Background: Emergency contraception remains an important strategy for preventing unintended pregnancies, yet its use is often shaped by complex social, cultural, and personal factors. In southeastern Nigeria, particularly in urban centers like Aba, perceptions surrounding Postinor extend beyond medical considerations to include moral, religious, and societal influences. Understanding these dynamics is essential for improving reproductive health interventions and promoting informed contraceptive choices.

Objective: This study assessed the attitudes, perceptions, and sociocultural influences affecting the use of Postinor as an emergency contraceptive among women of reproductive age in Abia State, Nigeria.

Methods: A descriptive cross-sectional survey was conducted among 375 women aged 18 years and above in Aba, selected through a multistage sampling technique. Data were collected using a structured, self-administered questionnaire covering socio-demographic characteristics, attitudes, safety perceptions, moral and religious concerns, social influences, stigma, and healthcare trust. Responses were measured using a 5-point Likert scale where applicable. The instrument demonstrated acceptable reliability (Cronbach’s alpha ≥ 0.70). Data were analyzed using SPSS version 25, employing descriptive statistics and inferential tests including chi-square, ANOVA, correlation, and logistic regression, with significance set at p < 0.05.

Results: The majority of respondents were aged 20–29 years (48.8%) and had at least secondary education (80.0%). Overall, attitudes toward Postinor were moderately positive, with 60.3% expressing acceptance and 57.1% willing to recommend its use. However, concerns about safety and side effects were notable, as 62.9% believed frequent use could be harmful. Sociocultural influences were significant; 40.6% reported religious discouragement, while 47.0% perceived the method as morally questionable. Stigma was prominent, with 61.6% acknowledging its existence and 65.9% indicating that users are often judged. Despite this, 65.6% had used Postinor, mostly obtained from pharmacies. Statistical analysis showed significant associations between Postinor use and age (p = 0.031), education (p = 0.010), marital status (p = 0.024), and religion (p = 0.015). Positive attitudes (AOR = 2.76, p < 0.001) and tertiary education (AOR = 2.14, p = 0.002) significantly increased the likelihood of use, while stigma reduced it (AOR = 0.61, p = 0.019).

Conclusion: While usage of Postinor is relatively high, its acceptance is influenced by persistent sociocultural barriers, including stigma, moral concerns, and religious beliefs. Addressing these factors through culturally sensitive education and community engagement is crucial for improving the uptake and appropriate use of emergency contraception.

Unintended pregnancy remains a significant public health concern globally, particularly in low- and middle-income countries where access to effective contraceptive methods is often limited or inconsistent [1]. Emergency contraception (EC), including levonorgestrel-based pills such as Postinor, provides a critical window of opportunity for preventing pregnancy after unprotected sexual intercourse or contraceptive failure. Its relevance is especially pronounced in settings like Nigeria, where the unmet need for family planning remains high and contraceptive prevalence rates are still relatively low compared to global targets [2]. Despite its clinical effectiveness, the utilization of emergency contraception is shaped not only by availability but also by individual attitudes, perceptions, and deeply rooted sociocultural norms.

Emergency contraception has been widely recognized as an essential reproductive health intervention that can significantly reduce the incidence of unintended pregnancies and unsafe abortions [3]. However, evidence from Nigeria suggests that awareness does not always translate into appropriate knowledge or correct usage. For instance, a recent study among antenatal women in southwestern Nigeria reported that over half of respondents had never received any information about emergency contraception, and only a small proportion had ever used it, despite Postinor being the most commonly recognized option [4]. Similarly, earlier findings among female undergraduates in southeastern Nigeria revealed relatively high awareness of Postinor-2, yet this awareness coexisted with poor attitudes and low levels of correct practice, including misconceptions about timing and mechanism of action [5]. These gaps highlight the complex interplay between knowledge and perception in determining contraceptive behavior.

Attitudes toward Postinor and other emergency contraceptives in Nigeria are influenced by a range of psychological, moral, and informational factors. While some women perceive emergency contraception as a convenient and necessary backup method, others associate it with health risks, moral concerns, or misuse. Misconceptions persist regarding its mechanism of action, with some individuals incorrectly believing that it induces abortion rather than preventing fertilization or implantation [6]. Such perceptions contribute to hesitation, fear, and, in some cases, outright rejection of its use. Moreover, concerns about side effects and long-term fertility implications further shape individual decision-making, often discouraging consistent or timely use.

