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1. INTRODUCTION
1.1. Background
Emergency contraceptive (EC) sometimes referred to as “morning after” or post-coital contraception methods provides a second chance for women in the first few days following unprotected intercourse in situations like ; when no contraceptive method has been used; when a condom breaks; when a woman forgets to take oral contraceptive pills for two or more days, or delays a scheduled injectable for more than two weeks; or when a woman is raped or forced into sex and is not currently using contraception to prevent an unplanned pregnancy (Liambila et al. ,2013 )

The two types of EC are: (1) The copper-bearing intrauterine device (IUD): a device that is inserted into women uterus vaginally for the prevention of pregnancy. When used as an emergency contraceptive method, WHO recommends that it should be inserted within 5 days of unprotected sexual intercourse and it is the most effective form of emergency contraception available which is over 99% effective in preventing pregnancy. The second type of EC is (2) Emergency contraceptive pills (ECP): Emergency Contraceptive Pills contain higher doses of the hormones used in regular oral contraceptive pills. An ECP option includes; (a) dedicated progestin-only ECPs (b) Oral contraceptive pills containing combined regimen of progestin and estrogen (also known as the Yuzpe method) (c) Progestin-only oral contraceptive pills (OCPs): taken as a first dose of 20 pills. This third ECP option is not generally recommended due to a large number of pills required but can be a backup option in the absence of the other options. ECPs are 52–94% effective in preventing pregnancy (WHO, 2016).

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ECs are safe for all groups of women, including adolescents. Frequent use of ECPs poses no known health risks, it is safe, and no evidence exist suggesting harm to a developing fetus. A primary mechanism of EC is disruption of ovulation and may prevent the sperm and the egg from meeting. ECPs cannot interrupt an established pregnancy or harm a developing fetus. And it is not an abortifacient. Nausea and vomiting are the most common side effects of EC. Other possible effects include Bleeding disturbances or spotting, headaches, dizziness, fatigue, and breast tenderness. Most side effects generally disappear within 24 hours of taking the pills (Trussell et al., 2016).

A primary use of EC is reducing the need for Abortion and the negative maternal health consequence. Around the world, every day, approximately 830 women die from preventable causes related to pregnancy and childbirth. Ninety- nine percent of all maternal deaths occur in developing countries. Young adolescents face a higher risk of complications and death as a result of pregnancy than other women (WHO, 2015).

According to the report of WHO, unsafe abortion is the cause of 70,000 maternal deaths each year or one in eight pregnancy-related deaths among women. Approximately eight million women per year suffer post-abortion complications that can lead to short or long-term consequences. Of 42 million abortions that take place around the world each year, about 20 million are unsafe and almost all of those occur in developing countries. Contraceptive use has

increased globally and in all region of the world, but it remains extremely low in Africa. Therefore, the world’s highest levels of unintended pregnancy found in Africa; which is three times the rate in Western Europe. Certainly, 26% of women in developing countries who are at risk of unintended pregnancy but do not use contraception account for 82% of the 75 million unintended pregnancies that occur each year (Guttmacher Inistitute, 2009).

Despite Advancement of modern contraceptive methods, unintended pregnancy is still a big problem in Ethiopia. Ethiopia has the fifth highest number of maternal deaths in the world: One in 27 women die from complications of pregnancy or childbirth annually. Low levels of contraceptive use lead to high levels of unintended pregnancy, the root cause of abortion. One hundred women die in Ethiopian health facilities each year from abortion-related complications (Guttmacher institutes, 2010).

For most youths, tertiary education is a shift toward independence from home, an opportunity to form a new friendship and sexual relationship. For most young people, as defined by WHO those aged between 10 and 24 years, including both adolescents (aged 10-19 years) and youth (aged 15-24 years) it is a time of sexual initiation and experimentation which is often characterized by infrequent, unplanned, and sometimes non-consensual encounters and this type of sexual activity is frequently unprotected or insufficiently protected against pregnancy and sexually transmitted infections (STIs) (Hossain et al., 2009).

Teenage pregnancy is a major health concern because of its association with higher morbidity and mortality for both mother and child. Childbearing during the teenage years frequently have adverse social consequences particularly on educational attainment, because women who become mothers in their teens are more likely to drop-out their education (CSA Ethiopia and ICF International, 2012).

Emergency contraceptive is a crucial component of comprehensive reproductive health care, enabling women of all ages to decrease the risk of an unwanted pregnancy after an assault or contraceptive failure or contraceptive nonuse. Despite well-proven safety and effectiveness, global access to EC continues to vary with local political and religious conventions. In many places, access to oral EC continues to be limited by financial, knowledge, and other barriers. Concerning their attitudes, many people continue to conceptualize EC as an abortifacient. Therefore, women need to know about EC and have access to it (The Society for Adolescent Health and Medicine, 2016).

Different studies show that there is a gap on knowledge Attitude and practice of EC. Thus Increasing awareness and accessibility of EC to students can help to prevent unintended pregnancy.

1.2. Statement of the Problem

Unintended pregnancies and unplanned births can have serious Health, Economic, and social consequences for women and their families and also have broader negative consequences on the mother’s psychological well-being. One immediate outcome of some unintended pregnancies is induced abortion which is unsafe in many countries. For unmarried adolescents and young women, the consequences of an unplanned birth can include being forced to drop out of school, faces rejection from their family and community (Singh et al., 2010).

Around the world, about 16 million girls and women aged 15 to 19 years give birth each year. Most of these pregnancies are unintended and are more likely to end in induced abortion. Ninety five percent of these births occur in low and middle-income countries. More than 50% proportions of births that take place during adolescence occur in sub-Saharan Africa. Half of all adolescent births occur in just seven countries including Ethiopia. About 2.5 million adolescents have unsafe abortions every year, and adolescents are more seriously affected by complications than older women. Many girls who become pregnant have to leave school which has long-term implications for them as individuals, their families, and communities. Therefore, delaying adolescent births could significantly lower population growth rates, potentially generating broad economic and social benefits, in addition to improving the health of adolescents (WHO, 2016).

Additionally, according to the Guttmacher institute estimation of both intended and unintended pregnancy worldwide in 2012, 85.2 million unintended pregnancies occurred globally, of which 40% lead to abortion. Among those unintended pregnancies, 19.1 million or 23% was counted in Africa, which is due to limited or no access to effective and affordable family planning especially modern contraceptive method (Sedgh et al., 2014).

In Ethiopia, nearly half of adolescent pregnancies are unintended, as young people often face barriers to contraceptive services. An estimated 620,300 induced abortions were performed in Ethiopia in 2014. The annual abortion rate was 28 per 1,000 an increase from 22 per 1,000 in 2008 (Moore et al., 2016).

