KNOWLEDGE, ATTITUDE AND PRACTICE ON EMERGENCY CONTRACEPTION AMONG JIRREN HIGH SCHOOL FEMALE STUDENTS SOUTH WEST ETHIOPIA

By: Guesh zenebe Alemayehu (Health officer intern)

A RESEARCH PAPER SUBMITTED TO: JIMMA UNIVERSITY, COLLEGE OF PUBLIC HEALTH AND MEDICAL-SCIENCE, CBE OFFICE AND MEDICINE AND HEALTH OFFICER COORDINATING OFFICE

JULY, 2012 JIMMA, ETHIOPIA

KNOWLEDGE, ATTITUDE AND PRACTICE ON EMERGENCY CONTRACEPTION AMONG JIRREN HIGH SCHOOL FEMALE STUDENTS

BY: GUESH ZENEBE ALEMAYEHU ADVISORS:-MR.GARUMMA TOLU (B.SC, MPH)

-MRS. TIZITA TILAHUN (B.SC, MSC, ASSISTANT PROFESSOR /PHD FELLOW)

JULY, 2012 JIMMA, ETHIOPIA

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ABSTRACT

Back ground:-Unintended pregnancy and induced abortion can be prevented and reduced by expanding and improving family planning services and choices. Emergency contraceptives as a backup method is the only method of contraception that can prevent pregnancy after unprotected sexual intercourse, method fail ere or incorrect method use and adds an important option for helping sexually active young people to avoid unintended pregnancy. Objective:-The aim of the study was to assess the knowledge, attitude and practice of emergency contraceptives and identify associated factors among female students of Jirren high school. Methods:-Across-sectional descriptive study was conducted at Jirren high school from February to July 2012.Data was collected by using pre tested questionnaire and the collected data was compiled manually and analyzed using scientific calculator and chi square test was employed to determine the association of some variables. Result. The age of students ranged from 15 to 25 years, with majority of respondents 248(99.2%) between the ages 15 and 20 years; of the total respondents 11.6% had ever had sexual experience. Over all, 58.4% of the total respondents had ever heard of EC and 3.6% had ever used EC. Sixty four percent of those ever heard of EC mentioned pills and 48.0% of them identified 72 hrs as a time limit to start the first dose of ECP. The major sources of information were TV/radio 52% and 23.3% from health professional. Around seventy five percent of the respondents had positive attitude to wards EC. Knowledge had significant association with educational level. Reproductive health issues discussion had significant association with knowledge, practice and attitude. Ever used of EC was significantly higher among respondents who were married than the single. Conclusion and recommendation:- More than fifty percent of the respondents were lacking knowledge about EC. Information education and communication to increase awareness and knowledge about EC is important. Means of RH discussion should be encouraged.

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ACKNOWLEDGEMENT

At the very beginning and for the most I would like to express my gratitude to Jimma University for giving me this opportunity to do this research project I would like to express my heartfelt gratitude to my advisor Mr.Garumma Tolu and Mrs.Tizita Tilahun for their constructive advices and information. My thanks also goes to health science documentation, computer and networking room and information desk workers for their energetic support. I would like to extend my deepest gratitude to Jirren high school administration for their hospitality and providing important data for my study.

TABLE OF CONTENTS

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LIST OF TABLES

Table 1: Socio demographic and academic characteristics of respondents among Jirren high school female students, February to July 2012..................................................................................................................................................................................................................14

Table 2: Reproductive health related characteristics among Jirren high school female students, February to July 2012............................16

Table 3: Knowledge and practice on EC among Jirren high school female students, February to July 2012.................................................20

Table 4: Attitude on EC among Jirren high school female students, February to July 2012...........................................................................22

Table 5: Relationship of socio-demographic and academic characteristics with knowledge of EC among Jirren high school female students, February to July 2012.......................................................................................................................................................................25

Table 6: Relationship of socio-demographic and academic charestestics with attitude and practice of EC among Jirren high school female students, February to July 2012.......................................................................................................................................................................25

Table 7: Relationship of reproductive health issues with knowledge on EC among Jirren high school female students, February to July 2012..................................................................................................................................................................................................................26

Table 8: Relationship of reproductive health issues with attitude and practice on EC among Jirren high school female students, February to July 2012.......................................................................................................................................................................................................27

ACRONYMS AIDS-Acquired Immune Deficient Syndrome EC--Emergency Contraceptive FGAE_-Family Guidance Association of Ethiopia HIV_ Human Immune Deficiency Virus IEC_ Information Education and Communication IUD_ Intra Uterine Device

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KAP_ Knowledge, Attitude and Practice SRH_ Sexual and Reproductive Health US AID_ United State Agency for International Development WHO_ World Health Organization

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CHAPTER ONE INTRODUCTION 1.1 Back ground information Emergency contraception, also called post coital contraception is a method of preventing pregnancy as result of unanticipated Sexual activity, contraception failure, or sexual assault. Emergency contraception takes two forms: the administration of emergency. Contraceptive pills (ECPs), which contain high doses of female sex hormones, or the insertion of copper intra uterine device (CU_IUD) in the uterus (1) There are two types of emergency contraceptive pill, one type contains combination of the female sex hormones estrogen and progestin and a second type of Ecps contains only progestin. The hormones in Ecps (emergency contraceptive pills) prevent an egg from being fertilized by sperm, either by delaying or preventing ovulation, or by affecting the ability of sperm to reach the egg. These hormones may also prevent an egg from implanting in the uterus. Ecps should not be confused with mifepristone; a drug that prevents pregnancy but also cause abortion when taken within the first seven weeks of pregnancy. The first dose of ECP is taken within 72 hours of unprotected intercourse. The second dose is taken 12 hours later. Alternatively, both pills may be taken at the same time, as soon as possible after unprotected sex. ECP may be taken up to 120 hours, but its effectiveness is lower (1-3) Effectiveness of emergency contraceptive pills is 75% -89% when taken within 72 hours of unprotected inter course. When taken within 72 hrs of unprotected intercourse, Ecps that contain both estrogen and progestin reduce the risk of pregnancy by 75%. When initiated within 24hrs of unprotected inter course, progestin only Ecps were found to reduce the risk of pregnancy by 95 percent (2) Ecps do not induce an abortion rather helps prevent the need of abortion. They do not protect against reproductive tract infections, including HIV/AIDS. Because of the short term nature of their use, there are no medical conditions that make Ecps unsafe for any woman. Thus all women who can use Ecps safely and effectively including women who cannot use ongoing hormonal contraceptive methods (1 & 3) Another form of emergency contraception is the insertion of a copper IUD by a trained health care professional. When inserted within five days of unprotected sex, the copper IUD is 99% effective in preventing pregnancy. The use of copper IUD is not recommended for women with sexually transmitted infections of inflammatory pelvic disease, women with multiple sexual partners, who have been sexually assaulted, or new partner because of the risk of spreading undiagnosed infections to the uterus the IUD is inserted. If a woman intends to use an IUD as long term method and meets the screening criteria, emergency insertion of copper bearing IUD may be good alternative to ECP use (1-3)

