Keeping silent about emergency contraceptives in Addis Ababa: a qualitative study among young people, service providers, and key stakeholders

Background: The growing popularity of emergency contraceptives (ECs) among urban youth in Sub-Saharan Africa is accompanied by debates on morality and health. This study was situated in Addis Ababa, Ethiopia and aimed to explore how these debates affect the way in which the product is promoted at a national level, how it is dispensed by service providers, and how young people access, purchase, and get informed about ECs. Methods: Data were collected using qualitative methods: observations in pharmacies, administering semi-structured questionnaires to young people in pharmacies (N = 36), informal interviews with young people (N = 65), and in-depth interviews with service providers (N = 8) and key stakeholders (N = 3). Results: Key stakeholders, uncomfortable with high sales of ECs, and service providers, worried about women's health, promiscuity and the neglect of condoms, stay silent about ECs. Most young people had used ECs more than once. In a context where premarital sex is morally sanctioned ECs provide young people with a way of keeping their sexual lives secret and they fit well with their sex lives that often entail infrequent sexual encounters. Young people preferred (but they are also left with no other option than) to seek information from discreet sources, including friends and partners, leaflets and the mass media. In addition, service providers misunderstood young people's purchasing behaviour, characterized by buying ECs quickly and feeling too embarrassed to ask questions, as a rejection of counselling. The resultant lack of information about ECs sometimes led to confusion about how to take the pills. Conclusions: The attitudes and beliefs of key stakeholders and service providers result in a lack of clear information on ECs available to young people. This could be addressed by improving the information leaflet, providing clear instructions of use on blister packages, strategically distributing posters, and service providers adopting a more proactive attitude.