INTRODUCTION:

“Motherhood is a blessing of God, the womb who gives birth to a child is the greatest blessing of God” (Mother Theresa) Background of the Problem: Women are the nucleus of our society. A woman passes through many stages of life; from childhood to puberty – A time of rapid physical, cognitive, social and emotional maturing as the girl prepares for adolescence and for motherhood. Our destiny lies with the wellbeing of women’s health. Health of women is not merely a state of physical well being out also an expression of many roles they play as wives, mothers health care providers in the family and in the changed scenario even as wage earners.¹ World over, there are millions of unintended and unwanted pregnancies each year. Many of them end in unsafe abortions, while others are carried on till term and contribute to the ever-increasing population burden on the Earth. This is specially felt in developing countries like India. When not planning for a pregnancy, exposure to unprotected sex takes place often, necessitating the use of emergency contraception, to avoid the potential hazards of pregnancy termination.⁶

Birth control, also known as contraception and fertility control, are methods or devices used to prevent pregnancy. Planning and provision of birth control is called family planning. Contraceptive use in developing countries has decreased the number of maternal deaths by 40% (about 270,000 deaths prevented in 2008) and 2 could prevent 70% if the full demand for birth control were met. There are different methods of contraception, both temporary and permanent, available in India. “No woman wants an abortion. Either she wants a child or she wishes to avoid pregnancy”².

Emergency contraception or emergency birth control prevents pregnancy after sex and it must be taken in 72 hours of intercourse. Emergency contraceptive pills are also known as the morning after pill/ the day after pill/ morning after contraception. Emergency contraception may be effective up to 120 hours (5 days) after intercourse.⁸ The department of Family welfare, Ministry of health and family welfare, has introduced emergency contraceptive pills in the family welfare program, as a contribution to achieving the National population policy goals.

Emergency contraception (EC) refers to all methods of contraception that are used after intercourse and before implantation. Emergency contraception has been available for more than 30 years. The increase in the number of induced abortions globally has intensified the role of emergency contraception. In 1995, the Rockefeller Foundation convened a meeting in Bellagio, Italy to discuss emergency contraception and expand its access and use in developing countries. Soon after this meeting, a group of seven international organizations working in the field of family planning formed the Consortium for Emergency Contraception. The Consortium’s mission was especially compelling the stark reality that many unplanned pregnancies in developing countries result in illegal abortion, exacting a huge toll on women’s health and wellbeing. Most contraceptive decisions are made to avoid or postpone pregnancy. Informed reproductive decision making involves awareness of options, accurate information regarding the risks, benefits, and consequences of emergency contraception and Knowledge of its effective usage.

There are two major types of emergency contraceptive methods available: Hormonal methods emergency contraceptive pills (ECPs) & Copper-bearing intrauterine contraceptive devices (IUCDs). Levonorgestrel (LNG) only pills and Combined estrogen and progestogen pills (Yuzpe regimen) are the two types of hormonal contraception. The hormonal emergency contraception concept was introduced in India in 2000. Now even government supply of emergency contraception pill is available. In 2003 emergency contraceptive pill was introduced in health centres and hospitals by the name of EC pill in India. Over the last decade, LNG-only pills have been found to be more effective than the Yuzpe regimen for emergency contraception, with fewer side effects. One dose of 0.75mg LNG pill should be taken as soon as possible after unprotected coitus, followed by same dose taken 12hours later; both doses must be taken within 72hours of intercourse. The Yuzpe regimen consists of oral dose of ethinyl oestradiol 0.1mg with 1.0mg of dinorgestrel, taken within 72hrs of unprotected coitus and it was widely practiced since the 1970s.

Emergency contraceptive pills stops or slows down the process of ovulation (called the suppression of ovulation). It can also stop sperm from fertilizing ovum by thickening the cervical mucus and to make difficult for sperm penetration. If an egg has already been released and been fertilized, they can prevent it from implanting in the uterus wall by thinning the endometrial lining of the uterus.