A study conducted in Hawasa University on the pattern of sexual behavior of students shows that Students who were engaged in unplanned and unprotected sexual practice were more likely to get pregnant, which ended up in unsafe abortions. As a result, some of the students were forced to withdraw or get an academic dismissal. Consequently, High prevalence of HIV infection and unplanned pregnancies among these students were also reported (Alano et al., 2014).

In spite of the high rate of unwanted pregnancy and its complications, utilization of emergency contraceptives to prevent such occurrence is very low among students of different universities in Ethiopia. The most frequently reported reason is lack of knowledge (Alemitu, 2011; Nibabe and Mgutshini, 2014; Tolossa et al., 2013). Ensuring access to and use of ECPs can be a critical component in any Reproductive Health program’s efforts to reduce unintended pregnancies among Young women (Hossain et al., 2009). This study area has not been given much attention. However, there are a non-research based report and few studies. Escalating unintended pregnancy and unsafe abortion are of great concern in Hawassa university female students. Therefore, this research is initiated to fill gaps in information regarding emergency contraceptives.

1.3. The significance of the study

The study will help program designers to design strategies on reproductive health services. The study focuses on searching for facts and information on the knowledge, attitude, and practice of emergency contraceptives which is believed to be an opportunity to prevent unintended pregnancy after unprotected sexual intercourse among female adolescents. Therefore, the findings will benefit governmental and non-governmental organization working to provide reproductive health service to these populations. Furthermore, Hawassa health office and non-governmental organization found around the study area like family guidance associations which are providing emergency contraceptive service can utilize the result of this study as a baseline data in planning awareness creation programs for university female students. In addition, this study also indirectly helps for awareness creation on emergency contraception among female students of Hawasa University.

1.4. Objectives
1.4.1. General Objective
The general objective of this study is to assess the knowledge, attitude, and practice of emergency contraceptive among female students of Hawassa University, College of Agriculture.

1.4.2. Specific objectives

To assess knowledge about Emergency contraceptives among the female students.
To examine attitudes toward Emergency contraceptives among female students.
To assess the practice of emergency contraceptive among female students.

Strength and Limitation of the Study

The strength of the study

The study is enriched by the qualitative method which helped to explore factors that are not addressed by the quantitative data.

All data collectors during the focus group discussion were females this helped the study subjects express their feelings freely since the study touches sensitive issues.

Limitation of the study

Self-reported information is subjected to reporting errors and missed information. Since the study touches sensitive issues the possibility of underestimation cannot be excluded, even though the study was anonymous

Only female students were included in the study

Operational definitions
Unprotected sex: Act of sexual intercourse performed without the use of birth control or a condom or in case of contraceptive failure, condom slippage or accidental sex to prevent pregnancy.
Unintended pregnancy: are pregnancies that are mistimed, unplanned or unwanted at the time of conception.
Unwanted pregnancy: A pregnancy that is not desired by one or both biologic parents.
Unsafe abortion: The termination of pregnancy carried out by someone without the skill to perform the procedure or in a place that does not meet minimal medical requirement standards.
Emergency contraceptives: is emergency birth control, which uses either emergency contraceptive pills (ECP) or an intrauterine device (IUD) to prevent pregnancy following unprotected sexual intercourse.
Knowledge: A general awareness of EC types, situations when EC should be taken, a place to obtain, the time limit to take EC after unprotected sexual intercourse, drug content, effectiveness, mechanism of action to prevent unwanted pregnancy. And classified as, adequate knowledge (Respondents who scored 5 and above correct answer from 9 knowledge measuring questions) and inadequate knowledge (Respondents who scored 0-4 from 9 knowledge measuring questions).
Attitude: views, evaluations, opinions, and intentions of respondents towards utilization of EC. Respondents who had positive outlooks and score mean and above ( 50 and above) to attitude measuring items were considered as having a positive attitude and those who had negative outlooks and score below mean ( 0 – 49) to attitude measuring items were considered as having a negative attitude.
Practice: History of ever used EC to prevent unwanted pregnancy among respondents.

2. LITERATURE REVIEW
2.1. Knowledge Attitude and Practice of Emergency Contraceptives
Worldwide use of emergency contraception is low relative to that of most other modern contraceptive methods, but usage varies by country. While there was variation among the countries, knowledge, and use of EC was very low in all settings, and was only available in the context of post-rape care. In 2002, emergency contraceptives were available without a prescription in 27 countries, including France, Portugal, and the United Kingdom. As of August 2010, 100 countries had registered an emergency contraceptive product, but emergency contraception remains the least known and least used contraceptive method among women ages 15 to 44 in 35 developing countries (Benevides et al., 2014).

In developing countries, according to the 2007 report of USAID, the percent of married women who had heard about emergency contraception ranged from 12% in Haiti to 35% in Colombia. The percent of married women who had ever used or were using emergency contraception was even lower; only 0.2% of married women in Uganda, 1.8% in Nigeria, and 0.2% in Jordan had ever used emergency contraception (USAID, 2012).

A review of Demographic and Health Surveys (DHS) data in 45 countries analysis of trends in knowledge and use of EC in each country between 2000 and 2012, affirmed; Latin America reported the highest knowledge and use of EC (34.8%, 3.5%, respectively), followed by Europe and West Asia (24.4%, 2.3%), Africa (15.0%, 1.8%), and Asia (10.8%, 0.3%). In all regions, there was a significant variation of EC knowledge and use among countries (Benevides et al., 2014).

DHS data show that the percentage of women who have heard about ECPs as a contraceptive option is systematically lower than for other modern FP methods. Women’s awareness of ECPs continues to be below 10% in Senegal and Zambia, and across the globe, knowledge of ECPs is only around 20% (Health Communication Capacity Collaborative, 2014). According to PSI baseline surveys, even in countries like Kenya where the method is better known (56% of women report having heard about ECPs), usage remains low. Among those who have heard about it, misconceptions remain. One-third believed that it causes abortion, and only about two-thirds knew the correct timeframe for using the method (Liambila et al., 2013)

Access to ECPs varies across different country contexts and is influenced by a number of cultural, social, and political elements. A global synthesis of existing demand creation evidence for ECPs found that there are three significant barriers to address in order to increase provision of ECPs. Those barriers are Low awareness, knowledge, and acceptability at the individual, community and societal level (Health Communication Capacity Collaborative, 2013).

2.2. Emergency Contraceptive Knowledge and Use in Ethiopia

In Ethiopia there is no national data exist on the percentage of Ethio¬pian women who have used EC as EC use has not been included in Ethiopia’s DHS. However, a published 5 surveys evaluation of an emergency contraceptive among EC users in five of the most populated regions of Ethiopia revealed that 41% of EC users were married and 47% were between the ages of 20 and 24. Young women under age 19 comprised 20% of the sample who used EC (ICEC-Ethiopia, 2015).

2.3. Knowledge Attitude and Practice of Emergency Contraceptives among University Students
Improving EC access to women and young adults could play an important role in preventing unplanned and unwanted pregnancies, women especially young adults and adolescents lack information whom to use to get family planning products (Hossain et al., 2009).

