Emergency Contraception (EC) is a secondary post-coital measure that aims to prevent an unplanned pregnancy after unprotected sexual activity, contraceptive failure or non-consensual sexual encounters [1]. In the world, each year millions of women become pregnant and a significant number of these pregnancies are aborted, many of which are unsafe, resulting in high rates of maternal morbidity and mortality [2,3]. Population growth and large unmet family planning needs are still major public health challenges in developing countries like Bangladesh [4]. Although many people use regular family planning, there are still frequent structural gaps in awareness and in the use of regular family planning, which result in unplanned gestations [5].

Levonorgestrel-based Emergency Contraceptive Pill (ECP) is most effective if taken within 3 days (72 to 120 hours) after unprotected sex [6,7]. Accessibility of ECP is considered a critical component of reproductive health services and a key action to decrease the use of unsafe abortion procedures, as described by the World Health Organization (WHO) [8]. Menstrual regulation and unsafe abortions are a significant cause of maternal complications in Bangladesh and ECP is a safe, non-invasive option [9,10]. But the lack of in-depth sex education, misinformation about side effects, and limited communication from community health workers (CHWs) and sociocultural taboos hamper their use [11,12].

Recent national demographic health survey analyses indicate that although baseline awareness of general oral contraceptives is near-universal, specific knowledge regarding ECP mechanism, precise timing, and safety profile remains remarkably low among Bangladeshi women [13,14]. Sociodemographic disparities between rural communities and peri-urban low-income settlements further compound these inequities in health literacy and accessibility [15,16]. Assessing public awareness and behavioral perceptions is vital for identifying barriers to family planning commodities [17]. Therefore, this study aimed to evaluate the knowledge, attitude, and practice (KAP) regarding emergency contraceptive pill use among women of reproductive age attending two distinct healthcare facilities in rural and urban Bangladesh.

A hospital-based cross-sectional study was conducted at the Department of Obstetrics and Gynaecology, 100 Beds Upazila Health Complex, Shibchar, Madaripur and Kamrangirchar 31-Bed Hospital, Dhaka, Bangladesh from June 2025 to July 2026.

Inclusion Criteria:

1. Women of reproductive age (15-49 years) visiting the outpatient department (OPD) of the selected healthcare facilities during the study period.
2. Women who gave voluntary informed consent in writing or orally to participate in the study.
3. ​ Women who were sexually active with the capacity to self-report reproductive health information.

​Exclusion Criteria:

1. Women with serious medical conditions, cognitive problems or mental health disorders that affected their ability to understand or complete the survey.
2. ​ Women who declined informed consent and/or who did not complete the interview.
3. ​ Women with a professional background (healthcare professionals, formal family planning service providers) to avoid a professional response bias in the assessment of baseline technical knowledge.

Data Collection Instrument and Procedure

Data collection involved the use of a pre-tested, structured interviewer-administered questionnaire which was translated in Bengali. The tool included sociodemographic information, baseline understanding of the timing and indications for ECP, attitude ratings, and past experiences with ECP.

Statistical Analysis

Data were cleaned and analyzed using SPSS version 26. Descriptive statistics (frequencies, percentages, means, and standard deviations) were calculated to summarize sociodemographic traits and KAP domain scores. Significance was evaluated at p < 0.05.

A total of 200 women of reproductive age were enrolled in this study. Table 1 shows the highest proportion of respondents belonged to the 25–34 age (47.0%, n = 94), followed by the 15–24 age group (34.0%, n = 68), and the 35–49 age group (19.0%, n = 38). In terms of educational level 60.5% (n = 121) had secondary education, 21.5% (n = 43) had higher secondary or above education and 18.0% (n = 36) had no education. Most of the study population were married (86.5%, n = 173). Regarding their occupation, 61.0% of the participants were homemakers (n = 122), 24.0% were working in a service or garments occupation (n = 48) and 15.0% were students or self-employed business owners (n = 30).

