Emergency contraception among female university students in Sierra Leone: An exploratory study of use, knowledge, attitudes, and associated factors

Abstract

BackgroundUnintended pregnancy remains a major public health concern in Sierra Leone, where stigma, misconceptions, and access barriers hinder the timely use of emergency contraception (EC).ObjectivesTo estimate the prevalence of EC use, assess related knowledge and attitudes, and identify associated factors among female university students in Sierra Leone.DesignA cross-sectional study using convenience sampling.MethodsConducted in 2024 among 366 female undergraduate students at Njala University, Sierra Leone, using convenience sampling and a structured, self-administered questionnaire to assess sociodemographic characteristics, EC utilisation, knowledge, and attitudes. The knowledge and attitudes were scored and categorised based on the mean scores. Descriptive statistics, logistic regression, and Pearson's and Spearman's correlations were used for analysis.ResultsAmong participants, 68.3% (n=250) reported ever using EC, with 36.5% (n=91) of ever-users using it within the past four weeks and 29.5% (n=74) between one and three months prior to the survey. Of participants, 53.0% (n=194) had good knowledge, and 49.7% (n=182) had a positive attitude toward EC. Ever-use was more likely among students aged 26-30 years (AOR 3.58; 95% CI 1.42-8.90) and in year two (AOR 2.64; 95% CI 1.25-5.55), but less likely with poor knowledge (AOR 0.16; 95% CI 0.09-0.30) and negative attitudes (AOR 0.19; 95% CI 0.10-0.36). No prior history of EC use was associated with lower odds of both good knowledge (AOR 0.20; 95% CI 0.10-0.41; p < 0.001) and positive attitude (AOR 0.23; 95% CI 0.11-0.46; p < 0.001). Knowledge and attitudes were strongly correlated (r=0.659; rho=0.611; p<0.001).ConclusionEC use is widespread among sampled students but is influenced by knowledge and attitudes. These exploratory findings suggest that targeted, peer- and provider-led education to address misconceptions and improve service navigation could enhance informed contraceptive choices and reduce unintended pregnancies in this context.