Regarding University students, Very few students have awareness about emergency contraception methods in most settings. Even, of those who are aware of the availability of EC, the majority lack the specific detail knowledge about the method. A study conducted among engineering college girls in central India shows that Knowledge and utilization of emergency contraception by students is low. Although 92.7% of participant had heard of EC, Only 26.6% knew that IUD can be used as EC and 78.5% knew pills as EC. About 46.0% and 42.4% knew situations when EC is generally recommended and the time limit for EC after unprotected sex respectively. The study concluded the overall knowledge of what EC constitutes as poor only 3.6% had good knowledge. Regarding the attitude of students towards EC positive attitude (72.2%) indicating a strong tendency to use EC in the future by respondents. However, about 54.6% thought EC as a method of early abortion. Overall, 5.7% reported that they had previously used ECPs. A majority of respondents heard about EC from media (Nisha et al., 2012).

Another cross-sectional study carried out on female students of the Islamic Azad University of Iran shows a lack of knowledge about ECs among students, only 35% had ever heard of ECs and their main source of information about EC were friends. Among those, only 2% of the participants had good knowledge. The majority (44%) didn’t know situations when EC should be taken. Only 16% and 44% know the drug composition and how EC works and 17% and 5% identified the recommended time frame for ECP and IUD respectively. Their attitude shows, only 14% agreed that EC cannot hurt the baby in case it failed. In general, 16% had a positive attitude and none of students have used EC (Samira et al., 2014).

Similar to this, Study conducted in Shahrekord University of Iran shows that, even though majority (95.4%) of respondents reported that they had heard of emergency contraceptive, Only 48.5% and 1% of students knew the recommended time limit of ECP and IUD, as 72hrs and 5 days after unprotected sex respectively. Majority (71%) of respondents’ didn’t know the mechanism of action of EC pills. About 85% and 10% of them mentioned pills and IUD as types of EC respectively. In general, only 7.7% had sufficient knowledge about EC, most of them obtained information about EC from the school-based curriculum. Their attitude indicates, 43.7% and 41.5% disagreed with statements that states EC encourages the non-responsible behavior and teratogenic for fetus respectively. Overall more than 80% of students had positive attitudes towards emergency contraception (Masoumeh & Hossein, 2012).

In agreement with the above findings, limited knowledge and practice of EC were observed among students in different Universities of Africa. A study conducted on undergraduate female students, in the University of Rwanda, shows that, about 47.6% had heard about EC. Among

those, only19.1% made it clear the correct time limit for ECP after unprotected sex. Regarding their attitude towards EC, about 64.5% and 69.6% of respondents are favorable to use and recommend ECs to friends respectively and 41.9% strongly accepted to make ECs available for female students. However, only 31% were convinced that ECs would reduce abortion rates and related deaths, or reduce the rate of class dropout. For the practice, about 5.4% had used ECs (Uwamariya et al., 2015).

A study carried out in Dar Es Salaam, Tanzania among female students’ shows that, 57% were aware of ECP and only 32.4 % had good knowledge and14% had used EC. Regarding their attitude toward EC, 58.1% thought Recommending ECPs to friends is dangerous (Kagashe et al., 2013).

Another study conducted at the University of Namibia shows that only 4.4% of respondents heard of emergency contraceptive. Among those, 7.8% knew the right time to take ECP, 45.4% of respondents know that EC is available at public health facilities and 68.5% of them know how EC works. For attitude and practice, 72.72% had positive intention to use EC in the future, 91.7% ever used EC, of those, none of the respondents used IUCD (Magesa, 2014).

In contrary to the above findings, among female undergraduate students in Kenya, 72.9% of the participants were aware of EC. About two-thirds (68%) know a time limit to take ECP and Majority (92.1%) reported clinics as a place to obtain EC pills. About 58.6% of the participants agreed that EC is safe for users. For practice, 23% of the students reported frequent use of EC (Isaiah, 2017).

Awareness about emergency contraception is 75% among students at the University of Limpopo, Botswana while 45.9% had adequate knowledge and 15.9% had used emergency contraception (Modikwe and Mathildah, 2016).

.Knowledge attitude and practice of Emergency contraceptives among Ethiopian University Students
Like other African countries the knowledge, attitude, and practice of emergency contraceptives varies and in the majority, it is low among university students in Ethiopia. For instance,
Finding among Wollo university students shows that, 72.5% had heard and 36.5% had General knowledge of EC. Regarding detailed knowledge of EC, 70.6% knew pills and only 2.8% knew IUCD as a type of EC. majority of respondents (40.7%) knew all the situations to take emergency contraceptives, 74.2% know the recommended time frame to take ECP after unprotected sex while a majority of respondents (61.7%) did not know the appropriate time frame for IUCD. About 56.1% and 27% correctly identified effectiveness percentages of EC pills and IUD in preventing pregnancy respectively. Regarding the attitude of students towards EC, 50.6% and 83.9% of respondents believe that EC as one way of abortion and it poses a health risk respectively. Overall, 59.4% of the students have a negative attitude towards EC. Only 21.3% ever used Emergency contraceptives (Temesgen et al., 2017).

A study conducted by Fekadu Y, 2017 among Arba Minch University female students showed that 54.9% and 19% identified oral pills and IUD as possible methods of emergency contraceptive. About 87.2% and 70.6% of the respondents have correctly identified the recommended time limit for pills and IUD after unsafe sexual intercourse respectively. Overall 95.9% of them were knowledgeable, about 87.1% of students had a positive attitude and 58.8% of the respondents have ever used EC. Majority’s reason to use EC was due to not using the regular contraceptive. And

nobody was recommended them to use. Another finding at Haramaya University indicated, 95.38% of the respondents have heard about ECs, their common sources of information were teachers in class (40.32%). About 53.23% knew that ECPs were procured from retail outlets, their attitude toward EC shows, 42.31% are intended to use EC in the future, 36 (61.02%) of them have used ECP. Their reason for not using EC was religious issues (Samira and Mekonnen, 2016).

Similarly, a cross-sectional study conducted at six colleges in Dessie shows, of total students, 69.9% had heard about EC. Among those, only 33.9% had good knowledge of EC. Regarding the type of contraceptives used as an emergency, 53.7% said pills, and 11.4% said IUD and 19.1% cited both pills and IUD. With respect to the composition of drug used as EC, 41.9% correctly answered that it is the same but stronger dose than the ordinary contraceptives. 32.1% and 37.8% correctly identified effectiveness percentages of EC pills and IUD in preventing pregnancy respectively. Coming to their attitude; 63.6% had a favorable attitude toward EC. 69.6% agreed that EC should be available for all females; only 15.4% of the students used EC (Nibabe and Mgutshini, 2014).