The intra uterine device is also used as emergency contraception. Copper T 380A intra uterine device (ParaGard) can be inserted up to 5 days after unprotected sexual intercourse but should be inserted as soon as possible. The intra uterine device can be removed after women’s next menstrual period. Emergency intra uterine device insertion is 99.9% effective for women, who request emergency contraception 4 between 72 and 120 hours of unprotected intercourse⁷. Based on evidence from a number of studies, copper-bearing IUCDs prevent pregnancy by interfering with fertilization. It can by stop the sperm from fertilizing the egg, decreasing the number of sperm reaching the uterine tube interferes with their motility & prevents the fertilized egg from implanting in the uterus.

Emergency Contraception is safe and effective, easy to use, few temporary side-effects, safer and less invasive than surgical pregnancy termination. Today India has the right policy environment to improve the quality of Reproductive Health and quality of life of Indian women.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of structured teaching programme on knowledge & attitude regarding emergency contraception among married women in selected areas of Alappuzha district.

OBJECTIVES:

1. To Evaluate the effectiveness of structured teaching programme on knowledge and attitude of emergency contraception.

2. To find out the association between the pre test score and selected demographic variables.

HYPOTHESIS:

H1: The post test knowledge score of married women regarding emergency contraception will be significantly higher than pre test knowledge score.

METHODOLOGY:

The research design used in this study is Quasi Experimental, one group pretest post test design. A pilot study is a miniature of actual study in which the instruments are administered to the subjects drawn from the same population⁴⁰. It is a small-scale version or trail run in preparation for the major study and its main aim is to find out the feasibility and practicability of the study design.

The pilot study was conducted in the 9^th ward of Pandenkery village, Edathua, Alapuzha district from 6/2/2013 – 13/2/2013.The investigator obtained written permission from the concerned authorities prior to the study. Study was conducted among 10 married women who met the sampling criterion for the study. The purpose of the study was explained to the respondents and consent was obtained. The pre test was conducted on 6/2/2013 by structured knowledge and attitude questionnaire, followed by structured teaching programme. Post test was conducted on the seventh day 13/2/2013.Analysis of the data was done using descriptive and inferential statistics. The tools were found feasible and practical.

ANALYSIS AND INTERPRETATION:

SECTION A: Distribution of Samples according to Demographic Profile:

Table 1: (n =100)

Age	Frequency	Percentage
18-24 yrs	14	14
25-31 yrs	39	39
32-38 yrs	36	36
9-45 yrs	11	11
No. of children
1	25	25
2	60	6
3 and more	7	7
Nil	8	8
Religion
Christian	46	46
Hindu	53	53
Muslims	0	0
Others	1	1
Educational Qualification
Below 10th Class	36	36
10th Class	12	12
Pre-Degree	30	30
Graduate	21	21
Post-Graduate	1	1
Occupation
House Wife	66	66
Self Employed	12	12
Govt. Employee	3	3
Private Employee	19	19
Source of Information
Magazines	17	17
Television	30	30
Newspaper	3	3
Friends/Relatives	18	18
All the above	32	32
Duration of marital life
< 1 yr	2	2
1-5 yrs	34	34
5-10 yrs	34	34
10-15 yrs	26	26
15 yrs and more	4	4
Type of Family
Nuclear Family	59	59
Joint Family	41	41

Data presented in table-1 reveals that with regards to age, among 100 married women, 14% were in the age group of 18-24 years, 39% were in the age group 25-31 years, 36% were in the age group 32-38 years and 11% were in the age group 39-45 years. In number of children, 25% were having 1 child, 65% were having 2 children, 7% were having 3 and more children and 8% were not having children. Religion, 46% of married women were Christians, 53% were Hindus, and only 1% belongs to others category and there were no Muslims. Educational qualification of married women, 10% had 10^th class education, 12% had below 10^th class education, 30% had pre-degree education, 21% had graduate level and only 1% had completed postgraduation. Occupational status, 66% of mothers were housewives, 12% were self-employed, 3% were government employees and 19% were private employees. Source of information reveals that, 17% of samples had access to magazines, 30% had access to television, 3% had access to newspapers,18% had information from friends and relatives and 32% belongs to all the above category. Regarding duration of marital life, 2% of the samples were in less than 1 year, 34% were in 1-5yrs, 34% were in 5-10yrs, 26% were in 10-15 yrs. And 4% were in 15 yrs. and more category. Regarding type of family, that 41% belongs to joint family and 59% belongs to nuclear family.