Sociocultural influences play an even more profound role in shaping attitudes and perceptions toward Postinor use. Nigerian society is characterized by strong cultural, religious, and gender norms that influence reproductive health behaviors. Studies have consistently shown that religious beliefs significantly affect acceptance of emergency contraception, with many individuals viewing its use as morally inappropriate or contrary to faith-based teachings [5]. In addition, societal expectations regarding female sexuality often stigmatize contraceptive use, particularly among unmarried women. This stigma can limit open discussions about contraception and discourage women from seeking accurate information or purchasing emergency contraceptives openly.

Peer influence and informal information networks also contribute significantly to contraceptive decision-making. Research indicates that friends and peers are among the primary sources of information about emergency contraception, often surpassing healthcare providers [4]. While peer networks can facilitate awareness, they may also propagate misinformation, leading to inappropriate use or reliance on ineffective alternatives. Indeed, qualitative studies in Nigeria have documented the use of non-standard methods and local concoctions as substitutes for emergency contraception, reflecting both misinformation and sociocultural barriers to accessing formal healthcare services [7].

Another important sociocultural dimension is the influence of gender dynamics and societal expectations regarding fertility. In many Nigerian communities, fertility is highly valued, and childbearing is often linked to social status, marital stability, and economic security. As a result, contraceptive use, including emergency methods, may be perceived as conflicting with these expectations. Additionally, decision-making regarding reproductive health is not always autonomous, as male partners, family members, and community norms may significantly influence women’s choices. Adolescents and young women, in particular, face heightened challenges due to parental control, fear of judgment, and limited access to youth-friendly reproductive health services [8].

In the context of Abia State, these issues are particularly relevant given its sociocultural diversity and the coexistence of urban and rural populations with varying levels of education, access to healthcare, and cultural beliefs. Although southeastern Nigeria generally demonstrates relatively higher levels of educational attainment compared to some other regions, cultural and religious influences remain strong determinants of reproductive health behavior. The presence of institutions such as Abia State University Teaching Hospital also suggests a mix of formal healthcare access and informal community-based health practices, which may further shape patterns of Postinor use.

Despite the growing body of research on emergency contraception in Nigeria, there remains a need for context-specific studies that examine not only awareness and utilization but also the underlying attitudes, perceptions, and sociocultural drivers of behavior. Understanding these factors in Abia State is essential for designing targeted interventions that address misconceptions, reduce stigma, and promote informed decision-making. Such insights are vital for improving reproductive health outcomes, reducing unintended pregnancies, and enhancing the overall effectiveness of family planning programs.

Study Design

A descriptive cross-sectional survey design was adopted for this study. This approach allowed for the systematic collection of data on participants’ attitudes, perceptions, and sociocultural influences related to Postinor use at a single point in time. The design was appropriate for identifying patterns, associations, and prevailing beliefs within the study population without manipulating any variables.

Study Area

This study was conducted in Aba, a densely populated commercial hub in southeastern Nigeria. Aba is known for its vibrant markets, diverse population, and active informal and formal economic sectors. The city’s heterogeneous sociocultural composition, including varying religious affiliations, educational levels, and occupational groups, makes it a suitable setting for examining attitudes and sociocultural dynamics surrounding the use of emergency contraception such as Postinor.

Study Population

The study population comprised women of reproductive age residing in Aba, Abia State. Eligible participants were females aged 18 years and above who were sexually active or had the potential to use emergency contraception. Individuals who were unable to provide informed consent or who declined participation were excluded.

Sample Size Determination

The sample size was determined using Cochran's formula for estimating population proportions, as outlined by Akwuruoha et al. [9]:

n =     

The formula components are defined as follows:

                n represents the minimum required sample size.

                Z is set at 1.96, corresponding to a 95% confidence level.

                P denotes the estimated proportion of awareness of emergency contraception in Nigeria.

                e signifies the allowable margin of error, fixed at 5% (0.05).

q = 1 - p

A recent study conducted by Adewale et al. [10] reported the estimated proportion of awareness of emergency contraception in Nigeria as 33.3% 

P = 33.3% = 0.333

q = 1 – 0.333

= 0.667

n =  

n =  

n = = 341.30

The minimum sample size was 341, but it was adjusted to 375 to account for a 10% non-response rate.

Sampling Technique

A multistage sampling technique was employed. Initially, Aba was stratified into its major administrative areas (Aba North and Aba South). Within each stratum, communities and clusters such as markets, schools, residential areas, and healthcare facilities were randomly selected. Systematic random sampling was then used to recruit eligible participants within these clusters. This approach ensured a representative sample across different socioeconomic and cultural backgrounds.

