Adölesan Dönemde Evlenen Kadınların Üreme Sağlığı Davranışları: Bir Karma Yöntem Çalışması

Abstract

Amaç: Adölesan yaşta evlilik, fizyolojik ve psikolojik bakımdan evlilik ve çocuk doğurma sorumluluğu almaya hazır olmadan ve genellikle 18 yaşından önce gerçekleşen evliliklerdir. Bu araştırma, adölesan dönemde evlenen kadınların üreme sağlığı davranışlarını incelemek amacıyla yapılmıştır. Yöntem: Bu çalışmada, nicel ve nitel yöntemlerin aynı anda kullanılabileceği karma yöntem desenlerinden yakınsayan paralel desen kullanılmıştır. Bu araştırma nicel bölümde yer alan 245, nitel bölümde yer alan 25 kadın ile gerçekleştirilmiştir. Nicel verilerin toplanması sırasında yüz yüze görüşme ve yarı yapılandırılmış görüşme teknikleri kullanılmıştır. Veriler içerik analizi yöntemi kullanılarak toplanmış, nicel verilerin analizinde betimsel istatistik kullanılmıştır. Bulgular: Kadınların, ilk evlilik yaşı ortalamasının 16,1± 0,94 (Aralık: 12-17) olduğu saptanmıştır. Nicel verilerden alınan sonuçlara göre; kadınların gebelikte sağlıklı yaşam aktivitelerine uyum sağladığı (%88,7), sağlıklı doğum için hijyen/beslenmeyi sürdürdüğü / ağrı ile baş etme teknikleri uyguladığı (%95,0), doğum sonrası bakımda ise bireysel hijyeni sürdürdüğü (%69,8) belirlenmiştir. Araştırmanın nitel bölümünde ise, kadınların cinsel yaşam ve kadına yönelik şiddet ile ilgili elde edilen veriler kodlanarak "sağlıklı cinsel yaşam, cinsel şiddet, yasal prosedürler, sosyal destek ve önleyici uygulamalar" beş tema oluşturulmuştur. Sonuç: Bu çalışmada, adölesan yaşta evlenen kadınların üreme sağlığı özellikleri ve üreme sağlığına yönelik sorun yaşadıkları belirlenmiştir. Ebeler, hizmet sunumları sırasında bu hassas gruba yönelik hizmet gereksiniminin karşılanmasında, üreme sağlığı sorunlarının çözümünde ve kadın sağlığının geliştirilmesinde aktif rol alabilirler.

Keywords

• Adölesanlar
• ebelik
• evlilik yaşı
• güvenli cinsellik
• üreme sağlığı.

Reproductive Health Behaviors of Women Married in the Adolescent Period: A Mixed Method Study

Abstract

Objective: Adolescent marriages are those that take place before the age of 18 years or before maturity and are associated with a wide range of health and psychological problems. This study was carried out to examine the reproductive health behaviour of women who got married during the adolescent period. Methods: In this study, convergent parallel design, in which the quantitative and qualitative stages of mixed method designs can be applied simultaneously, was used. This research was carried out with 245 women included in the quantitative section and 25 women in the qualitative section. During the collection of the quantitative data, face-to-face interview and semi-structured interview techniques were used. The data were collected using the content analysis method, and descriptive statistics were used in the analysis of quantitative data. Results: The mean age at first marriage was 16.1±0.9 (range 12–17) years. Quantitative analysis showed that, to have a healthy delivery, women adopted the practices of healthy life during pregnancy (88.7%), for the birth they maintained nutrition, ensured good hygiene and performed pain coping techniques (95.0%) and maintained personal hygiene during post-partum (69.8%). Analysis of the data collected in the in-depth interview on the women’s practices on sexual life and violence against women, five themes were identified ‘healthy sex life, sexual violence, legal procedures, social support and preventive practices’. Conclusion: Women who got married at adolescent age had problems with their reproductive health characteristics and reproductive health. Midwives can take an active role in meeting the service needs for this vulnerable group, solving reproductive health problems and improving women’s health during service provision.