The need for emergency contraception is clearly demonstrated by the occurrence of high magnitude of unwanted pregnancy and induced abortion. If emergency contraception is easily available and distributed along with appropriate advocacy and information education and communication (IEC) activities millions of unwanted pregnancies and abortions could be averted (4,6) In 2001, the Family Guidance Association of Ethiopia (FGAE) in collaboration with the population council initiated for the time a pilot project to introduce EC in selected youth center clinics in the country. In this project EC was provided in a repackaged attractive brand for adolescents and youth by cutting the regular contraceptive pills though the services were limited in scope and coverage (6) Emergency contraception was officially introduced in Ethiopia by Ministry of Health in 2005 with the aim of improving sexual and reproductive health (SRH).The method, however, remained poorly known and unavailable (6) 1.2. Statement of the problem One fourth of world population is between age ten and twenty four .One third of the total population of sub Saharan Africa is aged between ten and twenty four years (7).Ethiopia has a predominantly young population that makes up 30% of the total population(8). Young people today marry later, and more start sex before marriage. Thus they face more risk of unwanted or unintended pregnancy (9). Behavioral factors that frequently put adolescents at greater risk of unintended pregnancy include experimentation and risk taking, as well as limited ability to plan ahead. The nature of relationships and frequency of intercourse are often different during adolescent years than later in life. Shorter relationships, sometimes with long intervals in between, are not uncommon, and sex may be infrequent and sporadic. This may lead to reluctance to adopt a regular family planning method or make it harder to plan to use one (10).For many youth, sex is largely unplanned and sporadic yet few young people know about the option of emergency contraception, contraceptives after unprotected intercourse (11). An estimated 536,000 maternal deaths occur worldwide each year, 99 %( 533,000 of them in developing countries. Slightly more than half of the maternal deaths (270,000) occurred in the sub Saharan Africa region alone. The World Health Organization estimates that 13% of world wide maternal deaths are due to unsafe abortions (12).Forty to sixty million abortions is performed each year and among these twenty million are unsafe abortions. This represents almost one in ten pregnancies, or a ratio of one unsafe abortion to seven births. (13) The proportion of women aged 15-19 years in Africa who have had an unsafe abortion is higher than any other region; almost 60% of unsafe abortions-in Africa are among women aged less than 25 years and almost 80% are among women below age 30. (13)In Ethiopia about 25,000women die

every year due to pregnancy and child birth complications, and abortion is estimated to account for 32% of these deaths (14) Unintended pregnancy poses major challenge to the reproductive health of young people in developing countries. Some women with unintended pregnancies obtain abortions many of which are performed un safe conditions and others carry their pregnancy to term, incurring risk of morbidity and mortality higher than those for adult women (15) Compared with women in their twenties, adolescents ages 15-19 are two times more likely to die (16.) Early pregnancy poses special health risks for the child. Children of teenage mothers have poorer survival prospects than children whose mothers are in their twenties or thirties(10).In addition to the higher risk of morbidity and mortality, adolescent pregnancy can lead to serious social stigma and health consequences for both mother and child. The adverse social and economic consequences for an adolescent who become pregnant will depend on her particular martial, cultural, familial, and community situation. However, in many developing countries, pregnancy severely limits an adolescent in pursuing education and in having broader economic opportunities in the future. (10)By preventing unintended pregnancy, ECPs can help avert the risks to the mother and child associated with pregnancy and child bearing(10). Emergency contraception is largely underutilized worldwide and has been referred to as one of the best kept secrets in Reproductive Health. In USA less than 13% college students had ever used EC in 2002.In many low income countries, the lack of knowledge about and access to emergency contraception many result in young females resorting to unsafe abortions, which contribute significantly to maternal morbidity and mortality(22). Studies showed that there was a gap on knowledge, attitude and practice of emergency contraception in the studies conducted in emergency contraception in the studies conducted in different countries (17-21). Different studies conducted in Ethiopia indicated that awareness of EC is less than 50% except, 64.1% among high school students of Jimma university community school and utilization is less than 10%(26-30).Thus, this particular study aims to assess knowledge, attitude and practice of emergency contraception among Jirren high school female students and what factors affect their knowledge, attitude and practice.

CHAPTER TWO LITERATURE REVIEW 2.1. Knowledge, attitude and practice on emergency contraception A study conducted in Finland by collecting data every second year using self administered questionnaire among girls aged 12-18 years old in1999-2003 indicated that the awareness of EC increased. In Finland over the counter sales to those aged 15 or older were aware in 2002. In 2003, 61% girls aged 12 and 98% of those aged 18 knew about emergency contraception but the awareness is not related with the change to non prescription status. In 2003, had ever used of EC were 2%, 15% and 29% for aged 14, 16, and 18 yrs respectively. Alcohol use, smoking, dating and having good school achievement were related to higher awareness of EC. And EC use increased with increased alcohol consumption particularly at age 14, smoking, dating and poor school achievement and as well as not living in nuclear family (17). A comparative study conducted on adolescent clinic and drug treatment center in USA between 1996 and 2002 showed that the percentage of participants: had ever heard of EC, knowledge of the correct time for EC, attitude towards EC and ever used of EC was significantly increased between 1996 and 2002. Had ever heard of EC was 44% and 73% in 1996 and 2002 respectively. Knowledge about the correct time limit for EC grew from 20% to 51% between 1996 and 2002.Knowledge where to get EC was increased from 78% to 95%.and ever used of EC increased from 4% to 13% and participant positive attitude toward EC grew from 72% to 96% for 1996 and 2002 respectively(18). A study done in Swedish women presenting for induced abortion revealed that 83% were aware of EC but 15 women used it to prevent this pregnancy. Fewer, 38% know the recommended time frames for use and 54% had knowledge of the mode of action. The two most common source of information about ECPs were media and friends. One out of five, 22% had previously used the method, and at the time of conception, 55% would have taken ECP if it had been available at home, and 52% were positive to having ECP available over the counter. (19) Another study done in Swedish teenagers showed that almost half (45.4%) of the teenagers had had sexual inter course and of those, 28.3% stated that they themselves or their partner had used ECP. Four of five teenagers knew about ECPs and where to obtain it if necessary. Many teenagers (67.3%) also knew that ECP prevented implantation. The main source of information about ECP was youth clinics and friends. The attitude toward using ECP in an emergency situation was positive, but the teenagers, especially girls, were restrictive as to whether ECP should be available without prescription. The girls believed that ECP could be used much more and two third of both sex thought it could lead to negligence with ongoing contraception. Seventy seven percent of teenagers preferred turning to youth clinic when in need of ECP. One in four believed that concerns for side effects could determine them from using ECP.(20)

A cross sectional study done among women in Western Cape province of South Africa indicated from the total 831 sexually active women 30% of the women had ever heard of emergency contraceptives when asked directly ,after the method was described to them. Only 15%mentioned EC by name or description spontaneously. Knowledge of EC was independently associated with higher education, being married, and living in an urban setting. Four percent of women had ever used EC (21). Studies conducted among female students, youth and general population women in different areas in Ethiopia showed that the level of awareness and practice of emergency contraception were low.(22-26) A cross sectional study conducted in Ethiopia, Arsi college female students: 228(27.4%) of respondents have heard of EC, 107(46.9%) reports ECPs and of those 72(8.6%) mentioned the time limit within 72 hours. And 10(1.2%) knew IUCD is to be inserted with in 120 hrs after unprotected intercourse.434(52.1%) of respondents had positive attitude to making easy availing of EC for all female and 62.9%have an intention to use EC in the future as needed. Only 20(2.4%) have used EC in their life time. Age of students and year of study was strongly associated with awareness of EC.As the age and year of study increased the awareness also increased students of health science college had better awareness of EC than the other colleges [22]. A study conducted on assessment of KAP of EC among women seeking post abortion care services in Addis Ababa showed that 288(69.1%) of respondents had ever used regular contraception methods.199(47.7%)of the pregnancy were unwanted and their reason were 60(30%) forgetting to take contraception,38(19%) rap,14(7%) contraception failure and 10(5%) rupture of condom. Fifty nine (14.1%) of study subjects have ever heard EC and 29(49.2%) of them mentioned the time frame correctly. The source of information for EC was 24(40.8%) health institution,20(33.9%)friends and relatives and 16.9% mass medias .Of the respondents 15(3.6%) had ever used EC(23). Another study conducted on KAP of emergency contraceptives among the youth in Hawassa town revealed that 28.2% of the respondents have heard of EC while only 21.9% knew the correct time limit to take it. Youth with primary or more educational level had more knowledge about EC. Among the total respondents only 5.7% ever used the EC.84% of the respondents have intention to use EC after being informed about EC. The study concluded that knowledge about availability of EC is very limited indicating the need for awareness creation on the method (24). Another cross-sectional study conducted among women with unsafe abortion in Jimma Marie Stopes Clinic, on knowledge, attitude and practice and barriers to use EC showed that only 20(13.1%) of the total respondents had heard about EC and out of this only seven(35%) correctly identified 72 hrs as the time limit of taking EC. The most common source of information about EC were health institutions, and Marie Stopes Clinic which accounted for 12(60%) of the respondents followed by neighborhood and partner each accounting for three (15%).The study has also

revealed that after having explained about EC, the vast majority respondents 130(84.3%) had positive attitude towards the method and showed interest to share information about EC with their friends. Regarding use among the total respondents only seven (4.5%) reported previous use. The most common reason given for non use of EC were lack of awareness about the existence of EC,132(86.3%); fear of side effects ,five (3.4%) and the rest reported unavailability of service, partner disagreement ,religion and culture.(25) A study conducted on assessment of knowledge and practice of EC among high school female students of Jimma University Community School revealed that sixty eight (64.1%) of respondents had heard about EC and the most common source of information were school teachers and health professionals. Out of those who have heard about EC, only 13 (19%) of the respondents were able to tell the recommended time for EC use .Awareness about EC was not found to be associated with their age or educational level.EC use among the total respondents was found to be very low 3(2.8%)(26).

