Contraceptive Use and Associated Factors among Female Students in Wolaita Sodo ATVET College, Southern Ethiopia

Scientific Study, 2016
38 Pages, Grade: A





Acronyms and Abbreviation

List of table

List of figure

1. Introduction
1.2 Statement of the Problem
1.3. Significance of the Study

2. Literature Review
2.2 Gender Based Violence in College Students
2.3 Importance of Contraception for Youth
2.4 Conceptual Frame Work

3. Objective
3.1 General Objective
3.2 Specific Objectives

4.1 Study Area and Period
4.2 Study Design:-Institution based cross-sectional study design was used.
4.3 Source Population: -
4.4 Inclusion criteria
4.5 Sample Size Determination
4.6 Sampling Technique/ Procedure
4.7 Data Collection Technique
4.8 Study Variables
4.9 Data Quality Management
4.10 Data Analysis Procedures
4.11 Ethical Considerations
4.12 Dissemination of the Result

5.2 .Prevalence rate of Contraceptive utilization
5.4 Contraceptive Practices and Pregnancy Related Characteristics
5.5 Factors Associated with Contraceptive Use

6. Discussion

7.1 limitation of the study

8.1 Conclusion
8.2 Recommendations


Annex- I – Information Sheet

Annex II Questionnaire


Background: Contraceptive use by sexually active female students in a College setting is both practical and intelligent. Reliable, consistent, and therapeutically correct contraceptive use prevents unintended pregnancies and assures a greater likelihood of uninterrupted or impeded higher education for the young woman.

Objectives: The objective of this study was to assess contraceptive use and identify the factors associated with contraceptive use.

Methods: An institutional based cross-sectional survey was conducted among 1067 female college students of Wolaita Soddo ATVET from October 21, 2016 to November 9, 2016. Multistage sampling technique with Probabilities proportional to size was used. After data collection, each questionnaire was checked for completeness and consistency. Data was analyzed by manually then different frequency tables, graphs and descriptive summaries were used to describe the study variables and 95% Confidence Intervals to adjust for possible confounding variables.

Results: Of the total respondents, 598(96.5 %) of them replied that they have heard about contraceptives. Among those who have ever heard of contraceptives, 221 (35.6 %) mentioned condom only, 155 (25.6 %) mentioned pills only and 149(24.0%) Norplant and 44(7.11%). This study has shown that 450 72(%) of the female college students use contraceptive.

Conclusion: ATVET collage clinic also has high contribution on contraceptive utilization by providing access to contraceptive with multiple chooses. The collage also creating Reproductive Health Clubs in the college and enhance the awareness on contraceptive


First and foremost, I would like to thank the research team of the college for their invaluable comments and suggestions throughout the proposal work.

My special thanks and sincere appreciation also go to Wolaita Soddo ATVET College administration and health center staff as well as supervisors and study participants for contribution to the success of the data collection.

Acronyms and Abbreviation

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List of table

Table 1: Socio - demographic and academic characteristics among female college students at Wolaita Soddo ATVET College,november 2016

Table 2: Knowledge, attitude and practice about regular type of contraceptives among female College students in Wolaita Soddo ATVET College, November 2016

Table 3: Contraceptive practice and Pregnancy related characteristics among sexually active female college students at Wolaita Soddo ATVET College, November 2016

Table 4: Factors Associated with Contraceptive Use among Female Students in Wolaita Soddo ATVET College, November2016

List of figure

Figure 1 Contraceptive Use and Associated Factors

Figure 2 Percentage of type of modern regular contraceptives used by the respondents at waliata sodo ATVET collage, November 2016

Figure: - 2 Schematic presentation of sample size at waliata sodo ATVET collage, November 2016

1. Introduction

In every setting, sexual activity appears to begin during adolescence among a substantial proportion of youth. Much of this activity is risky; the practice of contraception and condom use is often erratic and unwanted pregnancy and unsafe abortions are observed in many settings. Sexual relations are not always consensual: force and coercion are far from unknown. While young people tend to be generally well informed, they have only patchy in-depth knowledge of issues related to sexuality. Moreover, expressed norms often conflict with behavior. Moreover, there are wide gender-based differences in sexual conduct, and in the ability to negotiate sexual activity and contraceptive use. Contraceptive experience of abortion-seekers suggests that practice tends to be irregular, or incorrect, and the method of choice is largely traditional (1).

