Gülhane Askeri Tıp Akademisi jinekoloji popülasyonunun acil kontrasepsiyonla ilgili bilgi ve tecrübesi

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Introduction
Despite the availability of highly
effective methods of contraception, twenty-five percent of pregnancies are unintentional in the worldwide. A large body
of epidemiologic evidence suggest that
unintentional pregnancies are a worldwide problem and affect not only women
but also their families (1). Sixty percent of
these pregnancies results with abortion
and 33% of these abortions takes place
under unsafe conditions (1). Unsafe
abortions carry a higher risk of morbidity
and mortality. World Health Organization declared that the maternal death
resulting from an unsafe abortion was
approximately 70 000/year (1). Many ofCilt 48 · Sayý 1 · Gülhane TD Emergency contraception · 5
knowledge about EC. First question was
"Do you know any contraceptive method
that can be used after an unprotected
intercourse?" Answers that included
emergency contraception, use of oral contraceptive pills in high doses, insertion of
an intrauterine device (IUD) were
accepted as correct. The second question
was related with the critical time-frame in
which the emergency contraceptive
method should be used. Answers that
included 72 hours for pills and 5 days for
IUDs were accepted as correct. Other
questions included the individual and
gynecologic characteristics of patients
such as age, educational level, current and
previous contraceptive use (method,
duration and behaviour) and availability,
usage, effectiveness and information
source of EC.
One of the authors interviewed
women after self-completing the questionnaire to ensure that they had understood exactly what information was
required from each question. At the end
of the interview, EC information paper
was delivered.
Data analysis was carried out using
SPSS version 11.0. The main outcome
measure was the correct knowledge rate
of participants with regard to educational
level and age group. Statistical tests used
in the analysis were non-parametric (χ2
,
chi-square) test multivariate test (Anova).
χ2
test was used to investigate the relations among the demographic characteristics. Statistical significance was indicated
by p <0.05.
Results
Of the 689 women requested for the
study, 34 did not want to contribute and
11 refused to complete the questionnarie
during the interview. The response rate
was 93.4% and the sample included 644
completed questionnaries. The mean age
of the participants was 25.78 (±3.74) The
youngest women was 16 years old and the
oldest was 44 years old. All of the participants were married.
Three hundred forty seven of 644
participants (53.9%) didn't know anything
about EC. Some of them stated that they
had never heard about nor had an idea
about this issue. One hundred eighty four
participants (28.6%) gave irrelevant
answers to the EC questions. This group
was classified as incorrect knowledge.
One hundred and twelve participants
(17.5%) answered the questions correctly.
Of these 112, 92 knew oral contraception
pills as an EC method while 14 knew
IUD. Nine participants knew both oral
contraceptive pills and IUD correctly.
The knowledge status of patients
according to age groups is demonstrated
in Table I. Among the age groups, participants under 20 years old demonstrated
the highest correct or incorrect knowledge about the EC (26.9% and 42.0%,
respectively). Null answers were lowest
in this age group (32.1%). Sixty eight
point eight per cent of women aged more
than 39 years gave null answers to questions.
The knowledge status of patients
according to educational level is demonstrated in Table II. Among the age groups,
participants with an education of 9 or
more years demonstrated the highest correct knowledge about the EC (16.9% and
20.7%, respectively). There was a significant difference between this group and
the group with a 8 or less years of education (p=0.037). Null answers were highest in the literate group (77.8%).
