COUNTRY REPORT OF TURKEY
FOR
THE FIFTH ASIAN AND PACIFIC POPULATION CONFERENCE
Introduction
Turkey, as a European, Balkan, Black Sea, Mediterranean and Middle East country
and as a country occupying a unique position in its region, has been taking the
necessary steps to adapt herself to the new world order by achieving radical
improvements with regard to her economic and social structure and by taking part in
internationally agreed documents.
Population growth rate of Turkey, which was above 2 percent until the year 1990,
displays a decreasing trend in recent years. According to the 2000 Population Census,
the population of Turkey is estimated to be 70.3 million at the end of the year 2002
with an annual growth rate of 1.48 percent. Birth rate and infant mortality rates are
decreasing at a considerable level. Interprovincial migration appears to be the most
outstanding population problem of Turkey.
The interrelation between “population” and “development” has gained a new
dimension reflecting the effects of globalisation, democratisation, participation and
higher emphasis on the quality of life, human rights and poverty. These two basic
concepts have been taken as main pillars of the development strategy in planning
process in Turkey.
In fact, Bali Declaration on Population and Sustainable Development, the ICPD
Programme of Action and Key Future Actions adopted by High-level Meeting (ICPD
+ 5) have similarities with the Five-Year Development Plans, which Turkey has been
implementing since 1960s. The population policies are taken both implicitly and
explicitly as an integral part of sectorial plans within the context of Turkish
development planning. These sectorial plans specify the objectives, strategies and
programmes designed to influence the key elements of population change in the
country. Therefore, population concerns are integrated in all policies and programmes
relating to sustainable development.
The basic purpose of development is enhancing the level of individual well being. In
order to assist in the realisation of this aim, measures and programmes directly or
indirectly affecting population variables, such as the size of population, growth rate,
distribution and quality become integral parts of the population policy. Therefore, a
population policy has the feature of being integrated with social development policies.
Population policies, while respecting fundamental human rights and the
responsibilities of individuals and families, gained a perspective encompassing our
responsibilities for future generations. Adoption of an approach, that emphasises the
interaction between population, resources, environment and development, has become
the cornerstone of sustainable development.
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In the Eighth Five-Year Development Plan that encompasses 2001-2005 period, basic
population policy is to improve quality of life with respect to health, education and
human resources, and alleviate regional disparities to reach a balanced and sustainable
development.
1. Overview of the population and development situation and prospects, with
special attention to poverty
Turkey is currently the most populous country of the Middle East and is among the
most populous 20 countries of the world. In 1990, the Population Census had
established a population of 56.5 millions. The latest population census in 2000 puts
Turkey's population at 67.8 millions, indicating an annual growth rate of around 18
per thousand for the 1990-2000 period. These figures imply that the country's
population has increased more than five times since the establishment of the Republic
in 1923.
Subsequent to discussions in the 1960s on problems regarding the environment,
population, economic development and future safety, and the declerations about the
need for international policies in these areas, the concept of sustainable development
emerged as a new objective to solve these problems at the local, national, regional and
global levels. Relative to this development the international community has also
started a new process of debating the relationship between poverty, population and
sustainability.
Turkey does not face a problem of absolute poverty by the standards of a developing
country. However, indicators of living standards and economic opportunity describe a
country which despite substantial progress, still faces a steep challenge in bringing the
great majority of its poor and economically vulnerable population into the economic
mainstream. Progress in reducing poverty, while significant, has been uneven. The
data also reveal disparities within the country, between urban and rural areas, between
prospering regions and impoverished ones. Poverty in Turkey affects mostly specific
groups of the population whose ability to participate in economic progress is
handicapped. Education, employment and earnings opportunities are key determinants
of poverty risks.
Poverty alleviation and effective social protection of vulnerable persons and groups
are important policy issues stressed both in the five year development plans and in the
government programmes. There are earnest efforts for creating both legal and
institutional structures for poverty related issues in Turkey. Many organisations have
been created, in particular the Social Solidarity Fund and The General Directorate of
Social Services and Child Protection, which form the institutional structure of efforts
to combat poverty. Regional development programmes the Southeastern Anotolian
Project, The General Directorate of Women Status and Problems, which aim to
contribute to solution of gender discrimination problems and The Administration for
Persons with Disabilities, which gives support to persons with disabilities to enable
their participation in the society as active and productive individuals, can also be
added to this institutional structure.
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However, in practice, combatting poverty generally takes the form of expost
interventions and little is done to address the causes of poverty and unequal
distribution of income. Almost all efforts are geared towards alleviating effects of
these disparities and poverty. Although succesfull projects have been developed in
this regard, the fact that the causes of these problems can not be eliminated without
making structural changes, is not given full recognition.
While the number of persons that can be classified under “absolute poverty” line is
low in Turkey, income ditribution is extremely skewed, and thus, “relative poverty”
exists as a significant problem. According to the research study on income
distribution conducted in 1994 and the analysis made in the following years:
(a) About 2.5 percent of the population has a daily income less than US$ 1.
(b) While the share of income of the poorest 10 percent of the population is
2.3 percent, the share of the richest 10 percent is 32.3 percent. The GINI
coefficient of Turkey is about 45 percent, which indicates an income
distribution far from being equal.
(c) If access to minimum nutritution per capita is taken the variable to indicate
poverty, there are disparities both between rural and urban areas and
among regions.