Adolescent pregnancy is common place in many countries. About 16 million adolescent girls aged 15-19 give birth each year, roughly 11% of all births worldwide. Almost 95% of these births occur in developing countries. Half of all adolescent births occur in just seven countries: Bangladesh, Brazil, the Democratic Republic of Congo, Ethiopia, Nigeria, India and the United States (2).

Young people disproportionately resort to unsafe abortion due to limited availability and high cost of quality medical abortion procedures and because they have more unwanted pregnancies than older women (3). Overall risk of death from unsafe abortion is by far the highest in Africa, where the case fatality rate reaches 7 deaths per 1000 unsafe abortions (4). Pregnancies occurring among unmarried women are often unintended.

Unintended pregnancies result from contraceptive non-use, misuse, and method failure. Adolescent women are more likely not to use and to misuse contraceptive than older women (5).

In Ethiopia where approximately 33% of the population falls between the ages of 10-24, a significant proportion of the youth practice unsafe sex and sex at early age (6, 7).

The Ethiopian Ministry of Health has developed of the national adolescent and youth reproductive health (AYRH) strategy, to alleviate the RH problem youth including the contraceptive needs (8). Furthermore, it has developed standards on youth friendly reproductive health services that entailed nine standards on how the service should be provided in different settings.

However, higher learning institutions, where only young people are residing, student clinics are not being utilized for contraceptive services. In spite of this, most of the existing services are non-youth friendly, undertaken in small scale and not well organized to meet the contraceptive service needs of this section of the population (9). Having this in mind this study tried to assess the prevalence of contraceptive use and identify the associated factors among female students in Wolaita Sodo ATVET College.

1.2 Statement of the Problem

Unplanned pregnancies among young women are a worldwide problem with social and economic repercussions for the unprepared young individual (10). A critical challenge in the global effort to reduce maternal mortality is the persistence of unsafe abortion as a result of unwanted pregnancy, which accounts for 13% of Pregnancy related deaths worldwide (11).

In many low income countries, the lack of knowledge about and access to Contraceptive Use may result in women resorting to unsafe abortions, which contribute significantly to maternal morbidity and mortality (12). Each year, about 210 million women around the world become pregnant. Among them, about 75 million pregnancies (36%) are unplanned and/or unwanted. And globally, more than 20 million women experience ill health as a result of pregnancy each year (13, 14). It is estimated that between 8 and 30 million pregnancies each year result from contraceptive failure either due to inconsistent or incorrect use of contraceptive methods or failure of the method itself (15). Research studies conducted in the USA have reported that higher rates of unintended pregnancy occur among college-age women, with 60% of pregnancies among 20-24 years old being unintended. The percentage of unintended pregnancy is even higher among 18-19-year-old females (79%) (16). Unintended pregnancy poses a major challenge to the reproductive health of young adults especially in developing counties. High rates of unintended pregnancy are associated with higher incidences of abortion, & specifically unsafe abortions, which further place women at risk of death and disability.

Each year, an estimated 19 million unsafe abortion occurs in the developing world, and around 70,000 women die from abortion –related causes where abortion is often legally restricted and maternal care services are lacking. In addition to those who die from unsafe abortions, tens of thousands suffer from chronic and sometimes irreversible health consequences, including infertility (11, 17).

Unsafe abortion is often the only option available to women who wish to terminate a Pregnancy in countries where abortion is illegal /legally restricted, or where significant access barriers exist including lack of access, Knowledge or awareness and use of contraception. By expanding number of family planning’s and increasing awareness’s especially towards contraception options available to women is a critical part of increasing contraceptive coverage, decreasing unintended pregnancies and reducing maternal morbidity and mortality around the globe (18). Lack of use or access to contraceptives is a major cause of unwanted Pregnancy. More than half of all women in the developing world are at risk because they are using a traditional method with high failure rates; or they are using a reversible method that requires regulars supply; or they are using no method at all. Since no contraceptive work perfectly every time even wide spread modern contraceptive use will not completely eliminate the need for recourse to abortion (19).

