Vol.3, No.6, 333-337 (2011)
doi:10.4236/health.2011.36057
C
opyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Health
Services provided at the premarital counseling center
and characteristics of the clients, in kayseri, Turkey
Mürüvvet Başer1*, Tülay Özkan1, Pinar Tekinsoy2, Evrim Albayrak1, Sultan Taşci2
1University of Erciyes, Health Science Faculty, Department of Gynecology and Obstetric Nursing, Kayseri, Türkiye; *Corresponding
author:
2University of Erciyes, Health Science Faculty Dean of Assist, Department of Medical Nursing, Kayseri, Türkiye; ptekin-
Received 22 March 2011; revised 29 March 2011; accepted 10 April 2011.
ABSTRACT
Objectives: The study was conducted retro-
spectively to evaluate the services offered at the
Premarital Counseling Center (PCC) and the
characteristics of the individuals who obtained
counseling at the center in Kayseri. Methods: A
retrospective review is based on data from the
Premarital Counseling Center (PCC) in Kayseri.
Seven hundred fifty four (754) individuals who
attended the Center were included in the study
sample. Data were collected from the Center’s
records. Records of all people were reviewed by
the researchers. Differences in proportions
were analyzed by Chi square test and t test.
Results: The age-average of the individuals who
consulted the PCC was 26.2 ± 8.3, 91.1% of the
individuals had Rh (+), 99.5% of them had VDRL
(-), 3.9% had Hbs Ag (+), 0.8% had HCV (+) while
none of the individuals was HIV (+) affected. It’s
shown that 90.6% of the individuals who were
between the ages of 15 - 19 were women, 9.4%
of them were men. The difference between the
age and the gender of the individuals who came
to the center was considered significant. It was
determined that the individuals who received
counseling services at the PCC were not given
any kind of educational and consulting services
before.
Keywords: Marriage; Premarital Counseling
1. INTRODUCTION
Family is an institution comprised of two individuals
of opposite gender bound together legally and morally
and which has psychological, social, and biological
functions [1]. Family is defined as a group or an organi-
zation while marriage is defined as a contract between
two individuals of opposite gender who wish to live to-
gether, to share experiences, to have children, to raise
them. Marriage is an institutionalized way, a system of
relations, a kind of legal relationship that unites the hus-
band and wife as spouses, that provides the children to
be born with a given status in which the state has con-
trols, rights and authority [2]. Various forms of marriage
have existed for thousands of years all over the world
though the significance and purposes may have varied.
In our society, too, marriage is considered to be a normal
and expected way of life.
Premarital Counseling Services (PCS), which are very
common in developed countries, is a concept that has
been discussed in Türkiye and in recent times efforts to
establish such services have been tried in this country.
PCS should begin in the form of engagement counseling
services when choosing a spouse and later should pro-
vide information about such topics as family planning,
genetic consultation, Rh incompatibility and sexually-
transmitted diseases [2].
Article 4721 of the Turkish Civil Code, which was
legalized on 01/ 01/ 2002, requires couples to obtain a
health report that documents that the couples do not have
any illnesses which would prevent them from marrying
[3]. Besides, according to Article 122 of the 1593 Public
Hygiene Code [4], men and women who intend to marry
are required to undergo a medical examination before
marriage. The 4134 circular of the Turkish Health Min-
istry declares that “… the consulting during the pre-
marital period should be considered as an opportunity to
provide consultancy services against infectious diseases
and genetically infectious diseases and to provide the
public with counseling services against the interpersonal
risks, effects, prevention methods of the mentioned dis-
eases.” Health reports (which document that the couples
This paper had been presented in 4.th International Congress of Re-
p
roductive Health & Family Planning (April 20 - 23, 2005, Bilken
t
Hotel & Conference Center, ANKARA, TÜRKİYE).

M. Başer et al. / Health 3 (2011) 333-337
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
334
do not have any illnesses that would prevent them from
marrying) must be issued by State Clinics, Mother and
Child Health Centers and Family Planning Centers.
During the medical examination and counseling services
husband and wife candidates must be questioned about
syphilis, gonorrhea, soft chancre, leprosy, tuberculosis,
mental diseases, AIDS, hepatitis A, hepatitis B and hepa-
titis C and genetically- transmitted diseases and must
undergo a general medical examination. Services must
provide the individuals with medical counseling and
information concerning the aforementioned infectious
diseases, genetically-transmitted diseases and family
planning. Furthermore, the individuals must be in-
formed about what to do if they believe they might have
such diseases at a later time. If during the examination,
the doctor suspects the presence of disease or if one of
the future spouses asks the doctor to do certain medical
tests, the required checks and tests can be done if paid by
those making the request. The previously registered
health reports must be evaluated only by medical insti-
tutes. In addition, in order to protect the dignity of the
individuals involved and so as not to offend them, their
human and personal rights must be respected [4]. Pre-
marital Counseling Services should be organized and
conducted according to the legal laws.
