
==== Front
BMC Womens Health
BMC Womens Health
BMC Women's Health
1472-6874
BioMed Central London

39245745
3330
10.1186/s12905-024-03330-6
Research
Determinants of the desire to avoid pregnancy after the disaster of the century in Türkiye
http://orcid.org/0000-0003-1906-9537
Özşahin Zeliha zeliha.ozsahin@inonu.edu.tr

https://ror.org/04asck240 grid.411650.7 0000 0001 0024 1937 Department of Midwifery, Faculty of Health Sciences, Inonu University, Malatya, Turkey
9 9 2024
9 9 2024
2024
24 49622 4 2024
23 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

After natural disasters, the occurrence of mental health problems and adverse effects on reproductive health in women of reproductive age can be attributed to a multitude of factors, including the deterioration of health facilities, a shortage of qualified health professionals, a lack of socio-economic stability, and a paucity of familial and community support.

Methods

The descriptive correlational study was conducted through social networks with 405 women who had experienced the disaster of the century 8 months after (between November and December 2023) the earthquake. The snowball sampling method was used to obtain the research data. The questionnaire form, developed for the purpose of data collection, was disseminated to women who consented to participate in the study through social networks. The data were evaluated using a variety of statistical techniques, including number, percentage, mean, standard deviation, independent sample t-test, one-way analysis of variance, and structural equation modeling.

Results

According to the results of linear regression analysis, these were found to be predictors of the desire to avoid pregnancy: having housing problems (β-coefficient 0.173; p = .008), having a damaged home (β-coefficient. 276; p = .009), sleep patterns (β-coefficient 0.433; p = .022), eating habits (β-coefficients 0.248, 0.044), use of psychiatric medication (β-coefficient 0.436, p = .003), and problems related to the food and water supply (β-coefficient 0.127, p = .003). In addition, a structural equation model (SEM) was established to examine the relationship between these variables and mental well-being and pregnancy avoidance. Only the model constructed with mental well-being demonstrated significance in the SEM analysis.

Conclusions

This study shows that women’s mental health is negatively affected in unpredictable emergencies such as earthquakes and that poor mental health negatively affects pregnancy planning. The findings of the study may help to guide health professionals working in the field of women’s health to protect women’s mental health in emergency situations, to provide counseling about pregnancy planning, and to provide social and psychological support programs.

Keywords

Earthquake disaster
Woman’s health
Mental well-being
Desire to avoid pregnancy
issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcBackground

Earthquakes are a common and destructive phenomenon across the globe. They are among the most frequent natural disasters with the potential to cause significant destruction [1]. The earthquakes that occurred in Pazarcık and Elbistan, districts of Kahramanmaraş province in Turkey, on February 6, 2023, had a magnitude of 7.8 Mw and 7.5 Mw, respectively, and occurred within an interval of 9 h. These earthquakes were recorded as the most massive earthquake of Turkey with the highest intensity level, XII (cataclysmic), according to the Mercalli scale [2]. The two major earthquakes that struck Turkey on February 6, 2023, had a significant impact on several provinces, with Kahramanmaraş, Adıyaman, Hatay, and Malatya being among the most severely affected regions. Given the extensive geographical scope of the earthquake-affected region, there were inevitable delays in the provision of essential services, with some locations only accessible after a few days [3]. Additionally, a considerable number of women were compelled to reside outside of their homes, separated from their spouses and families. Many of these women lost their loved ones or were forced to endure extended periods of uncertainty, awaiting the rescue of their relatives who were trapped beneath the rubble of the earthquake for days on end [4, 5]. The region was subjected to considerable damage to its infrastructure. As indicated in the official data, the premises of a total of 42 hospitals affiliated with the Ministry of Health of Turkey (comprising 27 public hospitals, 6 university hospitals, and 9 private hospitals) were severely or moderately damaged by earthquakes. Conversely, 35 field hospitals were established across the region [6].

The occurrence of natural disasters gives rise to a number of short-term and long-term health issues, with a range of effects on human health. Furthermore, these disasters present a significant threat to public health [7, 8]. The World Health Organization (WHO) has indicated that natural disasters, such as earthquakes, have the potential to precipitate mental health issues, with the risk of exacerbation in the future. According to the WHO, one in five individuals who do not receive assistance in the aftermath of such disasters may develop mental health concerns within a decade [8]. The WHO further notes that poor mental health can give rise to a range of adverse outcomes, including fear, stress, post-traumatic stress disorder (PTSD), and depression [9].

The hypothesis that preexisting gender and socioeconomic inequalities were deepened even further along with disasters has been put forth by several researchers [9]. There is a substantial body of evidence indicating that women are affected by natural disasters to a greater extent than men. This evidence suggests that women are more vulnerable to the effects of natural disasters than men [10–13]. For example, women are more vulnerable than men in the context of disasters, with increased exposure to violence, sexual harassment, disease, and psychological trauma [14]. The average lifespan of women is shortened by natural disasters to a greater extent than that of men. Furthermore, the low socioeconomic status of women exacerbates the lethal impact of disasters on women [15]. It is evident that reproductive-related hormonal developments are adversely impacted during traumatic periods, such as disasters, which can precipitate or exacerbate mental health issues and anxiety disorders [16]. Some researchers posit that greater attention should be devoted to addressing the reproductive needs of women in the aftermath of natural disasters [17–19]. The occurrence of disasters can serve to enhance the susceptibility of individuals to unfavorable outcomes with respect to reproductive health. This is due to the fact that such events often result in a reduction of access to reproductive health services, which can be attributed to the damage sustained by health facilities and the subsequent scarcity of available health professionals [20]. A study conducted in the aftermath of the 2018 Indonesian earthquake revealed that women’s desire for pregnancy was influenced by several factors, including age, the number of previous pregnancies, and the contraceptive method employed [20]. In the aftermath of the global spread of the COVID-19, the desire of women to avoid pregnancy increased [21]. The evidence indicates that alterations in brain function resulting from disasters are among the causes of physiological and psychological stress [22]. Mental health and reproductive health are significant factors that contribute positively to the general well-being of women [23]. Mental health issues have been linked to a reduction in contraceptive use and an increase in unplanned pregnancies [18, 24, 25]. It has been posited that poor mental health is both a cause and consequence of unwanted pregnancies. It has been asserted that women with poor mental health have been unable to select the appropriate contraceptive method and engage in sound pregnancy planning, resulting in a greater number of unwanted pregnancies [26, 27]. To the best of our knowledge, this is the first study to examine women’s desire to avoid pregnancy after the earthquake together with their mental health and the negative conditions caused by the earthquake. Therefore, it is thought that the results of the study will make important contributions to the field.

