How to cite this article: Ospina J, Niño C, Vargas L. Use of the emergency contraceptive pill in university students from Tunja, Boyaca.

Ciencia e Innovación en Salud. 2020. e85: 257-265. DOI 10.17081/innosa.85

Use of the emergency contraceptive pill in university students from

Tunja, Boyaca

Uso de la píldora anticonceptiva de emergencia en estudiantes

universitarias de Tunja, Boyacá

Juan Manuel Ospina Díaz

*, Carlos Alberto Niño Avendaño

1, 2

, Ledmar Jovanny Vargas Rodríguez

Universidad Pedagógica y Tecnológica de Colombia, Tunja, Colombia

Universidad de Boyacá, Tunja, Colombia

* Corresponding author: juan.ospina@uptc.edu.co

ABSTRACT

Background: The objective of this study was to asses frequency of employ, as well, as the level of knowledge

of post-coital contraception in young female university students, living at the municipality of Tunja, Colombia

Methods: Descriptive, observational cross-sectional study. A sample of 615 students from two universities,

public one and private the other, answered a survey about knowledge, sexual practices and the use of

contraceptive methods, including the emergency contraceptive pill. Results: Mean age 21.18 years; Mean

age of onset of sexuality 16.5 years; 59.7% had a stable partner; 69.6% answered that they had taken

emergency contraception pill at least once in their life and 36.4% reported a frequency equal or greater than

twice a year, while 17.5% considered it as a contraceptive method of habitual employment. Conclusions:

Although the use of mechanical barrier methods as a method of contraception is not the objective of this study,

we found that the condom is still the most commonly used contraceptive method by university students, but not

used permanently or regularly. There is a high percentage of employment of emergency contraception pill, even

with repetitive uses in short time periods. There is a high degree of conviction among young users about the

contraceptive safety of the use of emergency contraception pill.

Article History

Received:

23 01 20

Accepted:14 07 20

Published:12 08 20

Keywords: Uncertainty; quality of life; caregivers; palliative care; nursing theory.

I. INTRODUCTION

Among Latin American adolescents and young people, it is very common

for unprotected sex to occur; One of the immediate consequences are

unwanted pregnancies, which in many circumstances significantly affect the

future of young people, being cause, in many cases, dropout and health

damages. It is estimated that in the period 2010-2014, about twenty-five

million abortions were performed, a third of them clandestine (1), in poor

technical and hygienic conditions and in countries with low development.

Emergency contraception (EC), also called the morning after pill, is an

acceptable efficiency resource to avoid unwanted pregnancy, in particular

cases such as violations or mishaps leading to the absence of contraceptive

protection.

DOI 10.17081/innosa.85

Ospina-Días

et al.

258

The most common employment recommendation is: women must start taking the emergency

contraceptive pills as soon as possible, after a sexual intercourse without adequate protection,

whatever the circumstances and the time of the current menstrual period; contraception should

be effective even until five days after intercourse, although the effectiveness of the method is

inversely related to the time elapsed, so that the sooner it is, the greater the likelihood to

preventing a pregnancy (2).

Despite the promotion of the use of emergency contraception pill as an alternative, there is still

no clarity if in the promotion and prevention processes, focused on sexual and reproductive

health, indications say clearly enough about the characteristic of being an exceptional method

(3) and that their employment should not become a sequential or "routine" method of

contraception, which is apparently true, particularly among adolescent girls and young students.

In Colombia, four emergency contraception schemes are recognized at the Ministry of Health:

1. Yuzpe or combined regimen (four pills containing Etinil Estradiol and Levonorgestrel), 2 tablets

or pills are taken until 72 hours after sexual intercourse, followed by two more tablets or pills, 12

more hours late;

2. Only progestin: pills containing levonorgestrel (two tablets or pills with 750 µg). The tablets or

pills taken within 72 hours after unprotected sexual intercourse;

3. Intrauterine device (IUD) or Copper T, It can be used until the fifth day after risky sexual

intercourse;

4. Ulipristal acetate, which can be taken until the fifth day (120 hours) after risky sexual

intercourse, prevents pregnancy in 98% of cases (4), its use is not recommended in women less

than 18 years age (5).