As there has not been any study on income distribution after 1994, there is no reliable
information on where Turkey today stands in terms of income distribution and
poverty.
In connection with the relationship with the nutrition and health, sinificant nutritional
problems are observed which are thought to be largely related to poverty. The fact
that a portion of the population can hardly afford the foodstuffs that are the basic
sources of nutrition and important for a balanced diet unavoidably lead to health
problems that burden the society with new cost.
The situation of education and health services also provides additional information on
poverty in Turkey. Although importants progress has been made since 1992, Turkey
lags behind countries at a similar level of economic development in terms of the
indicators listed below. The gaps between these and the European average are even
larger.
 Life expectancy at birth is 69 years.
 Infant mortality rate is 38 per 1000 live births.
 The ratio of underweight children under age six is about 10 percent.
 The ratio of births not attanded by health staff is about 20 percent.
 The estimated number of persons with disabilities varies between 3 to 7 million
persons. Some of these disabilities are the type of disabilities that could have
been prevented with timely and correct interventions.
 The share of total health expenditure in GDP is 3.5 percent.
 The share of total expenditure on education is 2.5 percent
 The ratio of adult illiteracy is 13 percent, the ratio being 20 percent for women.
Turkey is ranked 85th among 174 countries according to the Human Development
Index of the year 2000, based on 1997 data. The Human Development Report also
indicates there are serious regional differences.
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When we look at the functional income distribution on the other hand, despite the fact
that the productivity of labour (total value added/average number of workers) has
been steadily increasing since 1980, the real wages of workers did not increase
parellel to the increase in productivity and remained mostly stable.
The unemployment rate has grown considerably, particularly during the last economic
crisis. The current official unemployment rate of 10 percent is expected to result in
social problems and increased poverty both in the short and long terms. In addition to
this, a large section of the labour force is either employed as family workers or in the
informal sector, and thus, does not have social security.
The informal sector is believed to have a considerable weight in Turkey. Studies on
the informal sector have shown that the children working in this sector do not receive
the education they need. The uneducated child labourers, mostly working under substandards working conditions, are also important with respect to poverty. According
to 1999 data, although the number of working children aged 6-17 was lower than
previous years, it still stood around 1.6 millions.
Poverty is the most significant factor reinforcing child labour. On the other hand,
child labor may cause poverty to become permanent. Children who are affected by the
unhealthy conditions of their working environments, are debilitated at an early age
and can not work productively in their adult years. Since they miss schooling for
professional training, they have to continue working as unskilled labourers in their
adult lives.
It can be argued that, all these problems are largely related to high fertility rates of the
recent decades. While the population growth rate of Turkey are declining, history of
high fertility rate puts extra pressure on society.
The Eighth Five-Year Plan addresses following issues as the main objectives for
eradication of poverty;

The main principle will be to implement economic and social policies in harmony
which aim at increasing economic growth, eliminating absolute poverty,
alleviating realtive poverty and approximating the income of the poor segment to
an average welfare level.

The transfer system will be restructured with a view to ensuring a more effective
redistribution of income to the poor or those who are at the poverty line.

In order to alleviate disparities among regions, along with economic investments,
investments on education, health and social services shall be increased.

Social services and social assistance systems shall be made more accessible to the
poor population. Local administrations, private sector and NGOs shall be
encouraged to be more efficient in programmes combatting with poverty in
collaboration with public institution.
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2. Fertility levels and trends, and their implications for reproductive health,
including family planning programmes
The latest estimate of the total fertility rate (TFR) comes from the 1998 Turkish
Demographic and Health Survey (TDHS), referring to 1996-1998 period, at 2,6 live
births per woman. The long-term trend of declining fertility, which began in the
1950s, and accelerated after 1970s, when the TFR was about 5 children per woman
and continued until the early 1990s, declining to 2,6 births, is estimated to reach
replacement level by 2015.
Current fertility is characterised by significant regional and urban-rural differences.
While TFR is at replacement level in the Western region, it is still as high as 4,2 in the
East, according to the 1998 TDHS. There is also considerable difference in the
fertility of women in urban and rural areas (2,4 versus 3,1). From the standpoint of
the national trend, the weight of the high fertility areas is declining due to outmigration and the weight of low fertility areas is rising due to in-migration. Thus, the
national decline of fertility is reinforced by a process of selective internal migration
and population redistribution.
While marriage remains as a universal social institution and celibacy is very rare,
Turkish women marry at moderately late ages. Age at first marriage was around 23
for females and 26 for males in 2000. Latest estimates show that women aged 25-29
married at a median age of 20.4, and had their first births at the median age of 22.2,
indicating some control of fertility even at early stages of marriages.
Turkish Governments diverted from traditional pro-natalist population policy due to
medical problems and high maternal mortality caused by illegal abortions in 1965
with a legislative reform. During the1980s, the government considered revising the
existing population planning law in order to meet the needs of the families on a more
comprehensive scale. A new population law was accepted in 1983. The new
legislation authorised non-physicians to insert intra-uterine devices (IUD), legalised
surgical contraception and abortion and permitted general practitioners to terminate
pregnancies. According to the new law, intersectoral collaboration was also
emphasised for successful family planning services. Since then, Turkey has had one
of the most comprehensive and liberal population planning legislation, which means
that there is no legal barrier in the country to practice family planning.
