In Turkey, clients often do not receive family planning information, counseling, or services after they have had an abortion--even when it's clear that they wish to begin using a contraceptive method.

One of the most important findings of a 1994 study conducted in Turkey was that although nine out of ten women interviewed said they wanted to begin using some method of contraception following abortion, fewer than half actually left the facility with a method in hand.

The study showed that facilities missed many opportunities to provide family planning information and services to women after an abortion--even when staff were knowledgeable about the methods available.

As a follow-up to the study, AVSC is working to help improve linkages between postabortion and family planning services in Turkish clinics and hospitals. "All the resources are there," says John M. Pile, who was country representative for AVSC's Turkey Office before becoming the country director for AVSC programs in India this year. "The knowledge and skills are there; the clients are receptive."

Awareness of Methods
The 1994 study was commissioned by the Turkish Ministry of Health and was conducted by the Department of Public Health, Gazi University. AVSC International and the Population Council's Asia-Near East Operations Research/Technical Assistance Project provided technical and financial support.

The study looked at reproductive health services, including abortion, offered at a sampling of public and university service sites in seven Turkish provinces. AVSC is actively supporting the introduction of permanent and long-acting contraceptive methods at these sites. Researchers interviewed 194 postabortion clients and 24 staff members involved in postabortion services. Half the clients had undergone a previous abortion, and nearly 70% were using a contraceptive method when they got pregnant. More often than not, this method was withdrawal, although about half of the women had at one time used a modern contraceptive method.

The medical staff at the facilities where the abortions were performed were fully conversant with the contraceptive methods available. The 15 staff members who said they provide postabortion family planning services had, on average, received their last reproductive health training within one year of the interview. An average of nearly four years had elapsed for those who provided no such services.

Opportunities Exist
Most of the clients said they had a pre-abortion consultation at the facility during which the pregnancy was verified. An appointment was then made for the procedure. On the day of the abortion, clients were frequently accompanied by their spouses. Opportunities to discuss family planning options with clients occur at the time of initial contact (to verify the pregnancy), on the day of the abortion, prior to the procedure, and in the recovery area following the procedure.

Need for Linkages
If the opportunities exist, the clients are eager for the services, and the staff are knowledgeable about the methods available, why did fewer than half of the women leave with a family planning method?

The answer comes down to the provider. "What is lacking," said Pile, "is the will on the part of the providers to offer the necessary information or service. Public-sector physicians who also perform abortion in their private practices may have a financial disincentive to provide family planning services. Clearly, there is an indifference on the part of public hospitals to providing those services."

AVSC International is stressing the ease with which linkages between postabortion and family planning services can be made. "Simply speaking with the director of a facility can effect dramatic change," said Pile. "At one facility, about 80% of women left with a family planning method after the facility director decided to provide the pertinent information."

Funding for AVSC's work in Turkey is provided by the U.S. Agency for International Development.

This article is based on a paper presented at the Annual Meeting of the Population Association of America in New Orleans, May 1996. Enid Harlow is a freelance editor/writer for AVSC International.