Emergency contraceptive use in Addis Ababa, Ethiopia: Challenging common assumptions about young people’s contraceptive practices

Abstract

Drawing on an ethnographic case study of young people's (aged 18-29) use of emergency contraceptives (ECs) in Addis Ababa, Ethiopia, this article highlights areas of disconnect between how reproductive health experts envision EC use and local meanings ascribed to ECs by young people. ECsdesigned by reproductive health experts to be used only in case of emergency -were preferred by study participants over other contraceptive methods because of their ease of use, discreetness, perceived minimal side effects on beauty and future fertility, and usefulness in navigating reproductive intentions. The findings point to features that young people find desirable when it comes to contraceptive methods and suggest that common assumptions of reproductive health experts about young people's contraceptive practices need to be reconsidered, namely: 1) that young people can plan for prevention of unwanted pregnancy by buying a contraceptive method in advance; 2) that existing contraceptive technologies are appropriate for young people; 3) that young people prefer to use modern contraceptive methods; and 4) that young people in premarital relationships aim to prevent unplanned pregnancy.

Quality of Family Planning Counseling in Ethiopia: Trends and determinants of information received by female modern contraceptive users, evidence from national survey data, (2014- 2018)

“…This finding may reflect the fact that long-acting methods such as implants and IUDs have been reported to be favored and promoted as the contraception option by family planning professionals [37]. Emergency contraception use in Ethiopia is not relevant to the general population and limited to the context of adolescent and young adult premarital sexual intercourse in mostly urban areas such as Addis Ababa [38]. Female sterilization is also a method that has not been the norm nor an important method of choice across the country [15].…”

The Political, Research, Programmatic, and Social Responses to Adolescent Sexual and Reproductive Health and Rights in the 25 Years Since the International Conference on Population and Development

“…training programs [41,42]. There is also a large and growing private sector that adolescents with financial resources turn to when government services do not respond to their contraceptive needs [43,44]. However, in many countries, the private sector is largely unregulated, raising concerns about the quality of information and services provided.…”

Sexual and reproductive self care among women and girls: insights from ethnographic studies

“…Infrequent and unplanned sex, combined with fears about side effects of other hormonal contraceptives, are reasons some women and girls opt for emergency contraceptives. 25 In Ethiopia, emergency contraception is popular among young people because it can be purchased only when needed (fewer pills), allows for discreet use (users can take the pill and then throw away the box), and is believed to lack side effects and minimally affect future fertility. 25 However, users and healthcare providers are often uncomfortable when buying or prescribing these drugs because of the taboos around premarital sex.…”

“… 25 In Ethiopia, emergency contraception is popular among young people because it can be purchased only when needed (fewer pills), allows for discreet use (users can take the pill and then throw away the box), and is believed to lack side effects and minimally affect future fertility. 25 However, users and healthcare providers are often uncomfortable when buying or prescribing these drugs because of the taboos around premarital sex. Young people therefore rely on friends and partners, leaflets, and the internet for information and access to this product.…”

“…For example, research on fertility regulation among young women in Ethiopia shows that emergency contraceptives constitute a “plan A”—not a “plan B”—mode of contraception. 26 28 Alongside common information channels, such as posters placed in pharmacies and places where young people meet, Both 25 suggests printing key messages (eg, instructions for use) on the blister package because most users discard the box and the leaflet shortly after purchase to ensure discretion and using mobiles phones, the internet, and social media to deliver information. Given that most women and girls purchase emergency contraception after weekends or holidays, campaigns could be targeted around these times.…”