Seyoum Alemu.pdf

COLLEGE OF HEALTH SCIENCES DEPARTMENT OF PUBLIC
HEALTH
PERCEIVED SUSCEPTIBILITY TO PREGNANCY,
CONTRACEPTIVE USE, AND ASSOCIATED FACTORS AMONG
COLLEGE FEMALE STUDENT IN FITCHE TOWN, OROMIA,
ETHIOPIA, 2022
INVESTIGATOR: - SEYOUM ALEMU GEMECHU (BSc)
A RESEARCH THESIS SUBMITTED TO SALALE UNIVERSITY,
COLLEGE OF HEALTH SCIENCES DEPARTMENT OF PUBLIC
HEALTH IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF MASTERS OF PUBLIC HEALTH IN
REPRODUCTIVE HEALTH
SEPTEMBER, 2022
FITCHE, ETHIOPIA

SALALE UNIVERSITY, COLLEGE OF HEALTH SCIENCES,
DEPARTMENT OF PUBLIC HEALTH
PERCEIVED SUSCEPTIBILITY TO PREGNANCY,
CONTRACEPTIVE USE AND ASSOCIATED FACTORS AMONG
COLLEGE FEMALE STUDENT IN FITCHE TOWN, OROMIA,
ETHIOPIA, 2022
INVESTIGATOR: -
SEYOUM ALEMU GEMECHU (BSc)
ADVISORS:-
MULUGETA MUKRIA (MPH/ASSIST. PROFESSOR)
DEGEMU SAHELU (MPH)
SEPTEMBER, 2022
FITCHE, ETHIOPIA

I
Abstract
Background: - Despite widely available and accessible contraceptive methods globally, their use
remains low among young women in low and middle-income countries, including Ethiopia.
Some research‟s showed that young women‟s perceived susceptibility to pregnancy can makes
them decide to use, not to use, or discontinue use of contraceptive methods. As a result of non-
contraceptive use about 295,000 women lost their lives during and following pregnancy and the
majority of these deaths (94%) occurred in low-income countries. Objective: The aim of this
study was to assess the perceived susceptibility to pregnancy, contraceptive use and associated
factors among college female students in Fitche town.
Method: - An institution-based cross-sectional study was conducted from March 08 – May
07/2022 among college female students in Fitche town. Simple random sampling technique was
used to select a total of 419 study participants. A pre-tested structured questionnaire was used for
gathering data. Bivariable and multivariable logistic regression analyses were performed using
SPSS version 22. AOR and P-value < 0.05 had been used to assess the strength and existence of
association with the outcome variable. Finally the result was presented by text, graph and table.
Result: - A total of 419 respondents participated in this study with a response rate of
100%. About 78% (CI: at 95% 73.7, 81.7) of the respondents were highly perceived
susceptible to pregnancy, and 40.3% (CI: at 95% 34.1, 46.2) of the study participants ever used
contraceptives. Respondents aged 20 to 24 years (AOR = 2.27; 95% CI: 1.22, 4.21) and
knowledgeable about contraceptive methods (AOR=2.13; 95% CI: 1.33, 3.42) had an association
with perceived susceptibility to pregnancy, whereas respondents who had a discussion about
family planning with their boyfriends (AOR = 3.42; 95% CI: 2.06, 5.69) and parents (AOR =
2.01; 95% CI: 1.34, 3.01) were significant association with contraceptive use. Conclusion: -
This study concluded that the prevalence of contraceptive use among female college students
was moderate and the perceived susceptibility to pregnancy of respondents was considerable
high. The age of respondents and having multiple sexual partners were predictors of perceived
susceptibility to pregnancy. Having a discussion with parents about family planning, marital
status, sexual activity, and perceived susceptibility to pregnancy were identified as predictors of
contraceptive among female college students in Fitche town. A young women in college needs to
be informed about reproductive health and the importance of the use of contraceptive.
Key word: - contraceptive use, emergency contraceptive, perceived susceptibility to pregnancy

II
Acknowledgement
First, I would like to thank Salale University College of Health Sciences department of Public
Health, for giving me this chance to conduct my study on this topic. I also would like to express
my deepest gratitude to my advisors, Mr. Mulugeta Mukra and Mr. Degemu Sahelu, for their
unreserved support during this thesis. Last but not least, I would also like to pass my deepest
gratitude and appreciation to all the staff of colleges under this study for their support, and I
would also like to acknowledge study participants for voluntarily participated in this study and
giving their time to filling out the questionnaire.

III
Table Contents
Abstract............................................................................................................................................I
Acknowledgement ..........................................................................................................................II
Table Contents .............................................................................................................................. III
List of Table .................................................................................................................................. V
List of Figure.................................................................................................................................VI
Acronym ......................................................................................................................................VII
1. Introduction................................................................................................................................. 1
1.1. Background: ......................................................................................................................... 1
1.2. Statement of the problem ..................................................................................................... 2
1.3. Significance.......................................................................................................................... 3
2. Literature review......................................................................................................................... 4
2.1. Contraceptive use................................................................................................................. 4
2.2. Perceived susceptibility to pregnancy.................................................................................. 4
2.3. Factors associated with contraceptive use............................................................................ 5
2.3.1. Socio-demographic characteristics................................................................................ 5
2.3.2. Sexual and reproductive health factors/variables .......................................................... 6
2.3.3. Knowledge of contraceptive methods ........................................................................... 7
2.3.4. External influence.......................................................................................................... 8
2.4. Factors associated with perceived susceptibility to pregnancy............................................ 9
2.4.1. Socio-demographic characteristic.................................................................................. 9
2.4.2. Sexual and reproductive health history ....................................................................... 10
3. Objective................................................................................................................................... 13
3.1. General Objective............................................................................................................... 13
3.2. Specific objective............................................................................................................... 13
4. Methods and materials .............................................................................................................. 14
4.1. Study Area and period........................................................................................................ 14
4.2. Study design....................................................................................................................... 14
4.3. Population .............................................................................................................................. 14
4.3.1. Source population........................................................................................................ 14
4.3.2. Study unit..................................................................................................................... 14
4.4. Inclusion and exclusion criteria.......................................................................................... 14
4.4.1. Inclusion criteria.......................................................................................................... 14
4.4.2. Exclusion criteria......................................................................................................... 15

IV
4.5. Sample size determination ................................................................................................. 15
4.6. Sampling technique............................................................................................................ 16
4.7. Data Collection tools and procedures................................................................................. 18
4.8. Study Variables .................................................................................................................. 18
4.8.1. Dependent variable...................................................................................................... 18
4.8.2. Independent variable.................................................................................................... 18
4.9. Operational definition ........................................................................................................ 19
4.10. Data Quality Management ............................................................................................... 20
4.11. Data Processing and Analysis .......................................................................................... 20
4.12. Ethical consideration........................................................................................................ 21
4.13. Dissemination of the study result..................................................................................... 21
5. Result ........................................................................................................................................ 22
5.1. Socio demographic characteristic of the study participants............................................... 22
5.2. Sexual and reproductive health history of the respondents................................................ 23
5.3. Reason to start sexual intercourse ...................................................................................... 25
5.4. Source of information on contraceptive methods .............................................................. 26
5.5. Health facility contribution on provision of contraceptive methods for study participants27
5.6. Perceived susceptibility to pregnancy................................................................................ 28
5.7 Contraceptive use................................................................................................................ 29
5.8. Associated Factors with perceived susceptibility to pregnancy and contraceptive use ..... 31
5.8.1: Factor associated with perceived susceptibility to pregnancy..................................... 31
5.8.2 Factor associated with contraceptive use...................................................................... 33
6. Discussion................................................................................................................................. 35
6.1. Strengths and weaknesses of the study .............................................................................. 37
7. Conclusion and recommendation.............................................................................................. 38
7.1. Conclusion.......................................................................................................................... 38
7.2. Recommendation................................................................................................................ 38
8. Reference .................................................................................................................................. 39
Annex............................................................................................................................................ 44
Annex I- Consent Form for Self-administered questionnaire................................................... 44
Annex –II Questionnaire........................................................................................................... 46
Annex III: Declaration .................................................................................................................. 77

V
List of Table
Table 1. Sample size for the second objective among female college students of Fitche town.
Oromia, Ethiopia 2022.................................................................................................................. 16
Table 2. Socio-demographic characteristics of Female college students in Fitche Town Oromia,
Ethiopia 2022................................................................................................................................ 22
Table 3. Sexual and reproductive history of female college students in Fitche town, Ethiopia,
2022............................................................................................................................................... 24
Table 4. Contraceptive utilization among female college students in Fitche town 2022 ............. 30
Table 5. Multivariable logistic regression analysis of selected variable with perception of
susceptibility to pregnancy among college female students Fitche town, Oromia, Ethiopia, 2022
....................................................................................................................................................... 32
Table 6. Multivariable logistic regression of selected factors associated with contraceptive use
among female college students in Fitche in 2022......................................................................... 34

