Contraceptive Literacy and Behavioral Patterns among Female Undergraduates in Higher Education: Evidence from Sikkim, India

Introduction: Contraceptive knowledge, attitudes, and sexual behavior are important determinants of reproductive health among young women. However, cultural norms, stigma, and communication barriers may limit access to accurate contraceptive information. The present study aimed to assess contraceptive knowledge, attitudes, and sexual behavior among female undergraduate students and examine their associations with selected socio-demographic factors. Methods: An analytical cross-sectional study was conducted among 362 female undergraduate students selected through proportionate stratified random sampling from four non-medical universities in Sikkim. Data were collected using validated self-administered questionnaires on socio-demographic characteristics, contraceptive knowledge, attitudes, and sexual behavior. Data were analyzed using SPSS version 27. Descriptive statistics, Pearson correlation, multiple linear regression, and Chi-square/Fisher’s exact tests were applied. Results: All participants had heard of contraceptives, and 97.0% were aware of modern contraceptive methods. Social media was the primary source of information (77.9%). The mean knowledge score was 12.74 ± 2.46 (out of 20), indicating moderate knowledge, while the mean attitude score was 17.51 ± 2.48. Overall, 72.1% of participants had neutral attitudes, 27.6% negative attitudes, and 0.3% positive attitudes. Knowledge and attitude showed a weak positive correlation ( r = 0.30, P < 0.001). Only 5.3% reported ever having sexual intercourse, and 42.9% of respondents with a sexual history reported contraceptive use during first intercourse. Course of study and addiction were significant predictors of knowledge, whereas course of study, family type, and monthly family income predicted attitudes. Addiction was the only factor significantly associated with sexual activity. Conclusion: Despite universal awareness, participants demonstrated predominantly moderate contraceptive knowledge and neutral attitudes, highlighting the need for culturally appropriate, university-based reproductive health education to promote informed contraceptive decision-making.