Abstract
BackgroundThe growing popularity of emergency contraceptives (ECs) among urban youth in Sub-Saharan Africa is accompanied by debates on morality and health. This study was situated in Addis Ababa, Ethiopia and aimed to explore how these debates affect the way in which the product is promoted at a national level, how it is dispensed by service providers, and how young people access, purchase, and get informed about ECs.MethodsData were collected using qualitative methods: observations in pharmacies, administering semi-structured questionnaires to young people in pharmacies (N = 36), informal interviews with young people (N = 65), and in-depth interviews with service providers (N = 8) and key stakeholders (N = 3).ResultsKey stakeholders, uncomfortable with high sales of ECs, and service providers, worried about women’s health, promiscuity and the neglect of condoms, stay silent about ECs. Most young people had used ECs more than once. In a context where premarital sex is morally sanctioned ECs provide young people with a way of keeping their sexual lives secret and they fit well with their sex lives that often entail infrequent sexual encounters. Young people preferred (but they are also left with no other option than) to seek information from discreet sources, including friends and partners, leaflets and the mass media. In addition, service providers misunderstood young people’s purchasing behaviour, characterized by buying ECs quickly and feeling too embarrassed to ask questions, as a rejection of counselling. The resultant lack of information about ECs sometimes led to confusion about how to take the pills.ConclusionsThe attitudes and beliefs of key stakeholders and service providers result in a lack of clear information on ECs available to young people. This could be addressed by improving the information leaflet, providing clear instructions of use on blister packages, strategically distributing posters, and service providers adopting a more proactive attitude.
Highlights
The growing popularity of emergency contraceptives (ECs) among urban youth in Sub-Saharan Africa is accompanied by debates on morality and health
Study findings suggest that young people have occasional sex, especially during weekends and around holidays, and that ECs are a more attractive and discreet option for them than other contraceptive methods that are preferable according to reproductive health experts
The findings suggest that young people have many questions about ECs, especially about side effects and how to use them, but often feel too shy or ashamed to raise these issues with service providers
Summary
The growing popularity of emergency contraceptives (ECs) among urban youth in Sub-Saharan Africa is accompanied by debates on morality and health. While ECs can be taken safely as often as needed, they are not recommended for regular use because they are less effective than other contraceptive methods and frequent use can result in menstrual irregularities [5]. They are marketed for use in emergencies only: when other contraceptives have failed (for example, after breakage or slippage of condoms), after incorrect use of contraceptives (for example, after missing one or more regular contraceptive pills), or after being forced or coerced into unprotected intercourse [7]. Repeat or regular use is considered by reproductive health experts as an ‘unintended’ way to use ECs
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