VI
List of Figure
Figure 1. Conceptual framework of perceived susceptibility to pregnancy and contraceptive use
among female Fitche college students North shoa zone Oromia, 2022 (adapted from
literature(48,66–68). ..................................................................................................................... 12
Figure 2. For schematic presentation of sampling techniques among female college students of
Fitche town, Oromia, Ethiopia, 2022............................................................................................ 17
Figure 3. Diagrammatic presentation of reason for sexual intercourse started among college
female students in Fithe town, Oromia, Ethiopia, 2022. .............................................................. 25
Figure 4. Source of information for female college students about contraceptive methods in
Fitche town, Oromia, Ethiopia 2022............................................................................................. 26
Figure 5. Health facility contribution on contraceptive provision for female college students in
Fitche town, Oromia, Ethiopia, 2022............................................................................................ 27
Figure 6. Perceived susceptibility to pregnancy of college female students in Fitche town,
Oromia, Ethiopia, 2022................................................................................................................. 28

VII
Acronym
AGYW Adolescent Girls and Young women
AYSRH Adolescent and Young sexual and Reproductive Health
CI Confidence interval
CPR Contraceptive prevalence rate
EC Emergency contraceptive
EDHS Ethiopia demographic and health survey
FMOH Federal Minister of Health
HIV Human immune virus
LARC long acting reversible contraceptive
Min-EDHS Min Ethiopia demographic and health survey
MSc Master‟s degree in science
OCP oral contraceptive pills
SRH Sexual and Reproductive Health
SRS simple random sampling
SSA Sub-Saharan Africa
STD Sexually transmitted disease
TFR Total fertility rate
USA United States of America

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1. Introduction
1.1. Background:
Contraception as a method of family planning allows parents to have the number of children they want while
also allowing them to plan the spacing and/or delaying of their pregnancies(1). Perceived susceptibility refers to
a person‟s belief about their chances of getting a certain unhealthy condition/disease and people who believe
they are at risk for disease, illness, or unfavorable health consequences are more likely to take action to prevent
it from occurring, whereas people who believe they are not at danger or are at low risk are more likely to engage
in unhealthy activities (2).
More than 1.8 billion young people aged 10 to 24 live in this world, with more than 600 million young females
in need of youth-friendly health services such as reproductive health and family planning(3). According to a
recent report, roughly half of the world's population is under the age of 25 and most of them (90%) live in
developing countries (4). Ethiopia is characterized by rapid population growth and the second most populous
country in Africa in which most of the population is under 25 years old. Young people (10–24 years old) make
up about 35 % (33.4 million) of the total population, and the majority of college students are in the age category
of 15–24 years old (5).
Family planning is one aspect of the targets around universal access to sexual and reproductive health found in
the Sustainable Development Goals (3.7 and 5.6), implemented through multi-sector organizations, including
donors, the private sector, and the research and development community to enable 120 million additional
women and girls to have access to rights-based family planning services and supplies by 2020 (6), but according
to the World Fertility and Family Planning 2020 report, only 49% of women age 15-49 use contraceptive
methods. And also, the Ethiopian health sector transformation plan targets to increase the contraceptive
prevalence rate to 55%, reduce the total fertility rate (TFR) to 3, and help an additional 6.2 million women and
adolescents with FP services by 2020(7).
Despite these policies and strategies implemented to improve contraceptive use worldwide, 38% of pregnancies
are unintended (80 million) pregnancies annually, and in sub-Saharan Africa, unintended pregnancy accounts
for more than a quarter of the (40 million) pregnancies that occur annually (8). Young women around the world
experience a high risk of unintended pregnancy(9).

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Contraceptives are a main intervention to reduce and prevent unintended pregnancy and their negative health
consequences among young people. It also improves young women's sexual and reproductive health and social
and economic well-being, as well as reduces girls' school dropouts(10,11).
Despite widely available contraceptive methods in public health facilities, AGYW in SSA to use contraceptive
methods are a majority of them have challenges with access to contraceptive services or that negative
perception towards contraceptive use persists, and, as a result, it remains a major health problem among young
women (12–14) Women‟s perceptions of their susceptibility to pregnancy may interact with their intentions to
use contraceptives (15). Some of these perceptions appear to stem from women‟s own understanding of their
biological capacity to become pregnant, which may lead to women not using contraceptives because they
perceive themselves to be infertile or at low risk of pregnancy (16).
1.2. Statement of the problem
Childbearing at a very young age is linked to an increased risk of complications during pregnancy and
childbirth and higher rates of neonatal mortality (7). Unintended pregnancy is found to be a major public health
problem among young women aged 15–24 years, with a variety of causes and consequences such as unsafe
abortion, maternal depression, stress, inadequate prenatal care, and maternal complication(17–19) and giving
birth at a young age is not only a risk factor for pregnancy outcomes but also has a negative impact on the
mother and newborns' future well-being (19).
Worldwide, about 295,000 women lost their lives during and following pregnancy, and the vast majority of
these deaths (94%) occurred in low-income countries in 2017(20). Approximately 11% of global births occur in
adolescent girls, with 95% occurring in developing countries (21). Although contraceptives have been
considered effective in fertility regulation, their use among adolescent girls and young women (AGYW) in sub-
Saharan Africa (SSA) remains an issue that needs urgent attention (1). Unintended pregnancy among AGYW
remains a serious health and social issue throughout the world, including in Sub-Saharan Africa (SSA) (22).
In Sub-Saharan Africa, approximately 14 million unintended pregnancies occur each year (23)with young
women aged 15-24 being the most vulnerable group (4).Because of the high prevalence (about 70%) of sexually
active young women with low utilization of effective contraceptive methods (less than 10%) (4,24).
Additionally, unmarried sexually active adolescents and young women are likely to have a high unmet need for
contraception, which increases their risk of unintended pregnancies (23,25). In low and middle-income

3
countries, nearly half (49%) of pregnancies are unintended among young women (26–28). Early and unintended
pregnancies result in increased risks of maternal mortality and morbidity, premature births, low birth weight,
unsafe abortions, and social consequences such as stigmatization, school drop-out, and poverty (27).
Despite recent improvements in adolescent and youth sexual and reproductive health (AYSHR) services in Sub-
Saharan Africa (SSA), there remains a disproportionately low level of AYSRH services in SSA compared to
other parts of the world, with variations within the region (29). Ethiopia‟s government is implementing youth
policies and national adolescent and youth health strategies to support young people in increasing their access to
sexual and reproductive health services, including family planning (9). Despite this, in Ethiopia, adolescent and
youth pregnancy is a public health issue and a demographic challenge (30), and also the Ethiopian Demographic
and Health Survey report revealed that the prevalence of mistimed and unwanted pregnancies was found to be
17.00% and 8.00%, respectively, with the lowest (16%) contraceptive utilization among young women aged
15–24 years old (7), and over all prevalence of contraceptive use is 41% and the fertility rate is also 4.1, which
is far from the set target(31).
Despite widely available and accessible contraceptive methods globally, their utilization remains low among
young women in low- and middle-income countries, including Ethiopia. Some researches show that young
women‟s perceived susceptibility to pregnancy makes them decide to use, not use or discontinue use of
contraceptive methods (16,32) while other show that there are no association between contraceptive use and
perceived susceptibility to pregnancy (33). But little research has paid specific attention to determining and
identifying how perceived susceptibility to pregnancy determines contraceptive use and what factors affect their
perceived susceptibility to pregnancy among college students worldwide (15).
Therefore this study primarily determined perceived susceptibility to pregnancy and identified factors that
indirect an association with contraceptive use among female college students through assessing factors
associated with perceived susceptibility to pregnancy and finally to assess contraceptive use and identify factors
directly associated with contraceptive use.
1.3. Significance
The findings of this study will provide input to policy makers to design appropriate policy, programmes and
strategies to address factors leading to low perceived susceptibility to pregnancy and contraceptive use among
college female students. The findings of this study will be used as an important input for concerned bodies to

