What Turkish women know about
emergency contraception?

Muruvvet Baser¹, Salime Mucuk², Evrim Bayraktar³,
Tülay Özkan4, Handan Zincir5

ABSTRACT

Objective: To determine the knowledge of women about Emergency Contraception (EC) and its use.

Methodology: It is a descriptive cross-sectional study. Women attending the Family Planning Center, Kayseri during the three months (1600 women) were enrolled in this study.

Results: While 9.8% of the women had heard of EC, none of them had previously used it. The young, married, multiparous women and those who had higher education were more informed about EC (p<0.01). Among the study women (n=157) had heard of EC and 86 subjects knew EC have to be taken within 72 hour after unprotected coitus.

Conclusion: Many women hadn’t had enough knowledge about Emergency Contraception (EC) and none of the women had previously used it.

KEYWORDS: Emergency contraception, Women, Knowledge.

Pak J Med Sci    July - September 2009    Vol. 25 No. 4    674-677

How to cite this article:

Baser M, Mucuk S, Bayraktar E,Ozkan T, Zincir H. What Turkish women know about emergency contraception?. Pak J Med Sci 2009;25(4):674-677.

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1. Muruvvet Baser, RN, PhD,
Associate Professor
Department of Nursing,
2. Salime Mucuk, RN, Msc,
Instructor, Department of Nursing,
3. Evrim Bayraktar, Msc,
Instructor,
Department of Nursing,
4. Tülay Ozkan, RN, Msc,
Instructor,
Department of Nursing,
5. Handan Zincir, RN, PhD
Instructor,
Department of Nursing,
1-5: Erciyes University Atatürk School of Health,
Kayseri-Türkiye.

Correspondence

Muruvvet Baser, RN, PhD,
Associate Professor
Department of Nursing,
Erciyes University Atatürk School of Health,
38039, Kayseri-Türkiye.
E mail: mbaser_8@yahoo.com

* Received for Publication: April 21, 2009
* Revision Received: April 23, 2009
* Revision Accepted: July 10, 2009

*Presented at 5th International Congress of Reproductive Health & Family Planning, April 19-22, 2007, Ankara, Turkey

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INTRODUCTION

Emergency Contraception (EC) is a safe and effective contraceptive method utilized after an unprotected intercourse to prevent unintended pregnancies. The use of EC could help to reduce the number of unwanted pregnancies.1-3

While EC has proved to be safe and effective4,5 most of women haven’t used it. Numerous surveys have addressed possible reasons for this phenomenon which include inadequate public education6 logistical barriers to EC access,7 provider attitudinal barriers8,9 and consumer attitudinal barriers.10,11 Some studies have compared the frequency of EC use when provided in advance of need with on-demand provision.12-14 Studies show that the knowledge of the women is not sufficient regarding EC in Türkiye.3,15,16

Several publications have advocated the need for more widespread knowledge of EC.15-18 Despite reported recent increases in knowledge regarding EC its use is still not widespread.19-21 Nurses and Midwives should be aware that factors such as religious beliefs and affiliations may impact patients’ decision to seek medical assistance.22 Our objective was to determine the knowledge of women about EC and its use.

METHODOLOGY

This study was conducted at the Family Planning Clinic of Maternity Hospital (FPMH) in Kayseri, Turkey. FPMH in Kayseri is the largest center, providing family planning services in this area.

It is a descriptive cross-sectional study. One thousand nine hundred fifty one women attending the FPMH from April 1st 2006 to June 30 2006 were enrolled in this study. Two hundred seventy women refused to respond and there were 81 incompletely filled questionnaires. As such only 1600 questionnaires were suitable for analysis.

The data were collected with questionnaire form prepared by the researchers. The questionnaire included 23 questions to determine demographic features and women’s knowledge about EC. For example; Have you heard of emergency contraception? Are emergency contraceptive pills effective? etc. Accuracy of EC knowledge was formulated according to literature by the researchers.2-5

After obtaining permission from the Health Administration Organization and Maternity Hospital Administration (Approval date and no: March 30-2006, B-104.ISM.4380005/190), women were explained the purpose of the study and the questionnaire was completed by using an interview technique. All the women who participated in the study were informed about the project orally and also their written consents were taken. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki (revised October 2000).

Descriptive statistics generated demographic and women’s knowledge about EC variables. Chi square test were carried out to compare mean differences between groups. An alpha level of p less than 0.05 was considered statistically significant for all analyses.

RESULTS

The mean age of the participants was 31.2 ± 9.2 years and 93.0% of them were married, 65.6% had primary school education and 52.6% have had <3 parity. Eight thousand ninety subjects (55.7%) reported using contraceptives. The most widely used modern contraceptive method is the Intra Uterine Device (IUD) (25.8%).