CHAPTER THREE SIGNIFICANCE OF THE STUDY: As shown in many countries where unintended pregnancies are high, wide spread use of EC could prevent very high number of unintended pregnancies and abortions. The reproductive health impacts of unintended pregnancy and unsafe abortion are high among adolescents especially in developing countries like Ethiopia. Preventing unintended pregnancies by improving the family planning services including emergency contraception which is convenient to the youth people will contribute to the reduction of maternal morbidity and mortality. Thus EC is the only method of contraception that can prevent pregnancy after unprotected sexual intercourse. To be utilized by the women who need it, every effort should be made to ensure that women know about emergency contraception before they need them. So, in our country it is little known by the women especially adolescents who faced the burden. Primarily the assessment of knowledge, attitude and practice of EC is mandatory to intervene on the result. However, in Ethiopia very limited studies are conducted. Thus this study will provide information regarding knowledge, attitude and practice on EC in high school setting. Further, it may serve as an insight/base line data for any research inters ted in improving similar study, especially at high school level and particularly helpful to policy makers and programmers to emphasis on reproductive health issues of adolescents starting from the lower educational level.

CHAPTER FOUR OBJECTIVES: 4.1 General objective:To assess the knowledge, attitude and practice of emergency contraception among Jirren high school female students.

4.2 Specific objectives. To determine the level of knowledge on school female students. emergency contraceptive methods among Jirren high

To determine the attitude of Jirren high school female students towards emergency contraceptive methods. To assess the practice of emergency contraceptive among Jirren high school female students. To identify factors that affect knowledge, attitude and practice of emergency contraceptive among Jirren high school female students.

CHAPTER FIVE
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METHODS AND MATERIALS 5.1 study area and period:The study was conducted in Jirren high school, found in Jimma town, Jimma zone, Oromia region, south west Ethiopia. The school has a total of 2143 students of them 1050 are males and 1093 are females in this year. In the school there are a total of 12 clubs working among these; health and environmental protection club, Red Cross and anti AIDS club, female and children's right club, female students club, Mini media and counseling and sport club are some of the clubs working in health related issues.(27) 5.2. Study design:A cross sectional descriptive study was conducted from February to July 2012 among Jirren high school female students. 5.3. Population 5.3.1. Source population:The source population was all female students in Jirren high school in the year of 2012. 5.3.2. Study population:The study population was all the sampled female students from the source population. 5.4. Inclusion criteria and exclusion criteria: 5.4.1. Inclusion criteria Regular female students Age 15 year and above 5.4.2 Exclusion criteria: Those who have visual impairment

5.5 Sample size and sampling technique:

Sample size calculation:-Sample size was determined using single proportion formula. No= (Z x/2)2 p (1-P) /d2 Where, No=the required sample size Z x/2=standard score corresponding to 95% confidence interval P=Assumed proportion of emergency contraception knowledge to be 30%,which was the average based on the results among different studies conducted in Ethiopia, Arsi college female students, Addis Ababa women seeking post abortion care, Jimma Marie Stopes clinic women with unsafe abortion and Jimma university community school among high school female students. d=the margin of error No= (1.96)2x0.30 (1-0.30) / (0.05)2 =322.69~323 Because the total source population was less than 10, 000, it was calculated as follows: N1=No/ (1+No/N) ; Where No=the sample size from an infinite population& N=finite population size (source population) N1=the sample size from finite population N1=323/ (1+323/1031 =245.94 N1 ~246 And 5% non response rate was added. N1=246+5% non response rate =246 + 12 =258 Sampling procedure:-The two grades (grade 9 & 10) were considered in the sampling process for the selection of the study subjects. The total female students were stratified in to the two grades and the sample was distributed to each grade using probability proportional to their size. The study subjects were selected from each grade using simple random sampling. Programmes was arranged with the school head and teachers. 5.6 Study variables: 5.6.1 Dependent variables:
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-knowledge, attitude and practice on emergency contraceptive. 5.6.2 Independent variables: socio demographic (age, marital status, religion, grade, and place of origin ) Sexual exposure/behavior. Discussion of reproductive health issues. 5.7. Plan for data collection: 5.7.1. Data collection instrument:Data was collected using self administering standardized and well structured and pre tested questionnaire. 5.7.2. Data collection procedure:Data was collected by self administering questionnaire during one class session under the supervision of principal investigator(PI) & the questionnaire was enclosed in an unmarked envelop & a brief explanation was given to respondents before the data collection. 5.8 Data quality control and data quality management: Quality control measures was employed during data collection and analysis. The principal investigator made make follow up to the data collection process and check for missing information and in consistencies. A pre test was done one week prior to the actual data collection in the same study area. Five female students were involved in the pre test who wouldnt involved in the actual study .After data entered in to computer it was cleaned and edited, identified errors corrected by reviewing the original questionnaire. 5.9 Definitions and operational definitions: 5.9.1 Definitions: .Ever used-utilization of EC in the past. Ever heard- awareness of EC. Sexual experience- sexual contact at least once in the past Unprotected sexual intercourse-sexual intercourse without using any contraception method. 5.9.2 Operational definitions: Attitude-is an opinion, out looks, values, position and intentions of the study subjects towards the utilization of EC methods.
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Six attitude questions: Intention to use EC in the future? Do you think EC one way of abortion? Do you believe EC may hurt the baby in case it doesnt work? Do you believe the available EC carry few side effects? Do you think the available EC are fairly effective to prevent pregnancy? Do you encourage use of EC after unprotected sexual intercourse? Positive attitude-form the six attitude questions on EC who responded correctly three and above. Negative attitude- form the six attitude questions on EC who responded correctly two and below. Practice-those who have used EC at least once. Knowledge-include heard about EC, type of EC, know time limit to be taken EC after unprotected sex with in 72 hrs for ECPs and 120 hrs for IUD, mechanism of action of EC and occasions when EC will be used. Six knowledge questions: Have you ever heard about EC? Types you know? Do you know time limit for ECPs? Do you know time limit for IUD? What is the mechanism of action of EC? What are the occasions EC will be used? Good knowledge-form the six knowledge questions on EC who responded correctly four and above. Faire knowledge-from the six knowledge questions on EC who responded correctly two to three questions. Poor knowledge/Not knowledgeable-those who responded correctly to one and less than one of the six knowledge questions. 5.10 Data processing and analysis

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The collected data was complied manually and analyzed using scientific calculator and chi square test was employed to determine the association of some variables. 5.11 Ethical consideration Ethical approval was obtained from the ethical review committee of t the College of Medical science and Public Health, Jimma University. Clear communication was conducted with the high school head, guard, teachers and program was arranged to conduct the study. In addition, after brief explanation of the purpose of the study, consent was obtained from the study participants and those voluntary to participate was provided the questionnaire to fill. The confidentiality was assured by excluding their name and not to participate on the study or withdraw at any point from the study was respected. 5.12 Plan for communication of results -At the end of the research project, the result will be presented to Jimma University, Medicine and Health officer coordinating Office and all other concerned bodies.

CHAPTER SIX RESULT

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5.11 Socio demographic and academic characteristics of respondents Out of the expected 258 respondents 250 agreed to participate into his study and eight students were refused. Full response was obtained from a total of 250 respondents making the response rate of 96.9%. The age of students ranged from 15 to 25 years, with majority of respondents 248(99.2%) were between the ages of 15 and 20 years and two (0.8%) of the respondents were between 21 to 25 years old (Table 1). One hundred thirty two (52.8%) of the respondents were Orthodox Christians, 69(27.6%) Muslims, 45(18%) protestants and 4(1.6%) were Catholics by religion. (Table1). The majority of study participants 237 (94.8%) had never married (single) and 199(79.6%) of the respondents were from Jimma town and the remaining 51(20.4%) were from outside Jimma town (surrounding Jimma town) Table (1).

