The main findings of the study are presented below under themes that mirror the study’s objectives.
Perceived susceptibility to unplanned pregnancy
Participants not in a sexual relationship mentioned that they were not susceptible to unplanned pregnancy because they were practicing abstinence while those in sexual relationships believed that the use of contraceptives has significantly reduced their risk of getting pregnant. To many, preventing unplanned pregnancy is as simple as expressed by this participant;
You either stay away from sex or protect yourself (23 year old third year student).
Nonetheless, some participants acknowledged that unplanned pregnancy is still a risk they face because the use of contraception does not guarantee a 100 % prevention of unplanned pregnancy. Respondents generally believed that broken condoms, missed pills or outright neglect of condom use could make them susceptible to unplanned pregnancies. Their narratives suggest that sometimes a condom could break without the knowledge of the female; however if their partner informs them they could take some drugs to prevent unplanned pregnancy. One participant indicated that she practices after sex contraception because she believes her partner may deliberately not inform her.
Sometimes, you may not know that the condom burst especially if the man does not tell you (IDI, 22 years old year three student).
Perceived severity of unplanned pregnancy
Most participants consider unplanned pregnancy to have many negative consequences. The perceived stigma from friends, alienation from parents, perceived effect on education and perceived stringent financial implication were mentioned as reasons why most participants consider unplanned pregnancy to be severe. The views from some of the study’s participants capture this:
My parents are disciplinarians. My Father can disown me as a daughter if he hears that I got pregnant in school seeing how stressful it is to pay my school fees (IDI, 23 year old fourth year student).
If I get pregnant, I may not be able to cope financially. My parents would not support me if I get pregnant in school because they sent me to learn in school and I am meant to behave myself (FGD, 18 year old, second year student).
It is like a stigma to get pregnant in higher institution. People have a negative perception towards pregnancy out of wedlock. The Yoruba’s would say that “ko l’oyun, o gb’oyun ni” (A term used to express disapproval of premarital unplanned pregnancies). Your classmates would think that you are not smart enough (22 year old, fourth year student).
Many participants stated that they go the extra mile in their quest to prevent unplanned pregnancy with some even reporting having a history of abortion.
Method of preventing unplanned pregnancy
Research participants expressed strong support for abstinence and the use of condoms, referring to these as not only the safest forms of contraception but as the most efficacious ways to prevent the consequences of unplanned pregnancies. Most of the respondents in their early years of study particularly favoured abstinence, and these respondents were also the least knowledgeable about contraceptive issues. Among the sexually active participants (n = 43), especially those in the later years of study, male condom was the preferred contraceptive.
Overall, respondent’s narratives revealed three main contraceptive use patterns, namely, condom only, condom or pills, and condom, pills or douching. One respondent remarked thus about her use of the first pattern:
“I use protection, condoms of course; I always insist that my partner use a condom, because I do not think that a female condom is hygienic enough”. (IDI, 25-year old, fourth-year student).
The second pattern, the use of either condom or emergency pills, was evident in the following response:
I protect myself by using condoms or pills. I use Postinor
Footnote 1
(IDI, 20-year old, year three student).
The third pattern, condom, pills or douching, was summed up by a 24-year old respondent:
I use condom, but after sex I use drugs-Postinor - or salt and water or wash off immediately. (FGD, 24-year old, year four student).
Methods of preventing unplanned pregnancies after-sex
Most participants indicate some methods of preventing pregnancies after sex although not all methods mentioned are conventional. Respondents who did not have any knowledge of after sex contraception were relatively young and mainly in their first year of study. The study revealed that students also relied on what was locally termed “concoction” – a mixture of substances with unproven efficacy, such as salt and hot water, soft drinks, a local brand of analgesic known as Alabukun, lime and potash, and lime and Alabukun. Respondents were convinced that these concoctions were highly efficacious as after-sex contraceptives:
If unprotected sex happens, instantly, there are some drugs like lime and “Alabukun” at the same time; they work in most cases. (IDI, 24-year old, fifth-year student).