A study that was employed at Debre-Markos University indicated that awareness of EC was 71.1%. The majority got information from health institution. 62.5% had good knowledge about EC. Of those, 61.5% could tell the correct timing of administration of pills, while only 8.9% could tell the correct timing of administration of the IUCD. 62.9% of respondents stated that they could get EC from government hospitals and 47.6% from the pharmacy. Out of this 53.8 % of the students have a positive attitude towards emergency contraceptives. 82.5% support the idea of EC safe for its users and the prevalence of ever use of emergency contraception among female students is only11.4% (Marta and Hinsermu, 2015).

2.5. Factors contributing to knowledge, attitude, and practice of Emergency contraceptives

Various factors contribute to the knowledge, attitude, and practice of emergency contraceptive. Socio-demographic factors, Family background, and other factors determine the level of knowledge, attitude practice of EC among female university students.

Socio-demographic factors:

Young women have less knowledge about reproductive health and more limited access to contraceptives in general than older women and are therefore less likely to be using an ongoing contraceptive method, even if they are married (Hossain et al., 2009). Various studies have also illustrated that younger women have less information regarding knowledge and the use of emergency contraceptives as compared with their elders.

A multi-country analysis to examine knowledge and use of emergency contraception in 45 countries; in Africa, Asia, Europe and West Asia, and Latin America and the Caribbean using population-based survey data on women aged 15–49 shows that, Young women have less knowledge and practice about emergency contraceptives than older women in majority of the study and Generally, older women were more likely than 15–19-year-olds to be aware of emergency contraception. Increasing age was positively associated with having heard of emergency contraception (Guttmacher Institute, 2014).

In the case of Ethiopia, Young people have limited access to Sexual and Reproductive Health information and services. According to EDHS report, 5.2% of adolescents 15-19 and 22% of 20-24-year-olds are using a modern contraceptive method. Nearly 33% of adolescents and 22% of youth 20-24 have an unmet need for contraception (Worknesh, 2013). According to Performance Monitoring and Accountability 2020 data, 1.4% of unmarried sexually active contraceptive users used EC in 2013 in Ethiopia (ICEC, 2013).

In addition to these, different findings in the different universities are consistent with the above findings. The finding in Mizan-tepi University indicated that students of age 20 and above were 2.3 times more likely to have good knowledge about EC than their counterparts (under 20 years) (Shiferaw et al., 2016). Which is also similar to a study on female students of the Islamic Azad University of Iran where the highest level of knowledge exists in ages 20-24 than 15-20 years of age (Samira et al.,2014).Students age 25 and above were 9 times more likely practice EC than who are aged between 15-19years in Debre- Markos University (Marta and Hinsermu, 2015).

EC knowledge, attitude, and practice can also be influenced by the previous place of residence before joining the university. Currently, married women in urban areas are twice as likely as their rural counterparts to use any contraceptive method in Ethiopia (CSA Ethiopia and ICF International, 2012). Female students who came from the urban area were 1.43 times more likely to use EC when compared to those who came’s from rural area among students of Arba Minch University (FekaduY, 2017). Related to marital status, Married respondents were 2 times more likely to have knowledge of EC than unmarried respondents among college students of Dessie ( Nibabe and Mgutshini, 2014 ) and similarly, students who are married were 7 times more likely practice EC than not married among Debre-Markos university students (Marta and Hinsermu, 2015).

Knowledge and Practice of Emergency Contraception is positively associated with educational level in different universities in Ethiopia; those who were in the second year and above classes were more likely to be aware and practice of EC than those at first-year level among Debremarkos, Wollo and Hawassa university students (Marta and Hinsermu, 2015; Temesgen et al., 2017 Tolosa et al., 2013). Regarding parent’s educational status increased in educational level of mother and father has a positive relationship with knowledge, attitude and practice of EC among respondents in Arbaminch, Haramaya and Debremarkos universities students (Alemitu, 2011; Berhanu and Nigatu, 2011; Marta and Hinsermu, 2015).

Religion was found to be a statistically significant factor that affects respondents’ knowledge and attitude toward EC among Haramaya university students. Higher knowledge and favorable attitudes towards EC were observed among Orthodox Christians than Protestant, Catholic and Muslim .where Protestant, Catholic, and Muslim were 54.2% less likely to be aware of EC and 64.1% less likely to have a favorable attitude toward EC (Berhanu and Nigatu, 2011).

Communication about reproductive health issues:

When young people feel unconnected to home, family, and school, they may become involved in activities that put their health at risk. However, when parents affirm the value of their children, young people more often develop positive, healthy attitudes about themselves. Confident, loving parent-child communication leads to improved contraceptive and condom use, improved communication about sex, and fewer sexual risk behaviors among adolescents (Alicia, 2010).

A study conducted among Adolescents in Gondar town shows that discussion with family, peer group, sexual partners and teachers on family planning had a significant association with FP service utilization which allows adolescents to create more opportunities to exchange information, experiences, and builds comprehensive knowledge about Family Planning. The study has shown that Sexual and reproductive health communication associated with increased contraceptive awareness by about four times (Feleke et al., 2013).

Another study also showed that, Discussion on sexual and reproductive health issues with family and peers has a positive effect on contraceptive awareness of students and discussing sexual and reproductive health issues with parents and peers were found to be predictors for contraceptive awareness among female students in six secondary schools in Mekelle town (Melaku et al., 2014).

Sexual and reproductive history:

Sexual and reproductive history is the determinant factors for knowledge and use of emergency contraceptives among Mizan-tepi university students which indicates, Female students who had sexual intercourse and who had history of pregnancy were found 4.9 and 4.4 times more likely to be aware of EC than their counterparts respectively (Shiferaw B et al., 2016). Similarly, Study conducted in Kenya among female youth also showed that the respondents who had an early onset of sexual intercourse below the age of 19 years, had used the ECPs fewer times than those who were 20 years and above. Those who had ever terminated pregnancy were more likely to use ECPs than those with no history of abortion (Kevina, 2014).

Provider’s knowledge and attitude:

Provider knowledge, attitudes, and practices are among the multitude of contextual and systematic limitations in accessing EC. Provider attitudes about EC use toward adolescents and youth are more conservative than the general population. Rates of approval for EC provision to adolescents were low in Ghana (51 %), South Africa (41 %), and Nigeria (32 %) and in general, providers are less supportive of EC utilization among a younger population. Many providers believe EC use increases promiscuity and sexual risk-taking and decreases utilization of other contraceptive methods (Williams, 2011).

Provider’s knowledge about EC in different countries is low. In Bangladesh, 54% of providers incorrectly classified ECPs as a product that can cause abortion and 42% of providers in Pakistan were unsure whether ECPs could cause abortion or not. A study in Mexico showed significant pharmacist confusion between ECPs and the abortion pill. Even in developed countries like the United States, ECPs are still confused with abortion pill (The Health Communication Capacity Collaborative, 2014).

