In this article we present the results of three studies investigating methods for including men in antenatal education in Istanbul, Turkey. Participants were first-time expectant parents living in low and middle-income areas. After a formative study on the roles of various family members in health during the period surrounding a first birth, an antenatal-clinic-based education programme for women and for couples was carried out as a randomised, controlled study. Based on the results, separate community-based antenatal education programmes for expectant mothers and expectant fathers were tested. There was demand among many pregnant women and some of their husbands for including expectant fathers in antenatal education. In the short term, these programmes seemed to have positive effects on women and men's reproductive health knowledge, attitudes and behaviours. In the clinic-based programme the positive effects of including men were mainly in the area of post-partum family planning, while in the community-based programme positive effects among men were also seen in the areas of infant health, infant feeding and spousal communication and support. Free antenatal education should be made available to all expectant mothers and when possible, men should be included, either together with their wives or in a culture such as that of Turkey, in separate groups.

A cross-sectional survey was conducted in Istanbul to investigate the relationship between contraceptive choice and reproductive morbidity. Altogether, 918 women who had ever used any means of avoiding pregnancy were interviewed at home, and, among these, 694 parous nonpregnant women were examined by three female physicians. The women were aware of bearing a considerable burden of ill health, with 81 percent reporting at least one episode of illness in the three months prior to the interview. Current users of the intrauterine device were significantly more likely than users of other methods to report menstrual disorders, but pelvic relaxation and reproductive and urinary tract infections, whether perceived or diagnosed, were not significantly related to any of the contraceptive methods. The relatively small amount of switching between methods suggests that most users tended to stay with the same method once chosen and that health concerns played an important part only in the initial choice of the method.

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SummaryIn countries where population-based data on health problems are scarce, the extent of reproductive morbidity can be estimated from replies in structured interviews as a complement or as an alternative to reports from physician's examination and laboratory tests. We examined the sensitivity and specificity of detected morbidity based on these replies as compared to medical diagnoses and explored the consistency of replies when the questionnaire was administered twice, by two types of interviewers in different environments. Data were collected in a cross-sectional survey in Istanbul. The presence or absence of five morbidities, reproductive and urinary tract infections (RTI and UTI), menstrual disorders, pelvic relaxation and anaemia was determined by algorithms based on the replies, and by the physician's diagnosis. Except with anaemia, questionnaire replies were more specific than sensitive in detecting morbidity, probably partly due to many morbid conditions being accepted as normal. Specificity exceeded 80% for home reports of menstrual disorders (93.0%), pelvic relaxation (95.7%), RTI (abnormal discharge and pain) (81.2%) and UTI (80.7%), with the corresponding figure for anaemia at 41.7%; the best sensitivity results were for anaemia (58.3%), RTI (abnormal discharge only) (49.3%) and menstrual disorders (45.4%) with figures for pelvic relaxation and UTI reaching only 17.3 and 13.0%. Reliability between the interviews (assessed by the coefficient), was highest at 66.1% for pelvic relaxation and lowest at 39.9% for menstrual disorders. Reliability varied between the two lay interviewers, suggesting the interviewer and the interview conditions are important. Questionnaire-based information on this type of morbidity is most useful for ascertaining perceived ill-health and only of limited use for the corresponding medically defined conditions. keywords reproductive health, health interview surveys, Turkey correspondence Véronique Filippi, Maternal and Child Epidemiology Unit,

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