SECTION-B Assessment of the level of Knowledge and Attitude regarding Emergency Contraception.

Assessment of level of knowledge in pre test:

Figure-1 Pre test level of knowledge

Figure 1 shows that 47% of the samples had poor knowledge level, 49% had average knowledge level and 4% had good knowledge level in the pre test.

Assessment of level of Attitude in pre test

Figure-2 Pre test level of attitude

Fig -2 depicts that 5% had poor level of attitude ,77% had average & 18% had good level of attitude in the pre test.

SECTION-C

Effectiveness of structured teaching programme on knowledge and Attitude regarding emergency contraception Comparison of the level of knowledge among pre test and post test (n=100)

Figure 1: Percentage distribution of pretest post test level of knowledge

Figure 1 presents the comparison of the level of knowledge regarding emergency contraception according to Pretest and Posttest scores. In the pre test, 47% of the samples had poor level of knowledge, 49% had average level and 4% had good level of knowledge. After structured teaching programme on emergency contraception, none of the samples were having poor level of knowledge ,9% were having average level of knowledge and 91% were having good level knowledge.

Comparison of the level of attitude among pre test and post test (n=100)

Figure-2 Percentage distribution of pre test post test level of attitude

The figure 2 presents the comparison of the level of knowledge regarding emergency contraception according to Pretest and Posttest scores. In the pre test, 5% of the samples had poor level of attitude, 77 % had average and 18% had good level of attitude. After structured teaching programme on Emergency contraception, none of the samples were having poor level of attitude, 8% were having average level of attitude and 91% were having good level of attitude.

Table-2 Paired t-test to assess the level of knowledge regarding emergency contraception. (n =100)

Test	Mean	S.D.	T	Significance (p-value)
Pre-test	10.68	3.45	21.328	p < 0.01**
Post-test	18.82	2.12	21.328	p < 0.01**

**Significant at 0.01 level

The average knowledge score regarding emergency contraception before and after structured teaching programme among married women were 10.68 and 18.82 respectively. The mean difference of 8.14 can be observed among married women. The paired ‘t’ test statistics (t=21.33, p<0.01) shows that the knowledge level has improved. To conclude that there is highly significant effect of structured teaching programme on knowledge regarding emergency contraception.

Table-3 Paired t-test to assess the level of Attitude regarding emergency contraception

Test	Mean	S.D.	T	Significance (p-value)
Pre-test	32.12	7.67	16.548	p < 0.01**
Post-test	47.47	4.82	16.548	p < 0.01**

**Significant at 0.01 level

The average attitude score regarding emergency contraception before and after structured teaching programme among married women were 32.12 and 47.47 respectively. The mean difference of 15.35 can be observed among married women. The paired ‘t’ test statistics (t= 16.55, p<0.01) shows that the attitude level has improved. To conclude that there is highly significant effect of structured teaching programme on attitude regarding emergency contraception in post test.

Table-4 Association between pre-test knowledge and selected demographic variables

