse, 99% of expected pregnancies are prevented (Glasier, 1997; Trussell &Ellertson, 1995). However, the risk of STIs and the desire to avoid using the IUD in the long term are two reasons that limit the use of copper-bearing IUDs in most adolescents (WHO, 2014).
1.2 Statement of problem
The precise postcoital mechanism of action of ECPs and copper-bearing IUDs is not known. In the case of ECPs, the mechanism may also vary according to the point in the menstrual cycle at which they are used. The main effect is inhibition or delay of ovulation (Swahn et al., 1996) but it is also possible that ECPs and the IUD may have effects on the genital tract that affect the survival or motility of sperm and the transport function of fallopian tubes, or prevent fertilization. Some studies have also shown that when ovulation occurs, ECP use results in an insufficient corpus luteum. In addition, the type of endometrium that develops after ECP use might not be appropriate for normal implantation. Current evidence points to a pre-implantation effect of ECPs. Once a fertilized egg is implanted, ECPs are not; and becauseECPs do not interrupt pregnancy; they are not a form of abortion.
The contraceptive effect of ECPs is transitory, and return of fertility is immediate. The need for a regular method of contraception therefore needs to be discussed. Return of fertility after IUD use is also immediate, and an IUD should only be chosen if the prospective user is an appropriate candidate and wants the IUD for continuous contraception.
Nausea and vomiting are frequent and sometimes severe side-effects of ECP use, especially with the COC regimen. About 19% of COC and 6% of POP users vomit during use. Dizziness, breast tenderness, headaches and fatigue may also be experienced. In addition, bleeding irregularity may occur in the cycle during which ECPs are used. If treatment is taken before ovulation, the onset of bleeding may be 3–7 days earlier than expected; if taken after ovulation, bleeding may be at the expected time or delayed. Where circumstances permit, anti-emetic drugs could be used prophylactically, but once nausea and vomiting has begun, anti-emetics are ineffective. As with adults, when vomiting occurs within two hours of ECP administration, a second dose of ECPs and the prophylactic use of anti-emetics is recommended. If vomiting continues, a repeat dose of ECPs can be given vaginally (WHO, 2014).
1.3 Study Objectives
The broad objectives of the study-
1. To understand the current usage, practice and side effects with regard to the use of emergency contraceptive and everyday pill
2. Users perception about different contraception method available in this segment and the profile of users, including media habits
3. To identify the factors that determine the choice of contraception methods
1.4 Research Questions
1. What is the current usage, practice and side effects with regard to the use of emergency contraceptive and everyday pill
2. Users perception about different contraception method available in this segment and the profile of users, including media habits
3. To identify the factors that determine the choice of contraception methods
1.5 Significance of the Study
These study findings may be significant to adolescence as they may be able to know the factors that hinder them from the knowledge of use of contraceptives. Also, the findings from the study may be of great importance to other teenagers aspiring to undertake contraceptive methods as they might be able to know the factors that influence uptake of contraceptives.
The study findings may be of great significance to family planning specialists. This is because they may be able to know the factors that hinder that hinder people from the knowledge of use of contraceptives and contraceptive methods especially among the youth. Also they may obtain information on how to overcome barriers to uptake of contraceptives by poor urban residents.
Moreover, the study findings may be of great significance to the government as they may have relevant information to be used in enhancing high uptake of contraceptives among teenagers in an effort to reduce unwanted pregnancies among them.
1.6 Scope and Limitations of the Study
The study was conducted in Benin of Edo state. This slum is characterized by high poverty levels, low levels of education, large household sizes that affect access to basic health services including family planning services. The target population was adolescent girls in Benin. The unit of analysis will be households of adolescent girls in Benin, Edo state, while the unit of observation were adolescent girls who have ever conceived at age 18-24 years. This study took a duration of six months.
According to Best (2008) limitations are conditions beyond the control of the research that may place restrictions on the conclusion of the study and their application. One of the main limitations is brought about by the topic of the research itself. Pregnancy is about sexual behavior and due to secretive nature of people’s sexual behavior it may be challenging and threatening to ask people questions touching on their sexuality which is a very private affair. The researcher did everything possible to make informants at ease and ensured that the researcher creates a rapport before asking questions. Another limitation of the study was that it was difficult to get valid responses about the sexual lives of the respondents/ informants.
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