The objective of this study was to identify the factors that influence the desire for pregnancy among women of reproductive age in Türkiye in the aftermath of the disaster of the century that occurred in the country.

Research questions

Do earthquake-induced adverse events affect the desire to avoid pregnancy?

Does post-earthquake mental well-being affect the desire to avoid pregnancy?

Methods

Research design and sample

This correlational survey study was conducted between November and December 2023. The study included women who experienced the Kahramanmaraş earthquakes in Turkey. In the study, the correlational survey model was utilized to analyze the interactions between two or more variable sets in a multifaceted manner including direct and indirect effects [28]. The study population consisted of women of reproductive age residing in the four provinces most severely impacted by the Kahramanmaraş earthquake, namely Kahramanmaraş, Hatay, Adıyaman, and Malatya. The minimum sample size for the research was calculated with G*Power 3.1.9.2, with the mean Desire to Avoid Pregnancy Scale score in the study by Güney and Okyay serving as the reference point [29]. In this regard, the minimum sample size was calculated as 358 women in the power analysis with an effect size of 0.26, a margin of error of 5%, a confidence interval of 95%, and a power of 80% to represent the population. In light of the potential for data loss during the research process, the study was conducted with a total of 405 women who consented to participate. Since the study data were collected from the four provinces most severely affected by the earthquake, the data were collected via an online form.

In order to obtain the requisite research data, the snowball sampling method was employed. This method is utilized in instances where it is challenging to gain access to the individuals who constitute the research population, or when data such as the population size are unavailable [30, 31]. The advantages of this sampling method include an increase in the amount of data collected and a focus on critical cases [32]. Upon responding to the research questions, the women who had consented to participate in the study were requested to disseminate the survey link to other women whom they were aware would meet the inclusion criteria for the study. The researcher employed an online survey form created using her personal Google account for the purpose of data collection. The survey link was disseminated to women who had consented to share the survey form with other women through social networks (WhatsApp, Facebook, X, and Instagram). In the initial phase of the study, the researcher sent the survey link to the women she was acquainted with directly or indirectly in the four provinces through the aforementioned social networks. The women who were reached in this manner were then asked to disseminate the survey link to their acquaintances. The women were required to meet several criteria in order to be included in the research. These criteria included being aged 18 years or above, residing in one of the four Turkish provinces that had been most affected by the Kahramanmaraş earthquakes, being sexually active, not pregnant, using a smartphone, having an internet connection, and voluntarily agreeing to participate in the study. In contrast, the research excluded women who were pregnant or sexually inactive.

Data collection tools

The Personal Information Form, the Warwick-Edinburgh Mental Well-Being Scale, and the Desire to Avoid Pregnancy Scale were utilized to collect research data.

Personal information form

In the aftermath of a seismic event, women are confronted with a multitude of challenges, including economic deprivation, difficulties in accessing health facilities, shelter, and hygiene problems, in addition to reproductive health concerns [23, 33, 34]. These issues have the potential to give rise to mental health concerns among women [23]. In view of this information, the personal data form was developed to include 23 questions based on an analysis of the relevant literature.

Warwick-Edinburgh mental well-being scale [WEMWBS

The WEMWBS comprises 14 items and assesses an individual’s positive mental health by examining psychological and subjective well-being. It is a five-point Likert-type scale [1: strongly disagree – 5: strongly agree], and the scare range of the scale is 14–70 points. In this study, a minimum score of 14 and a maximum score of 70 were obtained. The WEMWBS does not include any inverse items. Gökay Keldal conducted a validity and reliability study to create its Turkish form in 2015 [35]. In this research, the Cronbach’s alpha coefficient was employed as a measure of internal consistency, with a value of 0.945 obtained for the WEMWBS.

Desire to avoid pregnancy [DAP] scale

Rocca et al. [2019] developed the DAP Scale. Subsequently, Okyay et al. conducted a validity and reliability study to create its Turkish form. It was developed with the objective of prospectively measuring the range of a sexually active woman’s preferences for a likely pregnancy in the future, as well as identifying the woman’s desire to avoid pregnancy. The DAP Scale, comprising 14 items, included five items pertaining to the woman’s feelings and thoughts about conceiving a baby in the next three months and nine items concerning her feelings and thoughts about having a baby in the next year. The minimum score on the scale is 0 and the maximum score is 4. In this study, the minimum score was 0 and the maximum score was 4. A high DAP Scale score indicates that the respondent has a strong desire to avoid pregnancy. The Cronbach’s alpha coefficient, which is a measure of internal consistency, was reported as 0.94 for the Turkish form of the scale [36]. In this study, the Cronbach’s alpha coefficient was found to be 0.92 for the DAP Scale.

Data collection

The data were gathered via online sources by the researcher between November and December of 2023.

