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\title{Contraception Among Tertiary Students: Knowledge, use and Behaviour of Female Undergraduates in Edo State, Nigeria}
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             \author[1]{Dr. Aigbiremolen  A.O.}

             \affil[1]{  Irrua Specialist Teaching Hospital, Irrua, Edo State, Nigeria.}

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\date{\small \em Received: 9 December 2013 Accepted: 2 January 2014 Published: 15 January 2014}

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\begin{abstract}
        


Background: increased sexual activities among young people, unwanted pregnancies, unsafe abortions and secondary infertility have become major reproductive health concerns in nigeria. Unwanted pregnancy while preventable through appropriate contraception is a risk factor for disruption of education, future unemployment, and secondary infertility.Aim: To assess contraceptive knowledge, use and related behavior among female undergraduates in tertiary institutions in edo state, nigeria.Methods: The study was a descriptive cross-sectional survey using semi-structured self-administered questionnaire. Female undergraduates from two tertiary institutions (federal polytechnic, auchi and ambrose alli university, ekpoma) in edo north and central districts were selected using a multistage sampling technique and a sample of 374 students was drawn from both institutions.Results: The age group of 20-24 years constituted the highest proportion (61.5%) of respondents with the mean age being 23 ±4.2 years. majority (80.6%) of them were singles.