		Level of Pre-test Knowledge				Test of Significance	Df	p-value
		Poor	Average	Good	Total
Age	18-24 yrs	7	7	0	14	χ² = 7.518	6	0.276
	25-31 yrs	14	22	3	39
	32-38 yrs	19	17	0	36
	39-45 yrs	7	3	1	11
	Total	47	49	4	100
No. of Children	1	10	13	2	25	χ² = 2.819	6	0.831
	2	28	30	2	60
	3 and more	4	3	0	7
	Nil	5	3	0	8
	Total	47	49	4	100
Religion	Christian	17	26	3	46	χ² = 4.98	4	0.289
	Hindu	29	23	1	53
	Others	1	0	0	1
	Total	47	49	4	100
Education Status	Below 10th Class	17	18	1	36	χ² = 6.143	8	0.631
	10th Class	6	6	0	12
	Pre-Degree	15	12	3	30
	Graduate	9	12	0	21
	Post-Graduate	0	1	0	1
	Total	47	49	4	100
Occupation	House Wife	29	34	3	66	χ² = 3.087	6	0.798
	Self Employed	7	4	1	12
	Govt. Employee	2	1	0	3
	Private Employee	9	10	0	19
	Total	47	49	4	100
Source of Information	Magazines	8	9	0	17	χ² = 6.96	8	0.54
	Television	11	18	1	30
	Newspaper	1	2	0	3
	Friends/Relatives	8	8	2	18
	All above	19	12	1	32
	Total	47	49	4	100
Duration of Marital Life	< 1 yr	1	1	0	2	χ² = 5.862	8	0.663
	1-5 yrs	13	20	1	34
	5-10 yrs	14	18	2	34
	10-15 yrs	17	8	1	26
	15 yrs and more	2	2	0	4
	Total	47	49	4	100
Type of Family	Nuclear Family	29	27	3	59	χ² = 0.873	2	0.646
	Joint Family	18	22	1	41
	Total	47	49	4	100

Table-5 Association between pre-test Attitude and selected demographic variables

		Pre-test Level of Attitude				Test of	df	p-value
		Poor	Average	Good	Total	Significance
Age	18-24 yrs	0	13	1	14	χ2 = 10.387^	6	0.109
	25-31 yrs	0	31	8	39
	32-38 yrs	4	27	5	36
	39-45 yrs	1	6	4	11
	Total	5	77	18	100
Number of Children	1	0	22	3	25	χ2 = 5.084^	6	0.533
	2	4	43	13	60
	3 and more	1	5	1	7
	Nil	0	7	1	8
	Total	5	77	18	100
Religion	Christian	1	33	12	46	χ2 = 4.989^	4	0.288
	Hindu	4	43	6	53
	Muslim	0	0	0	0
	Others	0	1	0	1
	Total	5	77	18	100
Education Status	Below 10th Class	2	30	4	36	χ2 = 5.470^	8	0.706
	10th Class	1	8	3	12
	Pre-Degree	2	20	8	30
	Graduate	0	18	3	21
	Post-Graduate	0	1	0	1
	Total	5	77	18	100
Occupation	House Wife	4	48	14	66	χ2 = 4.142^	6	0.657
	Self Employed	1	10	1	12
	Govt. Employee	0	2	1	3
	Private Employee	0	17	2	19
	Students	0	0	0	0
	Total	5	77	18	100
Source of Information	Magazines	2	13	2	17	χ2 = 7.274^	8	0.507
	Television	1	23	6	30
	Newspaper	0	3	0	3
	Friends/Relatives	1	16	1	18
	All above	1	22	9	32
	Total	5	77	18	100
Duration of Marital Life	< 1 yr	0	2	0	2	χ2 = 8.238^	8	0.411
	1-5 yrs	0	29	5	34
	5-10 yrs	2	26	6	34
	10-15 yrs	3	16	7	26
	15 yrs and more	0	4	0	4
	Total	5	77	18	100
Type of Family	Nuclear Family	3	43	13	59	χ2 = 1.62^	2	0.445
	Joint Family	2	34	5	41
	Total	5	77	18	100

Table 5 shows that there is no significant association between the attitude scores and demographic variables like age, number of children, religion, occupation, educational status, source of information, duration of marital life and type of family.

CONCLUSION:

Comparison of pre-test and post-test knowledge & attitude scores revealed that structured teaching programme regarding emergency contraception was effective. The significance (p-value) is less than 0.01, the average improvement in the knowledge, 8.14 is significant. So there is highly significant effect of structured teaching programme on knowledge and attitude regarding emergency contraception

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Received on 18.07.2024 Revised on 10.09.2024

Accepted on 07.10.2024 Published on 28.02.2025

Available online from March 26, 2025

A and V Pub Int. J. of Nursing and Med. Res. 2025; 4(1):6-12.

DOI: 10.52711/ijnmr.2025.02

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