Original StudiesTurkish Adolescents' Knowledge on and Attitude toward Emergency Contraception
Introduction
Adolescence is generally the time period when the human species begin to discover their sexuality and become sexually active. Unfortunately, however, this is also the period of time of insufficient knowledge and experience. As a result, adolescents, unaware of sexually transmitted diseases and contraceptive methods, begin to experience their sexuality with little or no protection, which puts them under the risk of various infections and unwanted pregnancies.
The increasing tendency for adolescents to participate in sexual activities at an early age all over the world in recent years has increased unwanted pregnancy rates and complications related to them.1 In fact, a study carried out in the USA revealed that the abortion rate was higher among teenagers when compared to other age groups.2 This situation has proven the necessity of preventing unwanted pregnancies and decreasing abortion rates in order to protect reproductive health.
Adolescent pregnancy challenges the United States and Europe because not all sexually active adolescents use contraception, and even those who do use contraception sometimes use it incorrectly.3 Thus, high rates of adolescent pregnancy remain a challenge for health care providers. Of the estimated 3.5 million unintended pregnancies that occur each year in the United States, some 1.7 million are thought to be the result of contraceptive failure. The extremely high numbers of unintended pregnancies not only in the United States but also worldwide indicate that emergency contraception remains an important but underused method of pregnancy prevention.4
Emergency contraception (EC) specifically refers to contraceptive methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure, or incorrect use. It has been determined that the EC method suggested by Prof.Dr. Yuzpe, which is the application of 100 μg ethinyl estradiol and 1 mg norgestrel or 100 μg ethinyl estradiol and 0.5 mg levonorgestrel within 72 hours after unprotected intercourse and repeated 12 h later, has decreased the pregnancy rate by 74%.5
Despite the listed benefits of emergency contraceptives, studies carried out in several countries revealed that most teenagers lacked sufficient knowledge about this method and how to apply it.6 Emergency contraception still has not taken its place precisely among family contraception method in Turkey also. Actually, according to the demographic health survey performed regularly every 5 years and the last being completed in 2003, 98% of adolescents were aware of contraceptive methods but 55.7% have never used any contraceptive method. Only 16.9% used a modern method for contraception and 46.5% of married adolescents used a contraceptive method for the first time once they had already given birth.7 In this survey, however, there are no data about whether emergency contraception is among the contraception methods used by adolescents or not. It may be thought that neither the adolescents nor the reproductive age women know or use this method effectively. In all, these results emphasize that contraception is ineffective among adolescents in Turkey.
Using EC, in Turkey, where modern contraceptive use is low and the induced abortion rate is high compared to developed countries, will yield important results. Moreover, the continuity rate of modern contraceptive methods is low in our country.7 This situation increases the incidence of unprotected or inefficiently protected intercourse and thus makes EC more important. All of this reveals that being aware of EC and using it correctly is essential for women's health in our country.
Family planning services all over the world are indispensable for women and public health. Nevertheless, different cultural, religious, and moral values bring about diversities in using family planning services in various countries. Therefore, each country needs data in order to determine its own family planning policies. In Turkey, sexual intercourse before marriage is rare due to moral values, but the marriage rate during adolescence is high and the use of modern contraception is low in this age group.7
The most important data about the status of adolescents in Turkey can be found in “Turkey's Population and Health Research” performed in 2003. According to the report, 19.7% of our population is composed of adolescents.7 And, 11.9% of adolescents between 15 and 19 years old are married. This number rises to 49.8% for those between 20 and 24. This clearly shows us that almost half of the Turkish people get married during adolescence. Related to this, an important number of pregnancies also occur at adolescence. According to “Turkey's Population and Health Research,” 20.7% of women at 19 have either given birth or are pregnant. Strikingly, 38.2% of women between 20 and 24 have already given birth.7 These data show us that an important number of pregnancies occur at adolescence in our country, which emphasizes the importance of EC for our public health.
As adolescents are under risk of unwanted pregnancies, detecting their level of knowledge on emergency contraception and providing them information is important to prevent such pregnancies. For most sexually active adolescents, pregnancy is unintended.
In the light of this aim, we planned a study among university students in order to determine their knowledge and their attitude about emergency contraception. To our knowledge, there is no research related to adolescents' emergency contraception use in our country. Even if the following study does not represent the whole population, we hope that it will enable us to provide the first data related to emergency contraception among university students and will lead to further studies in this area.
Section snippets
Materials and Methods
The study was performed with 385 freshman students of “Occupational Education Faculty” and “Technical Education Faculty” in Gazi University, Ankara. Ankara is the capital city of Turkey and Gazi University is one of the biggest universities of Ankara. A questionnaire including questions about demographic properties, obstetrical history, status of contraceptive use, level of knowledge and opinions on emergency contraception was applied to the students. Questionnaires were distributed to the
Results
A total of 385 adolescents were included in the study; 157 males (40.8%) and 228 females (59.2%). The mean age of the participating students was 18.4 ± 1.6. Only 6 students were married (1.6%) and the rest were single.
When asked about their sexual experiences, 57 students responded that they had sexual intercourse (14.8%). Of these 57 students, 53 were single males, 2 were married males, and 2 were single females. This means 35% of males and 0.9% of females had a previous sexual intercourse.
Discussion
Even desired or occurring within the context of a marriage, adolescent pregnancies carry high risks such as increased maternal and fetal morbidity and mortality.8 Most of such pregnancies end in therapeutic curettages which are not performed by medical professionals but by inexperienced people. These invasive procedures may result in abnormal bleeding, uterine perforation, and sepsis, and may threaten adolescents' health. Long-term effects may include adhesions secondary to infections, which
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Cited by (9)
Sexual, relationship, contraceptive and personal factors influencing emergency contraception use: A qualitative study
2011, ContraceptionCitation Excerpt :These studies demonstrate that even when available, EC is underused [7,8]. Limited knowledge about EC, including how to use it and its mechanism of action, negative attitudes toward EC, perceived moral implications of using EC and lack of awareness of pregnancy risk all undermine EC use [9–16]. As opposed to nonuse, less is known about EC use.
A comparison between adolescent mothers and adult mothers in terms of maternal and infant outcomes at follow-ups
2013, Journal of Maternal-Fetal and Neonatal MedicineEmergency contraception: Knowledge, attitudes and practices among married Malay women staff at a public university in Malaysia
2012, Southeast Asian Journal of Tropical Medicine and Public HealthUse of emergency contraception by the adolescent and young adult women
2012, International Medical JournalKnowledge and opinions of Turkish university students about contraceptive methods and emergency contraception
2012, Sexuality and DisabilityKnowledge and practices about the subject emergency contraception of the pharmacists and their helpers in the pharmacies in Manisa
2012, TAF Preventive Medicine Bulletin