Data evaluation

The research data were analyzed by using the Statistical Package for Social Science (SPSS) 25.0. The Kolmogorov-Smirnov test was utilized to find whether the research data exhibited a normal distribution [37]. Prior to conducting the multivariate analysis, it was first necessary to ascertain whether the multiple variables in question were normally distributed. The calculated skewness value for the model was 7.124, which was below 8. Consequently, multiple variables were deemed to be normally distributed [38].

To establish a basis for comparison, a cut-off point of 0.05 was set for statistical significance (p < .05). As the variables were normally distributed (p > .05), the subsequent analyses were conducted using parametric tests. Descriptive statistics for variables were expressed as numbers, percentages, means, and standard deviations. To ascertain whether there were differences between the groups, an independent samples t-test and one-way analysis of variance were employed. To determine the relationship between mental well-being and the desire to avoid pregnancy, structural equation modeling was utilized. Cronbach’s alpha coefficient was utilized to test the reliability of the scales used in the study. The t-test and one-way analysis of variance (ANOVA) were used as comparative tests. A simple linear regression analysis was used to ascertain whether the variables could predict DAP. Subsequently, a Structural Equation Model (SEM) analysis was performed was conducted using AMOS 24.0.

Ethical considerations

Prior to the commencement of the study, approval for the research project was granted by the Scientific Research and Publications Ethics Committee of Inonu University of Türkiye. Prior to the collection of research data, prospective participants were informed about the study, and subsequently, expressed their informed consent in an online format (Google Forms) to participate in the study. The research was conducted in accordance with the tenets set forth in the Helsinki Declaration.

Results

The mean age of the female participants was determined to be 31.47 ± 7.74 years. Additionally, 61.7% of the female participants had obtained a university degree, while 54.6% were not currently employed. The majority of participants (70.6%) reported a medium-level income, with the majority (71.6%) residing in the provincial center. The majority of participants (74.1%) had at least one child, with 20% having a child below the age of two. It was determined that 51.9% of the subjects exhibited alterations in their menstrual cycles, 53.3% demonstrated prolonged menstrual cycles, 59.3% exhibited an increase in the number of days during which they had menstrual bleeding, 34.6% exhibited intermenstrual bleeding, and 45.2% encountered difficulties in accessing hygienic pads (Table 1).

Table 1 Socio-demographic characteristics and menstrual cycles experienced by the participants after the earthquake

Variable n	n	%	
Age			
< 35	289	71.4	
≤ 35	116	28.6	
mean ± sd	31.47 ± 7.74		
Education level			
Primary education	66	16.3	
High School	89	22.00	
University and above	250	61.7	
Employment status			
Working	184	45.4	
Not working	221	54.6	
Perceived income status			
High	83	20.5	
Middle	256	70.6	
Low	36	8.9	
Place of Residence			
Province	290	71.6	
District	87	21.5	
Village-Town	28	6.9	
Do you have children			
Yes	300	74.1	
No	105	25.9	
Do you have children under 2 years old?			
Yes	81	20	
No	324	80	
Has your menstrual cycle changed?			
Yes	210	51.9	
No	195	48.1	
Did your cycle duration change?			
No, there was no change.	77	19	
Yes it decreased	112	27.7	
Yes increased	216	53.3	
Has your number of bleeding days changed?			
No, there was not	77	19	
Yes it decreased	88	21.7	
Yes increased	240	59.3	
Have you had spotting in between?			
Yes	140	34.6	
No	265	65.4	
Have you had problems accessing sanitary pads?			
Yes	183	45.2	
No	222	54.8	
Total	405	100	

Furthermore, it was determined that 49.4% of individuals residing in the Malatya province of Turkey had experienced earthquakes. As a result of these seismic events, 65.4% of the population had sustained damage to their residences, 35.3% had been compelled to relocate to alternative accommodations, 52.4% encountered challenges related to their housing, and 29.2% were residing in temporary shelters, such as tents or container houses. A total of 5% of the respondents reported difficulties in accessing food and beverages, while 92.3% experienced changes in their sleep patterns. Additionally, 78.8% of the respondents indicated alterations in their dietary habits, 62.5% reported changes in their physical activity levels, and 38.3% lost a relative or relatives. Furthermore, 14.1% of the respondents started using psychiatric medications during the post-earthquake period. The mean DAP Scale scores for women who experienced accommodation problems, women whose houses were damaged by earthquakes, women who experienced changes in sleep patterns, women who experienced changes in dietary habits, women who used psychiatric medications, and women who experienced problems finding food and beverages were all lower than the respective mean scores for other groups of women who did not experience such problems (Table 2).

Table 2 Comparison and percentage distribution of mean DAP scores of independent variables

In which province did you experience the earthquake?	n	%	DAP/Mean/SD	Test ve p değeri	
Kahramanmaras	66	16.3	1.524 ± 1.030	F = 1.990	
Malatya	200	49.4	1.630 ± 0.971	p = 0.115	
Adiyaman	95	23.5	1.331 ± 1.067		
Hatay	44	10.9	1.626 ± 1.033		
Was your home damaged?					
Yes	140	34.6	1.447 ± 1.003	t=-0.266	
No	265	65.4	1.723 ± 1.014	p = 0.009	
Did you have to go somewhere else?					
Yes	143	35.3	1.481 ± 0.980	t=-1.647	
No	262	64.7	1.654 ± 1.069	p = 0.100	
Did you have any housing problems?					
Yes	212	52.4	1.411 ± .938a	F = 3.876	
No	120	29.6	1.664 ± 1.038b	p = 0.022

