Dissertations / Theses on the topic 'Emergency contraceptives'

The number of unwanted pregnancies has not decreased in recent years and this should be addressed. Emergency contraception may be effective when used correctly having the advantage that it can be used after an episode of unprotected sexual intercourse (when regular contraception has failed or was not used). In this research project I set out to explore some of the major reasons why there are still many unwanted pregnancies in Australia. I decided to focus on the use and non-use of emergency contraception, e.g. emergency contraception pill (ECP) “method failures” are not well understood because the actual mechanisms of action are still unclear. There is evidence ECP can effectively interfere with follicle growth and ovulation. It is much less clear is whether ECP is able to interfere with fertilization and implantation, in a way, which may make it acceptable to those who have strong religious beliefs in fertilization being the start of new life. Emergency contraception has the potential to prevent many unwanted pregnancies when unprotected intercourse has occurred. It has relatively high efficacy in many studies, but true method failures are not well understood. By contrast, many unwanted pregnancies occur for “social reasons” where emergency contraception has not been used. I set out to study changes in knowledge and usage of emergency contraception in these groups of Australian women seeking termination of pregnancy: 1. Before a dedicated emergency contraception pill (ECP) pack (Postinor) became available in Australia 2. One year after dedicated ECP became available on prescription 3. One year after the ECP pack became available “over the counter” without prescription. Ninety-nine women were recruited during their presentation with a request for ECP at the six Family Planning Clinics in Australia. All women took LNG 1.5mg in a single dose during the clinic consultation. A blood sample was taken immediately prior to ingestion of the ECP for estimation of serum LH, oestradiol and progesterone levels to calculate the day of the menstrual cycle. Based on these endocrine data we estimated the timing of ovulation to within a ±24-hour period with an accuracy of around 80%. Women were followed up 4-6 weeks later to ascertain pregnancy status. The effectiveness of ECP when taken before and after ovulation was determined. Three women in this study became pregnant despite taking the ECP (pregnancy rate 3%). All three women who became pregnant had unprotected intercourse between day -1 and 0 and took the ECP on day +2, based on endocrine data. Day zero was taken as ovulation day. Among seventeen women who had intercourse in the fertile period of the cycle and took the ECP after ovulation occurred (on day +1 to +2) we could have expected 3 or 4 pregnancies, based on Wilcox et al data. Three pregnancies were observed. Among 34 women who had intercourse on days –5 to –2 of the fertile period, and took ECP before or around ovulation, four pregnancies could have been expected, but none were observed. The major discrepancies between women’s self-report of stage of the cycle and the dating calculation based on endocrine data were observed in this study. These data are supportive of the concept that the LNG ECP has little or no effect on post-ovulation events, but is highly effective before ovulation. Our interpretation of the data in terms of timing of treatment relative to ovulation may explain why EC with LNG works sometimes and fails at other times. A larger study is needed to prove this hypothesis. To investigate other reasons for such a high rate of unwanted pregnancy, which probably has a larger impact we looked into womens knowledge of and attitude towards ECP. Seven hundred and eighteen women participated in this study by answering a questionnaire consisting of 15 questions on their demographic and reproductive characteristics as well as the knowledge about the ECP, e.g. 208 women were enrolled before the ECP was marketed in Australia in 2001, 308 after it was marketed and 202 after it became available over the counter (Group 1, 2, and 3, respectively). We found that the participants who have heard about ECP were significantly younger (p<0.005). The mean age of women who have never heard about of ECP was 29.8 years compared to 26.3 years in women who have heard about ECP. More women were aware about the ECP after it became available over the counter. Women in group 2 had higher educational level in comparison to women in group 2 and 3 (p<0.005). There was significant trend in increased use of ECP in women of higher educational level (p<0.005). The use of ECP did not increase significantly with improved availability and access to the ECP amongst women presenting for termination of pregnancy. Wider availability of he ECP pack in Australia and an easier access to it has increased women’s awareness about the ECP. However, the use of ECP has not increased. This study provides better understanding of mechanism of action of LNG ECP and an explanation to the method failure. It also reveals poor knowledge about ECP despite its wider availability and accessibility. Improving these is a worldwide challenge for family planners and all health professionals.

Master of Medicine
The number of unwanted pregnancies has not decreased in recent years and this should be addressed. Emergency contraception may be effective when used correctly having the advantage that it can be used after an episode of unprotected sexual intercourse (when regular contraception has failed or was not used). In this research project I set out to explore some of the major reasons why there are still many unwanted pregnancies in Australia. I decided to focus on the use and non-use of emergency contraception, e.g. emergency contraception pill (ECP) “method failures” are not well understood because the actual mechanisms of action are still unclear. There is evidence ECP can effectively interfere with follicle growth and ovulation. It is much less clear is whether ECP is able to interfere with fertilization and implantation, in a way, which may make it acceptable to those who have strong religious beliefs in fertilization being the start of new life. Emergency contraception has the potential to prevent many unwanted pregnancies when unprotected intercourse has occurred. It has relatively high efficacy in many studies, but true method failures are not well understood. By contrast, many unwanted pregnancies occur for “social reasons” where emergency contraception has not been used. I set out to study changes in knowledge and usage of emergency contraception in these groups of Australian women seeking termination of pregnancy: 1. Before a dedicated emergency contraception pill (ECP) pack (Postinor) became available in Australia 2. One year after dedicated ECP became available on prescription 3. One year after the ECP pack became available “over the counter” without prescription. Ninety-nine women were recruited during their presentation with a request for ECP at the six Family Planning Clinics in Australia. All women took LNG 1.5mg in a single dose during the clinic consultation. A blood sample was taken immediately prior to ingestion of the ECP for estimation of serum LH, oestradiol and progesterone levels to calculate the day of the menstrual cycle. Based on these endocrine data we estimated the timing of ovulation to within a ±24-hour period with an accuracy of around 80%. Women were followed up 4-6 weeks later to ascertain pregnancy status. The effectiveness of ECP when taken before and after ovulation was determined. Three women in this study became pregnant despite taking the ECP (pregnancy rate 3%). All three women who became pregnant had unprotected intercourse between day -1 and 0 and took the ECP on day +2, based on endocrine data. Day zero was taken as ovulation day. Among seventeen women who had intercourse in the fertile period of the cycle and took the ECP after ovulation occurred (on day +1 to +2) we could have expected 3 or 4 pregnancies, based on Wilcox et al data. Three pregnancies were observed. Among 34 women who had intercourse on days –5 to –2 of the fertile period, and took ECP before or around ovulation, four pregnancies could have been expected, but none were observed. The major discrepancies between women’s self-report of stage of the cycle and the dating calculation based on endocrine data were observed in this study. These data are supportive of the concept that the LNG ECP has little or no effect on post-ovulation events, but is highly effective before ovulation. Our interpretation of the data in terms of timing of treatment relative to ovulation may explain why EC with LNG works sometimes and fails at other times. A larger study is needed to prove this hypothesis. To investigate other reasons for such a high rate of unwanted pregnancy, which probably has a larger impact we looked into womens knowledge of and attitude towards ECP. Seven hundred and eighteen women participated in this study by answering a questionnaire consisting of 15 questions on their demographic and reproductive characteristics as well as the knowledge about the ECP, e.g. 208 women were enrolled before the ECP was marketed in Australia in 2001, 308 after it was marketed and 202 after it became available over the counter (Group 1, 2, and 3, respectively). We found that the participants who have heard about ECP were significantly younger (p<0.005). The mean age of women who have never heard about of ECP was 29.8 years compared to 26.3 years in women who have heard about ECP. More women were aware about the ECP after it became available over the counter. Women in group 2 had higher educational level in comparison to women in group 2 and 3 (p<0.005). There was significant trend in increased use of ECP in women of higher educational level (p<0.005). The use of ECP did not increase significantly with improved availability and access to the ECP amongst women presenting for termination of pregnancy. Wider availability of he ECP pack in Australia and an easier access to it has increased women’s awareness about the ECP. However, the use of ECP has not increased. This study provides better understanding of mechanism of action of LNG ECP and an explanation to the method failure. It also reveals poor knowledge about ECP despite its wider availability and accessibility. Improving these is a worldwide challenge for family planners and all health professionals.