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strengthen family planning services and local health authorities and may inspire other researchers to do further
investigation in the future in the study area.
2. Literature review
2.1. Contraceptive use
According to a cross-sectional study design conducted in Wuhan, China among female college students,
condoms are the most commonly used contraceptive method (61.5%) and oral contraceptives are the second
most popular form of contraception method used by respondents (26.8%)(34). According to study done in the
Democratic Republic of the Congo among 1,022 sexually active women reveal that ever-use of a contraceptive
method is 31.4% among 15–24-year-olds(35).
According to a study done in Ghana among 809 sexually active unmarried adolescents and young women aged
15–24, the contraceptive prevalence rate (CPR) among adolescents and young women aged 15–24 years was
43%, with 34% using modern methods and 9% using traditional methods (29) and other studies in the same
country show that 18.7% of adolescent girls use contraceptives (36). The study results done in Uganda show
that more than half (55.1 %) have ever used any contraceptive method while only 46.6 % are using
contraceptives during the study period, with male condoms being the most commonly used method (34.5 %)
(37).
The findings in Kenya among 421 secondary school female students from sexually active students reveal that
43.0% have ever used contraceptive methods, with the pill being the most commonly used (83.6%) (38).
According to a cross sectional study done in all regions of Ethiopia, among the 982 young women 538 (54.8%)
used any contraceptive method during the time of the survey (current users) with the Oromia region at 44.8%
and ever user is 65% (39). According to a study done in four regions of Ethiopia among adolescent and young
girls aged 15–24 years to assess contraceptive utilization, ever users are 66% (40)
2.2. Perceived susceptibility to pregnancy
According to a study done in the United States, low perceived susceptibility to pregnancy is 35.8% while high
perceived susceptibility to pregnancy is 62.4% (41). Whereas another study result conducted among 1152
adolescent and young women among low income women in the USA show that 62.3% are perceived
susceptibility to pregnancy without using contraceptives and has no association with contraceptive use (42),

5
according to study findings in veterans among of young women 60% have high perceived susceptibility to
pregnancy, and this finding shows that women with low perceived susceptibility to pregnancy are less likely
than those with high perceived susceptibility to have used any contraceptive methods(43), According to a study
done in Nigeria, correctly answer their perceived susceptibility to pregnancy is 19% while 81% are incorrectly
perceived susceptibility to pregnancy during the study period and this finding show that there is no significant
association between perceived susceptibility and contraceptive use among young women (33)
According to other study done in the same country show that there are an association between perceived
susceptibility and contraceptive use(44). According to a cross-sectional study design conducted in the US,
reveals that younger female students 96% of women are high perceived susceptibility (45). The results of a
study in China show that women with low perceived susceptibility to pregnancy are less likely than women
with high perceived susceptibility to have used a highly effective method rather than one of the least effective
methods; 40% of those with low perceived susceptibility, but only 28% of those with high perceived
susceptibility, had used one of the least effective methods; conversely, use of a highly effective method was
reported by 34% of women with high perceived susceptibility, but only 26% of those with low perceived
susceptibility (29).
According to a study conducted in South Africa, reveals that the perception that one could get pregnant with
one sexual intercourse in a month was high among participants 86% perceived susceptible to pregnancy while
14% are not perceived susceptibility to pregnancy (46). According to the results, in the North-West area of the
Tshwane District of South Africa, perceptions of female teenagers contribute to non-use and discontinue use of
contraceptives (47). A study in Tanzania reveals that the main reasons for the utilization of contraception is fear
of pregnancy (49.2%) and fear of contracting HIV/AIDS (17.2%). According to a cross-sectional study design
with qualitative methods conducted in Los Angeles, inconsistent or nonuse of contraception can be partially
attributed to a low perceived risk of becoming pregnant (48).
2.3. Factors associated with contraceptive use
2.3.1. Socio-demographic characteristics
According to a population survey conducted in Pakistan based on Demographic and Health Survey data,
women‟s age, education, and residence are significant associations with modern contraceptive use, which is
more commonly used by older age, urban, and higher educational level (49). A cross-sectional design study

6
conducted among female students in four colleges in Wuhan, China reveals that younger female students (15–
19 years) had lower odds of contraceptive use than older students (20–24 years)(34).
Also, a similar study design conducted in some sub-Saharan Africa with a high fertility rate among adolescent
girls and young women shows that significant associations between age, level of education, marital status,
parity, sex of household head and decision maker in healthcare with contraception use(13) and the other cross-
sectional study design conducted in Ghana among sexually active unmarried adolescent girls and young women
aged 15–24 years reveals that level of education, place of residence, and age at first sex are not significantly
associated with contraceptive use (29).
Whereas a cross-sectional study design results show that age of women, parity, preference for children,
women‟s education and place of residence appear as strong predictors for use of modern contraception(50). A
cross- sectional population-based survey result in Democratic Republic of the Congo in North and South Kivu
among adolescent and young women reveals that primary education and religion were not associated with
modern contraceptive use (35). According to institutional based cross-sectional survey conducted among young
females in high school students of Ambo town, Young females who are in the age group of 20-24 years
are about 2.55 times more likely to use RH services than whose age ranges from 15-19 years (51). According to
cross sectional study design conducted in Ghana among sexually active female adolescents show that
educational level, occupation, religion, ethnicity and number of children they have are not significant
association with contraceptive use (52).
According to a cross-sectional survey conducted in our country, age and marital status have a statistically
significant association with contraceptive method utilization (39) and the study finding among four region of
Ethiopia contraceptive use are statically significant association with age which are youths (aged 20-24) are
more likely to use contraceptives than adolescents (aged 15-19) (53) and a cross sectional study design
conducted in Ethiopia reveal that residence and visited by health workers are significantly associated with
contraceptive use among fecund married women who want no more children (54).
2.3.2. Sexual and reproductive health factors/variables
According to a cross-sectional study design conducted among sexually active unmarried adolescent girls and
young women aged 15–24 years, overall, CPR is higher among those who have ever been pregnant (52.5%),
those who have an abortion 5 five years prior to the study (54.4%), and those who have ever given birth
(51.2%) compared with their counterparts (32.6%). Study results in South Africa show that women who have

7
experienced an unplanned pregnancy are more likely to use a contraceptive method (14). According to a cross-
sectional study design conducted in Los Angeles, women‟s decisions are primarily based on their past
experiences with the method and perceptions of side effects. Condom use was limited to sexual partners outside
of the primary relationship or when fidelity is in question (48).
According to a Ugandan study of 1008 undergraduate female students, half (51.2%) are in sexual relationships
during the study period, and nearly 70% have ever engaged in sexual intercourse, with 62.1% reporting sexual
intercourse in the previous 12 months (37).The study findings in Ghana reveal that the reason for the perception
of side-effects of contraceptives reported in the current study could be due to inadequate information, education,
and communication about contraceptives among adolescents (36).
According to a cross-sectional study done among 421 secondary school adolescent girls in Kenya, 33.7% have
ever engage in sexual intercourse and the mean age of sexual debut is 15.0 years (38). According to a cross-
sectional survey conducted in our country, age and marital status, parity, future birth intention, and knowledge
of contraceptive methods have a statistically significant association with contraceptive method utilization (39).
The study results among adolescents of age 15–19 years old in Debre Berhan town show that one hundred sixty-
two (25.0%) of the study participants are ever have sexual intercourse (55). The study conducted in Nigeria
found that participants with multiple sexual partners in 12 months prior to study period are more likely to use
contraceptive methods than with no sexual partner (33).
2.3.3. Knowledge of contraceptive methods
According to a cross sectional survey conducted in Cambodian among adolescent girls show that the main
reason not to use contraceptive is an absence of a holistic SRH literacy program in Cambodian schools‟
curriculum and as a result youth can‟t make an informed decision to use contraception as they do not have the
SRH literacy despite attaining formal education (51). According to study results in India show that 98% of
the students have knowledge about family planning and 86% of them have heard about contraceptives. Most
of them know about condoms (85%) and contraceptive pills (40%), but knowledge about permanent methods
and IUCD is poor (average 12%) (10).
And the other qualitative study conducted in Nigeria reveal that adolescents who have low awareness, poor
knowledge of contraception, and fear of side effects of contraceptive are a positive association with
contraceptive use (56) and according to the cross sectional study design result conducted in Ghana among

8
sexually active female adolescents in order to assess Respondents' knowledge on contraceptives show that
most of the participants (96%) have heard about contraceptives (52) and another study conducted in Ghana
among sexually active unmarried adolescent girls and young women aged 15 – 24 years also show that the
most commonly known contraceptive method is male condom (99%), while male sterilization is the least
known method (33%) (29).
Whereas according to a cross sectional study design conducted in Uganda among female University students
show that the most commonly known contraceptive methods are pills (86.7 %) and male condoms (88.4 %),
followed by injectable (50.3 %), IUDs (35 %) and implants (26.7 %), female condom (22.1 %), while
withdraw (34.2 %) is the most commonly mentioned traditional methods and the commonest sources of
contraceptives are Hospitals (government, 64.3 %; private, 53.6 %), clinics (general 24 %, or Contraceptives
27.4 %) and pharmacy/drugs shops (36 %) (37). According to a descriptive survey result in Nigeria 163
university students when rating factors not using contraceptive shows that a great majority (68.7%) feels
embarrass or ashamed to use or purchase condom/contraceptives(50.3% ), belief that occasional sex cannot
lead to pregnancy (28.2%), don't want or like condoms (22.7%), to always abort the pregnancy (21.5%) and
fear of side effects (9.8%) (53).
2.3.4. External influence
According to a cross-sectional survey conducted in Cambodia among adolescent girls, women‟s decisions to
access health care, including contraception, are usually made either by their husband or by another family
member (elder) in the household and physically access a nearby health care facility (57) and according to a
cross-sectional survey conducted in Wuhan, China among female students in four colleges' availability of
health-related media, convenient provision of contraceptives and birth control has a greater odds of
contraceptive use(14).
According to a community-based cross-sectional study design conducted in Nekemte, Ethiopia among street
adolescents, the main reasons for sexual activity among sexually active street adolescents are peer pressure
(81.6%), and exchange for money (49.2%) (58). And according to a community-based cross-sectional survey
result in the Democratic Republic of the Congo in North and South Kivu among adolescents and young women,
distance is not associated with modern contraceptive use (35). According to an article review conducted among
18 countries, including Ethiopia in Sub-Saharan Africa, Cultural beliefs and gender norms greatly influence

