- Academic Editor
Background: Our study aimed to investigate the demographic
characteristics of patients who applied for legal curettage and the incidence of
depression in patients after the procedure. Methods: Our study
was carried out in Ortaca/Turkey in 2021–2022. It is a prospective
cross-sectional study. Our study was conducted on 35 patients. In our study, the
patients’ income level, education level, place of residence, family structure,
religious belief, and the reason for the legal eviction request were
investigated. It was investigated whether the patients were affected in their
work, private, social, and sexual life after the procedure. Post-procedure Beck
depression inventory (BDI) was applied to the patients and their spouses. The
incidence of post-procedure depression was investigated. SPSS Version 28.0.1
program was used for statistical analysis. Results: The mean age was
33.74
In its simplest definition, abortion means the termination of an unwanted pregnancy by various methods. However, not wanting to be pregnant is itself the subject of ethical, political, and legal debates and practices. In other words, whether or not she wants to bring a child into the world is not seen as a matter that a woman can decide on her own as an individual [1]. Family planning is when couples can have as many children as they want, whenever they want. Couples need to benefit from family planning services adequately. As a result, both unwanted pregnancies and excessive fertility will be prevented, mother-child health and public health will be positively affected, and the effective use of country resources will be realized [1]. Although there have been important developments as a result of the policies implemented in our country for about 30 years, the use of family planning methods has still not reached the desired levels [2, 3, 4]. Unwanted pregnancies are an important medical, social, and social health problem [5]. The World Health Organization states that approximately 84 million unintended pregnancies occur each year [6]. An average of 46 million abortions occur each year and 17 thousand women die due to unsafe abortions [7]. The fact that the rate of use of modern contraception methods is not at the desired level in Turkey and the application rates for abortion is still high are seen as an important problem in terms of women’s health [8]. Family planning services are provided free of charge by the Ministry of Health in Turkey. These services are carried out by health personnel trained in family planning centers affiliated with the Ministry of Health. Despite the free provision of these services, the high rates of unwanted pregnancy and legal abortion show that women do not know this issue. In our study, the causes of legal abortion, the demographic characteristics of the patients, and the development of depression were investigated. We aim to make available data a great contribution to family planning services.
Our study aims to learn the reasons for abortion in patients who come for legal abortion and to contribute to family planning and various planning for these reasons. It is also to contribute to the health plans to be made according to the demographic characteristics of the patients. To determine the rate of depression that will develop after curettage in patients and to draw attention to the need for psychiatric support in patients who come for legal curettage. Our study was conducted in Turkey. Our study is a study that examines the Beck depression inventory (BDI) scores of the mothers before and after legal pregnancy discharge and the effects on the social life of the mothers after the legal termination of pregnancy. At the same time, BDI scores of fathers after legal termination of pregnancy were compared with mothers. For these reasons, it is one of the rare studies that will contribute to the literature.
Our study is a prospective cross-sectional study.
Our study was carried out in Muğla/Turkey Ortaca Yücelen Hospital, Gynecology, and Obstetrics clinics between Sep 2021 and April 2022.
Our study was conducted on patients over the age of 18. Patients who did not have a medical indication for curettage and who wanted legal curettage were included in the study. Patients under the age of 18 were excluded from the study by Turkish laws. Article 6 of Law No. 2827 on Population Planning (NPHK), which came into force in 1983, states that “If people are married, the consent of the spouse is required for sterilization or evacuation of the uterus”. Therefore, patients whose consent could not be obtained from one of the spouses of married patients were excluded from the study. The study was designed on 40 patients who applied to our center for legal pregnancy evacuation under 10 weeks between the relevant dates. However, 3 patients did not want to participate in the study. And 2 patients were not included in the study. They could not be reached in any way because they came for a holiday. Patients who had curettage with medical indication were excluded from the study. It was performed on 35 patients who met the working conditions.