Another evaluation of EC provision in refugee camps and post-conflict settings in the Democratic Republic of the Congo, Ethiopia, Kenya, and Jordan by the International Rescue Committee revealed low levels of knowledge about EC among providers (only 25% knew the correct time period that ECPs can be taken) (Perera, 2013).

2.6. Conceptual Framework

One of the ways to improve maternal health and to reduce cases of maternal mortality due to unintended pregnancies leading to unsafe abortions is the use of modern methods of contraception. Based on the literature reviewed above, various factors contribute to the knowledge, attitude, and practice of emergency contraceptive among university students.
The conceptual framework below highlights factors which are likely to influence the knowledge attitude and practice of emergency contraceptives. The socio-demographic, family background, communication of sexual and reproductive history and other factors are considered as independent variables and knowledge attitude and practice of EC as the dependent variable.

The independent variables, socio-demographic factors such as age, marital status, religion, year of study, sources of information and place of origin; Family background factors such as parents educational level, and communication about reproductive health issue between family and other factors like peer communication and communication between partners about RH matters, providers knowledge and attitude determines the level of knowledge, attitude practice of EC among female university students.
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Figure 1: Conceptual framework

Source: (Adopted and modified from Berhanu and Nigatu, 2011)

METHODOLOGY
3.1. Description of Study Area
This study was conducted at Hawassa University which is one of the campuses of Hawassa University. Hawassa University is found in Hawassa town. Hawassa town is the capital city of Southern Nations Nationalities and Peoples Regional State (SNNPR) which is located 273 Km from Addis Ababa, the capital city of Ethiopia. Hawassa College of Agriculture is one of the oldest and most prestigious Colleges in Ethiopia established in 1976 as a Junior College of Agriculture. The college applied new organizational set up which paved way for the establishment of the Debub University (now Hawassa University) in 2000. Consequently, the College of Agriculture resumed functioning as one of the Colleges of Hawassa University. Currently, Hawassa University College of Agriculture has 4 schools (Animal and Range Sciences, Plant and Horticultural Sciences, Food Science and Human Nutrition and Environment, Gender and Development Studies) offering study programs to a student in undergraduate and postgraduate programmers’. Source: http://www.hu.edu.et/.According to the statistics obtained from registrar office of Hawassa University, College of Agriculture, the total number of undergraduate regular students who are attending their education during 2016/2017(2009 E.C) is about 1119 and out of these 478 of them are female students. The college has one clinic in the campus which provides reproductive and health services to the university students.

3.2. Study design

The research design was a cross-sectional survey including both quantitative and qualitative study. The quantitative data of the survey was gathered by structured self-employed questionnaire and qualitative part was gathered by interview of key informants and FGD. The quantitative study was enriched by the qualitative study. The Purpose of the qualitative study was to elaborate on the gaps identified and to explore some of the major quantitative results further.

3.3. Source population

All undergraduate regular female students who were attending their education in Hawassa University College of agriculture, at the time of the study, were the source of the population.

3.4. Study population

Sampled undergraduate female students from the source population selected with multi-stage sampling procedure from selected departments at the time of the study were the study population.

3.5. Inclusion and exclusion criteria

1. Inclusion criteria:
It includes all undergraduate regular female students who were attending their education
during the time of the study, at Hawassa University College of Agriculture.
2. Exclusion criteria:
Night and summer students because they were not available during data collection.
It didn’t include male students.

3.6. Sample size and Sampling technique

3.6.1. Sample size

The sample size was calculated by using Yamane (1967:886) simplified formula considering a 95% confidence interval (CI) and precision 5% was considered as the margin of error.
Where, n is the sample size,
N is the population size, and
e is the level of precision.

The total number of undergraduate regular female students who were attending their education during 2016/2017(2009 E.C) was 478.

n = N/(1+N(e)²)
n = 478/(1+478(.05)²)
= 478/(2.195)
n = 218 + (10% non response rate)
n= 240
By considering non-response rate of female students 10% of sample size (n=22) was added making final sample size 240. Then it was proportionally divided to each department.

3.6.2. Sampling technique

Multistage sampling technique was used to enlist participants for the study. Initially, of the whole male and female students of Hawassa University College of Agriculture, undergraduate regular students, all female students were selected purposely for study. Total university female undergraduate students were stratified into the four schools. In the second stage, departments were selected using simple random sampling technique from each school and the sample was distributed to each departments using probability proportional to their size. And accordingly, the required number of female undergraduate students sample size was distributed to each year of study again using probability proportional to size. Finally, a random sampling technique was used to select students among each department and year of study who met inclusion criteria proportionally.

Figure 2: Schematic representation of the sampling procedure

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3.7. Data collection procedure

The data was collected by a principal investigator and assistant data collectors using structured and pre-tested self-administered questionnaires. The questionnaire included the respondents’ socio-demographic characteristics, family educational background, family, peers and partner communication about reproductive health issues, sexual history of the respondents and their knowledge of the regular contraception and EC related knowledge, attitude and practices. The questionnaire was adopted from different works of literature.

Before starting data collection, training was provided to data collectors on how to provide an introduction to the students about the questionnaire to be filled. The principal investigator supervises and provided important guides and helped them during data collection. The selected students were informed about the purpose of the study, the importance of their participation and verbal and signed consents were ensured. Based on their willingness to participate in the study, they were provided the questionnaire to fill and return the data to the data collectors. Qualitative data were collected from focus group discussions (FGDs) held with female students and key informants interview with health care providers. Five FGD with 8-12 female students in each group from all departments were recruited randomly from each year of study for the FGDs by the principal investigator and the guiding issues of the FGDs were knowledge of methods for prevention of unintended pregnancy and the knowledge attitude and practice towards ECs. The key informants’ interview was carried out with six selected health care providers from the selected FP service centers. Like FGA Hawassa branch, Marie Stop Clinic Hawassa branch, and student’s clinic of Hawassa University College of agriculture.

The interview was carried out by the principal investigator and experienced data collector who provides family planning service; using open-ended and responsive questioning and the information obtained were recorded in the notebook. The interview focuses on the knowledge and attitude of health care providers towards ECs.

3.8. Data quality assurance

Data collectors were recruited based on their prior experience in data collection. Two days training along with the demonstration of data collection tools were prepared by the principal investigator to all data collectors then data collection instrument was pre-tested. A pilot study was conducted on 5% (12) female students of Hawassa University from the main campus, five days prior to the main data collection day so as to check the functionality of data collection tools and data collectors. Some internal consistency checks were made to assess the quality of the data. Then based on the findings of a pilot study, necessary modification of the data collection tools was made. Principal investigator closely followed the data collection process and completed questionnaires were checked for completeness.

3.9. Data processing and analysis
Quantitative data was entered cleaned and analyzed using SPSS version 20 of statistical software. The analysis part was consists of descriptive statistics (frequencies, proportions, and graphs) used to describe the percentages and number distributions of the respondents by socio-demographic and other characteristics.