\end{abstract}


\keywords{contraception, sexual behavior, unwanted pregnancy, undergraduates.}

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\let\tabcellsep& 	 	 		 
\section[{Background}]{Background}\par
he environment in higher institutions of learning is characterized by high levels of personal freedom and social interaction. This social interaction often translates to sexual interaction \hyperref[b8]{(Alexander et al, 2007)}. Permissive sexual lifestyle in higher educational institution in Nigeria and a number of other African countries have been documented as featuring a high level of risky sexual behaviors such as transactional sex, multiple sexual partners, and unprotected casual sex. (Manena-Netshikweta, 2007; \hyperref[b21]{Katjaviri and Otaala 2003)}.\par
Such reproductive health behavior is prone to consequences of unwanted pregnancies, unsafe abortions, disruption of education and secondary infertility \hyperref[b24]{(Malhotra, 2008;}\hyperref[b7]{Akingba, 2002;}\hyperref[b5]{Adegoke, 2003)}. Given the increasing level of sexual activities among young people and decreasing age at first sex in developing countries, the use of contraceptives to prevent unwanted pregnancy and unsafe abortion is especially important (Adedoyin et al, 1995; \hyperref[b29]{Okonkwo et al, 2005;}\hyperref[b39]{Uthman, 2008)}.\par
It has been reported by the Nigerian Population Commission (NPC) that knowledge of contraception is lowest among women with no education and greatest among women with more than secondary education  {\ref (NPC and ICF Macro, 2009)}. This indicates that along the line, there is improvement in contraceptive knowledge though it may not always translate to the same level of utilization. This utilization gap has been highlighted in some studies among adolescents and out of school women (Idonigie et al, 2011; \hyperref[b2]{Abiodun et al, 2001)}. A high level of knowledge and concomitant utilization of contraception is desirable among adult women, a significant proportion of which is in tertiary institutions.\par
The current contraceptive prevalence rate in Nigeria is about 15\%  {\ref (NPC and ICF Macro, 2009)}. This low rate underlies the population explosion and other reproductive health challenges being currently experienced in the country. Women in tertiary educational institutions are included in the over 200 million women worldwide who have an unmet contraceptive need  {\ref (McPhail et al, 2007)}. This study was to investigate the knowledge, use, and behaviour regarding contraceptives among female undergraduates in tertiary institutions in Edo State. 
\section[{II.}]{II.}\par
Methods 2012/2013. The two institutions are located in urban communities in the central and northern districts of Edo State.\par
The sample size was determined using the Cochran formula \hyperref[b10]{(Cochran, 1963;}\hyperref[b19]{Israel, 2012)}, N= Z 2 pq/E 2 Where, N= Sample size; E=Tolerable Error of margin (0.05); p= prevalence (25.4\%) of contraceptive use in a study done in tertiary institutions in Illorin, Nigeria \hyperref[b0]{(Abiodun and Balogun, 2009)}; Z= Standard Normal Deviation (1.96); Q= 1-p (1-0.58=0.42). The minimum sample size was thus calculated to be 288. However 400 questionnaires were administered to the study group to enhance the validity, while 356 questionnaires were analysed after setting aside poorly filled ones.\par
The sample was designed to accommodate all categories of female students in the tertiary institutions. The multistage sampling technique was used. Two institutions and two faculties each from the institutions was selected by simple random technique. Selfadministered questionnaires were subsequently distributed to available students in the selected faculties. The questionnaires were semi-structured and dealt with such areas as the knowledge of the benefits and methods of contraception, and the utilization of contraceptives. Knowledge of contraception was assessed with a scoring system based on responses to mainly questions on the methods and benefits of contraceptives (Box 1).\par
Statistical package for scientific solutions (SPSS) version 16 was used for data collation, editing, and analysis. Other secondary analyses were done with the WINPEPI software  {\ref (Abramson, 2011)}. Results are presented in tables. Test of significance using chisquare was applied to selected variables. Ethical guidiance was provided by the Department of Community Health, Ambrose Alli University, Ekpoma. Permission was obtained from the authorities of the two selected institutions while verbal consent was obtained from each study participant.  
\section[{Results}]{Results}\par
