Induced abortion, no matter what the cause is, is very common among women worldwide within different social status. In our day, 20% of the pregnancies all around the world end up in induced abortion. In developing countries most of these abortions are performed under unsafe conditions and are responsible for 13% of maternal mortality [1,2]. Worldwide, 68.000 women are dying because of induced abortion; also, millions of women experience nonfatal complications and sequel. Besides all of the above, unsafe abortions result in high costs to health system [1,3]. Due to its frequency, high health risks, economic costs, and the fact that it can be prevented, induced abortion is substantially an important issue for both women and public health. There are different rules in different countries about induced abortion. Out of all women in the world population 61% are living in countries where induced abortion is legal, 14% in countries where it is only legal when there is a medical, psychological, and social indication, 21% in countries where therapeutic abortion is needed to save mother’s life, and 4% in countries where it is totally forbidden no matter what the reason is [4]. In Turkey, in 27 May, 1983, with the 2827 Numbered Law About Family Planning, induced abortion was legalized until 10 weeks with the condition of getting consent from the spouse. A specialist or an educated practioner under the supervision of specialist can applicate curettage. Above 10 weeks of pregnancy, medical abortion is permitted in conditions were there is a disease compromising maternal health, and/or there is a disablement in the fetus that would affect the infant’s life, with a medical report based on objective facts [5].

The aim of this study was to evaluate the perception of married women aged 18-49 regarding induced abortion and family planning.

This is a descriptive study. All the women aged 18-49 who attended the three primary health care centers for any reason in Talas, Kayseri Province during 1-15 October 2011 were invited to participate in the study. Four hundred and nineteen agreed and gave written consent.

A structured questionnaire was used in the study. It was prepared by the investigators with the help of relevant literature. It was consisted of 39 questions for women without a history of induced abortion, and 55 questions for women who had. There were questions about the socio-demographic characteristics of the women; thoughts on family planning methods, also questions about their knowledge related to induced abortion situation in our country, and their attitude regarding induced abortion. Also questions about induced abortion experience were directed to women who had an induced abortion. The data was collected by five educated midwives/nurses. The women were enlightened about the study. They were allowed not to answer the questions which they did not want to.

The evaluation of data was done with descriptive statistics. Student T test was used to compare the mean age and education year of the women with their spouses. p<0.05 was accepted as significant. Approval for the study was taken from the Ethical Committee of Erciyes University.

The mean age of the women participating in the study was 34.0 ± 7.7, and mean education was 9.1 ± 3.7 years. The mean age and education year of the spouses were higher compared to the women (38.1 ± 7.8 years, 10.4 ± 3.7 years respectively, p<0.0001). The distribution of the socio-demographic characteristics and the fertility characteristics are shown in Table 1.

Table 1: The distribution of the socio-demographic characteristics and the fertility characteristics of the women.

The mean ideal number of children stated by the women participating in the study was 2.6

0.7; 2.5% stated the ideal number as one, 41.7% as two, 45.3% as three and 10.5% as four and above.

Out of 419 women 77.5% were using a contraceptive method at the moment. The methods used from most to least were; condom (37.2%), intrauterin device (IUD) (22.1%), coitus interruptus (16.0%), oral contraceptives (12.3%), tubal ligation (9.2%), calender method (0.6%), vasectomy (%0.6), and injection (0.3%). The most common three reasons for using a traditional method instead of a modern one were; drawbacks about the side effects of modern methods and the perception that traditional method was harmless, that it was easier, and it was the spouse’s choice. The distribution of opinions (%) whether family planning was a sin or not, in spouses and themselves of can be seen in Table 2. 24.1% of the women thought that tubal ligation was a sin, and 25.5% that vasectomy was a sin.

Table 2: The percent distribution of the answers and opinions of both spouses and themselves.

We asked the opinions of women regarding if induced abortion is a sin in some situations and the distribution of their answers are given in Table 3. The women who thought that induced abortion was a sin were asked about the reason, and 74.9% stated that it was a kind of murder, therefore was forbidden by religion.