Fertility control is not a modern concept. In virtually every culture of historical importance there is evidence of a desire to control fertility by artificial means ( Dickinson 1970 ). The desire for, as distinct from the achievement of, reliable contraception has been characteristic of many societies widely removed in time and place, even in societies dominated by mores and religious codes demanding that people increase and multiply( Hines 1970 ). Today fertility control is widely seen as a basic right, a right of the individual to the knowledge and means to procreate only when desired. The right to fertility control The right to family planning was first made explicit at an international forum in 1953 to ratify the constitution of the International Planned Parenthood Federation. In 1968 it was enshrined in the United Nations' body of rights declarations at the United Nations Conference on Human Rights. In 1969 the United Nations Declaration on Social Progress and Development expanded the basic right to choose the number and spacing of children, to include access to adequate family planning education, information and methods. This right has since been reaffirmed in many fora, including the United Nations Convention on the Elimination of All Forms of Discrimination Against Women. The recent International Conference on Population and Development held in Cairo in September 1994 reaffirmed the basic right of all women, men and adolescents to make free and informed choices regarding their own sexual and reproductive health and to have the means to exercise this right. Implicit in the right to family planning is the right to choice of method. This means that all medically approved methods should be available, with complete information on advantages and disadvantages to enable people to make a free choice. This includes access to postcoital methods. Health professionals, who deny women information or access to postcoital contraception based on their own moral or ethical beliefs are infringing a woman's human rights.

Emergency contraception is an effective backup for contraceptive failure. In Hong Kong, levonorgestrel emergency contraceptive pill is a prescription drug. In most developed countries, it is provided in advance or over-the-counter to eliminate the barrier to access. The objective of this thesis is to evaluate the feasibility and acceptability of these novel delivery modes in Hong Kong. Four studies were conducted to study pertinent subject matters. A retrospective review on 11014 clinical records of The Family Planning Association of Hong Kong on emergency contraception prescription between 2006 and 2008 was performed to delineate the characteristics of emergency contraceptive users. One-year follow-up data was available in 4728 records, with 89.4% used emergency contraception once and 8.5% used it twice. The proportion of subjects not using ongoing contraceptives reduced from 20.6% at the emergency contraception visit to 4.5% at post-treatment follow-up, 3.9% at 6th month and 3.3% at 12th month. Young age was not associated with not using ongoing contraceptives and repeat use of emergency contraceptives. A randomized controlled trial with 1030 women was conducted to compare the behavior of those given three courses of levonorgestrel emergency contraceptive pills in advance against those who had to get them from clinics when needed. After one year, 29.9% of women in the advanced provision group had used the pills versus 12.9% in the control group (odds ratio 2.87, 95% confidence interval 2.07-3.97). The advanced provision group used three times more pills than the control group (278 versus 95 courses, p<0.001). The median coitus-treatment interval in the advanced provision group was significantly shorter than the control group (11 h versus 20 h; p<0.001). Most women used condoms before (90%) and during (89%) the study. In both groups, consistency of use was higher after emergency contraception (65%) than before (60%) (p<0.001). This study confirmed that advanced provision increased the utilization of emergency contraceptive pill, facilitated its early use and did not hamper ongoing contraceptive use. A questionnaire survey was conducted to evaluate the acceptability of novel use of emergency contraceptive pill among women practicing contraception. Of the 1405 questionnaires analyzed, 46.3% of women supported more advertising on emergency contraception; 48.7% supported advanced provision of emergency contraceptive pill and 25.7% supported over-the-counter provision. Another questionnaire survey assessed the attitude of physicians who provide family planning services. Half (54.2%) of them supported advanced provision of emergency contraceptive pill; 32.5% supported advanced provision to girls aged 16 and below and 40.2% supported over-thecounter provision. Among 352 physicians who provided emergency contraception, only 21.7% of private family physicians and 15.9% of private obstetrician-gynaecologists prescribed emergency contraceptive pills in advance. In conclusion, local women used emergency contraception responsibly and remained vigilant with ongoing contraception even when they got pills in advance. Minority of physicians practice advanced provision. The acceptance of advanced provision, among women and physicians who do not know much about it, is around 50%. It is thus possible to improve when more education on advanced provision is provided. The support for over-the-counter provision was too weak to boost.
published_or_final_version
Medicine
Master
Doctor of Medicine