a < b

	
Sometimes	73	18	1.724 ± 1.140		
Where did you stay?					
Home	215	53.1	1.543 ± 1.016	F = 980	
Container	91	22.5	1.475 ± 0.991	p = 0.418	
Tent	27	6.7	1.420 ± 0.844		
Both tent and house	59	14.6	1.744 ± 1.108		
Both container and house	12	3	1.279 ± 1.047		
Did you have problems accessing food and beverages?					
Yes	144	35.6	1.389 ± .945a	F = 4.814	
No	160	39.5	1.523 ± .990b	p = 0.009	
Sometimes	101	24.9	1.792 ± 1.106c	c > b > a	
Has your sleep pattern changed?					
Yes	374	92.3	1.509 ± 1.004	t=-2.189	
No	31	7.7	1.9424 ± 1.062	p = 0.022	
Have your eating habits changed?					
Yes	319	78.8	1.489 ± 1.002	t=-1.982	
No	86	21.2	1.738 ± 1.039	p = 0.044	
Has your physical activity level changed?					
Yes, it decreased	253	62.5	1.5152 ± 0.992	F = 951	
Yes increased	56	13.8	1.4605 ± 1.03	p = 0.387	
Unchanged	96	23.7	1.6629 ± 1.04		
Have you lost someone close to you?					
Yes	155	38.3	1.4899 ± 0.98677	t=-0.833	
No	250	61.7	1.5754 ± 1.032	p = 0.410	
Did you use antidepressants after the earthquake?					
Yes	57	14.1	1.1679 ± 0.852	t=-3.039	
No	348	85.9	1.6041 ± 1.026	p = 0.003	
Change in menstrual cycle					
Yes	210	51.9	1.502 ± 1.01	t=-0.829	
No	195	48.1	1.586 ± 101	p = 0.407	
Total	405	100			
DAP: Desire to Avoid Pregnancy, SD: standard deviation, t: independent samples t-test, F: ANOVA test

As indicated in Table 3, there was no correlation between the desire to avoid pregnancy and the province where earthquakes were experienced, the place of residence, the status of experiencing changes in the physical activity level, and the status of experiencing changes in the menstrual cycle. On the other hand, there were correlations between the desire to avoid pregnancy and other variables. Consequently, a linear regression analysis was conducted, based on these correlations, to ascertain the model. Findings demonstrate that, in the post-earthquake period, women who experienced accommodation problems, women whose houses were damaged by earthquakes, women whose sleeping patterns changed, women whose dietary habits changed, women who were using psychiatric medications, and women who experienced problems accessing food and beverages had a lower desire to avoid pregnancy.

Table 3 Results of linear regression analysis of DAP on significant variables

Independent Variable	β1	β2	p	t	R 2	
Having a housing problem	0.131	0.173	0.008*	2.652	0.017	
Damage to the house	0.130	0.276	0.009*	2.625	0.017	
Having to go somewhere else	0.082	0.172	0.100	1.647	0.007	
Change in sleep patterns	0.114	0.433	0.022*	2.295	0.013	
Change in eating habits	0.100	0.248	0.044*	2.023	0.010	
Change in physical activity	0.053	0.064	0.284	1.074	0.003	
Losing a loved one	0.041	0.086	0.410	0.825	0.002	
Use of psychiatric medication after the earthquake	0.150	0.436	0.003*	3.039	0.022	
Problems accessing food and beverages	0.149	0.127	0.003*	3.035	0.022	
Where he lived after the earthquake	0.022	0.019	0.657	0.444	0.000	
Change in menstrual cycle	0.041	0.084	0.407	0.829	0.002	
β1; Standardized regression coefficients, β2; Unstandardized regression coefficients, *p < 0,05; t test result for the significance of the regression coefficients; DAP: Dependent variable

Results of the structural equation modeling analysis

The objective of the SEM was to analyze the relationship between the variables and mental well-being and the desire to avoid pregnancy. The results of the SEM analysis indicated that only the model established with mental well-being was significant (Fig. 1).

Fig. 1 The diagram on the Structural Equation Modeling about the relationship between mental well-being and the desire to avoid pregnancy

In the model, mental well-being is the independent variable, the desire to avoid pregnancy is the dependent variable, and e1 refers to the residual. Table 3 presents the coefficients associated with the model.

Discussion

A review of the relevant literature revealed that women faced challenges related to accommodation and hygiene in the post-disaster period [26, 39]. Additionally, the present study revealed that a considerable proportion of women experienced earthquake-related damage to their residences, necessitating relocation. They encountered challenges in accessing food and beverages, alterations in their sleep patterns and dietary habits, reductions in their physical activity levels, and the loss of family members due to the earthquakes (Table 2). Such circumstances have been linked to an increased prevalence of mental health issues, including anxiety and depression, among women who have experienced earthquakes [23].

In the current research, a significant proportion of the participants exhibited alterations in their menstrual cycles, including prolonged menstrual cycles, an increase in the number of days during which they had menstrual bleeding, and the onset of intermenstrual bleeding (Table 1). A study conducted in the aftermath of the Wenchuan earthquake revealed that 30% of the female participants exhibited alterations in their menstrual cycles, with this phenomenon being more prevalent among those who had lost a child [40]. In a subsequent study conducted in the aftermath of the Wenchuan earthquake, it was observed that the duration of menstrual cycles exhibited a reduction among young women who were concurrently experiencing psychological distress [41]. It is acknowledged that alterations in the menstrual cycle may be linked to a number of factors, including stress. However, in the context of the present study, it is proposed that the stress induced by earthquakes is influenced by the variables that have been subjected to investigation. In instances of stress, the release of gonadotropins and gonadal steroid hormones is inhibited, which subsequently results in the disruption of the typical menstrual cycle. Prolonged exposure to stress can lead to complete deterioration of reproductive function [42]. As a matter of fact, natural disasters such as earthquakes, hurricanes, and floods can precipitate the onset of post-traumatic stress disorder [43]. In this context, it can be stated that the results of the current study are consistent with the results reported in the relevant literature.