9
contraception use, peer pressure, and young women„s difficulty in negotiating condom use with male
partners(8).
According to a qualitative study conducted in Vietnam among young unmarried women with high school,
college or university students, shows that contraception use is influenced by boyfriends' feelings uncomfortable
using condoms, and therefore they feel shy and embarrassed asking them and being first boyfriends(59) and
also, according to a community-based cross-sectional survey conducted in the Democratic Republic of the
Congo, use among adolescent and young women reveals that a higher proportion are reporting opposition by
their husbands or partners (35).
According to qualitative study results in Malawi among adolescent girls, factors influencing contraceptive use
are male partners, length of stay with friends/relationships, suspecting that their partners have multiple sexual
partners, privacy at service provision, and the conducive environment and easily accessible (60). According to
study conducted among 163 university female students in Kenya when rated factors for not using contraceptives
show that because the male partner dislikes condoms, unavailability of contraception (13.5%) and fear of
parental reaction (13.5%) (53).
2.4. Factors associated with perceived susceptibility to pregnancy
2.4.1. Socio-demographic characteristic
According to a cross sectional study design conducted in US among reproductive age group concerning age of
study participants younger women have higher odd of perceived susceptibility to pregnancy and regarding to
marital status marred women have highly perceived susceptibility to pregnancy than unmarried women (41) and
in the same country according to study conducted among adolescents and young women(age category of 16 to
24 years old) with low income, never married study participants, participants in age category of 16-19 years
old have a negative association with young women perceived susceptibility to pregnancy (61).
A result of cross sectional study design conducted in Veterans among women found that study participants in
age category of 30-34 and married women have highly perceived susceptibility to pregnancy (43). According
to study conducted in Nigeria among sexually active unmarried adolescent aged 15-24 years reveals that
adolescents aged 15-19 have a lower perceived susceptibility to pregnancy than those aged 20–24 years old
(33). A community-based cross-sectional study conducted in the Afar region, show that perceived partner
norms and perceived cultural and religious norms were negatively associated with contraceptive use (62).

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2.4.2. Sexual and reproductive health history
According to cross sectional study design conducted in US among adolescent and young having equal or more
than three sexual partners during data collection period and ever had number of sexual partners equal or more
than three in their life time have a negative association with young women perceived susceptibility to pregnancy
(61). And finding in Veterans shows that history of pregnancy and knowledge are a significant association with
perceived susceptibility to pregnancy (43).
According to a cross sectional study conducted in US young women who ever had sexual intercourse without
contraceptive use, those who have two or more sexual partners by the age of 18 and first sexual intercourse in
the age before 16 years old are less likely to perceived susceptibility to pregnancy than their counterparts (15).
According to a study conducted in Nigeria among young women, the number of sexual partners has a positive
effect on their perceived susceptibility to pregnancy (33).

12
Conceptual frame work
Figure 1. Conceptual framework of perceived susceptibility to pregnancy and contraceptive use among
female Fitche college students North shoa zone Oromia, 2022 (adapted from literature (57,58,61,63)
Individual factors
Fear
Previous side effect
Lack of decision
Knowledge about
contraceptive
Socio
demographic
characteristic
Age
Residences
Marital status
Ethnicity
Years of study
Family occupation
Religion
External factors
Information
Pear pressure
Partner influence
Sexual and
reproductive
health
Sexual experience
Recurrent abortion
Number of sexual
partners
Age at sexual
initiation
Type of sexual
partner
Perceived susceptibility
to Pregnancy
Contraceptive Use

13
3. Objective
3.1. General Objective
To assess perceived susceptibility to pregnancy, contraceptive use and associated factors among female college
students in Fitche town, Oromia, Ethiopia, form March 08 – May 07/2022.
3.2. Specific objective
To describe contraceptive use among female college students of Fitche town, Oromia, Ethiopia, form March 08
– May 07/2022.
To determine level perceived susceptibility to pregnancy among female college students of Fitche town Oromia,
Ethiopia, from March 08 – May 07/2022.
To identify factors associated with perceived susceptibility to pregnancy among female college students of
Fitche town Oromia, Ethiopia, from March 08 – May 07/2022.
To identify factors associated with contraceptive utilization among female college students of Fitche town
Oromia, Ethiopia, from March 08 – May 07/2022.

14
4. Methods and materials
4.1. Study Area and period
The study was conducted in Fitche town, North shoa, Oromia regional state, Ethiopia. It is located 114kms
northwest of Addis Ababa; Fitche town has 4 urban administrative kebeles. There are two college in the town
namely Fitche teacher training college, and Politechnique college. The total number of female students in the
colleges was 1289.
In the town there are one governmental general hospital (Salale University comprehensive hospital and two
health centers, six medium clinics, four lower clinics and 16 drug venders are found in the town and the two
health center give YFS. The study was conducted from March 08 – May 07/2022.
4.2. Study design
Institution based cross sectional study design was conducted
4.3. Population
4.3.1. Source population
The source populations were all female college students found in Fitche town.
4.3.1. Study population
The study populations were all female college students found in Fitche town.
4.3.2. Study unit
Individual female students
4.4. Inclusion and exclusion criteria
4.4.1. Inclusion criteria
All female students found in both colleges.

15
4.4.2. Exclusion criteria
Female students who were ill and unable to respond
4.5. Sample size determination
The sample size was determined by using the single population proportion formula with the assumption of p-
54.8 % (39), 95% confidence interval , and 5% marginal error, for contraceptive use
n=(Zα/2)2
P (1-P)
d²
n= (1.96) ² x 0.548(1-0.548) = 381 study participants
(0.05)²
By considering 10% nonresponse rate the finally sample size became 419 study participants.
Second objective: for the perceived susceptibility to pregnancy I was also use the same assumption as above with
p-value 43.5% (64). For the 2nd
objective I was use Epi info and the sample size was after adding 10 non
response rate was 321 with assumption of p=0.435 and margin error 5% and for the 3rd
and 4th
objective Epic
info version 7.2.5 was used and the result showed in table 1.

16
Table 1. Sample size for the 3rd
and 4th
objective among female college students of Fitche town. Oromia,
Ethiopia 2022.
** Variable selected for objective of factors associated with contraceptive while * Variable selected for
objective of factors associated with perceived susceptibility to pregnancy
The largest sample size among four objective was 419 which was a contraceptive prevalence taken from study
done in Ethiopia among adolescents and young women in age between 15-24 years old (39)
4.6. Sampling technique
At first, the determined total sample size was proportionally allocated to each college, and then in each college,
stratifying methods were employed based on their department and also within the department stratifying based
on their study years, and sample sizes were proportionally allocated for each study year. Finally, data was
collected from 419 female college students who were selected by simple random sampling methods from their
respected department and year of study.
S.N Factors Exposed Unexposed power Margin
of
error
OR Sample
size
By
adding
10%
Reference
Age** 49% 43% 0.84 1.96 1.66 107 118 (39)
Marital
status**
65% 48 0.84 1.96 1.61 285 314 (39)
Age * 58% 33% 0.84 1.96 1.76 309 341 (42)
Knowledge
on
contraceptive
methods*
42% 43% 0.84 1.96 0.56 138 152 (43)

17
Figure 2. For schematic presentation of sampling techniques among female college students of Fitche town,
Oromia, Ethiopia, 2022
Total number of female each
colleges
Teacher Training College 225
Politechniques College 1064
Total female students in both colleges were 1289
By proportional allocation of 419 sample s
PTC sample size was 346 TTC sample size was 73
419 participants will be
selected by SRS method
Agriculture
194
Building
construction
91
Electrical
and
infro
techno
225
Hoteland
tourizim181
Industry
and
development
158
Labour
and
social
services
215
Agriculture
63
Building
construction
30
Electrical
and
infro
techno
73
Hoteland
touri
59
Industry
and
development1
51
Labour
and
social
services
70
English
language
19
Maths
53
Afan
Oromo
86
Natural
science
67
English
language
6
Natural
science
22
Afan
Oromo
30
Maths
17

