STUDY ON THE INFLUENTIAL FACTORS
OF SEXUAL AND REPRODUCTIVE
HEALTH OF ADOLESCENTS IN THE
FIRST YEAR STUDENTS OF THE TWO
UNIVERSITIES IN TURKEY
REPORT
ANKARA, 2003
STUDY ON THE INFLUENTIAL FACTORS OF SEXUAL
AND REPRODUCTIVE HEALTH OF ADOLESCENTS IN
THE FIRST YEAR STUDENTS OF THE TWO
UNIVERSITIES IN TURKEY
Principle Investigators
Prof. Dr. Ayşe Akın
Assoc. Prof. Dr. Şevkat Bahar-Özvarış
This study received technical and financial support from the Special Programme of
Research, development, and research Training in Human Reproduction, World Health
Organization
Hacettepe University
Public Health Department-WHO Collaborating Center on RH
Ankara, 2003
1
STUDY ON THE INFLUENTIAL FACTORS OF SEXUAL
AND REPRODUCTIVE HEALTH OF ADOLESCENTS IN
THE FIRST YEAR STUDENTS OF THE TWO
UNIVERSITIES IN TURKEY
(PROJECT REPORT)
Project Team
Prof. Dr. Ayşe Akın
Assoc. Prof. Dr. Şevkat Bahar-Özvarış
Assoc. Prof. Dr. Melikşah Ertem
Assist. Prof. Dr. Nalan Şahin Hodoğlugil
Assist. Prof. Dr. Günay Saka
Dr. Dilek Aslan
Çiğdem Esin
Kezban Çelik
Report by
Prof. Dr. Ayşe Akın
Assoc. Prof. Dr. Şevkat Bahar-Özvarış
Dr. Dilek Aslan
Çiğdem Esin
Kezban Çelik
Ankara, 2003
Table of Contents
2
Page
Introduction & Methodology
8
Findings & Discussion
17
Thoughts/Opinions and Recommendations of Service Providers
59
Conclusions & Recommendations
78
References
88
Appendix:
90
1.
2.
3.
4.
5.
6.
Informed Consent Form for the Focus Group Discussions Subjects
Informed Consent Form for Survey Interviews
Informed Consent Form for Service Providers
Focus Group Discussions Directory Questions
Questionnaire Form of Survey
Questionnaire Form of Service Providers
List of Tables-I
(Findings & Discussion)
3
Table 1. Distribution of Students by Sex and Age
Table 2. Distribution of Some Socio-demographic Characteristics of Students by Sex
Table 3. Percent Distribution of Some Characteristics of Students’ Parents
Table 4. Percent Distribution of Students’ Current Residence
Table 5. Percent Distribution of Some Habits of Students by Sex
Table 6. Percent Distribution of Students’ Free Time Activities By Sex
Table 7. Percent Distribution of Sexual/Reproductive Health Definitions of Students by Sex
Table 8. Percent Distribution of Sources of Information on Sexual/Reproductive Health by
Sex of Students
Table 9. Distribution of Status of Speaking with Parents on Sexual/Reproductive Health and
Spoken Issues among Participant Students by Sex
Table 10. Percent Distribution of Status of Speaking with Mothers about S/R Health Issues
by Education of s of Mothers of Students
Table 11. Percent Distribution of Status of Speaking with Fathers about S/R Health Issues by
Education of Fathers of Students
Table 12. Percent Distribution of Preferred Sources of Information on Sexual/Reproductive
Health among Students by Sex
Table 13. Percent Distribution of Receiving Sexual/Reproductive Health Services by
Type of Social Security
Table 14. Percent Distribution of Students’ Status of Ever Receiving Sexual/Reproductive
Health Services and Types of Received Services by Sex
Table 15. Distribution of Institutions Where Participant Students Received
Sexual/Reproductive Health Services by Sex
Table 16. Distribution of Reasons of Not Receiving Sexual/Reproductive Health Services by
Sex
Table 17. Percent Distribution of Information of Students on the Period in Which Women
Have the Highest Possibility to Get Pregnant by Sex
Table 18. Distribution of Information of Students on the Best Age Interval for a Healthy
Pregnancy by Sex
Table 19. Percent Distribution of Students’ Ideas on Some Mentioned Sexual/Reproductive
Health Issues by Sex
Table 20. Distribution of Side Effects that Participant Students Think Some Contraceptives
May Cause by Sex
Table 21. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of Students
by Sex
Table 22. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of Students
by Age Groups
Table 23. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of
Participant Students by Mother’s Education
Table 24. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of
Students by Father’s Education
Table 25. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of
Students by Their Current Residence
Table 26. Percent Distribution of Status of Knowing, Using, and Knowing Where to Get
Contraceptive Methods among Students by Sex
Table 27. Percent Distribution of Status of Contraceptive Use among Participant Students by
4
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43
Sexual Experience
Table 28. Percent Distribution of Students’ Ever Use of Any Contraceptive Method by
Sexual/Reproductive Health Knowledge Score
Table 29. Percent Distribution of Status of Knowing Where to Get Contraceptive Methods
Among Participant Students by Sex
Table 30.1. Percent Distribution of Agreement Status of Students to Some Statements by Sex
Table 30.2 Percent Distribution of Agreement Status of Students to Some Statements by Sex
Table 31. Percent Distribution of Students’ Ever Having a Partner by Sex
Table 32. Distribution of Ideas of Students on What Sexuality May Include in Dating by Sex
Table 33. Percent Distribution of Ideas of Participant Students on “Pre-marital Sex is Natural
Part of Dating” by Sex
Table 34. Percent Distribution of Previous Sex Experience of Participant Students by Sex
Table 35. Percent Distribution of Students’ Definitions of Safe Sex by Sex
Table 36. Percent Distribution of Students’ Ideas on the Risks in Sexual Intercourse by Sex
Table 37. Percent Distribution of Students’ Ideas on “What Should be Done in Case of
Unwanted-Premarital Pregnancy?” by Sex
Table 38. Percent Distribution of Students/Their Partners’ Pregnancy Experience by Sex
Table 39. Percent Distribution of Ways of Termination of Pregnancy among Students by Sex
Table 40. Percent Distribution of Ideas on the Responsibility of Protection from Pregnancy
by Sex.
Table 41. Percent Distribution of Ideas on the Responsibility of Protection from STIs by Sex.
Table 42. Percent Distribution of Students’ Definitions of Sexual Violence Behavior by Sex
Table 43. Percent Distribution of Students’ Ideas on “Where Should Sexual/Reproductive
Health Services Specific to Young People be Provided?” by Sex
Table 44. Percent Distribution of Students’ Ideas on the Expected Qualifications of
Sexual/Reproductive Health Services Specific to Young People by Sex
Table 45. Distribution of Ideas of Students on the Qualifications of Service Providers by Sex
List of Tables-II
(Ideas and Recommendations of Service Providers)
5
43
44
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48
50
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51
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52
52
53
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56
57
Table 1. Age Distribution of Interviewed Service Providers
Table 2. Sex Distribution of Interviewed Service Providers
Table 3. Percent Distribution of Marital Status of Interviewed Service Providers
Table 4. Percent Distribution of Interviewed Service Providers by Having Children
Table 5. Percent Distribution of Interviewed Service Providers by the Last Attended School
Table 6. Percent Distribution of Interviewed Service Providers by Occupation
Table 7. Percent Distribution of Work Duration of Interviewed Service Providers
Table 8. Percent Distribution of Service Provided By Interviewed Providers
Table 9. Percent Distribution of Interviewed Service Providers by Their Status of Having
Training Specific to Young People
Table 10. Percent Distribution of Interviewed Service Providers’ Evaluation of Sufficiency of
Their Education Specific to Young People
Table 11. Percent Distribution of Services Specific To Young People Provided by Interviewed
Service Providers
Table 12. Percent Distribution of Interviewed Service Providers’ Evaluation of Sufficiency of
The Services Specific to Young People
Table 13. Percent Distribution of Young People’s Reasons for Application According to
Interviewed Service Providers
Table 14. Percent Distribution of Issues Out of Clinical Complaints that Young People Ask for
Information According to Interviewed Service Providers
Table 15. Percent Distribution of Opinions of Interviewed Service Providers on Status of Being
Comfortable of Young People While Talking About Their Complaints
Table 16. Percent Distribution of The Things To Be Done By Young People In The
Application Process To Receive Sexual/Reproductive Health Services
Table 17. Percent Distribution of Opinions of Interviewed Service Providers on Positive and
Negative Aspects of Application Process
Table 18. Percent Distribution of Opinions of Interviewed Service Providers on The Necessity
of Sexual/Reproductive Health Services Specific To Young Age
Table 19. Percent Distribution of Opinions of Interviewed Service Providers on Issues on
Which Young People Necessitated To Get Information
Table 20. Percent Distribution of Interviewed Service Providers’ Opinions on Areas of Services
Necessary To Be Provided for Young People
Table 21. Percent Distribution of Important Matters in Which Service Providers Should Be
Careful During Service Provision
Table 22. Percent Distribution of the Issues on which Service Providers Necessitate Further
Training
Table 23. Percent Distribution of the Influence of Service Providers’ Attitudes on the Decisions
of Youth to Utilize the SRH Services
Table 24. Percent Distribution of Interviewed Service Providers’ Opinions on Stratas/Regions
of Young Persons Receiving SRH Services
Table 25. Percent Distribution of Interviewed Service Providers’ Opinions on the Sex
Distribution of Applicant Young Persons for SRH Services
Table 26. Percent Distribution of Interviewed Service Providers’ Opinions on Provision of
Contraceptive Methods to Unmarried Women
Table 27. Percent Distribution of Interviewed Service Providers’ Opinions on Making Gender
Differentiation in Provision of Services
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Page
Table 28. Percent Distribution of Interviewed Service Providers’ Opinions on Providing 73
6
Information about Sexual/Reproductive Health
Table 29. Percent Distribution of Interviewed Service Providers’ Opinions on
74
Informing Families Before Provision of Information on Sexual/Reproductive Health to
Adolescents
Table 30. Percent Distribution of Interviewed Service Providers’ Opinions on Providing 74
Information about Sexually Transmitted Infections to Unmarried Adolescents
Table 31. Percent Distribution of Interviewed Service Providers’ Opinions on Tools of 74
Information Services about Sexual/Reproductive Health Specific to Adolescents/Young People
Table 32. Percent Distribution of Interviewed Service Providers’ Opinions on the Qualities of 75
an Ideal Sexual/Reproductive Health Service for Adolescents/Young People
7
INTRODUCTION
&
METHODOLOGY
8
RATIONALE AND OBJECTIVES OF THE STUDY
Rationale
Sexual and reproductive health of adolescents has been a major international concern and it had
been very clearly indicated in the 1994 International Conference on Population and Development
(ICPD) in Cairo. In the Programme of Action, in paragraphs 7.7. and 7.8 it is stated that
“reproductive health programmes should be designed to serve the needs of women, including
adolescents”, and that innovative programmes should be developed to “ensure information,
counseling and services for reproductive health accessible for adolescents and adult men” (UN,
1996).
The importance of adolescent sexual and reproductive health had been neglected in reproductive
health and population programs and studies due to the sensitivity of the issue for a long time. By
the strong emphasize on adolescent sexual and reproductive health in 1994 International
Conference on Population and Development in Cairo, and in Beijing Platform for Action
(Fourth World Conference on Women, 1995), where a comprehensive and holistic approach
towards sexuality, sexual and reproductive health was developed as part of basic human rights.
The programs of action developed in these conferences state that the characteristics and
necessities of adolescent/young people sexual and reproductive health should be included into
the programs designed to improve the health conditions all over the world (MSI, 1998).
The study on sexual/reproductive health of adolescents/young people requires specific focus and
perspective. Their reproductive health needs are rapidly increasing in a world where the number
of adolescents is increasing. While sexual activity is being initiated earlier, due to lack of adequate
information on sexuality and contraceptives, adolescents are exposed to increased risk of
unwanted pregnancy and sexually transmitted infections (STI). Under the current circumstances
in the world, adolescents can face serious physical, economic and psycho-social consequences
from pregnancy and STI (WHO/FRH/FPP, 1997).
Although great variation is observed in the incidence of adolescent pregnancies among countries,
this is more frequently a problem of more developed countries. Adolescent pregnancies increase
the morbidity and mortality of young mothers. Additionally, having children at an early age is a
barrier for many women for educational, psycho-social and economical development. Early
motherhood also causes increased morbidity and mortality for their children as well as for
themselves (WHO, 1998).
Married or unmarried, 15 millions of adolescents experience pregnancy each year. Since most of
these pregnancies are unwanted, young women tend to have induced abortions, whether legal or
not. Adolescent pregnancy and induced abortions are important problems in several countries
(UN Population Fund, WHO, Ministry of Health (MoH) of Ukraine, Ukrainian FP Association,
1999; WHO, MoH of Bulgaria, 1998) and according to WHO projections, nearly half of the
induced abortions occur under unsafe conditions. Unsafe abortions cause a serious morbidity and
mortality burden for women, and in the case of adolescents, the risk is even magnified (WHO,
1998). Also, even in countries where abortion is legal, unmarried adolescents, when compared to
married adolescents more often recourse to unsafe abortion partially due to moral and cultural
values and concerns.
Studies about STIs in adolescents show that the incidence is increasing. Today, each year, one in
20 adolescents suffer from an STI other than HIV/AIDS. Moreover, half of new HIV cases are
9
observed in the 15-24 age group. When factors such as lack of knowledge, frequent changing of
partners, or having multiple partners are combined, the risk of adolescents to contract the
diseases increases (WHO, 1998). Adolescents also lack sufficient information about
contraceptives and an important proportion does not know how to prevent pregnancy or prevent
transmission of STIs (Serbanescu F and Morris L, 1997).
It is necessary to develop plans and programs for adolescents / young people to easily access
sexual/reproductive health information and services within reproductive health programs in
order to solve the problems of sexual/reproductive health faced by adolescents/young people.
One of the prior precautions to be taken within this context is the provision of services specific
to adolescent age. These services should be provided by highly qualified health personnel with
specific training on sexual/reproductive health of adolescents. However, the studies conducted
with service providers show that they do not assess themselves “adequate” in provision of
services to adolescents/young people. A study on attitudes and practices of physicians toward
adolescent health care show that they have limited experience and perceive themselves to be
underskilled in dealing with adolescent health issues (Hardoff D, Tamir A and Paltı H, 1999).
Training programs on adolescent health need to be developed to meet the needs of health
personnel.
Sexual/Reproductive Health of Adolescents/Young People in Turkey
Sexual/reproductive health of adolescents/young people is an area of study that has been gaining
importance especially in developed countries. On the other hand, although the adolescent sexual
and reproductive health is a primary concern in terms of reproductive health issues, early
marriages, and fertility in developing countries (Koc & Unalan, 2000), the comprehensive studies
including Information-Education and Counseling (IEC) training phases have been accelerated
only in the last decade. Similarly, it is still an under-investigated area in Turkey. Especially, the
knowledge, perception, and attitude of adolescents on sexual/reproductive health are ignored
research subjects.
According to the 1995 census, the population of 10-19 age group is 13 331 000 and constitute
21.8% of the general population in Turkey. The 1998 Turkish Demographic and Health Survey
(TDHS) results show that women aged 15-19 constitute 20.1% of the female population (HUIPS
and DHS+, 1999).
The legal age of marriage was equalized to 17 for women and men in Turkey by a Law enacted in
2001. According to 1998 TDHS, currently 15.5% of women aged 15-19 are married. The
percentage of women with the age 15-19 at first marriage is 33.7%. In Turkey, the age at first
marriage and women’s educational status are generally lower in especially eastern and rural areas
(HUIPS and DHS+, 1999). Early marriage and adolescent pregnancies are to be an important
and known health problem of adolescent/young women in particular regions of Turkey. The
existing data on young women at these ages is mostly classified under the headings of age at first
marriage, pregnancy and becoming mother. According to 1998 TDHS, 1.8% of the women at the
age of 15; 9% of the women at the age of 17; and 23.1% of the women at the age of 19 are
married and have children (HUIPS and DHS+, 1999).
According to the 1998 TDHS, 3.7% of young women at the age group of 15-19 have no idea
about any type of contraceptive method. While 55.5% of married women at this age group are
using any traditional and/or modern contraceptive method, 44.5% of them do not use any
method (HUIPS and DHS+, 1999). According to the Results of Further Analysis of 1998 TDHS
10
(2002), the percentage of women in this age group with at least one induced abortion is 5.5%.
This figure increases to 7.3% in the age group of 20-24.
The limited number of studies on sexual/reproductive health of young people have not focused
on perceptions of sexual/reproductive health, attitudes and behaviors related to
sexual/reproductive health. Rather, most studies have investigated the knowledge of adolescents
on reproductive health. The findings of major studies conducted in Turkey are summarized
below:
A survey conducted in Ankara in 1992 among 13 665 female students aged 13-18 attending to 32
High Schools found the average age of menarche as 13.3. In this study, 85% of female students
had previous information about menarche, and while 34% indicated that they know how
menstruation occurred, only 22% knew it correctly. The study also reported that girl friends,
books, newspapers and magazines were the major sources of information on sexual issues and
those parents or health staff did not have a major role in acquiring knowledge. The same study
also indicated that 90% of all students wanted to have an education at schools about sexuality
(Vicdan, 1993).
Another study conducted in a high school in Gulveren, which is a slum area of Ankara, aimed to
identify the knowledge of students on sexual health and sexuality. Among the 170 senior high
school students, the level of knowledge was low, and only 1% was classified as having sufficient
knowledge. Combined oral contraceptives were mentioned most frequently as the known method
of contraception (60%) by both males and females. Also, male students seemed to have more
information on STD than female students (Ozvaris et al., 1995).
In a survey, which was conducted in slum areas of five big provinces by the collaboration of the
Turkish Ministry of Health and Hacettepe University Institute of Population Studies, knowledge
of STIs among adolescents was examined. In the 15-19 age groups, 21.8% of males and 34.6% of
females could not even say the name of any sexually transmitted disease (HUIPS and DHS+,
1999).
Another study aimed to find out the sexual health knowledge of teacher nominees. The study was
conducted in three Faculties of Education in Istanbul. For this study, 494 candidates were
surveyed and one focus group was conducted in each faculty. According to the results, 24.1% of
the candidates found their knowledge about STD, physiology, anatomy and fertility regulation
insufficient, while 55.7% rated themselves as average and 15.4% as having sufficient knowledge.
Overall, the knowledge scores were very low, however, prospective female teachers had relatively
higher scores (Ozyurek and Nalbant, 1998).
In short, results of all studies conducted in Turkey show that adolescents have insufficient
knowledge about sexual/reproductive health and their main sources of information are friends,
parents and mass-media. On the other hand, they are willing to have information and counseling
and services on these issues.
The main reason of the insufficient knowledge of adolescents/young people on
sexual/reproductive health is the close link of the issues with sexuality, and the cultural norms
about sexuality within Turkish society. Sexuality has been seen as a great taboo topic. Parents
maintain the traditional thoughts regarding sexuality, sexual practices. They prefer not to talk
about sexual issues with their children as they believe that it is for shame to speak with children
on sex, and talking about sexuality may encourage adolescents to have pre-marital sexual
intercourse, which is strictly prohibited in Turkish society. The attitudes and behaviors of
11
adolescents/young people and their families on sexual/reproductive health are primarily
influenced by the social values and cultural norms. The thoughts and behaviors around sexuality
and sexual/reproductive health seem similar in different socio-economic groups. Especially
young women have been the target of social pressure/control exercised over their body, sexuality
and their sexual practices.
The traditional attitudes towards sexual/reproductive health also influence the curriculum at
schools. There is an elective lecture at high-school curriculum of public schools on health.
However, the information provided to students in this lecture is limited to biological
reproduction of human beings. Therefore, adolescents/young people are unable to reach
confidential sources of information and get information from their peers, families or
professionals on sexual/reproductive health.
In general, it is observed that the thoughts and behaviors of university students related to
sexuality and sexual/reproductive health is relatively less conservative due to their higher level of
education. However, only 2.8% of the total population of women and 5.5% of the total
population of men in Turkey has university education (Women in Turkey, 1999). This less
conservatism in thoughts among university students may be explained by the relatively free
atmosphere of the campuses, by the students’ experience of living apart from their families or by
their changing values and norms while becoming an adult. It is possible to think that the social
interaction between young people with different backgrounds also influence the students’
thoughts and behaviors at the university atmosphere. When all these factors are taken into
consideration, pre-marital sex may also be expected to be more prevalent among university
students.
Methodology
A combination of qualitative and quantitative research methods are used in this research study.
These are focus group discussions, survey, and semi-structured interviews. The first year students
at Hacettepe University Beytepe Campus (Ankara) and Dicle University Campus (Diyarbakir)
constituted the research group. The aim of conducting the research in two different provinces is
to determine whether distinctive life styles, socio-economic status, and cultural structure of these
two provinces have different influences on thoughts and behaviors of adolescents/young people
or not. Service providers who provide sexual/reproductive health services to university students
in both provinces are also interviewed within the content of this research.
In the first phase, 8 Focus group discussions (two female and two male groups) were conducted
in each university in April-May 2001 as a baseline for the questionnaire design and to have a
general impression on the knowledge, attitudes, and perceptions of the young people about
sexual/reproductive health.
In the second phase of the study, a survey was conducted by using a self-administered
questionnaire among all 2179 first year students of Hacettepe University Beytepe Campus, and
2163 of Diyarbakır Dicle University who were attending the faculties other than medicine and
health-related departments in 2000-2001 academic years. 1789 students in Hacettepe University
Beytepe Campus, and 1877 students in Dicle University were surveyed. Totally 3666 students
responded the questionnaire, which is 84.7% of the entire group
In the third phase, semi-structured interviews were conducted with 45 health personnel who
provide services to adolescents/young people both in several institutions and centers in Ankara
and Diyarbakır between February-May 2002.
12
Objectives
Short term objectives
1. To identify sexual and reproductive health knowledge, perceptions, attitudes, risk
behavior and contraceptive practices of adolescents at universities
2. To identify underlying socio-cultural factors affecting the sexual and reproductive
attitudes and practices of adolescents at universities
3. To determine the level of Reproductive Health/Family Planning service utilization and
the expectations of sexual/reproductive health services among university students
4. To identify the knowledge, attitudes, Adolescent Sexual/Reproductive Health (AS/RH)
counseling skills and information, education, communication needs of the health
personnel who provide sexual/reproductive health services to university students in two
provinces.
Long term objectives
Based on the findings of this research:
a) To design and develop a model to provide Adolescent/Youth Friendly Sexual and
Reproductive Health Services (AFS/RHS) to youth in universities
b) To implement Adolescent and Reproductive Health Services responding to the S/RH
needs of young people at universities
c) To change university students’ knowledge, attitudes, service seeking, contraceptive use
and risk behaviors on S/RH in a positive manner
d) To contribute to the improvements of adolescents S/RH information and service needs
and the development of AFS/RHS in Turkey
The Variables of the Study
The main headings of the influential factors to be examined are as follows;
Background factors:








Community
Family structure
Demographic characteristics of the adolescent/young person
Socio-economic (SE) characteristics
Communication within family
Media
Peers
Availability of services
Intervening factors:

Perceptions of Adolescents, their attitudes and dating behavior
 Perception of risk, risk behavior
 Attitudes
 Gender Roles
 Alcohol and drug use
 Adolescents’/young people’s awareness of available services
 Accessibility of services
 Perceptions of quality of care, provider attitudes etc.
Study Site
13
Hacettepe University Beytepe Campus in Ankara consists of Faculty of Economics and
Administrative Sciences, Faculty of Applied Sciences, Science of Engineering, Science of
Education, and the Faculty of Literature. Totally 11 504 students were attending these faculties at
Hacettepe University Beytepe Campus in Ankara according to the statistics of the student office
in November 2000. 2179 of the total students were first year students and they were the target
group of this baseline study. Hacettepe University’s Medical Faculty, Nursing School and other
health science faculties and schools are located in another campus at Sihhiye. These students have
reproductive and sexual health lectures as part of their regular curriculum. Therefore, they were
not included in this study in order to overcome the contamination problem.
All first year students at Beytepe Campus were included in this study because strategically it was
not possible to reach a representative sub-sample of the group. Another reason for not studying
with a selected sample was that this study was planned in three phases and there would be a
follow-up phase after the initial baseline survey. If a sample was used, both baseline and followup samples should have been representative, which was difficult with the grouping system of the
University. Names of the students were not asked, and in case of a failure with
representativeness, data would not be comparable. Therefore, although the number 2179 seems
high, it was decided not to use a sample but include the whole group to the study.
Dicle University campus in Diyarbakir consists of Faculty of Justice, Applied Sciences and
Literature, Engineering and Architecture, Veterinary Medicine, Agriculture, Theology and the
Faculty of Education. There were totally 2163 first year students at Dicle University campus in
Diyarbakir in 2000-2001 academic year, and they constituted the target group of the baseline
survey. A sample was not selected with the reasons similar to Hacettepe University group. In
order to be able to compare Hacettepe University Beytepe campus’ students with those of Dicle
University campus, students of Medical Faculty and other health sciences were not included in
the survey in Diyarbakir.
Focus Group Discussions
Totally eight Focus Group Discussions were conducted at Hacettepe University Beytepe Campus
and Dicle University as the first phase of the research study. Focus group discussions (two female
and two male groups) were conducted at each university as a baseline for the questionnaire
design and for having a general impression on the sexual/reproductive health knowledge,
attitudes and perceptions of the young people.
The focus group discussions were conducted in Ankara and Diyarbakir with the participants
whose numbers changed from five to ten in each group. Totally 62 students participated in the
groups; 33 of them are female students while 29 of them are male students. The average age of
students is 19. The discussions were conducted on 14th, 15th, 21st, 27th of March 2001 in Ankara,
and 5th, 6th and 7th (two groups at the same day) of April 2001 in Diyarbakir. The duration of the
discussions changed from 1,5 hours to 3 hours depending on the size of the group. The groups
were moderated by a sociologist by a field guide together with an assistant moderator, who was
also a sociologist with a medical background (see Appendix 1).
The selection of the participants for the focus group discussions in both of the universities was
made by implementing simple questionnaires explaining the objective of the study, and the focus
group discussions, and asking the age and sex of the students. The forms were disseminated
during the information sessions of the first year students in the selected departments. The
volunteer students filled the questionnaire forms. They also wrote their phone numbers on the
forms. These forms were given back to the participants before the focus group discussions, and
14
the others were discarded later. The groups were single-sex groups. Two female and two male
groups in each university were conducted.
The participants were asked for consent before the discussions were recorded. The transcriptions
of the discussions were made by the social scientists, who moderated and assisted the discussions.
The tape cassettes were discarded after the transcriptions were completed.
Survey
The questionnaire used as the survey tool was based on the findings of the focus group
discussions, and the expressions of the participant students were used to form the questions. It
was a self-administered questionnaire (Appendix 2). In order to minimize the influence of their
responses on one another’s answers, data collection in each university was completed in one day
during class hours. The lecture lists and hours of all departments were checked, and the day, at
which the highest attendance is seen, was selected as the survey day. The necessary legal
permission was obtained from the rectors of each university for surveying during class hours, and
each teaching staff was informed about the survey in their class hours with a letter.
Pre-testing of the questionnaire was carried out on 40 second-year students from Department of
Health Administration. Necessary modifications were made according to the feedbacks of these
students.
During the survey phase of the study, 43 interviewers in Hacettepe University, and 41
interviewers in Dicle University were trained on the questions, surveying procedure, the possible
problems. The surveys were completed on the 22 May 2001 at Hacettepe University Beytepe
Campus, and on 28 May 2001 at Dicle Campus.
The collected data was coded in accordance with the coding guideline designed by the research
team, and the coded data were processed by SPSS 10. The data of the survey were analyzed
separately for female and male students and for Hacettepe and Dicle Universities in order to
make a comparison. A scoring of the knowledge of sexual/reproductive health was developed
with the answers of the questions 52, 53, 54, and 58. Each correct answer among 39 items was
scored with “1” whereas each false answer was scored with “0” in order to calculate the
“knowledge score” of each student. The top score was 39 according to this scoring system. The
categories of the students’ scores were shown in tables.
Interviews with Service Providers
In the last phase of the “Influential Factors on the Sexual/Reproductive Health of Young
People” project, semi-structured interviews with the service providers were conducted. This
phase was planned to make further interpretations with the contribution of the experience,
observation, thoughts, and recommendations of the professionals who are the other
sexual/reproductive health service providers. The interviews were made with the service
providers in two provinces from whom the university students likely to receive
sexual/reproductive health services.
A semi-structured interview form was designed to be used for the interviews with the service
providers (appendix 3). The form is composed of 35 questions including the personal
information, the types of the provided services, thoughts, experiences, and recommendations
about sexual/reproductive health.
15
After the design of the questionnaire was completed, the coordinators of Medico-Social Centers,
where the services are provided for especially young people, were contacted in order to arrange
the appointments in a way that the services would not be delayed.
The interviews took approximately 45 minutes although personal factors affected the duration. In
total, 45 service providers were interviewed. 23 of them were from Diyarbakir, and 22 of them
were from Ankara. They were selected among the professionals whom young people most
frequently apply, receive consultancy and curative services. Since the Medico-Social centers of
Hacettepe University were more equipped, the applicants are less sent to other poly-clinics.
Therefore, in Ankara, mostly the service providers working in Hacettepe Medico-Social Centers
were interviewed whereas mostly the specialists working in other units were interviewed in
Diyarbakır. The professionals, with whom interviews were conducted, were composed of the
OB/GYN specialists, urologists, psychiatrists, psychologists, and nurses.
The interviews were conducted, and the analysis of the data was made by two social scientists
who have been working in each phase since the beginning of this research project. The collected
data were processed and analyzed using SPSS 10.00 and the detailed findings are presented in the
next section.
16
FINDINGS
&
DISCUSSION
FINDINGS AND DISCUSSION
17
The findings of ''Influential Factors on Sexual/Reproductive Health of Adolescents in Turkey''
research are based on the data collected in qualitative and quantitative phases of the project. The
findings of 8 focus group discussions and a survey conducted with 3666 first year students in
Ankara Hacettepe University Beytepe Campus and Diyarbakir Dicle University are discussed in
this chapter. In parallel to the objectives of the research, some of the findings are discussed
comparatively with the findings of semi-structured interviews conducted with 45 service
providers working with adolescents in Ankara and Diyarbakir.
The findings and discussions are presented in the following sections:
1. Socio-demographic Characteristics of the Research Group and Some Personal Habits
2. Some Information and Thoughts of the Research Group on Sexual/Reproductive Health
3. Information of the Research Group on Sexual Intercourse and Risk Behaviors
4. Expectations of the Research Group about Sexual/Reproductive Health Services
1. SOCIO-DEMOGRAPHIC CHARACTERISTICS OF THE RESEARCH GROUP
AND SOME PERSONAL HABITS/PRACTICES
Socio-demographic Characteristics of the Research Group
The socio demographic characteristics of the first year students in Ankara Hacettepe University
Beytepe Campus and Diyarbakir Dicle University and their families, and some of their habits are
summarized below in the corresponding tables. These are thought influential factors on the
students' information on sexual/reproductive health, perception of risk behavior, and their
expectations of sexual/reproductive health services.
Table 1. Distribution of Students by Sex and Age (HU, DU, May 2001)
Characteristic
Sex
Female
Male
Total
Age Groups
15-19
20-24
25+
Total*
Hacettepe University
Dicle University
N
%
N
%
1071
718
1789
59.9
40.1
100.0
692
1185
1877
36.9
63.1
100.0
926
52.2
661
36.0
838
47.2
1109
60.3
11
0.6
68
3.7
1775
100.0
1838
100.0
mean:19.7 (sd:±1.3);median:19.0; min-max=16-34
mean=20.4 (sd:±1.96); median:20.0; min-max=15-38
*14 students at Hacettepe University; 39 students at Dicle University did not specify their age.
60% of the students at Hacettepe University Beytepe Campus are female while 40% of them
are male. The mean age is 19.7 (sd ± 1.3). On the other hand, 37% of the students of Dicle
University are female whereas 63% of them are male. The mean age is 20.4 (sd: ± 1.9). The
mean age of the students of Dicle University is one year older than the students of Hacettepe
University.
Approximately half of the students of Hacettepe (52%), and one third of the students of
Dicle (36%) are at adolescent age. The female students at the adolescent age are higher in
number in both universities (Table 1).
Table 2. Distribution of Some Socio-demographic Characteristics of Students by Sex
(HU, DU, May 2001)
18
Characteristic
Marital Status
Single
Married
Cohabiting
Engaged
Other
Total*
Family Type
Nuclear
Extended
Total*
Place Lived Longest until the Age
of 12
Province
Town
Village
Total*
Number of Siblings
None
1-2
3-4
5+
Total*
Self assessment of the economic
status of the family
Very high
High
Middle
Low
Very low
Total*
Social Security Institution
Yes
No
Retirement Fund
N
F
Hacettepe University
M
(%)
N
(%)
N
T
(%)
N
F
(%)
Dicle University
M
N
(%)
N
T
(%)
1041
3
16
2
5
1065
(97.5)
(0.3)
(1.5)
(0.2)
(0.5)
(100.0)
693
2
12
4
4
715
(96.8)
(0.3)
(1.7)
(0.6)
(0.6)
(100.0)
1734
5
28
6
9
1782
(97.3)
(0.3)
(1.6)
(0.3)
(0.5)
(100.0)
666
10
7
2
685
(97.2)
(1.5)
(1.0)
(0.3)
(0.0)
(100.0)
1135
25
14
2
1176
(96.5)
(2.1)
(1.2)
(0.2)
(0.0)
(100.0)
1801
35
21
4
1861
(96.8)
(1.9)
(1.1)
(0.2)
(0.0)
(100.0)
946
123
1069
(88.5)
(11.5)
(100.0)
601
112
713
(84.3)
(15.7)
(100.0)
1547
235
1782
(86.8)
(13.2)
(100.0)
555
123
678
(81.9)
(18.1)
(100.0)
897
246
1143
(78.5)
(21.5)
(100.0)
1452
369
1821
(79.7)
(20.3)
(100.0)
405
605
61
1071
(37.8)
(56.5)
(5.7)
(100.0)
188
437
93
718
(26.2)
(60.9)
(12.9)
(100.0)
593
1042
154
1789
(33.2)
(58.2)
(8.6)
(100.0)
371
264
57
692
(53.6)
(38.2)
(8.2)
(100.0)
327
558
300
1185
(27.6)
(47.1)
(25.3)
(100.0)
698
822
357
1877
(37.2)
(43.8)
(19.0)
(100.0)
(5.2)
50
(7.0)
106
(5.9)
(44.9)
334
(46.6)
815
(45.6)
(41.2)
248
(34.5)
689
(38.5)
(8.7)
85
(11.9)
178
(10.0)
(100.0)
717
(100.0)
1788
(100.0)
mean:2.8 (ss:±1.3);median:2.0; min-max=1-5
10
63
230
387
690
56
481
441
93
1071
(1
13
(1.1)
23
(1.2)
(9.1)
79
(6.7)
142
(7.6)
(33.4)
279
(23.8)
509
(27.4)
(56.1)
802
(68.4)
1189
(63.8)
(100.0)
1173
(100.0)
1863
(100.0)
mean:3.2(ss:±1.8); median:3.0; min-max=1-7
2
81
919
51
3
1056
(0.2)
(7.7)
(87.0)
(4.8)
(0.3)
(100.0)
3
51
597
51
3
702
(0.4)
(7.2)
(84.8)
(7.2)
(0.4)
(100.0)
5
132
1516
102
6
1761
(0.3)
(7.5)
(86.1)
(5.8)
(0.3)
(100.0)
1
36
561
53
6
657
(0.2)
(5.5)
(85.4)
(8.0)
(0.9)
(100.0)
32
813
214
41
1100
(0.0)
(2.9)
(73.9)
(19.5)
(3.7)
(100.0)
1
68
1374
267
47
1757
(0.1)
(3.8)
(78.2)
(15.2)
(2.7)
(100.0)
104
923
451
(10.1)
(89.9)
(48.9)
106
576
273
(15.5)
(84.5)
(47.4)
210
1499
724
(12.3)
(87.7)
(48.3)
83
568
190
(12.7)
(87.3)
(33.5)
263
852
286
(23.5)
(76.5)
(33.6)
346
1420
476
(19.6)
(80.4)
(33.5)
119
(12.9)
76
(13.2)
195
(13.0)
93
Social Insurance Institution
311
(33.7)
201
(34.9)
512
(34.2)
243
Private Insurance
35
(3.8)
20
(3.8)
55
(3.7)
15
Green Card
5
(0.5)
2
(0.2)
7
(0.4)
5
Medico-social
2
(0.2)
4
(0.5)
6
(0.3)
22
Total*
1027
(100.0)
682
(100.0)
1709
(100.0)
651
Spoken Language at home
Turkish
1061
(99.1)
689
(96.0)
1750
(97.8)
626
Kurdish
28
(2.7)
39
(5.4)
67
(3.6)
300
Other
98
(9.2)
76
(10.6)
174
(9.6)
51
Total*
1071
(100.0)
718
(100.0)
1789
(100.0)
692
*The total number of answering students. Column percentages are calculated over these total numbers for each category
(16.4)
(42.8)
(2.6)
(0.8)
(3.9)
(100.0)
142
323
13
42
46
1115
(16.7)
(37.9)
(1.5)
(4.9)
(5.4)
(100.0)
235
566
28
47
68
1766
(16.5)
(39.9)
(2.0)
(3.3)
(4.8)
(100.0)
(90.5)
(43.4)
(7.4)
(100.0)
862
745
85
1185
(72.7)
(62.9)
(7.2)
(100.0)
1488
1049
136
1877
(79.3)
(55.9)
(7.2)
(100.0)
Bag-Kur
The majority of the students (97%) in both universities are single. The marital status of female
and male students is found to be similar. 5 students at Hacettepe University, and 2% (35
students) at Dicle University are married. 1% of the students in both universities are cohabiting
with their partners.
The place of birth (65%) and the living region up to 12 years old (68%) of approximately two
third of Hacettepe’s students are Central and Western Anatolia. Nearly three fourth (75%) of
Dicle’s students were born, and 71% of them lived in Eastern Anatolia up to 12 years old. The
percentage of Hacettepe students who were born (10%) and lived in Eastern Anatolia up to 12
years old (7%) is low. On the contrary, the percentage of Dicle’s students who were born and
lived in Western Anatolia (3%) is also lower. The families of the students live in similar regions.
There is not a significant difference between female and male students in terms of regions they
were born and lived up to 12 years age.
More than half of Hacettepe students (58%), and almost half of Dicle students (44%) have lived
longest in a town until the age of 12. Almost one third of the students in both universities (33%
19
of Hacettepe students and 37% of Dicle students) have lived longest in provincial center until the
age of 12. The percentage of female students who have lived in a provincial center until the age
of 12 is greater than male students especially in Dicle University. The number of female students
who have lived in a village until the age of 12 is very low.
Most of Hacettepe students (86%) and 78% of Dicle students assess their families’ economic
status as middle.
Health expenses of 88% of Hacettepe students and 80% of Dicle students are covered by a social
security institution. Although the percentage of Hacettepe students with social security who
utilize medico-social services is very low (0.3%), the health expenses of 5% of Dicle students are
covered by health center of the university. The health centers of the universities provide primary
health care services without asking any social security, and compensate the treatment expenses of
students if they do not have any social security. Considering this regulations, 13% of Hacettepe
students and 24% of Dicle students are covered by medico-social centers of the university.
Almost all Hacettepe students state that the language spoken at home is Turkish. More than half
of Dicle students (56%) express that they speak Kurdish at home.
Table 3. Percent Distribution of Some Characteristics of Students’ Parents (HU, DU, May 2001)
Hacettepe University
20
Dicle University
Characteristics
N
F
(%)
N
M
(%)
N
T
(%)
Marital Status
Parents are married and living 958
(89.7)
635
(88.9) 1593 (89.4)
together
Mother alive, father dead
56
(5.2)
35
(4.9)
91
(5.1)
Father alive, mother dead
7
(0.7)
8
(1.1)
15
(0.8)
Parents live separately
43
(4.0)
32
(4.5)
75
(4.2)
Other
4
(0.4)
4
(0.6)
8
(0.5)
Total*
1068 (100.0)
714 (100.0) 1782 (100.0)
Mother’s age
30-39
104
(12.8)
62
(12.4)
166
(12.6)
40-49
563
(69.5)
336
(66.9)
899
(68.5)
50+
144
(17.7)
104
(20.7)
248
(18.9)
Total*
811 (100.0) 502 (100.0) 1313 (100.0)
mean:44.7(ss:±5.5);median:44.0; min-max: 31-90
Mother’s Level of Education
Primary not completed
96
(9.1)
102
(14.7)
198
(11.3)
Primary
357
(33.9)
220
(31.6)
577
(33.0)
Secondary
99
(9.4)
61
(8.8)
160
(9.1)
High-School
277
(26.3)
166
(23.9)
443
(25.3)
University
225
(21.3)
147
(21.0)
372
(21.3)
Total*
1054 (100.0) 696 (100.0) 1750 (100.0)
Mother’s Job**
Waged-Salaried
333
(34.4)
236
(37.7)
569
(35.7)
Daily payed
(0.0)
(0.0)
(0.0)
Employer
5
(0.5)
5
(0.8)
10
(0.6)
Self-Employed
31
(3.2)
15
(2.4)
46
(2.9)
Unpaid domestic Worker
594
(61.5)
369
(58.8)
963
(60.4)
Unemployed
4
(0.4)
3
(0.3)
7
(0.4)
Total*
967 (100.0) 628 (100.0) 1595 (100.0)
Father’s age
30-39
8
(1.0)
8
(1.7)
16
(1.3)
40-49
429
(55.9)
264
(54.8)
693
(55.5)
50+
330
(43.1)
210
(43.5)
540
(43.2)
Total*
767 (100.0) 482 (100.0) 1249 (100.0)
mean:48.9(ss:±5.5);median:48.0; min-max: 35-80
Father’s level of education
Primary not completed
Primary
Secondary
High-School
University
Total*
Father’s Job**
Waged-Salaried
Daily payed
Employer
Self-Employed
Unpaid domestic Worker
Unemployed
Total*
22
203
100
248
439
1012
710
3
86
175
3
9
986
(2.2)
(20.1)
(9.9)
(24.5)
(43.4)
(100.0)
(72.0)
(0.3)
(8.7)
(17.7)
(0.3)
(1.0)
20
152
56
176
269
673
460
2
65
123
5
6
661
(3.0)
(22.6)
(8.3)
(26.2)
(40.0)
(100.0)
(69.6)
(0.3)
(9.8)
(18.6)
(0.8)
(0.9)
42
355
156
424
708
1683
1170
5
151
298
8
15
1647
(2.3)
(21.1)
(9.3)
(25.2)
(42.0)
(100.0)
(71.0)
(0.3)
(9.2)
(18.1)
(0.5)
(0.9)
N
F
(%)
N
583
(85.8)
52
14
24
7
680
(7.6)
(2.1)
(3.5)
(1.0)
(100.0)
M
T
(%)
N
1008
(88.0)
1591
(87.1)
97
17
21
3
1146
(8.5)
(1.5)
(1.7)
(0.3)
(100.0)
149
31
45
10
1826
(8.2)
(1.7)
(2.5)
(0.5)
(100.0)
98
(19.7)
142
(18.0)
240
(18.6)
303
(60.8)
441
(55.8)
744
(57.8)
97
(19.5)
207
(26.2)
304
(23.6)
498 (100.0) 790 (100.0) 1288 (100.0)
mean:45.1(ss:±6.6); median:45; min-max=30-80
306
194
39
68
29
636
(48.1)
(30.5)
(6.1)
(10.7)
(4.6)
(100.0)
702
257
43
52
16
1070
(65.6)
(24.0)
(4.0)
(4.9)
(1.5)
(100.0)
1008
451
82
120
45
1706
(59.1)
(26.4)
(4.8)
(7.0)
(2.7)
(100.0)
67
1
9
9
359
2
447
(15.0)
(0.2)
(2.0)
(2.0)
(80.3)
(0.4)
(100.0)
61
6
35
616
8
726
(8.4)
(0.0)
(0.8)
(4.8)
(84.8)
(1.2)
(100.0)
128
1
15
44
975
10
1173
(10.8)
(0.1)
(1.3)
(3.8)
(83.1)
(0.9)
(100.0)
6
250
217
(1.3)
29
(3.8)
35
(2.9)
(52.8)
362
(48.5)
612
(50.1)
(45.9)
356
(47.7)
573
(47.0)
473 (100.0) 747 (100.0) 1220 (100.0)
mean:49.9(ss:±7.4); median:49; min-max=30-99
77
191
60
159
121
608
378
1
38
123
14
11
565
(12.7)
(31.4)
(9.9)
(26.2)
(19.9)
(100.0)
(66.9)
(0.2)
(6.7)
(21.8)
(2.5)
(1.9)
253
365
114
171
123
1026
529
7
53
265
51
19
924
(100.0)
(100.0)
(100.0)
(100.0)
* The total number of answering students. Column percentages are calculated over these total numbers for each category
**Parents’ jobs are asked open-ended. Later the answers are categorized according to the categories of State Statistics Institute (1997)
(24.7)
(35.6)
(11.1)
(16.7)
(12.0)
(100.0)
(57.2)
(0.8)
(5.7)
(28.7)
(5.5)
(2.1)
(100.0)
330
556
174
330
244
1634
907
8
91
388
65
30
1489
Parents of most students in both universities are married and living together. The mean age of
mothers is 44.7(sd: ± 5.5), while fathers’ is 48.9 (sd: ± 5.5). The mean age of mothers is 45.1(sd:
± 6.6) in Dicle University, whereas fathers’ mean age is 49.9 (sd: ± 7.4). The level of education
of Hacettepe students’ parents is higher than Dicle Students’ parents’. While parents’ level of
education of female and male students in Hacettepe University is similar, the number of female
students whose parents have high school or higher education level, is higher than the number of
male students in Dicle University.
21
(%)
(20.2)
(34.0)
(10.6)
(20.2)
(14.9)
(100.0)
(60.9)
(0.5)
(6.1)
(26.1)
(4.4)
(2.0)
(100.0)
Mothers of 60% of Hacettepe students, and 83% of Dicle students are unemployed/unpaid
domestic worker. 36% of Hacettepe students have mothers with paid work whereas this
percentage is 11% among Dicle students. The percentage of female students whose mothers have
paid work, is higher than male students in Dicle University. Fathers of 71% of Hacettepe
students and 61% of Dicle students have paid work. While there is no difference between female
and male Hacettepe students in terms of their fathers’ job, the percentage of female students
whose fathers have paid work is higher in Dicle University.
Table 4. Percent Distribution of Students’ Current Residence (HU, DU, May 2001)
F
N
Hacettepe University
M
(%)
N
(%)
N
T
F
(%)
N
Residence
Dormitory
534 (49.9)
274
(38.5)
808
(45.3)
284
Shared Flat (with friends)
84
(7.8)
132
(18.5)
216
(12.1)
65
Family’s house (together
377 (35.2)
240
(33.7)
617
(34.5)
290
with the family)
House (together with
40
(3.7)
36
(5.0)
76
(4.3)
30
relatives)
House (alone)
17
(1.6)
21
(2.9)
38
(2.1)
7
Guesthouse or dormitories
2
(0.2)
5
(0.7)
7
(0.4)
1
of institutions/associations
Shared flat (with
13
(1.2)
4
(0.6)
17
(1.0)
4
sister/brother)
Othel
4
(0.4)
1
(0.1)
5
(0.3)
1
Total*
1071 (100.0) 713
(100.0) 1784 (100.0) 682
Type of Dorm
Girls’ Dorm
355 (66.5)
(0.0)
355
(44.0)
128
Boys’ Dorm
(0.0)
208
(76.9)
208
(26.0)
Mixed
179 (33.5)
63
(23.1)
242
(30.0)
156
Total*
534 (100.0) 273
(100.0) 807 (100.0) 284
Status of Dorm
Public Dorm
260 (50.0)
119
(44.0)
379
(46.9)
265
Private Dorm
108 (20.0)
64
(23.4)
172
(21.4)
18
University Dorm
106 (20.0)
63
(23.0)
169
(20.9)
1
Dorms of
20
(4.0)
9
(3.2)
29
(3.5)
Institution/Organization/F
oundation or Guesthouse
Semi-public Dormitories
40
(6.0)
18
(6.4)
58
(7.3)
Total*
534 (100.0) 273
(100.0) 807 (100.0) 284
* The total number of answering students. Column percentages are calculated over these total numbers for each category
Dicle University
M
(%)
N0
(%)
N
T
(%)
(41.6)
(9.5)
(42.5)
281
326
453
(24.3)
(28.2)
(39.2)
565
391
743
(30.7)
(21.3)
(40.4)
(4.5)
63
(5.4)
93
(5.1)
(1.0)
(0.1)
22
4
(1.9)
(0.4)
29
5
(1.6)
(0.3)
(0.7)
5
(0.4)
9
(0.4)
(0.1)
(100.0)
2
1156
(0.2)
(100.0)
3
1838
(0.2)
(100.0)
(45.0)
(0.0)
(55.0)
(100.0)
72
211
283
(0.0)
(25.4)
(74.6)
(100.0)
128
72
367
567
(22.5
12.5
65.0
(100.0)
(93.5)
(6.3)
(0.2)
(0.0)
257
23
-
(91.7)
(8.3)
(0.0)
(0.0)
522
41
1
-
(92.5)
(7.2)
(0.3)
(0.0)
(0.0)
(100.0)
280
(0.0)
(100.0)
564
(0.0)
(100.0)
45% of Hacettepe students’ and 31% of Dicle students’ current residence is dorm. 35% of
Hacettepe students and 40% of Dicle students live with their families . The percentage of female
students who live in dorm or with their family is higher compared to male students in both
universities. 93% of Dicle students in dorms live in public dorms. In Hacettepe University, 47%
of students live in public dorms, 21% live in private dorms, and 21% live in university dorms.
Some Personal Habits of Students
Table 5. Percent Distribution of Some Habits of Students by Sex (HU, DU, May 2001)
22
Hacettepe University
F
M
N
(%)
N
(%)
N
Status of Smoking
Never Smoke
Sometimes Smoke
Regularly Smoke
Used to smoke, but ceased
Total*
666
177
175
40
1058
(62.9)
(16.7)
(16.6)
(3.8)
(100.0)
371
109
187
43
710
(52.3)
(15.3)
(26.3)
(6.1)
(100.0)
Age at start
5-9
10-14
15-19
20-24
Total*
1
38
294
14
347
(0.3)
(10.9)
(84.8)
(4.0)
(100.0)
5
78
214
14
311
(1.6)
(25.0)
(68.8)
(4.6)
(100.0)
Habits
No of daily cigarettes
(Package)
Half
1
2
2+
Total*
Having Alcohol
Never have
Sometimes have
Regularly have
Used to have, but ceased
Total*
Substance Use
Not use
Use
Used to use, but ceased
Total*
(%)
Dicle University
F
M
N
(%)
N
(%)
N
1037
286
362
83
1768
(58.7)
(16.2)
(20.5)
(4.6)
(100.0)
399
131
123
20
673
(59.3)
(19.4)
(18.3)
(3.0)
(100.0)
501
197
386
64
1148
(43.6)
(17.2)
(33.6)
(5.6)
(100.0)
900
328
509
84
1821
(49.4)
(18.0)
(28.0)
(4.6)
(100.0)
6
116
508
28
658
(1.0)
(17.6)
(77.2)
(4.2)
(100.0)
1
31
186
22
240
(0.5)
(12.9)
(77.5)
(9.1)
(100.0)
30
138
372
30
570
(5.2)
(24.2)
(65.4)
(5.2)
(100.0)
31
169
558
52
810
(3.8)
(20.8)
(68.9)
(6.5)
(100.0)
T
T
(%)
mean: 16.3 (sd:± 2.18 ); median: 17; min-max:7-23
mean: 15.9 (sd:± 2.90); median: 17; min-max: 5-24
235
73
10
318
(73.8)
(23.1)
(3.1)
(0.0)
(100.0)
137
131
21
2
291
(47.0)
(45.0)
(7.2)
(0.8)
(100.0)
372
204
31
2
609
(61.0)
(33.4)
(5.1)
(0.59
(100.0)
141
66
10
1
218
(64.6)
(30.2)
(4.5)
(0.7)
(100.0)
214
263
63
4
544
(39.3)
(48.3)
(11.5)
(0.9)
(100.0)
355
329
73
5
762
(46.5)
(43.0)
(9.5)
(1.0)
(100.0)
541
494
12
11
1058
(51.0)
(46.6)
(1.4)
(1.0)
(100.0)
264
372
47
27
710
(37.1)
(52.4)
(6.6)
(3.9)
(100.0)
805
866
59
38
1768
(45.5)
(49.0)
(3.3)
(2.2)
(100.0)
518
124
3
1
646
(80.1)
(19.1)
(0.6)
(0.2)
(100.0)
731
343
26
12
1112
(65.7)
(30.8)
(2.3)
(1.2)
(100.0)
1249
467
29
13
1758
(71.0)
(26.5)
(1.6)
(0.9)
(100.0)
1009
21
4
1034
(97.6)
(2.0)
(0.4)
(100.0)
648
22
14
684
(94.8)
(3.2)
(2.0)
(100.0)
1657
43
18
1718
(96.4)
(2.3)
(1.3)
(100.0)
619
13
4
636
(97.3)
(2.0)
(0.7)
(100.0)
1062
15
11
1088
(97.6)
(1.4)
(1.0)
(100.0)
1681
28
15
1724
(97.5)
(1.6)
(0.9)
(100.0)
* The total number of answering students. Column percentages are calculated over these total numbers for each category
Almost half of the students in both universities (59% at Hacettepe, 49% at Dicle) do not smoke.
The frequency of smoking among male students (41% at Hacettepe, 51% at Dicle) is higher than
female students (33% at Hacettepe, 38% at Dicle). The median age of starting smoking is found
as 17. Male smokers start smoking earlier than female smokers. 46% of Hacettepe students and
71% of Dicle’s students stated that they’ve never had alcohol. The frequency of alcohol use
among male students (59% at Hacettepe, 33% at Dicle) is higher than the female students (48%
at Hacettepe, 20% at Dicle). 2% of students in both universities report that they are substance
users.
Table 6. Percent Distribution of Students’ Free Time Activities By Sex (HU, DU, May 2001)
Hacettepe University
Dicle University
23
Activities*
F
M
N
Cinema-Theatre
Concert-Opera
Café, Place of
Entertainment, Coffee
House
Billiard-Bowling Hall
Several Hobbies
Conference, Discussion,
Panel
Periodical reading
Never
Once a week
More than once a week
Once a month
More than once a month
Once in a couple of months
Other
Total**
Type of periodical*
Cultural-Political
Literature,
History,
Philosophy
Scientific
Financial
Humor, Magazine, Music
Pornographic
Islamic
Sport-Automobile
Women’s Magazine
Health
Other
Status of TV watching
No
Yes
Total**
Type of TV programs*
News
Documentary
Entertainment, talk-show,
magazine
Local Series Movies, Soap
Opera, Movies
Discussion, Round Table,
Political Programs
Erotic
Sport
Cultural-Art Programs
Series Movies
Economy, Financial
Educational
Whatever I like
T
F
M
T
(%)
(n=1071)
297
(27.7)
655
(61.2)
161
(15.0)
N
(%)
(n=718)
278
(38.7)
427
(59.5)
63
(8.8)
N
(%)
(n=1789)
573
(32.0)
1082 (60.5)
224
(12.5)
N
(%)
(n=692)
31
(4.5)
354
(51.2)
191
(27.6)
N
(%)
(n=1185)
175
(14.8)
589
(49.7)
192
(16.2)
N
322
8
13
313
5
13
635
13
26
86
3
7
499
3
9
583
6
16
(30.1)
(0.7)
(1.2)
532
86
15
178
39
7
141
998
(43.6)
(0.7)
(1.8)
(35.5)
(0.7)
(1.5)
(12.4)
(0.4)
(1.0)
(42.1)
(0.3)
(0.8)
(%)
(n=1877)
226
(12.0)
943
(50.2)
383
(20.4)
(31.1)
(0.3)
(0.9)
(54.2)
(8.4)
(1.5)
(17.5)
(3.8)
(0.7)
(13..9)
(100.0)
(n=466)
154
(33.0)
123
(26.4)
303
77
19
132
37
7
106
681
(44.5)
(11.3)
(2.8)
(19.4)
(5.4)
(1.0)
(15.6)
(100.0)
(n=378)
137
(36.2)
58
(15.3)
835
(50.4)
163
(9.6)
34
(2.0)
310
(18.2)
76
(4.5)
14
(0.8)
247
(14.5)
1679 (100.0)
(n=844)
291
(34.5)
181
(21.4)
332
46
36
87
9
4
120
634
(52.4)
(7.3)
(5.7)
(13.7)
(1.4)
(0.6)
(18.9)
(100.0)
(n=302)
146
(48.3)
123
(40.7)
562
(52.8)
86
(8.1)
60
(5.6)
107
(10.0)
20
(1.9)
4
(0.4)
226
(21.2)
1065 (100.0)
(n=503)
304
(60.4)
158
(31.4)
894
(52.6)
132
(7.8)
96
(5.7)
194
(11.4)
29
(1.7)
8
(0.3)
346
(20.5)
1699 (100.0)
(n=805)
450
(55.9)
281
(34.9)
230
30
258
5
6
4
4
29
214
49
175
20
4
25
22
444
79
433
25
4
33
4
4
31
151
3
117
2
1
1
10
268
17
178
20
2
4
8
419
20
295
20
4
5
1
18
(49.4)
(6.4)
(55.4)
(1.1)
(0.0)
(1.3)
(0.9)
(0.9)
(6.2)
(56.6)
(13.0)
(46.3)
(5.3)
(1.1)
(6.6)
(0.0)
(0.0)
(5.8)
(52.6)
(9.4)
(51.3)
(3.0)
(0.5)
(3.9)
(0.5)
(0.5)
(3.7)
(50.0)
(1.0)
(38.7)
(0.0)
(0.7)
(0.3)
(0.3)
(0.0)
(3.3)
(53.3)
(3.4)
(35.4)
(4.0)
(0.4)
(0.8)
(0.0)
(0.0)
(1.6)
(52.0)
(2.5)
(36.6)
(2.5)
(0.5)
(0.6)
(0.1)
(0.0)
(2.2)
663
(62.6)
398
(37.4)
1061 (100.0)
(n=1071)
724
(68.4)
528
(49.9)
339
(31.7)
418
293
711
(58.8)
(41.2)
(100.0)
(n=718)
492
(69.4)
439
(61.9)
223
(31.3)
1083 (61.0)
691
(39.0)
1772 (100.0)
(n=1789)
1216 (68.8)
967
(54.7)
564
(31.5)
509
171
680
(74.9)
(25.1)
(100.0)
(n=692)
504
(74.6)
366
(54.1)
251
(36.3)
781
(69.1)
350
(30.9)
1131 (100.0)
(n=1185)
830
(74.7)
750
(63.9)
364
(30.7)
1290 (71.2)
521
(28.8)
1811 (100.0)
(n=1877)
1354 (74.6)
1116 (61.3)
613
(32.8)
593
(55.4)
451
(62.8)
1044
(58.4)
356
(51.4)
589
(49.7)
945
(50.3)
12
(1.1)
16
(2.2)
28
(1.6)
305
(28.5)
210
(29.2)
515
(28.8)
13
1
1
2
(0.0)
(20.3)
(1.6)
(0.0)
(0.0)
(1.6)
(3.1)
4
62
1
2
1
6
(3.6)
(55.9)
(0.9)
(0.0)
(1.1)
(0.9)
(5.4)
4
75
2
2
2
8
(2.3)
(42.9)
(1.1)
(0.0)
(1.1)
(1.1)
(4.6)
5
2
2
(0.0)
(10.9)
(4.3)
(0.0)
(0.0)
(0.0)
(4.3)
8
61
3
1
3
-
(5.7)
(43.3)
(2.1)
(0.7)
(2.1)
(0.0)
(0.0)
8
66
5
1
3
2
(4.3)
(35.3)
(2.7)
(0.5)
(1.6)
(0.0)
(1.1)
* Multiple activities are specified, and percentages are calculated over “n”.
** The total number of answering students. Column percentages are calculated over these total numbers for each category.
The most frequently specified activity among students is going to concert-opera. However,
concert is the actual activity. Because there is only one National Opera in Turkey that perform in
certain cities, students in Diyarbakır do not have such an opportunity. Another activity reported
by students is “billiard-bowling-sport”. Most students mean billiard halls within this category
because these are common and popular gathering places for especially male students. 39% of
Hacettepe’s students and 27% of Dicle’s students read daily newspapers. Nearly half of the
students in both universities do not read any periodicals except newspaper. Most common type
24
of periodicals read by Hacettepe students are “scientific” and “Humor, Magazine, Music”
whereas they are “Cultural-Political” and “Scientific” at Dicle University.
39% of Hacettepe’s students, and 29% of Dicle’s students state that they regularly watch TV. The
most frequently watched programs are news, documentary, soap operas, movies and sports
programs. Although none of the female students watch erotic programs, few male students
report that they do.
2. SOME INFORMATION AND THOUGHT OF THE RESEARCHED GROUP ON
SEXUAL/REPRODUCTIVE HEALTH
Table 7. Percent Distribution of Sexual/Reproductive Health Definitions of Students by Sex (HU,
DU, May 2001)
Hacettepe University
F
M
(n=1071)
(n=718)
N
(%)
N
(%)
Healthy sexuality/healthy 818 (76.4) 587 (81.8)
reproduction
Health/ hygiene of
436 (40.7) 215 (29.9)
reproductive Health
Organs
Sexually Transmitted
583 (54.4) 391 (54.5)
Infections
Fertility
344 (32.1) 206 (28.7)
Regulation/Protection
from Pregnancy
Problems of
488 (45.6) 296 (41.2)
Sexual/Reproductive
Health/Information on
these problems
Other **
3
(0.3)
8
(1.1)
Sexual/Reproductive
Health*
T
(n=1789)
N
(%)
1403 (78.4)
Dicle University
F
M
(n=692)
(n=1185)
N
(%)
N
(%)
453 (65.5) 815 (68.8)
T
(n=1877)
N
(%)
1268 (67.6)
651
(36.4)
209
(30.2)
266
(22.4)
475
(25.3)
974
(54.4)
250
(36.1)
488
(41.2)
738
(39.3)
550
(30.7)
163
(23.6)
246
(20.8)
411
(21.9)
784
(43.8)
299
(43.2)
375
(31.6)
674
(35.9)
11
(0.6)
-
(0.0)
5
(0.4)
5
(0.3)
* Multiple choices are specified, and percentages are calculated over “n”.
** “Includes none of the choices”, “Psychological Problems concerning Sexual/Reproductive Health”, Healthy, honest, happy sexual life”
Students most frequently define sexual/reproductive health as healthy sexuality/healthy
reproduction'' in both universities. Students also speak out STIs and Problems of
Sexual/Reproductive Health. Female and male students mention similar issues although male
students speak out STIs more.
Similarly students do not make a definition of sexual/reproductive health in focus group
discussions. Instead, they speak out issues and problems included in sexual/reproductive health.
"Talking about reproductive health, function and heath of all reproductive organs. I mean health in sexuality."(Dicle, F)
"Reproductive organs, everything related to reproduction I mean…" (Hacettepe, F)
Female students emphasize health and hygiene of reproductive organs" more than male students
(Table 7). It appears that this emphasis is a result of gender roles attributed to girls. Hygiene is
one of the basic rules taught to girls. The hygiene dimension of sexuality and/or reproduction
may be the only issue that is spoken with mothers. It may be read as the part of the general
attitude aiming to control female sexuality. Talking about hygiene does not directly refers to
sexuality, and will not have an encouraging effect on girls to initiate sexual activity in one hand,
and on the other hand, it may be used to make girls keep in mind that their primary responsibility
is reproduction, and they should take care of themselves.
25
The statements of the female students in focus group discussions are similar in emphasizing the
hygiene;
"It is necessary to keep organs hygienic in reproductive health" (Dicle, F)
"The only thing we know about sexual/reproductive health is reproductive organs. Pain we face, hygiene during our period. I
don't know…" (Dicle, F)
Similar to survey findings, sexually transmitted infections and protection are emphasized by male
students more.
"First thing in my mind is the sexual diseases; and protection ways from them." (Hacettepe, M)
"Protection from sexually transmitted diseases. To control reproduction. Healthy sexual life is part of human's nature. But it
is difficult to talk about." (Hacettepe, M)
Table 8. Percent Distribution of Sources of Information on Sexual/Reproductive Health by Sex of
Students (HU, DU, May 2001)
Hacettepe University
Source of information*
F
N
%
(n=1071)
Book/Magazine/Encyclo 579 (54.1)
pedia
Peers/Friends
514 (48.0)
School/Teacher
454 (42.4)
Parents
459 (42.9)
TV/Video Cassette
329 (30.7)
Sisters/Brothers/Other
209 (19.5)
members of the family
Physician/Professional
206 (19.2)
(Psychologist/Social
Worker)
Sexual Experience
92
(8.6)
Internet
37
(3.5)
Dicle University
M
T
N
F
M
T
%
(n=718)
383 (53.3)
N
%
(n=1789)
962 (53.8)
N
%
(n=692)
300 (43.4)
N
%
(n=1185)
472 (39.8)
N
%
(n=1877)
772 (41.1)
352
195
157
283
119
(49.0)
(27.2)
(21.9)
(39.4)
(16.6)
866
649
616
612
328
(48.4)
(36.3)
(34.4)
(34.2)
(18.3)
240
233
172
152
130
(34.7)
(33.7)
(24.9)
(22.0)
(18.8)
450
197
79
266
118
(38.0)
(16.6)
(6.7)
(22.4)
(10.0)
690
430
251
418
248
(36.8)
(22.9)
(13.4)
(22.3)
(13.2)
109
(15.2)
315
(17.6)
111
(16.0)
134
(11.3)
245
(13.1)
179
151
(24.9)
(21.0)
271
188
(15.1)
(10.5)
23
16
(3.3)
(2.3)
191
84
(16.1)
(7.1)
214
100
(11.4)
(5.3)
* Multiple choices are specified, and percentages are calculated over “n”.
The sources of sexual/reproductive health information in both universities are
"book/magazine/encyclopedia", "peers/friends", “school/teacher" respectively (Table 8). As it is
seen, young people primarily prefer using indirect sources from which they can get information
by themselves. Talking with peers/friends is also common among young people.
Similar sources of information are also expressed in focus group discussions.
“We learn in peer groups since we start talking about these issues after a certain age. Media, publications are also
effectively used in general."(Hacettepe, F)
"Everybody gets information from close friends in general. As he says, from media…there are specific magazines
also, and TV" (Hacettepe, M)
"I can't get information from my mom. From friends, I trust on them while they are speaking about their
experiences or I read magazines." (Dicle, F)
26
Friends are especially stated as a source of information. Because young people feel themselves
comfortable with their friends most while speaking about sexuality or reproduction. They think
that it is easier to speak about such sensitive issue with friends who have similar feelings and
problems.
"I mean, you can talk with friends. You know that they have similar feelings. We ask each other…most
comfortable with them" (Hacettepe, F)
Although young people talk with friends most, they don't think that it is possible to get "true”
information from them. Since it is thought that friends also have limited information.
"Our friends from whom we get information also get information from other friends. This means that they cannot
provide "correct” information." (Dicle, M)
"They know what they hear. Nothing else. Everybody tells his or her own thoughts. Therefore, what you learn from
friends may not be true." (Hacettepe, M)
It is found that “peer” has different meanings for Hacettepe and Dicle students. Dicle students
who participated into focus group discussions refer to elder, experienced, ad married peers or
again elder cousins or relatives to whom they feel themselves close enough like peers to speak
about sexual/reproductive health issues. The main reason of this preference is their perception of
age as criterion for “correct” information.
“I learned from my elders, and they also learned from their own elders. Not our families, but our elder brothers.” (Dicle, M
“-Which source of information you find reliable?
-Experienced persons. If there is an age difference between me and my friend, I know that what she knows is correct.” (Dicle, F)
Parents are found as the third source of information for female students at Hacettepe University
whereas they are fourth source of information at Dicle University. Parents are found as the last
source of information for male students especially at Dicle University (Table 8).
Table 9. Distribution of Status of Talking with Parents on Sexual/Reproductive Health and Spoken
Issues among Participant Students by Sex (HU, DU, May 2001)
N
Talking with mother
No
Yes
Total*
Talking with father
No
Yes
Total*
Spoken Issues**
Health of Reproductive
Organs
Problems of Adolescent
Age/Menstruation
Hymen/wedding night
Sexually Transmitted
Infections/Questions
Concerning Their Own
Body/AIDS
Other***
F
Hacettepe University
M
(%)
N
(%)
N
T
(%)
N
F
(%)
Dicle University
M
N
(%)
N
T
(%)
452
608
1060
(42.6)
(57.4)
(100.0)
537
175
712
(75.4)
(24.6)
(100.0)
989
783
1772
(55.9)
(44.1)
(100.0)
404
256
660
(61.2)
(38.8)
(100.0)
1025
91
1116
(91.8)
(8.2)
(100.0)
1429
347
1776
(80.5)
(19.5)
(100.0)
930
107
1037
(89.7)
(10.3)
(100.0)
491
206
697
(70.4)
(29.6)
(100.0)
1421
313
1734
(81.5)
(18.5)
(100.0)
622
27
649
(95.8)
(4.2)
(100.0)
1005
100
1105
(91.0)
(9.0)
(100.0)
1627
127
1754
(92.7)
(7.3)
(100.0)
123
(11.7)
67
(9.6)
190
(10.9)
16
(2.5)
22
(2.0)
38
(2.2)
227
(21.2)
164
(22.8)
391
(21.9)
68
(9.8)
76
(6.4)
144
(7.7)
74
102
(7.0)
(9.5)
17
140
(2.4)
(19.5)
91
242
(5.2)
(13.5)
21
27
(3.3)
(3.9)
5
53
(0.3)
(4.5)
26
80
(1.3)
(4.3)
1
(0.1)
3
(0.4)
4
(0.2)
-
(0.0)
4
(0.3)
4
(0.2)
*17 students at Hacettepe University did not specify whether they talk with mothers or not whereas 34 students did not specify whether they talk with fathers or not. On the
other hand, 101 students at Dicle University did not specify whether they talk with mothers or not while 123 students did not specify whether they talk with fathers or not.
** Multiple choices are specified, and percentages are calculated over “n”.
*** “We do not talk about these issues”.
27
Since sexuality is still accepted as a taboo topic for especially young people, it is not common to
talk with parents. 56% of Hacettepe students and 81% of Dicle students stated that they have
never talked with their mothers about sexual/reproductive health issues. The majority of students
in both universities (82% at Hacettepe, 93% at Dicle) express that they have never talked with
their fathers (Table 9). Girls are able to speak on health dimension of sexual/reproductive health.
However, because of the conservative attitude towards the issue in Diyarbakir, girls are not able
to establish a dialogue even with mothers. This situation is clearer in case of male students. They
do not talk with their parents on sexual/reproductive health issues. Only 8.2% of male students
at Dicle University express that they talk with their mothers whereas 9% of them state that they
talk with their fathers.
Table 10. Percent Distribution of Status of Talking with Mothers about S/R Health Issues
