Health Care Providers' Knowledge of, Attitudes toward and Provision of Emergency Contraceptives in Lagos, Nigeria

Article excerpt

CONTEXT: Emergency contraception can play an important role in reducing the rate of unintended pregnancies in Nigeria. Although it is included in the national family planning guidelines, there is limited awareness of this method among clients.

METHODS: In 2003-2004, a sample of 256 health care providers with Lagos State were surveyed about their knowledge of, attitudes toward and provision of emergency contraceptives, using a 25-item, self-administered questionnaire. Frequencies were calculated for the various measures, and chi-square tests were used to determine significant differences.

RESULTS: Nine in 10 providers had heard of emergency contraception, but many lacked specific knowledge about the method. Only half of them knew the correct time frame for effective use of emergency contraceptive pills, and three-fourths knew that the pills prevent pregnancy; more than a third incorrectly believed that they may act as an abortifacient. Fewer than a third of respondents who had heard of the pills knew that they are legal in Nigeria. Of those who had heard about emergency contraception, 58% had provided clients with emergency contraceptive pills, yet only 10% of these providers could correctly identify the drug, dose and timing of the first pill in the regimen. Furthermore, fewer than one in 10 of those who knew of emergency contraception said they always provided information to clients, whereas a fourth said they never did so.

CONCLUSIONS: Nigerian health care providers urgently need education about emergency contraception; training programs should target the types of providers who are less knowledgeable about the method.

International Family Planning Perspectives, 2006, 32(2):89-93

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Emergency contraceptives can be used after unprotected intercourse to prevent unwanted pregnancy. Several methods are safe and effective, including combined hormonal contraceptives taken in a higher dose than is used for regular contraception (the Yuzpe method), the levonorgestrel-only regimen and insertion of a Copper TIUD. (1) Emergency contraception prevents pregnancy mainly by inhibiting or delaying ovulation; it cannot interrupt an established pregnancy.

In Nigeria, unintended pregnancy poses a major challenge to the reproductive health of women, particularly young adults. Some young women with unintended pregnancies obtain abortions--many of which are performed under unsafe conditions--and others carry their pregnancies to term, incurring the risk of morbidity and mortality associated with pregnancy and delivery. (2) Emergency contraceptives could play an important role in averting pregnancies attributable to nonuse or incorrect use of contraceptives, contraceptive failure, lack of knowledge about or access to methods, or coerced sex. Their use could also reduce the rate of unsafe abortion.

The Nigerian government's national family planning guidelines follow those developed by the Planned Parenthood Federation of Nigeria, which include emergency contraceptives; the federation conducts educational and dissemination activities for the general public and health care providers. Levonorgestrel-only pills (Postinor-2, a dedicated product) and combined oral contraceptives (Lo-Femenal, a regular contraceptive that in high doses can be used for emergency contraception) are the most common products used in Nigeria; they can be obtained over the counter from patent medicine shops and pharmacies. Although the pills are sold over the counter, health care providers play a critical role in informing their clients about emergency contraception, and so it is imperative that providers themselves be well informed about the methods.

According to several studies, fewer than half of Nigerian women who were aware of or had used emergency contraceptives had received information on the method from trained health care providers. (3) This indicates that many providers may have inadequate knowledge about emergency contraception or may not be effectively conveying relevant information to their clients. …