18
4.7. Data Collection tools and procedures
Data was collected by using a structured questionnaire which was adapted from similar studies(35,46,65,66).
The questionnaire was adapted originally in English and translated to Afan Oromo and retranslated to English to
check for its consistency, and the Afan Oromo language questionnaire was used to collect data. One diploma
nurse and one midwife were recruited as data collectors and supervised by one environmental health
professional. The questionnaire had six parts: Part I: socio-demographic variables, Part II: focusing on sexual
experience, Part III, pregnancy knowledge assessment related questions Part IV: assessment of perceived
susceptibility to pregnancy, Part V: external influencing factors and Part IV focused on contraceptive
utilization.
4.8. Study Variables
4.8.1. Dependent variable
Contraceptive use: it was determined by Yes (used) or No (not used).
Perceived susceptibility to pregnancy: it was determined by highly perceived susceptibility to pregnancy and
low Perceived susceptibility to pregnancy after computing the question used for assessment of perception
4.8.2. Independent variable
Socio demographic characteristic
Age
Residences
Marital status
Ethnicity
Years of study
Family occupation
Religion
Sexual and reproductive health
Number of partners
Sexual experience
Abortion
Unintended pregnancy
Age at sexual initiation

19
Sexual violence
External factors
Information
Pear pressure
Partner influence
Parents influence
Individual factors
Fear
Previous side effect
Lack of decision
Knowledge about contraceptive
4.9. Operational definition
Contraceptive use: The use of contraceptive method to delay pregnancy and Spacing/limiting of children in a
family through the practice of contraceptive, or whose sexual partner is using, at least one method of
contraception, regardless of the method used(67)
Current contraceptive uses: -The use of any method of contraception within the last 12 months (68).
Sexually active: Those respondents who reported that they have had sexual intercourse, irrespective of their
marital status within the last six months (69).
Ever use contraceptive: use of any method of contraceptive at least once during the sexual life (68).
Modern contraceptive methods:- Modern methods include male and female sterilization, injectable,
intrauterine devices (IUDs), contraceptive pills, implants, female and male condoms, standard days method,
locational amenorrhea method, and emergency contraception(7)
Perceived susceptibility of pregnancy: The perceive susceptibility assessment involved ten items using a 5-
point Likert scale (5 =strongly agree, 4=agree, 3=Neutral, 2=disagree 1=strongly disagree) then after the
maximum value is 50 and the minimum value is 10 and the computed result will be categorized into highly
perceived susceptibility to pregnancy and Low perceive susceptibility pregnancy.
Highly perceive susceptibility:- score > 25 from question asked for assessment of perceive susceptibility to
pregnancy

20
Low perceive susceptibility:- Score ≤25 from question asked for assessment of perceive susceptibility to
pregnancy
4.10. Data Quality Management
First, the questioners were prepared in English and translated into Afan Oromo. A pre-test was conducted on
5% of total sample size before actual data collection in TVET in Sheraro (D/Tsige) town. Then, after correction
and modification is done based on the gap identified during pretest finding, Three days of training were given
for data collectors on the aim of the research, the content of the questionnaire, and the ways of data collection.
The questionnaires were self-administered and, after being filled out, they were put in the locally prepared
boxes to increase the confidentiality of study participants. The collected data was reviewed and checked for
completeness, accuracy, and consistency by the supervisor and principal investigator.
4.11. Data Processing and Analysis
The collected data was checked for completeness by the researcher, and then the data was coded, entered into
Epi Data Manager Version 4.6.0, and exported into SPSS version 22 for further analysis. A frequency
distribution was calculated to describe the study population in relation to relevant variables. Exploratory data
analysis was done to check potential outliers and Cronbach‟s alpha was checked to assure internal consistency
of perception and knowledge assessment questions. Multicollinearity coefficients were assessed to check for
correlations within the independent variables.
A binary logistic regression analysis was computed to assess the crude association between dependent and
independent variables. Since the outcome variable was dichotomy (1 = Yes and 0 = No), binary logistic
regression was fitted to identify important factors associated with contraceptive utilization. Variables with a p-
value 0.25 in the bivariable logistic regression analysis were entered into the multivariable logistic regression
analysis conducted by using a backward stepwise solution to identify variables that had a statistically significant
association with the outcome variable. Model fitness was checked by using the Hosmer-Lemshow test. Finally,
predictor variables were declared as having a significant association with the outcome variable based on AOR,
confidence interval at 95% and a P-value less than 0.05 and the finding was presented through tables, text and
graphs.

21
4.12. Ethical consideration
Ethical approval was obtained from the research and Ethical Committee (REC) of Salale University College of
health science. Supportive letter was written by public health department for the two colleges and college gives
a permission letter. Finally informed verbal consent or permission was obtained from study participants. The
freedom of students to participate or not to participate in the study respected. The student‟s privacy during the
data collection was maintained and the data obtain from them was kept confidential.
4.13. Dissemination of the study result
The final report of the study will be presented to college of health science, department of public Health, Salale
University during the final thesis presentation. Result of the study will also be communicated to study area such
as colleges, town and zonal health offices, and other relevant organizations working around sexual reproductive
health both in hard and soft copy. Finally efforts will be made publish the finding of the study peer reviewed
journal.

22
5. Result
5.1. Socio demographic characteristic of the study participants
A total of 419 female college students participated in the study, a response rate of 100%. More than 87.1% of
the respondents were between the ages of 20–24 years, with the mean age of 21.27 (1.79) years. In terms of
ethnicity and marital status, the majority of respondents were Oromo (393, 93.8%) and single (367, 87.6%),
respectively. Concerning the religion, family occupation and address of the respondents, the highest proportions
were orthodox followers (358, 85.4%), farmers 335 (80%) and rural residents 323 (77.1%) respectively
(Table.2).
Table 2. Socio-demographic characteristics of Female college students in Fitche Town Oromia, Ethiopia
2022
Variable Category Frequency Percent
Age category
15-19 54 12.9
20-24 365 87.1
Ethnicity
Oromo 393 93.8
Amhara 26 6.2
Religion
Orthodox 358 85.44
Muslim 10 2.38
Protestant
Others **
47
4
11.21
0.95
Address
Rural 323 77.1
Urban 96 22.9
Marital status
Single 367 87.6
Married 52 12.41
Family Occupation
Farmer 335 80.0
Merchant 35 8.4
Government employee 33 7.9
Private worker/employee 16 3.8
**Other represents in religion catholic and Wekefata

23
5.2. Sexual and reproductive health history of the respondents
Of 419 respondents, 343(81.9%) reported that they had boyfriends, and among those who had boyfriends,
190(55.4%) had communication about sexual issues with their boyfriends. From the total respondents,
273(65.15%) ever had sexual intercourse and among them, 15(5.5%) had started sexual intercourse between the
ages of 10–14 years old, with the mean age to start sexual intercourse was 17.86 (SD±2.322), and whereas
among those who ever had sexual intercourse, 151(55.3%) were currently sexually active, the majority of them,
139 (92.1%) had only one sexual partner.
Concerning first sexual partners, 123(45.05%) were with their steady friends. Among respondents who ever had
sexual intercourse, 68 (24.9%) had history of pregnancy, of which 40 (58.8%) were unplanned, and among
those unplanned pregnancy, 29 (74.4%) had an abortion, with 28 (96.55%) having had only one abortion.
Regarding communication about contraceptive methods, 179(42.7%) and 190(45.4%) ever had communication
(discussion) with their parents and boyfriends about contraceptive methods, respectively (Table 3).

24
Table 3. Sexual and reproductive history of female college students in Fitche town, Ethiopia, 2022
Variable Category Frequency Percent
Ever had boy friends Yes 343 81.9
No 76 18.1
Ever discuss about family planning with
boy friends
Yes 174 50.70
No 169 49.27
Age at first sexual intercourse 10-14 15 5.5
15-19 153 50.04
20-24 105 38.46
Ever had sexual intercourse Yes 273 65.15
No 146 34.85
Number of sexual partner ever had Only one 180 65.93
Two and above 93 34.06
Current Sexual intercourse No 122 44.68
Yes 151 55.31
Number of current sexual partner Only one 139 92.1
Two and above 12 7.9
Ever had pregnancy Yes 68 24.91
No 205 75.09
Ever had abortion Yes 31 45.6
No 37 54.4
Ever had unplanned pregnancy Yes 40 58.8
No 28 41.2
Result of unplanned pregnancy Alive baby 9 22.5
Abortion 31 77.5
Ever had Number of abortion Only one 28 90.3
Two and above 3 9.7
Ever had discuss about family planning
with parents
Yes 179 42.7
No 240 57.3
Have you ever sexual communication with
boy friends
Yes 190 55.4
No 153 44.6
With whom you had sexual intercourse for
the first time
Steady Friend 123 45.05
Causal Friend 67 24.54
Husband 50 18.31
Family Member/Relatives 33 12.09

25
5.3. Reason to start sexual intercourse
The majority of respondents 141 (52%) began sexual intercourse as a result of falling in love (Fig.3).
Figure 3. Diagrammatic presentation of reason for sexual intercourse started among college female
students in Fitche town, Oromia, Ethiopia, 2022.
Fall of love
52%
Desire of sexual
intercourse
13%
Married
14%
peer pressure
16%
Other
5%
%