Moreover, it was discerned that the mean WEMWBS score obtained by women experiencing the earthquakes in the current study was 10–15 points lower than those obtained in studies conducted in the same region before the earthquakes [44, 45]. A meta-analysis study revealed the presence of post-traumatic stress disorder among survivors in the aftermath of the earthquake [46]. Considering that socioeconomic problems experienced along with changes in reproductive health in the post-earthquake period would lead to the emergence of clinical depression and anxiety [25], it can be said that the result of the current research is consistent with the relevant literature. Additionally, our findings are corroborated by the fact that 14.1% of the female participants responded affirmatively to the inquiry: “Did you start to use any psychiatric medication in the post-earthquake period?”.

Furthermore, in comparing the mean DAP Scale scores of women in relation to the negative experiences they encountered in the post-earthquake period, it was observed that women who faced challenges in securing accommodation, women whose houses were damaged by earthquakes, and women who experienced changes in their daily routines exhibited lower DAP Scale scores than those who did not experience these problems. Additionally, women who experienced disturbances in their sleep patterns, women who experienced changes in their dietary habits, and women who used psychiatric medications exhibited lower mean DAP Scale scores than those who did not experience such problems. These differences between groups were statistically significant (Table 2). The results of the linear regression analysis were also in line with those of this analysis (Table 3).

The results of the analysis based on structural equation modeling revealed that mental well-being affected the desire to avoid pregnancy (Fig. 1). It is hypothesized that exposure to adverse circumstances may contribute to a decline in the mental well-being of women, which in turn may influence their decision to avoid pregnancy. The current research yielded a noteworthy result: it was hypothesized that women would be unlikely to consider becoming pregnant in the aftermath of such catastrophic earthquakes. Besides, a review of the relevant literature reveals that women with poor mental health are significantly more likely to engage in unsafe sexual practices, avoid using contraceptive methods [25, 46], fail to make healthy pregnancy planning, and are at an elevated risk of experiencing an unwanted pregnancy [26]. The results of the study conducted in the aftermath of the earthquake indicated that there was a correlation between pregnancy desire and several factors, including age, previous pregnancies, and contraceptive history [20]. A study conducted in Türkiye after the earthquake revealed a decline in contraceptive use among women and a reduction in the frequency of sexual intercourse [47]. It has been demonstrated that unplanned pregnancies result in a reduction in the level of antenatal care and birth assistance received by the mother, and an increase in the incidence of miscarriage and perinatal mortality [25, 48]. In light of the aforementioned findings, it is evident that politicians and service providers must prioritize the needs of women in the context of natural disasters.

Strengths and limitations of the research

Given that the research was conducted by a female academic based in a province that has been most severely affected by earthquakes, it is highly probable that her interpretations of the research results accurately reflect reality. A further strength of this study is that it makes a significant contribution to the development of the relevant literature on pregnancy intentions following earthquakes, a topic that has been under-researched to date. The present study is limited by its reliance on an interview form to examine women’s menstrual cycle characteristics, which has not yet been tested for validity and reliability. Additionally, the inability to generalize the findings to the entire population and the collection of data exclusively online introduce further limitations to the study. The researcher encountered difficulties in accessing the volunteer participants due to the logistical challenges of conducting the research in the region most affected by the earthquake. The aforementioned circumstances precluded the extrapolation of the findings to the entire population. It is therefore imperative to conduct longitudinal studies with a substantial number of participants. Furthermore, it is essential to ascertain the reasons behind women’s decisions to become pregnant or to refrain from doing so through in-depth qualitative research.

Conclusion

The mental health of women of reproductive age is negatively affected by the unfavorable conditions experienced in the post-earthquake period. Poor mental health can lead to unhealthy pregnancy planning. Therefore, health professionals working in the field of women’s health should provide family planning counseling to women who experienced the earthquake. They should also facilitate referrals to specialists for mental health interventions.

Acknowledgements

I would like to thank the women who participated in the study and Assoc. Prof. Dr. Feyza İnceoğlu for providing statistical support.

Author contributions

Z.Ö conducted all stages of the research.

Funding

All costs of the study were covered by the researcher.

Data availability

On request, the author can provide the data if she sees fit.

Declarations

Ethics approval and consent to participate

Ethical endorsement for the research was obtained from the Scientific Research and Publications Ethics Committee of XXXX University of Türkiye. The data are kept in a way that only the researcher can access.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References