Class of 2005 Abstract
Objectives: Describe the prevalence of alcohol and tobacco use in college women who use emergency contraception (EC) or oral contraceptives. Methods: This study was a descriptive, retrospective study that utilized patient charts to obtain clinical data including emergency contraception utilization, hormonal contraception utilization, alcohol and tobacco use. The primary dependent variables were smoking status and alcohol use. The overall prevalence of alcohol and tobacco use was calculated by counting the total number and percentage for each substance. Determining if descriptive variables vary according to type of contraception, groups were compared using a t-test for independent groups and a Chi square, respectively. The a priori alpha level is 0.05. Results: The most important finding in this study is students that obtained EC reported drinking alcohol at a significantly higher level than students who used hormonal contraception. 49% of students who used EC reported drinking 5 or more drinks a week. The data for the alcohol use was the only data that was found to be statistically significant (p<0.05). In this study 22% of students who requested EC had unprotected sex. A positive result seen in this study was that only 2% of the EC students requested EC more than once in the spring semester. Freshman composed 54% of the students that used EC during this study. Other data that was of interest was that 33% of students that used EC were currently using oral contraception but only 25% claimed that oral contraception incompliance was the reason for EC utilization. Implications: Prevalence of alcohol use is significantly higher in students who use EC than students who used hormonal contraception. This leads to the conclusion that students that use alcohol are more likely to engage in unprotected sex and therefore request EC. This study also has shown that nurses and physicians need to get more accurate information from students regarding tobacco and alcohol use.

Aim: The 1996 Choice on Termination of Pregnancy Act decriminalized abortion in South Africa and the South African Medicines Control Council in 2000 approved the dispensing of emergency contraceptive methods by pharmacists to women without a doctor's prescription. This legislation has been hailed as among the most progressive in the world with respect to women's reproductive justice. However the realisation of these rights in practice has not always met expectations in part due to medical practitioners' ethical objections to termination of pregnancy and the provision of related services. The aim of this study was to interpret the varying ways in which medical practitioners frame termination of pregnancy and emergency contraceptive services, their own professional identities and that of their patients/clients. Methods: Sample of 58 doctors and 59 pharmacists drawn from all nine provinces of South Africa. Data collected using an anonymous confidential internet-based self-administered questionnaire. Participants were randomly recruited from online listings of South African doctors and pharmacists practicing in both private and public sectors. Data were analysed using theoretically derived qualitative content analysis. Results: Participants drew on eight frames to justify their willingness or unwillingness to provide termination-of-pregnancy related services: the foetal life frame, the women's rights frame, the balancing frame, the social justice frame, the do no harm frame, the legal and professional obligation frame, the consequences frame and the moral absolutist frame. Conclusion: Health professionals' willingness or unwillingness to provide termination of pregnancy related services is highly dependent on how they frame or understand termination of pregnancy, and how they understand their own professional identities and those of their patients/clients.

Adolescents have become focal points of discussions and debates regarding sexuality and reproductive health matters. However, little research has been done particularly in South Africa to examine their knowledge concerning abortion and emergency contraception. Research indicates that a substantial proportion of adolescent pregnancies are unintended or unwanted. Abortion and emergency contraception are both time-sensitive services. Thus having accurate and comprehensive knowledge about both abortion and emergency contraception is pivotal, in the case of unintended or unwanted pregnancy or when engaging in unprotected sex or experiencing contraceptive failure that could lead to pregnancy. The 1994 International Conference on Population and Development (ICPD) defined reproductive health rights for both men and women as the right to "decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so" (p. 60). That is, men and women should "have the right to make decisions concerning their reproduction free of discrimination, violence and coercion" (ICPD, 1994, p.60). Based on these definitions, it is rather evident that comprehensive and accurate knowledge are at the core of one's ability to make an informed consent. This is confirmed by Adler's (1992, p. 289) definition of informed consent or choice "a) access to sufficient information b) understanding the information c) competence to evaluate potential consequences d) freedom to make a choice and e) the ability to make and express that choice". It is from this framework that this study emerged. The aim of this study was to examine adolescents' knowledge concerning abortion and emergency contraception. The participants were Grade 11 learners between the ages of 15-24 years from five different schools in the Buffalo City Municipality. A sample of 514 was achieved. Data were analysed using descriptive cross-tabulation, chi-square and qualitative methods where appropriate. The results revealed that most of the participants did not have sufficient accurate knowledge concerning the Choice on Termination of Pregnancy Act, consequences of legal abortion and emergency contraceptive pills to make informed decisions. Furthermore, data also revealed that the participants' schools playa role in their sexual activity, their knowledge about the Choice on Termination of Pregnancy Act and about emergency contraceptive pills. Although this method made it feasible for the researcher to make general assumptions, non-responses were one of the limitations of the study. Similar research in various municipalities/cities in and outside the Eastern Cape is recommended so as to increase further awareness concerning the level of knowledge that adolescents have about contraceptive pills particularly emergency contraceptive pills, the Choice on Termination of Pregnancy Act and abortion in general.

Abortion is a highly controversial subject that has again come into the spotlight in South Africa due to the legalisation of abortion on demand in 1996. The results of various studies conducted since the Choice on Termination of Pregnancy Act 92 of 1996 was implemented, have indicated that abortion providers have met with a great deal of negativism and ostracism. This study focused on the implications of abortion work on nurses' social relationships with family, friends, colleagues and their communities. Recent literature was reviewed on the subject. The researcher however, found little information on this specific aspect of abortion. The study was conducted with abortion nurses from two government designated hospitals in the East London area responsible for abortion services. Thus, results cannot be generalised. This is a qualitative study that aimed at obtaining firsthand information regarding the personal experiences of abortion nurses. A non-probability sampling technique was used viz. criterion sampling. The Interview Guide Approach was used whereby in-depth, semi-structured interviewed were conducted with the guidance of a set of questions in the form of an Interview Schedule. The ten respondents were asked to share their recommendations as to possible measures that could address the challenges mentioned during their interviews. The researcher came to the conclusion that nurses' social relationships and lives are definitely impacted by abortion work. This impact is largely negative as the majority of respondents experience labelling, stigmatization and ostracism from family, friends, and their colleagues. Abortion nurses also experience a lack of social support, ambivalent feelings with regard to abortion, and a range of negative emotions ranging from stress and depression to frustration and anger. A number of repeat abortions are being done and there seems to be a general lack of contraception. The need exists for nurses to go to Value Clarification Workshops and also to get support in terms of compulsory, continuous, counselling. Separate wards should be set up for abortions whilst sex education should be included in school curriculums at both primary and secondary schools. Family planning and facts about the abortion process should also be included in these sex education programmes. Overall. the need exists for family planning initiatives to promote contraception and deter women from using abortion as a means of contraception. As this study reveals, conducting abortions has come at a great cost for the majority of nurses who lack social support and bear the brunt of anti-abortion sentiment expressed by significant others in their lives. The latter being the people who would normally be the one's they would turn to for help, counsel, support and assistance