26
5.4. Source of information on contraceptive methods
The common sources of information about the contraceptive methods mentioned by study participants were
social media (28.5%), health workers (21.8%) and school clubs (21.5%), respectively (Fig. 4).
Figure 4. Source of information for female college students about contraceptive methods in Fitche town,
Oromia, Ethiopia 2022
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Media
Girl Friend
School club
Parent
Health worker
Others
28.5
10.1
21.5
11.9
21.8
6.2
%

27
5.5. Health facility contribution on provision of contraceptive methods for study participants
Regarding health facility contribution on contraceptive methods provision for study participants, almost all
types of health facility had an equal contribution, with the exception of health post which had the least
contribution on the provision of contraceptive methods for respondents (Fig. 5).
Figure 5. Health facility contribution on contraceptive provision for female college students in Fitche
town, Oromia, Ethiopia, 2022
24%
24%
4%
20%
23%
5%
Hospital
Health center
Health post
Private clinic
Private Pharmacy
Other

28
5.6. Perceived susceptibility to pregnancy
In this study, about 327 (78%) of the respondents were highly perceived susceptibility to pregnancy (Fig. 6).
Figure 6. Perceived susceptibility to pregnancy of college female students in Fitche town, Oromia,
Ethiopia, 2022
Low perceived
susceptibility
to pregnancy
22%
Highly
perceived
susceptibility
to pregnancy
78%(CI: at 95%
73.7, 81.7)
Percent (%)

29
5.7 Contraceptive use
About 110 (40.3%) (CI: at 95% 34.1, 46.2) of total respondents had ever used any contraceptive method, with
the majority 45 (41.1%), 33 (29.8%), and 32 (29.2%) using contraceptive methods always, usually, and
occasionally, respectively. The most common contraceptive methods ever used were injectable (38.1%).
Regarding the contraceptive methods ever used by respondents most of the respondents 91 (82.7%) use short-
acting contraceptive methods and 19(17.2%) use long-acting contraceptive methods. Current contraceptive
users were 76(69%), with the most methods used was oral contraceptive pills 51 (40.2%).
Concerning the reason for using contraception, the majority of respondents 58 (53%) used it to prevent
unwanted pregnancy and 9 (4.8%) used it to prevent STI infections. Also concerning the contraceptive methods
used among ever-users, 105 (95.8%) were used modern contraceptives and 5 (4.19%) were users of traditional
contraceptive methods. Whereas among current contraceptive users, 103 (93.7%) were users of modern
contraceptives and 7 (6.36%) were traditional. The most common reason for not using contraceptives methods
among study participants was embarrassment to buying/take from a health facility, while 6 (8.6%) were afraid
of being seen by parents and preferred methods were not available (Table 4).

30
Table 4. Contraceptive utilization among female college students in Fitche town 2022
Variable Category Frequen
cy
Percent
Ever hear about contraceptive No 44 10.5
Yes 375 89.5
Type of contraceptive heard Implant 260 62.1
Calendar methods 168 40.1
Oral contraceptive pills 310 74.0
Injectable methods 290 69.2
IUCD 201 48.0
Male condom 186 44.4
Female condom 153 36.5
Emergency contraceptive pills 168 40.1
Withdrawal 160 38.2
Ever used any contraceptive Yes 110 40.3
No 163 59.7
Methods ever used Oral contraceptive pills 64 38.1
Injectable 38 22.6
Implant 23 13.7
Condom 26 15.5
Others * 7 4.20
Currently contraceptive use Yes 116 69.0
No 52 31.0
Currently type of contraceptive
used
Oral pills 51 44.0
Injectable 28 24.14
Implant 9 7.80
Condom 14 12.10
Other* 4 3.45
Reason to use contraceptives To space births or to limit births 55 32.7
To avoid HIV infection 14 8.3
To prevent unwanted pregnancy 89 53.0
To prevent STI 10 6.0
Reason for not using
contraceptive
Fear side effect 9 12.9
Partner disapproval 6 8.6
Religious prohibition 12 17.1
Embracement to buy 28 40.0
*Traditional contraceptive methods such as withdrawal and calendar.

31
5.8. Associated Factors with perceived susceptibility to pregnancy and contraceptive use
5.8.1: Factor associated with perceived susceptibility to pregnancy
In bivairable logistic regression, nine variables were identified which had an association with perceived
susceptibility to pregnancy. Accordingly, at p-value < 0.25, respondents' age, having ever discussed family
planning with their boyfriend(s) and parents, being sexually active and respondents who were heard to be
contraceptive and knowledgeable about contraceptives were positively associated with perceived susceptibility
to pregnancy after unprotected sexual intercourse. However, having ever had sexual partners in their life,
current sexual partners, and a history of abortion were all associated with a negative perception of susceptibility
to pregnancy after engaging in unprotected sexual intercourse.
Finally those independent variables which showed positive and negative associations with perceived
susceptibility to pregnancy (p-value< 0.25) were entered into multivariable logistic regression analysis. In the
multivariable logistic regression analysis, age between 20 and 24 years (AOR = 2.27; 95% CI: 1.22, 4.21) and
having two or more sexual partners in their lifetime (AOR = 0.32; 95% CL: 0.16, 0.66) were among the
variables that showed significant association with perceived susceptibility to pregnancy after unprotected sexual
intercourse.
Additionally, respondents who discussed family planning with their sexual partner/s (AOR = 2.4; 95% CI: 1.22,
4.71) and respondents who were knowledgeable about contraceptive methods (AOR = 2.131; 95% CI: 1.33,
3.42) were among the variables that showed a significant association with perceived susceptibility to pregnancy
after unprotected sexual intercourse (table 5).

32
Table 5. Multivariable logistic regression analysis of selected variable with perception of susceptibility to
pregnancy among college female students Fitche town, Oromia, Ethiopia, 2022
Variable Category Perceived
susceptibility
to pregnancy
COR AOR and p-value
High Low COR (CI at 95%) AOR (CI at 95%) P -
value
Age category 15-19 34 20 1 1
20-24 293 72 2.39(1.3,4.4) 2.27(1.22, 4.21) 0.01
Ever discuss about
FP with boy friends
Yes 149 25 2.24(1.35, 3.73) 2.4(1.22, 4.71) 0.011
No 178 67 1 1
No of sexual partner
ever had
Only one 18 32 1 1
Two and above 28 152 3.05(1.52, 6.25) 3.13(1.52, 6.25) 0.02
Current Sexual
intercourse
No 127 24 1
Yes 57 22 2.04(1.058,,3.94) 1.08(0.06, 18) 0.96
No of current sexual
partner
Only one 120 19 1
Two and above 7 5 0.22(0.06,,0.77) 0.91(0.19, 4.24) 0.90
Ever had abortion Yes 20 11 0.16(0.04, 0.64) 0.38(.06, 2.22) 0.28
No 34 3 1 1
Ever discussed
about FP with
parents
Yes 152 27 2.1(1.27, 3.44) 0.82(0.39, 1.70) 0.58
No 175 65 1 1
Ever heard
contraceptive
methods
Yes 305 81 1.88(0.88,4.04) 1.57(0.72, 3.44) 0.26
No 22 11 1
Contraceptive
knowledge
Knowledgeable 212 42 2.19(1.37, 3.51) 2.13(1.33, 3.42) 0.002
Non
knowledgeable
115 50 1

33
5.8.2 Factor associated with contraceptive use
The bivariable logistic regression analysis revealed that age, marital status, family occupation, ever had
discussion with their parents and boyfriends about family planning, communication with their boyfriends about
sexual issues, current sexual intercourse, knowledge of contraceptive methods they had and their perceived
susceptibility to pregnancy were significantly associated with contraceptive use.
However, in the multivariable logistic regression model, only marital status (AOR = 0.53; 95% CI: .31, 0.88),
family occupation (AOR = 0.3; 95% CI: 0.16, 0.56), sexually active (AOR = 0.60; 95% CI: 0.39, 0.91) and
having a discussion with their boyfriends(AOR = 3.42; 95% CI: 2.06, 5.69) and parents(AOR = 2.01; 95% CI:
1.71, 3.01) about family planning, knowledge(1.74; 95% CI: 1.1, 2.73) and perceived susceptibility to
pregnancy(AOR = 1.95; 95% CI: 1.23, 3.11) were found to be significantly associated with contraceptive use
(Table 6).

