Parteneri
Chapter 4. Knowledge, Perception and Values about Contraception and Abortion
Chapter 4. Knowledge, Perception and Values about Contraception and Abortion
4.1 Contraception
Generally speaking people have a benevolent attitude towards the question of contraception and deem it necessary. The survey has shown that a great number of those questioned have adequate knowledge regarding modern methods of contraception. Many interviewed women either used or use at present IUD and consider it acceptable. The majority of those questioned declared that they used condoms. Only few people consider combined oral contraception to be a well-known or used method. Withdrawal still remains a wide-spread method of contraception. At the same time a small number of those questioned knew nothing about contraception, even its notion, and never used any method.
People, including chemists, are inadequately informed about the urgent method of contraception.
There still exist some myths and wrong concepts regarding the principles and attitude towards contraception, both among the members of community and doctors, such as: pills provoke hormone distortion, cancer and “hair grow”; contraceptive coil cause infection, there are rectal suppositories with contraceptive effect, urine therapy can be used as a method of contraception…All these have an influence upon some men who do not allow their wives to use contraceptive pills or IUD on the grounds that they generate serious body alteration.
Interviewed young people are better instructed and easily predisposed to use modern methods of contraception than the older ones.
People still consider the price for contraceptives to be very high and, in fact, do not know how to obtain contraceptives free of charge.
The adolescents remarked on the lack of confidentiality regarding the means of obtaining and aquiring contraceptives, considering this a barrier against contraceptive use. They also requested to leave condoms for distribution in accessible and uncontrolled places within schools.
Evaluation team members noticed low interest in contraceptive methods on behalf of chemist’s owners: unlike other medicine, contraceptives are placed in inaccessible areas and buyers are treated with no respect. At the same time, chemists, having no adequate knowledge, offer abortion pills to women and fail to inform them about contraceptives correct usage.
Recommendation
- To improve the efficiency of IEC measures focusing on explaining the wrong concepts spread within the population
- To attract chemists to the reproductive health training course
- See Chapter Prevention
4.2 Abortion
Findings
The attitude towards the question of abortion is contradictory and varies from a strong belief that it is an usual and frequent thing to opinions that it should be forbidden basing on the fact that “society is constantly declining”. Abortion is regarded as a serious problem, even dangerous, but, under certain circumstances, inevitable.
The majority of those questioned, including doctors, believe that abortion of all types pose great risk to both health and reproduction, omitting the fact that an abortion performed in good conditions is not dangerous.
This opinion becomes more rigid in the case of a school girl pregnancy: considering the abortion more dangerous, the girl decides to give birth when very young, but afterwards, having brought shame upon herself, she is forced to leave the school and abandon her studies.
Abortion is considered a “taboo” theme and is not discussed openly in society. This fact was noticed by adolescents and by those questioned, which fact proves very little knowledge about abortion, as compared to contraception and sexually transmitted diseases. The information about abortion is reduced to the procedure of curettage as being very stressing and dangerous.
Abortion is also considered a “sin” of women and doctors as well. This point of view is conditioned by univocal attitude of the Orthodox Church representatives towards the question of abortion, which is regarded as a big sin, “homicide”. The same attitude towards contraception have clergymen, especially when IUD is used, and towards sexual intercourse within the fast period. Those women, who confessed that they had had abortion, are punished with canonization, often blamed in public and threatened to be banished from church if they do not change.
But still there are many other opinions. For example, a clergyman of high rank, with a rich spiritual life, declared that contraception is acceptable and preferable to an abortion, although it stands against any church canons: contraception is contradictory to all divine laws but, at least, it does not embody a murder. In case a couple cannot bring up a child, he is to procreate.
Some other church representatives regard the abortion as a homicide and a mortal sin, except those cases when pregnancy pose risk to woman’s life. The Penticostale Evangelist Church representatives sustain that the doctor also shares this sin, if the abortion is performed but for the reasons of saving a woman’s life.
True Life Stories:
Woman, 36, two children, widow: when we decided to marry, we went, first of all, to church in order to wed. The relatives from the village insisted. I was pregnant, 17 weeks already. When the clergyman found out, he sent us away and said that we committed a sin and I was to get rid of my pregnancy, and afterwards we could come to wed. I had the abortion but even today I cannot forgive myself.
At the same time some doctors remark that there are clergymen’s wives among their patients who resort to abortion and contraceptives as well.
