BIRTH CONTROL METHODS

What is Birth Control and Fertility?

Birth control means having as many children as a couple can care for. The most common misconception here is that birth control is a method used to decrease the population, which is entirely wrong. What matters is the right of a couple in a society to have as many children as they can care for (according to their social and economic circumstances).

Fertility health is crucial. Female fertility health spans from ages 15 to 40. The better a society can care for women in this age group, provide good preconception education, the better off it will be.

What are the most commonly used birth control methods in Turkey?

In Turkey, compared to the rest of the world, the most commonly used birth control methods are intrauterine devices (IUDs). For example, in Europe, birth control pills are more widely used in countries like the UK, while in the US and Canada. In Turkey, birth control pills are used around 3-4%, and similarly, IUDs are used around 15-20%. Apart from that, modern methods are unfortunately still less utilized in Turkey. Methods are divided into traditional and modern. The most commonly used modern methods are birth control pills, subdermal implants, hormonal or non-hormonal intrauterine devices (IUDs), and condoms.

The traditional methods include withdrawal and calendar-based methods, meaning refraining from intercourse on certain days of the month. In Turkey, 40 out of 100 women still use any modern method, and approximately half of the remaining women prefer traditional methods.

Which birth control method do I recommend the most? Why?

I recommend a method based on the patient’s condition, circumstances, and fertility expectations. This is very important. For example, for a couple who has never had children, if suitable, I recommend birth control pills or condoms. If they have experienced fertility, meaning they have had at least one child, then I list all options for the woman postpartum. What are these methods? Intrauterine devices, birth control pills, condoms, or subdermal implants. It’s essential to emphasize that there is no one-size-fits-all birth control method for everyone; it varies for each individual.

Which birth control method is the least risky? What is the most guaranteed method?

There is no answer to this question because there is no risk-free and guaranteed method found worldwide. Each method has its pros and cons. If we say the least risky, of course, these are the simplest and easiest methods passed down from fathers, such as withdrawal or calendar methods. Still, there is still a risk of around 15-20% of becoming pregnant. On the other hand, the most guaranteed birth control method currently in the world is tubal ligation, meaning tying and burning both tubes of the woman, or subdermal implants, or hormonal IUDs. These are currently the safest birth control methods. However, each has its pros and cons. In summary, there is still no birth control method that is suitable for every couple in the world without any risk or the most guaranteed.

What are the latest birth control methods in Turkey and the world?

The latest birth control methods include subdermal implants, which are available both in Turkey and worldwide. Hormonal IUDs are also available both in Turkey and worldwide. Apart from these, there are patch types of birth control pills (i.e., applied to the skin), which are not currently sold in Turkey but may be available soon. Also, there are vaginal rings, which are available worldwide but not used in our country.

What are the side effects of birth control methods?

The side effects of birth control methods vary. Frankly, the side effects of pills (birth control) are a bit more concerning to the public. These include nausea, vomiting, dizziness, and can cause depression. They can also lead to fungal infections. In addition, intrauterine devices have side effects such as bleeding and pain. The common feature of hormonal spirals or subdermal implants is irregular bleeding or no bleeding at all. There is a risk of condom breakage (i.e., the risk of being unreliable). As you can see, each method has its own side effects.

Emergency Contraceptive Pills

What are Emergency Contraceptive Pills?

Emergency Contraceptive Pills, or Morning-After Pills, come in two types worldwide. Morning-After Pills have been available in Turkey for about 1-1.5 years. They have been available worldwide for a long time.

We can talk about two types of pills here. The first is called the “Emergency Contraceptive Pill,” which contains both estrogen and progesterone. The other is called the “Morning-After Pill,” which contains only progesterone. Both are for emergency protection. If a couple has had intercourse without using any method or if the method they used failed, the most common example being condom breakage, emergency contraceptive pills help in such situations. They prevent pregnancy by about 80-85%. Currently, the most preferred worldwide are the Morning-After Pills containing progesterone. This method has fewer side effects compared to others and is more effective. In summary, their effectiveness is higher compared to emergency contraceptive pills (containing both estrogen and progesterone).

What is Abortion?

There are several types of abortions. Elective abortion occurs when a woman has an unwanted pregnancy due to the failure of contraception or because she did not use contraception. In such cases, the pregnancy is terminated, or sometimes for medical reasons (i.e., medical reasons), if the mother’s life is in danger or if there is a disability in the baby. These are all reasons for abortion.

Is Abortion a Birth Control Method?

Absolutely not. Abortion is not a birth control method. It should not be accepted as such. However, many women in Turkey still consider abortion as a birth control method. This is definitely a mistake. Abortion is a last resort.

For what reasons do women in our country undergo abortion?