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
A contracepÃÃo de emergÃncia (CE) à um mÃtodo que evita a gravidez apÃs a relaÃÃo sexual. TambÃm conhecido por âpÃlula pÃs-coitoâ, esse mÃtodo utiliza progestogÃnio na forma concentrada e tem indicaÃÃo reservada Ãs situaÃÃes especiais ou de exceÃÃo, tais como falha conhecida ou presumida, uso inadequado e relaÃÃo sexual sem uso de mÃtodo contraceptivo, bem como em casos de violÃncia sexual. Descrever e analisar o nÃvel de conhecimento e a utilizaÃÃo da CE de usuÃrias do ServiÃo de Atendimento FarmacÃutico (SAC FARMA), de uma Rede de FarmÃcias ComunitÃrias em Fortaleza, CearÃ. Entre os meses de outubro de 2008 a maio de 2009, apÃs o esclarecimento de informaÃÃes sobre pÃlula pÃs-coito atravÃs do SAC FARMA, mulheres usuÃrias ou que tinham intenÃÃo de uso da CE, foram convidadas a participar da pesquisa sobre uso de CE. Para tanto, foi aplicado um questionÃrio e os dados foram incluÃdos no programa estatÃstico SPSS, versÃo 15.0. Das 54 entrevistas feitas, a maioria das mulheres estavam entre a faixa etÃria de 23 e 29 anos de idade (44,4%), solteiras (66,7%) e residentes no Estado do Cearà (66,7%). Tinham renda entre 1 e 3 salÃrios mÃnimos (48,1%) e cursavam ensino mÃdio (50,0%) e superior (42,6%). Pretendiam fazer uso ou utilizaram CE sem orientaÃÃo/prescriÃÃo mÃdica (92,6%) e a maioria (54%) obteve alguma informaÃÃo sobre CE atravÃs de amigos e familiares. Mais da metade (64,8%) afirmou que nÃo era a primeira vez de uso, sendo que 82% relataram utilizar uma ou duas vezes. Com relaÃÃo ao conhecimento sobre o risco de diminuiÃÃo de eficÃcia caso houvesse repetiÃÃo do uso, a maioria (64%) relatou desconhecer essa informaÃÃo. Relataram nenhuma reaÃÃo ou queixa (72%) e 98,1% conheciam outro mÃtodo contraceptivo, sendo o preservativo o mais conhecido (92,6%) e utilizado (84%). Um dos principais motivos para justificar a utilizaÃÃo da CE foi o sexo desprotegido (53,7%). Quando perguntadas atà quanto tempo apÃs a relaÃÃo sexual o mÃtodo pode ser utilizado, a maioria respondeu que pode ser atà 72 horas (56,3%), 25% nÃo souberam responder e 65,6% relataram que a âPÃlula do Dia Seguinteâ nÃo possui efeito abortivo. A maioria das mulheres avaliadas pretendia fazer uso ou utilizar a CE sem orientaÃÃo/prescriÃÃo mÃdica, obteve informaÃÃes sobre a pÃlula atravÃs de amigos e familiares e, alÃm disso, nÃo tinha conhecimento sobre o risco de diminuiÃÃo de eficÃcia se o uso for repetitivo. Estes fatos alertam para que se tenha uma maior preocupaÃÃo em relaÃÃo à possibilidade de uso indevido do medicamento e seu fÃcil acesso nas farmÃcias comerciais.
The emergency contraceptive pill (EC) is a method of the emergency contraception that prevents pregnancy after sexual intercourse. It is also known as the âpost coital pillâ and contains high dose progestin-hormone. The EC can be taken immediately or up to five days after sex if the woman did not use birth control, in cases of suspected birth control failure, or if she was forced to have sex. To describe the level of knowledge and use of EC by users of the Medicine Attendance Service (SAC FARMA) in a network of community pharmacies placed in Fortaleza, CearÃ. In the months October (2008) to May (2009), after each enquiry about the âpost coital pillâ, women who were using or intended to use this pill were invited to participate in a survey on the use of emergency contraception by the application of a structured questionnaire. The data were analyzed with the statistical program SPSS, version 15.0. Of the 54 women interviewed, the majority were aged between 23 and 29 years (44.4%), were single (66.7%) and resident in the State of Cearà (66.7%). (48.1%) had income between 1 and 3 minimum wages, 50,0% higher secondary education and 42.6% had higher education.). Almost all (92,6%) wished to use or have used EC without guidance/prescription and of these the majority (54%) obtained some information about EC through friends and family. More than half (64.8%) said it was not their first time of use, and 82% reported using EC once or twice previously. With respect to knowledge about the risk of loss of effectiveness if the use is repetitive, the majority (64%) were unaware of this information. Most (72%) reported no adverse reaction or other complaints. Also, 98.1% of interviewed reported that they knew other method of contraception, being the condom the most widely known (92.6%) and used (84%). One of the main reasons to justify the use of EC was unprotected sex (53.7%). When asked for how long after intercourse the method can be used, most answered within 72 hours (56.3%), 25% did not respond and 65.6% reported that "post coital pill" has no abortive effect. Most of the women studied wanted to use the EC without prescription and obtained information about EC pill from friends and family. Moreover most women had no knowledge about the risk of reduced effectiveness if the use is repetitive. These findings are of concern as they indicate the possibility of misuse of the EC given its easy access in pharmacies.