The study was conducted as a single-center multidisciplinary study. Patients who met the inclusion criteria were included in the study. In the study, the age and obstetric history of the patients were questioned. Income levels of the patients (1) Living on social assistance; (2) Single minimum-wage employee; (3) Two minimum-wage employees; (4) A single employee in a middle-income job; (5) Two employees in a middle-income job; (6) The high-income level was questioned. The middle-income level was taken as twice the minimum wage. Patients were classified as (1) Illiterate; (2) Primary school graduate; (3) Secondary school graduate; (4) High school graduate; (5) University graduates according to education level. The patients were classified as (1) Village; (2) Town; (3) District center; (4) Provincial center according to where they lived. The patients were classified according to their family structure: (1) The nuclear family (Parents and children); (2) Extended family (including grandparents, grandparents). Patients were classified as (1) Non-believer; (2) Having any religious beliefs. Patients were not asked which religion they belonged to avoid ethnic discrimination. The patients were asked about the reasons for the termination of pregnancy. (1) Being single; (2) Not knowing who his father is; (3) Pregnancy as a result of extramarital affair; (4) Fear that the body shape will deteriorate due to pregnancy; (5) Fear of raising and caring for children; (6) Getting pregnant as a result of family planning/conservation method error; (7) Having more than two children; (8) Thinking you’re too old to be a mother; (9) Being in financial trouble; (10) Not wanting to have children at all; (11) Thinking it’s too early to have children; (12) Thinking that you can’t be a mother or father was questioned. In our study, it was questioned whether the patients’ work, private, social, and sexual lives were affected after curettage. Beck Depression Inventory (BDI) was administered to the patients and their spouses one day before the procedure. BDI was applied to the patient and their spouses again on the seventh day after the procedure. BDI was administered face-to-face or online. No referral was made to the patients during BDI. We can express the evaluation of the scores as a result of BDI as follows: 0–9: Minimal Depression. 10–16: Mild Depression. 17–29: Moderate Depression. 30–63: Severe Depression. In BDI, the person chooses the option that best describes him/herself. Then, the points given to each item are added up. The lowest score that can be obtained from the scale is 0, and the highest score is 63. The total score; gives the result that it is none-mild, mild-moderate, moderate-severe, or severe. The incidence of depression in the patients was investigated.
While evaluating the findings obtained in the study, IBM SPSS Statistics 28 (PASW Inc, Chicago, IL, USA) program was used for statistical analysis. While
evaluating the study data, the Chi-Square test was used to compare qualitative
data as well as descriptive statistical methods (mean, standard deviation,
frequency). Significance was evaluated at the p
The general characteristics of the patients included in the study are given in
Table 1. The demographic characteristics and legal abortion requests of the
patients included in the study are given in Table 2. While the mean BDI score of
the mothers before the legal termination of pregnancy was 10.1143
Number (n) | Minimum | Maximum | Mean | |
---|---|---|---|---|
Age (Year) | 35 | 18 | 43 | 33.74 |
Total pregnancy | 35 | 1 | 5 | 2.742 |
Number of birth | 35 | 0 | 4 | 1.45 |
Number of live children | 35 | 0 | 4 | 1.42 |
Number of curettages | 35 | 0 | 4 | 1.17 |
Number of abortions | 35 | 0 | 1 | 0.085 |
Number (n) | Percent (%) | Total | ||
---|---|---|---|---|
Living place | ||||
Village | 5 | 14.3 | 35 | |
Town | 6 | 17.1 | 35 | |
District Center | 23 | 65.7 | 35 | |
Provincial center | 1 | 2.9 | 35 | |
Level of education | ||||
Primary school graduate | 1 | 2.9 | 35 | |
Secondary school graduate | 4 | 11.4 | 35 | |
High school graduate | 14 | 40 | 35 | |
Graduated from an Üniversty | 16 | 45.7 | 35 | |
Income rate | ||||
Living on social assistance | 1 | 2.9 | 35 | |
One minimum wage workers | 5 | 14.3 | 35 | |
Two minimum wage workers | 14 | 40 | 35 | |
One middle-income worker | 13 | 37.1 | 35 | |
Two middle-income workers | 2 | 5.7 | 35 | |
Family structure | ||||
Nuclear family | 28 | 80 | 35 | |
Extended family | 7 | 20 | 35 | |
Religious belief | ||||
Does not believe | 3 | 8.6 | 35 | |
Believes | 32 | 91.4 | 35 | |
Reason for requesting legal abortion | ||||
Not to be married | 5 | 14.3 | 35 | |
Not knowing his father | 5 | 14.3 | 35 | |
Extramarital affair | 1 | 2.9 | 35 | |
Fear of pregnancy-related body shape deformation | 0 | 0 | 35 | |
Fear of raising and caring for children | 4 | 11.4 | 35 | |
Getting pregnant as a result of family planning/conservation method error | 4 | 11.4 | 35 | |
Having more than two children | 3 | 8.6 | 35 | |
Thinking you’re too old to be a mother | 4 | 11.4 | 35 | |
Be in economic distress | 5 | 14.3 | 35 | |
Not wanting to have children at all | one | 2.9 | 35 | |
Thinking it’s too early to have children | 3 | 8.6 | 35 | |
Thinking that you can’t be a mother or father | 0 | 0 | 35 |
Mean |
Total number of patients (n) | p | |
---|---|---|---|
Mothers before the procedure | 10.1143 |
35 | 0.00* |
Mothers post-procedure | 19.457 |
35 | |
Fathers before the procedure | 6.28 |
25 | 0.956 |
Fathers post-procedure | 7.25 |
25 |
*Student’s t-test 95% Confidence Interval p
Mean |
Total number of patients (n) | p | |
---|---|---|---|
Mom | 19.45 |
35 | 0.00* |
Father | 7.25 |
25 |
* Student’s t-test 95% Confidence Interval p
* 10 patients do not have a partner.
