Emergency contraceptive pill (ECP), also known as the morning-after pill, is modern contraception and women take it to avoid pregnancy after unprotected sex or instances of contraceptive failure[1, 2]. Besides, Several studies have revealed that women who tend to undergo induced abortions are often found to be at the secondary and tertiary level of education, where ECP is often not accessible to them [3]. Wide range of global efforts are being made to achieve the fundamental goal of universal sexual and reproductive health and rights (SRHR) access, however, there remains major obstacle in achieving this goal 3 of agenda 2030 [4]. A study by Awoonor-williamset al. [5] also mentioned that emergency contraceptive use and its determinants are under rated in policy, research and consequently leading to unwanted pregnancies and promotes gender inequality. It helps young girls make well informed reproductive health decisions, giving them more control over their bodies and futures [6]. Other studies also provided convincing evidence into globally insight, as they opined that, there has been resounding existence of contraception methods as well as emergency contraceptive, but the quantum (84 million) of unplanned conceptions remain high and over half of these pregnancies end in induced abortions and over twenty-one million are unprofessionally manipulated which can easily be prevented with emergency contraceptives [3, 4]. In Ghana, approximately 200,000 abortions occurred in the year 2017, equating to 26.8 per 1000 women national abortion rate with 71% not legal [9] and majority (99.4%) of them being aware of undesirable health outcome of unsafe abortion [10].
In Ghana, Emergency contraceptive pills like postinor-2, Lydia post pill, NorLevo, and Pregnon are sold at pharmacies and family planning clinics without a prescription. Yet, the use of contraceptives has a significant regional variation with Northern region being the least [1, 7, 8, 9, 14]. In a study by Yeboah et al. [15], 79.67% of the study participants ever used emergency contraceptive post unprotected sexual intimacy and those who used emergency contraceptive due to failure of coitus interruptus were 24.69%.
About 22% of Ghana's nearly 31 million population constitutes the adolescent population whose sexual drives are high and will pursue anything possible to meet their sexual desires [16]. Most adolescents who found themselves pregnant have 80% risk of undergoing caesarian section [17]. A study conducted in Tamale by Em D. et al. [10] indicates that 22.9% of the study respondents have ever gotten pregnant at their adolescent stage and end up by aborting the pregnancy. Other studies have demonstrated good knowledge and attitude towards emergency contraceptive [13, 14, 15].
The educational status of the respondents’ parents was identified as a predictor of emergency contraceptive use and the most frequently used emergency contraceptive was condom [21] and having money [8, 15]. In studies by Yeboah et al. and Yussif et al. [15, 17] indicated that unprotected sex, knowledge level of female students about emergency contraceptive, age at first sex, history of pregnancy and past use of regular contraceptives were statistically significant determinants of emergency contraceptive use and marital status [7, 12]. Other studies by Em D. et al. and Mohammed et al. [10, 18] showed that, sexually active, age and being single were statistically significant determinants of the use. emergency contraceptive user.
One’s educational level was found to have association with contraceptive use as well as sex of the respondence with male students having higher chances of requesting contraceptives used [19, 11, 20]. Identified reasons for the use of emergency contraceptives were fear of unplanned pregnancy, a slip of condom, side effects of daily pills, menstrual period miscalculation, forceful unprotected sexual intercourse and lack of faith acceptance and age [14, 10]. Knowledge of respondent, sexual intercourse for the first time and history of conception were key determinants of emergency contraceptive use [26]. Significant determinants of modern contraceptive use were religion, age, wealth index and access to media [11].
Acceptance of emergency contraceptive use by cultural values, agreed sexual intercourse, conception after sex, contraceptive use as therapeutic purpose, free emergency contraceptive and attitude towards emergency contraceptive use did not showed a significant relationship using the binary logistic regression model however, awareness, therapeutic purpose and attitude towards emergency contraceptive use were significant in multivariate logistic model [23, 24, 11]. Studies in West Africa showed low prevalence of modern emergency contraceptive use of less than 20% among couples or those co-habiting in several countries [24, 15, 25].
Ghana`s 2014 Demographic and Health Survey shows the need for family planning services is 57%, but only 47% of that demand is achieved [32, 33].The high risk of unintended pregnancy and unsafe abortion is attributed to low level of awareness and patronage of emergency contraceptives [26]. Emergency contraceptive is the popular contraceptive method with rapid increase in use among Ghanaian women [22]. Unpublished report from the Yendi Municipal Health directorate Dhims2 in the year 2022 indicated that, the accepted rate of contraceptive use in Yendi is currently estimated to as 16%. Teenage pregnancy may often come with a long-term socioeconomic effect. Young parents typically struggle with school, work, and financial independence. Addressing emergency contraception usage among high school students may minimize the socioeconomic burden of adolescent births.
A greater number of research has been conducted on the determinants of contraceptive usage among married women and university students (who are believed to know more), as opposed to those conducted on secondary school students. Furthermore, an anecdotal report shows that there have been limited empirical studies showing the uptake of contraceptives among Secondary School adolescents in the Northern region of Ghana. A related study on Contraceptive pills by Gbagbo [21], indicated that, Senior high students are sexually active and have a woefully unmet need for contraceptive use due to sociocultural factors, misconceptions and stigma leading to high level of unwanted pregnancies and illegal abortions. The study finding further concluded that these drawbacks can hinder Ghana from attaining sustainable development goal three, highlighting the need for good health and well-being for all. To address this gap, the study aimed to assess the epidemiological determinants of emergency contraceptive use and prevalence among senior high students.