Unwanted pregnancies and induced abortions are made among Thai youths. The aim of this studywas to examine the knowledge, use and perceptions of Emergency contraceptive pills (ECPs) among undergraduate university students in Bangkok, Thailand, and also investigatedifferences between genders concerning these issues. An empirical descriptive cross- sectional study was performed. A quantitative method was used and Dorothea Orem’s Nursing Theory of Self- care deficit was provided as the theoretical framework. A questionnaire was distributed to 210 students at a university outside Bangkok. The result shows that 84% of the male and 88.9% of the female students knew that the purpose of using ECPs is to avoid unwanted pregnancies. About 36% of the males and 36% of the females had the misconception that ECPs aborts fertilized ovum. Around 21% of the male and 13.7% of the female students had the experience of using ECPs.One common perception among the students was that ECPs are the best method to prevent from unwanted pregnancies, 14.7% of the males and 27.7% of the females perceived that. This study results indicate that more knowledge about ECPs are required for these students.
Även om det är olagligt med aborter i Thailand, förutom under vissa omständigheter, sker dessa. Oönskade graviditeter och inducerade aborter förekommer bland unga thailändare. Syftet med denna studie var att undersöka kunskap, användande och uppfattningar av akut p-piller bland universitetsstudenter i Bangkok, Thailand, och även undersöka skillnaderna mellan kön gällande dessa områden. En empirisk deskriptiv tvärsnittsstudie genomfördes och en kvantitativ metod användes. Dorotea Orems egenvårdteori användes som teoretiskt ramverk i studien. Ett frågeformulär delades ut till 210 studenter på ett universitet utanför Bangkok. Resultaten visade att majoriteten av studenterna visste att akut p-piller ska användas i syfte att undvika oönskade graviditeter, 84% av de manliga och 88.9% av de kvinnliga studenterna visste det. Ca 36% av männen och 36% av kvinnorna hade missuppfattningen att akut p-piller aborterar ett befruktat ägg. Ungefär 21% av de manliga och 13.7% av de kvinnliga studenterna sa att de hade erfarenhet av akut p-piller-användning. En vanlig uppfattning bland studenterna var att akut p-piller är den bästa metoden för att förebygga oönskade graviditeter, 14.7% av männen och 27.7% av kvinnorna hade den uppfattningen. Resultatet visar på att mer kunskap om akut p-piller behövs bland dessa studenter.

The overall aim of this thesis was to study knowledge, attitudes and experience of emergency contraceptive pills among women and providers.

Both quantitative and qualitative methods were used. Focus-group interviews were conducted with teenage-girls (I) and with women who had purchased ECP without prescription (IV). Self-administered waiting-room questionnaires were administered to women presenting for induced abortion in three large hospitals (II, III), and after the deregulation of ECP, a postal questionnaire was sent to pharmacy staff and nurse-midwives in three counties in mid-Sweden (V).

Overall, women showed high basic awareness of ECP although specific knowledge such as the level of effectiveness, time-frames and how the method works was lacking. Approval of the method was high and most women were positive to use the method if they needed. Contradictory views as to whether ECP undermines contraceptive behavior were expressed. As many as 43% of women requesting induced abortion had a history of one or more previous abortions. Among the abortion applicants, one out of five, 22%, had previously used ECP and 3% had used it to prevent the current pregnancy. Media and friends were the two most common sources of information on ECP. Half of the women, 52%, were positive to having ECP prescription-free. Those women who had purchased ECP in a pharmacy without prescription, appreciated this possibility, and the major benefits expressed were time saving aspects. No severe side-effects were reported. The women's experiences of interaction with pharmacy staff were both positive and negative. The importance of up-to-date information about ECP and the OTC-availability from the health care providers was emphasized. Both pharmacy staff and nurse-midwives had positive attitudes towards ECP and the OTC availability. Of pharmacy staff, 38% reported that they referred women to nurse-midwives/gynecologists for further counseling and follow-ups. The need for increased communication and collaboration between pharmacies and local family planning clinics was reported by both study groups with suggestions of regular meetings for information and discussions.

The results suggest that ECP is still underused and that more factual information is needed before the method is becoming a known, accepted and integrated back-up method to the existing family planning repertoire. Longitudinal research to assess the long-term effects of ECP is needed.

Orientador: Luis Guillermo Bahamondes
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: O mecanismo de ação do levonorgestrel (LNG) na anticoncepção de emergência (AE) ainda não está totalmente esclarecido e seu efeito nas funções espermáticas também não está explicado. Os objetivos deste trabalho foram avaliar se o LNG, em dose igual à observada após a ingestão oral para AE, poderia afetar espermatozoides expostos in vitro à tuba uterina humana e realizar uma revisão bibliográfica sobre o efeito do LNG nas diferentes funções espermáticas. Foram realizados 15 experimentos. As tubas uterinas foram removidas através de mini-laparotomias e foram perfundidas com uma suspensão contendo 1x106 espermatozoides móveis, com e sem LNG. A tuba correspondente ao lado onde o folículo dominante estava presente recebeu a suspensão com LNG em pacientes alternados. Após um período de incubação de 4 horas, o istmo e a ampola de cada tuba foram separados. Cada segmento foi lavado separadamente e o material obtido foi avaliado quanto ao número de espermatozoides móveis recuperados, número de espermatozoides aderidos ao epitélio tubário e taxa de reação acrossômica (RA). A presença do LNG não afetou significativamente o número de espermatozoides móveis recuperados do istmo e da ampola, e não afetou o número de espermatozoides aderidos ao epitélio tubário. O LNG também não influenciou a taxa de RA. Diferenças significativas também não foram observadas quando o lado ovulatório foi considerado. A revisão bibliográfica realizada deixou evidente que existem poucos estudos que analisam a influência do LNG como AE sobre as funções espermáticas, apesar de este ser um possível mecanismo de ação. Além disso, os estudos revisados utilizam diferentes métodos de avaliação e os resultados são, muitas vezes, contraditórios. De acordo com os resultados observados na literatura, quando o LNG é usado na AE, provavelmente não atinge concentração plasmática suficiente para ser reconhecido pelos receptores de progesterona (P). Resultados positivos só foram observados quando a dose de LNG utilizada nos experimentos foi comparável ao sistema intrauterino liberador de LNG (SIU-LNG), ou seja, muito maior que a utilizada na AE. O LNG, em dose similar à observada no plasma após a ingestão oral para AE, não afetou o número, a aderência ao epitélio tubário, a distribuição e a taxa de RA de espermatozoides na tuba uterina humana, in vitro. De acordo com os resultados observados na literatura, se o LNG, na concentração utilizada para AE, afeta ou não a função espermática ainda não está claro, e mais estudos são necessários
Abstract: The mechanism of action of levonorgestrel (LNG) as emergency contraception (EC) is still under debate and the effect upon sperm function is partially explained. The aim of this study was to assess if LNG in a similar dose to those observed in serum after oral intake for EC could affect the spermatozoa when exposed in vitro to human tubes and also to give an overview of the effect of LNG as EC on several sperm functions. Fifteen mini-laparotomies were performed, the ovulatory side was recorded and both tubes were removed and perfused with a suspension of 1x106 of motile spermatozoa, one with LNG and the other without it. After an incubation period of 4hours the tubes were cut to separate the isthmus and the ampulla. Each segment was flushed and the material was evaluated regarding the motile sperm number, the number of spermatozoa adhering to the oviductal epithelium and acrosome reaction (AR) rate. The addition of LNG did not significantly affect the number of recovered spermatozoa neither at the isthmus nor at the ampulla or the number of recovered spermatozoa adhered at the human tubal epithelium. Additionally, LNG did not influence the rate of AR. There were no significant differences even when the ovulatory side was taken into account. The present review showed that there are few studies which focus on the influence of LNG as EC upon sperm functions; albeit it is a plausible mechanism of action. Additionally, the different studies used different methods of evaluation and the results were in many cases contradictories. According to the results observed at the literature, when LNG is used as EC, it is probable that the drug does not achieved sufficient serum concentrations in order to be recognized by the progesterone (P) receptors. Positive results only were observed when the dose of LNG used in the experiments was much higher (comparable to the LNG-IUS) than the proposed for EC. LNG in a similar dose to that observed in serum after oral intake for EC did not affect the number, the adhesion to tubal epithelium, distribution, and AR rate of spermatozoa at the human Fallopian tubes in vitro. According to the results observed at the literature, if the LNG in doses used for EC, affects sperm function or not, it is still uncertain and warrants further studies
Doutorado
Fisiopatologia Ginecológica
Doutor em Ciências da Saúde

