Examining health care resources for Syrian women in Turkey

Yasemin Ulusoy

Syrian refugees go on their daily life in a park on November 3, 2013, in Istanbul. AFP Photo

In refugee settings, family planning is not a priority: The initial response in any widespread displacement is focused on providing food, shelter, and protection. Refugee aid in Turkey is no longer simply a matter of initial response, however: The country has received around one million refugees from Syria over the last two years. What maternal health and family planning resources are provided for Syrian refugees in Turkey, if any?

Despite an estimated $3 billion spent by the Turkish government for Syrian refugee response since the start of the crisis, the integration process for refugees settled in the country is incomplete; the future of Turkey’s one million is still hazy. The rising numbers of Syrian beggars in large cities such as Istanbul and the growing anti-immigrant discourse and violence emerging within the Turkish population seem to be just the beginning of more economic and social problems to come.

Although the government has provided free healthcare to all Syrians, recent news reports suggest that the living conditions of the majority of refugees has been growing worse, Kemal Kirişçi, a senior fellow at the Brookings Institute, points out. Women and children are the most vulnerable members of the displaced population, and their problems are overlooked; women, for instance, suffer from social and cultural prejudices to a greater extent than do men.

A January 2014 report on sexual health risks in refugee settings by TAPV, the Turkish Family Health and Planning Fund, stresses that the health risks faced by refugees in any country are just as important for the citizens of the country to which they have moved. Therefore it is vital to take provide access specific health services for women refugees. 
 
Why maternal health and family planning?

Maternal health is especially pressing in refugee populations: Fragile living conditions such as the trauma of conflict can increase the risk of death and disability for both newborns and mothers. According to IMPAC , around 15 percent of all pregnancies develop life-threatening complications that call for skilled care or require major obstetrical intervention to survive. Yet such care is seldom available in refugee settings. In fact, places of conflict receive 50 percent less funding for reproductive health than do stable settings, writes Lizzy Berryman in The Guardian.

Pregnant women forced to leave their homes have little to no access to health services, and women are often left to give birth in their homes or other unhealthy circumstances. Poor living conditions can also foster miscarriages and the spread of deadly diseases like HIV/AIDS. 

Discrimination, marginalization, and a lack of peer support and health and social services also increase the risk of sexually transmitted infections (STIs) for refugees. In addition to difficulties locating access to health services, counseling, and medicine, refugees worldwide also face a number of legislative problems. These include inadequate information about health services and their costs, the inability to prove their identities and administrative barriers to further support. Women refugees struggle to find accessible health services compatible with their cultural ideals providing needed privacy.

Covering sexual education about STIs and infertility management, family planning is a vital support channel for the wellbeing of all women and mothers. In countries with large refugee populations struggling to meet the basic needs of the displaced, however, family planning support is often a secondary and under-budgeted concern. Private health care and planning support remains too expensive for most refugees, and women find themselves bearing this important responsibility alone.

Dr. Gökhan Yıldırımkaya notes that there is a lack of knowledge about how to develop necessary interventions, arguing that new research must identify the holes in current health services. Refugee groups must also be properly registered and included in a data pool, he says, so that appropriate health services have knowledge of specific health risks that are associated with refugees’ sites of origin. Responsibility also falls on Disaster and Emergency Management (AFAD) and the Health Ministry to organize regional administrators, universities, non-governmental organizations, teachers, and municipalities in a way that strengthens refugee access to health services.
 
The reality in Turkey:

An estimated 40,000 Syrian refugees in Turkey were pregnant in July 2014, according to a UNFPA report of that month. If the Turkish government and related agencies do not respond to family planning and maternal health concerns, it will only become increasingly difficult to address the health, education and employment requirements that follow the population boost.  

Before the civil war in Syria, family planning services in the country were free and used by 58 percent of women (WTO). Research on family planning access for Syrian refugees in Turkey is difficult, but UNFPA’s records from refugee camps in Lebanon show that the number of married women among Syrian refugees there that now use contraception has decreased to 37 percent.

When examining Turkey’s policies regarding female health, it's strikingly clear that policies concentrated on the reproductive capacity of the female population and growth policies until the ’60s, on family planning from the beginning of the ’60s, and on encouraging higher birth rates in at the beginning of the millenium, when the country’s decrease in birth rates was viewed as a threat.

Turkey joined the UN's Convention on the Elimination of All Forms of Discrimination in 1979, but it fails to address the 12th amendment that requires countries to give females equal status in family planning and all health care services. Dr. Belkis Kümbetoğlu of Yeditepe University states that Turkey does not have a group of representatives or any institutions that have placed this topic on their agenda and push for its implementation. 

In a 1994 agreement in Cairo at the Conference on Population and Development, Turkey was among the countries that forfeited control over population policies and officially accepted women's rights to their body and childbirth as a human right. But Pınar İlkkaracan, a founding member of Turkey’s Women’s Human Rights Institution (Kadının İnsan Hakları Derneği), draws attention to serious obstacles in the implementation of these principles. İlkkaracan emphasizes that the empowerment of young women on this issue is necessary for continuous equality between the sexes.

TAPV has been working to improve awareness on the health issues affecting Syrian women in Turkey, and to provide them with services and counseling. But the health of women in Turkey, whether refugees or not, has yet to become a fundamental topic in the country’s political, social, and economic agenda. Now more than ever, Turkey faces the need, to work toward new arrangements on health care and education services for its women and mothers. Mobilizing international humanitarian aid and Turkish organizations to focus on this issue within the Syrian population might provide a place to start.