Sources of information of participants
are demonstrated in Table III. Among the
participants who had knowledge about
the EC, newspapers/magazine was the
most commonly cited source of information (42.8%), while the friends was lowest
(6.7%). Twenty eight per cent (92/297) of
the participants stated that their knowledge source was medical care providers
Table I. Knowledge of emergency contraception according to age groups
_______________________________________________________________________________
Knowledge status
_______________________________________________
Age Group Correct Incorrect Null
_______________________________________________________________________________
n % n % n % n %
_______________________________________________________________________________
<20 78 12.2 21 26.9 32 41.0 25 32.1
20-24 187 29.0 33 17.6 49 26.2 105 56.1
25-29 159 24.6 29 18.2 45 28.3 85 53.5
30-34 114 17.7 16 14.0 25 21.9 73 64.0
35-39 90 14.0 11 12.2 31 34.4 48 53.3
>39 16 2.5 3 18.8 2 12.5 11 68.8
Total 644 100.0 113 17.5 184 28.6 347 53.9
_______________________________________________________________________________
Table II. Knowledge of emergency contraception according to education levels
_______________________________________________________________________________
Knowledge status
______________________________________________
Educational level Correct Incorrect Null
_______________________________________________________________________________
n % n % n % n %
_______________________________________________________________________________
Literate 18 2.8 1 5.6 3 16.6 14 77.8
1-8 years 42 6.5 3 7.1 11 26.2 28 66.7
9-12 years 314 48.8 53 16.9 94 29.9 167 53.2
>12 years 270 41.9 56 20.7 76 28.1 138 51.1
Total 644 100 113 17.5 184 28.6 347 53.9
_______________________________________________________________________________
Table III. Source and correctness of information about emergency contraception
_______________________________________________________________________________
Knowledge status
_________________________________
Educational level Correct Incorrect
_______________________________________________________________________________
n % n % n %
_______________________________________________________________________________
Newspaper / TV 127 42.8 25 3.9 102 80.3
Health Care Provider 92 31.0 68 10.6 24 26.1
Family 58 19.5 16 2.5 42 72.4
Friends 20 6.7 4 0.6 16 80.0
Total 297 100.0 113 38.0 184 62.0
_______________________________________________________________________________6 · Mart 2006 · Gülhane TD Güngör ve ark.
and this group demonstrated significantly
higher rate of correct knowledge (%74)
than the other groups (p=0.014).
The currently used contraceptive
method was oral contraceptive pill in
39.7% (n=255) of the participants, while
28.6% (n=184) of the participants were
using condoms. Usage of intrauterine
device or all the other methods was less
than ten percent (9.9% and 5.1%, respectively). Sixteen point eight per cent
(n=108) of the participants were not on
any contraceptive methods.
Thirteen point one per cent of participants (n=84) stated that they had confronted the need of an emergency contraceptive method in their sexual life. Ten
point six per cent of participants (n=68)
had used one of the emergency contraception in the past.
Discussion
EC is not only a safe and effective
method of contraception but also has the
potential to reduce drastically the number
of abortions performed in the world (7).
The overall protection provided by EC
(all methods) is reported in various studies to be approximately 75 percent (range
55 to 94 percent) (9,10). Emergency contraceptive pills, both combined and progestin-only pills, reduce rates of pregnancy
by 75 to 88 percent if taken within 72
hours of unprotected intercourse. IUD
insertion can take place within five to
seven days of unprotected intercourse and
can reduce a woman's chance of becoming pregnant by 99 percent (5).
One of the continuing mysteries of
EC is how little it has been used, Surveys
conducted in 1994 and 1995 showed that
EC was not well known by consumers in
the United States and was rarely prescribed by doctors. Even among obstetrician-gynecologists, who had a high
degree of knowledge about EC (99%) and
a willingness to prescribe it, one survey
indicated that a majority (75%) prescribed
EC fewer than five times a year (11,12).
Among women who might have need for
EC, survey data showed that only 1% had
ever used the technique, even though
over one half of women at risk indicated
they were interested in trying it. Fully
two-thirds of the women surveyed did
not know that anything could be done on
an emergency basis to reduce the risk of
an unplanned pregnancy (11,12). The use
of emergency contraceptive methods
were 9% and 12% in Australia and
Finland, respectively (13,14). In the present study, only 10.6% of the participants
used an emergency contraceptive method. The lack of knowledge seems to be
the main reason of this behaviour.
Some researchers showed that 50% to
90% of women do not know anything
about EC methods (15,16). Ozturk et al.
reported that the rate of knowledge about
EC was 7.4% (17). Zeteroglu et al. reported the knowledge rate about EC as 38.5%
among health care providers (8). In our
study although the mean educational
level of participants was higher than the
level of public, the level of knowledge of
EC was surprisingly low.
Roberts at al. found a positive association between knowledge of EC and having received formal sex education (18).
We found that knowledge about EC is
increasing by educational levels. However, more than half of women with at
least a high school educational level didn't
know anything about EC.
Women who uses postcoital contraception are reported to be commonly
younger than 25 years of age, sexually
active and have been used a contraceptive
method in their past life (19,20). Our
study demonstrated that younger participants use these methods more effectively.
Sorenson et al. reported similar results
(21).
In conclusion, although the rate of
correct knowledge of EC in our population was higher than the rates reported in
previous national studies, these rates were
lower than the expected levels. We conclude that formal reproductive health and
sex education should be given in schools,
and emergency contraceptive methods
should be inserted into the family planning programs.