Affordable, convenient and discreet: why emergency contraception is the family planning method of choice among female university students in Zambia

A significant unmet need for family planning exists among Zambian adolescent women aged 15-24. This study investigated knowledge, attitudes and behaviours regarding contraception use and associated barriers with obtaining contraception, among a group of female university students in Lusaka, Zambia. A descriptive qualitative study was conducted using focus-group discussions (FGDs). Through a preliminary online survey, enrolled university students indicated interest in attending FGDs to discuss sexual and reproductive health perceptions, attitudes and behaviours, including contraception use. FGDs were audio-recorded, transcribed and thematically analysed. Thirty-four female students participated in five FGDs. A key theme of frequent emergency contraception (EC) use emerged as a preferred pregnancy prevention method owing to its convenience, affordability and discretion. Barriers to accessing long-term, more reliable contraception methods included premarital sex stigma, healthcare workers' refusal to provide contraceptives, fears of contraceptive use judgement and misconceptions about side effects of other methods. Findings highlight favourable EC use among female university students over more reliable contraception options owing to significant health system and societal barriers. Differentiated service delivery methods, youth-friendly spaces and improved education to destigmatise contraception are needed in Zambia to mitigate high rates of unintended pregnancies for this vulnerable population.