Unsafe abortion as a result of unplanned/unwanted pregnancy is one of the leading causes of maternal mortality and morbidity in Ethiopia. Ethiopia has a high incidence of unwanted pregnancies and unsafe/septic abortions, particularly among adolescents. Several studies in the country have revealed that women who tend to undergo induced abortion are below the age of 30 years and are literate; many of whom being above the secondary educational level. Reasons for such huge numbers of unintended pregnancies in Ethiopia include a low rate of contraceptive use, method failure, and high unmet need for contraceptives (20).

In Ethiopia according to the survey conducted in 2000 by ESOG in nine administrative regions, 25.6 percent of 1075 abortion cases were induced abortions. Among them, 58 percent of the cases were in the age range 20-29 years. Of those pregnancies ended in abortion 60 percent were unplanned 50 percent were unwanted (21). Adolescent women face a high risk of unintended pregnancies and unsafe abortion, with devastating consequences for their lives and health (22).

According to the EDHS 2005, Ethiopia has one of the highest maternal mortality ratios in the world, estimated at 673 deaths per 100,000 live births. And in Ethiopia about 25,000 women die every year due to pregnancy and child birth complications, and several studies indicate that unsafe abortion may account for up to 25-35% of the maternal deaths in Ethiopia. Unplanned pregnancies are the result of various factors, including a lack of knowledge about menstruation and pregnancy, a lack of access to and knowledge about how to use contraceptives, difficulties in using contraceptives because of partner’s or family objections; contraceptive failure and sexual assault (23).

Wider use of contraception could prevent a substantial proportion of the millions of unplanned pregnancies that occur every year. Safe and effective hormonal preparations are available that can prevent a pregnancy by inhibiting ovulation, altering the ability of sperm to fertilize an ovum or inhibiting implantation in the womb (24, 25). Hence, this study will try to explore Contraceptive Use and Associated Factors among Female Students in Wolaita Sodo ATVET College, Southern Ethiopia.

1.3. Significance of the Study

This study is needed because contraceptives play a vital role in preventing unwanted pregnancies, induced abortions. It also helps for those female college students to have knowledge about contraceptives from being interrupted their education as a result of unwanted pregnancy. Research on Contraceptive Use and Associated Factors among college students may help to inform policy makers and education planners in Ethiopia. Unfortunately, no tangible research has been conducted in this area among the college students in the town. This study is assumed to provide baseline data for policy makers and education planners in developing appropriate evidence-based strategies and curricula in college to prevent unintended pregnancy and will have a great role for nursing and midwifery in consolidating, scaling up and keep up of the achievement in the health sectors of Ethiopia.

2. Literature Review

Fertility is high in Ethiopia. Women have an average of 5.4 children during their lifetimes and these larger families’ burden parents or caregivers in providing all that is needed for their proper care. Using contraceptives is an important step towards limiting family size. (26)

Contraceptive use in Ethiopia is not without socio-demographic predictors and cultural complexities. A variety of factors are associated with contraceptive use in the country. Major factors include marital status, educational level of wife, occupational status, family monthly income, and number of pregnancies, number of live births, number of living children, spousal educational level, and spousal occupational status. (27)

Unprotected intercourse can occur when there is coerced/ unplanned sex & when barrier methods break or dislodged or when other contraceptives are improperly used. Contraceptive Use prevents pregnancies. (28). The potential of Contraceptive Use and EC to prevent unwanted pregnancies and its utilization in developed counties has been well documented, However in vast majority of developing counties including Ethiopia the potential clients’ service providers and the services status is not well documented. Regarding the knowledge that help the women to decide whether to use or not about Contraceptive Use there is a wide gap between developed & Non- developed nations even between nations of different area. Different studies showed non developed nation have very low awareness whereas developed have higher awareness. Among six different studies in Ethiopia from 24-85.5% had heard about Contraceptive Use and Emergency contraceptive, from the six knowledge assessment studies, four studies had less than 50% awareness and only two studies in Bahirdar and Jimma University had 83.5%and 53% awareness respectively. Other studies from other countries had relatively had more awareness. For instances, studies in san Francisco 89%, Katmandu - Nepal 68 %.( 29)