Fifty five percent of the female population consists of women in reproductive age
whereas children under 15 years of age constitute 35 percent of the total population.
Overall contraceptive prevalence is 63 percent for families in reproductive age. User
prevalence of modern methods is 35 percent. Overall, the recent change seems to have
been characterised by an increase in the overall contraceptive use in rural areas and
decline in the use of traditional methods, especially in the urban areas. Male
involvement in family planning, together with reproductive health care activities for
adolescents need to be improved and expanded.
Induced abortion ratio is 17,9 in 100 pregnancies. Unmet need in family planning,
which is the proportion of women who do not want any more children but at the same
time who are not using any method is 12 percent. The infant mortality rate has been
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declining steadily over the years, but it is still high with a number of 43 per thousand
in 1998.
There are 1.5 million births per year, 63 percent of pregnant women receive antenatal
care, and 76 percent of deliveries is assisted by health personnel while 24 percent are
helped by traditional birth assistants. Proportion of families who do not want further
children is 70 percent. Twenty-seven percent of deliveries during the last five years
were the results of unwanted pregnancies. Sixty-eight percent of women in
reproductive age carry at least one of the following features which are risk factors for
pregnancy: age under 20 or above 35; having 5 or more pregnancies; having 2 years
or less pregnancy interval.
Future challenges waiting are, to realize the proposed plans in the current status and
circumstances. All the pilot activities in RH/FP which were initiated after the ICPD
should be definitely expanded all over the country, otherwise overall impact of those
innovations can not be significant for the target groups.
Monitoring and evaluation of the progress is also an essential element. In order to
monitor the overall improvement, the coverage and efficiency of the recording and
reporting system in the health sector need to be further improved.
Eighth Five-Year Development Plan aims at integrating reproductive health and
family planning services into basic health services and improving the quality within a
life long approach and without gender discrimination. It also aims at alleviating the
regional differences and considering the differences in defining target groups and
priorities. Furthermore, the plan put forward that accessibility, continuity and
prevalence of reproductive health and family planning services for the target groups
shall be enhanced, demand towards services shall be raised by increasing the
awareness of the society, cooperation among related sectors and institutions shall be
strengthened and an effective registration system enabling continual monitoring and
development in this field shall be established.
3. Mortality and morbidity trends and poverty
Turkey is known to have high infant and child mortality rates, incompatible with her
level of development and level of adult mortality. Sharp declines in infant and child
mortality have been observed during the recent decades. In the early 1980s, the infant
mortality rate (IMR) was as high as 109 per thousands live births; the 1998 Turkish
Demographic and Health Survey (TDHS) estimated the IMR at 43 per 1000 live
births. It is estimated that infant mortality rate decreased to 38 per 1000 births in
2002. A similar pattern is observed for under-5 mortality rates. These improvements
are generally credited to lower fertility, improved living conditions, education and
understanding among mothers, health services and special immunisation campaigns.
Reduction in infant and child mortality has played a major role in raising the average
expectation of life at birth. A large percentage of improvements in the increase of
survivors were attributable to the impact of special programs aiming improvements in
child health including programs of immunisation, control of diarrhoeal diseases, and
acute respiratory infections.
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A notable development in the infant and child mortality rates has led to a significant
change in the age pattern of deaths. Life expectancy at birth increased by 10 years
within a decade, from 55.1 years in 1970-1975 to 64.9 in 1985-1990. Current
estimates of life expectancy at birth are 71.2 years for females and 66.5 years for
males.
Diarrhoeal diseases are still among the important causes of childhood morbidity and
mortality. These are most frequently seen among children under the age of five. An
acute respiratory infection such as pneumonia is the second most common cause of
deaths among children under the age 5. As the rates of morbidity and mortality due to
infectious diseases are decreasing in Turkey, deaths from hereditary metabolic
diseases, other genetic diseases and the malignancies of childhood are becoming more
visible. The program for Screening Phenylketonuria, the program for Iodising the
Consumed Alimentary Salt (for the prevention of endemic goitre) and the program for
fluorine (for the prevention of periodontal diseases and tooth decay especially among
0-14 age group children) have been initiated recently in Turkey.
Maternal mortality rates (MMR) have been decreasing sharply in Turkey. According
to the results of a recent study based on deaths taken place in selected public hospitals
MMR was estimated to be 54.2 per 100,000 live births and the main causes of
maternal deaths were found as toxaemia (28.2 %), haemorrhage (5.6%) and infections
(5.6 %).
Cancer was the fourth leading cause of death 20 years ago but it has risen to the
second place among deaths from known reasons, following cardiovascular diseases.
Chronic diseases including hypertension and other circulatory diseases gained more
importance, because the life expectancy has been prolonged. In order to decrease the
mortality and morbidity due to these diseases improvement of the quality of life and
prolonging the life expectancy are planned activities in harmony with the targets.
According to the research conducted by Turkish Heart Foundation between 1991-96,
there were about 1.2 million patients who have coronary heart diseases in Turkey and
130 thousand of them died in a year.
Smoking is a widespread habit in Turkey. In order to prevent harmful effect of
tobacco consumption, a law was accepted in 1996. Under this law, cigarette smoking
is prohibited in all closed public areas.
In principle, drug related health problems must be recognised at its early stages. In
Turkey AMATEM (Alcohol, substance, research and rehabilitation centre) features to
be the only official institution specialised in services regarding substance dependence.