by Education of Mothers of Students (HU, DU, May 2001)
Mother’s level
of Education
Primary Secondary-High
Higher
Hacettepe University
Speak
Don’t speak
N
%
N
%
258
(35.3) 473
(64.7)
86
(43.3) 115
(56.7)
427
(52.4) 388
(47.6)
X2=45.75 p<0.05
Total
N
731
203
815
%
(100.0)
(100.0)
(100.0)
Dicle University
Speak
Don’t speak Total
N
%
N
%
N
247 (17.6) 1158 (82.4) 1405
27
(23.3) 89
(76.7) 116
62
(37.8) 102 (62.2) 164
X2= 36.50 p<0.05
%
(100.0)
(100.0)
(100.0)
When the relationship between mothers’ level of education and students' status of talking with
their mothers on sexual/reproductive health issues is examined, it is found that mothers with
higher level of education are more likely to talk with their children (Hacettepe: X 2=45.75 p<0.05,
Dicle: X2= 36.50 p<0.05) (Table 10).
Table 11. Percent Distribution of Status of Talking with Fathers about S/R Health Issues by
Education of Fathers of Students (HU, DU, May 2001)
Father’s level
of Education
Mother’s level
Primary Secondary-High
Higher
Hacettepe University
Speak
Don’t speak
N
%
N
%
75
(10.5) 638
(89.5)
34
(17.1) 165
(82.9)
199
(24.9) 599
(75.1)
X2=53.15 p<0.05
Total
N
713
199
798
%
(100.0)
(100.0)
(100.0)
Dicle University
Speak
Don’t speak Total
N
%
N
%
N
83
(6.0)
1305 (94.0) 1388
14
(12.2) 101
(87.8) 115
25
(15.5) 136
(85.5) 161
X2= 23.62 p<0.05
%
(100.0)
(100.0)
(100.0)
A similar relationship with fathers' level of education is found. Fathers with higher level of
education are more likely to talk with their children.(Hacettepe: X2=53.15 p<0.05, Dicle: X2=
23.62 p<0.05) (Table 11). As it is seen, parents' level of education directly influence their attitude
towards talking with children on sexual/reproductive health issues.
The issues on which students frequently talk with parents are Problems of Adolescent
Age/Menstruation or sexually transmitted infections. “Hymen/wedding night" is another issue
on which female students talk with their mothers (Table 9).
In both female and male groups, it is expressed that although they are willing to talk with their
parents about sexuality or sexual/reproductive health issues in general, they are not able to talk.
However, in female groups, it is stated that they talk with their mothers if they have a health
problem. One of the main reasons of this insufficient communication with parents on
sexual/reproductive health is stated as “shame”.
As it is understood through the expressions, mostly the parents prefer not to talk with their
children on this issue. The nature of the relationship with parents-especially the authority-based
relationship with the father necessitates not to talk about sexuality or reproductive health. Even if
28
the relationship with the parents is not authoritative, these issues are not spoken. Even a
television program or advertisements referring to sexuality may annoy the parents when they are
watching television together with children, and they turn off the television. Another important
point in the relationship with parents is the common idea that parents are less educated, and have
insufficient information on sexual/reproductive issues.
“...The ideal is learning from the family. This is so in Western societies. In our society, although we don’t have very
authoritative families, these sort of things are never spoken...” (Hacettepe, M)
“In fact, I...we have a good relationship with my dad, but there is nothing he knows. If he knows, he himself will use it...”
(Hacettepe, M)
“The first thing on this issue happens by the guidance of mum, but of course we have limited things to speak with her.”
(Hacettepe, F)
“I speak with parents about everything, but nothing about sexuality. It’s a shame in our family. I, myself go out of the room
whenever it is spoken...” (Hacettepe, M)
“We speak with my mum about issues such as puberty, menstruation, even with my aunts...but nothing else”
(Hacettepe, F)
“Why don’t we speak with our parents? Both sides are responsible. My parents do not know anything. Of course
they don’t...It will not change. If I am ready to speak, they will still not know anything, and will do nothing to
know...” (Hacettepe, M)
Similar to Hacettepe students, Dicle students express that they are not used to talk about
sexual/reproductive health with parents. Young women can only ask some simple questions
related to health dimension to their mothers. What is different in Diyarbakır about parentsespecially with father- is the lack of communication, not only on this issue, but also in each
sphere of life. Male participants explain this situation by “eastern culture”. Since they live in
feudal families, there should be a distance with the father. Therefore, usually they do not have
any kind of dialogue with their fathers.
"It may be natural for me to ask these things, but we know how my family is grown up like that. If I ask such questions to
my dad, he will ask "Are you going to continue your education or would like to marry after your military service?" It is very
difficult to get such an information from my family under current conditions…" (Dicle, M)
"A dad will never care of us like moms. There is always a distance between us. We have a formal relationship…I
don't know, may be he will tell something if I ask but…"(Dicle, M)
“If we think about specifically this region…I'm from this region. The authority of father is too strong in the
families. Televisions are usually turned off because of scenes related to sexuality. It is impossible to talk about such
things with family in this region."(Dicle, M)
On the other hand, female students can only ask health related questions to mothers.
"I cannot say that I speak with mom comfortably except about my periods." (Dicle, F)
"Our mothers are also grown up in eastern culture. Their beliefs are accordingly. I cannot tell her whether I have
sex with someone or anything similar. We can only talk about certain issues. If there is a health problem, you can
ask directly" (Dicle, F)
29
"East-west" dichotomy is frequently referred by Dicle students throughout focus group
discussions in general, and particularly in discussions on communication with parents is an
important factor that is thought influential on thoughts and behaviors of students concerning
sexual/reproductive
health.
It
has
directly
linked
to
the
notion
of
"modernization/westernization" of Turkey since the establishment of Turkish Republic.
"Modern" refers to "western", and symbolizes a western life style and way of thinking. People's
lives and values differentiate in terms of this notion of "modern/western" in western and eastern
regions of Turkey. Within this perception students refer to "developed" - "civilized" by "western
culture"; and "traditional"-"conservative" by "eastern culture". The general attitude towards
sexuality is conservative in general. This conservatism duplicates in "eastern culture". Students
seem to be aware of this fact and verbalize their problems caused by this attitude. However, it
seems to be interesting that young people themselves also tend to continue maintaining these
attitudes.
"Sexual experience" is specified as one of the sources of information by male students in both
universities. The last source stated by students in both universities is "internet" with slightly
higher percentage at Hacettepe University. "Sexual experience” and "internet” are stated as
sources of information by male students more (Table 8).
As it is found in focus group discussions, different from female students, male students are used
to use pornographic material such as video cassettes or magazines as an information source.
“...you produce something in your mind, something to understand these issues... and at the same time, from media...for
instance, pornographic publications, I mean some sort of publications that show all positions in a sexual intercourse.
Hmmm...you want to do and get those publications.” (Hacettepe, M)
“-I mean...we talk with my friends. What we see in some films...
-What kind of films? Pornography?
-Yes, pornography” (Dicle, M)
"Physician/professional” is found as one of the last sources of information in both universities.
This category is stated more by female students (Table 8). However, when the preferred sources
of information are examined in both universities, it is found that the first two preferred sources
of information are "physician/professional" and "book/magazine/encyclopedia". It appears that
adolescents/young people would like to receive information from the professionals who are
competent on sexual/reproductive health (Table 12).
The reason of this preference is explained by students in focus group discussions as
“confidentiality”. The confidential source of information for students in both universities are
“professionals” (physician, psychologist, social worker, nurse, etc.). However, it is stated that it is
impossible to have an access to these professionals easily. Because, it is not a common behavior
at their age to visit a professional to get consultancy on sexual/reproductive health issues.
Therefore, they feel uncomfortable.
“It is important to ask for information to a professional for our health.” (Hacettepe, M )
“It is important to consult with a professional who is competent. This is our health.” (Dicle, M)
“If you think rational, for sure you should get information from professionals, but unfortunately, as sexuality is still a taboo
for us. Therefore, that professional cannot reach you.” (Dicle, F)
Table 12. Percent Distribution of Preferred Sources of Information on Sexual/Reproductive Health
among Students by Sex (HU, DU, May 2001)
Hacettepe University
Dicle University
30
Preferred source of
Information *
School/Teacher
Parents
Sisters/Brothers/Other
Members of the Family
Peers/Friends
Book/Magazine/Encyclope
dia
TV/Radio/Video Cassette
Internet
Sexual Experience
Physician/Specialist
(Psychologist/Social
Worker)
F
N
%
(n=1071)
234
(21.8)
334
(31.2)
118
(11.0)
N
M
T
F
%
(n=718)
163
(22.7)
127
(17.7)
60
(8.4)
N
%
(n=1789)
397
(22.2)
461
(25.8)
178
(9.9)
N
%
(n=692)
93
(13.4)
135
(19.5)
55
(7.9)
N
M
%
(n=1185)
232
(19.6)
87
(7.3)
53
(4.5)
T
N
%
(n=1877)
325
(17.3)
222
(11.8)
108
(5.8)
190
297
(17.7)
(27.7)
124
193
(17.3)
(26.9)
314
490
(17.6)
(27.4)
104
178
(15.0)
(25.7)
211
270
(17.8)
(22.8)
315
448
(16.8)
(23.9)
127
38
67
626
(11.9)
(3.5)
(6.3)
(58.5)
124
62
132
303
(17.3)
(8.6)
(18.4)
(42.2)
251
120
199
929
(14.0)
(6.7)
(11.1)
(51.9)
64
18
15
331
(9.2)
(2.6)
(2.2)
(47.8)
145
56
144
390
(12.2)
(4.7)
(12.2)
(32.9)
209
74
159
721
(11.1)
(3.9)
(8.5)
(38.4)
* Multiple choices are specified, and percentages are calculated over “n”.
It is examined whether there is a difference between female and male students in terms of
preferred sources of information, and found that the first source of information preferred by
both female and male students are "physician/professionals". The second preferred source in
Hacettepe, and the third preferred source in Dicle is "parents". Female students are more likely
prefer their parents as a source of sexual/reproductive health (Table 12).
Although physicians and professionals are considered as one of the first two preferred
information sources by the adolescents, when the service providers are asked about their in
service training background specific to adolescents, the characteristics of adolescent age, the
physical and psychological changes specific to this age, it is found that 71.1% of the interviewed
service providers do not have such training. 57.3% of the interviewed service providers do not
find their current education and knowledge sufficient to provide services for young people
whereas 33.3% of them find it sufficient. Service providers’ awareness of their insufficiency and
self expression is important to be utilized for the improvement of the services and planning of
specific trainings for professionals.
It is found that the majority of the students in both universities have not received any
sexual/reproductive health service (82% at Hacettepe, 91% at Dicle). Approximately one student
out of five (18%) at Hacettepe University; one student out of 10 (10%) at Dicle University report
that they have received sexual/reproductive health service. The relationship between students'
having social security and receiving sexual/reproductive health services is also examined. More
students with "green card" compared to other students stated that they have received services in
both universities. Dicle’s students covered by "medico-social" also health security utilized the
services more among other groups. Type of students' social security statistically influence
utilization of the services at Hacettepe University whereas it does not at Dicle University
(Hacettepe: X2= 11.42 p<0.05, Dicle: X2= 8-26 p>0.05) (Table 13).
Table 13. Percent Distribution of Receiving Sexual/Reproductive Health Services by Type
of Social Security (HU, DU, May 2001)
Type of
Social Security
Retirement Fund
Hacettepe University
Receive
Not
service
service
N
%
N
137
(19.2) 576
receive
%
(80.8)
Total
N
713
31
%
(100.0)
Dicle University
Receive
Not receive Total
Service
service
N
%
N
%
N %
49
(10.8) 406 (89.2) 455 (100.0)
Bag-Kur
SSK
Private Insurance
Green Card
Medico-Social
32
85
18
36
(16.8)
(16.6)
(-)
(33.3)
(17.4)
159
(83.2)
426
(83.4)
6
(100.0)
36
(66.7)
176
(82.6)
X2= 11.42 p<0.05
191
511
6
54
212
(100.0)
(100.0)
(100.0)
(100.0)
(100.0)
15
53
2
5
31
(6.7)
(9.8)
(5.0)
(20.0)
(20.8)
208 (93.3) 223
486 (90.2) 539
38
(95.0) 40
20
(80.0) 25
360 (93.3) 391
X2= 8.26 p>0.05
(100.0)
(100.0)
(100.0)
(100.0)
(100.0)
When the type of ever received sexual/reproductive health services are examined, it is found the
most common services have been received as "information", "curative", and "consultancy"
respectively. The order of service types is found similar for female and male students (Table 14).
Table 14. Percent Distribution of Students’ Status of Ever Receiving Sexual/Reproductive Health
Services and Types of Received Services by Sex (HU, DU, May 2001)
Hacettepe University
F
M
N
(%)
N
(%)
Status of Receiving
Services
No
Yes
Total*
Type of the Received
Services**
Information
Consultancy
Curative
T
N
(%)
Dicle University
F
M
N
(%)
N
(%)
T
N
(%)
831 (79.4) 602
215 (20.6) 102
1046 (100.0) 704
(85.5) 1433 (81.9) 570
(14.5) 317 (18.1) 78
(100.0) 1750 (100.0) 648
(88.0) 1000
(12.0) 86
(100.0) 1086
(92.1) 1570 (90.5)
(7.9)
164 (9.5)
(100.0) 1734 (100.0)
153
22
35
(78.4)
(16.7)
(4.9)
(76.9)
(6.4)
(17.9)
(84.9)
(12.8)
(4.6)
(71.2)
(10.2)
(16.3)
80
17
5
233
39
40
(73.5)
(12.3)
(12.6)
60
5
14
73
11
4
133
16
18
(81.1)
(9.7)
(10.9)
* 39 students at Hacettepe University and 143 students in Dicle University did not specify whether they receive services or not.
**5 students at Hacettepe University did not specify the type of received service. 3 students at Dicle University specified the type of service although did not specify whether they
received sexual/reproductive health services or not. Percentages were calculated over the number of students who specified that they received services.
The status of students about receiving sexual/reproductive health services is in parallel to the
thoughts and observations of service providers. 40% of interviewed service providers express
that they do not provide specific services for young people. Instead they work in polyclinics and
deal with general health problems. When the strata, region, socio-economic status where the
young persons comes for the SRH services are asked, the most frequent answer is "from
everywhere" (32.6%). The second one is "educated persons" (24.5%). Rural-urban differentiation
is also mentioned. It is explained that rural clients usually come with social indications,
accompanied by their family if the case is very significant. A differentiation between the slum
areas and more urbanized areas is also made. It is stated that urban, high-educated young persons
apply to S/RH services comfortably even with simple reasons. Education is also mentioned as a
significant determinant in the users of the sexual/reproductive health services.
According to the interviewed service providers, young people apply to receive services with
several reasons. Infections including upper respiratory, gastro-intestinal and fungal infections
come first. The applications made to receive psychological support follow the infections.
Psychological support services include the problems such as adaptation to the atmosphere of the
university, the problems caused by being away from the family, anxiety about the future and the
anxiety that is experienced during exam periods. Some young applicants come to receive
information on family planning methods or sexual/reproductive organs. The interviewed service
providers express that some of the young people also apply to receive information on hymen and
virginity.
When service providers’ thoughts on the sufficiency of the provided services for young peopleis
asked; 46.8% of them defines the services as “insufficient” while 31.1% of them defines as
“partially sufficient”. It seems that half of the interviewed service providers assess the services
32
“insufficient”. Their assessment shows that the service providers are objective enough to see and
express the current problems in the provision of the services specific for young people.
According to the findings of the interviews with service providers, primary issues that young
people apply to receive information are sexual/reproductive health and sexually transmitted
infections (33.3%). Psychosocial problems are the second issue (22.2%) about which young
people ask for information. Another striking issue is the way of not getting pregnant before
marriage (17.4%). This statements of service providers are similar to findings of focus group
discussions in which the primary issues that come to young people’s mind while talking about
sexual/reproductive health. Those are hymen, virginity, pregnancy, and AIDS.
According to the service providers, the sexual/reproductive health issues on which young people
mostly need information are; anatomy and physiology of sexual/reproductive organs; the
definition and content and limits of sexuality; and sexually transmitted infections and protection.
Table 15. Distribution of Institutions Where Participant Students Received Sexual/Reproductive
Health Services by Sex (HU, DU, May 2001)*
Institutions
received
services
F
(n=215)
Hacettepe University
M
T
(n=102)
(n=317)
N
(%)
N
(%)
Medico-Social Centers of 19
(8.8)
5
(4.9)
The University
Public Hospitals ( SSK, 33
(15.3)
19
(18.6)
Military, Hospitals of Several
Public Institutions
Private
Clinics/Private 85
(39.5)
37
(36.3)
Hospitals
Health Center
11
(5.1)
4
(3.9)
Promotions by companies, 15
(7.0)
7
(6.9)
Conference,
Brochure,
Training
School/Teacher
43
(20.0)
19
(18.6)
Peers/Friends
(0.0)
(0.0)
Elder
(0.0)
1
(1.0)
Sister/Brother/Persons
Around
Physician/Specialist/Sexual 21
(9.8)
8
(7.8)
Health Center/AIDS Club
Other**
1
(0.5)
2
(2.0)
* Multiple choices are specified and percentages are calculated over n.
** “Pharmacy”, “brother”, “imam””
F
(n=78)
N
Dicle University
M
(n=86)
T
(n=164)
N
24
(%)
(7.6)
8
(%)
(10.3)
N
10
(%)
(11.6)
N
18
(%)
(11.0)
52
(16.4)
11
(14.1)
12
(14.0)
23
(14.0)
122
(38.5)
27
(34.6)
25
(29.1)
52
(31.7)
15
22
(4.7)
(6.9)
8
4
(10.3)
(5.1)
5
3
(5.8)
(3.5)
13
4
(7.9)
(2.4)
62
1
(19.6)
(0.0)
(0.3)
2
(0.0)
(0.0)
(2.6)
5
1
(0.0)
(5.8)
(1.2)
5
3
(0.0)
(3.0)
(1.8)
29
(9.1)
2
(2.6)
5
(5.8)
7
(4.3)
3
(0.9)
2
(2.6)
5
(5.8)
7
(4.3)
When the institutions where students ever received sexual/reproductive health services are
examined, it is found that the first institution specified by students in both universities is "private
clinic/private hospital". The medico-social center stated as the third institution in Dicle
University, and fifth institution in Hacettepe University (Table 15). Although it is expected that
medico social centers would be the first institutions for students to apply where they can access
easily, however they are not. As it is also expressed by service providers themselves, these centers
cannot provide "sufficient” services especially on sexual/reproductive health.
Table 16. Distribution of Reasons of Not Receiving Sexual/Reproductive Health Services by Sex
(HU, DU, May 2001)*
Reasons
F
(n=831)
Hacettepe University
M
T
(n=602)
(n=1433)
33
F
(n=570)
Dicle University
M
(n=1000)
T
(n=1570)
Not necessary
Feeling uncomfortable
Nowhere to go to receive
S/R Health services
Don’t trust on the
institutions where S/R H
services are provided
Thought that unmarried
persons cannot get S/R H
services
Prefer to speak with peers
about S/R H issues
Have no S/R H problem
Other**
N
401
45
201
(%)
(48.3)
(5.4)
(24.2)
N
365
53
124
(%)
(60.6)
(8.8)
(20.6)
N
766
98
325
(%)
(53.5)
(6.8)
(22.7)
N
204
53
186
(%)
(35.8)
(9.3)
(32.6)
N
438
118
297
(%)
(43.8)
(11.8)
(29.7)
N
642
171
483
(%)
(40.9)
(10.9)
(30.8)
55
(6.6)
59
(9.8)
114
(8.0)
46
(8.1)
63
(6.3)
109
(6.9)
40
(4.8)
15
(2.5)
55
(3.8)
29
(5.1)
49
(4.9)
78
(5.0)
112
(13.5)
97
(16.1)
209
(14.6)
98
(17.2)
206
(20.6)
304
(19.4)
374
8
(45.0)
(1.0)
205
9
(34.1)
(1.5)
579
17
(40.4)
(1.2)
186
7
(32.6)
(1.2)
230
15
(23.0)
(1.5)
436
22
(27.8)
(1.4)
* Multiple choices are specified and percentages are calculated over n.
** “These issues are not given importance, marginalized within the society”, “ Compared to other problems issues concerning the sexuality are unimportant for me”, “ I have
already received information from my family”, “ I have already received information from books, encyclopedia”, “ I satisfied my needs in another way”.
The students are asked the reasons of not receiving sexual/reproductive health services. The first
reason expressed in both universities is "not necessary" 54% at Hacettepe, 41% at Dicle). The
second reason for Hacettepe’s students is "have no sexual/reproductive health problem". Dicle
students specify "nowhere to go to receive sexual/reproductive health" services as the second
reason. (Table 16) Although sexual/reproductive health services are provided in medico-social
centers, most students are not aware of these services may be due to information on the services
has not been made efficiently or students do not even suppose that sexual/reproductive services
may be provided within the university. "prefer to speak with peers about sexual/reproductive
issues", "don't trust on the institutions where sexual/reproductive health services are provided",
and "feeling uncomfortable" are other reasons specified by students, which show the sensitivity
of the issue and personal discomfort of students on sexual/reproductive health (Table 16).
The findings of focus group discussions show that the students in both universities have very
limited information about sexual/reproductive health services. They know that services are
provided in several institutions. However, they have a common belief that these services are
provided to only married partners. Therefore, they cannot utilize these services.
“I guess you can go to a gynecologist, but people apply them only if they are married. If you have a problem I
mean...” (Hacettepe, F)
“There are mother-child health centers, but nowhere to apply for us together with my girl friend. People usually
apply those centers for family planning. Those married couples...” (Hacettepe, M)
Another common belief is that they should utilize sexual/reproductive health services if only they
have a health problem..
“We can go to a hospital, a gynecologist, but I have never gone before since I wasn’t ill” (Hacettepe, F)
“People do not go to the hospital if they are not ill. I think our people are not ready to go to the hospital to get
information.” (Hacettepe, M)
“-I heard that there is center at the university, but I don’t know whether everybody can go
there or not.
-I think only married people go there
-We are not used to go those centers unless we are ill. I would like to apply with my fiancé to get information
before marriage for instance.” (Dicle, F)
The level of knowledge students on some sexual/reproductive health issues is also examined in this study.
The findings are briefly explained below:
34
More than half of Hacettepe students (58%), and one out of three Dicle’s students (31%) know
the period in which women have the highest possibility to get pregnant. More female students
know the correct period compared to male students in both universities. One fifth of Hacettepe
students (21%), and 42% of Dicle students specify that they have “no idea” (Table 17). The high
percentage of “no idea” category among university students is one of the significant findings of
this study that should be considered in planning intervention programs.
Table 17. Percent Distribution of Information of Students on the Period in Which Women Have the
Highest Possibility to Get Pregnant by Sex (HU, DU, May 2001)
Possibility of getting
pregnant
F
Just after the menstruation
During Menstruation
2 weeks before the expected
menstruation
Always
No idea
Total
Hacettepe University
M
T
F
Dicle University
M
T
N
171
32
680
(%
(16.3)
(3.1)
(64.9)
N
103
39
322
(%)
(15.4)
(5.8)
(48.1)
N
274
71
1002
(%)
(16.0)
(4.1)
(58.4)
N
174
25
274
(%)
(27.1)
(3.9)
(42.6)
N
157
61
213
(%)
(16.7)
(6.5)
(22.7)
N
331
86
487
(%)
(20.9)
(5.4)
(30.8)
9
155
1047
(0.9)
(14.8)
(100.0)
8
198
670
(1.2)
(29.5)
(100.0)
17
353
1717
(1.0)
(20.5)
(100.0)
2
168
643
(0.3)
(26.1)
(100.0)
8
499
938
(0.9)
(53.2)
(100.0)
10
667
1581
(0.6)
(42.3)
(100.0)
The majority of the students (95% in Hacettepe, 89% in Dicle) know the best age interval for a
healthy pregnancy (Table 18).
Table 18. Distribution of Information of Students on the Best Age Interval for a Healthy Pregnancy
by Sex (HU, DU, May 2001)
Age Interval
<20
20-34
35+
No idea
Total
N
7
1027
7
23
1064
Hacettepe University
M
T
(%)
N
(%)
N
(%)
(0.7)
15
(2.2)
22
(1.3)
(96.4)
639
(92.3)
1666 (94.8)
(0.7)
1
(0.1)
8
(0.5)
(2.2)
37
(5.4)
60
(3.4)
(100.0) 692
(100.0) 1756 (100.0)
F
N
11
619
3
23
656
Dicle University
M
(%)
N
(%)
(1.7)
33
(3.3)
(94.3)
860
(84.7)
(0.5)
3
(0.3)
(3.5)
119
(11.7)
(100.0) 1015 (100.0)
F
N
44
1479
6
142
1671
T
(%)
(2.6)
(88.5)
(0.4)
(8.5)
(100.0)
The majority of female and male students in both universities (97%, 92% respectively in Hacettepe;
92%, 87% respectively in Dicle) know that a new condom should be used in each sexual intercourse
(Table 19)
Half of the female and male students in both universities (47%, 43% respectively in Hacettepe; 55%,
52% respectively in Dicle) know that not “only men have gonorrhea”. Similarly 41% of female
students and 36% of male students at Hacettepe University; 59% of female students and 55% of
male students at Dicle University know that the statement “STI can transmitted to women easier” is
not correct. However, it is important that half of the students in both universities still do not have the
correct information (Table 19).
50% of female students and 43% of male students at Hacettepe University; 37% of female students
and 34% of male students at Dicle University thought that “Pills should not be used after the age of
35” which is not a correct statement (Table 19).
Almost half of the students in both universities (46%, 42% respectively in Hacettepe; 45%, 49%
respectively in Dicle) know that “Copper IUDs provide protection for 10 years”. Three fourth of
female and male students (76%) at Hacettepe University; 60% of female students and 56% of male
students at Dicle University know that “Withdrawal is one of the most effective contraceptive
methods” which is an incorrect information. However, there are still students with incorrect
information on the effectiveness of this method (Table 19).
35
The majority of female and male students in both universities (82% in Hacettepe, 83% in Dicle) know
that “Oral/anal sex has the risk of STIs” although more than one tenth of the students have
incorrect information on this issue (Table 19).
24% of female and male students at Hacettepe University; 17% of female students and 15% of male
students in Dicle University think that the statement “It is wrong to terminate the first pregnancy
with induced abortion because of the risk of infertility in the future” is an incorrect statement (Table
19).
Table 19. Percent Distribution of Students’ Ideas on Some Mentioned Sexual/Reproductive Health
Issues by Sex (HU, May 2001)*
Issues
A new condom
should be used in
each
sexual
intercourse
Only men have
Gonorrhea
STI
can
be
transmitted
to
women easier
Pills should not be
used after the age
of 35
Copper
IUDs
provide protection
for 10 years
Withdrawal is one
of
the
most
effective
contraceptive
methods
Oral/anal sex has
the risk of STIs
It is wrong to
terminate the first
pregnancy
with
induced abortion
because of the risk
of infertility in
the future
Hacettepe University
Female
(n=1071)
True
False
N
(%)
N
(%)
Male
(n=718)
N
True
(%)
False
N
(%)
Dicle University
Female
(n=692)
True
False
N
(%)
N
(%)
Male
(n=1185)
N
True
(%)
N
False
(%)
1006
(97.3)
22
(2.1)
636
(92.4)
52
(7.5)
513
(92.1)
41
(7.4)
827
(86.7)
155
(15.7)
406
(47.2)
406
(47.2)
356
(55.4)
274
(42.6)
176
(39.4)
244
(54.6)
377
(43.1)
457
(52.2)
378
(40.5)
532
(57.0)
235
(35.8)
412
(62.8)
316
(59.0)
207
(38.6)
509
(55.3)
398
(43.3)
330
(41.8)
393
(49.7)
286
(50.5)
244
(43.0)
240
(55.6)
160
(37.0)
461
(60.1)
260
(33.9)
378
(45.6)
403
(48.6)
220
(41.5)
270
(50.9)
207
(44.9)
229
(49.3)
306
(49.0)
256
(41.0)
144
(18.0)
605
(75.9)
131
(21.4)
468
(76.5)
108
(29.0)
244
(60.2)
260
(36.5)
415
(56.3)
747
(82.0)
141
(15.5)
549
(82.3)
114
(17.1)
396
(83.0)
69
(14.5)
723
(83.8)
124
(14.4)
681
(73.7)
221
(23.9)
467
(73.4)
153
(24.1)
421
(80.0
89
(16.9)
714
(83.1)
130
(15.1)
Students have incorrect information on the side effects of contraceptive methods at both
universities. Students think that the pill can “give harm to hormonal balance” (Table 20). Students
also think that pill can cause “cancer” and “infertility”. Similarly students of both universities think
that condom “reduces pleasure” and causes “fungal/infection”. Students of both universities think
that IUD can cause “fungal infection”. “Cancer” and “amontiorrea” (Table 20). As seen students
have many incorrect information on modern contraceptive methods. Since they prefer to get
information by themselves or from peers/friends, they may have incorrect information therefore
these are expected result for young people. These findings clearly show that adolescents/young
people need information programs specific for their age and provided by the professionals.
Table 20. Distribution of Side Effects that Participant Students Think Some Contraceptives May
Cause by Sex (HU, DU, May 2001)
Hacettepe University
36
Dicle University
Side Effect
Pill
Cancer
Fungus/ Infection
Reduce pleasure
Low protection
Give harm to hormonal
balance
Cause to gain weight
Infertility
Stop menstruation
Impotence
Other**
Condom
Cancer
Fungus/ Infection
Reduce pleasure
Low protection
Give harm to hormonal
balance
Cause to gain weight
Infertility
Stop menstruation
Impotence
Other***
IUD
Cancer
Fungus/ Infection
Reduce pleasure
Low protection
Give harm to hormonal
balance
Cause to gain weight
Infertility
Stop menstruation
Impotence
Other****
Withdrawal
Cancer
Fungus/ Infection
Reduce pleasure
Low protection
Give harm to hormonal
balance
Cause to gain weight
Infertility
Stop menstruation
Impotence
Other*****
F
(n=1071)
N
(%)
M
(n=718)
N
(%)
T
(n=1789)
N
(%)
F
(n=692)
N
(%)
M
(n=1185)
N
(%)
T
(n=1877)
N
(%)
127
23
10
108
587
(11.9)
(2.1)
(0.9)
(10.1)
(54.8)
110
13
25
67
318
(15.3)
(1.8)
(3.5)
(9.3)
(44.3)
237
36
35
175
905
(13.2)
(2.0)
(2.0)
(9.8)
(50.6)
39
10
13
56
181
(5.6)
(1.4)
(1.9)
(8.1)
(26.1)
93
34
51
48
197
(7.8)
(2.9)
(4.3)
(4.1)
(16.6)
132
44
64
104
378
(7.0)
(2.3)
(3.4)
(5.5)
(20.1)
538
145
259
20
2
(50.2)
(13.5)
(24.2)
(1.9)
(0.2)
198
90
133
39
3
(27.6)
(12.5)
(18.5)
(5.4)
(0.4)
736
235
392
59
5
(41.1)
(13.1)
(21.9)
(3.3)
(0.3)
194
61
109
9
-
(28.0)
(8.8)
(15.8)
(1.3)
(0.0)
114
95
71
64
2
(9.6)
(8.0)
(6.0)
(5.4)
(0.2)
308
156
180
73
2
(16.4)
(8.6)
(9.6)
(3.9)
(0.1)
15
123
395
69
2
(1.4)
(11.5)
(36.9)
(6.4)
(0.2)
9
57
373
34
7
(1.3)
(7.9)
(51.9)
(4.7)
(1.0)
24
180
768
103
9
(1.3)
(10.1)
(42.9)
(5.8)
(0.5)
4
36
107
15
3
(0.6)
(5.2)
(15.5)
(2.2)
(0.4)
11
38
221
31
22
(0.9)
(3.2)
(18.6)
(2.6)
(1.9)
15
74
328
46
25
(0.8)
(3.9)
(17.5)
(2.5)
(1.3)
1
3
1
48
1
(0.1)
(0.3)
(0.1)
(4.5)
(0.1)
4
5
3
14
-
(0.6)
(0.7)
(0.4)
(1.9)
(0.0)
5
8
4
62
1
(0.3)
(0.4)
(0.2)
(3.5)
(0.1)
3
1
4
19
2
(0.4)
(0.1)
(0.6)
(2.7)
(0.3)
10
8
10
29
2
(0.8)
(0.7)
(0.8)
(2.4)
(0.2)
15
9
14
48
4
(0.8)
(0.5)
(0.7)
(2.6)
(0.2)
123
261
34
40
38
(11.5)
(24.4)
(3.2)
(3.7)
(3.5)
61
106
47
21
29
(8.5)
(14.8)
(6.5)
(2.9)
(4.0)
184
367
81
61
67
(10.3)
(20.5)
(4.5)
(3.4)
(3.7)
55
78
8
16
21
(7.9)
(11.3)
(1.2)
(2.3)
(3.0)
69
55
41
15
39
(5.8)
(4.6)
(3.5)
(1.3)
(3.3)
124
133
49
31
60
(6.6)
(7.1)
(2.6)
(1.7)
(3.2)
33
77
100
8
7
(3.1)
(7.2)
(9.3)
(0.7)
(0.7)
12
55
57
10
2
(1.7)
(7.7)
(7.9)
(1.4)
(0.3)
45
132
157
18
9
(2.5)
(7.4)
(8.8)
(1.0)
(0.5)
22
18
33
3
-
(3.2)
(2.6)
(4.8)
(0.4)
(0.0)
23
44
43
18
2
(1.9)
(3.7)
(3.6)
(1.5)
(0.2)
45
62
76
21
2
(2.4)
(3.3)
(4.0)
(1.1)
(0.1)
6
32
153
306
10
(0.6)
(3.0)
(14.3)
(28.6)
(0.9)
7
23
155
225
17
(1.0)
(3.2)
(21.6)
(31.3)
(2.4)
13
55
308
531
27
(0.7)
(3.1)
(17.2)
(29.7)
(1.5)
1
6
59
58
3
(0.1)
(0.9)
(8.5)
(8.4)
(0.4)
13
19
87
84
23
(1.1)
(1.6)
(7.3)
(7.1)
(1.9)
14
25
146
142
26
(0.7)
(1.3)
(7.8)
(7.6)
(1.4)
1
16
3
50
5
(0.1)
(1.5)
(0.3)
(4.7)
(0.5)
3
11
3
41
5
(0.4)
(1.5)
(0.4)
(5.7)
(0.7)
4
27
6
91
10
(0.2)
(1.5)
(0.3)
(5.1)
(0.6)
1
22
-
(-)
(0.1)
(-)
(3.2)
(-)
6
16
10
31
2
(0.5)
(1.4)
(0.8)
(2.6)
(0.2)
6
17
10
33
2
(0.3)
(0.9)
(0.5)
(1.8)
(0.1)
* Multiple Choices are specified and percentages are calculated over n.
** “Loosing weight”, irregular menstruation”, feeling tired, irregular sleeping”
*** “Not safe”, “problems of skin and allergy”, “disturbs skin”, “slipping”.
****“Irregular menstruation”, “ feeling tired, irregular sleep” "headache", "dizziness", “problems of circulatory system”
*****“It may cause everything”, “I don’t know exactly”, “Slipping”, “Influences health”, “I cannot give a clear answer”
The knowledge scores of students is calculated over 39 questions of which answers are
summarized above. Each correct answer is calculated as “1” whereas each incorrect answer is
calculated as “0”. The knowledge score of students is assessed over total 39 points. The mean
score of both universities is found 24.4 (sd: ± 13.6); and the median score is found 32. The
scores below the mean (0-24) is assessed as “unsatisfactory” whereas the scores over the mean
(25-39) is assessed as “satisfactory”. According to this assessment, the scores of the majority of
Hacettepe students (91%); and the scores of almost half of Dicle students (51%) are found
“satisfactory”. The scores of female and male students are found similar in Hacettepe University
whereas the scores of female students in Dicle University is higher (Table 21).
37
Table 21. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of
Students by Sex (HU, DU, May 2001)
N
974
Hacettepe University
M
T
%
N
%
N
%
(90.9
650 (90.5) 1624 (90.8)
N
388
Dicle University
M
T
%
N
%
N
%
(56.1)
574
(48.4)
962
(51.3)
97
(9.1
304
(43.9)
Knowledge score
Satisfactory
(25-39 points)
Unsatisfactory
(0-24 points)
Total
F
68
(9.5)
165
F
(9.2)
1071
(100.0) 718 (100.0) 1789 (100.0)
Mean: 30.5 (sd: ± 8.6), Median: 33 Min-max: 1-39
611
(51.6)
915
(48.7)
692 (100.0) 1185 (100.0) 1877 (100.0)
Mean: 18.8 (sd: ± 14.8), Median: 28 Min-max: 1-39
There is no statistically significant difference between the knowledge scores of students at adolescent age
(15-19) and young age (20+) (X2=1.98 p>0.05) in Hacettepe University. However, it is found that the
knowledge score is slightly higher as the age is older. More than half of Dicle students (51%) have
“unsatisfactory” knowledge score. This percentage is lower among younger age students (47%). However,
this difference is not statistically significant either (X2= 2.05 p>0.05) (Table 21).
Table 22. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of
Students by Age Groups (HU, DU, May 2001)
Age Groups
15-19
20-24
25+
Hacettepe University
Knowledge Score
Satis.
Unsatis.
Total
N
%
N
%
N
%
851
(91.9) 75
(8.1) 926
(100.0)
754
(90.0) 84
(10.0) 838
(100.0)
10
(90.9) 1
(9.1) 11
(100.0)
X2=1.98 p>0.05
Dicle University
Knowledge Score
Satis.
Unsatis.
Total
N
%
N %
N
327
(49.5) 334 (50.5)
661
587
(52.9) 522 (47.1)
1109
34
(50.0) 34 (50.0)
68
X2= 2.05 p>0.05
%
(100.0)
(100.0)
(100.0)
* 14 students in Hacettepe University and 39 students in Dicle University did not specify their age.
It is found that Hacettepe’s students have higher knowledge scores than Dicle’s students. It is
thought that this result might be influenced by place of birth, childhood residence, and current
residence, receiving sexual/reproductive health services, parents’ level of education, and
communication with parents.
Although there is a statistically meaningful relationship between mothers’ level of education and
knowledge scores of students at Hacettepe University (X2= 11.55 p<0.05), this relationship is not
found significant at Dicle University (X2= 1.65 p>0.05) (Table 23). There is not a statistically
meaningful relationship between fathers’ level of education and knowledge scores of students in
both universities (Hacettepe X2=8.01 p>0.05; Dicle X2= 2.36 p>0.05) (Table 24).
Table 23. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of
Participant Students by Mother’s Education (HU, DU, May 2001)
Hacettepe University
Knowledge Score
Mothers’ Level of
Unsatis.
Satis.
Education
N %
N
%
Primary 87
11.8
650
88.2
Secondary-High 18
8.8
187
91.2
N
737
205
Total
38
%
100.0
100.0
Dicle University
Knowledge Score
Unsatis.
Satis.
N
%
N
%
676
46.9 764
53.1
51
42.9 68
57.1
Total
N
%
1440 100.0
119
100.0
Higher
56
6.8
763
93.2
819
X2= 11.55 p<0.05
100.0
71
42.8
95
57.2
166
X2= 1.65 p>0.05
100.0
Table 24. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of
Students by Father’s Education (HU, DU, May 2001)
Father’s level
of education
Primary Secondary-High
Higher
Hacettepe University
Knowledge Score
Unsatis.
Satis
N
%
N
%
40
(12.5) 279
(87.5)
25
(10.4) 215
(89.6)
87
(7.7)
1050 (92.3)
X2=8.01 p>0.05)
Total
N
319
240
1137
%
(100.0)
(100.0)
(100.0
Dicle University
Knowledge Score
Unsatis.
Satis.
Total
N
%
N
%
N
267 (47.5) 428 (52.5) 815
110 (42.3) 150 (57.7) 260
274 (47.5) 303 (52.5) 577
X2=2.36 p>0.05
%
(100.0)
(100.0)
(100.0)
In this study, it is found that students’ communication with parent on sexual/reproductive health
is weak (Table 9). The level of education or socioeconomic status do not create a difference in
parents’ attitudes towards these issues (Table 24).
There is no statistically significant relationship between current residence of students and their
knowledge scores (Hacettepe: X2= 2.75 p>0.05; Dicle : X2= 13.28 p>0.05) (Table 25).
Table 25. Percent Distribution of Sexual/Reproductive Health Knowledge Scores of
Students by Their Current Residence (HU, DU, May 2001)
Current residence
Dorm
Together with
friends
Together with family
Together with
relatives
Alone
Guest House
Together with Elder
Sisters/Brothers
Other
N
74
74
Unsatis.
%
(9.1)
(11.1)
Hacettepe University
Knowledge Score
Satis.
Total
N
%
N
%
737
(90.9)
811
(100.0)
193
(88.9)
217
(100.0)
Unsatis.
N
%
249
(43.7)
208
(52.7)
Dicle University
Knowledge Score
Satis.
Total
N
%
N
%
321 (56.3)
570 (100.0)
187 (47.3)
395 (100.0)
53
6
(8.5)
(7.9)
570
70
(91.5)
(92.1)
623
76
(100.0)
(100.0)
366
51
(48.7)
(54.3)
386
43
(51.3)
(45.7)
752
94
(100.0)
(100.0)
4
2
(10.5)
(0.0)
(10.5)
34
7
17
(89.5)
(100.0)
(89.5)
38
7
19
(100.0)
(100.0)
(100.0)
16
2
6
(55.2)
(40.0)
(60.0)
13
3
4
(44.8)
(60.0)
(40.0)
29
5
10
(100.0)
(100.0)
(100.0)
-
(0.0)
5
5
(100.0)
-
(0.0)
3
(100.0)
3
X2= 13.28 p>0.05
(100.0)
X2= 2.75 p>0.05
(100.0)
When the students’ knowledge on the contraceptive methods is examined, the well known
contraceptives by female students are found as the pill (84% at Hacettepe, 55% at Dicle);
condom (82% at Hacettepe, 49% at Dicle); and IUD (74% at Hacettepe, 51% at Dicle), whereas
the methods well known by male students are condom (86% at Hacettepe, 47% at Dicle); the pill
(74% at Hacettepe, 37% at Dicle); and withdrawal (60% at Hacettepe, 24% at Dicle). Female
students know calendar, surgical methods and injectables with higher percentage compared to
male students (Table 26). It is encouraging that both female and male students know condom.
Nevertheless, it seems that female students know more effective contraceptives with higher
percentages whereas male students know withdrawal, which is a common traditional method
used in Turkey, and foam/jelly/cream more compared to female students. The least known
methods are found Implants® diaphragm by both female and male students because implants are
still not common in Turkey, and access to diaphragm is limited. Similarly, the places where to get
these methods are known least by both female and male students (Table 26). Female students
know where to get the pill condom and IUD with highest percents in both universities whereas
male students know where to get condom and pill. This finding may be the result of the fact that
these methods are available not only at hospital or health centers, but also in other places such as
markets, pharmacies.
39
40
Table 26. Percent Distribution of Status of Knowing, Using, and Knowing Where to Get Contraceptive Methods among Students by Sex
(HU, DU, May 2001)*
Methods
Hacettepe University
Female
(n=1071)
Know
Use
Male
(n=718)
Know
IUD/Spiral
N
788
(%)
(73.6)
N
4
(%)
(0.4)
Know where
to get
N
(%)
659
(61.5)
Pills
895
(83.6)
21
(2.0)
789
(73.7)
532
(74.1)
53
(7.4)
463
Condom
882
(82.4)
76
(7.1)
784
(73.2)
617
(85.9)
240
(33.4)
Calendar
method
511
(47.7)
32
(3.0)
371
(34.6)
293
(40.8)
54
Withdrawal
461
(43.0)
67
(6.3)
272
(25.4)
427
(59.5)
Norplant
32
(3.0)
-
(0.0)
36
(3.4)
16
Female
Sterilization
570
(53.2)
1
(0.1)
473
(44.2)
Male
Sterilization
359
(33.5)
-
(0.0)
356
Diaphragm
168
(15.7)
1
(0.1)
Injectables
423
(39.5)
2
Foam/Jelly/Cre
am
326
(30.4)
2
*Percentages are calculated over
Use
N
382
(%)
(53.2)
N
11
(%)
(1.5)
Know here to
get
N
(%)
303
(42.2)
Dicle University
Female
(n=692)
Know
Use
Male
(n=1185)
Know
Use
N
294
(%)
(24.8)
N
168
(%)
(1.4)
Know where
to get
N
(%)
229
(19.3)
N
353
(%)
(51.0)
N
