Objective: To assess knowledge, attitudes, and barriers associated with the practice of emergency contraception (EC) among women from the state of Sikkim, India. Methods: Between November 15, 2011, and June 14, 2012, trained female medical officers and interns used a standard questionnaire to interview 1474 women of reproductive age attending 2 outpatient gynecology clinics. Results: Of those who agreed to participate, 40.6% had ever heard of EC, and EC awareness was particularly low (6.4%) among illiterate women. The most common sources of EC information were electronic media (77.1%), friends and relatives (33.8%), and health personnel (30.4%). Overall, 71.9% of the participants who had heard of EC did not know the timeframe when it should be used. Only 19.6% of the women who had ever heard of EC had adequate knowledge of it, and only 15.1% of these (or 6.1% of the total sample) had ever used EC. The most common barriers to using EC were inadequate knowledge of it, its perceived non-availability, considering it an abortifacient, and religious beliefs. Conclusion: Knowledge and practice of EC was low among the women interviewed. There is a need for intensive information EC on the available methods and their correct timing. (c) 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.