Central Journal of Family Medicine & Community Health

Cite this article: Biranjia-Hurdoyal SD, Beharry SBD (2015) Knowledge, Perceptions and Practice of Mauritian Female Students about Contraceptive Pills. J Family Med Community Health 2(6): 1050.

Abstract

Background: Unwanted pregnancies and unsafe abortion among teenagers remain a concern in developing countries. The proper use and knowledge on oral contraceptive pills (OCP) could prevent such situations.

Aim & Method: This study aimed at investigating the factors which could affect knowledge, attitudes and perceptions on OCP in a random sample of female students aged 14 to 20 years. The participants were interviewed with the help of a self-administered questionnaire.

Result: Of the 652 participants, 94.8% were aware of the existence of OCP and 12.3% had used or are currently using OCP. Educational institutions, peers and advertisement had major roles in awareness. The subject of ‘sex and contraception’ was still a taboo at home for 42.3%. Knowledge on OCP was significantly affected by age, educational exposure and previous use of OCP (p<0.05). Future use of OCP was reported at higher prevalence among those who had a positive attitude towards OCP as compared to those who were negative (74.3% vs 46.8%; p<0.05) and knowing someone who had previously used OCP (LR=9.4; p<0.05). Younger students had a negative attitude towards the use of OCP (p<0.05) and teenagers who had misconceptions about the side effects were less likely to use OCP in future (p<0.05). Furthermore, 29.1% of the participants reported that OCP could be used as a method of protection against sexually transmitted diseases.

Conclusion: Although the awareness of OCP was high, the knowledge was rather limited. There is an urgent need to further strengthen the on-going program of ‘sex and contraception’ at educational level.

*Corresponding authorBiranjia-Hurdoyal SBD, Department of Health Sciences, University of Mauritius, Mauritius, Tel: 230-57872652;

Submitted: 26 June 2015

Accepted: 28 August 2015

Published: 30 August 2015

ISSN: 2379-0547

Copyright© 2015 Biranjia-Hurdoyal et al.

OPEN ACCESS

Keywords•Contraception•Unwanted pregnancy•Awareness•Attitudes•Teenage pregnancy

Research Article

Knowledge, Perceptions and Practice of Mauritian Female Students about Contraceptive PillsBiranjia-Hurdoyal Susheela D* and Beharry SBDDepartment of Health Sciences, University of Mauritius, Mauritius

INTRODUCTIONOral contraceptive pills (OCP) are considered as one of the

most effective and commonly used method of contraception worldwide, with a prevalence range of 33-62% in developed countries [1]. In Asian countries, its use has been found to be low, ranging from 6% to 15.9% [2,3].

Unintended pregnancies account for approximately 50% of all pregnancies, with a prevalence of 79% among those less than 20 years, 60% among women 20-24 years [4] and 51% in women aged 40 years or above [5]. The decreasing age of sexual activity and increasing teenage pregnancies have become matters of concern in many developing countries [6,7]. Furthermore, 9 out of 10 of young women bearing child under 20 years are found in developing countries [8].

In Mauritius, the Contraceptive Prevalence Survey carried out in 2002 reported that 22% of pregnancies were unplanned

and only 18% of sexually active women were using OCP despite 98.4% of women aged between 15-49 years were aware of contraceptive pills. The survey also revealed that one in nine teenagers was either already mother or pregnant with her first child [9]. Ten years later, teenage pregnancies continued to be matter of concern as in 2012, 10.2% of all live-birth were from women of less than 20 years of age [9]. These statistics inevitably leads us to question the extent of the awareness as well as the opinions of Mauritian teenage girls about contraceptive pills. This study aimed to assess the knowledge, perceptions and practice of Mauritian teenage females about OCP.