Since 1983, there has been rapid increase in the enrolments to AMATEM services.
Health services in Turkey are provided mainly by the Ministry of Health (MoH), SSK
(Social Insurance Organisation), Universities, the Ministry of Defence, and private
physicians, dentists, and pharmacists, nurses and other health professionals. The
Ministry of Health is the major provider of primary and secondary health care and of
the preventive health care services. At the central level, the MoH is responsible for the
implementation of the country's health policy and health services. At the provincial
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level, through provincial health divisions, health services are also provided by the
MoH.
In recent years, Turkey experienced notable improvements in Health Care Services,
however the lack of efficiency and effectiveness in using resources creates obstacles
to reach the targets. In order to ensure effective use of resources and to improve
consumer satisfaction through expansion, continuity and quality of services in the
health sector, the need for re-structuring of the health system with respect to
financing, administration and organisation, manpower, provision of services,
legislation and information persists.
In accordance with this principle, a health care reform project has been in progress.
The objectives of health care reform in Turkey are:
 Improve the health status of the Turkish population by covering the whole
population under the social health insurance scheme,
 Equity in health services,
 Emphasis on preventive services, health promotion and primary curative
care ,
 Efficiency in service provision,
 Separating service purchaser- provider,
 Establishing competition between service providers,
 Appropriate use of technology,
 Strengthening multi-sectoral cooperation for health services,
 Collection of effective, timely and accurate information to improve
information based decision making,
 Appropriate usage of human resources according to skill, duration, number
and combination,
 Delegation of decision making authority to the individual service units.
Since the implementation of reforms requires amendments in legislation, three major
draft laws (Health Financing Institution Law, Hospitals and Health Enterprises Law,
and Primary Care and Family Physician Services Law) have been prepared by the
MoH, Health Project Coordination Unit in collaboration with the concerned parties,
and have been submitted to the Parliament for approval.
4. Migration, urbanization and poverty
The population of Turkey has undergone a structural change with regard to
urbanisation especially starting from 1950s. 1970 census indicated that about onethird of the population (32.3 %) were living in settlements which are considered as
urban (with a population of 20,000 or more). This percentage increased to 51.4 in
1990. According to the 2000 population census, proportion of urban population
increased to 59 percent.
The increase of urban population is mainly due to migration from rural to urban
places. Migration as a process restricted rural growth and finally annual growth rate of
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rural areas became less than 5 per thousand. Unlike in developed countries,
urbanisation process in Turkey has occurred as a migration phenomenon in which
urban poverty is preferred to being rural.
Rapid urbanisation has led to considerable bottlenecks in urban services, to the
evolution of problem burden centres as a result of its unplanned nature and the
emergencies of Gecekondus where sub-culture groups are not yet assimilated to the
urban way of life blossoms. The process of rapid urbanisation accelerated the growth
of environmental problems.
Insufficiency in employment, infrastructure and social services and limited skills of
individuals and a low prevalence of knowledge and economic activities lead to
depreciation of rules and value of judgements in urban areas.
International migration is a phenomenon, which still exerts considerable influence on
the social, economic and demographic structure of the country. Intensive population
movements abroad started back in early 60s. Up to 1973 this was characterised by the
movement of Turkish citizens abroad for employment. Starting from 1974 and till the
end of the 80s this movement slowed down considerably and turned out to be mostly
for the reunification of families. Today, emigration is possible mainly through
marriages.
After the change of the regime in Iran and particularly during the Iraq-Iran war,
approximately five million Iranians are believed to have entered Turkey. At the end of
May 1989, ethnic Turks began to leave Bulgaria for Turkey in large numbers and
under severe hardship. In less than three months, about 320,000 ethnic Turks from
Bulgaria arrived in Turkey. Around 140,000 of them have since returned to Bulgaria,
but the rest remained in Turkey, most of them is granted Turkish citizenship. Several
measures have been taken by the Turkish authorities for their resettlement, vocational
education and placement in jobs relevant to their training background.
Movement of asylum seekers of Iraqi origin towards Turkey has occurred on three
major occasions in the years 1981-91. The first one occurred in the aftermath of the
Iran-Iraq war. In August 1988 more than 50,000 Iraqis fled to Turkey. The second
movement began with the Iraqi occupation of Kuwait in August 1991. However this
movement took place as small groups. The third and most important mass movement
occurred as a result of military action by the Iraqi government against civilian groups
in Northern Iraq at the end of the Gulf war. Almost over night 446,000 Iraqis took
refugee in Turkey in order to save their lives. This was, since the World War II, the
largest asylum movement in such a short time. In cooperation with the UN and other
international governmental and non-governmental organisations, their return to Iraq
has been arranged, with only a few thousands still remaining in Turkey. Each of these
movements of asylum seekers has affected Turkey politically, economically and
socially.
Because of the insufficient data regarding immigrants, The Eight Five-Year
Development Plan foresees systematic handling of the issue of immigration in terms
of registration and policy making.