Analytic statistics logistic regression using bivariate and multivariate logistic regression was also used to explore the association between independent and dependent variables. Variables found significant (p-value less than 0.05) on bivariate analysis were identified for multivariate logistic regression analysis. The degree of association between the independent and dependent variables was analyzed using the odds ratio with a 95% confidence interval. A P-value of less than 0.05 was considered to declare a result as a statistically significant association. Thematic analysis was used for qualitative analysis. Information generated through focus group discussions and in-depth interview were compared based on differences and similarities and categorized then grouped in theme as per objectives of the study. Certain verbatim was also quoted to reflect the perception of discussants. And then qualitatively analyzed and enriched the quantitative study results.

3.10. Study Variables

Dependent variable

Knowledge of emergency contraceptive: is an ordinal variable set to measure knowledge
scale of participants about EC and measured as a dichotomous variable classified in to
“adequate knowledge” and “inadequate knowledge” and coded as ‘0’ for inadequate
knowledge and coded as ‘1’ for adequate knowledge.

Attitude towards emergency contraceptive: is an ordinal variable set to measure the attitudinal
scale of participants about EC and measured as a dichotomous variable classified in to
“Positive attitude” and “Negative attitude” and coded as ‘0’ for Negative attitude and coded
as ‘1’for Positive attitude.

Practice on emergency contraceptive: is a nominal variable that identifies whether
participants used EC or not and measured as dichotomous classified in to “Used EC” and
“didn’t use EC” and coded as 0′ for didn’t use EC and coded as ‘1’ for Used EC.

Independent variables

Socio-demographic variables:

1.1. Age: is a continuous variable that identifies the respondent age at the time data
collection it is categorized as 1= less or equal to 19, 2= 20-21, 3= 22 and above

1.2 Religion: a nominal variable that identifies the respondent’s religion and categorized as
1= orthodox, 2= protestant, 3= Muslim, 4= catholic, 5= other

1.3. Marital status: a nominal variable that identifies respondents marital status and
categorized as 1= married, 2= living with boyfriends, 3= single

Exposed to media: nominal variable that identifies respondents sources of information about emergency contraceptives and categorized as 1= school, 2= television/radio
3= clinic/health institution, 4= internet, 5= friends 6= other

Place of residence (where they came from): a nominal variable that identifies respondents dwelling before they join university and categorized as 1= urban 2=rural.

Year of study: a continuous variable that identifies to what year of study respondents belong during data collection and categorized as 1= first year 2= second year and
3= third year.

Family background factors

2.1. Father educational level: it is a continuous variable that identifies the respondent’s father
educational status and categorized as 1= unable to read and write 2= read and write,
3= elementary, 4= secondary 5= tertiary

2.2. Mother educational level: it is a continuous variable that identifies respondent’s
mother educational status and categorized as 1= unable to read and write
2= read and write, 3= elementary, 4= secondary 5= tertiary

2.3. Father communication about SR matter daughter: it is a nominal variable that
identifies whether there is a discussion about the sexual and reproductive issue between
father and daughter categorized as 1= Yes 2= No

Mother communication about SR matter daughter: it is a nominal variable that identifies whether there is a discussion about the sexual and reproductive issue between mother and daughter categorized as, 1= Yes 2= No

3. Other factors

3.1. Sexual and reproductive history: it is a nominal variable that indicates a sexual history
of respondents whether they had a history of sexual intercourse, pregnancy, and abortion
or not and coded as, 1= Yes 2= No

3.2. Peer communication about RH issues: it is a nominal variable that identifies whether
there is a discussion about the sexual and reproductive issue between respondents and their
friends categorized as 1= Yes 2= No

3.3. Communication with boyfriend/husband about RH matters: it is a nominal variable
that identifies whether there is a discussion about the sexual and reproductive issue between
respondents and their sexual partners categorized as, 1= Yes 2= No

3.4. Providers’ knowledge and attitude about EC: data from a qualitative key informant
interview with healthcare providers about their knowledge of EC type, the time frame to take
ECP and IUD, mechanism of action, safety and drug efficacy and their opinion and
beliefs toward EC as it is promiscuous abortifacient, and their attitude toward
providing EC to young clients.

3.11. Ethical consideration

Ethical clearance was obtained from a research ethics committee of a school of environment gender and development studies, and a letter to the concerned selected schools and selected institutions for the interview was also obtained from Hawasa university school of graduate studies. Accordingly, prior to data collection, permission was obtained from each of the selected institutions and school. The respondents were given accurate and complete information regarding the purpose and objective of the study. Signed informed consent was obtained from each study participants and informed verbal consent was obtained from key informants and among FGD. All participants had the right to refuse or to be included in the study and the right to not respond to all or some questions and to withdraw at any time of interview or discussion. Information gather was kept strictly confidential.

3.12. Dissemination of the result

The result will be presented to Hawassa University, graduate studies, school of environment gender and development studies, department of Gender and family studies, by soft and hard copy. It will also be accessed to interested researchers through the Department of Gender and family studies, Hawassa University.

4. RESULTS AND DISCUSSION

4.1. Socio-Demographic characteristic of study participants

A total of 240 questioners were distributed to female students and full Response was obtained from students, making the response rate 100 %. The age of study participants ranged 18 to 23 years. Majority of respondents 104(43.3%) were within the age of 20 and 21. Eighty-seven (36.3%) of the respondents were 19 and below years old and 49(20.4%) were 22 and above years. The mean and median ages of the respondents were 20.24 and 20 respectively with an SD of 1.405. Concordance finding was reported from another study, where the majority of respondents were 20 and above years old in Arba Minch and Mizan -Tepi Universities (Fekadu, 2017; Yemaneh et al., 2018).

Most of the respondents were followers of orthodox Christianity 132 (55%) followed by Protestants 84(35%) and Muslims 24 (10%). Regarding the marital status of the respondents, more than half 141 (58.75%) were single, 82 (34.17%) reported living with their boyfriend, while only 17 (7.08%) of them were married. Their year of the study shows that majority 153(63.75%) were first-year students and the rest 40(16.67%) and 47(19.58%) were second and third-year students respectively.132 (55%) of the study subjects were urban dwellers prior to their entry to the university, while the rest 108(45%) were from a rural area of the country.

Table 1: Socio-Demographic characteristic of female undergraduate students (n=240), in Hawassa University college of agriculture Ethiopia.

Variable Frequency Percentage (%)
Age
19 and below 87 36.3
20-21 104 43.3
22 and above 49 20.4
Religion
Orthodox 132 55
Protestant 84 35
Muslim 24 10
Catholic 0 0
Other 0 0
Marital status
Married 17 7.08
Single 141 58.75
Living with boyfriend 82 34.17
Year of study
First year 153 63.75
Second year 40 16.67
Third year 47 19.58
Residence (where were you from)
Urban 132 55
Rural 108 45

4.2. Family background and discussion about Reproductive health issues

Respondent’s parent educational level revealed that 25% of the student’s fathers were unable to read and write, 12.5% were able to read and write while 20%, 17.5%, and 25% were elementary, secondary tertiary respectively. 35% of the respondent’s mothers were unable to read and write, while 10% were able to read and write. About 20% and 15% of respondent’s mother were secondary and tertiary respectively.