While 157 women (9.8%) said they had heard of EC, 1443 women (90.2%) hadn’t heard about it (Table-I). High awareness correlated with age; 6.3% of those 29 and younger aged women had heard of EC (p=0.000). High awareness was also correlated with multiparous (8.3%) (p=0.000), and those being single (17.0%) (p=0.010). High awareness was correlated with higher education (33.5%) (p=0.000). It was found that, none of the women (1600) who were recruited in this study had previously used EC.

Among 157 subjects who had heard of EC, 63.0% knew that EC has prevented to pregnancy. High awareness was correlated with higher education (74.4%) (p=0.014). Eighty six women (54.8%) knew that EC have to be taken within 72 hour after unprotected coitus. The subgroups who identified the 72 hour time interval were 29 and younger aged women (57.0%), single (68.4%), nulliparous (66.7%), women who hadn’t had induced abortion (55.3%). High awareness was correlated with higher education (68.0%) (p=0.008) and use of contraceptive (62.0%) (p=0.029) (Table-II).

Among the 157 subjects who had heard of EC, 59 women (37.6%) knew that combined OC is used for EC and 48 women (30.6%) knew that IUD can be used. Single (84.2%) (p=0.000) and nulliparous women (66.7%) (p=0.006) and hadn’t had induced abortion (41.9%) (p=0.039) had known combined OC is used for EC.

It was observed that 100 women (63.7%) knew EC but not used it regularly. High awareness was correlated with higher education (73.1%) (p=0.045) and married (66.7%) (p=0.000).

Most of the subjects (81) learned about EC from midwife or nurse (51.6%), family and friends (21.0), & the media (16.6%). Most of women (113) had known obtaining the EC from clinics (72.0%) & pharmacy stores (14.6%).

DISCUSSION

In this study, subjects were recruited from the biggest Family Planning clinic in Kayseri. These women have same cultural, diverse social and economic backgrounds.

TDHS 20031 conducted territory-wide survey on knowledge, attitude and practice about family planning among married women. This showed that the least known methods were female condom (14%) and EC (16%). Other studies have given the figures of 26.5%,15 31.7%.23 University students (18.8%) said EC might be used after unprotected sexual intercourse.16 In developed countries, there are more women who have heard of EC: 82% in Boston,24 83% in a Swedish25 and 95% in an American university.18 Other studies26,27 found that awareness of EC and knowledge about the method is relatively low. The use, knowledge and practice of EC was low in Turkey. Although there was higher awareness regarding EC among younger women, it was still much lower as compared to other countries. We also found that single, multiparous and those with higher education were more knowledgeable about emergency contraception.

Our study also confirmed the findings that women’s knowledge on the correct time frame for using ECs was inadequate. Almost half of the women knew EC pills should be taken within 72 hours after unprotected sex. Our finding are almost similar to other studies.6,23 We also found that women with higher education were better informed about use of contraceptives and that it had to be taken within 72 hour.

In this study, there was higher awareness among single, nulliparous and those who did not have induced abortion that combined oral contraception (OC) was used for Emergency contraception (EC). Though women with higher education and those who were married had more knowledge of EC but they did not use it regularly. Despite reported recent increases in knowledge regarding EC its use is still not widespread.

While most other studies have reported the media and friends as being the main information source, this study found that the source of EC information was more from midwife or nurse. Therefore, there is an urgent need to provide more emergency contraception education to women from health professionals especially nurses and midwives.

CONCLUSION

This study has showed that none of women had previously used emergency contraception and most of them hadn’t heard about it. Moreover many among them did not have correct knowledge regarding Emergency Contraception.

Limitations of the study: Sampling framework did not include a representative group of women from the community. Although 1600 women were included but the number of those who had heard of EC was very small. This study couldn’t determine women attitudes about EC usage, because all of them had not previously used emergency contraception.

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4. Turkish Health Ministry. National Family Planning Guide. Volume II, Damla Press, Ankara, 2005.

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17. Bromham DR, Cartmill RS. Knowledge and use of secondary contraception among patients requesting termination of pregnancy. BMJ 1993;306:556-57.

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19. Gordon AF, Owen P. EC: Change in knowledge of women attending for termination of pregnancy from 1984 to 1996. Br J Family Planning 1999;24:121-22.

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22. Douglass M. EC in the ED. J Emergency Nursing 2007;33:2:140–42.

23. Uzuner A, Ekºi Mª, Erbölükbaº R. Knowledge level of the reproductive age women about EC. 4th International Congress of Reproductive Health & Family Planning Book. Bayt Ltd.ªt. Ankara, 2005.

24. Chuang CH, Freund KM. EC knowledge among women in a Boston community. Contraception 2005;71:157-60.

25. Aneblom G, Larsson M, Odlind V. Knowledge, use and attitudes towards EC pills among Swedish women presenting for induced abortion. Brit J Obstet Gyneacol 2002;109:155-60.

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