A study done on Knowledge and practice of contraception among female undergraduates in the University of Lagos, Nigeria, revealed that 67.8% of the respondents reported knowing about emergency contraception. More than half (56.1%) were sexually active and of this group, 96.8% had ever practiced contraception with only 33.9% having ever practiced emergency contraception. However, only 37.8% and 36.3% of respondents who had reported knowing about contraception knew the correct time frame for effective use, and correctly identified contraceptives respectively. Among those who were aware of, and had used emergency contraception, 34.1% obtained their information from health care providers, while the larger majority obtained from friends. Knowledge and practice of emergency contraception was directly related to age, level of study, medical education, marital status, sexual activity, previous history of use of contraceptives and previous history of induced abortion. (30).Other similar Studies conducted on knowledge, attitude and practice towards Contraception and Fertility awareness among University Students in Kampala, Uganda, Makerere University showed that the mean age of the participants was 21 years. Less than half (45.1%) had ever heard about emergency contraceptive pills (ECPs).The most common sources of information about EC were friends (34%), media (24.8%) and schools (19.4%). The ever pregnancy rate was 3.4 percent and 42 percent were in a steady relationship of three or more months. The contraceptive ever-use rate was 14.5 percent. Among the users, the most common methods were condoms (48.9%) and withdrawal (23.4%).Other research conducted among Jimma university community high school students showed that, 64% of respondents heard about contraceptive where as studies among client seeking abortion at clinic had low awareness about Emergency contraception, which is only 13.5-14% of all the respondents heard about it (31 ). Reduction in unplanned pregnancies leads to lower abortion rates. It has been estimated that 43% of decline in abortions that took place between 1994 & 2000 in the United States was due to the increased availability of Contraception. (32)

Studies conducted in Addis Ababa University and Unity University College showed that 43.5% of the students said that they have heard about contraceptives. When asked about specific types of emergency contraceptives, among those who have ever heard of emergency contraceptives, 82.8% mentioned pills and 34.1% mentioned intrauterine contraceptive devices (IUCDs). About 53% of the students had positive attitude towards emergency contraceptives and only 4.9% respondents reported that they had used emergency contraceptive methods previously (33).

Similar other research conducted at Gondar University students indicated that 24.0 % thought that there are methods that can be used to prevent pregnancy when a woman had unprotected sex. Overall, 18.8% knew the correct methods of emergency contraception (pill or IUCD). Of those who mentioned pill as the only method of emergency contraception, 73.3% said the pill should be used within 72 hours after unprotected sex. Only one student used pill as emergency contraceptive. Students in the health field have 6.8 times higher knowledge on emergency contraception compared to students of FBE. Generally, there was an increasing trend in the knowledge of students when their age and year of study increases. Married or divorced students had 3.36 times higher knowledge when compared with never married students. (34)

2.2 Gender Based Violence in College Students

GBV is physical, mental or social abuse (including sexual violence) and act, attempted or threatened, done with some type of force, manipulation, or coercion & without the informed consent of the affected person/ survivor. Forms of gender based violence (GBV) include sexual violence, sexual abuse, sexual harassment, sexual exploitation, early or forced marriage, discrimination and female genital cutting. In a qualitative study by consortium of RH association (CORHA) in four universities in Ethiopia, female university students had reported they were harassed & raped both in and outside the university compasses.

In a school based survey among high school students in Addis Ababa & west Shewa prevalence of completed & attempted rape was 5% and 10% respectively. In similar study among high school students in Debark, North- west Ethiopia, sexual violence was reported by 65.3% of respondents. (35)

2.3 Importance of Contraception for Youth

Contraception involves methods of contraception used for preventing a pregnancy after unplanned or unprotected sexual intercourse. The concept appears appropriate for adolescents and students in higher institutions or those in vocational training who are engaged in sporadic and occasional sexual intercourse’s. The need for emergency contraception is clearly demonstrated by the occurrence of unwanted or induced pregnancies. In populations where most women of reproductive age don’t have access to contraception, unwanted / mistimed pregnancies occur frequently. Most victims of unwanted pregnancy are adolescents, who are expelled from school, often ending their formal education & the potential for future employment. For fear of being expelled from school, many adolescent girls resort to clandestine abortion, which often results in series complications or death.