Respondents in the age group 20 to 24 years constituted the largest group (61.5\%) and the mean, median, and modal ages were 23 +/-4.2 years, 22 years and 20 years respectively. The study group consisted mostly of singles (80.6\%) and Christians (85.6\%). About the same proportion of respondents participated from the two institutions (Table \hyperref[tab_0]{1}). A high level of awareness about contraceptives was found (94.4\%) but the level was lower (69.7\%) for emergency contraceptives (Table \hyperref[tab_1]{2}). The highest sources of information about contraceptives were mass media (34.0\%); health personnel (30.0\%) and friends (28.7\%). Over 76\% and about 56\% of the study respondents identified use of condoms and oral contraceptive pills (OCPs) as methods of contraception. Spermicidal agents and tubal ligation (10.7\% each) were the least popular as contraceptives. The school was one of the lowest contributors (6.7\%) to information on contraception. Only 31.2\% of the undergraduates had good knowledge of the methods and benefits of using contraceptives. Almost 57\% of respondents had used some form of contraceptives compared to only 10.7\% who had used emergency contraceptives. The most commonly used contraceptives were condoms (57.4\%) and OCPs (28.7\%). The least methods used were subcutaneous implants and rhythm method (2.5\% each) while only 40.1\% regularly used contraceptives. Thirtynine percent of respondents had used some form of contraceptives in the six months prior to data collection while 45.2\% had sex. Among those who have used emergency contraceptives, 28.9\% used laevonorgestrel. The greater proportion of respondents who had good knowledge of contraception were senior students (x 2 = 3.409; p = 0.182) and those who were sexually active (x 2 = 5.882; p= 0.054) though there was no statistically significant association. There was a statistically significant association between knowledge and current use (within the preceding 6 months) of contraceptives (x 2 = 7.756; p = 0.021). 
\section[{IV.}]{IV.} 
\section[{Discussions}]{Discussions}\par
A high proportion of the respondents were unmarried youths. This is consistent with the global picture of mostly young persons being in higher institutions of learning (Statistics Canada, 2010; \hyperref[b13]{Cadmus and Owoaje, 2009)}. The greater proportion of young persons found in higher institutions provides both an opportunity and a challenge. It provides an opportunity to learn, grow and develop. This group is faced with the challenge of risky sexual behavior and consequent unwanted and unplanned pregnancies and sexually transmitted infections including HIV/AIDS (WHO, 1999). Notably, Bronfenbrenner's socioecological model \hyperref[b32]{(Oswalt, 2008)} identifies the school as a component of the microsysytem-having direct influence on the behavior (sexual and otherwise) of the individual.\par
A high level of awareness (94.4\%) of contraceptives is not surprising to find among females in tertiary institutions. Reports from other findings (Abiodun and Olayinka, 2009; Tilahun et al, 2010) corroborates this. However, awareness of emergency contraception (EC) was lower (69.7\%) than that for general methods of contraception but much higher than that reported elsewhere \hyperref[b34]{(Puri et al, 2007;}\hyperref[b17]{Frank et al, 2002)}. This lower awareness may be due to the more technical understanding required to grasp the principles of emergency contraception. In addition, there are no too many methods of EC known and used today. The common methods of EC are laevonorgestrel, high dose COCP and intra-uterine contraceptive device (IUCD) \hyperref[b11]{(Weismiller, 2004;} {\ref WHO, 2012)}.\par
The sources of information were diverse ranging from mostly informal sources to a few formal sources.\par
Volume XIV Issue II Version I Year ( ) 
\section[{K}]{K}\par
Informal sources such as friends, peers and relatives are common information sources for young people \hyperref[b38]{(Tilahun et al, 2010;}) but yet prone to misconceptions, distortions and half-truths. In this study, mass media, health personnel and friends contributed the most as sources of information on contraception.\par
Internet and mobile phone messages which are relatively new ways of spreading health information also contributed to the knowledge about contraceptives among respondents. These two modern channels have special appeal for young people and should thus, be thoroughly harnessed in disseminating correct information about reproductive health issues \hyperref[b12]{(Diaz et al, 2002;}\hyperref[b26]{McNab, 2009)}. They have also taken the nature of mass media where no special authorization is required to spread sensitive and behavior-modifying information. Therefore, health professionals and institutions must contribute timely and adequate information through modern electronic media. In the absence of this, falsehood and half truths may become the order of the day because there is no vacuum in nature.\par
Condoms and oral contraceptive pills (OCPs) were popular among respondents, a finding consistent with other studies \hyperref[b4]{(Adegbenga et al, 2003;}\hyperref[b9]{Chakrapani et al, 2011;}\hyperref[b1]{Abiodun and Olayinka, 2009}). Among the least known methods were those requiring invasive procedures such as Intrauterine Contraceptive Device (IUCD), subcutaneous implants and vasectomy. Similarly, condoms and OCPs were the most commonly used contraceptive methods while the invasive methods were the least used. Other studies report similar results \hyperref[b22]{(Omo-aghoja et al, 2009;}\hyperref[b35]{McMahon et al, 2004)}.The distinction between invasive and non-invasive methods bothers on such factors as availability, ease of use and requirement of a health professional to use the method.\par