METHODOLOGYDuring November and December 2012, a cross sectional

survey was carried out among a random sample of 652 female students aged 14 to 20 years. Given it was holiday period, the recruitment was carried out at recreational centres and

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private tuition classes from various regions of Mauritius, including both rural and urban areas. The volunteers were provided with a consent form, information sheet and a self-administered questionnaire which was designed to gather relevant information concerning the study. The questionnaire was designed in English and a total of 1000 volunteers were given a copy of same on the day of their respective recruitment. They were contacted again after one week for collection. The questions consisted of basic demographic details, respondent’s knowledge, attitude, perception on OCP, ease of access, future use of OCP, whether the topic ‘sex and contraception’ has been covered at their educational institution and whether ‘sex and contraception’ was a taboo at home or it was mentionable. The knowledge was assessed by multiple choice questions such as whether they have heard of OCP, source of information, types of OCP, its effectiveness, any possible side effects and whether it could prevent sexually transmitted diseases. Their attitudes and perceptions were mostly assessed by asking both multiple choice and open questions about what they think about OCP or their teenage friends using OCPs and whether they would use OCPs later in life. SPSS v.16.0 was used for all statistical analysis. Chi-Square test and Student’s t-test were used to determine statistical significance. A p value < 0.05 was considered significant. This study was approved by the Department of Health Sciences, University of Mauritius.

RESULTOut of the 1000 questionnaires, only 652 were complete

for analysis. Ninety four of the respondents (14.4%) were aged between 14-16 years and 85.6% 17-20 years old. Furthermore, 38.5% were from rural areas and the rest from urban areas.

It was noted that 94.8% of the respondents were aware of the existence of OCP (Table 1), with a better awareness among the 17-20 years compared to the 14-16 years (p<0.05). The main source of information on OCP was from educational institution (60%) followed by friends (56%), advertisement (49%), family member (33%) and 18% from medical source including hospital and Pharmacy. The subject ‘sex and contraception’ was a taboo at home for 42.3% of the female students while the rest stated it was a mentionable topic, out of which 34.9% reported not to be at ease during discussion.

Seventy-five percent were concerned about the possible side effects of OCP. No statistical significant difference was noted between the 2 age groups (72.2% vs 75.3%). Area of residence and

educational exposure also were not found to affect the perception on OCP side effects. The most important side effects reported in this study were future infertility/complications with pregnancy, weight gain and menstrual periods deregulations. Interestingly, 53.3% of the respondents had no idea of the effectiveness of OCP while 43.2% reported OCP as being an effective method of contraception. Those who had previously used OCP were more aware of the effectiveness of the pills than non-users (77.6% vs 38.4%; p<0.05) (Table 2).

Educational exposure on the subject of “sex and contraception” at school was found to affect knowledge on OCP. Among the 14-16 years, if students had educational exposure on the subject “sex and contraception”, knowledge on OCP was better compared to those who were not exposed (88.9% vs 51.6%; p<0.05).

The knowledge on whether OCP provided protection against sexually transmitted diseases was rather low as 29.1% of the participants reported that OCP could be used as a method of protection against same, with the lowest knowledge level among the 14-16 years age group (34.7% vs 28.4%), although not statistically significant. Possible future use of OCP was found to be higher among those who perceived OCP as a method of protection against sexually transmitted diseases (69.4% vs 53.2%; p<0.05).

It was noted that 12.3% of the respondents had used or are currently using OCP, with a higher prevalence among those aged 17-20 years (13% vs 6.9%), although the difference was not statistically significant. Area of residence and educational exposure were not found to affect practice. A higher percentage of use of OCP was noted among respondents who reported the issue as a taboo at home compared those who reported it mentionable (15.6% vs 10%; p<0.05) and among those who had a friend or acquaintance who had used OCP (16.7% vs 8.2%; p<0.05).

Furthermore, 57.9% responded positively for future use of OCP. Those who perceived that OCP use as a responsible act, were more likely to use OCP at a later stage in life as compared to those who had a negative attitude towards OCP (74.3% vs 46.8%; p<0.05). Participant who knew someone who had used OCP was more likely to use same in future (LR=9.4; p<0.05). Teenagers who had misconception about the side effects and effectiveness were less likely to use OCP in future (p<0.05). Age, area of residence and educational exposure did not affect future use of OCP.

When the students were asked about their perceptions

Table 1: Knowledge of OCP.

Knowledge Participants (n=652) %

Aware or heard of OCP 94.8

Existence of various types of OCPsCombined Oral Contraceptive Progestin-Only Emergency Oral Contraceptive Aware that different types exist but do not know what they are.