Many adolescents are subjected to have sex sporadically, which makes contraceptive planning difficult. Other experience contraceptive failure & their failure rates may be higher than adults due to their in experience. No method of contraception is 100% effective. Furthermore, few peoples use their method perfectly every time they have intercourse thus demonstrating the need for an emergency backup method. Also many young women experience coerced sex, including rape. (31)

2.4 Conceptual Frame Work

illustration not visible in this excerpt

Figure:-1 conceptual formwork of Contraceptive Use and Associated Factors

Source: (review from different literature)

3. Objective

3.1 General Objective

To assess contraceptive use and associated factors among female students in Wolaita Sodo ATVET College, Southern Ethiopia, 2016.

3.2 Specific Objectives

1. To determine contraceptive use among female students in Wolaita Sodo ATVET College.
2. To identify factors associated with contraceptive use among female students in Wolaita Sodo ATVET College.


4.1 Study Area and Period

This study was conducted with female students in Wolaita Sodo ATVET College located in Soddo. Wolaita Soddo ATVET College is one of the 25 ATVET in Ethiopia. The college has six departments and more than 5000 students in regular, summer and weekend program. The study was conducted from October 21, 2016 to November 9, 2016.

4.2 Study Design:-Institution based cross-sectional study design was used.

4.3 Source Population: - The source population was all female students in Wolaita Sodo ATVET College. The study populations were female students residing on the Wolaita Sodo ATVET College.

4.4 Inclusion criteria: Regular

Exclusion criteria: Summer students, weekend students, night students and those who were not available during the time of questionnaires distribution.

4.5 Sample Size Determination

The sample size was determined using single population proportion formula assuming the proportion of students who are to determine and identified contraceptive use and associated factors is to be 50%. Adding non response rate of 10%, and multiplying by a design effect of 2 due to the multistage nature of the sampling method. The required samples based on the usual formula were as follows:

illustration not visible in this excerpt

Where, n=the required sample size

Z= standard score corresponding to 95% confidence interval

P= assumed proportion of aware of students towards the contraceptive.

d= the margin of error (precision) 5%

Then, n=1.962x (0.5x0.5) = 384, from un defined population so, for defined


Population was calculated as follows:

n= n0


N Where, no= the sample size from an infinite population.

N= finite population size

n = 384

N = n



1+384 = 282


By taking additional 10% contingency for non-response rate, the total sample size was: 282 +10 %( non-response rate) = 310 and considering the design effect of 2x312= 620

4.6 Sampling Technique/ Procedure

After calculating the sample size, the multistage stratified sampling was employed considering all departments and year of study in the sampling process for the selection of the study subjects.

Initially, of the whole six department three departments, Plant Sciences, Animal Sciences and Natural resources was selected randomly and the total sample size of the study was distributed over each of the department proportional to their size.

In the second stage, including all section from the selected department.Accordingly the sample size of the study allocated to each classes to their size.

Finally, the required numbers of female students were selected randomly (applying SRS) from each year of study again proportional to their size from the randomly selected section.

Sample Size Determination

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Figure: - 2 Schematic presentation of sample size at waliata sodo ATVET collage, November 2016.

Sample Proportion from Each Section

Natural Science Female Students

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Animal Science Female Students

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Plant Science Female Students

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Contraceptive Use and Associated Factors among Female Students in Wolaita Sodo ATVET College, Southern Ethiopia
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The objective of this study was to assess contraceptive use and identify the factors associated with contraceptive use.
contraceptive, associated, factors, female, students, wolaita, sodo, atvet, college, southern, ethiopia
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MA Wesen Altaye (Author), 2016, Contraceptive Use and Associated Factors among Female Students in Wolaita Sodo ATVET College, Southern Ethiopia, Munich, GRIN Verlag,


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