The available evidence suggests that currently, available information about contraceptive

methods, addressed to adolescents and young people in Latin America is relatively scarce and

not always well addressed, because health services do not adapt their information strategies to

Youth needs and expectations (6). In these circumstances, it is not uncommon to consider that

sexual and reproductive health interventions referred to adolescents and young people in general

are still directed by rigid regulations, which lead to sexual practices that occur in many cases,

under clandestine conditions and without adequate protection methods (7, 8).

In terms of strategies aimed to optimize the rational and measured use of emergency

contraception pill, it is important to consider the need for mass education strategies, aimed at

widely disseminating the benefits derived from the opportune and correct use of emergency

contraception pills; in the same way, the best methods to train dependents of pharmacies and

counseling services in sexual and reproductive health to encourage young women to use routine

contraceptive methods such as condoms, and to be able to use contraceptive use of emergency

259

method, only immediately after unprotected sex, and only as an exceptional employment

alternative.

This study lead to estimate the frequency of use as well as, the level of knowledge of post-

intercourse contraception pills, by young female university students, living in the municipality of

Tunja, Colombia, with the intention of collaborating with the institutional health authorities in the

orientation and design of public health policies aimed at optimizing the rational use of this

contraceptive technique as well as reducing the possible risks arising from excessive or

inappropriate use.

II. METHODS

A descriptive, observational cross-sectional study was designed. For this purpose, the young

female university students of two institutions of higher education, public one and private the

other, were considered as population. Sample size was estimated since a prevalence of

reported emergency contraceptive use in a Latin American country of 16% (9), with a

significance of 0.025 and 95% reliability, in 615 participants.

To collect the data, a datasheet was structured including social and demographic questions,

knowledge about contraception and emergency contraception, as well as frequency of use of

different contraceptive methods, which was revised and approved by a group of research

experts. Data collection was carried out by inserting the questionnaire in the Google Docs

application, together with an informed consent text. An invitation to participate in the study,

together with the corresponding link of the survey was sent to the active institutional email of

the students enrolled in the faculties of the corresponding universities; to proceed to answer

the questionnaire, it was necessary previously sign agree the corresponding informed consent.

When a total of 615 respondents were reached, data capture was ended.

Subsequently, an Excel database was assembled, which was analyzed using the Epi-Info 7

statistical program. In the cases of qualitative variables, a frequency analysis and the

corresponding 95% confidence intervals were performed; when there were quantitative

variables, measures of central tendency and dispersion were estimated. When it was

considered, to make correlations or comparison between variables, bivariate analysis was

carried out, with the corresponding Chi-square tests and significance value of p <0.05.

The designed protocol was submitted for assessing and approval of the corresponding

institutional Bioethics Committee, it was considered as a risk-free study, in accordance with the

guidelines of Resolution No. 8430 of 1993, issued by the Colombian Ministry of Health, which

establishes the standards scientific, technical and administrative for health research.

Participation was voluntary and subsequent to the signing of informed consent; the research

group was committed at all moments to preserve bioethical principles of confidentiality and

beneficence, guaranteeing the absolute privacy of the participants (10).

260

III. RESULTS

Characterization of the sample. 615 students, aged between 18 and 40 answered the

questionnaire; the mean age was 21.18 years (SD = 4.19), the median was 20 years. 72.9% (n

= 444) was studying the basic level of his program; 89% proceeding from urban areas; 90.0%

single and 59.7% said they had a stable couple. The average age of onset of sexual

intercourses was 16.65 years, although around 27% had their first relationship with penetration,

before they turned 16, and only 10% of those surveyed, with an average age of 18, said have

still not had sex; Table 1 shows the frequency of use of some contraceptive methods:

Table 1. Frequency of use of some contraceptive methods. University students from Tunja,

Colombia. 2017.