1. Erdoğan B Depremin Sosyolojisi: 6 Şubat Felaketinin Toplumsal ve Kültürel Boyutları TRT Akademi 2023 8 18 718 25 10.37679/trta.1306900
Erdoğan B. Depremin Sosyolojisi: 6 Şubat Felaketinin Toplumsal ve Kültürel Boyutları. TRT Akademi. 2023;8(18):718–25.10.37679/trta.1306900
2. AFAD. February 06 2023 Pazarcık (Kahramanmaras) MW 7.7 Elbıstan (Kahramanmaraş) MW 7.6 Earthquakes Prelımınary Evaluatıon Report.https://deprem.afad.gov.tr/assets/pdf/Kahramanmaras%20%20Depremleri_%20On%20Degerlendirme%20Raporu.pdf
3. Merve Koç, Yalçın S Afetlerde Krize Müdahale: Kahramanmaraş Depremi’Nde Aile ve Sosyal Hizmetler Bakanlığı’nın Çalışmaları Uluslararası Sosyal Hizmet Araştırmaları Dergisi 2023 3 2 93 105 10.57114/jswrpub.1257945
Merve Koç, Yalçın S. Afetlerde Krize Müdahale: Kahramanmaraş Depremi’Nde Aile ve Sosyal Hizmetler Bakanlığı’nın Çalışmaları. Uluslararası Sosyal Hizmet Araştırmaları Dergisi. 2023;3(2):93–105.10.57114/jswrpub.1257945
4. Topcu EG. Disaster preparedness: the effects of natural disasters on women’s health in Turkey. Int J Gynaecol Obstet. 2023;X10.1002/ijgo.15149.
5. One month has passed since the earthquakes centered in Kahramanmaraş. What aid has been provided in the region so far and what are the criticisms?https://tr.euronews.com/2023/03/05/kahramanmaras-depremleri-hakkinda-neler-biliniyor
6. Uzun N The February 6 Kahramanmaraş Earthquake and Field hospitals Türk Nöroşir Derg 2023 33 2 142 3
Uzun N. The February 6 Kahramanmaraş Earthquake and Field hospitals. Türk Nöroşir Derg. 2023;33(2):142–3.
7. Kohan S Yarmohammadian MH Bahmanjanbeh F Haghshenas A Consequences of earthquake (August 2012) on Iranian women’s reproductive health: a qualitative study Acta Med Mediterranea 2016 32 1503
Kohan S, Yarmohammadian MH, Bahmanjanbeh F, Haghshenas A. Consequences of earthquake (August 2012) on Iranian women’s reproductive health: a qualitative study. Acta Med Mediterranea. 2016;32:1503.
8. WHO. 2023. Delivering effective and accountable mental health and psychosocial support (MHPSS) during emergencies and beyond.https://www.who.int/news-room/feature-stories/detail/delivering-effective-and-accountable-mental-health-and-psychosocial-support-(mhpss)-during-emergencies-and-beyond
9. Sohrabizadeh S Tourani S Khankeh HR Women and health consequences of natural disasters: challenge or opportunity? Women Health 2016 56 8 977 93 10.1080/03630242.2016.1176101 27135961
Sohrabizadeh S, Tourani S, Khankeh HR. Women and health consequences of natural disasters: challenge or opportunity? Women Health. 2016;56(8):977–93. 10.1080/03630242.2016.1176101.27135961 10.1080/03630242.2016.1176101
10. Behrman JA Weitzman A Effects of the 2010 Haiti earthquake on women’s reproductive health Stud Fam Plann 2016 47 1 3 17 10.1111/j.1728-4465.2016.00045.x 27027990
Behrman JA, Weitzman A. Effects of the 2010 Haiti earthquake on women’s reproductive health. Stud Fam Plann. 2016;47(1):3–17. 10.1111/j.1728-4465.2016.00045.x.27027990 10.1111/j.1728-4465.2016.00045.x
11. Fatema SR, Islam MS, East L, Usher K. Women’s health-related vulnerabilities in natural disasters: a systematic review protocol. BMJ open. 2019; 9(12).
12. Murakami K Ishikuro M Obara T Traumatic experiences of the Great East Japan Earthquake and postpartum depressive symptoms: the Tohoku Medical Megabank Project Birth and three-generation cohort study J Affect Disord 2023 320 461 7 10.1016/j.jad.2022.09.139 36191647
Murakami K, Ishikuro M, Obara T, et al. Traumatic experiences of the Great East Japan Earthquake and postpartum depressive symptoms: the Tohoku Medical Megabank Project Birth and three-generation cohort study. J Affect Disord. 2023;320:461–7.36191647 10.1016/j.jad.2022.09.139
13. Kipay SS Earthquake reality and its effects on women’s health. İzmir Kâtip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 2023 8 2 855 60
Kipay SS. Earthquake reality and its effects on women’s health. İzmir Kâtip Çelebi Üniversitesi Sağlık. Bilimleri Fakültesi Dergisi. 2023;8(2):855–60.
14. Shooshtari S Abedi MR Bahrami M Samouei R The mental health needs of women in natural disasters: a qualitative study with a preventive approach J Family Med Prim Care 2018 7 678 83 10.4103/jfmpc.jfmpc_333_17 30234037
Shooshtari S, Abedi MR, Bahrami M, Samouei R. The mental health needs of women in natural disasters: a qualitative study with a preventive approach. J Family Med Prim Care. 2018;7:678–83.30234037 10.4103/jfmpc.jfmpc_333_17
15. Neumayer E Plu¨mper T The Gendered Nature of Natural disasters: the impact of Catastrophic events on the gender gap in Life Expectancy, 1981–2002 Ann Assoc Am Geogr 2007 97 3 551 66 10.1111/j.1467-8306.2007.00563.x
Neumayer E, Plu¨mper T. The Gendered Nature of Natural disasters: the impact of Catastrophic events on the gender gap in Life Expectancy, 1981–2002. Ann Assoc Am Geogr. 2007;97(3):551–66.10.1111/j.1467-8306.2007.00563.x
16. Driscoll JW Recognizing women’s common mental health problems: the earthquake assessment model J Obstetric Gynecologic Neonatal Nurs 2005 34 2 246 54 10.1177/0884217505274701
Driscoll JW. Recognizing women’s common mental health problems: the earthquake assessment model. J Obstetric Gynecologic Neonatal Nurs. 2005;34(2):246–54. 10.1177/0884217505274701.10.1177/0884217505274701