Table 3: The distribution of the answers to the questions regarding if induced abortion is a sin in the given situation (%).

There is a legal period for induced abortion in our country. 230 women (54.9%) knew that there was a legal time but only 77 gave the right answer as 10 weeks. Women were asked whether “induced abortion could be performed without the consent of the spouse”; 107 women said “yes”, 290 women said “no”, 6 women said “did not know”, and 16 women did not answer.

When the women were asked whether they would undergo induced abortion if something was wrong with the fetus; 20% have stated that they would, 47.3% that they wouldn’t and 32.7% that they were not sure. When they were asked whether “they would go through induced abortion if the pregnancy was dangerous for their health”; 35.1% said that they would, 26.3% that they wouldn’t, and 38.7% that they were not sure.

We gave some statements regarding induced abortion and asked to answer whether they agreed or not (Table 4).

Table 4: The distribution of the women according to their state of agreement with the statements (%).

Of the 407 women 6.5% had given birth to an unwanted child. 58 (12.7%) had an induced abortion. 47 of these women had an induced abortion once, eight women had twice, two had three times, and one had five times. Among the family planning methods used before pregnancy, condom was the first and coitus interrupts was the second. The most commonly stated causes were; inappropriate timing of pregnancy, economic reasons, and having enough children already. Both the women who had gone through induced abortion and those that did not, thought that induced abortion was a sin.

Within the demographic transition Turkey is going through, there have been many changes in the reproduction policies. The foundations of family planning were established in 1965 with the “Law Regarding Family Planning”. Within this context, it has been aimed to help families to have the amount of children they want at the time they want [6]. In our study, in order to establish the opinion of women regarding parenthood, we addressed the question of how many children was ideal for them, and 45.3% answered as three, 41.7% as two. According to the Turkey Demographic and Health Survey (TDHS) results in our country, in 1993 these rates were 60% for two children, 20% for three, in 1998 57% for two, and 19% for three, in 2003 56.9% for two, and 19.5% for three, and in 2008 50.6% for two, and 20.5% for three [7]. In this study we performed, it can be seen that this rate has increased in favor of three children. This result is a demonstration of the change in our country, due to the reproduction policies within the last years.

It is important to decide whether a family planning method is to be used, and also which one will be used. In our study 77.5% of the reproductive aged group women who participated in the study were using a family planning method at the time, similar to other studies [7,8]. Looking into the methods used, it was established that of the women using family planning methods; 16.6% preferred to use traditional methods, and this was lower than the other studies [7,9]. Some of the reasons that might explain this result can be that the study was performed in the province center, half of the women were educated for 9 years and above, and access to family planning methods was much easier. Similar rates were reported in studies conducted in the same area [10].

Studies have shown that when the family planning requirements are not met, the result is unplanned pregnancies, leading to induced abortions [11,12]. Induced abortions is a social issue, which has been discussed in many aspects such as; legal, ethical, economic, and philosophical. At some times, it was perceived as an act against the woman’s body integrity, and at other times like an act against the fetus. When evaluated historically, it can be seen that all of the religions have forbidden aborting the fetus that is already in the womb of a woman. From the perspective of Islamic law, discussions are within the agenda of Islamic ulama about whether abortion should be performed without a medical necessity and about the timing. Although most of the Islam ulama accept that unless there is a legitimate reason, abortion is not acceptable, some sects accept that abortion can be performed if necessary within certain time limits [13,14]. In this study most of the women (80.7%) have stated that induced abortion is a sin. An interesting observation was that women who had at least one abortion and above, just as those that did not have an induced abortion, have also stated that induced abortion is a sin. This is a conflicting situation, which really brings us to realize the psychological burden the women have tolerated by going through induced abortion although they see it as a sin. The answers to the question of whether abortion was still a sin in certain situations were diverse. 31.3% of the women thought that induced abortion was not a sin in the case of a handicapped fetus, 53.5% if the pregnancy was endangering maternal health and 41.8% if the pregnancy was the result of rape. 20% of the women stated that they didn’t know whether induced abortion was a sin in these situations. Another interesting observation is that when the women were asked about having an induced abortion in the case of a handicapped fetus, or else if their health was in danger, the rate of accepting an induced abortion was higher in the case of maternal health endangerment.