Table 1: Socio demographic and academic characteristics of respondents among Jirren high school female students, February to July 2012 Variable Age No %

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15-21 21-25 +25 Marital status Single Married Divorced Separated Widowed Religion Orthodox Muslim Protestant Catholic Others Palace of residence Jimma town Surrounding Grade 9 10

248 2 0

99.20 0.80 0 94.80

237 11 0 2 0 4.40 0 0.80 0

132 69 45 4

52.80 27.60 18.00 1.60

199 51

79.60 20.40 70.80

177 73 29.20

5.1.2 Reproductive health characteristics of respondents

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Age at menarche ranged from 10 to 19 years, 230(91.9%) of the respondents were between 13-15 years, 11(4.4%) between 10-12 year,7(2.8%) between 16-19 years and of all the respondents only two students not yet started menses. (Table2). Eighty three (33.2%) of the respondents mentioned that a women likely to get pregnant within 2-3 weeks of the menstrual cycle, 42(16.8%) said within one week of the menstrual cycle, 25(10%) during the menstrual flow and 100(40%) said they didnt know when a women can get pregnant. One hundred fifty four (61.6%) of the respondents discuss about reproductive health issues with at least someone else. Eighty five (55.2%) of those discussed RH issues with their friends, 83(53.90%) with their mother, 40(25.9%) with school teacher and the remaining with one or more individuals (Table 2). Out of the total 250 respondents 29(11.6%) had ever had sexual experience among these 4(13.8%) of them started before the age of fifteen and 22(75.86%) had only one partner. Twenty (68.96%) of those who had sexual contact stated their reason was due to love and 9(31.03%) due to marriage. (Table2) Eight (27.6%) of those respondents who had sexual experience had been pregnant and all of them had one pregnancy only. All of the pregnancies were unwanted and ended in indirect induced abortion, all of those abortions performed in the clinic/hospital. (Table 2)

Table 2: Reproductive health related characteristics among Jirren high school female students, February to July 2012 Variable No %

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Age at menarche Not started 10-12 yrs 13-15yrs 16-19yrs Knowledge about the time of pregnancy occurs during menstrual flow A week from menses 2-3 weeks after start menses Do not know Ever had sex Yes No Age at first sex <15 15-19 20-25 +25 Reason for sex Marriage Rape Love Mark 9 0 20 31.03 0 68.96 25 86.20 29 221 4 88.40 13.80 2 11 230 7 25 42 83 100 0.80 4.40 91.90 2.8 10 16.8 33.2 40 11.60

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6.3 Knowledge, Attitude and practice of Emergency contraceptives Number of partners One Two Three and above Reproductive issue discussion Yes No Ever been pregnant Yes No Age at first pregnancy 15-19 20-24 +25 Un wanted pregnancy Yes No Number of pregnancies One Two and above Out com of pregnancy Child birth Induced abortion Place of abortion Untrained abortionist Clinic/hospital 0 8 0 100 0 8 0 100 8 100 8 100 0 0 21 8 72.4 100 154 96 8 38.4 27.6 61.6 22 7 75.86 241

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One hundred forty six (58.4%) of the total respondents had ever heard of EC. Ninety four (64.0%) of those ever heard of EC mentioned pills, 76(52.0%) IUD and 90(62.0%) mentioned others. The major source of information were from television/radio 76(52%), 34(23.3%) from health personnel and reproductive health clubs 9(13.7%). Seventy (48.0%) of those ever heard of ECPs identified 72hrs as recommended time limit, 27(18.5%) mentioned within 24hrs and 38(26.0%) mentioned they didnt know as a time limit to start the first dose of ECPs after unprotected sexual intercourse. Only 9(6.2%) of those ever heard of EC identified five days as recommended time limit to have IUD after unprotected sexual intercourse. (Table 3) Ninety seven (66.4%) of those aware of EC mentioned that EC prevents from getting pregnancy, 7(4.8%) said it has abortive effect and 42(28.8%) dont know how it works. Seventy nine (54.1%) of those aware of EC said that EC to be indicated to those raped, 52(35.6%) to those who have unprotected sex without any contraception, 47(32.1%) to those missed pills and condom breakage/ slippage and 34(23.3%) didnt know the situations EC should be taken. (Table 3) By computing the knowledge questions of the respondents 38(15.2%) had good knowledge, 67(26.8%) faire knowledge and 145(58.0%) lack /poor knowledge. (Table3). Nine (6.2%) of those ever heard of EC had ever used emergency contraceptive method. Seven (77.7%) of those ever used EC had used pills and only two respondents had used IUD. Two of them had used only once, 2 twice and 5 three time and more. The main reason for using EC was 5 due to forget to take pills and 4 due to not using any contraception method. Eight of the EC users had got the service from private clinic and pharmacy, 1 from FGAE. (Table 3)

Table 3: Knowledge and practice on EC among Jirren high school female students, February to July 2012 Variable No %
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Ever heard of EC Yes No Types ever heard (146) Pills IUD Others Time limit for ECPs (146) 72 hrs 24hrs Immediately after sex Five days/in week I do not know After cessation of menses/missed period Time limit of IID Immediately after sex 24 hrs 72 hrs One week/five days After missed period I do not know 7 27 11 9 5 87 18.5 7.5 6.2 3.4 59.6 70 27 9 0 38 2 48.0 18.5 6.2 0 26.0 1.3 4.8 94 76 90 64.0 52.0 62.0 146 104 58.4 41.6

Variable Mechanism of action of EC(146)

No

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Prevent pregnancy from occurring Induce abortion I do not know Situation EC should be taken to prevent pregnancy (146) Forced sex/rage Condom breakage/slip rage Missed pills Unprotected sex without any contraception I do not know Knowledge summary Good knowledge Faire knowledge Poor/lack knowledge Ever used EC(146) Yes No No response Type EC used (9) - ECP - IUD Source of EC (9) - FGAC - Private/pharmacy - Public

97 7 42

66.4 4.8 28.8

79 47 47 52 34

28.8 54.1 32.1 35.6 23.3 15.2

38
67 145 26.8 58.0

9 126 11

6.2 86.3 7.5 77.7

7 2 22.2

1 8 -

11.1 88.9 -

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One hundred forty five (58.0%) of the respondents encourage making available and use of EC. And one hundred five (42.0%) of the respondents didnt encourage use of EC for the reasons of 63(60%) increase risky behavior, 36(34%) for religious, 31(30%) propagates HIV/AIDS and 11(10.5%) for fear of miss use. One hundred seventy (68.0%) of the respondents have an intention to use EC when the need arises and 98(39.2%) consider EC as one way of abortion. One hundred twelve (44.8%) of the respondents thought EC harms the fetus when pregnancy occurred and 147(58.8%) have reliability on the faire effectiveness of EC to prevent pregnancy. The attitude summary index below show majority 187(74.8%) of the respondents have positive attitude towards EC. (Table 4)

Table 4: Attitude on EC among Jirren high school female students, February to July 2012 Attitude questions No %

22

Encouragement use of EC Yes No Intention to use EC in the future Yes No EC are fairly effective to prevent pregnancy Yes No I dont know EC may hurt the baby in case it doesnt work Yes No I didnt know EC one way of abortion Yes No Available EC carry few side effects Yes No I didnt know Attitude summary (Index) Positive attitude Negative attitude 187 63 74.8 25.2 143 49 58 57.2 19.6 23.2 98 152 39.2 60.8 112 69 69 27.6 27.6 147 43 60 58.8 17.2 24.0 44.8 170 80 68.0 32.0 145 105 58.0 42.0

Knowledge about EC had significant association with educational status (P<0.05) but there was no significant association with age of respondents, residence area and marital status.
23

Ever had sexual contact had significant association with knowledge (P<0.05) and practice (P<0.05) but sexual relationship had no relation with attitude of EC. Ever became pregnant and age at 1st sex had no relation with knowledge, utilization and attitude of emergency contraception. (Table 5) Reproductive health issues discussion had great significant association with knowledge (P=0.000), practice (P=0.01) and attitude (P=0.04) of EC. Number of sexual partner had significant association with practice (P=0.00) but no relation with knowledge and attitude towards EC. (Table5). Marital status had strong association with practice (P=0.00) but no other socio demographic and academic characteristics had relation. Except religion the other variables had no association with attitude towards EC. (Table5)

Table 5: Relationship of socio-demographic and academic characteristics with knowledge of EC among Jirren high school female students, February to July 2012.

