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Investigating Determinants Influencing Contraceptive Adoption Among Third-Year Medical Students: A Study at KIU-WC Bushenyi District, Western Uganda

Amanyire Edward

Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda                                                  

ABSTRACT

This study assessed the prevalence and factors influencing contraceptive usage among 377 third-year medical students through a descriptive cross-sectional approach. Utilizing qualitative and quantitative data analyzed via SPSS, findings revealed compelling insights. Of the sampled students, 78.5% were sexually active, with 58.7% utilizing contraceptives while 38.0% did not. Most (73.1%) were unmarried, while 25.7% were married. Regarding contraceptive knowledge, 94% were aware, with 81.7% knowing how to use and 91.1% aware of access points. Information sources varied: 44.3% from school, 35.4% from healthcare providers, and 10.6% from media. While 52.3% knew about conception timing, barriers to optimal knowledge persisted, notably concerning emergency and rhythm methods. Despite a positive attitude towards contraceptive use (95.7% believing it necessary), nuances emerged. For instance, 54.3% agreed on male involvement in contraceptive decisions, while 42.0% disagreed. The study highlights the prevailing 58.7% contraceptive prevalence among third-year medical students, showcasing reasonable awareness and positive attitudes. However, gaps in knowledge, especially regarding specific methods, persist, alongside barriers related to efficacy, side effects, and misconceptions about sexual activity. Addressing these gaps could enhance comprehensive understanding and promote informed contraceptive choices among this demographic.

Keywords: Contraceptive use, Third-year Medical Students, Contraceptive methods, Sexual intercourse, Side effects of the methods.

INTRODUCTION

Family Planning is defined by the World Health Organization (WHO) as a voluntary and informed decision by a couple or an individual on the number of children to have and when to have them. This can be achieved by the various contraceptive methods and treatment of voluntary infertility according to the WHO 2013 fact sheet on Family Planning. Family planning is central to ensuring the health and development of youth, reducing unnecessary health risks, and improving their opportunities for education and productive livelihoods [1].  Having unsafe sex has been estimated to be the second most important global risk factor for health. More than half of the world’s population is less than 25 years old and approximately 85% of this demographic segment lives in low- or middle-income countries. Most (85%) of the university students are aged 17 – 24 years and highly sexually active. The sexual behaviour of such young people has become a crucial social and public health concern, especially about unintended pregnancies and Sexually Transmitted Diseases (STDs) [2]. Over 100 million acts of sexual intercourse take place each day in the world, resulting in around 3 million conceptions of which 50% are unplanned and 25% unwanted, which are associated with increased risk of unsafe abortions, maternal morbidity and mortality. This is worsened by the high unmet need for contraception in developing countries and Sub-Saharan Africa hits hardest, with an estimated 14 million unintended pregnancies per year and almost half occurring among young women aged 15–24 years [3]. An unplanned or unwanted pregnancy is a serious, global public health problem [4]. It is estimated that about 80 million, unplanned pregnancies occur in the world every year [5]. Unplanned pregnancies may be prevented by using contraceptive methods, such as oral contraceptive pills, long-term hormonal injections, condoms, tubal ligation or a vasectomy [6]. There are also emergency contraceptives available to prevent unplanned pregnancies and should be obtained and taken within 72 hours after engaging in unprotected sexual intercourse [7]. In research studies conducted worldwide amongst university students like in Botswana, several factors were identified as contributing to the non-utilization of contraceptives. These were, amongst others, lack of knowledge and awareness, age, culture, ethnicity, religion, poor access to contraceptive services, peer pressure, sources of information, alcohol and substance abuse and lack of partner support [8]-[10]. Another study conducted amongst university students in the United States of America (USA) estimated that regular contraceptive use can prevent about 12 million unwanted pregnancies every year [11]. In developing countries, one in three women give birth before the age of 20 and pregnancy-related death during childbirth is two times higher compared to women older than 20 years. A quarter of the estimated 20 million unsafe abortions and 70,000 related deaths each year occur among women aged 15–19 years. In sub-Saharan Africa alone, it is estimated that 14 million unintended pregnancies occur every year, with almost half occurring among women aged 15–24 years. The use of effective contraceptive methods would potentially prevent 90% of abortions, 20 % of pregnancy-related morbidity and a third (32 %) of maternal deaths worldwide [12]. In a study amongst 15 to 24-year-old South African women, it was estimated that only 52.2% of sexually experienced women are using contraceptives [13]. Because 80% of undergraduate students at higher educational institutions are sexually active, they must have access to safe, accessible and adequate contraceptive services [14]. [15] suggests that the main reasons for women not utilizing or discontinuing the use of contraceptives are side effects, lack of knowledge about different methods available, or lack of interest in utilizing them [15]; [11]. In Uganda, an estimated 1.2 million unintended pregnancies occurred in 2008, representing more than half of the country’s 2.2 million pregnancies [16]. The risk of pregnancy increases with a widening gap between sexual debut and the age of the first marriage [17]; [18].

Lack of access to safe, effective contraceptives among young people has resulted in unplanned pregnancies, unsafe abortion and resulting maternal death and disability [19]. They may also fail to complete their education, inability to maintain employment and make independent marital decisions [20]. Young students’ sexual activities are a communal, municipal and public health concern. These activities, especially pre-marital sexual activities, seem to be increasing among higher educational institution students in continents such as Asia and Africa, because of factors such as rapid urbanization and exposure to mass media [11]. The unmet need for family planning in less developed nations such as Uganda remains a major concern to the socioeconomic transformation and development. Furthermore, in the Ankole region for instance the unmet need for family planning was found to be 23.0% out of 66.1% total demand for family planning, with a contraceptive prevalence rate (CPR) of 43.1% which is way below the national target of 50% by 2020 [19]. This happens when 7 in 10 sexually active young Ugandan women are not using any form of contraception and also includes 3 in 10 who express a desire to delay childbearing [19]. A study done at six Ugandan universities showed overall condom use to be 51% and current use of contraceptive methods other than condoms was 9%. This study also found that 6% of sexually active students between ages 15 and 19 became pregnant. [12]. Few comprehensive studies have been conducted on university students in low and middle-resource settings to establish significant effects of knowledge, attitude and socio-demographic factors on the use of contraceptives among medical students in Uganda. Hence this remains unknown to the prevailing data. Therefore, the major objective of this study is to assess knowledge, attitude and barriers to contraceptive use among third-year medical students (KIU- WC).

CONCLUSION

The prevalence of contraceptive utilization at the time of the study was high with 58.6% using contraception of the 75.2% of sexually active students. Generally, third-year medical students at KIU-WC knew in terms of awareness and sensitization about contraceptive use though they still lacked knowledge about the available methods especially emergency contraceptive methods and rhythm methods. Third-year medical students of KIU-WC had a good attitude towards contraceptive use though a few had negativity concerning contraceptive use. The barriers towards contraceptive use include knowledge, sexual intercourse, effectiveness and side effects of the methods.

Recommendation

Based on the findings of the study, the investigator recommends that the university management should start holding thorough health talks with third-year medical students about contraceptive use especially contraceptive methods and their side effects. Furthermore, the University Committee on Reproductive Health should try to encourage the students to use the available recommended contraceptive methods despite associated side effects since the benefits of using contraception outweigh the risks of not using them.

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CITE AS: Amanyire Edward (2023). Investigating Determinants Influencing Contraceptive Adoption Among Third-Year Medical Students: A Study at KIU-WC Bushenyi District, Western Uganda. INOSR APPLIED SCIENCES 11(1):25-36. https://doi.org/10.59298/INOSRAS/2023/3.6.4000 

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