In the United Kingdom (UK) there is easy access to a wide range of contraceptive methods, available at no cost. In addition, oral emergency contraception (EC) (1.5 mg levonorgestrel) is now widely available from the community pharmacy. In spite of this, unintended pregnancy is common. In 2014 in England and Wales, 184,571 induced abortions were performed, and in Scotland, the corresponding figure was 11,475. Long acting reversible methods such as contraceptive implants and intrauterine contraception, are amongst the most effective methods available and National Institute for Health and Care Excellence (NICE) recommends that increased uptake can lead to fewer unintended pregnancies. However, uptake of long acting reversible contraceptive (LARC) methods remains low. The majority of women who require to use EC do so following unprotected sex or an accident with a condom. Increasingly women in Great Britain prefer to attend a pharmacy for EC rather than a sexual and reproductive health (SRH) service or general practitioner (GP). Starting an effective on-going method of contraception after EC use is clearly important if women are to avoid unintended pregnancy. Community pharmacists in the UK and most other high income countries are usually unable to provide any on-going contraception except condoms. So we have created a situation where EC is provided almost solely from settings where other more effective methods of contraception cannot be immediately provided. Novel strategies are therefore required to facilitate both uptake and continuation of the most effective methods of contraception, in order to prevent unintended pregnancy for more women. This thesis presents a mixture of biomedical, clinical and health services research to evaluate a series of strategies aimed at improving uptake of the most effective methods of contraception. Two studies investigated patient knowledge and information provision relating to contraceptive methods. The first sought to determine if women held misconceptions about intrauterine methods of contraception, and revealed that although myths persist in a small number of women, a lack of knowledge about these methods was also evident. The second study aimed to determine if the use of a digital video disc (DVD) to provide contraceptive information was acceptable and informative to women, and identified that it is, and could possibly enhance patient consultations. Studies three, four and five investigated strategies aimed at increasing the uptake of effective on-going contraception, following emergency contraception provided from a community pharmacy, and patient and health care provider attitudes to such approaches. They showed that simple interventions such as supplying one month of a progestogen only pill (POP), or offering rapid access to a family planning clinic (FPC), hold promise as strategies to increase the uptake of effective contraception after EC and that both women and clinicians were positive about such measures. Additionally, the problems encountered in conducting these studies provided valuable feedback to inform further development of research methods in the community pharmacy setting, and larger scale studies of such interventions. Community SRH services may be well placed to deliver more abortion care in the UK, and consequently this may result in greater uptake of contraception post abortion. Study six aimed to determine the views of health professionals working in SRH regarding their attitudes towards providing more abortion services and also the views of staff within one community SRH centre in Scotland where a service providing early medical abortion was due to commence. It showed there is clear support amongst health professionals in community SRH in the UK towards greater participation in provision of abortion care services.

The overall aim of this thesis was to investigate the knowledge of, attitudes toward, and experiences of the emergency contraceptive pill (ECP), sexual behaviour, and pornography consumption among high school students and young people. Data were obtained by questionnaires (studies I, II, and III), and by qualitative in-depth interviews (study IV).

A majority of 16-year old high-school students were aware that ECP existed, and knew where to obtain it. Attitudes toward using ECP were generally positive, but more girls than boys were hesitant as to whether ECP should be available without a prescription. Of those having experienced sexual intercourse, more than one fourth stated that they themselves or their partner had ever used ECP (I).

Almost half of the 16-year old high-school students surveyed (46%) had had sexual intercourse, a number similar in studies conducted 10 and 20 years earlier. Use of contraceptives at first intercourse had increased (to 76%) and use of alcohol had decreased (to 23%). More students in practical rather than theoretical programs smoked, had sexual intercourse at an earlier age, had more partners, and used contraceptives at first intercourse less often (II).

Three out of four 18-year old students had had sexual intercourse, of which almost three quarters reported contraceptive use at first intercourse. Anal intercourse was reported by one sixth, with infrequent condom use. Males who consumed more pornography were more likely than males who consumed less pornography to engage in a variety of sexual activities, as were males with an early age at first sexual intercourse (III).

The core category that emerged in the interviews was “Living with the current sexual norm”, pornography created sexual expectations and demands. The interviewees expressed contradictory feelings towards pornography and felt that sexuality was separated from intimacy. In order to deal with the current sexual norm, participants had different individual handling strategies, including liberal-, normalization-, distance-, feminist- and conservative strategies (IV).

Overall, the studies highlight several differences between genders and between students attending practical- and theoretical study programs in questions concerning ECP, sexual behaviour and pornography. These differences should be addressed while planning for counselling and sex education. We suggest that health- and school personnel discuss how sexuality is portrayed in pornographic material with young people.