24

Variables

Good knowledge (38)

Faire knowledge (67)

Lack/poor knowledge (145) Total P-value

X

Age 15-20yrs >+21yrs Residence area Jimma town Out of Jimma town Marital status single married and others Grade 9 10 Religion Orthodox Muslim Protestant Catholic 16 11 9 2 40 20 7 0 45 25 6 76 41 8 10 28 34 33 133 12 69 13 125 36 2 63 4 141 4 240 10 177 26 12 54 13 121 24 201 49 38 0 67 0 143 2 248 2

2 = 1.46 df = 2

P = 0.48
X

2 = 4.32 df = 2

P = 0.11

2 = 1.42 df = 2

P = 0.49 2 = 8..11 df = 2 P=0

2 = 7.74 df = 6

P = 0.25

Table 6: Relationship of socio-demographic and academic charestestics with attitude and practice of EC among Jirren high school female students, February to July 2012.
Positive Negative Total Yes No Total P-value

25

Variables

(attitude) (attitude) (187) (63)

250

P-value

practical practical 9 (241)

250

Age 15-20yrs +21yrs >21yrs Residence area Jimma town Out of Jimma 35 town Marital status single married others Grade 9 10 Religion Orthodox Muslim Protestant Catholic 108 49 24 6 18 16 27 2 126 65 51 8 127 60 50 13 177 73 179 and 8 61 2 240 10 14 49 185 2 63 0 248 2

2=0.67 9 0 239 2 248 2

2 = 0.075

df = 1 P = 0.40

P = 0.78 df = 1

2=0.36 7 2 194 47 201 49

2 = 0.041

152

49

201

df=1 P = 0.54

P = 0.83 df=1

X X

2 = 132.33

2= 0.14

2 7

238 3

240 10

P=0 df=1 2 = 3.13

df=1 p=0.69
X

2 =2.98

173

177

df=1 p=0.08 5 5 X2=28.79 df = 3 P = 0.00 0 4 0 65 47 8 65 51 8 68 121 73 126

df = 1 P = 0.07
X

2=5.42

Df = 3 P = 0.14

Table 7: Relationship of reproductive health issues with knowledge on EC among Jirren high school female students, February to July 2012.

26

Variables

Good knowledge (38)

Faire knowledge (67)

Lack knowledge (145)

Total

P-value

Ever had sex Yes No Age at first sex <15yrs 15-19yrs No. of partners one >2 Reproductive health issues discussion Yes No Ever had pregnant Yes No 8 8 5 21 13 0 12 4 71 4 96 8 2 25 1 55 4 74 7 154 6 6 10 11 9 5 25 22 8 30 2 12 55 2 9 136 0 29 221 4

2=10.02

df=2 P=0.00
x

2=2.36

df=2 P=0.30
x

2=3.66

df=2 P=0.159
x

2=19.01

df=2 P=0.00

2=4.52

df=2 P=0.10

Table 8: Relationship of reproductive health issues with attitude and practice on EC among Jirren high school female students, February to July 2012.

27

Positive Variables (attitude) (187) Ever had sex Yes No 22 165

Negative (attitude)

Total P-value

Yes (practice) (9)

X

No (practice) (241) 20

Total

P-value

2=002 9 0

2 = 71.14

7 56

29 221

df = 1 P = 0..88

29 221 22.1

df = 1 P=0

Age at 1st sex <15yrs 15-19yrs +20yrs No. of partners One >2 Reproductive health issues discussion Yes No Ever had pregnant Yes No 14 65 8 7 122 2 20 0 15

2=1.69

2 = 2.08

df=1 5 0 7 25 0 22
X

df = 1 9 16 25 P = 0.14

P = 0.19

2= 2.93

18

22

2 = 7.03

df=1 0 32 7 154 p=0.08

X

df=1 5 9 2 145 7 154 P = 0.00

X

2 =4.15

2 = 5.82

df=1 p=0.04 31 0 96 8
X

df = 1 p = 0.01 0 96 6 96 8
X

2 =3.51

2 = 0.18

df=1 7 21 p = 0.060 7 14 21

df = 1 p = 0.66

CHAPTER SEVEN

28

DISCUSSION

Age at menarche ranged from 10 to 19 years, 230 (91.9%) of the respondents were between 13-15 years and two of the respondent not yet started menses and this may be due to low socio demographic status leading to late growth of the girls and menstrual period could start later. Knowledge about fertile period in the menstrual cycle was poor. Less than fifty percent of the total respondents mentioned that a woman likely become pregnant with in 2-3 weeks of the menstrual cycle and if they had sexual contact the chance of unwanted pregnancy could be higher. Out of the total 250 respondents 29(11.6%) had ever had sexual experience. The prevalence of sexual relationship was lower than the result of Swedish teenagers. (20). The low sexual relationship prevalence could be the respondents might not expressed their real history because they considered that premarital sex is not socially accepted norm. From the total study participants, 146(58.4%) had ever heard of EC and this was lower than a study conducted among Swedish women presenting for induced abortion where 83% and Jimma university community school where 64.1% (19, 26). But the awareness of EC in this study was higher than studies conducted among women with unsafe abortion in Jimma Marie stops clinic and women seeking post abortion care in Addis Ababa where 13.1% and 14.1% were aware of EC respectively (24,25). This great discrepancy could be due to the socio-demographic difference of the respondents such as the age, educational status and marital status of the respondents. The major sources of information for EC were television/radio and health personnel and those sources had similarity to the information sources among Swedish women and Jimma university community school (19, 26). In addition to the above sources reproductive health clubs were also important sources of information in this study. This could be very important indication that high media coverage and reproductive health clubs could increase the knowledge of family planning not only for the young people but also to the general population.

29

The knowledge of correct timing for EC was better than other studies. Of those had ever heard of Ecps, 48.0% correctly identified 72hrs as recommended time frame limit to start the 1st dose of Ecps after unprotected sexual intercourse and this result was higher than the studies conducted in Arsi college, Jimma maries topes clinic and Jimma university community school (22,25&26). But, still high proportion of respondents didnt know the correct time limit, 26% of those ever heard of Ecps mentioned they didnt know the time limit, 18.5% mentioned 24 hrs and 6.2% immediately after sex as a time limit to start the first dose of ECPs after unprotected sexual intercourse. Such misinformation could inhibit from taking EC, because they thought that they had missed the frame. This indicated that there is a need to work hard in this area in order to improve the knowledge and utilization of EC among adolescents. The utilization of EC was higher than Arsi college where 2.4% and 2.8% Jimma university community school but similar, 3.6% with the study done on women seeking post abortion care services in Addis Ababa and lower than among the youth in Hawassa town where 5.7% and 4.5% Jimma Marie stops clinic. (22-26) One hundred seventy (68.0%) have an intention to use EC when need arises. Thus, in this study respondents had better attitude towards EC when compared to Arsi college students where 63% of the students had an intention to use EC in the future. (22) Ever had discussion about RH issues remained highly significant to increase awareness of emergency contraception. So creating a floor for convenient way of discussion may increase the awareness and practice of EC and it could prevent unwanted pregnancy and its consequences. Married respondents were likely to utilize EC than those never married respondents. This could indicate that the service sites were not convenient to non married clients.

CHAPTER EIGHT

30

CONCLUSION AND RECOMMENDATION 8.1 CONCLUSION

Increasing the awareness and use of EC is one means of reducing unwanted and teenage pregnancies. Knowledge of EC is crucial and it is important that potential users have information and are educated about EC before they actually need. The study finding showed that the knowledge of EC is low, less than fifty percent of the students had faire and good knowledge. As secondary school students would be expected to have higher knowledge than less educated. The knowledge of correct timing for EC was less than fifty percent and how EC prevent pregnancy was more than fifty percent (66.4%); although some respondents though EC has an abortifacient effect. The absence of correct information about EC could be a barrier from utilized by individuals who need it, including the young people who are at more risk of unintended pregnancy. The utilization of EC was very low, 6.2% of the total respondents who ever heard of the method. This leads to higher chance of unintended pregnancy among those who are not using the regular contraceptive methods. Discussion of RH issues and educational level had significant association with increased knowledge of EC. Medias, health professionals and reproductive health clubs were playing very important role in the dissemination of information to the students.