Keywords

• Adolescents
• marriage age
• midwifery
• reproductive health
• safe sex

References

1. Girls not Brides: (2019). Taking action to address child marriage, the role of different sectors An overview 2016. https://www.girlsnotbrides.org/wp-content/uploads/2016/03/1.-Overview-Addressing-child-marriage-role-of-diff-sectors.pdf Accessed December 14, 2019.
2. United Nations Children’s Fund (UNICEF) (2015). Child marriage, adolescent pregnancy and family formation in West and Central Africa Patterns, trends and drivers of change United Nations Children’s Fund. https://www.unicef.org/wca/media/1171/file/English%20PDF.pdf Accessed October 15, 2019.
3. Hacettepe University Institute of Population Studies (2019). 2018 Turkey Demographic and Health Survey. Hacettepe University Institute of Population Studies, T.R. Presidency of Turkey Directorate of Strategy and Budget and TÜBİTAK, http://www.hips.hacettepe.edu.tr/tnsa2018/rapor/TDHS2018_mainReport.pdf Accessed November 12, 2020.
4. United Nations Children’s Fund (UNICEF) (2016). The State of the World's Children, A fair chance for every child. New York. https://www.unicef.org/publications/files/UNICEF_SOWC_2016.pdf Accessed December 10, 2019.
5. Kaptanoğlu İY, Ergöçmen AB. Factors that pave the way for becoming a child bride. Journal of Sociological Research. 2012;15(2):128-161.
6. Cheung KK, Montgomery D, Benjamins LJ. Prevalence of Sexually Transmitted Infections Among Adolescents Entering Child Protective Services. J Pediatr Adolesc Gynecol. 2015; 28(5):324-326. doi:10.1016/j.jpag.2014.09.011.
7. Medhi R, Das B, Das A, Ahmed M, Bawri S, Rai S. Adverse obstetrical and perinatal outcome in adolescent mothers associated with first birth: a hospital-based case-control study in a tertiary care hospital in North-East India. Adolesc Health Med Ther. 2016;7:37-42. doi.org/10.2147/AHMT.S91853.
8. Darroch JE, Woog V, Bankole A, Lori SA. Adding It Up: Costs and Benefits of Meeting the Contraceptive Needs of Adolescents 2016. https://www.guttmacher.org/report/adding-it-meeting-contraceptive-needs-ofadolescents Accessed November 10, 2019.