34
Table 6. Multivariable logistic regression of selected factors associated with contraceptive use among female
college students in Fitche in 2022
Variable Category Ever use
contraceptive
COR (CI at 95%
AOR (CI at 95%) P-
Value
Yes No
Discuss about FP
with sexual partners
Yes 115 59 7.06(4.56,10.93) 3.42(2.06,5.69) 0.001
No 53 192 1
Sexually active Yes 49 119 0.52(0.31,0.99) 0.60(0.39, 0.91) 0.01
No 30 38 1
Age category 15-19 14 40 1 1
20-24 154 211 0.48(0.25,0.91) 0.53(0.26, 1.07) 0.09
Marital status Single 128 239 1
Married 40 12 0.16(0.08,0.32) 0.53(0.31, 0.88) 0.015
Family Occupation Farmer 83 191 1
Merchant 10 25 1.086(0.49,2.36) 1.52(0.65,3.54) 0.33
Gov‟t employee 42 22
0.23(0.13, 0.40)
0.3(0.16,0.56) 0.001
Private employee 33 13
0.17(0.09, 0.34)
0.29(0.12,0.68) 0.005
discussion with
boyfriends on
Sexual issue
Yes 110 80 2.59(1.67, 4.03) 1.19(0.75, 1.90) 0.461
No 53 100
discussed about FP
with parents
Yes 101 78 3.34(2.22, 5.03) 2.01(1.34, 3.01) 0.001
No 67 173 1 1
Contraceptive
knowledge
Knowledgeable 119 135 2.09(1.38, 3.16) 1.74(1.1,2.73) 0.017
Non knowledgeable 49 116
Perception of
susceptibility to
pregnancy
High perception 142 185 1.95(1.17, 3.23) 1.95(1.23, 3.11) 0.005
Low perception 26 66 1 1

35
6. Discussion
Our findings indicated that the majority of adolescents and young female college students had highly perceived
susceptibility to pregnancy (78%) after engaged into sexual intercourse without using contraceptive methods.
This finding is lower than a study done in South Africa (46), which showed that 86% are perceived to be
susceptible to pregnancy. but higher than two studies done in the USA which were 64.2% (65) and 62.3% (61),
Veterans (43) which is 60% and in Nigeria(33) which is 19%. The difference could be due to socio-
demographic characteristics and the tools they used for assessment of level of perception. For example in
Nigeria the researchers determine the level of perception only by one question.
This study also revealed that the prevalence of ever-contraceptive users among college female students was
40.3%. This value was consistence with the EDHS finding which is 39.6% (30) and the studies conducted in
Kenya, 43.0% (38), Tanzania, 43.6% (70), and Ghana, respectively. However, the value of this study finding
exceeds that of studies conducted among college students in West Arsi Zone, Ethiopia (33.2%) (71), Dilla
Town, Ethiopia among secondary and preparatory female students (15.7%) (72), Tigary community-based study
among adolescent women (18.0%) (37) and a community-based cross-sectional study among adolescents and
young women in the Democratic Republic of the Congo (28.9%) (35).
The possible explanation for the observed difference may be due to socio-demographic characteristics and study
setting. For example, there were differences in age and marital status between studies conducted in Dilla Town,
Ghana and those conducted in Tigray and the Democratic Republic of the Congo in community-based settings
(access to services may differ between community and college populations). The current study's findings,
however, were lower than those found in national surveys conducted in Ethiopia, 54.8% (39) and 66% (40);
Dilla University among female students, 69.1% (73); Uganda among female university students, 55.1% (37);
and South Africa, 60% (15). The difference may be due to educational level and socio-demographic
characteristics, like in the case of the Ethiopian national survey, most of the participants were married young
women. So being married vs. not being married can make a difference in contraceptive utilization.
The current study revealed that the prevalence of current contraceptive use was 69%, which was in line with the
study done at a national level in Ethiopia(40) Dilla University received 64.4% (73). but higher than a study done
in Kenya (74), which found 45% among community-based cross-sectional surveys among male and female
sexual active youth, and Uganda found 46.6% (37) among female university students. The possible explanatory
difference may be due to socio-demographic characteristics, source population, as well as sex differences that
can make service utilization differ (Kenya). This finding revealed that the methods predominantly used by

36
female college students were injectable methods (38.1%), which was similar to the study done at a national
survey in Ethiopia (40).
In terms of factors associated with perceived susceptibility to pregnancy, study participants aged 20–24 years
were more likely than those aged 15–19 to perceive susceptibility to pregnancy after unprotected sexual
intercourse, which is consistent with a study conducted in Nigeria (33). But according to a study done in
Veterans, age has no association with perceived susceptibility to pregnancy (43). The possible explanatory
difference may be the age difference of study participants, which is in Veterans the study was done among
people aged 20–45 years. This may cause no perception difference depending on age as well as socio-
demographic characteristics. There was a negative association with having more than one sexual partner. This
finding was similar to a previous study done in Nigeria (33).
Additionally, in this finding, respondents who had a discussion with their boyfriends about family planning,
having sexual partners in their life time, and being knowledgeable about contraceptive methods showed a
significant association with perceived susceptibility to pregnancy after unprotected sexual intercourse.
However, respondents who had a discussion with their parents about family planning, heard about contraceptive
methods, had a previous history of abortion and were sexually active and the number of current sexual partners
had no association with perceived susceptibility to pregnancy.
Concerning factors, this study revealed that unmarried respondents were 47% more likely to use contraceptive
methods than married respondents. This finding was in line with previous national surveys conducted in
Ethiopia (39), the Amhara region (68), and Benin (28) among adolescent girls and young women. However,
there is disagreement with the Gondar study among female college students (75) and Dilla town secondary and
preparatory school (72), as well as a Tigray region community-based study among female students (76), in
which married respondents are more likely to use contraceptive methods than unmarried respondents.
The possible explanatory difference may be due to contraceptive method preference, age, and a difference in
source population to assess contraceptive service utilization. For example study conducted in Gonder was
assessed LARC while current study was assessed all contraceptive methods among adolescent and young
women of college students. So that married respondents may more prefer LARC methods than unmarried
respondents and study conducted at Dilla town and Tigray region respondents were younger than current study
this may make a difference in contraceptive use (inTigray region 15-19 and in Dilla town 15-22 years old) in

37
addition in Tigray region study setting was community based. Another possible explanation may be the
difference between married students having regular sexual intercourse versus their counterparts.
Young women who had relatively good knowledge of contraceptive methods were more likely to use
contraceptive methods than those who were not knowledgeable. This finding was consistent with previous
national surveys done in Ethiopia (17). Respondents with high perceived susceptibility to pregnancy were
almost two times more likely than those with low perceived susceptibility to pregnancy to use contraceptives.
Respondents who had had a discussion with their sexual partners about family planning were three times more
likely to use contraceptives than their counterparts. Previous studies conducted among college female students
in West Arsi Zone (73), Dilla University undergraduate female students (73), female college students in Gonder
town (75), and a study conducted in the Tigray region (76) all supported this finding.
This finding revealed that the main sources of information on contraceptive methods were the media, health
care providers, and school clubs, which was consistent with previous studies done in Dilla town among
secondary and preparatory school students (72), West Arsi zone college students (71), and Tigray region (76),
and the most common reasons not to use contraceptive methods were embracement to buy/take contraceptive
methods, partner disapproval, and religious opposition to contraceptive methods use, which was supported by
previous findings (70,77) The common reasons for using contraceptive methods among respondents were to
prevent unintended pregnancy and birth spacing, which was similar to the study done in Dilla town, at national
level in Ethiopia and Zambia (5).
6.1. Strengths and weaknesses of the study
This study has some limitations that need to be considered while interpreting the results. First, since the study is
cross-sectional, it is difficult to establish a causal-effect relationship. Second, the findings from this study
cannot be generalized to all adolescent girls and young women in the community. There might be a social
desirability bias on personal and sensitive issues, and obtaining honest responses among young students might
have been difficult and is a limitation of this study, although we tried to collect data by self-administered
questionnaire with collection in locally prepared boxes to ensure their privacy.

38
7. Conclusion and recommendation
7.1. Conclusion
This study concluded that the prevalence of contraceptive use among female college students was moderate and
the perceived susceptibility to pregnancy of respondents was high. In a multivariable logistic regression
analysis, respondents' age, having a discussion with their boyfriends about family planning, and knowledge of
contraceptive methods were positive predictors of perceived susceptibility to pregnancy, while having multiple
sexual partners was a negative predictor.
The main reasons that respondents mentioned for not intending to use contraceptives were: Embracement to
buy, fear of possible side effects, religious prohibition, and partner disapproval. In this study, having discussion
with boyfriends and parents about family planning, marital status, sexual activity, family occupation,
knowledge and perceived susceptibility to pregnancy were the study variables that were identified as predictors
of contraceptive use among female college students.
Finally, we concluded that being aware of being (perceived) susceptible to pregnancy after unprotected sexual
intercourse was the main determinant factors of female college students to use or not to use contraceptive
methods. This has an effect on contraceptive use either directly or indirectly (via other variables that have a
distal effect on contraceptive use but a direct effect on perceived susceptibility to pregnancy).
7.2. Recommendation
In college institutions, there should be sexual and reproductive health clubs and information, education, and
communication activities regarding the utilization of contraceptive methods among adolescents and young
college students. This finding identified that respondents' knowledge, awareness (perception), information, and
communication about contraceptive methods were the main predictors of contraceptive use. Specific
recommendation:-
Health professionals, especially those who work with college students, should provide detailed information
about contraceptive methods, increase knowledge, and address potential side effects.
College and others stakeholders should work on the area of disseminating reproductive health information by
establishing and promoting sexual and reproductive health clubs at schools in order to increase awareness and
knowledge on contraceptive methods and enhance discussion with boyfriends and parents which has positive
impact on contraceptive use. For researchers, further studies with both qualitative and quantitative methods of
data collection are recommended for future research.