The study was conducted retrospectively to evaluate
the services offered at the Premarital Counseling Center
and the characteristics of the individuals who obtained
counseling at the Kayseri Premarital Counseling Center
(KPCC) of Kayseri Governorship in Kayseri Province.
2. METHODS
Study design: A retrospective, this research was car-
ried out in Kayseri, Türkiye. Kayseri, one of the largest
cities in Middle Anatolia, is a commercially and indus-
trially developed city. This region of Türkiye comprises
16.917 square kilometers, making up 2.2% of Türkiye’s
land area.
KPCC of Kayseri Governorship has been providing
services since November 2004. One nurse is on duty and
provides individuals who come to the center for medical
counseling with blood-grouping tests and such examina-
tions as VDRL, HIV, HCV and HBS on request.
Data collection and Participants: This study is based
on data from the KPCC in Kayseri. A total of 754 indi-
viduals who attend to the KPCC between the periods of
three months were included in the study sample. There
are registration records on file which indicate some
characteristics of the individuals (who came to the Pre-
marital Counseling Center), as well as age, gender, edu-
cation and reports about the required medical examina-
tions and tests, and medical reports of the doctors. We
collected data from the Center’s records on all clients.
The study was approved by Health Administration
Organization in Kayseri.
Statistical analysis: Data were analyzed by using the
Statistical Package Programmer. Data is expressed as
means  standard deviation and percentages. Differences
in proportions were analyzed by Chi square test and in-
dependent sample t test. A p value of < 0.05 was consid-
ered as significant.
3. RESULTS
The characteristic features of the individuals who par-
ticipated in the study are shown on Table 1. When we
analyzed the data of the individuals who consulted the
center, 50.7% of them were women and 49.3% of them
were men. 62.9% of the individuals were between the
ages of 20 - 29. The average age of the women was 24.2
± 7.9 whereas the average age of the men was 28.3 ± 8.2
and the age-average was 26.2 ± 8.3. The difference be-
tween the age and the gender of the individuals who
came to the center was considered significant (p = 0.000)
(Table 2).
Table 1. Distribution of client’s features of the premarital
counseling center (n = 754).
Descriptive Features n %
Gender
Female
Male
382
372
50.7
49.3
Age Groups
15 - 19
20 - 24
25 - 29
30 - 34
35 - 39
40 and older
128
231
235
74
31
42
17.3
31.2
31.7
10.0
4.2
5.7
Age Average (X ± SD) 26.2 ± 8.3
Table 2. Distribution client’s genders of the premarital coun-
seling center according to marriage average age (n= 754).
Gender n
Age Average
(X ± SD) t p
Female 376 24.2 ± 7.9
Male 365 28.3 ± 8.2
−6.79 < 0.001

M. Başer et al. / Health 3 (2011) 333-337
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
335335
The required tests and their results are listed on Table
3. Ninety one point one percent (91.1%) of the individu-
als had Rh factor (+), 99.5% of them had VDRL (–),
3.9% had Hbs Ag (+), 0.8% had HCV (+) while none of
the individuals was HIV (+) affected. Thirty one point
three percent (31.3%) of the individuals were tested to
detect blood group, 28.0% of them had VDRL test,
17.1% had Hbs Ag test, 16.2% had HCV test and 17.5%
had HIV test.
Table 4 shows the distribution of age groups and
gender of the individuals. Thirty point nine percent
(30.9%) of the women were between the ages of 15 - 19,
whereas only 3.3% of the men were between 15 - 19.
Eighteen point six percent (18.6%) of the 25 - 29 age
group were women whereas 45.2% of the age group
were men (p < 0.001).
No other educational or counseling services were
given to the individuals but their questions were an-
swered.
4. DISCUSSION
In Türkiye, marriage demographically is very impor-
tant, because besides being prevalent throughout the
country almost all birth occur within marriage. Therefore,
Table 3. Distribution of required medical test results of client’s
of the premarital counseling center (n = 754).
Medical Test Results n %
Rh Factor (n = 236)*
Positive
Negative
215
21
91.1
8.9
VDRL (n = 211)**
Positive
Negative
1
210
0.5
99.5
HBs (n = 129)**
Positive
Negative
5
124
3.9
96.1
HCV (n = 122)**
Positive
Negative
1
121
0.8
99.2
HIV (n = 131)**
Positive
Negative
–
131
–
100.0
*Blood groups had been tested unknown persons. ** This test had been
alone payment and voluntary.
Table 4. Distribution client’s age groups of the premarital
counseling center according to gender (n = 754).
