This study found that most participants had heard about emergency contraceptives, similar to previous research on adolescents 9. Although most participants knew P2 is an emergency contraceptive, it was very interesting to find that more than thirty per cent (30%) of the study participants had heard that Metronidazole could be used as an emergency contraceptive. Possibly the information might be shared between peers. A previous study among youths revealed that the majority had awareness about contraceptives, although still some factors were found to affect their use of contraceptive services 9.
Also, some awareness gaps were revealed where some of the participants reported that they use other methods, such as condoms and pills, which are methods for preventing pregnancy but not emergency contraceptives. In addition, in the current study, more than half of the participants had the experience of using emergency contraceptives, especially P2. It was astonishing to find that more than sixty per cent (60%) of the participants who have used contraceptives had the experience of using Metronidazole. This finding was interesting and can be explained by another study which linked antimicrobial misuse with social norms 10.
Additionally, among the participants who reported having used Metronidazole as an emergency contraceptive, most used more than three tablets, mostly six tablets, and had used between 1–2 times. This finding can be related to a report from a previous study which revealed that youths believed that high doses of drugs9 could prevent pregnancy. Also, among the participants who had peers with experience using Metronidazole as an emergency contraceptive reported that they used it once but in high doses. Furthermore, participants with experience using Metronidazole as an emergency contraceptive said that they got it from the pharmacy and the hospitals but were prescribed for other conditions. Easy access to prescription medicines from pharmacies without legal prescription explains the high percentage of participants obtaining Metronidazole, a prescription medication for unintended uses.
Also, some individuals who did not complete the treatment course used the remaining antibiotic for contraception. Moreover, it was exciting from the findings of this study that although more than half of the participants knew that Metronidazole was an antibiotic, some still reported it is an emergency contraceptive medicine.
The study found different sociodemographic characteristics to associate with using Metronidazole as an emergency contraceptive. The university from which the study participant came was found to be significantly associated with Metronidazole use. Few participants from institutions providing medical programs used Metronidazole as contraceptive medicine compared to those from non-medical institutions. This may be explained by the fact that participants from medical institutions might have more awareness about pregnancy prevention and contraception and the possible consequences of using Metronidazole in high doses and for unofficial indication.
Also, the participant's year of study was found to associate with Metronidazole use as contraceptive medicine. The reason could be that most participants in the early years of the study were younger and less sexually active in their early years of college/University. Still, later they become more sexually active and interact with colleagues participating in sexual actions. Moreover, other participants might be under parental guidance in the early years of college. Still, as they get used to the environment, they demand freedom which may lead to participation in risky sexual actions and hence the use of safe and unsafe pregnancy preventive measures.
Additionally, having peers with experience using Metronidazole as an emergency contraceptive was also found to associate with its use among the study participants. Previous studies also reported that using and misusing contraceptives and antibiotics have been associated with social life and peer influence 9–15. This observation may be explained by the fact that youths and age mates can easily share information and influence each other resulting in participation in healthy or non-healthy behaviours.
In the present study, many reasons were identified to influence the use of Metronidazole as an emergency contraceptive. The majority of the participants reported that they used Metronidazole because it is easy to get compared to other methods. Other reasons included being shy to ask for emergency contraceptive methods, being cheap and feeling that it has no severe side effects. Previous studies on misuse of antimicrobials and contraceptives also mentioned similar reasons, such as myths and misconceptions on conception, lack of awareness and young people's preferred source of contraceptives, and easy access and availability of medicines without prescription 9,11,13,14,16.
Another study done in Nepal reported that lack of knowledge by the consumers and financial difficulties might be another reason for antibiotics misuse 12. In the present study, possibly due to the norms and culture and the fact that the majority are not in official relationships, these youths may experience difficulties accessing recommended emergency contraception, hence using any methods that are easily accessible and affordable.
Limitations of the study
This study used a convenient sampling technique to obtain the participants; this technique might result in sampling bias.