The overall aim of this thesis was to inestigate Swedish adolescents' perceptions and behaviours regarding sexual risk taking. Specific objectives were to explore teenagers' perceptions of contraceptive use, unintended pregnancy, and abortion; teenage girls' experiences of decision making process and support connected to abortion; and male adolescents' perceptions of sexual risk taking and barriers to practicing safe sex. Another objective was to evaluate the effect of advance provision of emergency contraceptive pills to teenage girls. The methodologies included focus group discussions, in-depth interviews, and a randomized controlled trial.

Among the adolescents in our studies, teenage parenthood was generally viewed as a "catastrophe", and the majority expressed supportive attitudes towards abortion (studies I-IV). Occasions of failure to use contraceptives were common, especially when sex was unplanned (studies I-V). Pregnancy prevention was perceived as the woman's responsibility. However, many girls were reluctant about using homonal contraceptives due to worries about negative side effects (I, III). Initiating condom use was difficult for girls, as well as for boys, for a number of reasons (I-IV): fear of ruining an intimate situation, associations with disease, distrust, pleasure reduction, and (for the boys) the fear of loosing one's erection. Males generally perceived personal and partner-related risks connected to unprotected intercourse as low. Few males were worried that an unintended pregnancy would be carried to term, and the majority would urge the girl towards abortion if she seemed ambivalent (II, IV). Girls viewed the abortion decision as a natural, yet difficult choice, strongly influenced by attitudes of partners, parents, peers and societal norms (III). Teenage girls provided with emergency contraceptive pills in advance used it more frequently and sooner after unprotected intercourse compared with controls, without jeopardising regular contraceptive use (V).

Background- At the local, regional, national and global levels, unsafe abortion takes a tremendous toll on girls, women, families, communities, health systems and nations. An estimated 46 million induced abortions are performed annually with 78,000 deaths globally each year. In Ethiopia, unsafe abortion accounts for nearly 60% of all gynaecological admissions and almost 30.0% of all obstetric admission, about 22-54% of direct obstetric deaths are due to unsafe abortion. EC is increasingly regarded as a means to reduce abortion rates Objective – The aim of this study is to assess the knowledge, attitude and practice of female college students’ towards sex and emergency contraceptives so as to prevent unintended pregnancy. Methods – A descriptive cross sectional survey was conducted among 352 sampled female college students of Dessie, Ethiopia from June 4 to June 5/2012. Selfadministered questionnaire was used to collect the data. Data was entered into a computer using Microsoft Excel 2007 and analyzed using SPSS version 16.0 statistical software and Binary logistic regression analyses are used to measure the associations. Result- The age of students ranged from 18 to 25 years. Of the total respondents 36.6% ever had sexual experience, 53.3% know at least one regular modern contraceptive method, 69.9% heard about emergency contraceptives (EC) but, only 33.9 % had good knowledge about EC and 15.4% of them had ever used it. Conclusion & recommendation- Less than fifty percent of the respondents were knowledgeable about EC. The correct knowledge of the method such as the time limit is lacking for most of the students. Information, education & communication to increase awareness and knowledge about emergency contraceptive is important. Contraception information sessions should address; full details how the EC works and full details of how the contraceptives should be taken
Health Studies
M.A. (Master of Public Health)

Background- At the local, regional, national and global levels, unsafe abortion takes a tremendous toll on girls, women, families, communities, health systems and nations. An estimated 46 million induced abortions are performed annually with 78,000 deaths globally each year. In Ethiopia, unsafe abortion accounts for nearly 60% of all gynaecological admissions and almost 30.0% of all obstetric admission, about 22-54% of direct obstetric deaths are due to unsafe abortion. EC is increasingly regarded as a means to reduce abortion rates Objective – The aim of this study is to assess the knowledge, attitude and practice of female college students’ towards sex and emergency contraceptives so as to prevent unintended pregnancy. Methods – A descriptive cross sectional survey was conducted among 352 sampled female college students of Dessie, Ethiopia from June 4 to June 5/2012. Selfadministered questionnaire was used to collect the data. Data was entered into a computer using Microsoft Excel 2007 and analyzed using SPSS version 16.0 statistical software and Binary logistic regression analyses are used to measure the associations. Result- The age of students ranged from 18 to 25 years. Of the total respondents 36.6% ever had sexual experience, 53.3% know at least one regular modern contraceptive method, 69.9% heard about emergency contraceptives (EC) but, only 33.9 % had good knowledge about EC and 15.4% of them had ever used it. Conclusion & recommendation- Less than fifty percent of the respondents were knowledgeable about EC. The correct knowledge of the method such as the time limit is lacking for most of the students. Information, education & communication to increase awareness and knowledge about emergency contraceptive is important. Contraception information sessions should address; full details how the EC works and full details of how the contraceptives should be taken
Health Studies
M.A. (Public Health)

This study investigated factors contributing to adolescent mothers' non-utilisation of contraceptives in the Piet Retief (Mkhondo) area. Contraceptives, emergency contraceptives and termination of pregnancy services are available free of charge. Nevertheless the number of adolescent mothers continues to increase in this area. Structured questionnaires were completed by 107 adolescent mothers. Most respondents (70,0%) received no sex education prior to their pregnancies, and were not knowledgeable about contraceptives. Subsequent to the birth of their babies, only 59,81% used contraceptives, risking further pregnancies. Adolescents, from the age of 12, should receive sex education. Availability of contraceptives during weekends could help adolescents to postpone their pregnancies. Health education should be given to the mothers in the Piet Retief (Mkhondo) area so that they can provide more effective sex education (including contraception) to their daughters.
Health Studies
M.A. (Health Studies)

A quantitative, descriptive, explorative, contextual study was conducted to determine pharmacists and drug vendors' level of knowledge, attitude towards and practice on Emergency Contraceptive (ECl in Addis Ababa. Forty licensed service providers in Addis Ababa were randomly selected during 2008 and interviewed using a structured interview schedule. Data were analysed using a computer software package. The findings revealed that although these service providers were knowledgeable on the purpose and dOSing schedule of EC, they lacked knowledge on side-effects, contra-indications, and types of ECs. Most respondents portrayed a subjective attitude towards easy EC access of especially adolescent girls, since they believed that it will encourage promiscuity and unprotected intercourse. Their knowledge and practice need to be improved, as it has a direct effect on potential users and reducing unwanted pregnancies among young.
Health Studies
M.P.H. (Health Sudies)