Instrument for Data Collection

Data were collected using a structured, self-administered questionnaire titled “Attitudes, Perceptions, and Sociocultural Influences on Postinor Use.” The instrument was developed based on existing literature and tailored to the local sociocultural context.

The questionnaire comprised eight sections:

• Section A: Socio-demographic characteristics (age, marital status, education, occupation, religion, ethnicity)
• Section B: Attitudes toward Postinor use
• Section C: Perceived safety and side effects
• Section D: Moral and religious concerns
• Section E: Partner influence and peer pressure
• Section F: Stigma associated with Postinor use
• Section G: Trust in healthcare providers versus self-medication
• Section H: Experience with Postinor use (optional)

Items in Sections B–G were measured on a 5-point Likert scale ranging from 1 (Strongly Disagree) to 5 (Strongly Agree). The questionnaire was written in English, with on-the-spot clarification provided in local dialects where necessary.

Validity of the Instrument

Content and face validity were established through expert review by professionals in public health, reproductive health, and social sciences. The questionnaire was assessed for clarity, cultural relevance, and comprehensiveness. Necessary modifications were made based on feedback to ensure that the instrument accurately captured the constructs under study.

Reliability of the Instrument

A pilot study was conducted among 30 women in a nearby community outside the study area. Internal consistency of the questionnaire was assessed using Cronbach’s alpha. The overall reliability coefficient was ≥0.70, indicating acceptable internal consistency across the different domains.

Data Collection Procedure

Data collection was carried out over a period of 4–6 weeks by trained research assistants. Participants were approached in selected locations and provided with information about the study. After obtaining informed consent, questionnaires were administered and completed either independently or with assistance where necessary. Privacy and confidentiality were strictly maintained throughout the process.

Variables and Measurement

                Independent variables: Socio-demographic characteristics (age, education, marital status, religion, occupation, ethnicity)

                Dependent variables: Attitudes, perceptions, sociocultural influences, stigma, and trust in healthcare providers regarding Postinor use

Domain scores were computed by summing responses within each section:

• Attitude score
• Safety perception score
• Moral/religious score
• Social influence score
• Stigma score
• Trust/self-medication score

Negatively worded items were reverse-scored prior to analysis to ensure consistency.

Data Analysis

Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Descriptive statistics such as frequencies, percentages, means, and standard deviations were used to summarize the data. Inferential statistics, including chi-square tests, independent t-tests, and analysis of variance (ANOVA), were used to assess associations between variables. Logistic regression analysis was conducted to identify predictors of Postinor use and related attitudes. Statistical significance was set at p < 0.05.

Ethical Considerations

Participation was voluntary, and informed consent was obtained from all respondents. Participants were assured of confidentiality and anonymity, and no identifying information was collected. They were also informed of their right to withdraw from the study at any stage without any consequences.

Limitations of the Method

As a cross-sectional study relying on self-reported data, there is a possibility of recall bias and social desirability bias, especially given the sensitive nature of contraceptive use. However, anonymity and confidentiality measures were emphasized to minimize these effects.

The socio-demographic profile of respondents shows a relatively young population, with the largest proportion aged 25–29 years (25.9%), followed by 20–24 years (22.9%) as presented in Table 1. Most respondents were single (44.8%) or married (39.7%), and a substantial proportion had attained tertiary education (42.1%), with students (29.9%) and self-employed individuals (22.9%) forming the largest occupational groups. Christianity was the dominant religion (71.5%) (Table 1).

Attitudes toward Postinor use were generally positive (Table 2). A majority agreed or strongly agreed that Postinor is acceptable (60.3%), felt comfortable using it (57.1%), and would recommend it to a friend (61.6%). Similarly, 57.6% considered its use as responsible behavior, although preference over other contraceptive methods was less pronounced, with 46.4% expressing agreement.

Perceptions of safety and side effects varied (Table 3). While 51.8% agreed that Postinor is safe, a higher proportion believed that frequent use is harmful (62.9%). Concerns about long-term effects (51.7%) and general side effects (62.4%) were also notable. However, trust in healthcare information was relatively high, with 68.8% expressing agreement.