39
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44
Annex
Annex I- Consent Form for Self-administered questionnaire
Title of the study
Assessment of perception of susceptibility to pregnancy, contraceptive use and associated factors among female
college students of Fitche town
Procedures
Specifically we are going to ask you perception of susceptibility to pregnancy, contraceptive use and associated
factors as well as your background characteristics. We would expect you to complete the questionnaire by
yourself. You will be try to complete within 20 to 30 minutes and you may find some of the questions asked
sensitive in nature. Please do not write your name
The information that you provide during this study will be kept confidential. Only the researchers will have
access to the questionnaires and the information that you provide.
Risks and Benefits of the Study
By participating in this study, and answering our questions, you will not receive any direct benefit. However,
you will help to increase our understanding perception of susceptibility to pregnancy, contraceptive use and
associated factors. We hope that the results of the study will improve and make more acceptable the services
currently available to you. Your participation in this study will not involve any risks to you.
Right to refuse or withdraw:
You have full right to refuse from participating in this research. You have also the full right to withdraw from
this study at any time you wish, without losing any of your right
Declaration of the Volunteer:
I have understood that the purpose of the study is to collect information in regarding to Prevalence of long
acting and permanent contraceptive methods and factors associated with. I have read the above information, or
it has been read to me. I have had the opportunity to ask questions about it and any questions that I have asked
have been answered to my satisfaction. I consent voluntarily to participate as a subject in this study and
understand that I have the right to withdraw from the study at any time without in any effect on my life.
Signature of Volunteer (optional): ________Signature of Investigator: ________

45
. If you would like to know more, please contact:
Address of the Principal investigator Seyoum Alemu Mob. 0964426329/0922593283
Thank you for your cooperation

46
Annex –II Questionnaire
GENERAL INSTRUCTIONS: The questionnaire has Six parts, including questions regarding to socio-
demographic, Sexual and reproductive health related question, perception on susceptibility to pregnancy,
knowledge about family planning, external factors influencing, and contraceptive methods utilization. Please
read the instructions and questions carefully before proceeding to answering them.
Part I: Questions assessing the Socio-demographic characteristics of respondents
Instructions: Please circle the number in front of the option you choose. If you are asked to write a response or
if your answer is not listed among alternatives, please do in the blank space provided.
I Questions Responses
1. What is your department? ___________________
2. What is your year of study/level 1. year one/level I
2. year two/level II
3. year three/level III
4. year four/level IV
3. How old are you? ___________
4. What is the religion you follow? 1. Orthodox Christian
2. Muslim
3. Protestant
4. catholic
4. Other specify__________
5. What is your ethnic group? 1. Oromo
2. Amhara
3. Tigre
4. Gurage
5. Other specify_________
6. Marital status? 1. Single
2. Married
3. Divorced

47
4. Separated
7. Are you usually living with your
mother and father together?
1. Yes
2. No
8. If No, with whom do you usually live? 1. With relatives
2. With friends
3. Alone
4. Other specify__________
9. What is your parent‟ s
Occupation?
1. Farmer
2. Merchant
3. Government employee
4. Private employee
5. Other specify ______________
10. Where you are grow up 1. Rural
2. Urban
11.
How much income do you think your family gain per month? [specify _______
Part II Sexual and reproductive health related question
1. Have you ever had a boyfriend? 1. Yes
2. No
If no skip to
Qr No 3
2. Have you ever discussed about sexual
matters with your boyfriend?
1. Yes
2. No
3. Have you ever had sexual
Intercourse?
1. Yes
2. No
If no skip to
part III
4. At what age did you first have
Sexual intercourse?
1.age in complete
years________
99.I don't remember
5. What drove you to have your first 1. Fell in love

48
Sexual intercourse? 2. Had a personal desire
3. I got married
4. I was forced.
5. Peer pressure
6. To get money/gift
7. Others
specify________
6. With whom did you started first sexual
intercourse?
1. Steady friends
2. causal friends
3. Husband
4. Teacher
5. Other
specify____
7. What is the number of sexual partners you
had so far? ___________
8. Have you ever had sex in the last 6 months? Yes
No
If your answer
is no skip to
Qs No 10
9. How many partners did you have during
the last 6 months? ____________
10. Have you ever been pregnant? 1.Yes
2. No
If your answer
is no skip to
Qs No 15
11. Had you ever unplanned/unwanted
pregnancy?
1. Yes
2. No
12. If you had unplanned/unwanted pregnancy
what its out come
1. live birth
2. abortion
3. still birth
4.other specify __________
13. Ever had history abortion? Yes If your answer

49
No is no skip to
Qs No 15
14. How many times you had abortion 1. once
2.twice
3. three and more
15. Have you ever used any other
Contraceptive?
1.Yes
2. No
16. If is yes for Qrs # 9, how often? 1. Always
2. Some Times
3. Rarely

50
Part III Question related to perception of susceptibility pregnancy
1. Contraceptive user‟s Perceived susceptibility
2. Using contraceptives increase chance of getting sickness. Strongly
disagree
Disagree Neutral Agree Strongly
agree
3. Using contraceptives reduce the chances of un-intended
pregnancy.
Strongly
disagree
agree
4. Irregularly use of contraception may lead to pregnancy Strongly
disagree
agree
5. If you have sex only once without using birth control, will
you get pregnant
Strongly
disagree
agree
6. One sex cannot cause pregnancy Strongly
disagree
agree
7. If I do not use contraception regularly, I could make a
baby even when we do not plan to
Strongly
disagree
agree
8. I am at risk of having extended family if I don't use
contraceptive
Strongly
disagree
agree
9. If you have sex regularly, say twice a week, for a year
without using birth control, will you get pregnant
Strongly
disagree
agree
10. I am at risk of unwanted pregnancy if I don't use
contraceptive
Strongly
disagree
agree

51
Part IV questions related to knowledge assessment
s.n Knowledge about contraceptive Response
1. Have you ever heard contraceptive
method
1. Yes
2. No
2. Do you know pills Yes
No
3. Do you know injectable 1. Yes
2. No
4. Do you know Implant Yes
No
5. Do you know IUCD Yes
No
6. Do you know male condom 1. Yes
2. No
7. Do you know female condom Yes
No
8. Do you know emergency
Contraceptive
1. Yes
2. No
9. Withdrawal Yes
No
10. Do you know calendar methods to
prevent pregnancy
Yes
No
Part V:-External factors influencing contraceptive use
1. What is your source of information 1. media

52
about contraceptive? 2. my boyfriends
3. my girl friends
4. school club
5. my partners
6. Health worker
7. YES center
8. if other specify
2. Have you ever heard about
contraceptives?
Yes
No
3. If yes for Qs No 2 What is your
source of information about
contraceptive?
1. media
2. my boyfriends
3. my girl friends
4. school club
5. my partners
6. Health worker
7. YES center
8. if other specify
4. Have you ever discuss about family
planning with you parents?
1. yes
2. No
5. If your answer for Qrs # 2 is yes with
whom did you discuss??
1. With my mom
2. With my dad
3. Both my dad and mom
4. Other---------
6. Have you ever discuss about family
planning with you boyfriend?
1. yes
2. No
5 If your answer for Qrs # 4 is yes with
whom did you discuss??
1. the 1st
sexual partners
2. the 2nd
and more sexual partners
6 If your answer for Qrs # 4 is no why 1. I „m shamed to discuss with him

53
you didn‟t discuss with
him/them??
2.He has no other sexual partner/s
3. because I have not awareness
about contraceptive
4. if other specify ________
6 What are reasons why you did not
want to use contraceptive? (For ever
non-users)
More than one answer is possible
1. Religious opposition
2. Fear side effect
3. Afraid of being seen by Parents
4. Partner disapproval
5. Embracement to buy
6. Preferred method not available
7. Other/specify----------
Part VI question related to contraceptive use
sn Question Response skip
Have you ever used any contraceptive
methods
1.Yes
2.No
If your
answer is no
skip to Qs
No 6
1. If yes which one you ever used? 1. Oral pills
2. Emergency pill
3. Injectable
4. Implant
5. IUCD
6. Male condom
7. Female condom
8. Male sterilization
9. Female sterilization
7. Calendar methods
8. Coitus interrupts

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