Minimal depression | Mild depression | Moderate depression | Severe depression | Total | p | ||||||
---|---|---|---|---|---|---|---|---|---|---|---|
N | % | N | % | N | % | N | % | N | % | ||
Mom | 5 | 14.3 | 10 | 28.6 | 13 | 37.1 | 7 | 20 | 35 | 100 | 0.00* |
Father | 12 | 34.3 | 10 | 28.6 | 2 | 5.7 | one | 2.9 | 25 | 100 |
* Pearson Chi-Square 95% Confidence Interval p
10 patients do not have a partner.
N, Number; %, Percent.
Number (N) | Percent (%) | Total number (n) | Total percentage (%) | ||
---|---|---|---|---|---|
Business life | |||||
Affected | 20 | 57.1 | 35 | 100 | |
Not Affected | 15 | 42.9 | 35 | 100 | |
Social life | |||||
Affected | 16 | 45.7 | 35 | 100 | |
Not affected | 19 | 54.3 | 35 | 100 | |
Private life | |||||
Affected | 25 | 71.4 | 35 | 100 | |
Not affected | 10 | 28.6 | 35 | 100 | |
Sexual life | |||||
Affected | 29 | 82.9 | 35 | 100 | |
Not affected | 6 | 17.1 | 35 | 100 |
Worldwide, approximately 73 million abortions are performed each year, and more
than 90% occur in the first trimester [9, 10]. While women generally cope with
psychological problems related to abortion, some experience psychological
problems [11, 12, 13]. The Transactional Model, derived from stress and coping
theories, for example, can help explain the factors that influence women’s
responses to the experience of abortion. According to this model, a woman’s
psychological experience is shaped by how she evaluates the importance of
abortion and her coping skills. Perceived stress arises from situations in which
women assess that they exceed their coping abilities or resources. Women’s
perceptions of stress can influence the choice of certain coping behaviors and
subsequently their psychological well-being [14]. In our study, the rate of
moderate and severe depression in mothers was determined as 57.1%. In our study,
mothers with moderate and severe depression were given psychiatric support.
Farnoosh Moafi et al. [15] conducted a study on 185 women who had
spontaneous abortions between 2015 and 2016. In this study, they found the rate
of depression in patients to be 54%. In this study, it was reported that
religious belief, gestational age at the time of abortion, and education level
contributed to the development of depression [15]. In a different study, the rate
of depression was reported as 7.9% after curettage [16]. In a review of 23
studies among American women, factors such as the previous history of mental health
problems, gestational age, low self-esteem, low resilience, poor ability to cope
with abortion, indecision about the decision to have an abortion, stigma, and low
social support were effective in influencing female psychology [12]. In our
study, the post-procedural BDI scores of the mothers were significantly higher
than before the procedure. In a study conducted on 253 women who requested an
abortion in a tertiary hospital in Beijing in 2021, the stress level was found to
be 25.3%, and the depression level was 22.5% [17]. CERAN and TAŞDEMİR
conducted a study on depression and anxiety in patients who had a legal abortion
and were aborted for medical reasons. In the study, moderate-severe depression
was found to be statistically higher in the group seeking legal termination of
pregnancy than in the medically aborted group (31.4%, 5.7%, p
Our study is a single-center multidisciplinary study. Although it has the advantage of being a prospective study, the number of patients is small. There is a need for multicenter, multidisciplinary studies with more patients in this regard.
In our study, it was observed that there were various reasons for voluntary legal termination of pregnancy. The three most common reasons are not being married, not knowing the father of the child, and being in economic distress. The second most common reasons are fear of raising and caring for a child, getting pregnant as a result of family planning mistakes, and thinking that she is too old to be a mother. Other reasons are having more than two children, thinking that it is too early to have a child, pregnancy as a result of extramarital affairs, and not wanting a child in any way. BDI scores increased significantly after legal termination of pregnancy compared to the time of the first admission in mothers. The rate of moderate and severe depression after legal termination of pregnancy in mothers is 57.1%. In our study, mothers with moderate and severe depression were given psychiatric support. Post-procedure mothers are at high risk of depression and medical attention is needed. Compared to mothers, fathers have lower depression scores. Mothers are more affected by legal termination of pregnancy from a psychological point of view. Consideration should be given to providing psychiatric support to mothers.
Datasets are available from the corresponding author on reasonable request after permission from the local authorities.
Extraction and drafting of the manuscript—İK, BB, AY, HY; Analysis of data, manuscript revision—HY, İK; Design and revision—İK, HY; Statistical analysis—İK, BB, AY, HY. All authors read and approved the final manuscript.
The study was approved by the ethics committee of the University Faculty of Medicine with Protocol No: 220028 and Decision No: 28. The study was conducted by the Declaration of Helsinki. Informed consent was obtained from the patients included in the study.
We would like to express my gratitude to the nurses and health workers of Muğla Ortaca Yücelen Hospital who contributed to the preparation of this article.
This research received no external funding.
The authors declare no conflict of interest.
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