Moral and religious concerns showed mixed responses (Table 4). Although a considerable proportion disagreed that religion discourages use (42.7%) or that it is morally wrong (46.1%), some respondents still expressed agreement with these views. Feelings of guilt and cultural influence were also reported, with about one-third of respondents agreeing with these concerns. Additionally, 47.8?lieved that Postinor use could encourage promiscuity.

Regarding partner and peer influence (Table 5), most respondents reported no partner influence (65.6%), yet over half indicated willingness to use Postinor if suggested by a partner (57.1%). Peer-related factors were also evident, with 44.5?knowledging friends’ influence and 37.6% reporting peer pressure, while 52.8% were open to discussing Postinor with friends.

Stigma associated with Postinor use was prominent (Table 6). A majority reported that stigma exists (61.6%) and that users are judged (65.9%). Over half felt embarrassed (50.4%) or would hide usage (54.1%), while 46.9% indicated that stigma could prevent use.

In terms of healthcare engagement (Table 7), most respondents preferred consulting healthcare providers (60.8%) and expressed trust in pharmacists (68.3%). However, 39.7% still preferred self-medication, and 31.5% trusted friends more than professionals, while 63.2% were comfortable discussing Postinor use with healthcare professionals.

Experience with Postinor use was relatively high (Table 8), with 65.6% reporting prior use. Among users, the most common frequency was 2–3 times (37.4%), and pharmacies were the primary source (46.1%), followed by patent medicine stores (29.9%).

Chi-square analysis revealed statistically significant associations between age and Postinor use, education and attitude, marital status and usage, and religion and moral concerns (Table 9). However, occupation was not significantly associated with self-medication.

Correlation analysis indicated a moderate positive relationship between attitude and usage (r = 0.48), and a positive relationship with safety perception (r = 0.36) (Table 10). In contrast, moral concerns (r = -0.42) and stigma (r = -0.39) showed negative correlations with usage, while partner influence (r = 0.29) and trust in healthcare (r = 0.33) demonstrated positive relationships.

Logistic regression analysis identified age (20–29 years), tertiary education, positive attitude, and partner influence as significant predictors of Postinor use, while high stigma reduced the likelihood of use (Table 11).

Table 1: Socio-Demographic Characteristics of Respondents (n = 375)

Table 2: Attitudes Toward Postinor Use

Table 3: Perceived Safety and Side Effects

Table 4: Moral and Religious Concerns

Table 5: Partner Influence and Peer Pressure

Table 6: Stigma Associated with Postinor Use (n = 375)

Table 7: Trust in Healthcare vs Self-Medication (n = 375)

Table 8: Experience with Postinor Use (n = 375)

Table 9: Chi-Square Analysis of Key Associations

Table 10: Correlation Analysis of Key Variables

Table 11: Logistic Regression Analysis (Predictors of Postinor Use)

Emergency contraception remains a critical component of reproductive health, yet its uptake is often shaped by complex social, cultural, and personal beliefs. Postinor is widely used in Nigeria, but attitudes toward its use are still influenced by stigma, moral concerns, and misinformation. Understanding these dynamics is essential for improving access and informed decision-making among women of reproductive age. This study examined the attitudes, perceptions, and sociocultural influences affecting the use of Postinor among women in Aba, Abia State, Nigeria.

The findings from this study provide a nuanced and contextually grounded understanding of how women in Abia State perceive and use Postinor as an emergency contraceptive. What emerges is a complex interaction between knowledge, personal attitudes, sociocultural expectations, and structural factors such as access to healthcare and information. When situated within the broader body of evidence from Nigeria and sub-Saharan Africa, these results both reinforce existing patterns and offer deeper insight into evolving reproductive health behaviors.

The socio-demographic profile of respondents shows that the majority were within the 20–29-year age group and had at least secondary or tertiary education. This aligns with earlier Nigerian studies where young, educated women constitute the primary users and potential users of emergency contraception. For instance, research among female undergraduates in Eastern Nigeria reported relatively high awareness but lower actual use of emergency contraception, especially among younger women [11]. Similarly, a scoping review across sub-Saharan Africa noted that awareness tends to be higher among educated and urban populations, although this does not always translate into consistent utilization [12]. The current study’s higher usage rate (65.6%) compared to earlier reports suggests a gradual shift toward increased acceptance and access, possibly reflecting improved availability of Postinor in pharmacies and patent medicine stores.