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5. Population ageing
Older populations are expanding not only in developed countries but in developing
countries as well. Turkish population has had a young age structure since the
establishment of the Republic, due to persistent high fertility rates and relatively low
life expectancy at old ages. Consequently, the median age for the total population
remained below 25 until the 1990s. If the degree of ageing is expressed by the
percentage of the total population which is 60 years and over, the Turkish population
is considered to be a young one. Recent projections put forward that, only 8 percent of
the total population are above the age 60 and approximately 30 percent of the
population are under 15 years of age. However, as a result of declining fertility and
mortality the population is aging rapidly though the proportional figures are not
particularly comparable with those of developed countries where the proportion for
instance is one out of five in Europe.
According to the projections the proportion of the elderly in Turkey will rise to 13
percent in the year 2025. In terms of absolute numbers that is a greater concern for
policy making; the elderly population in Turkey comprises about 5,6 million people in
2002. The figure is expected to increase by 117 percent and reach 12.1 million in
2025. This yearly increase of more than 3 percent will undoubtedly mean
considerable pressure on the social and economic services provided to this group of
the population.
In most of the countries, social security systems face many challenges in adapting to
changes in family structure, to the emergence of more unstable work patterns, and, of
course, to changes in the age profile of populations. The problems of reform facing
the most developing economies are especially complex, not only because of low level
of resources available to them but also because of the structure of their economies
(large share of self-employment eg.). Social security in Turkey is based primarily on
social insurance, funded mainly from contributions by employers and employees.
The state does not make any regular contribution to financing of social security. But,
the state pays for deficit of the publicly mandated insurance organisations. Turkey's
social security system is structured under three major social insurance funds. These
are The Civil Servants Pension Fund (ES) for civilian and military public employees,
The Social Insurance Institution (SSK) for wage earners employed on contractual
basis, and The Social Security Organisation of the Self-Employed (Bağ-Kur) for self
employed including craftsmen, artists and artisans, small business owners working on
their own account, and people working independently in the agricultural sector.
The pension programs in Turkey cover approximately 87 percent of the population as
of 2000. These three public pension schemes are financed on a pay-as-you-go
(PAYG) basis. Because of the existing rules about contribution rates, contribution
periods and retirement age, the three publicly mandated schemes are in severe
financial crisis. Moreover, the organisational structure of the pensions is not as secure
as desired. Social security system in Turkey has been passing through a reform
process in which retirement age has been raised 58 and 60 respectively for women
and men with a recent law that envisages a gradual transition for present employees.
The new law also introduces for the first time an unemployment insurance scheme.
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The second phase of the reform aims at reorganising the financial and organisational
structure of the social security organisations.
Among the objectives and strategies of Turkey for the purpose of “Health for All”, the
objective regarding ageing proposes improvements in the health and well being, and
active participation of older persons in the society. It also proposes that the number of
older persons aged 70 and over who are self sufficient and active participants in the
society will be increased at least 50 percent until the year 2020.
For many years, Turkey has been implementing several policies towards alleviation of
poverty. These policies have been implemented through the functioning of various
organisations and through social aid programs that are mainly financed by the
government budgets and donations. The main objective of these organisations and
programs is to provide a safety net for the poor and elderly who are not covered by
other social security programs.
Groups outside the defined benefit mechanism in Turkey are served by a variety of
schemes. The Green Card program was initiated in 1992 for providing free in-patient
health services for the poor. Despite some problems both on provider and consumer
sides, as of 2002, 11 million beneficiaries are granted green card. By Old Age and
Disability Assistance Schemes, the needy people over the age of 65 and the disabled
receive payments from government without having to pay any premium. As of 2001,
around 1 million people are covered under this program. The Fund to Encourage
Social Aid and Solidarity provides support in kind and in cash to needy people. It
allocates available resources through over 900 foundations organised in provinces.
People are subject to evaluation on assets and means they have in hand in order to be
qualified for assistance.
In order to provide institutional care for the elderly in Turkey, there are 154 nursing
home and rehabilitation centres managed by central government, municipalities and
private sector serving around 10 thousands older persons. The elderly lacking
economic means, having no relations legally required to support them or such
relatives unable to do so due to economic constraints are admitted free of charge to
public nursing homes and rehabilitation centres. The non-paying elderly also receive
medical care free of charge and are paid a monthly allowance as pocket money. In
addition to meeting the daily needs of the elderly in nursing homes, efforts are made
to provide such services as medical care and treatment, assistance with psychological
and social problems, development of social relations, ensuring continuation of active
state and nutrition compatible with their state of health.
Public counselling centres for the elderly are also being established, to serve persons
aged 60 and over, living with their families or alone. They are provided counselling
services to meet social and psychological needs, assistance with house cleaning,
certain health needs, bathing, home repairs, shopping, paying bills and assistance with
such tasks as the elderly might have difficulty in doing by themselves.
There are particular challenges for the countries like Turkey, which have undergone
rapid rates of industrialisation and urbanisation where older persons very often find
themselves left behind in rural areas without any immediate family or access to
adequate infrastructure. Traditional solidarities and strong family ties provided
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Turkey with a considerable amount of time to adapt changing conditions while
entering into a bundle of problems associated with ageing. However, we are also
aware that the social capital we have enjoyed so far is running out. Hence, we believe,
it is time to devise new forms of national and international responses to this challenge.
6. Reproductive health
Turkey is one of the countries taking the recommendations of the ICPD very seriously
and initiating actions to change the traditional attitudes and practices, especially in
“reproductive health” (RH), as well as establishing mechanisms to follow-up the
progress in implementing the plan of actions in reproductive health.