4
(%)
(0.6)
Know where
to get
N
(%)
273
(39.5)
(64.5)
381
(55.1)
6
(0.9)
291
(42.1)
443
(37.4)
39
(3.3)
352
(29.7)
545
(75.9)
342
(49.4)
22
(3.2)
263
(38.0)
558
(47.1)
177
(14.9)
432
(36.5)
(7.5)
216
(30.1)
167
(24.1)
9
(1.3)
103
(14.9)
156
(13.2)
18
(1.5)
98
(8.3)
128
17.8)
255
(35.5)
143
(20.7)
16
(2.3)
56
(8.1)
280
(23.6)
77
(6.5)
142
(12.0)
(2.2)
3
(0.4)
20
(2.8)
14
(2.0)
-
(-)
9
(1.3)
31
(2.6)
3
(0.3)
25
(2.1)
230
(32.0)
4
(0.6)
185
(25.8)
261
(37.7)
1
(0.1)
172
(24.9)
177
(14.9)
4
(0.3)
121
(10.2)
(33.2)
258
(35.9)
4
(0.6)
190
(26.5)
136
(19.7)
-
(-)
94
(13.6)
173
(14.6)
7
(0.6)
107
(9.0)
135
(12.6)
110
(15.3)
9
(1.3)
89
(12.4)
47
(6.8)
-
(-)
24
(3.5)
72
(6.1)
6
(0.5)
48
(4.1)
(0.2)
337
(31.5)
224
(31.2)
11
(1.5)
163
(22.7)
208
(30.1)
3
(0.4)
132
(19.1)
200
(16.9)
8
(0.7)
142
(12.0)
(0.2)
278
(26.0)
287
(40.0)
32
(4.5)
223
(31.1)
106
(15.3)
-
(-)
69
(10.0)
209
(17.6)
23
(1.9)
143
(12.1)
n
41
As seen in the tables above, students’ level of information is not as satisfactory as it is expected.
The opinions of service providers on the provision of information to young people are as
follows:
All interviewed service providers believe that adolescents/young people should be informed on
their sexual/reproductive health. The positive and negative aspects of providing information on
sexual/reproductive health are also asked to service providers. The most frequent positive effect
stated by the interviewees is being able to protect them from the unfavorable physical, social and
mental consequences of insufficient knowledge on their health (39.7%). According to service
providers, young people are able to protect themselves against sexually transmitted infections or
unwanted pregnancies that may cause traumatic effects if they have correct and sufficient
information. Moreover, the information may reduce their anxiety about their body, and make
them happy individuals. The interviewees think that receiving information on their
sexual/reproductive health is a right of young people. Consequently, provision of informative
services is the crucial part of preventive approach, and is perceived as a significant means to
prevent the negative consequences.
There are also service providers among the interviewees who think that provision of information
services may have negative effects on young people (45.4%). It is stated that the information
provided by unauthorized professionals may have more negative effects. It is also expressed that
if the information provided to young people contradict with the social norms, they may face
unwanted consequences because of challenging the society or some conservative groups within
the society.
Service providers’ opinions are also asked whether families should be informed before
information sexual/reproductive health is provided to adolescents or not. In general it is thought
that there is no need to inform the families unless the family may contribute better utilization of
the services or adolescent is under legal age or there is a serious problem like sexual harassment
or abuse whereas only three interviewed service providers (6.7%) think that parents should be
informed in any case.
When the contraceptives ever used by students or their partners are examined, it is found that the
most frequently used contraceptive in both universities (7% of female students and 33% of male
students in Hacettepe; 3% of female students and 15% of male students at Dicle) is condom
(Table 26). It is a beneficial practice for the students since condom also provide protection from
sexually transmitted infections. However, the following method is withdrawal (6% of female
students and 18% of male students in Hacettepe; 2% of female students and 7% of male students
in Dicle), and calendar (3% of female students and 8% of male students at Hacettepe; 1% of
female students and 2% of male students at Dicle) which are les effective traditional methods. It
seems necessary to provide information and counseling on the effectiveness of contraceptive
methods for young people. The pill comes fourth among the contraceptive methods used by
students in both universities (2% of female students and 7% of male students in Hacettepe; 1%
of female students and 3% of male students in Dicle). However, this method seems the easiest
one that can be used at this age. Students may not prefer the pill because it must be taken
regularly, and this necessity might discourage students without regular sexual life. The incorrect
information of students about the side effects of the pill as seen in Table 20 may be explanatory
in less use of the pill by students.
The relationship between students’ sexual experience and the status of ever use of contraceptives
is also examined. 45.6% of Hacettepe students with sexual experience stated that they have ever
used contraceptive while 54.5% of them do not. The percentage of Dicle's students with sexual
experience who have ever used contraceptive is 29.4% whereas the percentage of non-users with
42
sexual experience is 70.6%. There are also students who specify that they have ever used
contraceptive even though they do not report any sexual experience. 8.8% of Hacettepe students
, and 10% of Dicle's students without sexual experience state that they have ever used
contraceptive. Students with sexual experience are more likely to use contraceptive compared to
the students without sexual experience. This difference is fund statistically significant (X2=303.99
p<0.05, X2= 84.92 p<0.05).
Considering the findings of focus group discussions, the fact that sexual experience may have a
wide range of meanings in students’ minds. Students may not always understand sexual
experience as penetrative sex. Therefore, they might have ever used contraceptive in nonpenetrative sex in order to protect themselves against possible risks of STIs (Table 27).
Table 27. Percent Distribution of Status of Contraceptive Use among Participant Students
by Sexual Experience (HU, DU, May 2001)
Sexual
Experience
Yes
No
Hacettepe University
Contraceptive
Not used
Used
Total
N
%
N
%
N
%
317
(54.4) 266
(45.6) 583
(100.0)
990
(91.2) 95
(8.8)
1085 (100.0)
X2=303.99 p<0.05
Not used
N
%
286 (70.6)
962 (90.0)
Dicle University
Contraceptie
Used
Total
N
%
N
%
119
(29.4) 405 (100.0)
107
(10.0) 1069 (100.0)
X2= 84.92 p<0.05
The relationship between students’ sexual/reproductive health knowledge score and status of
ever use of contraceptives is examined. It is determined that 13.9% of Hacettepe students with
unsatisfactory knowledge score; and 21% of Hacettepe students with satisfactory knowledge
score have ever used any contraceptive method. However, this difference is not found statistically
significant (X2=4.79 p>0.05). On the other hand, 6.5% of Dicle students with unsatisfactory
knowledge score; and 18.4% of Dicle's students with satisfactory knowledge score have ever used
any contraceptive method. This difference is found statistically significant (X2=60.97 p<0.05)
(Table 28). It seems that as the knowledge score of students is higher their use of any
contraceptive method increases.
Table 28. Percent Distribution of Students’ Ever Use of Any Contraceptive Method by
Sexual/Reproductive Health Knowledge Score (HU, DU, May 2001)
Hacettepe University
Contraceptive Use
Knowledge
No
Yes
Total
Score
N
%
N
%
N
%
Unsatis.
143
(86.1) 23
(13.9) 166
(100.0)
Satis.
1291
(79.0) 344
(21.0) 1635 (100.0)
X2=4.79 p>0.05
Dicle University
Contraceptive Use
No
Yes
Total
N
%
N
%
N
%
866 (93.5) 60
(6.5)
926 (100.0)
796 (81.6) 179 (18.4) 975 (100.0)
X2=60.97 p<0.05
The first place stated by female and male students in Hacettepe University and female students in
Dicle University, where they can get contraceptives is “pharmacy”. The second place is
“hospital”. The first place specified by male students in Dicle University is “hospital” and the
second place is “pharmacy”. The third place specified by all students in both universities is
“health center/MCH/FP center” (Table 29).
43
Table 29. Percent Distribution of Status of Knowing Where to Get Contraceptive Methods Among
Participant Students by Sex (HU, DU, May 2001)*
Place to get
contraceptive
Health Center, FP/MCH
Centers
Hospital
Pharmacy
Market
Other**
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
N
(%)
N
(%)
N
(%)
520 (48.6) 237 (33.0) 757 (42.3)
F
(n=692)
N
(%)
355 (51.3)
767
936
187
24
438
501
75
9
(71.6)
(87.4)
(17.5)
(2.2)
372
608
195
11
(51.8)
(84.7)
(27.2)
(1.5)
1139
1544
382
35
(63.7)
(86.3)
(21.4)
(2.0)
(63.2)
(72.3)
(10.1)
(1.3)
Dicle University
F
T
(n=1185)
(n=1877)
N
(%)
N
(%)
320 (27.0) 675 (35.9)
944
881
215
11
(79.6)
(74.3)
(18.1)
(0.9)
1382
1382
290
20
(73.9)
(73.6)
(15.4)
(1.0)
* Multiple choices are specified. Percentages are calculated over n.
** “Health Professionals”, “Internet”, “No idea”
The agreement status of students to some statements concerning to sexual/reproductive health is
examined. The statement “Men may have pre-marital, penetrative sexual intercourse” is found
more acceptable by both female and male students in both universities compared to the
acceptability of the same situation for women (Table 30.1-30.2). The percentage of disagreement
with the statements “Women may have pre-marital, penetrative sexual intercourse” is higher
among Dicle students compared to Hacettepe students. Four times more male students
compared to female students in both universities agree with “Men may have multiple sexual
partners, but it is better for women to have one partner”. However, the percentage of
disagreement of female students with this statement is higher (Table30.1-30.2). These percentages
directly reflects the patriarchal values dominant within the society and the sexual roles attributed
to "gender" women and men within this culture.
The statement about the virginity also reflects the traditional patriarchal attitude towards women.
The majority of the students in both universities agree with the statement “Virginity is important
for me for marriage”. Male students have higher percentage of agreement with this statement.
Similarly, more male students disagree with the statement “Adolescents/Young People may not
care the suppressive attitude of society about virginity” (Table 30.1-30.2).
Te percentage of agreement the statement “Adolescents/Young People talk speak with parents
only about the health dimension of sexuality” is higher among Dicle students-particularly higher
among male students-. Because some students in both universities in general and male students in
Dicle University in particular think that “Talking about sexuality with parents may give harm to
the relationship between parents and children”. Nevertheless, there are students, especially female
students who disagree with the statement “Adolescents/Young People should talk with their
parents only about the health dimension of sexuality” (Table 30.1-30.2).
44
Table 30.1. Percent Distribution of Agreement Status of Students to Some Statements by Sex
(HU, May 2001)*
Hacettepe University
Statement
Agree
N (%)
Female
(n=1071)
Not sure
N
(%)
Disagree
N
(%)
N
Male
(n=718)
Not sure
N
(%)
Agree
(%)
Disagree
N
(%)
Men may have pre-marital, 561
penetrative sexual intercourse
(53.8)
211
(20.2)
271
(26.0)
414
(59.0)
110
(15.6)
178
(25.4)
Women may have pre-marital, 405
penetrative sexual intercourse
(38.8)
245
(23.4)
395
(37.8)
278
(39.7)
143
(20.4)
280
(39.9)
Virginity is important for me for 506
marriage
(48.9)
196
(19.0)
332
(32.1)
379
(54.5)
134
(19.3)
182
(26.2)
Adolescents/Young people should 305
talk with parents only about the
health dimension of sexuality
(29.3)
317
(30.5)
418
(40.2)
268
(38.5)
234
(33.6)
194
(27.9)
57
(5.5)
167
(16.0)
819
(78.5)
61
(8.8)
174
(25.1)
459
(66.1)
61
(5.9)
188
(18.0)
795
(76.1)
102
(14.6)
218
(31.2)
378
(54.2)
490
(47.0)
298
(28.6)
255
(24.4)
383
(54.9)
157
(22.5)
158
(22.6)
478
(46.1)
359
(34.5)
201
(19.4)
288
(41.4)
227
(32.7)
180
(25.9)
(3.2)
66
(6.4)
940
(90.4)
111
(16.0)
85
(12.2)
499
(71.8)
Talking about sexuality with
parents may give harm to the
relationship between parents and
children
A woman who was subjected to
sexual violence (harassment,
rape, battering, etc.) might have
deserved this
Violence cases may seem less
frequently in high socioeconomic strata
Adolescents/Young People may
not care the suppressive attitude
of society about virginity
Men may have multiple sexual 33
partners, but it is better for women
to have one partner
* Percentages are row percents.
Table 30.2 Percent Distribution of Agreement Status of Students to Some Statements by Sex
(DU, May 2001)*
Dicle University
Statements
N
Men may have pre-marital, penetrative sexual
intercourse
Women may have pre-marital, penetrative
sexual intercourse
Virginity is important for me for marriage
Adolescents/Young People should talk with
parents only about the health dimension of
sexuality
Talking about sexuality with parents may give
harm to the relationship between parents and
children
A woman who was subjected to sexual
violence (harassment, rape, battering, etc.)
might have deserved this
Violence cases may seem less frequently in
high socio-economic strata
Adolescents/Young People may not care the
suppressive attitude of society about virginity
Men may have multiple sexual partners, but it
is better for women to have one partner
Agree
(%)
Female
(n=692)
Not sure
N (%)
Disagree
N
(%)
N
Agree
(%)
Male
(n=1185)
Not sure
N
(%)
Disagree
N
(%)
270
(44.5)
118
(19.5)
218
(36.0)
526
(53.5)
139
(14.1)
319
(32.4)
151
(24.8)
121
(19.8)
338
(55.4)
247
(25.1)
149
(15.1)
590
(59.8)
376
255
(63.2)
(41.9)
77
146
(12.9)
(24.0)
142
207
(23.9)
(34.1)
710
433
(72.9)
(44.5)
102
285
(10.5)
(29.4)
162
254
(16.6)
(26.1)
51
(6.5)
111
(18.5)
437
(73.0)
205
(21.3)
233
(24.2)
526
(54.5)
59
(9.8)
115
(19.0)
431
(71.2)
217
(22.3)
295
(30.3)
461
(47.4)
336
(56.1)
106
(17.7)
157
(26.2)
592
(61.3)
152
(15.7)
222
(23.0)
265
(44.2)
152
(25.4)
182
(30.4)
353
(36.8)
205
(21.4)
400
(41.8)
58
(9.7)
52
(8.7)
489
(81.6)
308
(31.6)
126
(12.9)
541
(55.5)
* Percentages are row percent
45
Sexual violence is a type of violence against women. However, the general attitude towards
women subjected to violence is blaming the sexual violence survivors. The opinion of students
on violence against women is examined in this study. Although the percentage is not so high,
Dicle students compared to Hacettepe students; male students compared to female students
specify more that they are agreeing with the statement "A woman who was subjected to sexual
violence (harassment, rape, battering, etc.) might have deserved this". Nevertheless, it is
encouraging to find out that three fourth of female students and almost half of male students are
disagreeing with this statement.
In focus groups conducted with female students it is expressed that they disagree with the belief
that women who are exposed to violence might have deserved this, and women who are
subjected to any type of violence should react in a way.
“ You know, there is a belief in society that if a woman doesn’t want, man will not come. That’s nonsense in my opinion. No
woman says “come and rape me” (Hacettepe, F)
“ Your affair should never include violence. I mean, I must not encourage him in any way. He should know that he would
regret if he cuffs me” (Hacettepe, F)
“Even if a gaze disturbs me, it’s violence. It is necessary to react. Shouting for instance. Verbalize this. Nothing to be
shamed. That’s his shame” (Hacettepe, F)
Although it is known that violence against women is also experienced in groups with high socioeconomic level, half of Hacettepe students and more than half of Dicle students are agreeing with
the statement "Violence cases may seem less frequently in high socio-economic strata". On the
other hand, one fourth of students in both universities is disagreeing with this statement (Table
30.1-30.2).
Similarly during focus discussions conducted with female students, it is expressed that less
violence cases may seem among high socio-economic groups. Educated women from high socioeconomic strata are not subjected to violence. Since they have the choice to leave their partners if
they’re subjected to violence; they have the power to react against violence. On the other hand,
educated men from high socio-economic strata do not expose violence since they can satisfy their
sexual needs easily, and no need to repress their sexuality that might be burst out in form of
violence later.
“ If a woman with economic freedom has a well-educated husband-he seems like that-, but he beats her or makes her do
something she doesn’t want to do, this woman can go away whenever she wants…” (Hacettepe, F)
“…I think these violence cases seem among people for whom sexuality is a taboo; in slum areas. I don’t believe that this kind
of behaviors can be seen in more luxurious places.” (Hacettepe, F)
“It’s a matter of education rather than wealth and poverty. If a person doesn’t have an occupation of something else to be
successful in, he wants to satisfy himself in another way. You don’t see violence among educated persons. They have an aim in
life.” (Hacettepe, F)
46
3. KNOWLEDGE OF THE SURVEYED STUDENTS ON SEXUAL INTERCOURSE
AND RISK BEHAVIORS
Seventy six percent of Hacettepe's students and 66% of Dicle's students specify that they have
ever had a partner. 24% of Hacettepe's students and 34% of Dicle students have not had a
partner. The percentage of female students who have ever had a partner is lower than male
students (Table 31).
Table 31. Percent Distribution of Students’ Ever Having a Partner by Sex (HU, DU, May 2001)
Having a partner
Yes
No
Total*
F
N
763
270
1033
Hacettepe University
M
T
(%)
N
(%)
N
(%)
(73.9)
550
(79.9) 1313 (76.3)
(26.1)
138
(20.1) 408
(23.7)
(100.0)
688
(100.0) 1721 (100.0)
F
N
(%)
374 (62.6)
223 (37.4)
597 (100.0)
Dicle University
M
T
N
(%)
N
(%)
661 (68.0) 1035 (66.0)
311 (32.0) 534 (34.0)
972 (100.0) 1569 (100.0)
*68 students in Hacettepe University, and 296 students in Dicle University did not specify whether they have ever had a partner (Girl/Boy Friend) or not.
Participant students' ideas are asked on "what may sexuality include in dating?". The answers are
"handling/kissing", "touching", "sexual intercourse without penetration", "sexual intercourse
with penetration" respectively. The percentages in Dicle University are lower. Female students
specify the category "handling/kissing" with higher percentage compared to male students in
both universities whereas male students specify the category "sexual intercourse without
penetration" with higher percentage. The percentage of male students, who specify penetrative
sexual intercourse, is two times higher than female students in both universities (Table 32).
Table 32. Distribution of Ideas of Students on What Sexuality May Include in Dating by Sex (HU,
DU, May 2001)
Ideas*
Handling/Kissing
Touching
Sexual Intercourse
without Penetration
Sexual Intercourse with
Penetration
Other**
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
N
(%)
N
(%)
N
(%)
710 (66.3) 353 (49.2) 1063 (59.4)
527 (49.2) 312 (43.5) 839 (46.9)
378 (35.3) 320 (44.6) 698 (39.0)
F
(n=692)
N
(%)
355 (51.3)
177 (25.6)
163 (23.6)
Dicle University
M
(n=1185)
N
(%)
503 (42.4)
367 (31.0)
336 (28.4)
243
(22.7)
336
(46.8)
579
(32.4)
81
(11.7)
321
(27.1)
402
(21.4)
33
(3.1)
42
(5.8)
75
(4.2)
42
(6.1)
65
(5.5)
107
(5.7)
T
(n=1877)
N
(%)
858 (45.7)
544 (29.0)
499 (26.6)
* Multiple choices are specified, and percentages are calculated over n.
** “It depends the extend of dating”, “sexuality is not so important, friendship is fine”, “none of them”, “meeting, conversation, talking”, “love, respect, emotions”, “sexuality is
an issue of marriage”, “wherever it goes further”, oral/anal intercourse”, “having pleasure by looking”, “none of your business”, “something to be experienced after economic
independence”, “well-balanced limitations”, “excessive is harmful”, “it depends on the education”
As it is found in focus group discussions, the image of sexuality in students’ minds differ s from
each other. It was observed that most of them preferred not to say “sexual intercourse”.
Therefore, the question should be clarified, and asked in the form of “penetrative sexual
intercourse”.
“In my opinion, sexuality is the expression of love by body language. This happens when you are dating. There are
some couples who have further very further sexual life, but there are also couples with normal sexual
relationship…” (Hacettepe, M.)
“I don’t think that sexuality is an urgent necessity. People are emotionally satisfied by handling for years. On the
other hand, it is not a rule that there won’t be any sexuality…” (Hacettepe, F.)
47
“If there are real feelings between two people, it is normal to touch, to kiss each other. This is more healthier.”
(Hacettepe, M.)
“Kissing and touching are normal for me…if you’re sexually attracted?” (Dicle, M.)
“I’m never against sex, but I cannot do it. We have values in Turkey. For sure, we may experience sex up to a
certain degree. Sex never means tearing of hymen I think.” (Dicle, F.)
Premarital sex is not an approved behavior for young women in Turkey. The findings explained
above directly reflect this attitude. The students are also asked whether premarital sex is natural
part of dating for young people. Almost half of Hacettepe's students (45%) and more than one
third of Dicle students (35%) reply "yes". Half of Hacettepe's students (50%) and two third of
Dicle's students (63%) reply "no" (Table 33).
As it is seen, a significant number of students think that premarital sex is not natural part of
dating. However, there are students who think that premarital sex is natural part of dating inspite
of the conservative and suppressive attitude of the society especially over young women. On the
other hand, it is found that more male students in both universities think that premarital sex is
natural part of dating.
Table 33. Percent Distribution of Ideas of Participant Students on “Pre-marital Sex is Natural Part of
Dating” by Sex (HU, DU, May 2001)
Hacettepe University
Dicle University
Sex is natural part
F
M
T
F
M
T
Of dating?
N
(%)
N
(%)
N
(%)
N
(%)
N
(%)
N
(%)
Yes, it is
383 (37.3) 380 (55.2) 763 (44.5) 152 (26.2) 377 (39.8) 529 (34.6)
No, it isn’t
574 (56.0) 275 (40.1) 849 (49.5) 416 (71.8) 547 (57.7) 963 (63.0)
It depends
37
(3.6)
14
(2.0)
51
(3.0)
7
(1.2)
16
(1.7)
23
(1.5)
Have no certain idea
25
(2.4)
12
(1.7)
37
(2.2)
2
(0.3)
4
(0.4)
6
(0.4)
Yes, but no in our society
7
(0.7)
7
(1.0)
14
(0.8)
3
(0.5)
4
(0.4)
7
(0.5)
Total*
1026 (100.0) 688 (100.0) 1714 (100.0) 580 (100.0) 948 (100.0) 1528 (100.0)
*75 students in Hacettepe University, and 349 students in Dicle University did not specify whether pre-marital sexual intercourse is natural
part of dating or not.
The thoughts of students on acceptability of premarital sex are found similar both in focus group
discussions and survey findings. The general attitude of both young women and men is that the
premarital sexual intercourse is unacceptable. The ones, who state that it is acceptable, emphasize
that it may be experienced in a long term dating in which the couple is sure that they will marry.
“Virginity” is important in a relationship as it is stated in both female and male groups. The most
expressed reason of this attitude is “social pressure”.
“Generally, I don’t accept sexuality. The best thing in dating understands each other. For instance, I see men who
use (sexually) the girls and break up the relationship. If a man really loves you he never asks for anything
(sexually) until you marry.” (Hacettepe, F)
“No need for sexuality I think. Nobody knows what will happen tomorrow, and we know the status of girls
within the society. For example, you dated with someone, but broke up later. No problem with you (man), but for
her? Problems with family...If she marries with another man in the future, the first condition is that (virginity) for
marriage...” (Hacettepe, M.)
“My own opinion is that people should not experience premarital sexual intercourse. Whatever you call, family
structure or personal choice, I don’t want to take such a risk...” (Hacettepe, F.)
48
“I think it shouldn’t be done before marriage. In fact, the problem is not pre or post marriage, but my friend and
families have social values. What does marriage mean? Having legitimized comfortable sexual intercourse. People
marry for this purpose...” (Hacettepe, F.)
“I mean, may be because of the way we were grown up or my own choice. I think premarital sex is something wrong.” (Dicle, F.)
In one of the male groups in Dicle University, such an expression is told:
“If you love a woman, you never think about premarital sex with her” (Dicle, M)
On the other hand, it is also stated that persons may experience sexual intercourse in dating.
However, especially young women express that “sexual intercourse may come at the end of long term,
emotional affair” and “should be shared with a man whom they trust”
“Whenever I believe that the person I love really loves me, we will experience sexuality. But if you think that he is really valuable
enough to give whatever you have. In my opinion, it (virginity) is the most valuable and last thing I can give…” (Hacettepe, F.)
“I think it depends on my partner. If I really love and plan to marry him, I know that, and I will have sex with
him.” (Dicle, F.)
Although more flexible ideas on premarital sex are expressed in female groups in theory, the practice
seems highly problematic. It is expressed that virginity is an issue about which young women have
strict thoughts and feel a great anxiety due to the values of their social environment.
“Sexual affair must be lived after marriage. I mean, a human being is a social creature, and we have to adapt
wherever we live. Since premarital sex is unacceptable here (Diyarbakir), we have to obey the rules." (Dicle, F.)
“...These are ancient values, but still important for the society. For example, in the east-it may be in west also-people
are against sexual intercourse. In my opinion, the most valuable thing of a girl is not having sex. If virginity goes, it
goes. It is my most sacred part. It must be done after marriage…"(Dicle, F.).
“We were taught in this way. I mean, it is difficult to go back for a woman in Diyarbakir after getting married. It
was more difficult before. I think of myself…I am not sure whether I survive if my father hears that I have sex with
my boy friend" (Dicle, F.)
As it is understood from the expressions of students in focus group discussions premarital sex is
unacceptable for young women. Young people maintain the traditional attitude towards women's
sexuality and the value attributed to virginity. Their explanations of their attitude based on social
pressure indicate the intensive influence of the social norms over their ideas concerning sexuality.
It is noteworthy that the focus of the discussions about sexual intercourse and virginity is “woman’s
sexuality” and “honor” both in female and male groups. Virginity is accepted as the indicator of a
woman’s honor, and a precondition in marriage decisions. The statements of both female and male
students reflect this attitude. For male students in this study, they do not have sex with a young
woman means showing respect to her virginity and honor. This is the reflection of the perception
that man is responsible of woman’s honor, and should protect it. The above-explained expressions
show the cultural dynamics that influence the behaviors about this issue.
Students’ previous sex experience is asked in order to determine their behaviors. 7% of Hacettepe’s
students and 9% of Dicle’s students report that they have previous sex experience. On the other
hand, 50% of Hacettepe’s students, and 45% of Dicle’s students specify that they do not have
previous sex experience. It is found that around 2% of female students and 13% of male students in
both universities have previous sex experience. This difference reflects the gender inequality in
practice of students in parallel to their thoughts discussed above. A significant finding is that almost
half of the students in both universities (43% at Hacettepe, 47% at Dicle) do not answer this
49
question. Most probably, the students do not want to give such a personal and private information
although the questionnaire was self-administered (Table 34)
Table 34. Percent Distribution of Previous Sex Experience of Participant Students by Sex (HU, DU,
May 2001)
Previous sex
Experience
Yes
No
Unanswered
Total
Hacettepe University
M
T
N
(%)
N
(%)
N
(%)
25
(2.3)
92
(12.8) 117
(6.5)
663 (61.9) 233 (32.5) 896 (50.1)
383 (35.8) 393 (54.7) 776 (43.4)
1071 (100.0) 718 (100.0) 1789 (100.0)
F
Dicle University
M
T
(%)
N
(%)
N
(%)
(2.3)
152 (12.8) 168
(9.0)
(58.5) 432 (36.5) 837 (44.6)
(39.2) 601 (50.7) 872 (46.5)
(100.0) 1185 (100.0) 1877 (100.0)
F
N
16
405
271
692
Students are asked to define “safe sex”. The first category specified by Hacettepe students is
“protection from STIs” whereas it is “monogamy” in Dicle University. The second category is
“monogamy” in Hacettepe whereas it is “protection from STIs” in Dicle. The third definition
specified in both universities “condom use” which is followed by “contraceptive use”. The gender
difference in these definitions is examined and it is found that female students specify “monogamy”
first, “protection from STIs” second, and “contraceptive use” third whereas male students specify
“protection from STIs” first, “monogamy” second, “condom use” third. Female students specify
“monogamy” with higher percents compared to male students (Table 35).
Table 35. Percent Distribution of Students’ Definitions of Safe Sex by Sex (HU, DU, May 2001)*
Safe Sex
Abstinence
Monogamy
Condom use
Sex without pregnancy at
the end
Protection from STIs
Contraceptive use
Methods
Other**
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
N
(%)
N
(%)
N
(%)
45
(4.2)
21
(2.9)
66
(3.7)
490 (45.8) 178 (24.8) 668 (37.3)
192 (17.9) 163 (22.7) 355 (19.8)
68
(6.3)
46
(6.4)
114
(6.4)
F
(n=692)
N
(%)
45
(6.5)
256 (37.0)
70
(10.1)
29
(4.2)
Dicle University
M
(n=1185)
N
(%)
55
(4.6)
304 (25.7)
196 (16.5)
55
(4.6)
489
224
(45.7)
(20.9)
225
90
(31.3)
(12.5)
714
314
(39.9)
(17.6)
208
72
(30.1)
(10.4)
331
97
(27.9)
(8.2)
539
169
(28.7)
(9.0)
5
(0.5)
5
(0.7)
10
(0.6)
8
(1.2)
7
(0.6)
15
(0.8)
T
(n=1877)
N
(%)
100
(5.3)
560 (29.8)
266 (14.2)
84
(4.5)
* Multiple choices were specified, and percentages were calculated over n.
** “Having sex after marriage”, “conscious sex (pre information)”, “sex within limits of religious rules”, “ no idea”, “ gays are ignored”, “not having so much
sex”, “the physical side of love”, “relationship between pleasure and health”, “have a positive approach”.
Another significant finding related to safe sex is specification of “abstinence” although with low
percent.
As it is seen in Table 35, safe sex primarily means “protection from STIs” for young people.
Although female students specify it as the third category, “protection from pregnancy” is specified
less by male students. As it is seen in Table 36, the most frequently specified risks are “AIDS” and
“other STIs” in both universities. While “pregnancy” is specified as a risk by Hacettepe’s students,
“damaging of hymen” is specified as a risk in sexual intercourse by Dicle’s students (Table 36). A
significant finding in this question is expression of “damaging of hymen” as a risk with higher
percentage in Dicle University.
Virginity is also discussed as one of the important risks for non-married young women in both
female and male focus groups. It is called as a social risk. Both female and male participants express
their anxiety about the social exclusion that a non-married young woman may face if she is not a
virgin.
“Girls have social risks about virginity. We know the belief of the society…” (Hacettepe, F.)
50
“More risky for girls. They will face the results. I mean, when they lose their virginity, they are excluded from the
society…they have such a risk.” (Hacettepe, M)
Table 36. Percent Distribution of Students’ Ideas on the Risks in Sexual Intercourse by Sex (HU,
DU; May 2001)*
Risks in Sex
Pregnancy
AIDS
Other STIs
Damaging of hymen
Other**
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
N
(%)
N
(%)
N
(%)
242 (22.6) 201 (28.0) 443 (24.8)
871 (81.3) 545 (75.9) 1416 (79.2)
370 (34.5) 209 (29.1) 579 (32.4)
128 (12.0)
82
(11.4) 210 (11.7)
3
(0.3)
8
(1.1)
11
(0.6)
F
(n=692)
N
(%)
121 (17.5)
421 (60.8)
171 (24.7)
139 (20.1)
1
(0.1)
Dicle University
M
T
(n=1185)
(n=1877)
N
(%)
N
(%)
214 (18.1) 335 (17.8)
699 (59.0) 1120 (59.7)
276 (23.3) 447 (23.8)
197 (16.6) 336 (17.9)
10
(0.8)
11
(0.6)
*Multiple choices are specified, and percentages are calculated over n.
**“Pressure, feeling uncomfortable, love, respect, religious risks”, “infections/abortion”, “dissatisfaction”, “no idea”, “none”, “everything that gives harm to
human beings”, “you become aware of the fact that the only important part is sexuality for your partner ”, “being aware of the importance of the issue”, “family
or brother of the girl”.
An unwanted pregnancy occurred as a result of a premarital sexual intercourse have negative
consequences in young woman’s life at present and in the future. She may face a strong social
exclusion and pressure in many forms. Participant students’ thoughts are asked on “what should be
done in case of unwanted premarital pregnancy” in order to see their reaction to such an “extreme”
situation. The first solution specified by Hacettepe’s students is “induced abortion”, and the second
solution is “marriage” whereas the first solution of Dicle’s students is “marriage”, and the second
solution is “induced abortion”. The third solution specified in both universities is “pregnancy should
be continued in any case” (Table 37). The gender difference in these ideas is examined, and it is
found that female students in both universities specify “induced abortion” and “marriage” with
higher percentage compared to male students. Both female and male students in Hacettepe
University specify “induced abortion” as the first category while both female and male students in
Dicle University state “marriage” first (Table 37).
Table 37. Percent Distribution of Students’ Thoughts on “What Should be Done in Case of
Unwanted-Premarital Pregnancy?” by Sex” (HU, DU, May 2001)*
What should be done
in case of unwantedpremarital pregnancy
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
N
(%)
N
(%)
N
(%)
527
(49.2)
321
(44.7)
648
(36.2)
257
(24.0)
157
(21.9)
414
(23.1)
8
(0.7)
14
(1.9)
22
(1.2)
225
(21.0)
179
(24.9)
404
(22.6)
F
(n=692)
N
(%)
158
(22.8)
294
(42.5)
6
(0.9)
127
(18.4)
Dicle University
M
T
(n=1185)
(n=1877)
N
(%)
N
(%)
248
(20.9)
406
(21.6)
446
(37.6)
740
(39.4)
24
(2.0)
30
(1.6)
224
(18.9)
351
(18.7)
Induced abortion
Marriage
The affair should be ended
Pregnancy should be
continued in any case.
It depends on the situation
40
(3.7)
31
(4.3)
71
(4.0)
14
(2.0)
14
(1.2)
and conditions of the affair
Induced abortion if it is
5
(0.5)
3
(0.4)
8
(0.4)
4
(0.6)
3
(0.3)
suitable
The woman should be
1
(0.1)
1
(0.1)
2
(0.1)
3
(0.4)
2
(0.2)
punished
Precautions should be taken
6
(0.6)
1
(0.1)
7
(0.4)
2
(0.3)
6
(0.9)
not to become pregnant
Not morally correct to
(-)
1
(0.1)
1
(0.1)
(-)
2
(0.2)
become pregnant before
marriage
I don’t know
6
(0.6)
9
(1.3)
15
(0.8)
1
(0.1)
9
(0.8)
Other**
7
(0.7)
7
(1.0)
14
(0.8)
0.0-)
5
(0.4)
* Multiple choices are specified, and percentages are calculated over n.
**“The mother should decide”, “I disappear”, “nothing if partners had sex with their own consent”, “to apply to professionals”.
51
28
(1.5)
7
(0.4)
5
(0.3)
8
(0.4)
2
(0.1)
10
5
(0.5)
(0.3)
Although it is very few in number, there are students in both universities who think “the woman
should be punished”. Another opinion is “it is not morally correct to become pregnant before
marriage” which is specified by one student in Hacettepe University, and 2 students in Dicle
University. The idea of punishment may have extreme results such as “honor killings”. Therefore, regardless of the low number-the specification of “the woman should be punished” category by
university students is considered as a significant striking finding for this study.
Students/their partners’ pregnancy experience is also asked in this study. It is ascertained that 5% of
Hacettepe’s students and 6% of Dicle’s students have previous pregnancy experience. 3% of female students
at Hacettepe University and 4% of female students at Dicle University; 8% of male students’ partners in both
universities report pregnancy experience (Table 38).
Table 38. Percent Distribution of Students/Their Partners’ Pregnancy Experience by Sex (HU, DU,
May 2001)
Hacettepe University
Dicle University
M
T
F
M
T
N
(%)
N
(%)
N
(%)
N
(%)
N
(%)
N
(%)
Yes
25
(2.5)
50
(7.7)
75
(4.5)
21
(4.0)
63
(7.5)
84
(6.1)
No
964
(96.8)
597
(91.7) 1561 (94.7)
486
(94.4)
764
(90.5) 1250 (91.9)
No partner
6
(0.6)
4
(0.6)
10
(0.7)
8
(1.6)
10
(1.2)
18
(1.4)
I don’t know
1
(0.1)
(0.0)
1
(0.1)
(0.0)
7
(0.8)
7
(0.6)
Total*
996 (100.0) 651 (100.0) 1647 (100.0) 515 (100.0) 844 (100.0) 1359 (100.0)
* 142 students at Hacettepe University, and 518 students at Dicle University did not specify whether they have had pregnancy experience or not.
Pregnancy Experience
F
The students with pregnancy experience are also asked about the termination ways of their
pregnancy. 59% of 44 Hacettepe’s students with pregnancy experience; and 48% of 34 Dicle’s
students with pregnancy experience specify the category “I and my partner went together to have an
induced abortion”. 2 female students in both universities stated “had induced abortion” whereas 7%
of Hacettepe students specify the category “A girl friend of mine accompanied me while going to
have induced abortion”. 17% of female students with pregnancy experience at Hacettepe University
and 50% of female students with pregnancy experience at Dicle University specify that they “got
married, and continued pregnancy”. 6% of female students and 4% of male students at Hacettepe
University; and 25% of male students at Dicle University specify that they or their partners
“continued pregnancy without getting married” (Table 39). It is contradictory that almost half of
Dicle students, who specify “marriage” in case of unwanted pregnancy, specify that they had
induced abortion.
Table 39. Percent Distribution of Ways of Termination of Pregnancy among Students by Sex (HU,
DU, May 2001)
Way of termination
N
2
6
Hacettepe University
M
(%)
N
(%)
N
(11.1)
(0.0)
2
(33.5)
20
(77.0) 26
F
T
(%
(4.5
(59.1)
N
2
3
Had induced abortion
I and my partner went
together to have induced
abortion
A girl friend of mine
1
(5.5)
2
(7.7)
3
(6.8)
accompanied me while going
to have induced abortion
Got married, and continued
3
(16.8)
2
(7.7)
5
(11.4)
5
pregnancy
Continued pregnancy
1
(5.5)
1
(3.8)
2
(4.5)
without getting married
Other
5
(27.6)
1
(3.8)
6
(13.7)
Total*
18*
26**
44
10***
* 6 students did not specify the way of termination although they specified that they had experience.
** 24 students did not specify the way of termination although they specified that they had experience.
*** 11 students did not specify the way of termination although they specified that they had experience.
****39 students did not specify the way of termination although they specified that they had experience.
52
F
(%)
(20.0)
(30.0)
Dicle University
M
N
(%)
(-)
13
(54.2)
N
2
16
T
(%)
(5.9)
(47.5)
(0.0)
-
(0.0)
-
(0.0)
(50.0)
4
(16.6)
9
(26.5)
(0.0)
6
(25.1)
6
(17.6)
(0.0)
1
24****
(4.1)
1
34
(2.9)
The students’ thoughts are asked on “Whose responsibility is protection from pregnancy?”.
When the ideas specified by students are examined, it is found that the majority of students in
both universities (90% at Hacettepe University; 81% at Dicle University) think that “both woman
and man are responsible”. More male students in both universities think that “only man is
responsible” and “only woman is responsible” compared to female students. The percentage of
male students at Dicle University (11%) who think that “only woman is responsible for
protection from pregnancy”, is higher than male students at Hacettepe University (Table 40).
Table 40. Percent Distribution of Ideas on the Responsibility of Protection from Pregnancy by Sex.
(HU, DU, May 2001)
Responsibility of
Hacettepe University
Dicle University
protection from
F
M
T
F
M
T
Pregnancy
N
(%)
N
(%)
N
(%)
N
(%)
N
(%)
N
(%)
Man
19
(2.0)
28
(4.3)
47
(2.8)
24
(4.4)
50
(5.6)
74
(5.1)
Woman
18
(1.7)
26
(3.9)
44
(2.6)
15
(2.8)
99
(11.1) 114
(7.9)
Both of them
936 (91.9) 574 (87.5) 1510 (90.2) 472 (85.0) 691 (78.1) 1163 (80.7)
One of them/No matter
44
(4.3)
28
(4.3)
72
(4.3)
43
(7.8)
47
(5.2)
90
(6.3)
No need to be protected
1
(0.1)
(0.0)
1
(0.1)
(0.0)
(0.0)
(0.0)
Total*
1018 (100.0) 656 (100.0) 1674 (100.0) 554 (100.0) 887 (100.0) 1441 (100.0)
* 142 students in Hacettepe University and 436 students in Dicle University did not specify who should be responsible for protection from
pregnancy.
The students’ thoughts are also asked on “Whose responsibility is protection from STIs?”. When
the ideas specified by students are examined, it is found that the majority of students in both
universities (94% at Hacettepe University; 87% at Dicle University) think that “both woman and
man are responsible”. Although female and male students with similar percentages (2%) think
that “only man is responsible”, 5% of female students and 4% of male students at Dicle
University think that protection from STIs is only man’s responsibility (Table 41).
Table 41. Percent Distribution of Ideas on the Responsibility of Protection from STIs by Sex. (HU,
DU, May 2001)
Hacettepe University
Dicle University
Responsibility of
Protection from
F
M
T
F
M
T
STI
N
(%)
N
(%)
N
(%)
N
(%)
N
(%)
N
(%)
Man
21
(2.0)
18
(2.7)
39
(2.3)
26
(4.7)
34
(3.7)
60
(4.3)
Woman
4
(0.5)
7
(1.5)
11
(0.6)
7
(1.2)
35
(3.9)
42
(2.8)
Both of them
977 (95.0) 614 (92.2) 1591 (94.0) 501 (89.7) 771 (86.1) 1272 (87.3)
One of them/No matter
25
(2.4)
24
(3.6)
49
(3.0)
24
(4.4)
55
(6.3)
79
(5.6)
No certain idea
1
(0.1)
(0.0)
1
(0.1)
(0.0)
(0.0)
(0.0)
Total*
1028 (100.0) 663 (100.0) 1691 (100.0) 558 (100.0) 895 (100.0) 1453 (100.0)