31

8.2 RECOMMENDATION

Strengthening IEC to increase awareness and knowledge of adolescents and teenagers about EC as back of method.

There is need to creates/empower young people to discuss sexual and RH issues with their parents, friends and others.

Creating and strengthening of RH clubs starting from the lower level of education is important.

Media coverage for family planning awareness including emergency contraception should be improved.

Expanding accessibility of emergency contraception method to adolescents and women as a whole.

REFERENCES 1. International Consortium for Emergency Contraception. Emergency Contraception Pills: medical and service delivery Guidelines. Second edition

32

2. Emergency Contraception in India http://www.plannedparenthood.org/library/birthcontrol/emergcontra.htm 3. WHO, Bloomberg School of public health, UNAID .Family Planning Global Hand Book for providers. 4. Family Health International, Emergency Contraceptive pills, New work 2001; 21(1) 5 Kumbi S. A first for Ethiopia. ECafrique bulletin Dec 2004; 2(3):4. 6. Ethiopian Society of Obstetricians and Gynecologists, Ministry of Health, ECafrique.2004. Emergency contraception: A training curriculum for mid-level health Workers in Ethiopia Addis Ababa http://www.esog.org.et/Emergency%20Contraception%20Guideline.htm 7. World Health Organization. 2002. World health report, statistical annex. Geneva 8. Federal Democratic Republic of Ethiopia Ministry of Health. National Adolescent and Youth Reproductive Health Strategy .2007-2015 9. Robert .A. Hatch contraceptive technology; 16th ed. New-York (USA) 1994-1996 10. Chris. P. 2005.Adolescents and Emergency Contraceptive Pills in Developing Countries. http://ec.princeton.edu/references/ecps-adolescents 11. Clack.S, Bruce.J and.A.2006.Protecting young women from HIV/AIDS: The case against child and adolescent marriage International family planning perspectives 32(2), New York, USA. 12. WHO, UNICEF, UNFPA, and the World Bank. Maternal Mortality in 2005 Estimates 13. World Health Organization.2004. Global and regional estimates of the incidence of unsafe abortion and associated mortality in 2000. Fourth edition. Geneva 14. Central statistical authority (CSA) and ORC Macro. 2000. Ethiopian demographic and health survey, Addis Ababa, Ethiopia: CSA and ORC Macro 15. Harrison KA, The influence of maternal age and parity on childbearing with special reference to primigravidae aged 15 years and under, British Journal of Obstetrics and Gynaecology, 1985 5(Suppl.):2331; and Harrison KA, Obstetric fistulae, unpublished data, Geneva: World Health Organization, 1989 16. United Nations Childrens Fund (UNICEF) 2000. The Progress of Nations 2000. New York: Available at: http://www.unicef.org/pon00/.

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17. Kobra F., Elise K., Rahman S. and Arja R, 2007. Emergency contraception among Finnish adolescents: awareness, use and the effect of non-prescription status. BMC Public Health http://www.biomedcentral.com/1471-2458/7/201/prepub 18. Allison M., Melanie A. and Andrew M. changes in young womens awareness, Attitudes, and perceived barriers to using emergency contraception USA 19.Aneblom G,Larsson M,odlind V,Tydan T.Knowledge,use & attitude towards ECPs among Swedish women presenting for induced abortion, International journal of obstetrics & gynecology 2002;109(2):155-60(midline). 20.Sweddis teenagers attitude toward the ECP:Journal of Adolescent Health,2001 4(issue):313318 21. Landon.M,Regina M,Dicooper,Jennifer.S, & chelsea M;knowledge & use of emergency contraception among women in the west cape province of South Africa. Available at: http: //www.biomedcentral.com/1472-6874/7/14. 22. Seife M.2007 . Assessment of level of awareness and utilization of Emergency Contraception among college female students, in Oromia regional state, Arisi zone, Asella town, south east Ethiopia. MPH thesis 23. Birhanu D.2006 . An Assessment of Knowledge, Attitude and Practice of Emergency Contraception among women seeking post abortion care services in Addis Ababa. MPH Thesis 24.Helen T.knowledge,attitude & practice of emergency contraception among the youth in Hawassa town:Annotated bibilographyof population & reproductive health researchs in Ethiopia,2002-2007 25. Anteneh A,Bosena T.Knowledge,attitude & practice and barriers to use emergency contraceptives among women with unsafe abortion in Jimma Marie Stopes Clinic,South west Ethiopia.Ethiopian Journal of Reproductive Health,2009 1(suppl);vol(3). 26. Tadesse A.Teklebrehan T.Knowledge & practice of Emergency contraception among high school female students of Jimma University Community high school,Jimma,south west Ethiopia.Ethiopian Journal of Reproductive health,2009 1(suppl);vol(3). 27. Jirren high school students statistics of the year 2011/12 academic year

Annex I: QUESTIONNAIRES

34

JIMMA UNIVERSITY COLLEGE OF PUBLIC HEALTH AND MEDICAL SCIENCE, DEPARTMENT OF PUBLIC HEALTH A STUDY ON KNOWLEDGE, ATTITUDE AND PRACTICE OF EMERGENCY CONTRACEPTION AMONG JIRREN HIGH SCHOOL FEMALE STUDENTS. Principal investigators name and address

Name Guesh Zenebe Alemayehu E-mail gueshzenebe@yahoo.Com

The purpose of the study is to assess knowledge, attitude and practice on EC among Jirren high school female students, in order to generate useful information for planning appropriate reproductive health strategies and interventions for high school students. To attain this purpose your genuine participation in filling the questionnaire with truth information is very important and highly appreciated. I would like to assure you, your name will not be written on this form and all the information gathered will be kept strictly confidential. You have full right to refuse, to take part of; or to interrupt the study at any time. But the information that you will be give us is quite useful to achieve the study and to bring change in reproductive health services. THANK YOU!!! Are you willing to participate in the study? Yes___________ No______________

Instruction: Put mark X in the space provided according to your choice, write the answer in space provided.

35

PART I: socio demographic and academic characteristics of the respondents among Jirren high school female students. 1 .How old are you? (Age in completed years)__________________________________ 2. What is your religion? A. Orthodox ----C .protestant----D. Muslim-----B. Catholic-----

E. others----------- (specify) _________________________________ 3. What is your current marital status? A. Single-------B. Married----4. What is your grade? A. Grade 9 B. Grade 10 C .Divorced-----D .separated-----E. Widowed--------

5. Residence/place of origin area A .Jimma town---B. out of Jimma town--------

PART II: Reproductive health related characteristics among Jirren high school female students 6. At what age have you seen your menses for the first time? (Age in completed years)__________________________________ 7. If a woman has regular menstrual cycle when do you think pregnancy is most likely to occur? A. During the menstrual cycle------B. The first week of menstrual cycle---8. Have you ever bad sexual intercourse? A. Yes-----B. No---C. NO response-----C. The second & third week of menses----D.I don't know------

If No skip to 19 9. If yes, at what age did you have the first sexual intercourse?

36

________________________ (age in completed years) 10. What was the reason for your sexual practice? A. Marriage----B. Forced sex/rape-----C. Love----D. To get some advantage form partner--------E. To get mark------F. Others------- (specify)

11. How many sexual partners have you ever had in your life time? A. One----- C. Three -----12. Have you ever been pregnant? A. Yes---- C. No response-------13. If yes, how many times? A. once ----B. Two----C. Three------- D. More than three----B. No-----If NO skip to 19 B. Two---D .More than three------

14. At what age was your first pregnancy? __________________ (age in completed years) 15. Was the pregnancy wanted? A. Yes---B. No----If No skip to 17

16. If your pregnancy is not wanted, how do you fail to prevent the pregnancy? A. Forced sexual intercourse----B .Forget to take pills-----C. Condom breakage----D. In frequent sex-----E. Perceived not become pregnant-----F. others------- (specify) _____________________

17. What was the outcome of your pregnancy? A. Child birth-----B. Induced abortion----

18. If the outcome of the pregnancy was induced abortion where did you perform? A. Clinic/hospital-----B. Local abortionist----C. No response---D. others-------- (specify) _________________________

19. Have you had communication about reproductive issues with anyone else?

37

A. Yes-----

B. No-----

20. If the answer to Q 19 is yes, with whom had discussed the issue? (More than one answers possible) A. With mother-----B. With father----E. With school teacher-----F. with health person------G. Other------------ (specify)

C. with sister-------____________________________________ D. With friend-------

PART III: Knowledge, attitude and practice on emergency contraception among Jirren high school female students.