The activities related to ICPD recommendations on reproductive health in Turkey are
as follows:

Following the ICPD, traditional MCH/FP approaches changed and a
comprehensive reproductive health care approach was adopted in health care
services. Primary health care (PHC) system in Turkey has been first established
in 1961 and then expanded to all provinces in 1984. The infrastructure of this
system in terms of physical facility and health manpower is quite favorable to
provide RH care services as integral part of PHC.

A significant event following the ICPD in reproductive health and population
issues in Turkey, was the inclusion of the reproductive health concept and related
targets and strategies into the Seventh Five-Year Development Plan. Moreover,
the Seventh and Eight Five-Year Development Plan focus on human resources
for sustainable development and it considers women and children as sensitive
groups and it deals with the problems of these groups under a separate title as
well as dealing with them under general basic social sectors such as population,
education, health employment, social services and social security.

To help couples and individuals meet their reproductive goals in a framework that
promotes optimum health, responsibility and family well-being and respects the
dignity of all persons and their rights to access high quality reproductive health
services, Women’s Health and Family Planning Strategic Plan was prepared in
1995 by intersectoral collaboration in Turkey, under the guidance of the General
Directorate of MCH/FP of the MoH. In this plan all recommendations of the
ICPD, especially on reproductive rights and reproductive health were adopted
according to the country’s needs besides other recommendations on morbidity
and mortality.
Besides preparation of the national plan of actions on women’s health, the following
programmes and activities are being carried out to improve reproductive health level
in Turkey:

Several meetings, publications and mass media programmes have been realised to
publicise the recommendations of the ICPD and the Fourth World Women
Conference.
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
An undergraduate curriculum of medical schools and midwifery schools on
reproductive health have been revised and improved.

The National Service Delivery Guidelines on Family Planning have been prepared
which covers all aspects of reproductive health and sets the criteria and standard
for the service provision. These guidelines have been printed and distributed
nationwide and are in use since 1993.

Several special programs have been carried out to strengthen IEC components of
reproductive health care services. Under these programs, three training and
communication centres have been established which produce IEC materials like
brochures, flip books, video films, slides as well as providing training for the
health personnel on how to produce and use IEC materials effectively. These
centres are located in the three different geographic areas in Turkey, which cover
all provinces.

New long acting contraceptives (ie. Norplant and injectables) have been newly
introduced into the national family planning program to increase method choices
of modern contraceptives and to help to decrease unmet need in family planning.
For the same purposes, pilot programs have been initiated to provide family
planning services in postpartum and post abortion periods. Activities to expand
these initiatives nation-wide are still continuing.

To improve the knowledge and practices of the public and increase utilisation of
health care units, community based services have been tested. Male and female
volunteers from various communities have been trained to provide IEC to their
communities and also to motivate them to use/consult formal health care services.
The results are very encouraging.

Another successful approach, which was pilot tested, was to provide all
reproductive health care services in one primary care unit. For this purpose, some
of the MCH/FP units were converted into Free Standing Family Health Clinics. In
these clinics, the reproductive health services gained a comprehensive
characteristic in terms of including adolescents and men as target groups, making
them available of counselling services. Antenatal care, postpartum care, STDs and
counselling are among the services provided as well as abortion and post abortion
contraception services. Additionally, some services such as early diagnosis of
malignancies and menopause counselling and care, which are traditionally not
included in primary care, are also offered in these clinics. As for family planning,
all contraceptive methods including Norplant, injectables, tubal ligation and
vasectomy are being provided.
In Turkey for long time only women was targeted in reproductive health and
especially in family planning programmes. However, men should also be considered
in reproductive health programmes, particularly in a male-dominant society. Some
operational research has shown that when men are targeted using appropriate
personnel and training materials, contraceptive prevalence increases. The needs of
men were assessed through a survey and IEC programmes were developed
accordingly.
13
In Turkey, health care services for infertility has traditionally been a part of
comprehensive family planning services. STD screening and Infection Prevention
measures have been emphasised at the primary care level and services have been
strengthened. In addition, to update the standards according to the recent technologies
in the assisted reproduction, the regulations, which have been formulated in 1987,
were revised and published in 1996, are in use now.
After the ICPD, involvement of the NGOs and private sector in the RH/FP activities
has been increased. In 1996 a system called “Health Care System in Women’s Health
and Family Planning” has been established which is a network of NGOs, private
surgeries, private hospitals and pharmacies to provide improved and affordable
services to the clients.
Social marketing has been another initiative to increase the use of modern
contraceptives. A pilot project has been running on with pills and condom. The results
were encouraging. Now there is a plan by an NGO to put injectables on social
marketing programme.
For the first time, in Turkey seventeen NGOs which are associated with women’s
health issues made an agreement and formed a commission which is called
“Commission on Women’s Health” (KASAKOM in Turkish). This commission has
prepared a project to be implemented in some provinces in Turkey, where the needs
are greater. The project involves community based RH/FP services to improve the
status of women (courses for literacy and income generation).
Turkey has a favourable opportunity to evaluate the progresses in reproductive health
and population issues. Since 1963, a nation wide health and population study has been
carried out regularly with the last one being conducted in 1998.