* 98 students at Hacettepe University and 424 students at Dicle University did not specify who should be responsible of protection from STIs.
When it is asked, “Whose responsibility is protection?” during focus group discussions, both
female and male students reply that both of the partners’ in principle. But, they also state that in
practice, usually women carry the responsibility although the protection by men is easier and less
“harmful”.
“Both partners should think in my opinion, but actually women are protected more.” (Hacettepe, F.)
“Two persons have sex. So, both of them will face the results, and take precautions together” (M, Ankara)
“I think both partners. Probably male methods are easier to use, but women are protected in general. “ (Dicle,
F.)
53
Students are asked to specify the definition of sexual violence behaviors. The first behavior
specified by students in both universities is “rape” (89% at Hacettepe University; 68% at Dicle
University). “Battering during sexual intercourse” is specified in the second order (79% at
Hacettepe University; 52% at Dicle University) while the third one is “Sexual harassment by
hand, with eyes or in words” in Hacettepe University; and “Having sexual intercourse without the
consent of one of the partners in marriage or dating” in Dicle University. “Emotional pressure
for having sex” is also specified in Hacettepe University. The ordering of sexual violence
behaviors is similar for female and male students although the percentages of female students in
both universities are higher (Table 42)
Table 42. Percent Distribution of Students’ Definitions of Sexual Violence Behavior by Sex (HU,
DU, May 2001)*
Sexual Violence
Behavior
Sexual harassment by
hand, eyes or words
Having sexual intercourse
without the consent of
one of the partners in
marriage or dating
Rape
Emotional pressure for
having sex
Battering during sexual
intercourse
Other**
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
N
(%)
N
(%)
N
(%)
597 (55.7) 374 (52.1) 971 (54.3)
F
(n=692)
N
(%)
254 (36.7)
Dicle University
M
T
(n=1185)
(n=1877)
N
(%)
N
(%)
398 (33.6) 632 (33.7)
421
(39.3)
210
(29.2)
631
(35.3)
247
(35.7)
402
(33.9)
649
(34.6)
973
419
(90.8)
(39.1)
620
184
(86.4)
(25.6)
1593
603
(89.0)
(33.7)
504
186
(72.8)
(26.9)
764
219
(64.5)
(18.5)
1268
405
(67.6)
(21.6)
893
(83.4)
516
(71.9)
1409
(78.8)
413
(59.7)
558
(47.1)
971
(51.7)
1
(0.1)
4
(0.6)
5
(0.3)
-
(0.0)
6
(0.5)
6
(0.3)
* Multiple choices are specified, and percentages are calculated over n.
** “Sadho-mazhoist, deviant behaviors”, “any behavior that one of the partners do not like in sexual intercourse”
It is understood that sexual violence is primarily perceived with its physical dimension by both
female and male students although the emotional dimension is thought with lower percentages. It
is typical that the emotional pressure is specified by female students as a form of sexual violence
with higher percentages in both universities.
In focus groups, it is discussed that violence is exposed by men in all groups. Principally, each
participant is against violence. Sexual violence directly reminds rape to young men whereas young
women talk about a wider range of behaviors while talking about sexual violence. The
participants’ definitions and ideas on sexual violence are as follows;
“Rape I mean…by the men…I’m absolutely against” (Hacettepe, M)
“Women have nowhere to go when they are raped. For instance, I know people who were kidnapped and raped by their
husband, and had to marry them later” (Hacettepe, F)
“Rape of course. I don’t know how girls feel, but it should be a nightmare. It must be a psychological disaster. Maybe their
life**** since they lose their virginity. Maybe the person whom she loves will blame her. I can’t imagine...” (Dicle, M)
“ I had a friend. He never used physical violence, but he spoke with the girl and emotionally forced her to have sex. He said “
if we don’t have sex we should broke up then” (Hacettepe, M)
“Having sex without our consent or if we have consent, in a way that we don’t like. I mean, by force” (Hacettepe, M)
“I mean woman doesn’t want, but man does. It is violence if he enforces her to do this.” (Dicle, F)
54
“Not only rape, but also between married couples. If one of the partners doesn’t want...if one partner get satisfied ,but the
other one doesn’t. It is also violence.” (Dicle, M)
“Think about a married couple. It is violence if the husband forced her to make sexual things that she doesn’t like for his
own satisfaction. Socially, if you’re verbally harassed on the street, being touched at the bus…by men I mean.” (Hacettepe,
F)
“Do you see the street fashion shows? There are models there. Men watch them. A man on TV says that they are not
sexually satisfied, and watch those models. They expect to be satisfied by a breast or a leg. And it is not seen as a sexual
harassment by people.” (Hacettepe, F)
“Rape is only one form. What about harassment? By men. We are seen as sexual objects. For instance, girls living
in dorms in Diyarbakır, if they are accompanied by their boy friends to the dorms, they are seen as “bad” girls as
if they are...” (Dicle, F)
4. EXPECTATIONS
OF
THE
RESEARCH
SEXUAL/REPRODUCTIVE HEALTH SERVICES
GROUP
ABOUT
Students’ thoughts on the ideal places where sexual/reproductive health services should be
provided are as follows: The most frequently specified place in both universities is “school” (66%
at Hacettepe University; 47% at Dicle University). The second place is “medico-social centers of
universities” (60% at Hacettepe University; 42% at Dicle University). Students may mean
universities they currently attend by “school”. The third place is “specific consultancy centers”
(44% at Hacettepe University; 29% at Dicle University) where students think that
sexual/reproductive health services should be provided (Table 43).
“Hospitals” and “health centers” are specified with lowest percentages as ideal service institutions
in both universities. The ordering of female and male students in Hacettepe University is similar
whereas the first place specified by male students is “school”, and by female students is “medicosocial centers of universities” in Dicle University. It is understood that students prefer
universities and related centers as the ideal sexual/reproductive health service institutions (Table
43).
Table 43. Percent Distribution of Students’ Opinion on “Where Should Sexual/Reproductive Health
Services Specific to Young People be Provided?” by Sex (HU, DU, May 2001)*
Ideas
Hospitals
Health Centers
Medico-Social Centers of
Universities
Schools
Specific Consultancy
Centers
Other**
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
N
(%)
N
(%)
N
(%)
406 (37.9) 206 (28.7) 612 (34.2)
223 (20.8) 131 (18.2) 354 (19.8)
664 (62.0) 413 (57.5) 1077 (60.2)
F
(n=692)
N
(%)
185 (26.7)
98
(14.2)
345 (49.9)
Dicle University
M
(n=1185)
N
(%)
265 (22.4)
134 (11.3)
434 (36.6)
709
510
(66.2)
(47.6)
475
270
(66.2)
(37.6)
1184
780
(66.2)
(43.6)
317
208
(45.8)
(30.1)
563
334
(47.5)
(28.2)
882
542
(47.0)
(28.9)
11
(1.0)
14
(1.9)
25
(1.4)
7
(1.0)
16
(1.4)
23
(1.2)
T
(n=1877)
N
(%)
430 (22.9)
232 (12.4)
779 (41.5)
* Multiple choices are specified, and percentages are calculated over n.
** “Wherever it is possible”, “ media, communication media, magazines, internet”, “no need for these services”
Students’ thoughts on the qualifications of sexual/reproductive health services specific to young
people are asked. The most frequently specified qualification is “It should include both the
consultancy and curative services” in both universities (77% at Hacettepe University; 51% at
Dicle University). The second qualification is “there should be easy access to these services”
(63% at Hacettepe University; 40% at Dicle University). The third one is applications and the
55
spoken problems should be kept confidential (59% at Hacettepe University; 37% at Dicle
University). The fourth one is “Services should be provided to both individuals and groups”
(44% at Hacettepe University; 29% at Dicle University). The idea that “Female professionals
should provide services to young women, male professionals should provide services to young
men” specified by Dicle students with the percentage of 25% while it is specified with the
percentage of 23% at Hacettepe University. Female and male students specify the category
related to the gender of the service providers with similar percentages (Table 44).
Similar thoughts are expressed by students on the sexual/reproductive health services in focus
group discussions. Confidentiality seems to be the first expectation of students concerning the
services.
“First of all, it is important to speak with a competent professional there. I must trust on her/him” (Hacettepe,
M)
“It is necessary to feel confident with the professional. She/he should be serious, and give true and clear replies to
your questions.” (Hacettepe, F)
“ We must trust on the person who will provide service to us. Moreover, nobody must learn what we speak.”
(Dicle, F)
“Personal interviews with the couples is necessary. Nobody will know that we go there. “ (Dicle, F)
As it is understood the main issue for young people in receiving sexual/reproductive health
services is their anxiety about being known by others. They do not want others to learn that they
receive sexual/reproductive health services; they are sexually active. So, confidentiality is very
important for them. It is important to consider “confidentiality” as a crucial component of
sexual/reproductive health services.
Table 44. Percent Distribution of Students’ Opinions on the Expected Qualifications of
Sexual/Reproductive Health Services Specific to Young People by Sex (HU, DU, May 2001)*
Qualifications
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
N
(%)
N
(%)
N
(%)
637
(59.5)
419
(58.4) 1056 (59.0)
Applications and the spoken
problems should be kept
hidden
It should include both the 865
(80.8)
503
(70.1) 1368 (76.5)
consultancy and curative
services
There should be easy access 694
(64.8)
431
(60.0) 1125 (62.9)
to these services
Services should be provided 484
(45.2)
302
(42.1)
786
(43.9)
to both individuals and
groups
Female professionals should 249
(23.2)
168
(23.4)
417
(23.3)
provide services to young
women, male professionals
should provide services to
young men
Promotion of the services 458
(42.8)
290
(40.4)
748
(41.8)
should be made in the places
where young people usually
go
Other**
4
(0.4)
3
(0.4)
7
(0.4)
* Multiple choices are specified, and percentages are calculated over n.
** “Sex based approached”, “It should be told that these services are necessary and natural”.
56
F
(n=692)
N
(%)
259
(37.4)
Dicle University
M
T
(n=1185)
(n=1877)
N
(%)
N
(%)
432
(36.5)
691
(36.8)
396
(57.2)
552
(46.6)
948
(50.5)
301
(43.5)
452
(38.1)
753
(40.1)
234
(33.8)
340
(28.7)
547
(29.1)
161
(23.3)
298
(25.1)
459
(24.5)
143
(20.7)
238
(20.1)
381
(20.3)
-
(-)
2
(0.2)
2
(0.1)
Students’ thoughts on the qualifications of service providers are also examined. The first
qualification expressed in both universities is “they should be well-qualified professionals
(physician, psychologist, and social worker, etc.)” (87% at Hacettepe University; 66% at Dicle
University). The second qualification expressed by students is “they should have a friendly
relationship with young people rather than a traditional physician-patient one” (75% at Hacettepe
University; 63% at Dicle University). The third one is “they should be sensitive and
unprejudiced.” (69% at Hacettepe University; 44% at Dicle University). The fourth qualification
specified by students in both universities is “they should be trustful” (69% at Hacettepe
University; 40% at Dicle University). These qualifications which students think service providers
of sexual/reproductive health must have are stated by Hacettepe students with higher percent
compared to Dicle students. (Table 45).
Table 45. Distribution of Thoughts of Students on the Qualifications of Service Providers by Sex
(HU, DU, May 2001)*
Qualifications of service
providers*
They should be wellqualified professionals
(physician, psychologist, and
social worker, etc.)
They should be sensitive and
unprejudiced.
They should be young
They should be trustful
They should have a friendly
relationship with young
people rather
than a traditional physicianpatient one.
Hacettepe University
F
M
T
(n=1071)
(n=718)
(n=1789)
F
(n=692)
Dicle University
M
(n=1185)
T
(n=1877)
N
956
(%)
(89.3)
N
594
(%)
(82.7)
N
1550
(%)
(86.6)
N
496
(%)
(71.7)
N
747
(%)
(63.0)
N
1243
(%)
(66.2)
757
(70.7)
479
(66.7)
1236
(69.1)
345
(49.9)
489
(41.3)
834
(44.4)
78
768
821
(7.3)
(71.7)
(76.7)
111
458
515
(15.5)
(63.8)
(71.7)
189
1226
1336
(10.6)
(68.5)
(74.7)
28
311
491
(4.0)
(44.9)
(71.0)
108
434
689
(9.1)
(36.6)
(58.1)
136
745
1180
(7.2)
(39.7)
(62.9)
8
(0.4)
2
(0.3)
1
(0.1)
3
(0.2)
Other**
1
(0.1)
7
(1.0)
* Multiple choices are specified, and percentages are calculated over n.
** “It is enough if they have knowledge and experience”.
Similar expressions are found in focus group discussions on the qualifications of
sexual/reproductive health service providers. Participants think that the service provider should
be competent professionals. It is emphasized that these professionals are not necessarily expected
to be physicians.
“Those service providers should be specialist in that area. Not necessarily physician, but should be competent on the issue, and
know how to listen to you.” (Hacettepe, F)
“Physician, psychologist who knows the sexual/reproductive health issues well and is able to understand the
problems of young” (Dicle, M)
The second important point expressed by students is their expectation of service providers who
understand, and do not judge them. Therefore, they prefer service providers of young ages.
“Her/his age must be close to ours. It is difficult for an old professional to understand the psychology of young
people.” (Dicle, M)
“We will have wrong opinions of course. At that time this service provider should behave in a positive way instead
of saying “this is wrong!”. He must be friendly enough to motivate us to ask further questions” (Dicle, F)
“ Counselors in such a center must not be prejudiced. They should have a flexible style to make us tell everything
comfortably.” (Hacettepe, F)
57
“Young professionals should work in those centers. You know physicians are so cool. Instead we need professionals
who want to help us without judging.” (Hacettepe, F)
Another focus of the discussions on the qualifications of service providers is the relationship
between the service provider and the young people. Students prefer to make a friendly
conservation instead of traditional physician-patient relationship in which they feel themselves
unconfident and weak. They think that they will express themselves better on this sensitive issue
in such a friendly atmosphere.
“I don’t like a professional who asks “what is your problem?” and writes a recipe. She/he must be a person who
listens to me and answers my questions.” (Dicle, F)
“Nobody will apply to those centers if there is a physician-patient relationship. I am here and the physician is there
far away from me. There must be less distance, more friendly atmosphere to motivate me to go there, and get
consultancy.” (Hacettepe, F)
Another point emphasized during focus group discussions is that if they apply to service provider
with very personal/private problems, the service must be provided by male service providers to
male students whereas female students must receive services by female service providers. They
think that it will be easier for them to tell their problems if the service provider is from the same
gender.
“I would like to speak with a male service provider in order to tell comfortably.” (Dicle, M)
“You should have the choice to prefer a male or female personnel. I don’t like to speak with a female service
provider for instance.”(Hacettepe, M)
In addition to students’ thoughts, service providers have detailed and various ideas on the quality
of sexual/reproductive health services specific to young people. According to the interviewed
service providers, the most important quality of an ideal service is “well-trained, competent, eager
personnel”. The answers can be categorized into three; the first category is about the quality of
service provider. The service provider should be well educated, competent, equipped with
complete and true knowledge, who follows the improvements in the field of sexual/reproductive
health.
The second category is about the quality of the unit where the sexual/reproductive health
services are provided. This unit is expected to be well equipped, hygienic, accessible, working
with appointment system, with sufficient financial resources where free and continuous services
are available with the administration of the university for young people.
The third category is about the qualities of the service itself. According to the interviewees, the
sexual/reproductive health services specific to young people should include parents’ training,
should be interdisciplinary, confidential, sensitive to privacy, open to new developments,
sensitive to social values, flexible, and valid with easy procedure to utilize. According to the
interviewed service providers, the services should also be able to utilize the peer trainers, the
media and community leaders.
The qualifications stated by the service providers are similar with the students’ ideas searched in
other phases of this study, and may guide the planning of specific sexual/reproductive health
services for adolescents/young people.
58
THOUGHTS/OPINIONS
AND RECOMMENDATIONS
OF
SERVICE PROVIDERS
59
THOUGHTS/OPINIONS AND RECOMMENDATIONS
OF SERVICE PROVIDERS
ON THE SEXUAL/REPRODUCTIVE HEALTH OF YOUNG PEOPLE
One of the phases of the “Influential Factors on the Sexual/Reproductive Health of Young
People” project carried out collaboratively by Hacettepe University Public Health Department
and World Health Organization is the interviews with the service providers. This phase was
planned to make further interpretations with the contribution of the experience, observation,
thoughts, and recommendations of the professionals. The interviews were made with the service
providers from Hacettepe and Dicle Universities from whom the young people receive services
frequently in several units.
A semi-structured interview form was designed to be used for the interviews with the service
providers. The form is composed of 35 questions including the personal information, the types
of the provided services, thoughts/opinions, experiences, and recommendations about
sexual/reproductive health.
After the design of the questionnaire was completed, the managers of the Medico-Social Centers,
where the services are provided for especially young people, were contacted in order to arrange
the appointments in a way that the services would not be delayed.
The duration of the interviews takes approximately 45 minutes although personal factors affect
the duration. Totally 45 service providers were interviewed. 23 of them were from Diyarbakir,
and 22 of them were from Ankara. The interviewees were selected among the professionals,
whom young people most frequently apply, receive counseling and currative services. Since the
Medico-Social centers of Hacettepe University were more equipped, the applicants are less sent
to other polyclinics. Therefore, in Ankara, mostly the service providers working at Hacettepe
Medico-Social Centers were interviewed whereas mostly the specialists working in other units
were interviewed in Diyarbakır. The professionals, with whom interviews were conducted, were
composed of the specialists of obstetrics and gynaecology, urology, psychiatry, psychology, and
nurses.
The interviews were conducted, and the analysis of the data was made by two social scientists
who have been working in each phase since the beginning this research project. The collected
data was processed and analyzed using SPSS 10.00 and the detailed findings are presented in the
next section.
60
FINDINGS AND DISCUSSION
Table 1. Age Distribution of Interviewed Service Providers (HU, DU, May 2002)
Age
25-29
30-34
35-39
40-44
<45
Total
N
%
5
8
10
15
7
45
11.1
17.8
22.2
33.3
15.6
100.0
When the age distribution of the service providers are examined, it is seen that 33.3% of them is
in the age group of 40-45 whereas 22.2% of them is in the age group of 35-39. The age
distribution shows that more than half of the service providers (55.8%) are in the middle and
higher ages. There are also 5 interviewees (11.1%) from 25-29-age group, and 7 interviewees
from 45 years and over. As it is understood from the percentages, the thoughts of service
providers from several age groups are asked. However, age is not a criterion for selection. Rather,
the direct and indirect service provision for young people is taken as a criterion for selection.
Table 2. Sex Distribution of Interviewed Service Providers (HU, DU, May 2002)
Sex
Female
Male
Total
N
%
24
21
45
53.3
46.7
100.0
The service providers, who are interviewed, are composed of 53.3% female and 46.7% male
professionals. Sex is not a criterion for selection either. But equal number of female and male
professionals is interviewed. The total number of the interviewees is not sufficient to assess the
differences based on sex. As it will be seen in other findings, female and male interviewees do not
have very different expressions and approaches based on their sex differences. However, this
report shows the ideas of equal number of female and male professionals.
Table 3. Percent Distribution of Marital Status of Interviewed Service Providers (HU, DU, May
2002)
Marital Status
Married
Single, living with family
Single, living alone
Divorced
Widow
Total
N
%
36
4
2
2
1
45
80.0
8.9
4.4
4.4
2.3
100.0
As Table 3 shows, 80% of the interviewed service providers are married. 2 persons (4.4%) are
divorced. 8.9% of them is single, and live together with their family whereas 4.4% is single and
lives alone.
61
Table 4. Percent Distribution of Interviewed Service Providers by Having Children. (HU, DU,
May 2002)
Having Child
Yes
No
Total
No of Children
1
2
Total
N
%
34
11
45
75.6
24.4
100.0
17
17
34
50.0
50.0
100.0
The number of children they have are asked to the interviewees in order to understand the
influence of being parents in addition to being service providers on their thoughts,
recommendations, and expectations. 34 (75.6%) of the married service providers have children.
The number of children within the families changes due to regions, rural-urban, and educational
level in Turkey. However, no difference seems in the number of children between the service
providers working in Hacettepe University and Dicle University. The number of children changes
between 1 and 2 in both universities. This finding shows the close relationship between the
educational level and number of children. As it is seen in other studies, the number of children
decreases as the educational level increases.
Table 5. Percent Distribution of Interviewed Service Providers by the Last Attended School (HU,
DU, May 2002)
The Last Attended School
High school/Occupational High School
Two-year Higher Schools
University
Graduate Study
Ph.D.
Degree of Specialist after B.Sc. in Medicine
Total
N
%
4
3
11
2
5
20
45
8.9
6.7
24.4
4.4
11.1
44.4
100.0
Table 4 shows that almost half of the service providers (44.4%) have a degree of specialist after
their Bachelor of Science degree in Medicine. The lowest level is occupational high-schools
(8.9%). The university graduates constitutes the 24.4% of the group. 4.4% has MA degree
whereas 11.1% has Ph.D.
Table 6. Percent Distribution of Interviewed Service Providers by Occupation (HU, DU, May
2002)
Occupation
Nurse/Midwife
General Practitioner
Gynaecologist
Urologist
Psychiatrist
Psychologist
Public Health Specialist
Internist
Family Physician
Social Worker
Total
62
N
%
11
6
5
5
5
5
4
2
1
1
45
24.1
15.3
11.1
11.1
11.1
11.1
8.9
4.1
2.1
2.1
100.0
The most important assistant service providers are nurses and midwives in Turkey. The
professionals who are first met in a health unit, and who guide the applicants are nurses and
midwives. Therefore, it is thought that their ideas and recommendations will contribute to the
findings of this study, and 11(24.1%) nurses and midwives were interviewed. The numbers of
interviewed urologists, gynaecologists, psychiatrists, and psychologists are equal. 4 (8.9%) public
health specialists who provide preventive services were also interviewed.
Table 7. Percent Distribution of Work Duration of Interviewed Service Providers (HU, DU, May
2002)
Work Duration (Year)
1-5
6-10
11-15
16-20
21-25
25+
Total
N
%
15
8
8
6
3
5
45
33.3
17.8
17.8
13.3
6.7
11.1
100.0
More than two third of the interviewees have been working more than 5 years; 17.8% of them
have been working between 6-10 years, 17.8% of them between 11-15 years, 13.3% of them
between 16-20 years, 6.7% of them between 21-25 years, and 11.1% of them have been working
more than 25 years. On the other hand, 33.3% of them have been working less than 5 years.
As it is seen in Table 7, more than half of the interviewed service providers have been working
more than 5 years. It is possible to make various interpretations on the relationship between
work duration and the quality of work. Although longer duration may increase the experience, it
may also reduce the motivation. Medicine is an area where a continuous development in
knowledge, technology, method, and approaches is needed. Therefore, the longer work duration
may make it difficult to follow this development process. Considering the insufficient number of
in service training and control system over the level of knowledge in Turkey, it may be concluded
that longer work duration do not always mean better service provision.
Table 8. Percent Distribution of Service Provided By Interviewed Providers (HU, DU, May 2002)
Provided Services (n=71) *
Diagnosis, treatment, and referral in the area of their specialization
Counseling (Family Planning and Psychological)
Administrative duties
*
N
%
33
32
6
46.5
45.0
8.5
One person expresses multiple services.
As Table 8 shows, the interviewees define a range of services that they provide within the limits
of their area of specialization (46.5%). “Area of specialization” includes the responsibility of the
patients in the service, surgical operation, the services provided in menopause and infertility
clinics, and family planning service for gynaecologists. Similarly, it includes clinical, poly-clinical,
surgical operations, and shifting services for urologists.
The provided services include examination, consultancy, and sometimes training for general
practitioners. The services provided by public health specialists include poly-clinical service,
preventive health services, training, consultancy, provision of information and guidance on
sexually transmitted infections. On the other hand, the physicians and nurses working in MotherChild Health/Family Planning Centers provide services such as provision of information on
pregnancy, hygiene, and contraceptive methods while psychologists working in several units
provide psychological consultancy services for young people.
63
“Administrative duties” include the duties implemented in addition to the health care services by
the interviewees. Bureaucratic procedure, meetings, duties related to the organization of the
personnel necessary to be carried on within the units are also included in the responsibilities of
the service providers.
Table 9. Percent Distribution of Interviewed Service Providers by Their Status of Having
Training Specific to Young People (HU, DU, May 2002)
Status of Having Specific Training
No
Yes
Total
N
%
32
13
45
71.1
28.9
100.0
The service providers are also asked about their in service training background specific for
adolescents, the characteristics of adolescent age, the physical and psychological changes specific
to the age. Table 9 shows that 71.1% of the interviewees do not have such training. Among the
ones, who state that they have training (28.9%), only one of them expresses the name and time of
the training. Others express that adolescent age is an important part of their education, and they
have sufficient knowledge on this age. When extra training specific to adolescent age is asked
again, they say that the congresses that they attended during the last years included specific
sections on adolescents and young people, which they followed.
Following this question, the interviewees are asked whether their existing knowledge is sufficient
to provide services to young people in their opinion.
Table 10. Percent Distribution of Interviewed Service Providers’ Evaluation of Sufficiency of
Their Education Specific to Young People (HU, DU, May 2002)
Sufficiency of the Education
No
Yes
Partially sufficient, necessary to support by new knowledge
Total
N
%
26
15
4
44
57.8
33.3
8.9
100.0
Table 10 shows that 57.3% of the interviewed service providers do not find their education and
knowledge sufficient to provide services to young people whereas 33.3% of them find it
sufficient.
It is noteworthy that the service providers are aware of their insufficiency, and clearly express this
situation. This finding is important since it shows the first step to be taken for the improvement
of the services. That is provision of training to service providers specific to adolescents and
young people. Their own expressions may be taken as a sign that shows that they will be willing
to participate in such training.
The services provided specific to young people that are expressed by the interviewed service
providers are listed in the table below.
64
Table 11. Percent Distribution of Services Specific To Young People Provided by Interviewed
Service Providers (HU, DU, May 2002)
Provided service Specific To Young People (n=93) *
Polyclinical & Clinical Services
Consultancy (Sexual Reproductive Health and Psychological)
No specific service, what is demanded in their application
*
One person specifies multiple services.
N
37
35
21
%
39.8
37.6
22.6
The answers show that 39.8% of the services provided to young people are routine poly-clinical
and clinical services specific to their physical problems. 21 interviewees (22.6%) state that no
services specific to young people are provided.
On the other hand, 37.6% of the interviewed service providers express that services specific to
young people including sexual/reproductive health and psychological consultancy, guidance,
information provision are provided.
The interviewees, who state that they provide services of consultancy and guidance in family
planning (except Mother-Child Health/Family Planning staff), emphasize that these services are
not a part of the program in their units, but they necessitate to provide these services by their
own initiative.
These expressions show that the provided services are not comprehensive enough to address the
needs of young people in terms of sexual/reproductive health. As it will be seen in Table 12,
most of the service providers define the services provided for young people as “insufficient”.
Table 12. Percent Distribution of Interviewed Service Providers’ Evaluation of Sufficiency of The
Services Specific to Young People (HU, DU, May 2002)
Sufficiency of the services
Totally sufficient
Sufficient
Partially sufficient
Insufficient
Totally insufficient
Total
N
%
1
7
14
21
2
45
2.2
15.5
31.1
46.8
4.4
100.0
When the interviewees are asked to define the level of sufficiency of the services specific to
young people, 46.8% of them define the services as “insufficient” while 31.1% of them define as
“partially sufficient”. 7 persons (15.5%) find the services “sufficient”. It seems that half of the
interviewed service providers assess the services “insufficient”. Their assessment shows that the
service providers are objective enough to see and express the existing problems in the provision
of the services specific to young people.
Table 13. Percent Distribution of Young People’s Reasons for Application According to
Interviewed Service Providers (HU, DU, May 2002)
Reasons for Application (n=133) *
Several Infections
Receiving Psychological Support
Receiving Information on the Anatomy and Physiology of Sexual/Reproductive Organs
Receiving Family Planning Services
Psycho-somatic problems
Receiving information on hymen and virginity
*
One person expresses multiple reasons.
65
N
%
34
30
23
23
12
10
25.8
22.8
17.4
17.4
9.0
7.6
The interviewed service providers are also asked about the reasons of young people’s applications
to the units where they provide services. The reasons differentiate by the area of specialization
and the unit that is applied. Several infections including upper respiratory system infections,
gastro-intestinal system infections, fungal infections come first (25.8%) among the reasons of
application. The applications made to receive psychological support follow the infections
(22.8%). Psychological support services include the problems such as adaptation to the
atmosphere of the university, the problems caused by being away from the family, anxiety about
the future and the anxiety that is experienced during exam periods. 17.4% of young applicants
come to receive information on family planning methods or sexual/reproductive organs. The
interviewed service providers express that 7.6% of young people apply to receive information on
hymen and virginity.
Table 14. Percent Distribution of Issues Out of Clinical Complaints that Young People Ask for
Information According to Interviewed Service Providers (HU, DU, May 2002)
Issues To Receive Information(N=64) *
Sexual/Reproductive Health-Sexually Transmitted Infections
Psycho-social problems
Things to be done not to get pregnant before marriage
Various infections
Hymen, menstruation
*
One person states multiple issues.
N
21
14
11
8
7
%
33.3
22.2
17.4
12.7
11.2
As Table 14 shows, the primary issues that young people apply to receive information are
sexual/reproductive health and sexually transmitted infections (33.3%). Psycho-social problems
are the second issue (22.2%) about which young people ask for information. Another interesting
issue is the ways of not getting pregnant before marriage (17.4%).
This expression of service providers is similar to findings of focus group discussions in which the
primary issues that come to young people’s mind while talking about sexual/reproductive health
are hymen, virginity, pregnancy, and AIDS.
Table 15. Percent Distribution of Opinions of Interviewed Service Providers on Status of Being
Comfortable of Young People While Talking About Their Complaints (HU, DU, May 2002)
Being Comfortable (n=45)
Yes
Partially/Depends Due to Personal Differences
No
They do not feel comfortable at the beginning, but they become comfortable after they
feel trusty
Married ones are comfortable, non-married ones are uncomfortable
They are uncomfortable while talking about sexuality, harassment, incest
Reasons of Being Comfortable(n=45)
Personal Characteristics (socio-economic, cultural)
The level of education, being university student
The attitude and approach of service providers
Environmental Factors (internet, media)
Reasons of Not Being Comfortable (n=28)
They are not comfortable while talking about sexuality
Family and Social Structure
Personal Reservations
The attitude and approach of service providers
N
%
23
10
8
2
51.1
22.3
17.8
4.4
1
1
2.2
2.2
17
14
10
4
37.9
31.1
22.2
8.8
10
8
6
4
35.8
28.5
21.4
14.3
When the idea of service providers are asked whether young people are comfortable when they
apply to receive services, 23 interviewees (51.1%) state that they are comfortable whereas 8
66
persons (17.8%) express that they are uncomfortable. 22.3% of the interviewed service providers
express that young people are partially comfortable.
Some of the interviewees make detailed explanations. For instance it is expressed that young
people become comfortable after they feel confident although they are not comfortable at the
beginning. Since it is not common to receive services related to sexuality for non-married people,
service providers express that married people feel more comfortable while receiving services.
When the service providers are asked about the reasons of being comfortable, the most
important reason that are stated are personal characteristics (37.9%) such as socio-economic level
of the families, and the place of residence. Another reason expressed by service providers is the
high level of education (31.1%). Since they are university students, they feel more comfortable in
receiving services of sexual/reproductive health.
The attitudes and approaches of service providers (22.2%) is another important reason according
to interviewees. The personality of the service provider, the type of the place where the service is
provided, the quality of relationship between the young person and the service provider, and the
program of the unit are determinant factors.
It is better to evaluate the expressions about the reasons of being uncomfortable separately for
Ankara and Diyarbakır. According to the service providers in Diyarbakır, the most important
reason is conservative family and social structure. On the other hand, service providers in Ankara
think that young people feel uncomfortable because it is not common to talk about sexuality and
because of their personal reservations. A parallel situation was observed in focus group
discussions. Students from Ankara talked about sexual/reproductive health as personal attitudes
and values whereas students from Diyarbakır viewed the sexual/reproductive health issues rather
a social phenomena.
When a general evaluation is made, the reasons of being comfortable expressed by service
providers are education, the qualifications of service providers, higher socio-economic level
whereas the reasons of being uncomfortable are that speaking about sexuality is still not
common; families and the society have a conservative attitude towards everything about sexuality
and the personal qualifications of service providers. It seems that young people do not tell their
expectations and the problems related to sexual/reproductive health as comfortable as they tell
their health complaints.
Table 16. Percent Distribution of The Things To Be Done By Young People In The Application
Process To Receive Sexual/Reproductive Health Services (HU, DU, May 2002)
Thing To Be Done (n=18)
They come to the Information Desk, tell their complaints and be guided there
We listen to them, understand the problem and guide them
They are referred by their faculties, and the necessary things are done
They show their student ID, get a card, and see us
I have no idea about the procedure
They come either directly or by the consultation of other units
They see the nurses, and be guided by them
N
%
6
3
3
2
2
1
1
33.2
16.7
16.7
11.1
11.1
5.6
5.6
The application process that the young people pass to see a specialist for receiving
sexual/reproductive health services is asked to the interviewed service providers. According to
the interviewees, most of the young people do not apply to receive specifically
sexual/reproductive health services. They follow the routine application process (32.2%). An
important detail stated by the service providers is that young people do not prefer to express
67
their sexual/reproductive health problems directly. Instead, they apply for other physical
problems and ask their questions during examination.
When the positive and negative aspects of the current application procedure are asked, the
interviewees reply that it is a good procedure under the current conditions (42.8%). On the other
hand, the important negative aspect is referring the applicants to other units due to insufficient
equipment of the medico-social centers (36.3%), and the type of social security (18.1%).
Referring the applicants to other units make it difficult to provide and receive services regularly
and to follow up the patients.
Table 17. Percent Distribution of Opinions of Interviewed Service Providers on Positive and
Negative Aspects of Application Process (HU, DU, May 2002)
Positive Aspects (n=7)
A good process under the current conditions
We have more time in medico-social centers to deal with the young people
We give importance to privacy
Practical, easy
Negative Aspects (n=11)
Insufficient equipment not to refer to other units
Referral process by the type of social security
Physical conditions are not suitable for a medico-social center
No sufficient time is allocated due to great number of applicants
Young people are not used to bureaucratic processes
An information unit composed of physicians and nurses is unavailable
Divison of labor based on specialization is unavailable
N
%
3
2
1
1
42.8
28.6
14.3
14.3
4
2
1
1
1
1
1
36.3
18.1
9.1
9.1
9.1
9.1
9.1
Table 18. Percent Distribution of Opinions of Interviewed Service Providers on The Necessity of
Sexual/Reproductive Health Services Specific To Young Age (HU, DU, May 2002)
Necessity of Specific Sexual/Reproductive Health Service
Yes
No
Total
N
%
45
0
45
100.0
0.0
100.0
All of the interviewed service providers (100%) agree that young people need services specific for
their age group. Following this question, the types of necessary services and issues are asked to
service providers.
Table 19. Percent Distribution of Opinions of Interviewed Service Providers on Issues on Which
Young People Necessitated To Get Information (HU, DU, May 2002)
Issues Necessitated To Get Information (n=126)
The anatomy and physiology of sexual/reproductive organs
The meaning of sexuality
Sexually Transmitted Infections
Everything about Adolescent Age
Sexual Deviance
N
%
39
33
29
4
2
30.9
26.1
23.2
3.1
1.5
According to the interviewees, the most needed information related to sexual/reproductive
health is about anatomy and physiology of sexual/reproductive organs (30.9%). Information on
the definition and content of sexuality (26.1%) is the second necessary issue. Sexually transmitted
infections (23.2%) are also mentioned by the interviewed service providers.
According to the interviewed service providers, the issues, on which young people need to get
information, are as follows:
68