METHOD

PEOPLE THAT HAS USED IT

PERCENTAGE

BARRIER (CONDOM)

518

84,1%

SECUENTIAL HORMONAL METHODS

408

66,2%

NATURAL METHODS (OGINO, RITHM

220

35,7%

EMERGENCY CONTRACEPTIVE PILLS

429

69,6%

Source: own data

Among those who said they had used emergency contraceptive pill methods, it was found that

the average age at which they began using these methods was 17.4 years (SD = 2.5; median

17, mode 17); 36.34% (n = 161) showed a frequency of emergency contraception pills

employment greater than 1 time each year. When were asked about the frequency of

emergency contraception pills in the last six months, a prevalence of 38.03% (n = 208) was

found, while 16.5% (n = 102) had used it in two or more opportunities. A similar percentage of

participants, 17.7% (n = 109) stated that they considered emergency contraception pill as a

usual contraceptive method. 29.87% (n = 184) consider that the method of emergency

contraception pill completely eliminates the risk of pregnancy.

Table 2. Main symptoms referred after the employment of the emergency contraception pills.

University students from Tunja, Colombia. 2017.

LINKED SYMPTOMS

FREQUENCY (n=429)

PERCENTAGE

Nausea / Vomiting

22,30%

Headache

21,40%

Colic

10,00%

Mood changes

3,26%

Bleeding

3,50%

Source: own data

When the women were questioned that, When an unprotected sexual relationship occurred, it

would be adequate to seek the advice of a health agent, 84.9% (n = 523) answered

affirmatively, while 80.5% (n= 496) considers that, if a woman is using with hormonal

261 
 
contraceptive methods, and has forgotten or missed taking them, emergency contraception pill 
would be indicated as the best method of protection. 
 
IV. DISCUSSION  
It was found that in this population group in the city of Tunja, the age of 16.5 years for start 
sexual  activities  has  decreased,  compared  to  an  study  carried  out  in  2007  with  university 
students from this city, who reported an age of 17.5 years (11), although it is a record of age 
less than reported in other regions of the country (12). In this regard, it should be noted that 
although the age to onset of sexual relations seems to be a non-easily modifiable factor, the 
degree  of  knowledge  about  fertility  and  contraception  of  young  women  and  adolescents 
constitutes a serious obstacle to the development of sexuality in safe conditions or with low risk 
of  unwanted  events  such  as  pregnancy  or  venereal  diseases  (13).  Moreover,  to  this 
circumstance is added the fact of the spontaneity, instability and short duration of the affective 
or sex intercourses established by young women and adolescents that lead to higher rates of 
contraception failure, discontinuity, omissions and low adherence to systematic employment of 
contraceptive methods such as condom or anovulatory use in all your sexual interactions (14-
16). 
Then,  it should be considered,  which social sector  has  the responsibility  of  designing and 
implementing  communication  and  health  education  strategies  that  allow  adequate 
appropriation, as well as a solid motivation in young people and adolescents, so that in the case 
of  assuming sexual practices,  they can  consider beforehand  the risks  and the appropriate 
protection measures for the erotic experience. In various inquiries it has been found that the 
main source that provides knowledge about sexuality is made up of secondary school teachers 
(17), it is also reported in other sources that the best alternative considered by young women 
to obtain clear and reliable information on health aspects sexual and reproductive are health 
professionals (18); This is how in this work, almost 85% of the participants also expressed their 
interest  in  being  advised  mainly  by  health  personnel.  It  would  then  be  convenient  for  the 
governing authorities of the health and education sectors to propose efforts and resources 
aimed  at  focusing  the  emphasis  on  knowledge  of  sexual  and  reproductive  health  in  the 
universities that offer bachelor's degrees in education, while at the same time Faculties of health 
sciences  will  be  reinforced  in  the  areas  of  primary  care  and  preventive  medicine  the 
components of pedagogy and didactics (19). 
In relation to what has to do with the research that is being carried out on the way in which 
young women and adolescents assume the use of emergency contraception pill, it is clear that 
the interest is more focused on the frequency of use of the method, and on minor degree about 
the level of knowledge that users have about the correct way of employment, the security it 
offers and the possible risks and side effects (20). 
Another  worrying  aspect  regarding  the  level  of  knowledge  about  the  use  of  emergency 
contraception pill, has to do with the conviction reflected in the response of almost a fifth of the 
respondents that considers this practice analogous to a contraceptive sequential method, a 
circumstance that as It has been seen, can lead to significant changes in the physiology of the 
menstrual  cycle  while  negatively  modifying  the  rate  of  effectiveness  as  a  contraceptive 

262

technique (21). So far there are no known reports of adverse events associated with emergency

contraception, nor increased cardiovascular risk, it is recognized that there may be inter-

menstrual bleeding and increased period duration, as well as endometrial modifications, which

would show as significant modifications of the hormonal rhythm (22). The frequency of use, in

the last 6 months on two or more occasions of emergency contraceptive pill therapy is

consistent with that reported in an advanced study in a Latin American country, with a sample

of university students (23).