38

21. Is there any method that could be taken to prevent pregnancy after unprotected sex? A. Yes --B .No----C. I don't know------

22. If yes, mention all the methods that you know_________________________ ___________________________________________________________________ ___________________________________________________________ ________________________________23. Have you ever heard of about emergency contraceptive? A. Yes-----If No skip to 35 24. If the answer to Q 23 is yes, which method of emergency contraceptive do you know? (More than one answer is possible) A. Oral pills--------B. IUD---------C. Injectables----------25. If the answer to Q 23 is yes what is the source of information? A. TV/radio-------- D. Formal education--------- G. Others------ (specify) ____________ B. Health workers------C. Family/friends-----E. RH clubs--------F. Health institution--------D. Implants--------E. Other---------- (specify) _______________________ B. No--------

26. To prevent pregnancy with in what time frame emergency contraception pill should be taken after unprotected sex? A. Immediately after sex---------B. within 24 hrs after sex------C. within 72 hrs after sex-------D. Within 05 days-----E. After missed period-----F. I don't know--------

27. To prevent pregnancy with in what time frame IUD should be inserted? A. Immediately after sex------B. within 24 hrs after sex---C. within 72 hrs after sex -----E. Within 05 days-------F. After missed period----G. I don't know--------

39

D. Within one week after sex----28. What is the mechanism of action of emergency contraceptive? A. Prevent pregnancy from occurring------- B. Induce abortion------C. I do not know-------29. In what situation EC should be taken to prevent pregnancy? (More than one answer is possible) A. When forced sex-----D. When unprotected sex without any contraceptive method-----------

B. When condom broken----- E. Others----- (specify) ______________ C. When there is a missed pill---30. Have you ever used EC? A. Yes---B. No---- C. NO response----If No, skip to Q35 F.I don't know----------

31. If yes, which method of EC have you used? A. Oral pills--B. IUD---C. Other---- (specify) ________

32. If yes, how many times have you used the method? A. Once--B. Twice---C. Three times--D. More than three times----

33. What was the reason for your using EC? A. Forced sex---B. Condom breakage---- C. No used any contraceptives----

D. Forget to take contraceptive pills----- E. Others---- (specify) ______ 34. Where did you get the EC? C. Privet clinics----A. FGAE--B. Public health institution---E. From youth center----

D. Pharmacy----

F. Others---- (specify) ______ 35. Do you encourage use of EC after unprotected sexual intercourse? A. Yes_______ 36. If your answer to q.35 is no, why? A. It may increase risk behavior--B. Fear of Miss use---B. No---------

40

C. Propagates HIV/AIDS---

D. Religious reasons----

E. Others------ (specify) ____________ 37. Do you have an intention to use EC in the future if the need arises? A. Yes--B. No----C. no response-----

38. Do you think the available are fairly effective to prevent pregnancy? A. Yes---B. No----------C. I dont know-------

39. Do you believe EC may hurt the baby in case it does not work? A. Yes------B. NO---C. I do not know----------------

40. Do you think EC is one way of abortion? A. Yes-------B. No-----------

41. Do you believe the available EC carry few side effects? A. Yes---------B. No--------C. I dont know-----THANK YOU!!

AFAAN OROMO VERSION QUESTIONNAIRE

41

Jimma Unvaarsiti ,kollejjii fayyaa hawaassumma fi saayinsii medikaala,muumme fayyaa hawaasuma Qorannoo waae beekumsaa,hubannoo fi fayyadama mala ittisa daumsaa tasaa dubartoota manaa barumsaa sadarkaa lamaffa Jireen irratti. Maqaa fi iddoo ittigaafatamaa qoranicha: Maqaa: Guish Zenebe Alamayehu E-mail: gueshzenebe@yahoo.com Kaayyon qoronnoo kanaa bekumsaa,hubanno fi fayyaadamina mala ittisa daumsaa tasaa irratti barattotni dubara mana barumsaa Jireen sadarkaa lamaffaa qaban funannun informeshiini argamuu irratti hundauun barattota manaa barumsaa sadarkaa lamaffaaf tajajla,kaayyoo fi fullefannoo egumsaa fayya walhormaata kayyessu fi hoji irra olchuf gargara. Kaayyo kana galmaan gauuf deebiin sirritaefi dhugaa qabeessa tae kennun hirmaanna gotaan baayee kan dinqisiifamudha. Wantin hubachiisu barbaadu maqaan kessan formii gaaffii kana irratti guutuun hin barbachisu.Akkasumas yaadni/informashinii isin irra fuunaanamuu ichittin isaa kan egamedha.Qoranno kana irratti mirgii walumma galatti hirmachu dhiisu,hama tokko hirmaachuu yookin heruumma kamiyyuu addan kutuu kan egamegha.Garuu yaadni faayida qabeessa taee isin irra argamuu qoranicha galmaan gahuufi tajajilla egumsaa fayya walhormaatatif jijjiramni fiduu baaye faayida qabeessa. Gallaatooma!!! Hirmaachuu dhaaf fedhii qabdaa? Mooti--------Eyyee-----------

42

Qajeelch :- Deebin taa jettee ken yaaddu mallattooX kai.deebii barreefamaan bakka duwwaa irratti berreessi. kutaa 1:haala hawaasummaa fi barnoota ilaalchisee 1. umriin kee meeqa?_______________________________(waggaan) 2. Amantaan kee maali? A.Ortodoksii ------------B.Kaatolikii______ C.Proostaantii_______

D.Musiliima_____ 3. Haala qaailaa

E.Kan biraa yoo tae haa ibsamu------------

A.Kan hin heerumne-----------

B. kan heerumte------------ C.Kan hiikte---------------

D.Yeroodhaaf kan adda bahan-------- E. Abbaan manaa ishee kan due------4. Kutaa meeqa baratta? A.9ffaa------5. Eessaa dhufte? A.Magaalaa Jimmaa------------ B.Magaalaa Jimmaatiin ala-----------Kutaa 2: Haala walhormaataa ilaalchische 6. Guyyaan jalqaba laguu kan agarte waggaa meeqaffaatti? umrii waggaa__________________ 7. Dubartiin tokko guyyaan laguu ishee kan sirrii taee yoom ulfaauu dandeessi? A.yeroo laguu---------------- B.Ergaa laguu itti dhufee torban tokko keessatti-----------------C. Ergaa laguun itti dhufee torban lemaafisadi keessatti------------------ D.Hin beeku-------------8. Walqunnamtii saalaa raawwattee beektaa? A.eeyyee-------------B. hin raawwanne--------------- C.deebii hin kennu------------------B.10ffaa-------

Deebiin kee hin raawwanne/deebii hin kennu yootae gara gaaffii 19ffaa 9. Gaa ffii 8ffaa deebiin eeyyee yoo t ae yeroo jalqabaa waggaa meeqaffaatti raawwatte? _________________________________(waggaadhaan)

43

10. sababiin walqunnamtii saala raawwatteef maali? A.Gaaila---------------B.Dirqisiisee------------- C.Jaalala----------------E.Kan biraa yoo jiraate haa ibsamu________________-

D.Faayidaa argachuuf---------------

11. Umrii kee keessatti namoota meeqa wajjin walqunnamtii saala raawwatte? A.Tokko--------------- B.Lama-------------- C.sadi----------------12. Ulfooftee beektaa? A.Eeyyee-------------B.Hinbeeku------------ C.Deebii hin kennu--------------

Deebiin kee hin beeku yootae gara gaffii 19ffaa 13. Gaaffii 12ffaa irratti eeyyee yootae yeroo meeqa ulfoofte? A.Tokko-----------B.Lama-----------C.Sadii-------------- D.Sadii ol-----------

14. Jalqaba yeroo ulfoofte umurii kee meeqa turee? Umriin meeqa?_________________15. Ulfaauu barbaaddeetii? A.Eeyyee--------------B.Hin barbaadde------------