Concerning communication about sexual and reproductive health issue of respondents with their parents, friends, and partners; respondents were discussing reproductive health issues more with their friends (87.5%) than their mothers (57.5%) and fathers (17.5%). And among those who had a partner (n=99), (93.94%) of them were discussing the sexual and reproductive issue with their boyfriends or husbands.

Table 2: Family background and discussion about Reproductive health issues of study participants (n=240), in Hawassa University college of agriculture Ethiopia

Variable Frequency Percentage (%)
Father educational level
Unable to read and write 60 25
Read and write 30 12.5
Elementary 48 20
Secondary 42 17.5
Tertiary 60 25
Mother educational level
Unable to read and write 84 35
Read and write 24 10
Elementary 48 20
Secondary 48 20
Tertiary 36 15
Discuss reproductive health issues with father
Yes 42 17.5
No 198 82.5
Discuss reproductive health issues with mother
Yes 138 57.5
No 102 42.5
Discuss reproductive health issues with friends
Yes 210 87.5
No 30 12.5
Discuss reproductive health issues with a partner (n=99)
Yes 93 93.94
No 6 6.06

4.3. Sexual and Reproductive history of respondents

Out of the total respondents (n=240), 114 (47.5%) have had sexual intercourse in their lifetime. which is nearly similar to the studies conducted among Wollo University students (49.1%) (Temesgen et al., 2017) and Female Students in Preparatory School of East Shoa, Adama (47.6%) (Girma et al., 2015). But higher than a similar study conducted on higher education students in Addis Ababa University (Yared, 2016 ) and undergraduate female students of Mizan-Tepi University (Yemaneh et al., 2018) which is 27.09% and 28.57% respectively. But it was much lower than the finding of studies conducted among Arba-Minch University students (Fekadu Y ,2017), Hawassa university female students (Tolossa et al., 2013) and youths in Kenya (Kevina ,2014) where 84.7%, 92.7% and 85.1% of them experienced sexual intercourse in their lifetime respectively. This difference could be due to the number of married female students.

The reason for the low finding of sexual experience in this study could be, the proportion of students who were married were lower (7.08%) compared to studies those had higher findings of sexually experienced students mentioned above. And other possible reason could be the respondents might not express their real sexual history because of the social norm.

The age of respondents at first sexual intercourse in this study ranges from 14 to 20 years with a mean and median age of 17.66 and 18 years and SD of 1.844respectively. About 5.3% of respondents started sex before the age of 16 and majority 46.5% started sex at age 16 to 18 years and 40.3% started sex at the age of 19 and above. However, the remaining 7.9% of those who ever had sexual intercourse skipped the question at what age they started sexual intercourse. This is consistent with the finding of studies reported among Addis Ababa University where majority (63.67%) had their first sexual intercourse before they were 19 years of age (Yared, 2016) and youths in Kenya that majority of the respondents with history of sexual relationship had their first sexual intercourse between the age of 15 and 19 years (Kevina, 2014). The mean age of first sexual intercourse in this study also comparable to the mean age of unmarried women of the reproductive age group in Adama town which was 17.39 years (Aman et al., 2016). However, this finding is in contrary to the studies of Wollo University students where most of the students (68.5 %) started sexual relationship after 18 years of age (Temesgen et al., 2017) and Female Students in Preparatory School of Adama in which majority (73.3%) of respondents didn’t remember their age at first sexual intercourse (Girma et al., 2015).

Of those students who had a sexual experience (n=114), 20(17.54%) had ever got pregnant. The main reasons given for becoming pregnant included: Forgetting to take contraceptive 8 (40%), Failure of other contraceptives 6 (30%) and forced to have sex 6 (30%) as shown in figure 3 below.

Figure 3: Reason for being pregnant (n=20) by study participants in Hawassa University, College of Agriculture.

13(65%) out of the 20 pregnancies were unplanned and 5 (38.46%) of those unplanned pregnancies were ended in abortions. The prevalence of unwanted pregnancy among sexually experienced respondents in this study was nearly in line with study finding reported among female undergraduate students of Addis Ababa University which were 68.18% (Yared, 2016).

The result was much higher than findings reported by other studies conducted among female students in University of Rwanda (Uwamariya et al., 2015) , Female Students in Seto Semero high school in Jimma Town (Asmare et al., 2015) and Wollo University students (Temesgen et al., 2017) which accounted 4.1%, 3.2% and 46.6% respectively. The finding was lower when compared to similar studies conducted on higher education students in Ethiopia like colleges in Dessie (78.3%) and Mizan- Tepi University (85.2%) (Nibabe and Mgutshini, 2014; Shiferaw et al., 2016). The discrepancy could be the difference in the contexts of the study areas and study subjects. Abortion as a consequence of unwanted pregnancy is being one of the causes of maternal deaths, female university students reporting abortion imply that students are exposed to a life-threatening condition which could have been prevented by use of an effective contraceptive method.

Out of the total study participant (n=240), 83.75 % of them know any method to prevent unwanted pregnancy after unprotected sexual intercourse. This result shows the existence of better awareness towards knowledge of how to prevent unwanted pregnancy compared with the study result of youths in Kenya where 42.3% of the interviewed youth know that something can be done by a woman immediately after unprotected intercourse to protect her against pregnancy (Kevina, 2014). However, the result was comparable to Female Secondary School in Namibia where 83.4% of respondents have heard of any method that girl/woman might use to prevent herself from becoming pregnant (Magesa, 2015).

With respect to knowledge of respondent’s about modern contraception methods, pills are the most commonly known method by the respondents which accounts 61.7% followed by condoms (52.5%) and injectables (48.7%) and also the less frequently mentioned methods of modern contraceptives by respondents were; implant (16.7%) and IUD (12.1%). The result was consistent with the survey findings of Aman et al (2016), Tolossa et al (2013) and Marta and Hinsermu (2015) which shows oral pills, injectables and condoms were the most widely known regular contraceptives. But it was contrary to study conducted at University of Rwanda (Uwamariya et al., 2015) and University of Dar Es Salaam, Tanzania (Kagashe et al., 2013) where the condom is the most mentioned modern contraceptives method by respondents.
Table 3: a Sexual and reproductive history of study participants in Hawassa University College of agriculture, Ethiopia
Variable Frequency Percentage (%)
Ever had sexual intercourse
Yes 114 47.5
No 126 52.5
Age at first sexual act (n=114)
Below 16 6 5.3
16-18 53 46.5
19 and above 46 40.3
Age not filled 9 7.9
Ever got pregnancy (n=114)
Yes 20 17.54
No 94 82.46
Planned pregnancy (n=20)
Yes 7 35
No 13 65
Reason for becoming pregnant (n=20)
Contraceptive failure 6 30
Forget to take contraceptive 8 40
Pressure from partner 0 0
Forced to have sex 6 30
Other if any 0 0
Had abortion before (n=13)
Yes 5 38.46
No 8 61.54
Know how to prevent unwanted pregnancy
Yes 201 83.75
No 39 16.25
Types of modern contraceptive known*
Pills 148 61.7
Injectable 117 48.7
IUD 29 12.1
Condom 126 52.5
Tubal ligation 0 0
Vasectomy 0 0
Implantation 40 16.7
Have you ever heard about EC
Yes 213 88.75
No 27 11.25
Source of information about EC (n=213)
School 5 2.3
Television/radio 80 37.6
Clinics/health institution 24 11.3
Internet 0 0
Friends 104 48.8
Other 0 0

*number exceed because of more than one response.