9. World Health Organization (WHO) (2018). World health statistics, monitoring health for the SDGs, sustainable development goals. https://apps.who.int/iris/handle/10665/272596 Accessed December 11, 2020.
10. World Health Organization (WHO) (2017). Preventing unsafe abortion. https://www.who.int/news-room/detail/28-09-2017-worldwide-an-estimated-25-million-unsafe-abortions-occur-each-year. Accessed December 21, 2019.
11. Ulu N, Demi̇r H, Taşar M, Dallar Y. The knowledge of sexually transmitted diseases among adolescents in a low socioeconomic area of Ankara. Turkish Journal of Pediatric Disease. 2015;9(1):32-38. doi:10.12956/tjpd.2014.100.
12. Öztürk F, Akın A, Karataş SÇ, İlik B, Türkçelik E. Protection and support program to combat violence against women in resource book, In: Project “Combating Violence Against Women Through Prevention And Support”. 2015; First issue; 1-127.
13. Yount KM, Crandall A, Cheong YF, Osypuk TL, Bates LM, Naved RT, Schuler SR. Child Marriage and Intimate Partner Violence in Rural Bangladesh: A Longitudinal Multilevel Analysis. Demography. 2016;53(6):1821-1852. doi.org/10.1007/s13524-016-0520-8.
14. Soylu N, Ayaz M. Sociodemographic characteristics and psychiatric evaluation of girls who were married at younger age and referred for criminal evaluation. Anatolian Journal of Psychiatry. 2013;14(2):136-144. doi.org/10.5455/apd.36694.
15. International Confederation of Midwives (ICM) (2013). Essential competencies for basic midwifery practice 2010, Revised 2013. The Essential Competencies for Basic Midwifery Practice is a living document. http://www.safeabortionwomensright.org/wp-content/uploads/2016/05/ICM-Essential-Competencies-for-Basic-Midwifery-Practice-2010-revised-2013.pdf Accessed December 21, 2020.
16. TR. Ministry of Health (2014). Regulation on Job and Job Descriptions of Healthcare Professionals and Other Professionals Working in Healthcare Services. Official newspaper, 29007. https://www.resmigazete.gov.tr/eskiler/2014/05/20140522-14.html Accessed January 12, 2020.
17. Creswell JW, Plano Clark VL. Mixed method pattern selection. In: Design and Execution of Mixed Methods Research, Ed. Dede Y, Demir SB. Mixed method pattern selection. In: Design and Execution of Mixed Methods Research, (2nd ed.). Ankara, Anı Publishing, 2015.
18. Hacettepe University Institute of Population Studies (2014). 2013 Turkey Demographic and Health Survey. Hacettepe University Institute of Population Studies, T.R. Ministry of Health Care For Women International 15 Development and TUBITAK. http://www.hips.hacettepe.edu.tr/tnsa2013/rapor/TDHS_2013_main.report.pdf Accessed December 11, 2019.
19. Yıldırım A, Şimşek H. Qualitative research methods in the social sciences. Ankara, Seçkin Publishing, 2016.
20. Ayaz M, Ayaz AB, Soylu N. Psychiatric Evaluation of Child and Adolescent Forensic Cases. Journal Clinic Psychiatry. 2012;15(1):33-40.
21. Güneş M, Selçuk H, Demir S, İbiloğlu AO, Bulut M, Kaya MC, Yılmaz A, Atli A, Sır A. Marital harmony and childhood psychological trauma in child marriage. Journal of Mood Disorders.2016;6(2):63-70. https://app.trdizin.gov.tr/makale/TWpNNE1qTTFOUT09/cocuk-evliligi-yapan-kadinlarda-cift-uyumu-ve-cocukluk-cagi-ruhsal-travmasi Accessed December 12, 2019.
22. Karaçalı M, Özdemi̇r R. The factors influencing the access of married women, aged 15-49, to family planning services in Karabük province. Turk J Public Health. 2018;16(2):131-145.
23. Karabulut A, Özkan S, Bozkurt, T Karahan, S Kayan. Perinatal outcomes and risk factors in adolescent and advanced age pregnancies: Comparison with normal reproductive age women. Journal of Obstetrics and Gynaecology. 2013;33(4):346-350. doi.org/10.3109/01443615.2013.767786.
24. Leppälahti S, Gissler M, Mentula M, Heikinheimo O. Is teenage pregnancy an obstetric risk in a welfare society? A population-based study in Finland, from 2006 to 2011. BMJ Open. 2013; 3: e003225. doi.org/10.1136/bmjopen-2013-003225.
25. Tulay A, Tanriverdi G: Comparison of Postpartum Women Cares In Different Cultures: Qualitative Research. International Refereed Journal of Gynaecology and Maternal Child Health. 2017;9(1):1-25.
26. Altuntuğ K, Anık Y, Ege E. Traditional Practices of Mothers in the Postpartum Period: Evidence from Turkey. Afr J Reprod Health. 2018;22(1):94-102. doi.org/10.29063/ajrh2018/v22i1.9.
27. Grigoriadis S, Dennis C, Kenneth F, Gail R, Sarah R, Lori R, Cornelia C. Postpartum cultural practices: a systematic review of the evidence. Ann Gen Psychiatry. 2008:7,S163. doi.org/10.1186/1744-859X-7-S1-S163.
28. Dönmez A, Çoban AO, Canbay FC: Unwanted pregnancy and unsafe abortions of solution the role midwife's. TAF Preventive Medicine Bulletin. 2016;15:450-457. doi.org/10.5455/pmb.1-1453470432.
29. Kocaöz S, Peksoy S, Atabekoğlu C. The contraceptive methods used before pregnancy and preferred in the postpartum period by women. Balıkesir Health Sciences Journal. 2013; 2(1): 1-8.
30. Çelik AS, Kırca N: Complementary and Supportive Care Practices Used by Infertile Women. Journal of Anatolia Nursing and Health Sciences. 2018;21(3):178-188.
31. Ghosh S, Subrata LS, Nitin DN. Understanding Happiness and Psychological Wellbeing Among Young Married Women in Rural India. Journal of Comparative Family Studies. 2017; 48(1): 113 - 131. doi.org/10.3138/jcfs.48.1.113.
32. Şenol D, Yıldız S. Perception of Violence Against Women - With Men and Women Perspectives. Ankara, Happy Kids Association Publications. 2013.
33. Anik M, Barlin R: The Problem of Child Brides in Turkey: Balıkesir Example. Journal of the Human and Social Sciences Researches. 2017;6(3):1827-1841. https://doi.org/10.4049/jimmunol.176.3.1348.