Eeyyee yootae gara gaaffii 17ffaa 16. Gaaffii15deebiin kee hin berbaadne yootae (ulfa hin barbaachisne) yootae ulfa akkamitti ofirraa ittisuu uadhebde? A.Dirqisiisee waan guddedaameef--------------B.Kiniinii dhale ittisu fudhaachuu waanan irraanfadheef------------C.kondomiin waan baheef/waan tarsaeef ---------------D.Walqunnamtii saalaa derbee derbee waanaa raawwadhuuf---------- E.Kan biroo yoo jiraate ibsii 17. Firiin ulfaauu inni dhumaa maal ture? A.Mucaan dhalate-------------B.Ulfi ofirraa baasisuu--------------

18. Buaan ulfaa ofirraa baasisuu yootae eessatti raawwateme? A.Kilinika/hoospitaala-------------- B.Naannoo gaadammeessan kan baasisan biratti------------C. Kan biraa yoo jiraate haa ibsamu------------- D. Deebii hin kennu------------------

44

19. Haala wal homaataa namoota wajjin haasoftee beektaa? A. Eeyyee-----------B. Hin beeku---------------

20. Lakk 19 ffaa eeyyee yoo tae eenyu wajjin?(tokkoo ol deebii kennuun ni dendaama) A. Haadha koo wajjin--------------- B. Abbaa koo wajjin----------------C. Abboleetti koo wajjin----------- D.Hiriyyaa koo wajjin-------------E. Barsiisa/toota koo wajjin------------ F. Ogeessaa fayyaa wajjin----------------G. Kan biraa yoo jiraate haa ibsamu------------------Kutaa 3: Bekumsaa,hubanno fi fayyadaminsa malaa ittisa daumsaa ilaalchise. 21. Wal qunnamtii saalaa of eeggannoo hin qabnee booda malli ulfa ittisu nijiraa? A. Eayyee---------------- B. Hin jiru---------------- C. Hin beeku------------22. Lakk.21 faa deebiin eeyyee yootae ken beektu hunda ibsi __________________ _________________ _______________________ ________________________-

23. Mala ulfa tasa ittisuu dhageessee beektaa? A. Eeyyee---------------------B. Dhagahee hi beeku--------------------

Dhagahee hin beeku yootae gara lakk.35 deemi 24. Lakk.23faa irratti deebiin kee eeyyee yootae mala kami beekta?(deebii tokkoo ol kennuun ni dandaama) A.Kiniinii liqimsamu------------------B. Gadameessa keessa kentaau---------------------

C. Marfeedheen ken kennamu-------------------- D. Ciqilee keessa kan taae(awwaalamu)-----E. Kan biraa yoo jiraate haa ibsamu-----------------25. Ammas lakk.23 faa deebiin kee eeyyee yoo tae yeroo jalqabaaf odeeffannoo (yaada) eessaa argatte? A. Televizyiinii/raadiyoo------------------- B. Ogeessa fayyaa irraa-----------------C. Maatii/hiriyyaa irraa------------------- D. Mana barumsaa irraa-----------------E. Kilabii wal hormaataa irraa-----------

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F. Dhaabbata fayyaa irraa--------------- G. Kan biraa yoo jiraata haa ibsamu----------------26. Ulfaa walqunnamti ofeggannon ala dhorkuuf mala ittissa daluumsa tasa kinni yeroo hamami kessatti fayyadamu qabu? A. Walqunnamti boodde bakkumatti/yoosumma/------------ B.Saa 24 kessatti------------C. saa 72 kessatti---------------- D. Guyyoita shan kessatti---------------E. Laggun erga hafe bodde--------------- F. Hin beeku-----------------27. Ulfaa walqunnamti ofeggannon ala dhorkuuf mala ittissa daluumsa tasa kan gadamessa kessa galuu(IUD) yeroo hamami kessatti galu qaba? A. Walqunnamti boodde bakkumatti/yoosumma/--------- B. saa 24 kessatti------C. saa 72 kessatti------D. Torbee kessatti------ E. Guyyoota shan kessatti-----G.Hin beeku-------

F. Laggun erga hafe boodde_________

28. Malli ittisa daumsaa tasa akkamitti hojjata? A. Ulfi akka hin umamne dhorka------------- B. Ulfa basaa--------------C. Hin beeku-------------29. Malli ittisa daumsa tasa ulfau dhorkuf halli akkami yoo ummamu fudhatamu qaba?(deebin tokko ol hin dandaama) A. Dirqisisani guddedun yoojirate-------------B. Kondomin yoo irra bahee yookin yoo tarsae----------------C.Kinnin ulfa ittisuf fudhatama osoo jiruu yoo irran fatamu-------------D. Mala ittisa daumasa osoo hin fayyadamin yoo walqunamtinsala tasifame-------------------E. Hin beeku------------------ F. Kan biraa yoo jirate yaa ibsamu----------------30. Mala ittisa daumsaa tasa fayadamte beekta? A. Eyyee------------B. Fayyadame hin beeku--------------- C. Debbi hin kennu---------------

deebii hin kennu yookin fayyadame hin beeku yootae gara gaa ffi lakk.35tti 31. Gaffi lakk.30 yoo deebin kee eyye tae kam fayyadamte? A. Kan hiqimfamu(kinnini)_________ B. Gaddamessa kessa kan galuu_____

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C. Kan biraa yoo jiratte yaa ibsamu______________ 32. Gaffi lakk.30 yoo deebin kee eyye tae yeroo meeqaa fayyadamte? A. Yeroo tokko------------- B. Yeroo lama-------------- C. Yeroo sadii-------------D. Yeroo sadii ol----------33. Mala ittisa daumsaa tasa fayyadamuu keef sababni mal ture? A. Dirqisusani guddeduu---------------- B.Kondomin irra bahuu yookin tarsauu-------------C. Mala ittisa daumsaa kammu waanan hin fayyadaminif----------D. Mala ittisa daumsaa fudhatama jiruu waan irranfa tamef-------------E. Kan biraa yoo jiratte yaa ibsamu---------------34. Mala ittisa daumsaa essaa argatte? A. Dhabbata qusanno maatii Itiiyyophiya---------- B. Dhabbata fayya motumma irra------------C. Kilinikaa dhunfaa irraa------------------ D. Farmasii irra--------------------E. Waldaa dargaggo irraa---------------- F. Kan biraa yoo jiratte yaa ibsamu----------------35. Walqunnamti salaa deggartaa? ofeggannon alaa boodde mala ittisa daumsaa tasa fudhachuu hin

A. Eyyee--------------- B. Hin deggaruu----------------36. deebin kee lakk.35 hin deggaruu yoo tae maalif? A. Wanta badatti wan nama saxilluf------------------B. Seeran ala fayya damun waan jiratuf---------------C. HIV/AIDS waan daddabarsuuf-------------------- D. Amantin waan dhorkuf------------------37. Karaa fulduraf barbachisa taee yoo argame mala ittisa daumsaa tasa fayyadamuf fedhii qabda? A. Eyye-------------- B. Fedhi hin qabu-------------C. Debbi hin kennu--------------

38. Yeroo amma malli ittisa daumsaa tasa jiran daumsaa ittisuf gaumsaa qabu jette yaada? A. Eyye----------------- B. Hin yaadu----------------- C. wartin beeku hin jiruu-----------------

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39. Malli ittisa daumsaa tasa osoo hin hojattin yoo hafe ulficha ni midha jette yaada? A. Eyye----------B. Hin yaadu------------- C. Waantin beeku hin jiruu--------------

40. Malli ittisa daumsaa tasaa karaa ulfaa basuu keessaa tokko jette yaada? A. Eyyee------------B. Miti------------41. Malli ittisa daumsaa tasaa xiqqoo rakkina qabuu jette yaada? A. Eyye--------------B. Hin jedhuu--------------- C. Wanti beeku hin jiru--------------

Gallatooma!!!

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Amharic version Questionnaire

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52

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DECLARATION
I, the undersigned, declare that this research is my original work, has not been presented for a degree in this or any other university and that all sources of materials used for the research have been fully acknowledged.

Name: ___________________________

Signature._________________________

Name of the institution: _______________

Date of submission: __________________

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This research has been submitted for examination with my approval as university advisor

Name and signature of the ___________________________________

_____________________________________

Name and signature of the second advisor __________________________________

____________________________________

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