The biggest reasons are ignorance and negligence. Why negligence? Because many intellectual women, including doctors, do not use contraception. They even rely on traditional methods.

As a result, these women become pregnant. I think the two biggest reasons in Turkey are negligence and ignorance of contraception.

What factors should be considered before abortion?

The most important factor to consider before abortion is how many weeks the baby is. Currently in Turkey, abortion is allowed up to 10 weeks, and abortion beyond 10 weeks is not legal. However, abortion can be performed for medical reasons, i.e., if there are reasons related to the mother and the baby. This should be approved by at least two specialists on the subject. Although there is generally no specific decision, abortions are performed in Turkey up to the 24th week.

In addition to these, it is essential not to perform abortion unless necessary. Just as we mentioned earlier, abortion is not a birth control method. But if it needs to be done, the physician performing the abortion must be experienced in this regard. Because despite abortion seeming simple, complications of abortion are still at the forefront of legal cases between doctors and patients today. Therefore, it is essential for the physician to be knowledgeable and experienced in this regard, and hygiene must be ensured at the place where the abortion is performed. At the same time, it is crucial that abortion be performed in hospital conditions, where intervention can be made in case of any problems, rather than in clinics or small offices.

How is abortion currently performed in our country?

All kinds of methods used worldwide are also applied in our country. Methods such as cervical dilation, followed by vacuum or curettage to empty the uterus, as well as various medical techniques to facilitate abortion both in the world and in Turkey. Honestly, we cannot say that Turkey has lagged behind in this regard in terms of global developments or methods.

What techniques were used in the past? What is the situation now?

In the past, some drugs related to abortion were used more. These drugs are not used today. Nowadays, more types of prostaglandins are used. The purpose of this method is to facilitate cervical dilation and make abortion easier. This is the most significant development. Other than that, surgical methods still continue as before. This is the same worldwide. One method used worldwide but not in Turkey is the use of progesterone antagonists.

What is the most suitable method for abortion?

It is difficult to give a definite answer to this question.

Because the method varies according to the individual. But the most commonly used method, as mentioned, is to give a medication before abortion to dilate the cervix, and then to perform vacuum aspiration, which is the removal of the embryo through vaginal means using medical instruments.

What are the risks of abortion?

Abortion carries many risks. The first is the risk of retained products of conception, and the second risk is bleeding. In addition to these, there is the risk of infection in the patient, and there are risks related to anesthesia.

Furthermore, if certain medical conditions or certain situations are not taken into account, complications due to these factors can also occur. For example, risks for a woman with heart disease… One of the most common complications we encounter as physicians is uterine perforation, tearing, or bleeding, retention of tissue in the uterus, and infection in the uterus.

What should be done after abortion?

Ideally, the woman should rest for at least two days. It is beneficial to use antibiotics after abortion (especially if hygiene is compromised or if the place where the abortion was performed is not very hygienic). Painkillers should also be used.

A woman who has had an abortion should refrain from sexual activity for at least two to three weeks, should not perform vaginal cleaning, and should take showers…

A woman who has had an abortion can become pregnant again. That is, there is no medical contraindication after the next menstrual period (if there were no complications during the abortion). However, psychological support is essential for her to become pregnant again. If the woman plans to have another abortion, it can create serious problems. Therefore, if a woman does not want to become pregnant again, she must use contraception. If she wants to become pregnant after abortion, she should do so when she feels ready. It is essential to be mentally prepared, not just physically.

What emotional states have you observed in women after abortion?

You observe various emotional states in women… In some women, you see distress, while in others, you observe relief and relaxation. Some women express sentiments like “I’m glad I did it, otherwise, I wouldn’t have been able to handle this pregnancy,” especially those who have issues in their marriage. Or if there are extramarital abortions, they may be seen as a relief. However, particularly if one of the couples really wants the baby and has had to terminate the pregnancy due to certain reasons, serious aggressive behaviors can be observed later on.

What recommendations do you have for women after the abortion procedure?

After abortion, we definitely inquire about contraception methods and when they want to become pregnant again, especially if the abortion was done at the woman’s request. We make recommendations accordingly. This is crucial to prevent future abortions.

In the meantime, if the abortion was not by the woman’s choice but was necessary, we try to address any issues before the next pregnancy… Then we facilitate her becoming pregnant.

Is psychological support necessary for women coming for abortion?

Providing psychological support is in the hands of the doctor. Instead of immediately saying, “Okay, let’s remove the fetus,” we ask why they felt the need for an abortion. And then we try to prevent it as much as possible… Sometimes, even if it’s a decision made jointly, we’re happy to see couples change their minds.

Sometimes, Turkish women may go to other doctors instead of their own, saying “Oh, I don’t want my doctor to see me like this.” In such cases, there’s nothing we can do.