Factors Influencing Emergency Contraceptive Prescription Among Healthcare Providers In The Accra Metropolis

ABSTRACT Introduction Emergency contraceptive pills (ECP) are one amongst the thirteen essential commodities self-addressed by the United Nations Commission on Life-Saving Commodities for ladies and youngsters. Several studies have shown that inadequate provider knowledge is an important barrier to EC provision and use in a range of settings. This study therefore sought to examine the factors influencing emergency contraceptive prescription among health providers in the Accra Metropolis. Methodology The study employed a mixed method approach. The quantitative part was a cross sectional study involving 300 participants selected using proportional quota sampling technique. In addition, 12 participants were purposively selected and interviewed for the qualitative section of the study. Both structured questionnaire and an interview guide were used to obtain information from the participants. The quantitative data was analyzed using STATA (version 13.0). Univariate analysis presented proportions of demographic characteristics, knowledge, perception, attitude and barriers to EC dispensing. Bivariate analysis presented associations between explanatory variables (age, educational level, sex, ethnicity and marital status) and outcome variables (knowledge, perception, attitude and barriers). Binary logistic regression was used to identify factors influencing EC dispensing. The qualitative data was analyzed using inductive thematic analysis. Results More than half of the providers 217 (72.3%) did not agree that the correct time for initiation of Progesterone. Contraceptive is 120 hours. Close to half of the providers 144 (48.0%) reported that POEC should be repeated if a woman vomits within two hours. About two-thirds (68%) of the providers in this study had adequate knowledge of EC while 32%  did not have adequate knowledge of EC. About two-thirds of the providers 193 (64.3%) have had the opportunity to prescribe EC. Majority of the providers 262 (87.3 %) agree that the benefits of EC outweighs its risks. More than half 59% of the providers have positive attitude towards EC. Close to half of the providers 131(43.7%) perceived EC use promotes promiscuity. More than a third (36.7% n=110) of the providers feel uncomfortable prescribing EC because of religious and or ethical reasons. About one quarter 79 (26.3 %) of the providers reported that they are reluctant to prescribe EC because of their experiences. Providers with adequate knowledge on EC were more likely to dispense EC compared with those who had inadequate knowledge (AOR=2.26; C.I. = 1.55-3.14). Providers with positive attitude towards EC were more likely to dispense EC compared with those who have significant negative attitude (AOR=3.06; C.I. =1.73-3.73). Having access to EC increased providers’ ability to dispense two times compared with having no access (AOR=2.03; C.I. = 1.59-3.18) as well as availability (AOR=2.14; C.I. =1.54-3.09). Conclusion Providers had adequate knowledge on the definitions, side effects and mode of action of ECs. A large proportion of the providers in this study have been trained on various aspects of ECs while a small proportion are only using knowledge obtained during their undergraduate studies. A little above half of the providers had positive attitude towards EC dispensing. Per the interviews, providers were not influenced by their religious and cultural beliefs in dispensing ECs. Providers in this study were clearly aware of their professional and social roles in this study. Reproductive health education should be taught in all health institutions as part of their curriculum. This will make all health care providers adequately equipped for dispensing ECs in the Accra metropolis