17. Martine G, Guzmán JM. Populatıon, poverty, and vulnerabılıty: mıtıgatıng the effects. Environ Change Secur Project Rep. 2002; (8), 45.
18. Nour NN. Maternal health considerations during disaster relief. Reviews in Obstetrics and Gynecology. 2011; 4(1): 22. PMID: 21629495.
19. Ellington SR Kourtis AP Curtis KM Contraceptive availability during an emergency response in the United States J Women’s Health 2013 22 3 189 93 10.1089/jwh.2012.4178
Ellington SR, Kourtis AP, Curtis KM, et al. Contraceptive availability during an emergency response in the United States. J Women’s Health. 2013;22(3):189–93. 10.1089/jwh.2012.4178.10.1089/jwh.2012.4178
20. Rahman A, Giyarsih SR, Murti B, Santosa SH. Desire to have children reviewed from reproductive health as the ımpact of natural disasters in Palu, Indonesia. Int J Sustainable Dev Plann, 2023; 18(8).
21. Druetz T Cooper S Bicaba F Bila A Shareck M Milot D-M Change in childbearing intention, use of contraception, unwanted pregnancies, and related adverse events during the COVID-19 pandemic: results from a panel study in rural Burkina Faso PLOS Glob Public Health 2022 2 4 e0000174 10.1371/journal.pgph.0000174 36962234
Druetz T, Cooper S, Bicaba F, Bila A, Shareck M, Milot D-M, et al. Change in childbearing intention, use of contraception, unwanted pregnancies, and related adverse events during the COVID-19 pandemic: results from a panel study in rural Burkina Faso. PLOS Glob Public Health. 2022;2(4):e0000174. 10.1371/journal.pgph.0000174.36962234 10.1371/journal.pgph.0000174
22. Torche F Kleinhaus K Prenatal stress, gestational age and secondary sex ratio: the sex-specific effects of exposure to a natural disaster in early pregnancy Hum Reprod 2012 27 2 558 67 10.1093/humrep/der390 22157912
Torche F, Kleinhaus K. Prenatal stress, gestational age and secondary sex ratio: the sex-specific effects of exposure to a natural disaster in early pregnancy. Hum Reprod. 2012;27(2):558–67. 10.1093/humrep/der390.22157912 10.1093/humrep/der390
23. Anwar J Mpofu E Matthews LR Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience BMC Public Health 2011 11 1 1 13 10.1186/1471-2458-11-523 21199570
Anwar J, Mpofu E, Matthews LR, et al. Reproductive health and access to healthcare facilities: risk factors for depression and anxiety in women with an earthquake experience. BMC Public Health. 2011;11(1):1–13.21199570 10.1186/1471-2458-11-523
24. Raja M Azzoni A Sexual behavior and sexual problems among patients with severe chronic psychoses Eur Psychiatry 2003 18 2 70 6 10.1016/S0924-9338(03)00009-9 12711402
Raja M, Azzoni A. Sexual behavior and sexual problems among patients with severe chronic psychoses. Eur Psychiatry. 2003;18(2):70–6.12711402 10.1016/S0924-9338(03)00009-9
25. Marengo E Martino DJ Igoa A Unplanned pregnancies and reproductive health among women with bipolar disorder J Affect Disord 2015 178 201 5 10.1016/j.jad.2015.02.033 25827504
Marengo E, Martino DJ, Igoa A, et al. Unplanned pregnancies and reproductive health among women with bipolar disorder. J Affect Disord. 2015;178:201–5.25827504 10.1016/j.jad.2015.02.033
26. Hall KS Kusunoki Y Gatny H Barber J The risk of unintended pregnancy among young women with mental health symptoms Soc Sci Med 2014 100 62 71 10.1016/j.socscimed.2013.10.037 24444840
Hall KS, Kusunoki Y, Gatny H, Barber J. The risk of unintended pregnancy among young women with mental health symptoms. Soc Sci Med. 2014;100:62–71. 10.1016/j.socscimed.2013.10.037.24444840 10.1016/j.socscimed.2013.10.037
27. Moreau C Bonnet C Beuzelin M Blondel B Pregnancy planning and acceptance and maternal psychological distress during pregnancy: results from the National Perinatal Survey, France, 2016 BMC Pregnancy Childbirth 2022 22 1 1 12 10.1186/s12884-022-04496-3 34979996
Moreau C, Bonnet C, Beuzelin M, Blondel B. Pregnancy planning and acceptance and maternal psychological distress during pregnancy: results from the National Perinatal Survey, France, 2016. BMC Pregnancy Childbirth. 2022;22(1):1–12.34979996 10.1186/s12884-022-04496-3
28. Kline Rb Hypothesis testing: principles and practice of structural equation modeling: 3rded 2011 New York The Guilford Press 209 342
Kline Rb. Hypothesis testing: principles and practice of structural equation modeling: 3rded. Volume 7. New York: The Guilford Press; 2011. pp. 209–342.
29. Güney E Okyay EK Women vıctıms of vıolence: a comparison of their perceptıons of parentıng and desıre to avoıd pregnancy. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek Okulu Dergisi 2023 11 1 1110 21
Güney E, Okyay EK. Women vıctıms of vıolence: a comparison of their perceptıons of parentıng and desıre to avoıd pregnancy. İnönü Üniversitesi Sağlık Hizmetleri Meslek Yüksek. Okulu Dergisi. 2023;11(1):1110–21.
30. Patton MQ Qualitative research 2005 New York Wiley, Ltd
Patton MQ. Qualitative research. New York: Wiley, Ltd; 2005.
31. Baltacı A Nitel Araştırmalarda Örnekleme Yöntemleri ve Örnek Hacmi Sorunsalı Üzerine Kavramsal Bir İnceleme BEÜ SBE Derg 2018 7 1 231 74
Baltacı A. Nitel Araştırmalarda Örnekleme Yöntemleri ve Örnek Hacmi Sorunsalı Üzerine Kavramsal Bir İnceleme. BEÜ SBE Derg. 2018;7(1):231–74.