Out of the total respondents (n=240), 213 (88.75%) of respondents had ever heard about EC. awareness about EC in this study was nearly similar to study done on adolescents of Nigeria where 86.5% of respondents have heard of emergency contraceptive (Onasoga et al., 2016). But higher than studies conducted on married women in the reproductive age group in Tehran hospitals in Iran (38.6%) ( Ekhtiari et al., 2018), Seto Semero high school students in Jimma town (40.5%) (Asmare et al., 2015) and students of Toyserkan University in Iran (35%) (Samira et al., 2014). However, it was much lower as compared to a study done in different Higher

Institutions like Arba Minch University (95.9%), Haramaya University (95.38%) and under and postgraduate students in India (100%). (Fekadu, 2017; Semira and Mekonnen, 2016; Giri, et al., 2013) respectively. This great discrepancy could be due to the socio-demographic difference of the respondents such as the age, educational status, cultural differences and marital status of the respondents.

In all focus group discussions conducted among female students, the focus group discussion revealed that ten participants (two from a group I, two from group II and three from group III, two from group IV and one from group V) had heard of EC while the remaining students were completely unaware of the method.

The major sources of information about EC in this study were friends 104(48.8%) followed by television /radio 80 (37.6%), clinic/health institution 24 (11.3%) and schools 5(2.3%) as shown in figure 4 below. which is in agreement with the report from Rwanda (Uwamariya et al., 2015), Iran (Samira et al., 2014) and Hosanna (Abinet & Messay, 2014) among university students in which their main source of information about EC were friends. However, this was different from study report from colleges in Dessie in which the main source of information is TV/Radio (Nibabe and Mgutshini, 2014) and Debre Markos Higher Institutions and among married women in the reproductive age group in Tehran where Healthcare workers were the main source of information about EC (Abera et al., 2014; Ekhtiari et al., 2018).

Figure 4: Sources of information about EC (n=213), among female undergraduate students in Hawassa University college of agriculture.

4.4. Knowledge level of EC among female undergraduate students in Hawassa University College of agriculture.

Respondent’s level of knowledge about EC was assessed using nine multiple choice questions. The nine questions to evaluate the level of knowledge about EC for those who have heard about EC were: situations to use EC, place where to obtain EC, methods (types) of contraceptives used as EC, the correct time limit to take EC after unprotected sexual intercourse, drug composition, effectiveness and how EC works. Each knowledge assessment question responses were recorded into the value 1 for correct answers and the value 0 for the incorrect answers in the first place. The respondent’s correct responses to the questions were ranged from 0 – 9 (0-100%) Each correct answer corresponded to 1 point, and so there was a total of 9 points (100%) for the nine questions. Based on this, Respondents who scored 0–4considered as having inadequate knowledge and those who scored 5 and more were classified as having adequate knowledge about EC. A similar approach has been exercised by Shiferaw et al., 2016; Alemitu, 2011; Ewnetu, 2012.

Accordingly, of those who had heard about EC (n=213), concerning Situations in which Emergency contraceptive should be taken, Majority of them mentioned correct answers like When forced to have sex (34.7%), When condom slipped or broken (27.7%) and When there are missed pills (8.9%), others gave incorrect responses like when pregnancy occurs (20.2%) and the rest (22.5%) did not know at what situations that EC should be taken. Similar to this study, other studies conducted at different Universities in Debre-Markos, Haramaya and Mizan- Tepi showed that majority of respondents mentioned the right situations when EC should be taken (Marta and Hinsermu, 2015; Semira and Mekonnen, 2016; Shiferaw, et al., 2016) respectively. Majority mentioned Health institutions (36.6%), Pharmacy (34.7%) and Private Clinics (19.7%) as the place where women can obtain emergency contraceptives. While, 9.4% of respondents mentioned it is not possible to obtain, and 16.4% didn’t know where EC can be obtained.

Majority of the discussants in focus group discussion who aware of EC also indicated that EC is used under situations like sexually assaulted, sexual intercourse without any barrier method and in case of condom slippage to prevent unwanted pregnancy. The majority said that female students can obtain emergency contraceptives from health institutions and pharmacies (both private and governmental) while 3 of discussants were not sure where they can obtain EC.

Table 4: Knowledge of EC among female undergraduate students of Hawassa University, College of agriculture Ethiopia (n=213)
Knowledge statements Frequency Percentage (%)
Situations in which EC should be taken
When forced to have sex 74 34.7
When condom slipped or broken 59 27.7
When there are missed pills 19 8.9
When pregnancy occurs 43 20.2
When there is miscalculation calendar
method 0 0
Don’t know 48 22.5
Other 0 0
Where to obtain EC
Health institutions 78 36.6
Community health workers 0 0
Private clinics 42 19.7
Pharmacy 74 34.7
Impossible to obtain 20 9.4
Don’t know 35 16.4
Other 0 0
Methods used as EC
Pills 139 65.3
IUD 20 9.4
Implant 7 3.3
Condom 33 15.5
Injectable 20 9.4
Other 0 0
Time limit for EC pills after unprotected sexual intercourse
Immediately after sex 16 11.5
Within 24 hours 18 12.9
Within 72 hours 48 34.5
Within one week 34 24.5
At any time before the first day 0 0
At the next menses 0 0
Don’t know 23 16.5
Other 0 0
Time limit for IUD after unprotected sexual intercourse
Immediately after sex 0 0
Within 24 hours 4 20
Within 72 hours 6 30
Within 5 days 4 20
At any time before the first day 0 0
At the next menses 0 0
Don’t know 6 30
Other 0 0
The drug contained in EC pills
The same as regular contraceptive pills 22 15.8
The same but stronger dose than
regular contraceptive pills 39 28.1
Completely different drug from
regular contraceptive pills 35 25.2
Don’t know 43 30.9
Other 0 0
The effectiveness of EC pills in preventing pregnancy