Sexual/reproductive organs, phases of physiological development,
Sexual intercourse, its normal and abnormal limits,
Adolescent age,
Sexually transmitted infections and the protection methods.
Table 20. Percent Distribution of Interviewed Service Providers’ Opinions on Areas of Services
Necessary To Be Provided for Young People (HU, DU, May 2002)
Necessary Areas of Services (n=97) *
Information and training on sexuality, family planning methods, and their body
Specific center where multi-dimensional services are provided
Sufficient and accessible preventive health care and treatment services
The current services is OK, no need for another service
One-type and free service model including all students
Training specific for parents
Clubs established by students themselves
*
One person states multiple services.
N
%
54
28
8
2
2
2
2
55.6
28.8
8.2
2.1
2.1
2.1
2.1
As it is seen in Table 20, the interviewed service providers think that the services that must be
provided for young people are parallel to the issues on which young people needs information.
The main services that should be provided for young people according to interviewees are
information and training on sexuality, family planning methods, adolescent age, sexually
transmitted infections, sexual identity, the meaning of sexuality (55.6%). Specific centers where
multi-dimensional services are provided for young people are the second important services
mentioned by the interviewees (28.8%).
There are also differentiating thoughts on the services. Some of the service providers (2.1%)
think that young people may define and plan the services that they need in their own clubs and
organizations instead of receiving services planned and provided by adults.
Another necessary area of service stated by the interviewed service providers is education.
Training of parents, training of young people for the protection from the infections are the
examples of the mentioned training services. The interviewees emphasize that the services should
be one type and free of charge to be accessed easily.
Table 21. Percent Distribution of Important Matters in Which Service Providers Should Be
Careful During Service Provision (HU, DU, May 2002)
Important Matters in Which Service Providers Should Be Careful (n=138) *
Being respectful to privacy, staying away from the judging statements
Provision of true information
Use of a simple, understandable, and common language
Being sensitive to the socio-cultural structure of the society they work in
Having received medical education at minimum
*
One person states multiple matters
N
%
76
28
22
8
4
55.1
20.3
16.0
5.8
2.8
According to the interviewed service providers, the most important matters are being respectful
to the privacy, staying away from the judging statements, showing pity and respect to the young
people (55.1%). In this context, the service providers, who do not judge the applied young
people, must provide services. The professionals must not have a didactical behavior, and give
the right of choice to the young person.
69
The second important matter is “correct information” (20.3%). The interviewed service providers
emphasize the importance of sexual/reproductive health, and the information on it. A wrong
word or guidance may cause serious effects. Therefore, the service providers must be equipped
with sufficient/correct knowledge.
Another matter stated by the interviewed service providers is the language used during the
provision of the services (16.0%). The language must be simple and clear to make the
communication better.
Kurdish, is the common spoken language in Diyarbakır. Being unable to speak Kurdish may be
an obstacle for the qualified service provision specific to young people in Diyarbakır. Although it
may not cause a trouble for university students, it is necessary to consider the language barrier
while planning services for the young people in the community of the region.
There are service providers who strongly believe that sexual/reproductive health services should
be provided by only health personnel, who have medical education (2.8%). Other staff rather
than physicians are not seen as authorized personnel to provide services by these interviewees.
Table 22. Percent Distribution of the Issues on which Service Providers Need Further Training
(HU, DU, May 2002)
Necessary Issues (n=103) *
Service provider should be authorized on SRH+well-trained+well-equipped
Communication and empathy skills
Skills to be open minded and unprejudiced in sexual/reproductive health issues
Special training for non-medical professionals
*
One person states multiple issues.
N
%
58
39
3
3
56.4
37.8
2.9
2.9
The first stated issue on which the service providers need specific training regarding the
sexual/reproductive health is being authorized on SRH, well educated and well equipped
(56.4%). Communication and empathy skills are the second issues on which service providers
think that they need further training. (37.8%) It is thought that a service provider should know
the characteristics of adolescent age, have good communication skills, able to listen to the
adolescent/young person without any judgment and/or prejudice, and develop her/himself by
trainings.
The non-medical professionals emphasize that medical knowledge itself is not enough to provide
SRH services to youth. It is necessary to have communication skills to have a dialogue with them.
On the other hand, the physicians state that the non-medicals do not have the medical knowledge
on sexual/reproductive health, and are not able to provide services to youth without the support
of a physician. They believe that the non-medical professionals should not provide SRH services
by themselves.
Another important point emphasized by the interviewed service providers is the developments in
the medical knowledge, specifically sexual/reproductive health knowledge, and the changing
approaches. Professionals working in this area should have continued training to be informed on
these developments and changes.
70
Table 23. Percent Distribution of the Influence of Service Providers’ Attitudes on the Decisions of
Youth to Utilize the SRH Services (HU, DU, May 2002)
N
Attitude Influence
Yes, it has influence
Determines rather than influences
Absolutely influences continuity
Total
43
1
1
45
%
95.6
2.2
2.2
100.0
43 of the interviewed service providers state that the attitude of the service providers influence
the decisions of youth to receive SRH services. Although all of the interviewees do believe the
influence of attitudes, one person emphasizes the “determination” rather than influence while
another states that the attitudes influence the continuity.
Interviewees are asked to tell an example case of the attitude influence that they personally
experienced. However, only 2 persons told experiences. These are indirect stories emphasizing
the importance of attitudes on the continuity of service utilization.
Table 24. Percent Distribution of Interviewed Service Providers’ Opinions on Stratas/Regions of
Young Persons Receiving SRH Services (HU, DU, May 2002)
Strata/Region (n=49) *
Everywhere, every geographical region in Turkey
Educated Persons
Science students come more
Urban ones come with more simple complaints while rural ones with more significant complaints
Slum areas, new migrants
Rural areas, villages
Lower income groups
Urban ones come alone while rural ones come with the accompaniment of their family
Urban residents and university students
* One person states multiple staratas/regions
N
%
16
12
5
5
3
3
2
2
1
32.6
24.5
10.2
10.2
6.1
6.1
4.1
4.1
2.0
When the strata and/or region where the young persons receiving SRH services come from are
asked, it is explained that this strata/region category is a general one. The most frequent answer
is everywhere (32.6%). The second one is educated persons (24.5%). Rural-urban differentiation
is a significant finding. Rural applicants usually come with social indications, accompanied by
their family if the case is very significant. A differentiation between the slum areas and more
urbanized areas is also made. It is stated that urban, high-educated young persons apply to SRH
services with simple reasons. Education is also mentioned as a significant determinant.
Table 25. Percent Distribution of Interviewed Service Providers’ Opinions on the Sex Distribution
of Applicant Young Persons for SRH Services (HU, DU, May 2002)
Applicant Young Persons
Young women more
Young men more
Similar number of young women and men
Total
N
%
23
8
14
45
51.1
17.7
31.2
100.0
The interviewed service providers state that young women more frequently apply to receive SRH
services (51.1%). The higher number of young women may be related to the units where the
interviews are conducted. The number of gynaecologists and service providers working in
Mother-Child Health/Family Planning Centers are higher among the interviewed professionals.
Another reason may be related to the gender. A psychologist in Hacettepe University explained
71
that since women are identified with physical weakness due to the socially constructed gender
roles, it is easy for them to complain or to express their health problems. On the other hand,
men tend to apply less for their sexual/reproductive health problems unless it is very significant.
Because they believe that complaining about their health is a sign of weakness, which may be a
threat for their masculinity. They are not even able to explain their own health problems as
clearly as young women. A psychiatrist from the same university makes similar explanations, and
states that young men should be encouraged to apply to sexual/reproductive health units. 31.2%
of the interviewed service providers state that similar numbers of young women and men apply
to the health centers.
Table 26. Percent Distribution of Interviewed Service Providers’ Opinions on Provision of
Contraceptive Methods to Unmarried Women (HU, DU, May 2002)
Contraceptive provision for unmarried women
Yes
Yes if they are sexually active
Yes if necessary
Contraceptive provision for unmarried men
Yes
Yes if they are sexually active
Yes if necessary
Total
N
%
43
1
1
45
95.6
2.2
2.2
100.0
43
1
1
45
95.6
2.2
2.2
100.0
Almost all of the interviewed service providers state that they approve the provision of
contraceptive methods for both unmarried women and men. One person says that contraceptives
should be provided to unmarried young persons if they are sexually active. Another person states
that if it is necessary contraceptives are given to unmarried young persons.
Since the minds of the service providers are clear on the provision of contraceptives to
unmarried young persons, it may be thought that they will not resist against a new way of service
provision in the future. The expressions stated by the service providers to define the ideal SRH
services and service providers such as “unprejudiced”, “open-minded”, “tolerant”, “respectful to
the privacy” are also parallel to their answers about contraceptives, and determine the limits of an
ideal youth-friendly SRH service.
Table 27. Percent Distribution of Interviewed Service Providers’ Opinions on Making Gender
Differentiation in Provision of Services (HU, DU, May 2002 )
Behaving Differently (n=51) *
No need to behave differently, all of them are youth
Behavior, language, principles should be same, but problem based differentiation should be
made
Women should be cared more
They should be behaved differently due to rural-urban, educational differences
*
One person states multiple ideas.
N
%
30
10
58.8
19.6
6
5
11.7
9.9
More than half of the interviewed service providers (58.8%) think that young women and men
are not treated differently during service provision. On the other hand, 6 of the service providers
state that women should be cared more since they are weaker and more naïve.
On the other hand, 19.6% of the service providers state that attitudes, language and principles
towards young people from both sexes should be common. The nature of the problem may
determine the differentiation of the behavior rather than the gender. 9.9% of the interviewees
72
think that young people should be treated differently due to their characteristics such as rural or
urban origin and education.
The general tendency is towards the undifferentiated behavior. Both female and male young
persons should know each other. Therefore, the information and services should be planned and
provided considering their common needs.
Table 28. Percent Distribution of Interviewed Service Providers’ Opinions on Providing
Information about Sexual/Reproductive Health (HU, DU, May 2002 )
Provision of Information
Yes
No
Positive Effects (n=83) *
They learn how to protect themselves
They have better sexual and social life
Unwanted pregnancies are prevented
They know their body better
They know the opposite gender well
It is a right to receive sexual information
Information on the right time and place has positive influences
It is necessary and positive if time is right
Negative Effects (n=11) *
They may have frequent sex thinking that they know the contraceptive methods
Timeless and wrong information may give harm
It may give harm if the issue is not right and the attitude is not serious
They may face psychological problems because of challenging the social structure
It may be abused if the information is given by incompetent persons
It may be a problem for persons who are conservative on these issues
*
One person states multiple ideas
N
%
45
0
100.0
0.0
33
17
13
11
3
3
3
1
39.7
20.4
15.6
13.2
3.7
3.7
3.7
1.2
5
2
1
1
1
1
45.4
18.2
9.1
9.1
9.1
9.1
All interviewed service providers believe that adolescents/young people should be informed on
their sexual/reproductive health. The positive and negative effects of providing information on
sexual/reproductive health are also asked to service providers.
The most frequent positive effect stated by the interviewees is being able to protect them from
the negative physical, social and mental consequences of insufficient information on their health
(39.7%). According to service providers, young people are able to protect themselves against
sexually transmitted infections or unwanted pregnancies that may cause traumatic effects if they
have true and sufficient information. Moreover, the information may reduce their anxiety about
their bodies, and make them happy individuals. The interviewees think that receiving information
on their sexual/reproductive health is right of young people. Consequently, provision of
informative services is the base of preventive approach, and is perceived as a significant method
to prevent the negative consequences.
There are also service providers among the interviewees who think that provision of information
services may have negative effects on young people (45.4%). It is stated that the information
provided by unauthorized professionals may have more negative effects. It is also expressed that
if the information provided to young people contradicts with the social norms, they may face
unwanted consequences because of being against the society or some conservative groups within
the society may show reaction to them.
In general, it is thought that provision of information on sexual/reproductive health has positive
effects on young people’s lives.
73
Table 29. Percent Distribution of Interviewed Service Providers’ Opinions on Informing Families
before Provision of Information on Sexual/Reproductive Health to Adolescents (HU, DU, May
2002)
Families Should be Informed
No
It depends
Yes
Total
N
%
31
11
3
45
68.8
24.5
6.7
100.0
Although three interviewed service providers (6.7%) think that families should be informed
before information about sexual/reproductive health is provided to adolescents. In general it is
thought that there is no need to inform the families unless the family may contribute better
utilization of the services, there is a significant risk or there is a problem of sexual harassment or
abuse.
Table 30. Percent Distribution of Interviewed Service Providers’ Opinions on Providing
Information about Sexually Transmitted Infections to Unmarried Adolescents (HU, DU, May
2002)
Provision of STI Information
Yes
Yes, but gradually, appropriate for their level, and without horrifying them
Yes within safe sex approach
Total
N
%
43
1
1
45
95.6
2.2
2.2
100.0
All interviewed service providers believe that it is necessary to provide information on sexually
transmitted infections for adolescents/young people. It is expressed that a training program
appropriate for their age that will not horrify them will be a great advantage for young people.
Table 31. Percent Distribution of Interviewed Service Providers’ Opinions on Tools of
Information Services about Sexual/Reproductive Health Specific to Adolescents/Young People
(HU, DU, May 2002)
Tools (n=128) *
Brochure and poster
Training with visual material
Meeting, seminar, conference
TV, newspaper, magazine
Consultancy Centers
Courses at schools
Guides with Pictures
Training Cassettes
Specific Training for Health Personnel
Website
Training for parents
Free phone lines
Confidential consultancy
Specific research
Scientific, warning, non-didactical printed material
Professionals are ready to help, nothing else additional is necessary
It is necessary to provide the information in a concrete format
*
One person specifies multiple tools
N
%
30
21
20
16
10
8
7
4
3
2
1
1
1
1
1
1
1
23.4
16.4
15.6
12.5
7.8
6.3
5.5
3.1
2.3
1.6
0.8
0.8
0.8
0.8
0.8
0.8
0.8
The interviewed service providers are asked about the tools that can be used to provide
information of sexual/reproductive health to adolescents/young people. Brochure and posters
are stated as the most efficient tools to reach young people. Various tools such as “Training with
74
visual material”, “TV, newspaper, magazine”, “Meeting, seminar, conference”, “Website Training
Cassettes”, “Scientific, warning, non-didactical printed material” are also mentioned. Consultancy
centers are also expressed as a tool for reaching young people. Parents’ training, health
personnel’s training, courses at schools are stated as examples of training which are seen as
important tools. There is only one different idea on this topic. One of the gynaecologists in
Hacettepe University states that they are ready to provide services to young people, and there is
no need for additional tools to reach young people.
Participant students give similar answers in focus group discussion about the tools to reach them
in order to provide information on sexual/reproductive health issues. The similarity between the
answers of students and service providers may be helpful in determination of the appropriate and
efficient tools/materials.
Table 32. Percent Distribution of Interviewed Service Providers’ Opinions on the Qualities of an
Ideal Sexual/Reproductive Health Service for Adolescents/Young People (HU, DU, May 2002)
Qualities of the Service (n=174) *
Well-educated, competent, eager personnel
A center with sufficient physical conditions
Confidentiality
Interdisciplinary
Easy to access
Specific training at schools
Friendly personnel who likes working with adolescents
The services must include both consultancy and curative services
Sensitivity about privacy
Parents’ training shouldn’t be ignored
Continues service
STIs should be included
The place must be hygienic
Visual material should be used
It must be free of charge
Personnel with conservative religious ideas shouldn’t be employed
Procedure must be easy
The services should be continuously reviewed
Sensitivity about the reactions of the society
The services should be organized by the university
Peer trainer must be utilized
There is no need for a separate unit, the issue should be naturalized
Regional differences and conditions should be considered in organization of the services
Personnel should not feel uncomfortable about sexuality
Better dormitory conditions are necessary
There should be a team with a common language
Young people should come voluntarily without any enforcement
Media and local press should be utilized well
There should be financial support
Feedbacks should be received
A gynecologist should provide services
There should be a psychologist in the team
Young people should not wait in queue; an appointment system should be established
The service providers team should be flexible
There should be peer leaders trained by health personnel
Language, discourse and behaviors should be in parallel, not contradictory
Students with several social security should also be able to utilize these services
There should be a free phone line
*
One person specifies multiple qualities
75
N
41
36
9
8
8
6
6
6
6
4
4
3
3
3
3
2
2
2
2
2
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
%
23.5
20.7
5.2
4.6
4.6
3.4
3.4
3.4
3.4
2.3
2.3
1.7
1.7
1.7
1.7
1.1
1.1
1.1
1.1
1.1
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
0.6
As it is seen in Table 32 the interviewed service providers have detailed and various ideas on the
quality of sexual/reproductive health services specific to young people. According to the
interviewees, the most important quality of an ideal service is “well-trained, competent, eager
personnel” (23.5%). The replies can be categorized into three; the first category is about the
quality of service provider. The service provider should be well-educated, competent, equipped
with complete and correct knowledge who follows the advancements in the field of
sexual/reproductive health.
The second category is about the quality of the unit where the sexual/reproductive health
services are provided. This unit is expected to be well equipped, hygienic, accessible, working
with appointment system, with sufficient financial resources where free and continuous services
are available with the administration of the university for young people.
The third category is about the qualities of the service itself. According to the interviewees, the
sexual/reproductive health services specific to young people should include parents’ education,
should be interdisciplinary, confidential, sensitive to privacy, open to new developments,
sensitive to social values, flexible, and valid with easy procedure to utilize. According to the
interviewed service providers, the services should also be able to utilize the peer educators, the
media and community leaders.
The qualities stated by the service providers are similar with the students’ ideas searched in other
phases of this study, and may guide the planning of specific sexual/reproductive health services
for adolescents/young people.
CONCLUDING NOTES