68.023.010.042.065.0

Awareness of OCP and Area of residenceRural Urban

90.097.8

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on the use of OCP, 22% were agreeable to the practice, 30.7% condemned its use, stating that frivolous teenagers used OCP and 47.3% were indifferent. Attitudes towards teenagers using OCP were also driven by the local cultural belief. Some respondents stated that use of OCP was immoral and abstinence till marriage was the best prevention against teenage pregnancy. It was noted that the younger students had a negative attitude towards the use of OCP (43.1% vs 29.1%; p<0.05).

Access to OCP was found to be relatively easy by 64.7% of the respondents, with an easier access reported by the elder group (58.9% vs 32.2%; p<0.05). The ease of accessibility was found to be similar in both rural and urban areas. Students who had educational exposure on the topic found access to the pills easier (67.2% vs 56.3%; p<0.05).

DISCUSSIONThis study revealed very important findings on the knowledge,

attitudes and perceptions of female students about contraceptive pills in Mauritius. The awareness about OCP was high (94.8%) but knowledge on types of OCP, side effects and effectiveness was low. High levels of awareness but low perceived knowledge among students have been previously reported [10-12].

It was also noted that misconceptions over side-effects was a major factor which could affect future use of OCP. Weight gain was one of the most important side effects reported by the respondents. Previous studies have reported that weight gain was not significantly affected by OCP use. Slight weight gain is normal among teenagers and might be caused by fluid retention in 30% of OCP users [13,14]. The association between use of OCP and future infertility has also been nullified by previous studies [15,16].

Regarding the attitudes toward OCP, the younger respondents strongly condemned the use of OCP and it was found that such negative attitudes could affect future use of OCP. It could be

explained by the fact that cultural belief is a very strong pillar in Mauritius and sex before marriage is not openly accepted. However, it should be noted that use of OCP was higher among those who reported ‘sex and contraception’ as a taboo at home which makes it very important to provide the teenagers with complete information on OCP at their educational institutions. Previous studies have concluded that inaccurate knowledge could lead to OCP discontinuation, low OCP use and unwanted pregnancy [7,13].

The younger respondents might be finding access to OCP difficult due to shyness as they would be reluctant to disclose at the medical store or hospital that they were sexually active. Furthermore, in Mauritius, sexual relationship with a person who is less than 16 years of age is considered as child abuse. It further prevent the teenagers from seeking help until the matter gets out of hand, in the form of unwanted teenage pregnancy.

This study shows that mere awareness about OCP is not enough. There is an urgent need to revise and reinforce the on-going programs with emphasis on the various types of OCP, time to be taken and demystify the side-effects as they were very important factors which could affect future use of OCP. This strengthening exercise would work best if it is carried out at college levels with the collaboration of relevant ministries and NGO’s.

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towards contraception in Europe and America. Reprod Health. 2013; 10: 7.

2. K M U, M N D, Kumar D E J, K K, Nagure AG, Ramadevi. Survey of the attitude to, the knowledge and the practice of contraception and medical abortion in women who attended a family planning clinic. J Clin Diagn Res. 2013; 7: 493-495.

3. Sychareun V, Hansana V, Phengsavanh A, Phongsavan K. Awareness

Table 2: Perceived effectiveness of OCP.

CharacteristicsPerceptions of OCP effectivenesseffective Not effective no idea p value

All participants (14-16 years)

43.238.9

1.50.0

53.361.1

<0.05(17-20 years) 43.8 1.6 54.6Area of schoolingUrbanRural

43.942.0

1.51.3

54.656.6 NS

Possible future use of OCPWould useWould not use

47.138.0

1.61.4

51.360.6 <0.05

Previous use of OCP YesNo

77.638.4

2.61.3

19.760.3 <0.05

Having friends/acquaintances who have used or are using OCPsYesNo

63.923.8

1.71.3

34.474.9 <0.05

Education exposure on subject “sex and taboo” at schoolAddressedNot addressed 45.4

35.91.32.1

53.462.0 NS

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Biranjia-Hurdoyal SD, Beharry SBD (2015) Knowledge, Perceptions and Practice of Mauritian Female Students about Contraceptive Pills. J Family Med Com-munity Health 2(6): 1050.

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