Being aware of a concept does not always suffice for knowledge. There was a marked difference in this study between a high level of awareness (94.4\%) and a significantly low level of knowledge (31.2\%) about the methods and benefits of using contraceptives. This is a significant departure from many other studies which tended to focus on awareness alone or translate awareness to knowledge \hyperref[b37]{(Tayo et al, 2011;} {\ref Orji et al, 2005)}. The challenge of low level of knowledge has been identified as a major factor in the poor adolescent reproductive health status in Nigeria (Federal Ministry of Health, FMOH, Nigeria, 2002). Understanding the methods and benefits of contraception are critical to having motivated users. It has also been noted that motivation is one of the important factors in minimizing failure rates in the utilization of contraception \hyperref[b14]{(Egarter et al, 2012)}.\par
The low level of knowledge also agrees with the small proportion (40.1\%) of those who regularly use contraception, differing from a study by  {\ref Adegbenga and others (2003)}. It therefore follows that if they know the benefits and how to use contraceptives, they will not chose the risks of unwanted pregnancies, unsafe abortions, disruption of academics and career and possible death. Contraceptive education which is a component of sex education has been proven to improve risky sexual behaviour \hyperref[b15]{(Esere, 2008)}.\par
Current sexual activity among respondents was 45.2\%, a figure comparable to Kabir et al's (2004) finding of 53.0\% among tertiary students in Kano, northern Nigeria. This high level of sexual activity among the respondents is reflective of the social freedom and interaction among students in tertiary educational institutions.\par
This study did not find a significant association between level of knowledge of contraceptive and cadre of study. However, a higher proportion of respondents with good knowledge were senior students. Similarly, though there was no statistically significant association between level of knowledge and being sexually active, the greater proportion of those who had good knowledge were sexually active students. There was a significant association between level of knowledge and current use of contraceptives. Myer et al (2007) found a significant association between knowledge of emergency contraceptive and its use in South Africa. For those who care to read, contraceptives are usually packed with information leaflets that explain the basis for their use in lay terms. There is also the tendency of contraceptive users to pay more attention to discussions and health information on contraception.\par
V. 
\section[{Conclusion}]{Conclusion}\par
Poor knowledge and low utilization of contraceptive and high level of sexual activity exist side by side in the tertiary institution. This reality if left unchecked will continue to fuel the negative consequences that follow risky sexual behavior. Health promotion strategies directed at improving contraceptive utilization among sexually active youths are strongly recommended as part of a comprehensive reproductive health intervention in institutions of higher learning in Nigeria. \begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-2.png}
\caption{\label{fig_0}Box 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{1} \par 
\begin{longtable}{P{0.5937881873727088\textwidth}P{0.12637474541751528\textwidth}P{0.12983706720977597\textwidth}}
\tabcellsep respondents\tabcellsep \\
Variable\tabcellsep Frequency (n ? 356)\tabcellsep Percentage\\
Age (years)\tabcellsep \tabcellsep \\
15 -19\tabcellsep 67\tabcellsep 18.8\\
20-24\tabcellsep 219\tabcellsep 61.5\\
25-29\tabcellsep 45\tabcellsep 12.6\\
30-34\tabcellsep 11\tabcellsep 3.1\\
>34\tabcellsep 10\tabcellsep 2.8\\
Marital status\tabcellsep \tabcellsep \\
Single\tabcellsep 287\tabcellsep 80.6\\
Married\tabcellsep 57\tabcellsep 16.0\\
Divorced\tabcellsep 2\tabcellsep 0.5\\
Cohabiting\tabcellsep 10\tabcellsep 2.8\\
Religion\tabcellsep \tabcellsep \\
Catholic\tabcellsep 104\tabcellsep 29.2\\
Orthodox\tabcellsep 14\tabcellsep 3.9\\
Pentecostal\tabcellsep 187\tabcellsep 52.5\\
Muslim\tabcellsep 33\tabcellsep 9.3\\
Others\tabcellsep 18\tabcellsep 5.1\\
Level of study\tabcellsep \tabcellsep \\
Junior students and 2 nd year) (1 st\tabcellsep 141\tabcellsep 39.6\\
Senior year students (3rd and\tabcellsep 215\tabcellsep 60.4\\
above)\tabcellsep \tabcellsep \\
Institution\tabcellsep \tabcellsep \\
Ambrose Alli University\tabcellsep 182\tabcellsep 51.1\\
Auchi Polytechnic\tabcellsep 174\tabcellsep 48.9\\
\multicolumn{3}{l}{Mean age = 23 (+/-4.2) years; median age = 22 years;}\\
\multicolumn{2}{l}{modal age = 20 years}\tabcellsep \end{longtable} \par
 