The capacity of the medico-social centers in neither Hacettepe nor Dicle University is
sufficient enough to meet the information and service needs of students on
sexual/reproductive health. The basic problems in these centers are the physical conditions,
bureaucratic obstacles, and insufficient number of equipment and personnel
The health personnel working in health centers of both universities believe that their
knowledge about adolescent age is insufficient.
The services provided for adolescents/young people are general health care services. There is
not an established and continuous specific system for sexual/reproductive health of
adolescents/young people. The existing services are provided by individual efforts of the
service providers, and are not sufficient and common.
It creates a significant obstacle that the medico-social centers of the universities do not
provide services for the student with other social security.
Service providers believe that adolescents/young people need to get information specific to
sexual/reproductive health. The main issues on which adolescents/young people need to get
information are protection from pregnancy and sexually transmitted infections.
A “consultancy center”, where adolescents/young people can receive multiple and
comprehensive services, is the most important type of services.
The interviewed service providers think that unmarried young people should be provided
with contraceptive methods.
The interviewed service providers think that it is not necessary to behave in a special way
while providing sexual/reproductive health services to adolescents/young people.
The most important positive effect of providing young people with information stated by the
interviewed service providers is providing them with the ways of physical, social and mental
self-protection.
76

The negative effect expressed by the interviewed service providers is incorrect/wrong
information provided by incompetent personnel, and the motivating effect for sex.
 The most important tools that may be used to reach the adolescents/young people are
brochures, posters, training with visual material, meetings, seminars, conferences, and media.
 The most important quality of sexual/reproductive health services expressed by the service
providers are well-trained, competent, and eager service providers.
 Parents’ education is emphasized as a significant part of sexual/reproductive health services
specific to adolescents/young people. The importance of sexual/reproductive health courses
at high school as a part of curriculum is also emphasized.
77
CONCLUSIONS
AND
RECOMMENDATIONS
78
Conclusions and Recommendations
The research on “Influential Factors on Sexual/Reproductive Health of Adolescents in Turkey''
is conducted in Ankara Hacettepe University Beytepe Campus and Diyarbakir Dicle University in
order to determine the influential factors on sexual/reproductive health of adolescents/young
people. A combination of qualitative and quantitative research methods are used in this research
study.
This study, which is conducted in two universities located in different geographical regions of
Turkey, aims to determine the sexual/reproductive health information, thoughts, behaviors;
needs and expectations of services for the students. The short term objective of the study is
developing intervention studies specific to sexual/reproductive health whereas the long term
objective is providing guidance to similar studies in Turkey.
The findings of the study show the difference between students of two universities in parallel to
the socio-economic, cultural differences influenced by the regional characteristics. This situation
may be a result of the fact that Dicle’s students are usually from southeastern part of Turkey
while Hacettepe’s students usually come from Central and Western part of Turkey.
Conclusions
Sixty percent of the students at Hacettepe University Beytepe Campus are female while 40% of
them are male. On the other hand, 37% of Dicle University’s students are female whereas 63% of
them are male. The mean age of Hacettepe University’s student is 19.7 (sd ± 1.3) whereas it is is
20.4 (sd: ± 1.9) in Dicle University. Approximately half of the Hacettepe’s students (52%), and
one third of Dicle students (36%) are at adolescent age.
The majority of the students (97%) in both universities are single. 1% of the students in both
universities are cohabiting with their partners. 45% of Hacettepe students’ current residence is
dorm while 35% of them live together with their families. On the other hand, 31% of Dicle
students’ current residence is dorm while 40% of them live together with their families
The place of birth, childhood residence until the age of 12, and current residence of families of
Hacettepe students are Central and Western Anatolia whereas it is Eastern Anatolia among Dicle
students. Nearly one third of students’ childhood residence is provincial center whereas almost
half of the students’ childhood residence is town in both universities.
Majority of the students-with higher percentage in Hacettepe University-come from nuclear
families. Almost all Hacettepe’s students state that the language spoken at home is Turkish. More
than half of Dicle students express that they speak Kurdish at home. The parents’ level of
education in Hacettepe’s University is higher than parents’ in Dicle’s University. Most of
Hacettepe students, and less Dicle students assess their families’ economic status as middle.
Health expenses of 88% of Hacettepe’s students and 80% of Dicle’s students are covered by a
social security institution. It is found that 13% of Hacettepe students and 24% of Dicle students
are covered by medico-social centers of the university.
The frequency of smoking among male students (41% at Hacettepe, 51% at Dicle) is higher than
female students (33% at Hacettepe, 38% at Dicle). The median age of starting smoking is
determined as 17. Male smokers start smoking earlier than female smokers. The frequency of
79
alcohol use among male students (59% at Hacettepe, 33% at Dicle) is higher than female students
(48% at Hacettepe, 20% at Dicle). 2% of students in both universities report that they are
substance users.
More than one third of Hacettepe’s students and more than one fourth of Dicle’s students read
daily newspapers. Nearly half of the students in both universities do not read any periodicals
except newspaper. Most common type of periodicals read by Hacettepe’s students are “scientific”
and “Humor, Magazine, Music” whereas they are “Cultural-Political” and “Scientific” in Dicle
University.
Almost one third of the students in both universities specify that they regularly watch TV. The
most frequently watched programs are news, documentary, soap operas, movies and sports
programs. Although none of the female students watch erotic programs, few male students
report they do.
Information and Thoughts on Sexual/Reproductive Health
Students most frequently define sexual/reproductive health as “healthy sexuality/healthy
reproduction'', “sexually transmitted infections” and “problems of sexual/reproductive health” in
both universities. Female students emphasize “health and hygiene of reproductive organs" more
than male students.
The most frequently specified sources of sexual/reproductive health information in both
universities are "book/magazine/encyclopedia", "peers/friends", “school/teacher" respectively.
Speaking with peers/friends on sexual/reproductive health issues is common among young
people. According to the findings of focus group discussions, “peer” refers to elder, experienced,
or married peers in Dicle University.
Parents are found as the third source of information for female students at Hacettepe University
whereas they are specified as fourth source of information at Dicle University. Parents are found
as the last source of information for male students especially at Dicle University
It is not common to speak with parents on sexual/reproductive health. 56% of Hacettepe
students and 81% of Dicle’s students state that they have never spoken with their mothers about
sexual/reproductive health issues. The majority of students in both universities (82% at
Hacettepe, 93% at Dicle) express that they have never spoken with their fathers. Girls are able to
talk on health dimension of sexual/reproductive health. While more than half of female students
in Hacettepe University, and more than one third of female students in Dicle University speak
with their mothers, 30% of male students in Hacettepe University, and 9% of male students in
Dicle University talk with their fathers. Parents with higher level of education are more likely to
talk with their children.
In focus group discussions, it is found that communication with parents is quite weak although
students would like to talk. The nature of the relationship with parents-especially the authoritybased relationship with the father necessitates not to talk about sexuality or reproductive health.
Even if the relationship with the parents is not authoritative, these issues are not spoken. An
important point in the relationship with parents is the common thought that parents are less
educated, and have insufficient information on sexual/reproductive issues.
The issues on which students frequently speak with their parents are problems of adolescent
age/menstruation or sexually transmitted infections. “Hymen/wedding night" is another issue on
which female students talk with their mothers.
80
"Physician/professional” is found as one of the last sources of information in both universities.
However, when the preferred sources of information are examined in both universities, it is
found that the first two preferred sources of information are "physician/professional" and
"book/magazine/encyclopedia". But it is expressed that it is not easy to apply to a professional
in order to receive information on sexual/reproductive health. Because, it is not a common
behavior at their age to visit a professional to get consultancy on sexual/reproductive health
issues. Therefore, they feel uncomfortable.
Although students prefer to receive services provided by professionals, the interviewed service
providers report that 71.1% of them do not have specific training on the characteristics of
adolescent age, the physical and psychological changes specific to the age. 57.3% of the
interviewed service providers do not find their current education and knowledge sufficient to
provide services for young people
It is found that the majority of the students in both universities have not received any
sexual/reproductive health service (82% at Hacettepe, 91% at Dicle). Approximately one student
out of five (18%) in Hacettepe University; one student out of 10 (10%) at Dicle University report
that they have received sexual/reproductive health service. Type of students' social security has
statistically meaningful influence on receiving services at Hacettepe University whereas it doesn’t
at Dicle University. Types of ever received sexual/reproductive health services are found
"information", "curative", and "consultancy" respectively.
The first applied institution specified by students, who have ever received sexual/reproductive
health services, applied is "private clinic/private hospital" in both universities. The medico-social
centers stated as the third institution in Dicle University, and fifth institution in Hacettepe
University.
The status of students receiving sexual/reproductive health services is in parallel to the thoughts
and observations of service providers. 40% of interviewed service providers express that they do
not provide specific services for young people. Instead they work in polyclinics and deal with
health problems. According to service providers, young persons receiving SRH services come
from "everywhere" although "educated persons" and “female young” receive services more.
According to the interviewed service providers, young people apply to receive services with
several reasons such as infections including upper respiratory system infections, gastro-intestinal
system infections, fungal infections. It is specified that young applicants come to receive
information on family planning methods or sexual/reproductive organs. The interviewed service
providers express that young people also apply to get information on hymen and virginity.
According to the findings of the interviews with service providers, primary issues that young
people apply to receive information are sexual/reproductive health and sexually transmitted
infections (33.3%). Psychosocial problems are the second issue (22.2%) about which young
people ask for information. The sexual/reproductive health issues on which young people mostly
need information are; anatomy and physiology of sexual/reproductive organs; the definition and
content and limits of sexuality; and sexually transmitted infections and protection according to
the opinions of service providers.
All interviewed service providers believe that adolescents/young people should be informed
about their sexual/reproductive health. The positive and negative effects of providing
information on sexual/reproductive health are also asked to service providers. The most frequent
positive effect stated by the interviewees is being able to protect them from the negative physical,
social and mental consequences of insufficient information on their health. There are also service
81
providers among the interviewees who think that provision of information services may have
negative effects on young people
The most frequently specified reasons of not receiving sexual/reproductive health services by the
students in both universities is "not necessary"; "have no sexual/reproductive health problem".
Dicle’s students specify "nowhere to go to receive sexual/reproductive health" services as the
second reason. "Prefer to speak with peers about sexual/reproductive issues", "don't trust on the
institutions where sexual/reproductive health services are provided", and "feeling
uncomfortable" are other reasons specified by the students.
The knowledge scores of students is calculated over 39 questions of which the answers are
summarized above. Each correct answer is calculated as “1” whereas each incorrect answer is
calculated as “0”. The knowledge score of students is assessed over total 39 points. The mean
score of both universities is found 24.4 (sd: ± 13.6); and the median score is found 32. The
scores below the mean (0-24) is assessed as “unsatisfactory” whereas the scores over the mean
(25-39) is assessed as “satisfactory”. According to this assessment, the scores of the majority of
Hacettepe’s students (91%); and the scores of almost half of Dicle’s students (51%) are found
“satisfactory”. The scores of female and male students are found similar in Hacettepe University
whereas the scores or female students in Dicle University are higher .
Although there is a statistically significant relationship between mothers’ level of education and
knowledge scores of students in Hacettepe University, this relationship is not found meaningful
in Dicle University. There is no statistically significant relationship between fathers’ level of
education and knowledge scores of students in both universities. No statistically meaningful
relationship between current residence of students and their knowledge scores.
The contraceptives known by female students are found to be the pill, condom, and IUD
whereas the methods well known by male students are condom, pill, and withdrawal. Female
students know calendar, surgical methods and injectables with higher percentage compared to
male students. On the other hand, male students know withdrawal, which is a common
traditional method used in Turkey, and foam/jelly/cream more compared to female students.
The least known methods are Norplant® diaphragm by both female and male students. Female
students know where to get the pill condom and IUD with highest percentages in both
universities whereas male students know where to get condom and pill.
When the contraceptives ever used by students or their partners are examined, it is found that the
most frequently used contraceptive in both universities (7% of female students and 33% of male
students in Hacettepe; 3% of female students and 15% of male students in Dicle) is condom.
However, it is also found that the other methods used which are less effective such as withdrawal
and calendar. The pill use is not common among students. It is also found that as the knowledge
score of the students increases, their contraceptive behavior use also increases.
The first place stated by female and male students in Hacettepe University, and female students
in Dicle University, where they can get contraceptive is “pharmacy”. The second place is found
to be “hospital”. The first place specified by male students in Dicle University is “hospital” and
the second place is “pharmacy”. The third place specified by all students in both universities is
“health center/MCH/FP center”.
When the agreement status of students to some statements concerning to sexual/reproductive
health is examined, it is found that both female and male students in both universities agree with
the statement that “men may have pre-marital, penetrative sexual intercourse” more compared to
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the acceptability of the same situation for women. The percentage of disagreement with the
statement “Women may have pre-marital, penetrative sexual intercourse” is higher among Dicle
students compared to Hacettepe students. Four times more male students compared to female
students in both universities agree with “Men may have multiple sexual partners, but it is better
for women to have one partner”. The majority of the students in both universities agree with the
statement “Virginity is important for me for marriage”. Male students have higher percentage of
agreement with this statement. Similarly, more male students disagree with the statement
“Adolescents/Young People may not care the suppressive attitude of society about virginity”.
Similarly, students discussed the importance of virginity, and social pressure as the reason in
focus groups.
Students in both universities agree with the statement “Adolescents/Young People should talk
with parents only about the health dimension of sexuality”. The percentage is higher among Dicle
students, particularly among male students.
Although the percentage is not so high, Dicle’s students compared to Hacettepe’s students; male
students compared to female students specify that they are agreeing with the statement "A
woman who was subjected to sexual violence (harassment, rape, battering, etc.) might have
deserved this". Nevertheless, it is positive to find that three fourth of female students and almost
half of male students are disagreeing with this statement. Although it is known that violence
against women is also experienced in groups with high socio-economic level, half of Hacettepe’s
students and more than half of Dicle’s students agree with the statement "Violence cases may
seem less frequently in high socio-economic strata". On the other hand, one fourth of the
students in both universities disagree with this statement
Information On Sexual Intercourse and Risk Behaviors
Seventy six percent of Hacettepe’s students and 66% of Dicle’s students specify that they have
had a partner whereas 24% of Hacettepe students and 34% of Dicle students declared that they
have never had a partner. The percentage of female students who have ever had a partner is
lower than male students. The percentage of having partner is found higher in older ages.
Female students think that sexuality in dating may include "handling/kissing" with higher
percentage compared to male students in both universities whereas male students specify the
category "sexual intercourse without penetration" with higher percentage. The percentage of male
students, who specify penetrative sexual intercourse is twice higher than female students in both
universities
A significant number of students think that premarital sex is not a natural part of dating.
However, there are students who think that premarital sex is a natural part of dating in spite of
the conservative and suppressive attitude of the society especially over young women. On the
other hand, it is found that more male students in both universities think that premarital sex is a
natural part of dating. The thoughts of students on acceptability of premarital sex are found
similar both in focus group discussions and survey findings. The general attitude of both young
women and men is that the premarital sexual intercourse is unacceptable. The ones, who state
that it is acceptable, emphasize that it may be experienced in a long term dating in which the
couple is sure that they will marry. “Virginity” is important in a relationship as it is stated in both
female and male groups.
Seven percent of Hacettepe’s students, and 9% of Dicle’s students report that they have previous
sex experiences. It is found that around 2% of female students and 13% of male students in both
83
universities have previous sex experiences. This difference reflects the gender inequality in
practice of students in parallel to their ideas discussed above. A significant finding is that almost
half of the students in both universities (43% at Hacettepe, 47% at Dicle) do not reply this
question. Most probably, the students do not want to give such a personal and private
information although the questionnaire forms are self-administered. 45.6% of students at
Hacettepe University with previous sexual experience; and 29.4% of students at Dicle University
with previous sexual experience specify that they have used contraceptive methods before.
Safe sex primarily means “protection from STIs” for young people. Although female students
specify it as the third category, “protection from pregnancy” is specified less by male students.
The most frequently specified risks are “AIDS” and “other STIs” in both universities. While
“pregnancy” is specified as a risk by Hacettepe students, “damaging of hymen” is specified as a
risk in sexual intercourse by Dicle students. A significant finding in this question is expression of
“damaging of hymen” as a risk with higher percentage at Dicle University. Virginity is also
discussed as one of the important risks for non-married young women in both female and male
focus groups.
The first solution specified by Hacettepe’s students in case of unwanted pregnancy is “induced
abortion”, and the second solution is “marriage” whereas the first solution of Dicle’s students is
“marriage”, and the second solution is “induced abortion”.
It is ascertained that 5% of Hacettepe’s students and 6% of Dicle’s students have previous
pregnancy experiences. 3% of female students in Hacettepe University and 4% of female
students at Dicle University; 8% of male students’ partners in both universities report previous
pregnancy experiences. 59% of 44 Hacettepe’s students with pregnancy experience; and 48% of
34 Dicle students with pregnancy experience specify the category “I and my partner went
together to have induced abortion”. 11% of female students with pregnancy experience in
Hacettepe University and 27% of female students with pregnancy experience in Dicle University
specify that they “got married, and continued pregnancy”.
The majority of the students in both universities (90% at Hacettepe University; 81% at Dicle
University) think that “both partners are responsible for contraception”. It is also determined
that the majority of female and male students in both universities (94% at Hacettepe University;
87% at Dicle University) think that “both partners are responsible for protection from STIs”.
The most frequently specified sexual violence behavior by students in both universities is “rape”
(89% at Hacettepe University; 68% at Dicle University). “Battering during sexual intercourse” is
specified in the second order (79% at Hacettepe University; 52% at Dicle University) while the
third one is “sexual harassment by hand, eyes or words” in Hacettepe University; and “having
sexual intercourse without the consent of one of the partners in marriage or dating” in Dicle
University. “Emotional pressure for having sex” is also specified in Hacettepe University. It is
understood that sexual violence is primarily perceived with its physical dimension by both female
and male students although the emotional dimension is thought with lower percentages. The
emotional pressure is specified by female students as a form of sexual violence with higher
percentages in both universities. Sexual violence directly reminds rape to young men during
focus group discussions whereas young women talk about a wider range of behaviors while
speaking about sexual violence.
84
Expectations on Sexual/Reproductive Health Services
According to the students’ thoughts on the ideal places where sexual/reproductive health services
should be provided, the first place in both universities is “school” (66% at Hacettepe University;
47% at Dicle University). The second place is “medico-social centers of universities” (60% at
Hacettepe University; 42% at Dicle University). Students may mean universities they currently
attend by “school”. The third place is “specific consultancy centers” (44% at Hacettepe
University; 29% at Dicle University) where students think that sexual/reproductive health
services should be provided.
Students’ thoughts on the qualifications sexual/reproductive health services specific to young
people are asked. The most frequently specified qualification is “It should include both the
consultancy and curative services” in both universities (77% at Hacettepe University; 51% at
Dicle University). The second qualification is “there should be easy access to these services”
(63% at Hacettepe University; 40% at Dicle University). The third one is “applications and the
spoken problems should be kept hidden” (59% at Hacettepe University; 37% at Dicle
University). The fourth one is “Services should be provided to both individuals and groups”
(44% at Hacettepe University; 29% at Dicle University).
The first qualification of service providers expressed in both universities is “they should be wellqualified professionals (physician, psychologist, and social worker, etc.)” (87% at Hacettepe
University; 66% at Dicle University). The second qualification expressed by students is “they
should have a friendly relationship with young people rather than a traditional physician-patient
one” (75% at Hacettepe University; 63% at Dicle University). The third one is “they should be
sensitive and unprejudiced.” (69% at Hacettepe University; 44% at Dicle University). The fourth
qualification specified by students in both universities is “they should be trustful” (69% at
Hacettepe University; 40% at Dicle University). These qualifications which students think service
providers of sexual/reproductive health should have are stated by Hacettepe students with higher
percent compared to Dicle students.
Recommendations
1. The medico-social centers of the universities should provide more comprehensive and
qualified services specific to sexual/reproductive health of young people. The professionals
working in these centers should receive specific training. The quality of the services should
include:
a.
b.
The quality of service provider: The service provider should be well-trained,
competent, equipped with complete and correct/significant knowledge who follows
the advancements in the field of sexual/reproductive health. Provision of
sexual/reproductive health services necessitates special skills and knowledge. For this
purpose in service trainings for the service providers should be planned.
The quality of the unit where the sexual/reproductive health services are provided:
This unit should be well equipped, hygienic, accessible, working with appointment
system, with sufficient financial resources where free and continuous services are
available with the administration of the university for young people. “Youth Friendly
85
c.
Consultancy Centers” should be established by the universities, which needs to be
promoted by meetings, posters, brochures among students.
The quality of the service itself: The sexual/reproductive health services specific to
young people should include parents’ training, be interdisciplinary, confidential,
sensitive to privacy, open to new developments, sensitive to social values, flexible,
and valid with easy procedure to utilize.
2. Students need to be informed on sexual/reproductive health. Since they prefer to receive
information services from professionals competent on these issues, these information
services should be provided by the staff working in medico-social centers of the universities
who are trained on sexual/reproductive health services specific to young people. Training
should include especially “sexual/reproductive organs, physiological development”,
“adolescent age”, “sexuality”, “problems about sexuality”, risk behaviors and safe sex”,
“sexually transmitted infections and ways of protection”, “contraceptive methods” and
“violence against women”.
3. In previous studies, it is determined that “peer education” have positive consequences in
sexual/reproductive health. Considering that “peers/friends” has a significant place as a
source of information in this study, “peer education” technique should be utilized in
university centers, and peer educators should be trained.
4. In addition to information services, consultancy, and curative services on sexual/reproductive
health should be provided to young people. A well-designed referral chain should also be
established between health institutions.
5. All specifically designed sexual/reproductive health services should be promoted and
publicised by tools which is accessible and interesting for young people that will encourage
their utilization from these services.
6. The messages in mass media should be revised in order to give “correct” information to
young people on sexual/reproductive health issues.
7. In order to meet the changing needs of adolescents/young people, the feedback from the
students receiving sexual/reproductive health services should be examined. Therefore,
students’ satisfaction should be measured periodically, and their recommendations should be
taken into consideration.
8. A well designed recording-reporting system should be established in medico-social centers of
the universities in order to improve the sexual/reproductive health services. In this way, an
auto control system will be processed in these centers.
9. Medico-social centers of the universities are able to provide primary health care services for
students with any type of social security. However, the services are currently provided in the
form of writing prescriptions to the applicants and referring them to the hospitals. The
services and structure of these centers should be reviewed by primary health care approach in
order to restructure them as “ youth friendly” center.
10. The findings of this study show that regional/cultural differences should be taken into
consideration in developing information-training-communication programs and clinical
services. Thus, the model services should not be planned “mono type” in Turkey, where
socio-demographic and cultural differences exist.
86
11. Gender roles and gender discrimination is found diffused in the thoughts and behaviors of
this age group in this study especially in Dicle University where patriarchal values are more
dominant. It is necessary to give importance to gender mainstreaming in several sectors by
“advocacy” programs.
12. In-depth studies and analysis on the negative influence of socio- cultural structure of the
society on health should be carried out. Social/legal intervention programs should be
developed and implemented where necessary.
87
REFERENCES
1. Blanc K.A, Way A. A. 1998. Sexual Behavior and Contraceptive Knowledge and Use among Adolescents in
Developing Countries. Studies in Family Planning: Adolescent Reproductive Behavior in the
Developing World, June, V. 29, N.2, pp.106-16.
2. Cage J. A.1998. Sexual Activity and Contraceptive Use: The Components of the Decision-making Process.
Studies in Family Planning: Adolescent Reproductive Behavior in the Developing World,
June, V. 29, N.2, pp.154-66.ü
3. Friedman L. H, Edstrom G. K. 1983. Adolescent Reproductive Health: An Approach to
Planning Health Service Research, WHO Offset Publication No: 77. Geneva.
4. Hacettepe University Institute of Population Studies. 1999. A Baseline Survey of the Project for
Applying Information Education and Communication Approach and Provide Public
Support in Slum Areas of Turkey, Ankara.
5. Hacettepe University Institute of Population Studies, Measure DHS+, Macro International
Inc.1999.Turkish Population and Health Survey 1998, Ankara.
6. Hardoff D, Tamir A and Paltı H. 1999. Attitudes and Practices of the Israeli Physicians
Toward Adolescent Health Care, A national survey, Journal of Adolescent Health, 25: 35-39.
7. Hughes J, Mccauley P. A. 1998. Improving the Fit: Adolescents’ Needs and Future Programs for Sexual and
Reproductive Health in Developing Countries. Studies in Family Planning: Adolescent
Reproductive Behavior in the Developing World, June, V. 29, N.2, pp. 233-45.
8. Koc, I., Unalan, T. 2000. Adolescent Reproductive Behavior in Turkey, The Turkish Journal of
Population Studies, V. 22, pp.37-56.
9. Ministry of Education. Dept. of Research, Planning and Coordination. 1999. Quantitative Data
of National Education, Ankara.
10. Ministry of Health of Bulgaria, World Health Organization. 1998. Improving The Accessibility
of Health Services that Meet the Sexual and Reproductive Health Needs of Adolescents
in Schools, Sofia.
11. MSI (Medical Student International). 1998. Adolescents and Reproductive Health,
February,Vol. 3, No:6
12. Network: Family Health International. 1997. Issue on Adolescent Reproductive Health. Spring, V.
17, No.
13. 13.Ozvaris B.S. at al. 1995. Evaluation of Sexual Knowledge of Adolescents, Journal of Health and
Social Welfare Foundation, 2:2-7.
14. Ozyurek E, Nalbant H. 1998. Knowledge Level of Last Year Education Faculty Students about Sexual
Health. Human Resource Development Foundation: Project for the Support of Adolescent
Sexual Life, Project Report, Turkey, Istanbul.
15. Serbanescu F, Morris L. 1996.Young Adult Reproductive Health Survey, Preliminary
Report, Romania.
16. The Alan Guttmacher Institute. 1998. Young Women’s Sexual and Reproductive Lives. Into a New
World, Washington.
88
17. United Nations Population Fund. 1996. Programme of Action adopted at the International
Conference on Population and Development, USA
18. United Nations Population Fund, World Health Organization, Ministry of Health of Ukraine,
Ukrainian Family Planning Association. 1999. Adolescent Reproductive and Sexual Health in
Ukraine.
19. UNDP, UNFPA, WHO.1997. Sexual Behavior of Young People. Progress in Human Reproduction
Research, No: 41.
20. Vicdan K. 1993. Demographic and Epidemiological Characteristics of Adolescents,
Current Problems and Recommendations for Solutions in Our Country, Zekai Tahir Burak
Maternity Hospital, Unpublished Specialty Thesis, Ankara.
21. WHO/ Maternal and Child health Division of Family Health. 1986. Reproductive Health in
Adolescence: Position Paper, MCH/85.12. Rev. 1. Geneva.
22. WHO, Adolescent Health Programme, Division of Family Health. 1992. A Study of the
Sexual Experience of Young People in Eleven African Countries: The Narrative Research
Method. WHO/ADH/92.5, Geneva.
23. World Health Organization. 1997. Action for Adolescent Health. Towards a Common
Agenda, WHO/FRH/ADH/97.9.
24. World Health Organization/Family and Reproductive Health/Family Planning and Population,
1997. Communicating Family Planning in Reproductive Health. Key Messages for
Communicators, WHO/FRH/FPP/97.33. Geneva.
25. World Health Organization. 1998. World Health Report, A vision for all in the 21st century,
Geneva.
26. Contraception, Abortion and Maternal Health Services in Turkey: Results of Further
Analysis of the 1998 Turkish Demographic Health Survey, 2002. (Ed.) Ayşe Akın. Hacettepe
University, Turkish Family Health and Planning Foundation, UNFPA. Ankara.
89
APPENDIX
90
Appendix 1. Informed Consent Form for the Focus Group Discussion Subjects
“Good morning (Good afternoon/evening)
My name is ……………., I am from (Hacettepe University/Dicle University/or other
institution)
Purpose of the Study
We are doing a study on the knowledge, attitude and behaviors of adolescents in regard to
sexuality and reproduction. We also want to collect information about the health service needs of
adolescents in these issues and how they behave when they need assistance.
Procedures
As a part of this study, we are going to bring together small groups of men and women to discuss
relevant issues and to inform us on these matters. You are among the group of people who have
volunteered and been chosen for this purpose. We have chosen you because we think you would
be in a position to discuss these matters with other members of the group and thus describe us
the relevant attitudes and perceptions within your community of university adolescents.
The discussion group you may join will consist of 10 or 12 people and each group will be
consisted of entirely males or females. There will be two people from our research team. One of
the latter will act as the organizer of the group, explain the purpose and procedure of group
discussion, keep time and make sure that the group discusses the critical points and that
everybody gets a chance to express their views. The second researcher will write down the main
points of the discussion and, if the group agrees, to record the proceedings on an audio tape. The
audio tapes will be kept until they have been transcribed onto paper and then will be destroyed.
In the time that it takes to transcribe them they will only be accessible by the researchers involved
in this study and will be treated as strictly confidential and kept under lock. Each group
discussion session may take about two hours of your time, and may include issues that you find
sensitive.
Please note that in these group discussions you are not expected to talk about yourself or anyone
you know. You are expected to talk about people in general, or about a typical young man or
woman from your community. We will advise you and other members of each discussion group
to avoid open references to any known individual and to know that the process and outcome of
your discussions will be treated as confidential.
Risks and Benefits of the Study
By participating in this study and answering your questions, you will not receive any direct
benefit. However, you will help to increase our understanding of the needs of the community in
terms of adolescent sexual and reproductive health. We hope that the results of the study will
improve the quality and utilization of the services currently available for you. Your participation
in this study will not involve any risks to you.
Rights
You are completely free to take part in this study or to refuse to do so. Even after you agree to
participate in the study, you will be free to leave the discussion any time you wish and/or to
refuse to participate on any topic that you are uncomfortable with. The decision to not to
participate or to withdraw will not affect any future aspects of your university life, any medical
care you should require or any other benefits to which you would be entitled.
91
Do you have any questions about what I have just told you?
YES [Interviewer please answer any questions to the best of your ability]
NO [ Interviewer, go to the next question]
Now, please tell me, do you clearly understand the purpose of the group discussion sessions I
have just described?
YES [ Interviewer, go to the next question]
NO [ Interviewer, repeat the section on the purpose of the study and make sure that the
interviewee has understood it]
Do you agree to take part in the group discussion session and share your views with other
members of the group?
YES [ Interviewer, ask the respondent to sign the form (or an acceptable equivalent)]
NO [ Interviewer, thank the interviewee and leave him/her]
Declaration of the Volunteer:
I have understood that the purpose of the study is to collect information about the knowledge,
attitude and practice of adolescents with regard to sexual and reproductive health issues and to
examine the health needs of adolescents in these aspects.
I have read the above information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions that I have asked have been answered to my satisfaction. I
consent voluntarily to participate as a subject in this study and understand that I have the right to
withdraw from the study at any time without in any way affecting my further university life or
medical care.
Signature of Volunteer (optional): ______________ Signature
_______________
Date:
Date:
92
of
Investigator:
Appendix 2. Informed Consent Form for Survey Interviews
Statement of the Study
Situation of and Influential Factors on Sexual and Reproductive Health of Adolescents in Turkey
Purpose of the Study
We invite you to participate in a study on the knowledge, attitude and behaviors of adolescents in
regard with sexuality and reproduction. We also want to collect information about the health
service needs of adolescents in these issues and how they behave when they need assistance.
Procedures
Specifically we are going to ask you for information about knowledge, attitudes and needs in
terms of sexuality and reproduction, as well as your background characteristics. We would expect
you to complete the questionnaire yourself, during your class hour. The completion time is about
30 to 40 minutes and you may find some of the questions asked sensitive in nature. Please do not
write your name and provide as sincere answers as you possibly could.
The information that you provide during the study will be kept confidential. Only the interviewer
and researchers will have access to the questionnaires and the information that you provide.
Risks and Benefits of the Study
By participating in this study, and answering our questions, you will not receive any direct benefit.
However, you will help to increase our understanding of the needs of the university adolescents
in terms of sexual and reproductive health. We hope that the results of the study will improve
and make more acceptable the services currently available to you. Your participation in this study
will not involve any risks to you.
Rights
Your participation in this study is voluntary and you have the right to refuse to participate or to
answer any questions that you feel uncomfortable with. If you change your mind about
participating during the course of the study, you have the right to withdraw at any time. The
decision to not to participate or to withdraw will not effect any aspects of your university life, any
future medical care you should require or any other benefits to which you would be entitled. If
there is anything that is unclear or you need further information, we shall be delighted to provide
it. [Interviewer ask if the respondent has any questions and provide the necessary clarifications]
Declaration of the Volunteer:
I have understood that the purpose of the study is to collect information about the knowledge,
attitude and practice of adolescents in regard to sexual and reproductive health issues and to
examine the health needs of adolescents in these aspects
I have read the above information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions that I have asked have been answered to my satisfaction. I
consent voluntarily to participate as a subject in this study and understand that I have the right to
withdraw from the study at any time without in any way affecting my further university life or
medical care.
Signature of Volunteer (optional): ______________ Signature
_______________
of
Investigator:
Date:
Date:
Appendix 3. Informed Consent Form for Service Providers
Statement of the Study
“Situation of and Influential Factors on Sexual and Reproductive Health of Adolescents in
Turkey”
93
Purpose of the Study
We conduct a study on the knowledge, attitude and behaviors of adolescents/young adults in
regard to sexuality and reproduction. We also want to collect information about the needs of
health service providers in providing various services of sexual/reproductive health to
adolescents/young adults, including informative-, educative-, and counseling-services.
Procedures
As part of this study, we would like to ask you some questions regarding your demographic
characteristics as well as some other topics, to learn about above mentioned issues and your
personal opinions on those. We would expect you to complete the questionnaire in about 20 to
30 minutes. You may find some of the questions sensitive. Please do not write your name on the
questionnaire and provide as sincere answers as you possibly could.
The information that you provide during the study will be kept confidential. Only the interviewer
and researchers will have access to the questionnaires and the information that you provide.
Risks and Benefits of the Study
By participating in this study, and answering our questions, you will not receive any direct benefit.
However, you, the health providers, will help to increase our understanding of the needs of the
health providers in terms of providing services of information, education, and counseling on
sexual and reproductive health of adolescents. We hope that the results of the study will improve
and make more acceptable health services currently available to adolescents. Your participation in
this study will not involve any risks to you.
Rights
Your participation in this study is voluntary and you have the right to refuse to participate or to
answer any questions that you feel uncomfortable with. If you change your mind about
participating during the course of the study, you have the right to withdraw at any time. The
decision to not to participate or to withdraw will not effect any aspects of your occupational life,
or legal- or any other benefits to which you would be entitled. If there is anything that is unclear
or you need further information, we shall be delighted to provide it. [Interviewer ask if the respondent
has any questions and provide the necessary clarifications]
Declaration of the Volunteer:
I have understood that the purpose of the study is to collect information about the knowledge,
attitude and practice of adolescents in regard to sexual and reproductive health issues;and, to
collect information on and examine the needs of health providers in providing services of
information, education, and counseling to adolescents on in these aspects.
I have read the above information, or it has been read to me. I have had the opportunity to ask
questions about it and any questions that I have asked have been answered to my satisfaction. I
consent voluntarily to participate as a subject in this study and understand that I have the right to
withdraw from the study at any time without in any way affecting my further occupational life or
legal benefits.
Signature of Provides (optional): ______________ Signature
of
Investigator:
_______________
Date:
Date:
94
Appendix 4. Focus Group Discussions Directory Questions
1. Sources of Information
General Sources of Information:

How do young people of your age get information about relationships, sexuality or
contraception?
 Whom or what do young people find confidential in terms of information?
 Do young women and men get information from different sources?
 Do young people of your age easily talk about sexuality and related issues with other people?
- Are there any persons whom young people prefer not to talk?
Friends:

Do young women/men of your age talk about sexuality with their friends?
- Do they generally talk to female or male friends?
- With one person or in groups?
- How do they start speaking?
- How does it develop?
- What are the most spoken issues?
 Do you think young women and men talk about sexuality in similar ways?
- What are the similarities?
- What are differences?
Parents:

Do young women/men of your age talk about sexuality with their parents?
- If they do, how do they start talking?
- Who starts talking?
- If they don’t, why don’t they talk?
- What do they talk about most?
 Are there differences between young women and men in talking with parents?
-What are these differences?
2. Sexual Development
Dating-Sexual Intercourse:



At what age do young people of your age start dating?
What does dating involve? What do young people who are dating do together?
Do young people think that having sexual intercourse is a natural part of dating?
Gender Roles:



What do you think are the main differences between young women and men?
Are women treated differently from men?
Do young women/men behave how they should, how others expect them?
Sexual Violence:



What does sexual violence mean to you?
What kind of activities can be perceived as sexual violence activities?
Who are generally subjected to violence at your age? Women or men?
3. Knowledge of Sexual/Reproductive Health
95



What does sexual health mean to you?
What does reproductive health mean to you?
Are there differences between young women and men in terms of sexual/reproductive
health?
4. Sexual Risk Taking
Risk Perception:




What does safe sex mean to young people of your age?
To what extent do you think that young people take risks during sex?
Do young women and men take similar or different risks?
Which is the most important risk for young people? Pregnancy, AIDS or STIs?
Risk Prevention:





Who should be responsible for protecting against pregnancy of STIs during sex?
Who is generally responsible for protection or contraception?
Do young people talk about protection with their partners?
What do young people think about condoms?
What are the positive and negative aspects of condom?
5. Sexual Health Services
Knowledge of Services:

Do you know the places where services of sexual/reproductive health services are provided
to young people?
Use of Services:
 Do young people visit the places that you mentioned to get information or advice?
- If not, why don’t they visit?
Expectations:



What should be the qualifications of sexual/reproductive health services for young people?
Who should provide sexual/reproductive health services to young people?
What kind of a promotion for sexual/reproductive health services specific to young people
can be made?
96
Appendix 5: Questionnaire Form of Survey
"INFLUENTIAL FACTORS ON
THE SEXUAL/REPRODUCTIVE HEALTH OF ADOLESCENTS”
QUESTIONNAIRE
This study is conducted to search the influential factors on sexual/reproductive health of first year
students in Ankara, Hacettepe University (Beytepe Campus) and Diyarbakır, Dicle University in order to
plan the future sexual/reproductive health services specific for young people in university campus. Please
do not write your name on the questionnaire. All information on the questionnaire will be kept
confidential
We thank you for answering the questions, and wish you success.
HACETTEPE UNIVERSITY, MEDICAL FACULTY DEPARTMENT OF PUBLIC HEALTH
PERSONAL INFORMATION
1. Your sex?
1.Female
2.Male
2. Your birthday?
Day................................Month.................................Year........................................
3. Please specify your marital status.
1.Single
2.Married
3.Living with a partner
4.Other (specify)........................................................................................
4. Please clearly specify your place of birth.
Province........................................Town.........................................Village.................
(if you were born abroad) Country.....................................................................
5. Please specify your place of living until the age of 12.
Province........................................Town.........................................Village.................
(if you lived abroad) Country.....................................................................
6. Please specify the place where you have lived longest after the age of 12.
Province........................................Town.........................................Village.................
(if you lived abroad) Country.....................................................................
7. Please specify the place where you spend your holidays (the longest duration) after the age of
Province........................................Town.........................................Village.................
(if it was abroad) Country.....................................................................
8. Please specify the number of your sisters/brothers (except you)
1.Don’t Have
2.One
3.Two
4.Three
5.Four
6.Five
7.More than five
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9. Please specify which child you are (in order) of your family?
.........................................................................
10. Please specify the last level of education you completed?
1. Public High School
2. Anatolia High School
3. Super High-School
4. Private High School
5. Vocational High School
6. Religious High School
7. Other (specify)....................................................
11. Please specify the department where you currently attend at the university.
........................................................................................
12. Please specify the place where you currently stay.
1. Dormitory
2. Together with friends at home (go to Q18)
3. Together with family at home (go to Q18)
4. Together with relatives at home (go to Q18)
5. At home-alone (go to Q18),
6. Other (specify)).......................................................
13. Please specify the type of the dorm where you currently stay.
1. Girls’ dorm
2. Boys’ dorm
3. Mixed (girls and boys)
14. Please specify the status of the dorm where you currently stay..
1. Public dorm
2. Private dorm
3. Other (specify).............
15. Please specify the number of person (including you) at your room, in the dorm.
1. I have a private room.
2. ..........................persons together with me.
16. Please specify whether there is a separate study room in your dormitory or not?
1. Yes, there is.
2. No, there isn’t.
17. Please specify whether there is a separate rest/television room in your dormitory or not?
1. Yes, there is.
2. No, there isn’t.
18. How much do you get as a pocket money from your family?
1. Less than 50 million.
2. Between 51-100 million.
3. Between 101-150 million.
4. Between 151-200 million.
5. More than 200 million.
6. Other (specify).....................................
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19. Please specify whether you have another income (except your pocket money) or not (you may
mark multiple choices).
1. Scholarship (from public scholarship institution)
2. Scholarship from other organizations/institutions, except university)
3. Wage earned from part-time or full-time jobs.
4. Regular pocket money from other relatives.
5. No income
6. Other (specify)..........................................................
20. Please specify the work place/work/institution if you work for income.
.............................................................................................................................................
21. Please specify the social security institution where you or your family are registered.
1.The Institution of Retirement Fund (for state officers)
2.Bağ-Kur (for self-employed people)
3.Institution of Social Insurance (for workers)
4.Green Card
5.Private Insurance
6.I have no social security
7.Other (specify).........................
THE QUESTIONS RELATED TO PERSONAL HABITS AND HOBBIES
22. Have you ever smoked or do you currently smoke?
1.Never (go to Q25)
2.Occasionally
3.Always
4.I used to smoke (…year/month(s) ago)
23. How old were you when you start smoking………………
24. How many cigarettes did/do you smoke per day?………....cigarettes
25. Do you currently have a drink of alcohol?
1.Never (go to Q27)
2.Occasionally
3.Always
4.I used to drink (…year/month(s) ago)
26. Please specify the kind and amount of alcohol that you have.
1...........Glass(es) of..................per day.
2...........Bottle(s) of...................per week.
3...........Glass(es) of..................per week.
4...........Glass(es) of..................per week.
5.Other (specify)..........................
27. Please specify whether you have ever had any addicting substance (drug, cocain, eroin, etc.)
or not.
1.Yes (specify)......................................
2.No
3.I used to have before.
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28. Please specify the places you go in the table below by () mark.
Never go
Less than once a month
1-4 times per month
More than 4 times per month
Cinema
Theatre
Concert
Opera
Café
Place of
entertainment
Coffee house
Internet café
Billiard hall
Bowling hall
Other (specify)
29. Please specify whether you regularly read daily newspapers or not.
1.Yes
2.No
30. Please specify whether you read periodical publications except newspapers.
1.Yes (specify the frequency).........................................
2.No (go to Q32)
31. Please specify the type of the publication(s) you read (you may mark multiple choices).
1.Cultural-Political
2.Literature
3.Scientific
4.Financial
5.Humor
6.Magazine
7.Pornographic
8.Other (specify).....................................
32. Please specify whether you regularly watch TV.
1.Yes
2.No
33. Please specify the kind of TV programs that you watch most (you may mark multiple
choices).
1.News
2.Documentary
3.Entertainment
4.Competitions
5.Drama
6.Soap Opera
7.Feature films
8.Talk Shows
9.Other (specify) .......................
34. Please specify whether you regularly listen to radio.
1.Yes
2.No
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35. Please specify the kind of radio programs that you listen to most (you may mark multiple
choices).
1. Music
2. Actuality
3. Entertainment
4. Talk-shows
5. Other (specify).................................
INFORMATION ON FAMILY
36. Please specify whether other persons except your nuclear family (parents and children) live in
your family’s house or not.
1. Yes they live
2. No they don’t live
37. How do you define the marital status of your parents?
1.Married and live together
2.Mother alive, father dead.
3.Father alive, mother dead.
4.Not divorced, but live separately.
5.Divorced
6.Mother remarried
7.Father remarried
8.Other (specify)............................................
38. Please clearly specify the place where your family currently lives.
Province........................................Town.........................................Village.................
(If they live abroad) Country.....................................................................
39. Please specify the language(s) that you and your family speak at home (you may mark
multiple choices).
1.Turkish
2.Arabic
3.Greek
4.Laz Language
5.Kurdish and its Dialects
6.Syriac
7.Circassion
8.Georgian
9.Bulgarian
10.Other (specify)..................................
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40. Please write the age of your mother and father (if they are alive), and specify their education
and job in the table below by () mark.
Mother
Age
Education









Job
Father
Illiterate
Left primary school
Primary school
Left secondary school
Secondary school
Left High-School
High School Graduate
Left University
University Graduate

Employer employing 10 or more employees







Employer employing less than 10 employees
Salaried (government officer)
Waged (public sector)
Waged (private sector)
Works for her/his own
Unpaid domestic worker (including housewives)
Other (specify) ...............
41. What is the socio-economic status of your family compared to other families in your opinion?
1.Very rich
2.Rich
3.Middle
4.Poor
5.Very poor
KNOWLEDGE AND IDEAS ON SEXUAL/REPRODUCTIVE HEALTH
42. What does sexual/reproductive health mean to you?
1.Healthy sexual life.
2.Health of reproductive organs.
3.Hygiene of reproductive organs.
4.Protection from sexually transmitted infections.
5.Regulation of fertility.
6.Contraceptive methods.
7.Problems of sexual/reproductive health.
8.Other (specify).....................................................
43. Please specify whether you got any information on sexual/reproductive health from anywhere
or anyone or not.
1. Yes I have.
2. No I haven’t.
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44. Please specify the suitable cell for you by () mark about information sources of
sexual/reproductive health in both of the columns.
About sexual/reproductive health
Place/person from
information is got
whom
Place/person from whom it is
preferred to get information
School
Mother
Father
Brother
Sister
Other family members
Peers
Physician/
Psychologist/social worker
Instructor
Magazine
Book/encyclopedia
Television/radio
Video cassette
Internet
Sexual experience
Other (specify)
45. Please specify whether you talk about sexual/reproductive health with your mother or not.
1.Yes I do
2.No I don’t
46. Please specify whether you talk about sexual/reproductive health with your father or not.
1.Yes I do
2.No I don’t (go to Q48)
47. Please specify what you talk about sexual/reproductive health with your parents (you may
mark multiple choices).
1.Health of reproductive organs
2.The problems of adolescent age
3.Menstruation
4.Hymen/wedding night
5.Sexually transmitted infections
6.Her/his own body and sexuality
7.AIDS
8.Other (specify)................................................
48. Have you ever used any sexual/reproductive health service?
1.Yes I have
2.No I haven’t (go to Q51).
49. Please specify one of the choices below that fits the service you used.
1.Information
2.Advise/Consultation
3.Treatment
4.Other (specify)..................................
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50. If you used any service, where did you get this service?
1.Health center of the university
2.Public Hospital
3.Institution of Social Insurance
4.Private clinics and hospitals
5.Military Hospital
6.Private clinic of a physician
7.Other institutional hospitals
8.Health Center
9.Other (specify)......................
51. If you did not use any service, why didn’t you use?
1.It wasn’t necessary
2.Because I feel uncomfortable
3.There is nowhere to go.
4.I don’t trust the institutions that provide these services
5.Because I think that only married partners can use these services
6.Because I prefer to speak with my friends about these issues
7.I didn’t have any problem to use these services
8. Other (specify)…………………………..
52. Which of the choices below is the period in which the possibility of becoming pregnant is the
highest for a woman?
1.Just after the menstruation
2.During menstruation
3.Two weeks before the menstruation
4.Always
5.I have no idea.
53. Which is the best age interval for a healthy pregnancy?
1.Before the age of 20
2.Between the ages 20-34
3.The age of 35 and later
4. I have no idea.
54. Please specify your ideas about the statements below by writing True (T), False (F) or I don’t
have any idea (I).
1. A new condom should be used for each sexual intercourse. ________
2. Only men have Gonorrhea._______
3. STIs transmit to women easier. _________
4. Birth control pills should not be used after the age of 35.________
5. Copper IUDs (spirals) provides protection for 10 years._______
6. Withdrawal method is one of the most effective contraceptives._______
7. Oral/anal sexual intercourse has the risk to transmit STIs.________
8. It is wrong to end the first pregnancy with induced abortion because of the risk of infertility in the
future.________
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55. Please specify the degree of your agreement to the statements below by “1, 2, 3”.
1. Agree
2. Neither agrees nor disagrees (No opinion)
3. Disagree
 Men may have extra-marital, penetrative sexual intercourse.___________
 Women may have extra-marital, penetrative sexual intercourse._________
 Virginity is important for me for marriage.________
 Adolescents should speak with parents only about the health dimension of sexuality.________
 Talking about sexuality with parents may give harm to the relationship between parents and
children ._________
 A woman who was subjected to sexual violence (harassment, rape, battering, etc.) might have
deserved this._________
 Violence cases may seem less in high socio-economic strata.________
 Adolescents may not care the suppressive attitude of society about virginity.________
 Men may have multiple sexual partners, but it is better for women to have one
partner._________
56. Please answer the questions about the contraceptive methods below by putting () mark.
Methods
Method
Know
Don’t know
I or my partner
Used
Not used
From where the method is got?
Know
Don’t know
IUD
Pills
Condom
Calendar method
Withdrawal
Norplant
Female sterilization
Male sterilization
Diaphragm
Injectables
Foam/jelly/
Cream
57. Please specify the places to get contraceptive methods (you may specify multiple choices).
1.Health Center
2.Hospital
3.Pharmacy
4.Supermarket/shop
5.Peers
6.Other (specify).............................................
58. Please specify the possible complications that the contraceptive methods below may
cause by putting () mark.
Pills
Complication
Cancer
Fungus/
Infection
Reduce pleasure
Low protection
Give harm to hormonal balance
Cause to gain weight
Infertility
Stop menstruation
Impotence
Other (specify)
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Condom
IUD
Withdrawal
SEXUAL INTERCOURSE AND RISK PERCEPTION
59. Have you ever had a partner (girl/boy friend)?
1. Yes I have.
2. No I haven’t.
60. What do you think may sexuality involve in dating? (you may mark multiple choices)
1.Handling/kissing
2.Touching
3.Sexual intercourse without penetration
4. Sexual intercourse with penetration
5.Other (specify)...............................
61. Do you think penetrative sexual intercourse is natural part of dating?
1.Yes, it is (go to Q63).
2.No, it isn’t.
3.Other (specify)........................................
62. Why don’t you think that penetrative sexual intercourse is not natural part of dating?
1.Because of social pressure
2.Because I cannot explain this to my family
3.Because I don’t trust on my partner
4.Because I am not sure that we will marry
5.Because the duration of the affair is not long enough
6.Because virginity is important
7.Other (specify)………………………
63. Have you ever had a penetrative sexual intercourse?
1.Yes, I have.
2.No, I haven’t.
64. What does safe sex means to you? (you may mark multiple choices)
1.Not having sex
2.Monogamy
3.Using condom
4.Not becoming pregnant
5.Protection from STIs
6.Using contraceptive methods
7.Having sexual intercourse with an unknown partner
8.Other (specify)………………………
65. Which one is the most important risk during penetrative sexual intercourse in your opinion?
1.Pregnancy
2.AIDS
3.Other sexually transmitted infections
4.Losing virginity
5. Other (specify)………………………
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66. What should be done in case of an extra-marital, unwanted pregnancy in your opinion?
1.Induced abortion
2.Partners should marry
3.Partners should end the affair.
4.Anyway pregnancy should be continued.
5. Other (specify)................................................
67. Please specify whether you or your partner have ever been pregnant or not.
1.Yes.
2. No. (Go to Q69)
3. Other (specify............................
68. Please specify how you ended the unwanted pregnancy (if you or your partner had).
1. I/she went to have induced abortion alone.
2. We went to have induced abortion together.
3. I/she went to have induced abortion together with a girl friend.
4. We married, pregnancy continued.
5. Pregnancy continued, we didn’t marry.
6. Other (specify).....................................
69. Please specify the suitable statement below about carrying condom of young people.
1.Each young person (female and male) should carry condom..
2.Only men should carry condom.
3. Only women should carry condom.
4.Not necessary to carry.
70. Who should be responsible of protecting against pregnancy during sex in your opinion?
1.Man
2.Woman
3.Both of them
4.One of them
5.Other (specify).....................................
71. Who should be responsible of protecting against STIs during sex in your opinion?
1.Man
2.Woman
3.Both of them
4.One of them
5.Other (specify).....................................
72. Which one(s) do you think are sexual violence activities? (you may mark multiple choices)
1.Sexual harassment by hand, eyes or words
2.Having sexual intercourse without the consent of one partner in marriage or dating
3.Rape
4.Psychological pressure into sex
5.Battering during sexual intercourse
6.Other (specify).........................
EXPECTATIONS ABOUT SEXUAL/REPRODUCTIVE HEALTH SERVICES
73. Where do you think sexual/reproductive health services should be provided to young people
(you may mark multiple choices)
1.Hospitals
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2.Health Centers
3.Health Centers of the universities
4.Schools
5.Special Consultations Centers on Sexual/Reproductive Health
6.Other (specify)......................................
74. What do you think the qualifications of sexual/reproductive health services should be? (you
may mark multiple choices)
1. Applications and the spoken problems should be kept confidential
2. It should involve both the consultancy and treatment services
3. There should be easy access to these services
4. Services should be provided to both one person and groups
5. Female professionals should provide services to young women, male
professionals should provide services to young men.
6. Promotion of the services should be made in the places where young
people usually go.
7. Other (specify).................................................
75. What do you think the qualifications of the professionals, who should provide
sexual/reproductive health services, be? (you may mark multiple choices)
1. They should be well-qualified professionals (physician, psychologist, and social worker, etc.)
2. They should be sensible and unprejudiced.
3. They should be young.
4. They should be trustful.
5. They should have a friendly relationship with young people rather
than a traditional physician-patient one.
6. Other (specify)...........................................

Did you participate into the focus group discussions conducted in March-April 2001 for the
same study before?
A) Yes
B)No
108
Appendix 6: Questionnaire Form of Service Providers
"INFLUENTIAL FACTORS ON THE SEXUAL/REPRODUCTIVE HEALTH OF
ADOLESCENTS” PROJECT SERVICE PROVIDERS
QUESTIONNAIRE FORM
1.Your age?
( ) 25-29
( ) 30-34
( ) 35-39
( ) 40-45
( ) 45 +
2.Your sex?
( ) Woman
( ) Man
3.Your marital status?
( ) Single, living with family
( ) Single, not living with family
( ) Cohabiting
( ) Married
( ) Divorced
( ) Widowed
4.Do you have children?
( ) Yes ( If yes, number of them, their ages and their sexes will be asked)
Number:…………………………………….
Age:……………………………………..
Sex:………………………………...
( ) No
5.The last school that you graduated from?
( ) High school/Occupational high school
( ) Distant Education/College
( ) University / Undergraduate
( ) Graduate
( ) PhD
( ) Other.........................................................
6.Your profession?
..........................................................................................
7.What is your duty / title in the institution you work?
………………………………………………….
8.How long have you been working there?
………………………………………………......
9.Which services are you responsible for?
…………………………………………………………
…………………………………………………………
…………………………………………………………
…………………………………………………………
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10.Have you ever received a special training (in-service training or meeting, seminar, education
etc.) about adolescents/young people (their development, their health, concerning characteristics
of this period)?
( ) Yes ( 10th question will be asked and the name of the training, the date of it, the duration of it and the
name
of
the
institution
from
it
is
received
will
be
written).
………………………………………………………….……………………………………………
………………………………………………………….……………………………………………
( ) No
10.Do you think that this training is sufficient?
( ) Yes
( ) No
11.What kind of services are provided specific to young people in this center/clinic?
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
(d)…………………………………………………………………………………………………
(e)………………………………………………………………………………………………….
12.Do you think that the services that you provide in this center / clinic are sufficient?
( ) Totally sufficient
( ) Sufficient
( ) Partially sufficient
( ) Insufficient
( ) Totally insufficient
13. According to your observations and experiences, for which reasons young people mostly apply
to your center?
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
(d)…………………………………………………………………………………………………
(e)………………………………………………………………………………………………….
14.Do they apply to your center other than receiving information about clinical complaints?
About which topics do they mostly want to be informed?
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
15.Do you think that young people feel comfortable when they are talking about their complaints?
( ) Yes
( ) No
16.What do you think are the reasons for them to feel comfortable?
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
17.What do you think are the reasons for them not to feel comfortable?
(a)…………………………………………………………………………………………………
(b)………………………………………………………………………………………………….
(c)………………………………………………………………………………………………….
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18.When young people come to this center, if they want to receive any sexual/reproductive
health service what kind of procedure should they pass through? What do you think are the
positive and negative aspects of these procedures?
The things that should be done:
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
(d)…………………………………………………………………………………………………
(e)………………………………………………………………………………………………….
Positive aspects:
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
Negative aspects:
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
19.Do you think that young people need receive information and service specialized to their age
group about sexual and reproductive health?
( ) Yes ( If yes, 20th question will be asked)
( ) No
20.Can you indicate 3 fields of information that you think they need and is
important for them?
1.…………………………………………………………
2.…………………………………………………………
3.…………………………………………………………
21.Can you indicate 3 types of services that you think they need and is important for them?
1.…………………………………………………………
2.…………………………………………………………
3.…………………………………………………………
22.Can you emphasize 3 points that you think health personnel should pay attention while they
are providing sexual and reproductive health services to young people?
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
23.According to you, do these health personnel, while providing such a service, need special
knowledge? If you think they need what kind of knowledge is this?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
24.Do you think that the attitude of the health personnel who provide sexual
/reproductive health services to young people affects the decisions of young on receiving
or not receiving that service? Have you ever experienced such a case in your professional
life that can be an example for this?
( ) Yes it affects / It is affecting
( ) I don’t think so/I haven’t faced with such a case
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Sample case:
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……...................................................................................................................................................................................
25. From which strata do young people who apply to receive service come from? (region, the
department they study)
…………………………………………………………………………………………………
…………………………………………………………………………………………………
…………………………………………………………………………………………………
26. Do young woman or young men mostly apply to receive information and service?
( ) Especially young women
( ) Especially young men
( ) With the same ratio
27. Do you think that contraceptive methods should be provided to an unmarried young woman?
( ) Yes
( ) No
28.Do you think that contraceptive methods should be provided to an unmarried young man ?
( ) Yes
( ) No
29. While providing service and information to young people, do you think that behaving
differently to young woman and young man will be useful? Why?
…………………………………………………………………………………………………
…………………………………………………………………………………………………
………………………………………………………………………………………………….
30. Do you think that unmarried young people should be informed about sexual and
reproductive health? Can there be positive and negative consequences of this?
( ) Yes, information should be given
( ) No, there is no need
Positive aspects:………………………………………………………………………………
………………………………………………………………………………………………….
Negative aspects:
…………………………………………………………………………………………………
………………………………………………………………………………………………….
31. Do you think that parents should be informed before young people / adolescents are provided
services about contraception?
( ) Yes, they should be informed
( ) No, they shouldn’t be informed
32. Do you think that unwanted pregnancies (Ankara or Diyarbakır) increase among unmarried
young people?
( ) Yes, it increases last years
( ) No, I don’t have such an observation
112
33. Do you think that information/service should be provided to young people and adolescents
about sexually transmitted infections?
( ) Yes
( ) No
34. Can you indicate 3 tools that you think they can be used to inform young people about
sexual
and
reproductive
health
and
will
be
useful?
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
35. According to you what are the 3 basic qualities of an ideal service that will meet young
people’s
needs
about
sexual
and
reproductive
health?
(a)…………………………………………………………………………………………………
(b)…………………………………………………………………………………………………
(c)…………………………………………………………………………………………………
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