32. Creswell JW Research Design: qualitative, quantitative, and mixed methods approaches 2013 New York Sage
Creswell JW. Research Design: qualitative, quantitative, and mixed methods approaches. New York: Sage; 2013.
33. Fatema SR, Rice K, Rock A, Islam MS, East L, Usher K. Physical and mental health status of women in disaster-affected areas in Bangladesh. Nat Hazards. 2023;1–19. 10.1007/s11069-023-05964-5.
34. Koyama H. (2021). Intersectional Vulnerability in Post Natural Disasters on Women’s Health – Systematic literature review. Oslo Metropolitan University, Faculty of Social Science, Master thesis. https://hdl.handle.net/11250/2983477
35. Keldal G Warwick-Edinburgh mental iyi oluş ölçeği’nin Türkçe Formu: Geçerlik ve güvenirlik çalışması J Happiness Well-Being 2015 3 1 103 15
Keldal G. Warwick-Edinburgh mental iyi oluş ölçeği’nin Türkçe Formu: Geçerlik ve güvenirlik çalışması. J Happiness Well-Being. 2015;3(1):103–15.
36. Okyay EK Güney E Uçar T Turkish adaptation of the Desire to avoid pregnancy scale: a validity and reliability study. Ebelik Ve Sağlık Bilimleri Dergisi 2023 6 3 128 34
Okyay EK, Güney E, Uçar T. Turkish adaptation of the Desire to avoid pregnancy scale: a validity and reliability study. Ebelik Ve Sağlık. Bilimleri Dergisi. 2023;6(3):128–34.
37. Alpar R, Spor. Sağlık ve Eğitim Bilimlerinde Örneklerle Uygulamalı İstatistik ve Geçerlik-Güvenirlik. 6 ed. Baskı, Detay Yayıncılık, Ankara; 2020.
38. Hayes AF Introduction to mediation, moderation, and conditional process analysis. A regression-based approach 2013 New York, NY Guilford
Hayes AF. Introduction to mediation, moderation, and conditional process analysis. A regression-based approach. New York, NY: Guilford; 2013.
39. Azad AK Hossain KM Nasreen M Flood-induced vulnerabilities and problems encountered by women in northern Bangladesh Int J Disaster risk Sci 2013 4 190 9 10.1007/s13753-013-0020-z
Azad AK, Hossain KM, Nasreen M. Flood-induced vulnerabilities and problems encountered by women in northern Bangladesh. Int J Disaster risk Sci. 2013;4:190–9.10.1007/s13753-013-0020-z
40. Liu X Yang Y Ping Y Zhang X Han Y Cao Y Xiong G A study of the relationship between mental health and menstrual abnormalities in female middle school students from postearthquake Wenchuan Biosci Trends 2010 4 1 4 8 20305338
Liu X, Yang Y, Ping Y, Zhang X, Han Y, Cao Y, Xiong G. A study of the relationship between mental health and menstrual abnormalities in female middle school students from postearthquake Wenchuan. Biosci Trends. 2010;4(1):4–8.20305338
41. Li XH Qin L Hu H Luo S Li L Fan W Li SW Influence of the Wenchuan earthquake on self-reported irregular menstrual cycles in surviving women Gynecol Endocrinol 2011 27 9 706 10 10.3109/09513590.2010.526663 21039320
Li XH, Qin L, Hu H, Luo S, Li L, Fan W, Li SW. Influence of the Wenchuan earthquake on self-reported irregular menstrual cycles in surviving women. Gynecol Endocrinol. 2011;27(9):706–10.21039320 10.3109/09513590.2010.526663
42. Ranabir S, Reetu K. Stress and hormones. Indian J Endocrinol Metabol. 2011; 15 (1).
43. Takeda T, Yoshimi K, Kai S, Inoue F. Association between loneliness, premenstrual symptoms, and other factors during the COVID-19 pandemic: a cross-sectional study with Japanese High School Students. Int J Women’s Health. 2023;655–64.
44. Gökbulut N Bal Z The relationship of mental well-being with healthy living awareness Anatolian J Health Res 2021 2 2 51 6 10.29228/anatoljhr.52199
Gökbulut N, Bal Z. The relationship of mental well-being with healthy living awareness Anatolian. J Health Res. 2021;2(2):51–6. 10.29228/anatoljhr.52199.10.29228/anatoljhr.52199
45. Arslandoğan A Türkmen M Elif T Demir B Hazar S Covıd-19 Sürecinde Fiziksel Aktivite Düzeyi İle Mental İyi Oluş Arasındaki İlişkinin İncelenmesi Sivas Cumhuriyet Üniversitesi Spor Bilimleri Dergisi 2021 2 2 67 75
Arslandoğan A, Türkmen M, Elif T, Demir B, Hazar S. Covıd-19 Sürecinde Fiziksel Aktivite Düzeyi İle Mental İyi Oluş Arasındaki İlişkinin İncelenmesi. Sivas Cumhuriyet Üniversitesi Spor Bilimleri Dergisi. 2021;2(2):67–75.
46. Nguyen T Brooks J Frayne J Watt F Fisher J The preconception needs of women with severe mental illness: a consecutive clinical case series J Psychosom Obstet Gynecol 2015 36 3 87 93 10.3109/0167482X.2015.1029448
Nguyen T, Brooks J, Frayne J, Watt F, Fisher J. The preconception needs of women with severe mental illness: a consecutive clinical case series. J Psychosom Obstet Gynecol. 2015;36(3):87–93.10.3109/0167482X.2015.1029448
47. Keskin Töre F, Ağralı C, Nacar G. Changes in family planning methods and sexual behaviors after Türkiye’s earthquake and the effect of on quality of sexual life. Am J Family Therapy, 2024; 1–15.
48. Yazdkhasti M Pourreza A Pirak A Fatemeh A Unintended pregnancy and its adverse social and economic consequences on health system: a narrative review article Iran J Public Health 2015 44 1 12 26060771
Yazdkhasti M, Pourreza A, Pirak A, Fatemeh A. Unintended pregnancy and its adverse social and economic consequences on health system: a narrative review article. Iran J Public Health. 2015;44(1):12.26060771