Attitudinal findings in this study indicate that a substantial proportion of respondents consider Postinor acceptable, feel comfortable using it, and would recommend it to others. This generally positive disposition is consistent with findings from the Niger Delta region, where adolescents demonstrated favorable attitudes toward emergency contraceptive pills despite low utilization rates [8]. However, the presence of a considerable neutral and negative response segment in the current study suggests that ambivalence still exists. Earlier studies have attributed such ambivalence to misinformation, fear of side effects, and moral hesitation [11]. The moderate positive correlation between attitude and usage (r = 0.48) further reinforces the central role of perception in shaping contraceptive behavior.

Perceptions of safety and side effects in this study reveal a mixed picture. While a fair proportion of respondents believe that Postinor is safe, there is also widespread concern about frequent use and potential long-term effects. This mirrors findings from previous Nigerian studies where fear of infertility, hormonal imbalance, and long-term reproductive harm significantly limited the uptake of emergency contraception [11]. Qualitative evidence has also shown that misconceptions about modern contraceptives often drive individuals toward ineffective or unsafe alternatives, including unverified concoctions [7]. The current study’s findings therefore highlight that, although trust in healthcare information is relatively high, persistent myths about safety continue to shape behavior.

Moral and religious concerns remain an important dimension of contraceptive decision-making. In this study, a notable proportion of respondents indicated that religion discourages the use of Postinor, and some viewed it as morally wrong or associated with guilt. This is consistent with broader evidence across sub-Saharan Africa, where cultural and religious beliefs significantly influence reproductive health choices [12]. The significant association between religion and moral concerns in this study further supports this link. At the same time, the fact that a larger proportion of respondents disagreed with these moral objections suggests a gradual shift toward more pragmatic attitudes, especially among younger and more educated women.

The role of interpersonal dynamics is also evident. Although most respondents reported no direct partner influence, more than half indicated willingness to use Postinor if suggested by a partner, and a considerable proportion acknowledged peer influence. This reflects findings from earlier studies where peer networks were major sources of information and behavioral influence regarding contraceptive use [11]. The weak but significant positive correlation between partner influence and usage (r = 0.29) in this study suggests that while individual autonomy is increasing, social relationships still play a meaningful role in decision-making.

Stigma emerges as a critical barrier in this study. A majority of respondents acknowledged the existence of stigma, with many indicating embarrassment, fear of judgment, and a tendency to conceal use. This aligns strongly with prior research in Nigeria, where stigma surrounding sexual activity and contraceptive use, especially among unmarried women, has been consistently reported as a major deterrent [8]. The negative correlation between stigma and usage (r = -0.39) and its significant effect in reducing likelihood of use in the regression model reinforce the idea that social judgment remains a powerful constraint, even in the presence of adequate knowledge and availability.

The findings on healthcare trust and self-medication provide additional insight into health-seeking behavior. While most respondents preferred consulting healthcare providers and expressed trust in pharmacists, a substantial proportion still engaged in self-medication. This dual pattern reflects earlier observations that pharmacies and informal drug outlets are often the primary sources of emergency contraception in Nigeria due to accessibility and perceived confidentiality [12]. The significant positive correlation between trust in healthcare and usage suggests that strengthening professional guidance could further improve safe and appropriate use.

Experience with Postinor use in this study shows relatively high prevalence, with most users reporting repeated use. This contrasts with earlier studies where utilization rates were considerably lower despite high awareness [11]. The dominant role of pharmacies and patent medicine stores as sources of the drug is also consistent with previous findings, reflecting the over-the-counter availability of Postinor and the preference for discreet access [7]. However, repeated use raises concerns about potential misuse and reinforces the need for better education on appropriate use and alternative contraceptive methods.

The inferential analysis further strengthens the study’s conclusions. Significant associations between age, education, marital status, and Postinor use are in line with existing literature that identifies these variables as key determinants of contraceptive behavior. The logistic regression results, particularly the strong predictive effect of positive attitude and tertiary education, are consistent with broader evidence that education enhances both awareness and autonomy in reproductive health decisions [12]. Conversely, the negative impact of stigma highlights the persistent influence of sociocultural barriers.

The findings from this study suggest that while awareness and acceptance of Postinor are improving in Abia State, utilization is still shaped by a delicate balance of knowledge, personal beliefs, social influences, and structural factors. Compared to earlier studies in Nigeria, there is clear evidence of progress, particularly in terms of increased use and more favorable attitudes. However, persistent misconceptions, stigma, and moral concerns continue to limit optimal use. Addressing these challenges will require culturally sensitive health education, strengthened healthcare engagement, and community-level interventions that normalize informed and responsible contraceptive use.