The local methods work. I have used salt and water
Footnote 2
to evacuate the sperm. It works. (FGD, 20 year old, year three student).
For one younger participant, her belief in the efficacy of “contraceptive” concoctions was based on “medical” authority”
A nurse once told me that you can drink the mixture of cold “7UP” [a brand of carbonated drink] and “Alabukun”
Footnote 3
to wash the womb (IDI, 18 year old, year one student).
Beside concoctions, some participants said they could personally testify to the efficacy of certain non-emergency contraceptive drugs. According to them, menstrogen tabletsFootnote 4, antibioticsFootnote 5, and gynaecosid tabletsFootnote 6 were particularly efficacious. Some participants were not only knowledgeable about approved emergency contraception pills (Levonorgestrel (Postinor), for example) but had personally used them.
I have used Postinor and it works (FGD, 23 years old, year four student).
The study found that in their quest to prevent unwanted pregnancy, students also relied on combinations that could prove quite dangerous, such as combining non-emergency contraceptive pills with what was described earlier as “concoctions”. One 22-year old respondent said that such a combination eliminated any chance of pregnancy after unprotected sex:
Menstrogen first, then lime and potash, can be used to prevent unwanted pregnancy. I have used this combination and it works (FGD, 22 years old year three student).
For some respondents, what worked best was a combination of emergency contraceptive pills with non-emergency contraceptive pills. As one 23-year old fourth-year student explained, EC pills such as Postinor I, Postinor 2 “worked better in combination” with non-EC drugs such as ampiclox capsules (antibiotics) and menstrogen.
Some participants preferred the combination of ECPs and concoctions:
I will use Postinor immediately, and then use very hot water and plenty of salt-just to be sure. (FGD, 21-year old, third year student).
Also as an after-sex contraceptive practice, participants reported that the method that worked for them was manual extraction of the semen through vaginal douching immediately after intercourse:
I stand up immediately and go the bathroom and try to bring out the sperm. (FGD, 28-year old fourth-year student).
You can use even Summer’s Eve Douche
Footnote 7
[a brand of vagina wash]. It would flush out the sperm. That is what I use. (FGD 26-year old fourth-year student).
While these various patterns of after-sex contraception have side effects, respondents’ narratives revealed that such side effects had become wrapped up in misconceptions and myths, even among the undergraduate students. Some of these misconceptions are illustrated in the next section.
Perceived efficacy and side effects of using emergency contraceptive pills
Firstly, the study found that some participants have doubts about the efficacy of medically approved ECPs, are exaggerating the side effects of ECPs and are associating it with infertility:
Too much of Postinor can cause damage to one’s womb, and one may not be able to fall pregnant again. (IDI, 20-year old, third-year student).
One 18-year old student’s preference for condoms was informed by her distrust of contraceptive pills:
I prefer condom, as the use of drugs are not good. It may not work and it can negatively affect the woman’s body (IDI, 18 year old, year one student).
Lastly, while the link between EC and future miscarriage is not documented as an EC complication, respondents assumed this link:
Too much of postinor-2 will weaken the wall of the womb and damage the uterus. This will cause miscarriages in the future. (IDI, 25-year old fifth-year student).
Acceptability of emergency contraception
Despite the apprehension of few participants about the side effects of EC, almost all participants indicated that they would use EC if faced with the risk of unplanned pregnancy.
“I would be scared of pregnancy risks and I would use the contraceptives like Postinor (FGD, 20 year third year student).
Even respondents who do not have knowledge of EC indicated their readiness to make use of EC if faced with the risk of unplanned pregnancies. Some indicated that they would consult a medical practitioner and the viewpoints of two students, one in year one and the other in year two, are thus presented below;
I can ask for advice from the pharmacy or anywhere (IDI, 19 year old, year one student).
I would go to the hospital, as they are experts. I cannot use pills as the pills can cause more problems. I have a friend that used pills, which caused her a lot of problems (FGD, 21 year old, second year student).
Most participants expressed a general positive attitude to the use of EC although many would rather use condoms or abstain from sex altogether.