Society and culture are important influences upon induced abortion. Demands for an induced abortion just because of the gender of the fetus, without any fetal or maternal health risks, is something encountered in some cultural environments. There were women in this study too, that would think of having an induced abortion if the fetus was a girl (13.1%).

In our country with the current legislations, induced abortion is permitted if applied by trained physicians, with the permission of the spouse. More than half of the women in the study (54.9%) were aware that induced abortion was legal in our country but, one third of these women (33.4%) did not know the legal limit of 10 weeks. 290 women (69.2%) did not know that they could not have an induced abortion without the permission of the spouse.

In our study 12.7% of the women had undergone an induced abortion. The most common reasons for having induced abortion were stated to be; unplanned pregnancy, economic reasons, and having enough children. These reasons were similar to those reported in other studies [7,15-19]. in our study, the evaluation of the contraceptive method used before becoming pregnant shows that, condom ranks first followed by coitus interruptus. Apart from the right choice of a modern contraceptive method, appropriate use of the method is as important in the prevention of unplanned pregnancy. An example to this situation is the fact that most of the women in the study from Bangladesh that underwent induced abortion were using oral contraceptive as a family planning method when they became pregnant [19]. On the other hand, the evaluation of the contraceptive method used by the women in our study showed that 16.1% of the women used coitus interruptus, and this method was among the first three methods preferred. It is a known fact that the failure rates of coitus interruptus are high increasing the risk of unplanned pregnancies. It would be appropriate to evaluate the reasons for preferring coitus interruptus (reservations regarding the side effects of modern methods, belief that traditional methods are harmless, and that they are easier to use, plus the desire of spouse), and plan future work in this field accordingly.

Another important result in our study was that within the modern methods, those that are irreversible, such as tubal ligation (24.1% of the women, and 17.2% of the spouses), and vasectomy (25.5%) of the women, and 17.4% of the spouses) were perceived as a sin.

Day by day the number of proponents saying that the women should decide about induced abortion is increasing, and this point of view is gaining importance within women’s movement and worldwide organizations [20,21]. In this study too, 55% of the women believed that the decision of whether or not to raise a child is the natural right of the woman. We did also get answers reflecting the cultural and religious characteristics of our country. 55.5% of the women did not agree upon the thought that every women should be allowed to get an abortion, and 69.7% did not agree to the idea that the women should decide on their own about getting an abortion. More than half of the women (59.2%) thought that if a woman got pregnant she should have the baby. 37.6% agreed to the idea that abortion should be banned worldwide, and 39.7% agreed that the department of religious affairs should ban abortion in our country. 37.9% of the women agreed to the statement that government should not interfere with the decision of terminating pregnancy, and 22.8% stated that they agreed partially. 65.5% of the women believed that abortion was contradictory to ethical/religious values, and 65.9% believed that if abortion was allowed, which is the case with the current law, people will behave more irresponsible and ethical values will go corrupt.

The evaluation of the perspective of the women in our study, regarding abortion, from the social, moral, and ethical aspect, it is seen that most of the women think that induced abortion is inappropriate. Apart from the rest of the data, at the same time women think that it is a woman’s natural right to decide about their own fertility. Therefore, it is suggested that the obstacles preventing the use of modern contraceptive methods should be eliminated, educations regarding the use of modern methods should be given, and the current legislation regarding induced abortion should continue.

Using a structured questionnaire is a limitation of our study. Qualitative studies can give more information for detecting thoughts.