Table 1: Sociodemographic Characteristics of the Respondents (N = 200)

Table 2 shows summarize the levels of knowledge, attitude, and practice concerning emergency contraceptive pills among the participants. Of the 200 respondents, a little more than half (54.0%, n = 108) had heard of ECP at least once. Detailed technical awareness was much lower with only 28.5% (n = 57) correctly identifying 72 hours as the period of effectiveness for the use of ECP. All items when scored together revealed a & Good Knowledge of 34.0% (n = 68) and 66.0% (n = 132) were poor knowledge. As far as attitudes are concerned, less than half of the participants (44.5%, n = 89) had a positive attitude towards ECP, while 55.5% (n = 111) had negative or neutral attitudes based on safety concerns or cultural inhibitions. This resulted in low actual practice: 45 (22.5%) of respondents reported having ever used ECP in their lifetime, while 155 (77.5%) reported not using ECP.

Table 2: Assessment of Knowledge, Attitude, and Practice regarding ECP (N = 200)

Table 3 shows outline the underlying reasons for administration. The most common cause reported was condom failure during sexual intercourse (51.1%, n = 23). 35.6% (n = 16) of instances of intake were because of missing the scheduled oral contraceptive dose and 13.3% (n = 6) were due to unprotected sex or unexpected sexual intercourse. In addition, when respondents who knew about ECP were asked, 41.7% (n = 45) reported getting their information from medicine shops, and 31.5% (n = 34) reported getting their information from informal networks, such as friends. Compared with formal health care workers providing primary information who made up 8.3% (n = 9) of mass media, the latter made up of 18.5% (n = 20).

Table 3: Reasons for ECP Use and Main Sources of Information

This dual-center study identified significant differences between awareness and knowledge about use of Emergency Contraceptive Pill (ECP) at baseline in the reproductive age group of Bangladeshi women. 54.0% of respondents knew that ECP existed, with 34.0% having adequate overall knowledge, especially in the critical 72-hour window to administer. These results are consistent with the findings of Ahmed MS and Yunus FM who found moderate awareness level of these items, but low detailed knowledge about the timing and proper indication in nationwide cohorts in Bangladesh [13].

A negative or neutral attitude towards ECP was observed in 55.5% of respondents, largely driven by fears of permanent infertility, disruption of normal menstrual cycles, and moral misgivings surrounding emergency contraception. Similar misapprehensions were highlighted by Lima et al. in rural Bangladesh, where erroneous beliefs that ECP acts as an abortifacient hindered positive perceptions and timely uptake [12]. Furthermore, Nakalema et al. demonstrated that low comprehensive reproductive health literacy directly predicts negative attitudes toward non-regular contraceptive methods [14].

The practice rate of ECP in our sample was 22.5%, which is comparable to reported utilization rates in urban slum and rural hospital surveys in South Asia (Chaudhary, 2022; Biradar, 2025) [11,15]. Most participants acquired ECP directly from local drug stores without professional medical counseling. As noted by Mahfuzur MR et al., community health care workers and family planning field officers represent underutilized vectors for disseminating accurate ECP counseling in Bangladesh [16]. Expanding grass-root educational interventions and training pharmacy dispensers are vital steps toward bridging the KAP gap and preventing unwanted pregnancies [17].

Limitations of the Study

 There are some limitations in this study. The cross-sectional design first makes it difficult to draw causal inferences. Second, self-reported data may have recall bias and social desirability bias about sensitive approaches to reproduction. Third, the study's convenient sampling and small sample size (200 women from two hospitals) may not allow the study to be generalizable to the larger population of Bangladesh.

The findings of this study reveal a significant gap in general awareness and accurate practical knowledge of ECPs among reproductive age women in rural and urban Bangladesh. Although general awareness is good, misconceptions about the timing of dosing, effectiveness and side effects are common, which affects positive attitudes and uptake. The work of educating the public, counseling them routinely and training retail pharmacy staff to provide effective, evidence-based contraceptive education, counseling, and distribution must fill this void at the community level, where community health programs and family planning providers operate.

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