Gender
Female Male
X2 p Age
Groups
n % n %
15 - 19 11630.912 3.3
20 - 24 13134.8100 27.4
25 - 29 70 18.6165 45.2
30 - 34 30 8.0 44 12.1
35 - 39 12 3.2 19 5.2
40 and older17 4.5 25 6.8
Total 376*100.0 365** 100.0
132.683< 0.001
*6 clients no data. ** 7 clients no data.
age at first marriage is a significant demographic indi-
cator since it represents the onset of a women’s exposure
to the risk of pregnancy. The median age at first mar-
riage is 20.8 among women 25 - 49, indicating that half
of the women in those age groups married before that
age. A steady increase is observed in the median age at
first marriage, from years for the 45 - 49 age groups to
22 years for the 25 - 29 age groups. There has been a
marked decline in getting married at very young ages.
[5].
In our study, there was significant difference between
the genders concerning first marriage average age (p =
0.000). 30.9% of the women married at ages 15 - 19,
whereas only 3.3% of the men were in the 15 - 19 age
groups. The 25 - 29 age group was composed of mostly
men whereas a small portion of the same age group con-
sisted of women (p = 0.001) (Table 3). We know that
adolescent marriages may result in adolescent pregnancy
in Türkiye. In our study, it was found that a large number
of women were married between the ages of 15 - 24.
Teenage fertility is a major health concern because
teenage mothers and their children are at high risk of
illness and death [6-8].
It has been stated that a large portion of the men mar-
ried between the ages of 20 - 29. In Türkiye, the family
responsibility is mostly on men’s shoulders. Therefore,
without sustainable, stable employment and completion
of the military service, marriage does not happen. Also,
in Turkish culture, when marriage occurs, it is preferred
that the women be younger than the men. Considering
the results obtained, it may be concluded that early mar-
riage is more common among the women compared to
the men in Kayseri.
Both in Türkiye and in the world ABO and Rh sys-
tems are used commonly for blood grouping. It is very

M. Başer et al. / Health 3 (2011) 333-337
Copyright © 2011 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
336
important for a baby’s health if the mother’s Rh factor is
negative. Each Rh (+) baby of mothers with Rh (–) may
be at risk for erythroblastosis fetalis [9,10]. Thus, Rh
factor must be determined before the preparations for a
woman’s pregnancy period. In this study, 91.1% of the
individuals were Rh (+) factor. According to another
study [11], 90.7% of the subjects were Rh (+), and this
result was similar to ours. The frequency of venereal
diseases and HIV/AIDS has increased recently. Accord-
ing to the reports of the World Health Organization, it is
emphasized that more than 6 million people are
HIV/AIDS infected and urgently need medical treatment
[12-14]. By December 2001, 40 million HIV/AIDS
cases and 20 million HIV/AIDS death were reported all
over the world. In Middle Africa, the number of
HIV/AIDS cases is reported to be increasing so fast as to
change the population pyramids [15]. According to the
Health Ministry data (2008), in Türkiye only one
HIV/AIDS case and only one carrier were reported in
1985 while the number of HIV/AIDS cases and porter
increased to3175 according to the Ministry’s 2008 data.
682 of the cases were AIDS, 2493 of them were HIV
positive [16].
HIV/AIDS cases in Türkiye are mostly seen in the 15
- 49 age groups and 68.8% of the cases were men, 31.2%
were women [17]. It was positive and encouraging not to
have seen HIV (+) cases in our study (Table 2).
Reproduction is considered normal within marriage in
our country. Therefore, it is very important for the cou-
ples to have protection against venereal diseases, to be
diagnosed and to receive treatment in case they are in-
fected. Today, there are more than 50 venereal diseases
and many other genitourinary infections that can affect
pregnancy [18]. In our study, it was found that 99.5% of
the individuals who participated in the study had VDRL
(–), 3.9% had Hbs Ag (+), 0.8% had HCV (+) (Table 2).
Another study carried out on the same subject matter
showed similar results that 3.6% of the individuals who
wanted a health report before marriage had Hbs Ag (+)
[19].
In this study, it was discovered that the number of the
tests conducted was very small compared to the indi-
viduals who had counseling. This is due to the fact that
the tests are carried out on request and must be paid for.
According to the data obtained from this study, we re-
alize that there are some differences between the law and
practice, that is, the realities of what is actually carried
out.
 The Türkiye Republic Health Ministry circulars
declare that “…marriage applications considered as
an opportunity” and 123 and 124 articles of Public
Hygiene Code’s declaration that “… the VDRL,
HBS, HCS, and HIV tests should be conducted on
only those who can pay for these services and who
wish these tests…”
 The Türkiye Republic Health Ministry circulars
considers the marriage applications as an opportu-
nity to give the individuals about to marry coun-
seling concerning reproductive health whereas
there is not any regular, organized education and
consultancy for them except the questions directed
to them.
5. CONCLUSIONS
In light of our results, it is recommended that couples
who receive counseling services at the premarital coun-
seling centers should be given not only psychological
counseling but also family planning information, genetic
counseling, blood compatibility tests, as well as infor-
mation about sexually transmitted diseases. Furthermore,
all of these services and information should be provided
by health professional.
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