\caption{\label{tab_0}Table 1 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.6037931034482759\textwidth}P{0.15241379310344827\textwidth}P{0.09379310344827586\textwidth}}
Variable\tabcellsep Frequency (n=\tabcellsep \%\\
\tabcellsep 356)\tabcellsep \\
Awareness about general contraception\tabcellsep \tabcellsep \\
Yes\tabcellsep 336\tabcellsep 94.4\\
No\tabcellsep 18\tabcellsep 5.1\\
No response\tabcellsep 2\tabcellsep 0.6\\
Awareness about emergency contraception\tabcellsep \tabcellsep \\
Yes\tabcellsep 248\tabcellsep 69.7\end{longtable} \par
 
\caption{\label{tab_1}Table 2 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{3} \par 
\begin{longtable}{P{0.6748582230623819\textwidth}P{0.07391304347826086\textwidth}P{0.10122873345935728\textwidth}}
Variable\tabcellsep Frequency\tabcellsep \%\\
\multicolumn{2}{l}{Respondents who have ever used any form of contraceptives n=356}\tabcellsep \\
Yes\tabcellsep 202\tabcellsep 56.7\\
No\tabcellsep 123\tabcellsep 34.6\\
No response\tabcellsep 31\tabcellsep 8.7\\
\multicolumn{2}{l}{Methods of contraceptives ever used (Multiple responses) n= 202}\tabcellsep \\
Condoms\tabcellsep 116\tabcellsep 57.4\\
Pills (OCPs)\tabcellsep 58\tabcellsep 28.7\\
Injectables\tabcellsep 16\tabcellsep 7.9\\
IUCD\tabcellsep 6\tabcellsep 3.0\\
Implant\tabcellsep 5\tabcellsep 2.5\\
Withdrawal\tabcellsep 14\tabcellsep 6.9\\
Rhythm\tabcellsep 5\tabcellsep 2.5\\
Others (spermicides, diaphragm)\tabcellsep 5\tabcellsep 2.5\\
\multicolumn{3}{l}{Current use (any method in the last 6 months) of contraceptives n= 356}\\
Yes\tabcellsep 140\tabcellsep 39.3\\
No\tabcellsep 180\tabcellsep 50.6\\
No response\tabcellsep 36\tabcellsep 10.1\\
Use of emergency contraceptive n= 356\tabcellsep \tabcellsep \\
Yes\tabcellsep 38\tabcellsep 10.7\\
No\tabcellsep 190\tabcellsep 53.4\\
No response\tabcellsep 128\tabcellsep 36.0\\
\multicolumn{2}{l}{Types of emergency contraceptive used n= 38}\tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}Table 3 :}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{4} \par 
\begin{longtable}{P{0.14733333333333334\textwidth}P{0.18275\textwidth}P{0.15583333333333332\textwidth}P{0.13175\textwidth}P{0.13175\textwidth}P{0.10058333333333333\textwidth}}
\tabcellsep \tabcellsep \multicolumn{2}{l}{contraceptive use}\tabcellsep \tabcellsep \\
\tabcellsep \multicolumn{3}{l}{Level of knowledge of contraceptives}\tabcellsep \tabcellsep Statistics\\
Level of study\tabcellsep Good (\%)\tabcellsep Fair (\%)\tabcellsep Poor (\%)\tabcellsep Total (\%)\tabcellsep \\
Junior\tabcellsep 48 (33.8)\tabcellsep 36 (25.4)\tabcellsep 58 (40.8)\tabcellsep 142 (100.0)\tabcellsep X 2 = 3.409, p=0.182\\
Senior\tabcellsep 64 (51.6)\tabcellsep 74 (34.6)\tabcellsep 76 (35.5)\tabcellsep 214 (100)\tabcellsep \\
Total\tabcellsep 112 (31.5)\tabcellsep 110 (30.9)\tabcellsep 134 (37.6)\tabcellsep 356 (100)\tabcellsep \\
Sex in the last\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
six months\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
No\tabcellsep 48 (30.0)\tabcellsep 43 (26.9)\tabcellsep 69 (43.1)\tabcellsep 160 (100)\tabcellsep X 2 =5.822, p= 0.054\\
Yes\tabcellsep 55 (34.2)\tabcellsep 57 (35.4)\tabcellsep 49 (30.4)\tabcellsep 161 (100)\tabcellsep \\
Total\tabcellsep 103 (32.1)\tabcellsep 100 (31.2)\tabcellsep 118 (36.8)\tabcellsep 321 (100)\tabcellsep \\
Current use of\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
contraceptives\tabcellsep \tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
No\tabcellsep 51 (28.5)\tabcellsep 48 (26.8)\tabcellsep 80 (44.7)\tabcellsep 179 (100)\tabcellsep X 2 = 7.756, p =0.021\\
Yes\tabcellsep 47 (33.3))\tabcellsep 52 (36.9)\tabcellsep 42 (29.8)\tabcellsep 141 (100)\tabcellsep \\
Total\tabcellsep 98 (30.6)\tabcellsep 100 (31.3)\tabcellsep 122 (38.1)\tabcellsep 320 (100)\tabcellsep \end{longtable} \par
 
\caption{\label{tab_3}Table 4 :}\end{figure}
 			\footnote{© 2014 Global Journals Inc. (US)} 			\footnote{Contraception among Tertiary Students: Knowledge, use and Behaviour of Female Undergraduates in Edo State, Nigeria} 		 		\backmatter   			 
\subsection[{Acknowledgements}]{Acknowledgements}\par
This study had no funding sponsors. However, we like to appreciate all our colleagues in the department of Community Medicine, ISTH, Irrua for their support and useful suggestions.\par
VII. 			  			 
\subsection[{Competing Interests}]{Competing Interests}\par
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