Knowledge, attitudes, and practices on contraceptive methods among Advanced Level students in the Ratnapura district

Abstract

Contraceptive knowledge is essential for preventing unplanned pregnancies and Sexually Transmitted Infections (STIs). Despite free family planning services in Sri Lanka, adolescents face knowledge gaps. This study assesses contraceptive knowledge, attitudes, and practices among Advanced Level (A/L) students in the Ratnapura District to identify disparities and improve reproductive health education. A cross-sectional study was conducted among 304 A/L students using stratified sampling. The sample consisted of 49.7% females (n = 151) and 50.3% males (n = 153) from five academic streams (Mathematics 21.4%, Biology 22.4%, Technology 17.1%, Commerce 20.0%, Arts 19.1%). Data were collected using a structured questionnaire and analysed using JASP (Version 0.19.1) with descriptive statistics and Chi-square tests. The questionnaire was based on contraceptive knowledge, sexual health education, and related behaviours. While 77% of students were aware of at least one contraceptive method, only 21% correctly identified the effective time period for Emergency Contraceptive Pills (ECPs). Male students exhibited higher contraceptive knowledge than female students (p<0.001). Students from the Biology (61.77%) and Mathematics (52.3%) streams demonstrated higher contraceptive knowledge. Social media was the primary source of contraceptive information, with 53.7% citing it over other sources. While 69.6% of students supported sexual health education starting from Grades 8–11, and 75.6% supported STI screening, actual contraceptive use (4.7%) and STI screening rates (0.8%) were very low, indicating barriers to healthcare access and social stigma. Further, 7.3% of students reported engaging in sexual activities. This study highlights the need for improved sexual health education, especially for females and non-science stream students. While the majority of the students are aware of contraceptive methods, detailed knowledge remains low, and contraceptive use is limited despite awareness. STI screening rates are also extremely low despite strong support. The results indicate barriers to access, social stigma, and educational gaps that require targeted interventions.