Contraceptives are available free of charge throughout South Africa. Nevertheless the number of requests for termination of pregnancy (TOP) services continues to increase. This research investigated challenges preventing women from using contraceptives effectively. Structured interviews were conducted with 47 women who requested TOP services. Gender and financial issues posed challenges for some women to access contraceptives as well as their reported inability to access contraceptives. Most (85,5%) of the respondents used contraceptives. They discontinued using contraceptives because they experienced side-effects, necessitating them to request TOPs. Knowledge about, access to, nor the actual use of contraceptive enabled these women to prevent unwanted pregnancies. More effective counselling about the side-effects of contraceptives and enhanced accessibility of contraceptives during weekends and lunch breaks could enable more women to prevent unwanted pregnancies and reduce the number of requests for TOPs in the Gert Sibande District (Mpumalanga).
Health Studies
M.A. (Health Studies)

Unwanted and unintended pregnancies pose major reproductive health challenges to women throughout the world. Despite the availability of modern contraceptives, many women and men fail to use contraceptives effectively. This research focussed on reasons for not using contraceptives effectively in the Northern Tshwane area of the Gauteng Province of the Republic of South Africa (RSA). Structured interviews were conducted with 83 women and 71 men about their contraceptive practices. Age, religion, educational level and residential areas influenced clients' contraceptive practices. These results were categorised for adult males and females as well as for adolescent males and females. Adolescents encountered problems in accessing contraceptive services. Adult females knew most about traditional contraceptives, although men knew about some of these methods, and adolescents used some of them. All respondents could gain additional knowledge about modern contraceptives. The respondents' knowledge about · emergency contraceptives was extremely limited. Although most respondents knew about legalised choice on.termination of pregnancy (CTOP) services in the RSA, they did not know when nor how to access these services. Nurses working in contraceptive health services, revealed during a focus group discussion that a lack of resources (including shortages of malcondoms, contraceptive injections and oral contraceptives) hampered the quality of services that could be rendered. Of particular concern was the nonavailability of Norplant implants and female condoms. Nurses expressed a need for pecific national policy guidelines about supplying contraception to adolescents. Although most nurses knew about emergency contraceptives, they did not promote its use because they assumed that clients would misuse emergency contraceptives.instead of using contraceptives regularly. The nurses indicated that very few facilities offered CTOP services. The nurses regarded women who obtained repeated CTOPs to be misusing these services and suggested that limitations should be placed on the number-of times any woman could obtain such services. The negative attitudes of community members and of colleagues towards persons working in CTOP services caused hardships for them. Recommendations address ways in which contraceptive services could be improved.
Health Studies
D. Litt. et Phil. (Advanced Nursing Sciences)

This study explored knowledge, perceptions and attitudes regarding contraception and contraceptive practices among secondary school learners in the Limpopo Province. Self-administered questionnaires were completed by 612 Grade 8 and 332 Grade 12 learners from 24 randomly selected secondary schools. The study found that permissive attitudes prevailed towards sex, characterised by casual sexual activities commencing at 12 years of age. The availability of contraceptive and termination of pregnancy (TOP) services did not enable learners to utilise them, because of social, cultural, financial and service barriers. Most learners were sexually active without being knowledgeable about contraceptives, emergency contraceptives and TOP services. Two workshops conducted with learners produced similar results to those obtained from the completed questionnaires. Semi-structured interviews conducted with nurses, providing contraceptive and TOP services in the Limpopo Province, also substantiated the findings from the questionnaires. Secondary school learners in the Limpopo Province require more knowledge about and ready access to contraceptives to enable them to delay child bearing until they are emotionally, financially and physically ready for these responsibilities. Nurses and teachers in this province can enhance the learners' contraceptive knowledge and utilisation to help learners make better informed decisions about their own and their future children's lives.
Health Studies
D. Litt. et Phil. (Health Studies)

The purpose of this study was to explore and describe the contributory factors to the high teenage pregnancy rate within a district hospital in the Ehlanzeni district of the Mpumalanga Province, South Africa. Quantitative, non-experimental, descriptive and exploratory research was conducted to explore the contributory factors to the high teenage pregnancy rate. Data collection was done using a self-designed structured interview schedule. The findings of the study supported the assumptions that there are factors related to biography, individual perceptions, knowledge and awareness of; and practices, perceptions regarding the use of contraception. Perceived seriousness and barriers to the use of safeguards that could have prevented pregnancy contribute to the high teenage pregnancy rate thus emphasise the need to develop strategies to prevent teenage pregnancies
Health Studies
M.A. (Health Studies)

BACKGROUND: One in ten sexually active adolescents in the United States become pregnant each year. Significant differences in unintended pregnancy and use of long-acting reversible contraceptive (LARC) methods: the sub-dermal implant, the copper intrauterine device (IUD) and hormonal IUDs, exist between socioeconomic strata as well as ethnic and racial groups. Women using LARC are 20 times less likely to experience a pregnancy than women using short-acting reversible methods. Thus, LARCs present a major opportunity for the prevention of unintended pregnancy. PURPOSE: Characterize contraceptive use, demographics, and behavioral characteristics of a novel population: young women presenting to an urban Pediatric Emergency Department (PED) in order to better understand the contraceptive needs of this population. METHODS: We characterized the current LARC usage. Using an anonymous paper-based questionnaire, we surveyed women ages 16-21 years regardless of chief complaint presenting to our PED regarding their demographics, health care access, sexual history, and history of contraceptive use. We conducted a cross-sectional analysis of demographic characteristics for current LARC and non-LARC users (n=331) using chi-squared for categorical variables and student's t-test for continuous variables. RESULTS: No significant differences were found between women currently using LARC and those not using LARC, however current LARC usage in our population was 15.8%, about three times that documented in the most recent national studies conducted in 2013. CONCLUSION: Current LARC use is particularly high in our urban PED setting. More research is necessary to determine if this is part of a larger national trend or if the early implementation of no-cost contraception in Massachusetts and changes in provider or patient attitudes towards LARC may explain the large observed difference in LARC usage.

Adolescent pregnancy is a worldwide problem. This study attempted to describe and explore the knowledge of female adolescents in Angola's knowledge with regard to contraception. The research results, obtained from interview schedules, revealed that the respondents lacked knowledge about themselves as adolescents as well as a lack of knowledge of their reproductive health and development. Furthermore, the results portrayed a lack of knowledge of contraceptives. The study findings may assist health care providers to identify educational programmes on contraception at schools, markets and in the community.
Health Studies
Thesis (M.A. (Health Studies))