Thus the evolution team has an impression that the minors and the young are brought up with religious beliefs but not authentic and efficient.
Women from rural areas say that they are against abortion, but if this refers to other women. While speaking about themselves they become more tolerant – “it happened, there was no other way out”.
Not a single woman speaks about it as a pleasant experience, but their recollections differ from being very stressing to quite ordinary and simple.
Nevertheless the majority of people agree that it is better to prevent and not to have an abortion.
Practically all those who render such kind of services noticed a significant reduction in the number of abortions, but they incline to explain this fact by emigration of women at the reproductive age and rather than by frequent usage of the family planning methods.
Recommendation
- To improve the efficiency of IEC measures focusing on explaining the wrong concepts spread within the population
- To hold seminars on reproductive health with church representatives in order to widen their knowledge, revise the values and standards of religious appeals towards the community.
4.3 The role of the partner
Findings
The evaluation team has also concluded that the partners, including the interviewed women’s husbands, play an important role in deciding between contraception or abortion. There has also been expressed an opinion that the number of abortion might be smaller if women found a greater support in their partners.
Generally speaking, it is considered that both partners should make such decisions as a result of their mutual accord. Nevertheless, there is an opinion that before marriage the decision regarding contraception belongs to partner, and afterwards – the wife decides it.
There has also been registered cases when the partner was against the contraception method used by woman; consequently, she was forced to resort confidentially to another method.
A nurse from a village said that men from socially vulnerable groups became violent on hearing about the contraception method suggested to their wives and forbade it; they also threatened doctors with physical violence in case doctors refused to withdraw IUD.
Some men think that only women should take full responsibility for abortion and prefer to stand aside.
Recently people who render these services in urban medical centers have noticed that women come often together with their partners asking for a piece of advice on contraception or abortion. This refers especially to adolescents.
Contrary to this phenomenon men from rural areas come seldom with their wives or partners to doctors.
It has been found out that sometimes men offer financial support for abortion to their partners.
There have been also registered several cases when men compel their wives to have an abortion or women themselves conceal this fact from partners.
Recommendation
- To improve the efficiency of IEC measures and to estimate health values and people rights for sexual life and reproduction within the population.
- To involve more men in the implementation of IEC measures, to attract NOG that examines gender problems.
4.4 The rights. The knowledge of legislation and regulatory documents
Findings
The legislation on abortion and reproductive health is well-known among those who render these services and is considered to be efficient and accessible. There is an opinion that before passing a law it is necessary to inform the public. It is believed that personal principles (subjectivism) are the decisive factors that influence law drafting and passing.
Regulatory documents reflecting this field are poorly known by obstetrician-gynecologists and even worse by family doctors. Ministry orders not always reach medical institutions. It is also possible that new dispositions are not carried out on the base of information and training lack.
The interviewed doctors expressed their opinion on II term criteria necessary to obtain an abort permission and which very often become barriers against rendering these services to women.
The population, especially from rural areas, is informed insufficiently about the legislation, although everybody knows that any woman can go to a doctor and obtain abort permission. The rules on having free family planning services or abortion, on categories, the regulations on how and where women can ask for these services are practically unknown.
The interviewed people declared that the situation in this field was not satisfactory, but it could be improved with the eradication of extortion.
The administrative local authorities from districts under survey possess vague knowledge about legislation on reproductive health, about MoH regulatory documents; they do not have information about reproductive health of the community, do not cooperate with health public institutions and even do not take it as a necessary premise.
Quotation: Mayoress: only women should take full responsibility for undesirable pregnancy: “Nobody tries to violate me. Why?”, “Everybody is responsible for his life, there is no sympathy”.
Nevertheless some representatives of public local authority showed interest in a close cooperation, considering that health managers should greatly collaborate in solving this problem. They also said that they could offer financial support to MFC if they had these institutions subordinated. A number of them think that it is important to develop a system of records, supervision and sexual education for those children whose parents work abroad. Apparently mayors are reliable partners in the question of health program cooperation (especially concerning financial support).
Recommendation
- To introduce information about legislation and regulatory documents in the agenda of IEC seminars for population and of training seminars for those who render services at all levels, administrative local authority representatives, and to provide all institutions with necessary documents.
- To form and train a monitoring system for regulatory documents learning and implementation of dispositions.