Turkey traditionally has had close collaborations with several international health
agencies, which not only provide financial support but also facilitate transfer of new
knowledge, approaches and technologies on health issues besides exchange of
experiences. So far, most of the projects related to RH/ FP have been carried out with
the collaboration of the UNFPA, WHO, USAID, JICA, GTZ and IPPF.
Decentralisation of health services, upgrading health services to include
comprehensive RH/FP services and exploring means to meet the needs of underserved groups in order to reduce inter-regional disparities all over the country still
require further efforts.
Introduction of measures to reduce turnover rates of trained service providers as well
as health managers has been the crucial element in the success of implementation of
the ICPD Programme of Action and it still remains as a problem.
7. Adolescent reproductive health
With regards to teenage pregnancy and motherhood, 1998 TDHS reports that 2
percent of 15 years old women had first pregnancy or child birth; increasing by age,
this rate was 23 percent among 19 years old women. This ratio was higher in rural
14
than urban and higher in Central, South and East regions. As educational level of
teenager (15-19) women increases, percent of childbearing decreases, (22 percent
among uneducated and 2 percent among who completed secondary education).
The main issue regarding adolescent reproductive health is lack of related systematic
education at schools. Primary school curricula do not give information on
reproductive health besides limited biology topics on the 8th year. First year high
school (9th year of education) has Health Knowledge lessons and there are topics on
adolescence physiology and psychology, maternal-child health/family planning and
communicable diseases including STDs. The drop out in enrolment at high school
limits access to this information. Vocational schools curricula include topics focusing
on MCH/FP and lack comprehensive reproductive health information for adolescents.
Training of teachers is not systematic and IEC materials targeting adolescents have
not been adequately developed. Media may not support education of adolescents and
may even give exploitative messages. A counselling system on reproductive health
has not been developed at schools and present teachers performing general
psychological counselling lack training in reproductive health.
Efficient links have not been established between schools and health institutions for
reproductive health care. Reproductive health care units are not positioned at
adolescents’ settings (schools, university, or hostels) to promote their access.
Facilities providing reproductive health services lack special programmes for
adolescents and their service providers do not receive training to deal with adolescent
needs. Adolescents are ignorant or shy to apply for reproductive health services and
there are not specifically designed IEC programmes to orient them to obtain services.
They may have difficulties to afford contraceptives from private sectors and may feel
unease in seeking them from public facilities, which are not tailored to serve them.
Health information system is not designed to collect and evaluate data on adolescent
reproductive health and health services.
ICPD can be considered as a turning point for the activities concerning adolescents.
Currently, NGOs are conducting mainly educational activities for university students,
adolescents in rural areas and in settlements where reproductive health facilities are
limited, through community based and a youth-to-youth programme, in collaboration
with the MoH. The Ministry of Education collaborated in the development of the
Reproductive Health and Family Health Courses for the intermediate school
curriculum. As a result of this joint effort, over 2 million adolescent girls have
attended IEC programmes on reproductive health. The local and national media have
also contributed much to these advocacy efforts.
The Eighth Five-Year plan stipulates that developing cooperation among institutions
shall be accelerated in order to carry out research studies and action plans to protect
the youth from harmful habits, to take dissuasive measures and to eliminate elements
creating an atmosphere for crime. Effective shall also be carried out in order to make
the youth and the public aware particularly of drug addiction, HIV/AIDS and similar
diseases.
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8. Demographic, economic and social impact of HIV/AIDS
The first case of AIDS was diagnosed in 1985. The total number of reported HIV
positive and AIDS cases reached to 1,325 in the period between 1985 and 2001. This
figure includes officially reported 404 AIDS cases, whereas it excludes reported 68
cases of death due to AIDS related causes in the period between 1985 and 2001. At
the beginning, almost all of the reported cases were among injecting drug users,
foreigners, blood-transfused patients and Turkish workers returning from foreign
countries. Starting from the second half of 1990s, the picture has begun to change and
signs of an exponential increase in the reported cases have become observable.
However, owing to problems in the surveillance system and health information
network, the official figures do not reflect the true number of cases. Likewise, casereporting system is inadequate for the epidemiological analysis of the diagnosed
cases. STDs subject to mandatory notification such as syphilis, hepatitis B-C and
HIV/AIDS are STDs with the highest incidence rate. On the other hand, total number
of HIV/AIDS cases, according to estimates of experts, ranges between 7.000 and
14.000 since the beginning of the epidemic.
Incidence rates for certain STDs and HIV/AIDS are considerably low compared to
many regional countries in Eastern Europe. As the ratio of HIV/AIDS cases is 1.96
per 100,000 population, recent status of HIV/AIDS in the country may be described
as “an early stage, with limited infiltration into the general population”.
Majority of officially reported HIV/AIDS cases cumulates in 15-39 age group. This
means that two-thirds of infected individuals contracted the virus in 20s. Among the
reported cases, heterosexual contact is the main route of transmission. Gender
distribution of HIV positive cases has started to shift in the direction of a balance
between males and females. Females constitute two thirds of HIV infected children in
15-19 age group. The share of mother to child transmission of HIV cases is 1.36%.
However, it is almost impossible to determine the exact reasons for children’s
contraction of the virus.
