Turkey should not compromise gains in women

Currently, more than 800 women die in pregnancy or childbirth every day around the globe. Each day, an of average 33,000 girls are forced into marriage at an early age. Over 214 million women want to avoid pregnancy, but they do not have access to modern contraception. Every year, 4 million girls could have their genitals mutilated. These are data provided by the United Nations Population Fund (UNFPA).

Except the last one -a practice nonexistent in Turkey, Turkish statistics have their share in these global figures.

The good side is that Turkey’s share on “certain parts” of the negative picture has been decreasing. The bad part is that Turkey, nevertheless, continues to contribute to this problem. But what’s worse is there is some backsliding in terms of gains made in certain areas.

Let me elaborate. Take the issue of maternal deaths, defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, due to causes related to pregnancy.

Turkey has pursued since the 1980s one of the most exemplary policies in the world in preventing maternal deaths.

In 1974, the rate of maternal mortality was 208 in every 100,000 live births. Fifty-three percent of mother deaths were due to unsafe abortions. Following the change in the law in 1983 and successful implementation of the law, the share of unsafe abortions in maternal deaths dropped to 2 percent. Maternal mortality went down to 28.5 in 100,000 live births in 2005 and to 16,4 in 2010.

Unfortunately, the steady drop has stalled since then, stagnating around 15 percent and reaching its lowest point at 13.6 only in 2018, according to data from the Turkish Ministry of Health. While the world average of preventable causes for mother deaths is 40 percent, it is 62.4 percent in Turkey.

One is too many, and one can translate the current situation as the state not having done enough to prevent maternal deaths. It is a widely known fact that the government has been pursuing a pro-natal policy. But it seems that the unintended consequence of the shift in the focus to encourage women to have more babies has been neglecting vigorous policies to prevent maternal mortality.

The most compelling evidence in that regard is provided by the 2018 Turkey Demographic and Health Survey (2018 TDHS) released on Nov. 8.

The unmet need for family planning has increased to 12 percent, an increase of 50 percent compared with the 2013 survey when this figure was 6 percent. Women with unmet needs are those who want to stop or delay childbearing but are not using any method of contraception.

Experts believe the government’s lukewarm policy towards birth control, in contrast to its highly encouraging stance on population growth, has had a role to play.

One other data set from the last survey that shows the state is not providing efficient services in terms of birth control is the rise in the use of condoms, which are widely available in the market. The use of modern contraceptive methods increased in the last five years (from 47 percent to 49 percent). The most prevalently used modern method is condom (19 percent), marking a rise compared with 2013.

While abortion is legal in Turkey, due to the government’s anti-abortion stance, doctors in state hospitals are unwilling to perform abortions unless it is medically justified - a situation that could lead women towards unsafe abortions, which is one of the main causes behind maternal deaths in Turkey.

The International Conference on Population and Development (ICDP), which took place between Nov. 12-14 in Nairobi, has provided an opportunity for countries to review their current situation and given a new impetus to policies that can accelerate progress. In that sense, three main targets were identified to achieve transformative results within the next decade: zero maternal deaths, zero unmet need for family planning and zero gender-based violence.

Each country voiced its commitments officially during the Nairobi summit. Turkey’s commitments focused only in one area: “zero preventable maternal death.”

“Our zero preventable maternal death aim will be addressed in official strategic plans and programs and be monitored as performance criteria not only for family physicians but also provincial and hospital managers,” said Bekir Keskinkılıç deputy director of the Turkish Ministry of Health.

As such, it stands as a strong commitment, but there are doubts as to how this commitment will be delivered when the unmet need for family planning has not gone down but up.

In fact, there was no mention of “zero unmet need for family planning,” a concept which officials avoid using.

The pregnancy of risks groups, such as pregnancy under 19 years old, is behind maternal deaths. According to TDHA 2018, 5 percent of women ages 15-19 were wed. No commitment was voiced in Nairobi on how marriage at an early age will be curbed.

No commitment was voiced either on preventing women murders in Turkey.

One positive part of Turkey’s official commitment was the promise to reach a zero target for maternal deaths among Syrian women refugees.
Turkey’s achievements on maternal mortality is still shown by the U.N. as an exemplary model; one hopes Turkey will continue to maintain its exemplary standing.