This is a descriptive cross-sectional study done in Sree Mankulavinayagar medical college and hospital, Puducherry, India to assess the knowledge, attitude and practice of EC among nursing personnel which includes staff nurse, ANM and nursing tutors.

After obtaining administrative and ethical committee approval, all the nursing personnel working in Sree Manakulavinayagar Medical College hospital (no =320) irrespective of their marital status were invited to participate in this study.They were briefed about the objectives of the study. One hundred eighty five members who consented to participate in the study were administered a self administered questionairre.

This questionairre was predesigned and pretested by the investigators and contained information on age, marital status, designation, years of experience followed by 14 questions on knowledge regarding EC like indication for EC, mode of action, availability, side effects and timing of administration of EC. Attitude towards EC was assessed using 10 questions which included questions on safety, willingness to use and recommend and willingness to attend awareness programmes on EC. Questions on practice of EC were optional as our study included both married and single nurses. Confidentiality was maintained as they did not disclose their name.

For evaluation of knowledge participants had to respond to statement using Yes / No / Do not know. They were given 1 point for correct answer and no point for a wrong answer or an unknown response. To assess attitude we used a five point Likert scale. Data was analysed using SPSS software. Descriptive analysis using percentages, mean and SD was used. One-way-ANOVA test was used to determine association among categorical variables. A p-value <0.05 was considered as significant.

Among 185 participants 141 held the position of staff nurse, 21 were ANM, 8 were senior staff with more than 6 yrs of experience and 15 were nursing tutors.

The responses to the statements reveal that at least 1/3 rd of the participants were aware of Yuzpe regimen. Only 43.24% were sure about indication for EC. Nearly 45.94% were aware of the time limit for administration but only 39.45 % were correct about the time interval for repeat dose [Table/Fig-1]. 70.27% responded that EC is contraindicated in early pregnancy as it does not act as an abortifacient, but when directly questioned about mode of action 51.35 % had responded that EC acts by causing abortion. Only 35.67% were aware that IUCD could be used as EC but nearly 48.64% were aware of Mifepristone. Awareness that EC pills are available OTC was only 30.81% which is an important observation. More than 1/2 (50.81%) of the participants had correctly said that EC could not be used in a regular basis [Table/Fig-2].

EC was felt safe by 56.75% for its users and nearly half of them were ready to use EC personally. 67.56% wanted more awareness programmes by the government and 72.97% were willing to attend them. 61.62% responded positively that using EC was better than undergoing abortion but only 37.29% had a positive attitude that EC was good for reproductive health Table/Fig-3.

The mean knowledge score and attitude score of the 185 participants as per their designation is shown in [Table/Fig-4,5].

Of these significant association was found between the duration of experience and attitude scores of staff nurse [Table/Fig-6]. The number of married and single nurses was 65 and 120 respectively and no significant association between marital status and knowledge or attitude score was found.

Regarding practice, 56.75% of the participants, were using either a temporary or permanent method of contraception. Only 22.7% of them had ever used EC but 27.02% had undergone induced abortions.

In our study 97 participants (52.43%) had good knowledge on the general information on and 95(51.35%) had a positive attitude towards EC. Takkar et al., who studied awareness of EC in working women which also included nursing personnel had reported that only 11.2% were aware of EC and only 10.3% had practiced EC whereas the willingness to use EC was 81% [5].

A similar study carried out in Sikkim reported that only 28% had actual knowledge on EC and 40% had a positive attitude towards EC [6]. In our study 30.81% of the participants were aware that EC was available OTC but 74% in the above study had awareness about its availability [6]. In a study done in Nepal on nursing personnel 65.5% knew about the dosage and administration of EC and 88.78% were aware that IUCD can be used as EC [7].

We observed that only 35.67% were aware about IUCD as a form of EC but 48.64% had said that mifepristone can be used as an EC. Thapa in his study also reported that 78.18% of their participants had a positive attitude towards EC, 80% of their participants said that EC was safe for its users and 91.7% were ready to use EC personally whereas in our study 56.75% considered it as safe and only 47.56% were ready to use EC [7]. Similar to our findings no statistically significant difference between duration of experience and knowledge was noted [7].

The mechanism of action of EC pills is still not clear even to practicing doctors as conveyed in a study by Khan et al., who reported that 96% of the doctors claimed that ECP’s worked by preventing implantation [8]. A study on nursing students who would be future service providers showed that 25.5% thought that EC acts as an abortifacient and 52.14% were not sure whether EC prevents against STD [9]. In our study too, 51.35% thought that EC acts by causing abortion and 48.64% said that EC may prevent STD. In a study carried out in Government dispensaries in Delhi which also included nursing personnel along with doctors and pharmacists, 6.1% of ANM and 5.6% of lady health visitors knew about the correct constituents, whereas right dose was known to 27.8% of staff nurse and 28% of ANM. Only 7.7% knew that it should not be given to those with confirmed pregnancy [10]. In the above study 90% said that EC should not be used in a regular basis whereas in our study only 50.8% agreed to it.

Eventhough 56.75% of our participants were protected by temporary or permanent method of contraception, 27.02% had undergone induced abortions. It is noticeable that eventhough 51.35% had a positive attitude towards EC, the actual use of EC was very low (22.7%). This indicates that participants had many misconceptions and apprehension regarding its use. 67.56% of participants wanted government to create more awareness programmes and 72.94% had expressed willingness to attend these programmes which should be utilized to create awareness among them.

National Demographic and Health survey shows that only 1% of married women had ever used ECP’s and less than 1/3rd of unmarried women knew about ECP’s [11]. Along with mass media, health care providers can do their part in promoting the use of EC which is a effective and safe method to prevent pregnancy.

Nurses with a complete knowledge and positive attitude towards EC can act as effective counsellors to the public to create awareness, improve their understanding and change their attitude towards EC.

So, training programmes to nursing personnel on EC is mandatory and regular updates are also essential to them regarding various aspects of contraception.