Knowledge, attitudes and practices of health professionals in public health institutions on emergency contraception in Pietermaritzburg, KwaZulu-Natal Province, South Africa

Abstract

RESEARCHBackground. Although emergency contraception (EC) is widely available, its use is surrounded by many controversies. Overall, it seems to be underutilised worldwide. Objectives. To determine healthcare professionals᾽ knowledge, attitudes and perceptions regarding EC, and how frequently they encounter, educate and issue it to patients. Methods. A questionnaire-based survey of doctors and nurses (volunteers) working in obstetrics and gynaecology was conducted in 3 public hospitals and 17 clinics in Pietermaritzburg, KwaZulu-Natal Province, South Africa. Data were analysed using SPSS. Results. Sixty-seven (25%) doctors and 201 (75%) nurses participated in the survey. Awareness of the three ECs available in the public sector overall was 56.4%, and 62.7% of participants could prescribe one EC correctly. Only 39.6% knew that EC pills prevent ovulation. Seventy-six percent thought that the use of EC could lead to high-risk sexual behaviour, high risk of transmission of HIV and non-use of other forms of contraception. Only 7.8% saw patients seeking EC often, 5.6% issued it often and 23.5% educated patients about it often. Conclusion. Participants were familiar with EC, but lacked accurate and detailed knowledge about its mechanism of action and had misperceptions on its social impact. They seldom prescribed it. It is estimated that about 41.0% of the 208 million pregnancies that occurred worldwide in 2008 were unintended.[1] East and Central Africa have the highest rates of unintended pregnancies and about 14 million unintended pregnancies are estimated to occur in subSaharan Africa annually. [1,2] Unintended pregnancies are resolved differently by women. Globally, there were an estimated 42 million induced abortions in 2003, of which 48% were unsafe and 97% of the unsafe abortions were performed in developing countries.[3] The World Health Organization (WHO) estimated that 21.6 million unsafe abortions occurred worldwide in 2008, an increase from 19.7 million in 2003, [4] with Eastern and Central Africa having the highest rates.[5] Unsafe abortions have a negative impact on maternal morbidity and mortality. A reduction in unintended pregnancies may result in a reduction of unsafe abortions, hence lowering maternal mortality.In situations where there is unprotected sexual intercourse or contraceptive method failure, emergency contraception (EC) may be used to prevent unintended pregnancies. Although EC is widely available in many countries, its use has been marred with controversies and misperceptions, especially concerning its mode of action, impact on behaviour and safety. EC pills prevent pregnancy by inhibiting or delaying ovulation, but they cannot disrupt an established pregnancy. However, an analysis of 1 077 articles in 113 newspapers between 1992 and 2002 showed that 44.5% of them included at least one instance of confusion between EC and medical abortion, with 31.0% of the articles inaccurately portraying the mode of action of EC as medical abortion.[6] The use of EC varies in different countries, and o...

Knowledge, attitudes, and perceptions of long-acting reversible contraceptive (LARC) methods among healthcare workers in sub-Saharan Africa: a systematic review and meta-analysis

“…The studies were conducted across 11 countries including Botswana (32), Ethiopia (33), Ghana (34,35), Kenya (36–38), Malawi (39,40), Nigeria (41–45), Senegal (46), South Africa (47–50), Tanzania (51), Uganda (52,53), and Zimbabwe (47,49). Eleven studies provided information on injectable contraceptives (34,37–40,45–47,51,53,54), 21 on IUCD (33–45,47,48,50–55), and nine on the contraceptive implant (34,38–40,46,47,51,53,55). Additionally, knowledge was reported by 15 studies (33,35,36,38,39,41–44,48–50,52–54), attitudes by 14 (35,36,38–44,48–50,53,54) and perceptions of HCW’s by ten studies (34,37–40,46,51,53,54,56,57).…”

“…other (19) None 7NR (18) separated (11) Surgeons 17Obstetricians/gynaecologist (12) Physicians ( Female (42) Male (38) Nurse (50) Doctor (30) Christian (78) Non-believer/other (2) Single (40) Married (33) <5 years (26)…”

“…Using the quality assessment tool designed specifically for KAP studies, a total score out of was assigned to each study (27). Eight studies (32)(33)(34)42,45,47,49,53) scored at least 15 or higher indicating good quality and eleven (35)(36)(37)41,43,44,46,48,(50)(51)(52) scored 14 or less indicating low quality. The three studies (38)(39)(40) that utilised a mixed-method study design were indicative of good quality.…”

“…Eleven studies provided information on injectable contraceptives (34,37-40,45-47,51,53,54), 21 on IUCD (33-45,47,48,50-55), and nine on the contraceptive implant(34,(38)(39)(40)46,47,51,53,55). Additionally, knowledge was reported by 15 studies(33,35,36,38,39,(41)(42)(43)(44)(48)(49)(50)(52)(53)(54), attitudes by 14(35,36,(38)(39)(40)(41)(42)(43)(44)(48)(49)(50)53,54) …”

Emergency Contraceptives: Knowledge, Attitude and Prescription Practice of Primary Healthcare workers in Sokoto Metropolis, Northwest Nigeria.

“…EC use has been marred with controversies and misperceptions in some countries, especially concerning its mode of action, impact on behaviour and safety (9) while it has been welcomed in some countries as just another contraceptive option and part of a broader reproductive health agenda. In others, EC has been met by claims that it is an abortifacient, a sign of the population's moral degeneracy, or a tool for abusing children (9). In order to eliminate these misconceptions, healthcare providers' knowledge and attitude towards emergency contraception therefore become key to the dissemination of awareness, consumer acceptance and use of contraceptives for their all-time benefits (10) since they interact with large numbers of women and are reliable sources of information.…”