Although the use of mechanical barrier methods as a method of contraception is not the

objective of this study, we found that the condom continues being the contraceptive method

with the highest rate of use, followed by hormonal compounds, a finding that coincides with that

reported in similar studies (9). Regarding the frequency of use of emergency contraceptive pill

methods, this shows a high frequency, increased by an exaggeratedly safe vision of this method

by young adolescents, a circumstance that shows a wide informative media display of the

method, at the institutional level and also by private ones, leading to finding that in Colombia,

66% of women have received some information on emergency contraception pill (24). The

present report also coincides with the evidence regarding a determining condition for the use

of emergency contraception pill, which is the level of education of the women surveyed, since

it is clear that greater schooling increases the employment rate of the method.

However, it is clear that the dissemination that health organizations extend about convenience

of post-intercourse contraception, leads us to believe that there is no emphasis about the fact

that this is a measure of protection that should be assumed as exceptional one, that is, as a

consequence of unforeseen circumstances, given the existence of other contraceptive

alternatives that are safer and less risky. In this way it is important to keep in mind that an

exaggeratedly frequent use in short periods, can lead to health complications and a modified

negatively contraceptive efficacy (25).

From health field, it is proposed assertively that in the primary care and preventive medicine

services, education components designed for the group of young women and adolescents are

builder and structured, doing emphasis on functionality of the body and the psyche in the

spheres of sexuality is first and foremost, as well as the ways of approaching it in a conscious

and responsible way; more detailed, emphasis is placed on a methodology called pedagogical

mediation, an intervention scheme in which not only the appropriation of knowledge is sought

by the recipient, but also full awareness towards its application in real-life circumstances (26).

Moreover, it is necessary that the research centers on the biology of reproduction, seek to

deepen instrumental studies that allow optimizing more effective and long-term contraception

mechanisms with minimum side effects, in order to facilitate young people, an extensive

exercise of eroticism, without fear to unwanted or unplanned pregnancy.

In concern with the scope and limitations of this study, although definitive conclusions cannot

be made due to the sampling that turns out to be sequential and non-probabilistic, if it is

important to consider that from the exploratory findings described door is opened, to design

more elaborate studies. It is also important to consider that for university institutions, a deep

revision of their strategies of well-being and support to students is proposed, about the need to

263

formulate appropriate and effective sexual and reproductive health education strategies, aimed

at the entire academic community.

Particular interest should be given to the prevention of adverse or unwanted events in terms of

sexual and reproductive health, facilitating that young students and adolescents can freely and

safely opt for sexuality that contributes to their personal fulfillment, eliminating possible risks.

V. CONCLUSIONS

A high rate of repetitive and routine use of emergency contraception pill is found that, for about

20% of users tends to seeing it as a sequential contraceptive method, because poor knowledge

of the efficacy and safety of the method in comparison with other more effectives and less risky.

Author Contributions: Conceptualization, J.M.O, C.A.N and L.J.V; Methodology, J.M.O,

C.A.N and L.J.V.; Software, J.M.O.; Validation, J.M.O, C.A.N.; formal analysis, J.M.O, C.A.N;

research, J.M.O, C.A.N and L.J.V.; resources, NA.; data healing, NA.; writing: preparation of

original draft, X.X.; writing: review and editing, J.M.O, C.A.N.; visualization, J.M.O, C.A.N;

supervision, J.M.O.; project management, J.M.O.; fund acquisition, NA. All authors have read

and accepted the published version of the manuscript.

Founds: This investigation did not require external financial resources

Conflict of interest: The authors declare that they have no conflict of interest

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