In Turkey, there are no sentinel surveillance sites, however the HIV surveillance
system covers all testing sites in the country. The system is designed to monitor the
spread of infection in certain risk groups, including blood donors, registered
commercial sex workers (CSWs), unregistered CSWs detained by security officers
and short term recruits (military service conscripts living abroad. In addition to these
groups in the system of sero-surveillance, routine pre-surgical screening for HIV has
been practiced in all hospitals. Besides, various vulnerable groups, such as pregnant
women, blood tested patients, individuals applying for marriage, have been included
in the sero-surveillance system in recent years. Due to limited resources and the
ethical problems aroused, the new groups added into the screening programs seem to
lead further complications.
Demographic, social and economic characteristics of Turkey set up a favourable
ground for the rapid spread of STDs, including HIV/AIDS. Young and highly mobile
population structure, low level of education, lack of public awareness, meager health
care system, high level of denial and indifference of public authorities to public health
risks of HIV epidemic are main factors considerably increasing vulnerability to STDs
and HIV/AIDS.
16
Along with developments in tourism sector, the number of visitors particularly from
East European and Central Asian countries has been increasing. Most of the countries
in this region suffer from the fastest growing HIV epidemic in the world as well as
high rates of STDs, and a substantial number women travel from these countries to
Turkey in order to involve in sex work. With regard to susceptibility to HIV epidemic,
it also is worth to mention about regular visits of nearly 3,5 million Turkish citizens
who permanently live in West European countries to Turkey.
Despite above-mentioned factors increasing vulnerability and susceptibility to STDs
and HIV/AIDS, the Ministry of Health gives higher priority to curative health
services. The emphasis given to primary and preventive health care is considerably
limited and concentrates mainly on mother-child health and family planning issues.
Due to significant disparities observed in terms of health care infrastructure,
distribution of health personnel as well as quality of services among regions,
reproductive health (RH) indicators vary significantly across the country. Pre- and
post-graduation as well as in-service training of health staff is not adequate to
improve the quality of RH services, and to deal effectively with STDs, including
HIV/AIDS.
The RH status of population, particularly women, is low compared to the countries
with the same level of development. In spite of improvement in life expectancy,
maternal and infant mortality rates are still below the regional averages. Some
findings of 1998 Demographic and Health Survey might be meaningful to explain the
low status of reproductive health in the country: the ratio of unwanted pregnancies is
19%, nearly one third of pregnant women do not receive antenatal care and a quarter
of births is delivered out of a health facility. One fifth of all births is delivered
without assistance of a doctor or trained health personnel. The use of modern
contraceptives is low. Condom use among married men is around 11.4%.
With regard to socio-economic characteristics of the population, significant disparities
are also observed between rural and urban areas and among regions. In addition to
existing disparities among regions, earthquakes in 1999 and economic crises in 2000
and 2001 have created devastating impact on economic growth, level of
unemployment and distribution of income; and resulted with deepened poverty and
increased vulnerability of the population to infectious diseases, including STDs and
HIV/AIDS. Developing tourism capacity and improving transportation facilities have
been seen as remedies for economic recession, whereas entrance of annually more
than 10 million tourists into the country is increasing the risk of STD and HIV/AIDS
outbreak.
Despite the general public awareness about HIV/AIDS, knowledge of individuals
about the infection, ways of transmission and methods of prevention is insufficient
and even erroneous. Information regarding reproductive health and family planning,
including HIV/AIDS, is included in the primary school (Grade 7) and high school
curriculum, but its content is very limited. Nevertheless, level of awareness on STDs,
including HIV/AIDS, is highest among high school and university students especially
living in big cities, according to the results of academic studies.
17
Principal aim of the National AIDS Commission (NAC) established in 1996 is to
scale up national response to HIV/AIDS. It is chaired by the Ministry of Health
(MoH) and a national NGO, the Family Planning Association of Turkey (FPAT),
functions as the secretariat of the NAC. FPAT organises NAC activities under the
supervision of the MoH. With the contribution of 30 national counterparts from public
institutions, academies and NGOs, the NAC identified national targets and strategies
in 1996, and prepared a plan of action composed of following components:
prevention, diagnosis-treatment and social support, legislation, information
dissemination and research.
The NAC remained inactive nearly two years, until it was reactivated with the
encouragement of national NGOs and UN TG on HIV/AIDS in May 2002. Recently,
a group of experts has been dealing with revision of national targets, strategies and
national plan of action, in accordance with the principles of Declaration of
Commitment on HIV/AIDS.
In the fight against HIV/AIDS, the most active and devoted national stakeholders
have been NGOs. The majority of NGOs concerned with HIV/AIDS is active under
the leadership of academicians working for clinical microbiology or infectious
diseases departments of medical faculties. The scope of their activities is limited,
however most of them are experienced on advocacy and information, education and
communication (IEC) activities, such as training programmes for adolescents,
students, public, and specific groups of specialisation, publication of materials, etc.
Mandate of some most experienced NGOs, on the other hand, is reproductive and
sexual health that necessarily includes HIV/AIDS related activities.
Some favourable conditions in Turkey provide certain advantages in the fight against
HIV/AIDS. One of these is the traditional behavioural code and strong social pressure
that still have sway on society. Influence of strong social control associated with
considerations on honour is demonstrated both in rural and urban areas inter alia by
low divorce rate; severe reaction to promiscuity and extramarital relations; a relatively
high age in the first sexual experience, especially for girls; tight family and kinship
ties, etc.
Strong social control also hampers practice and disclosure of certain unapproved
behaviours and styles of living such as drug abuse, homosexuality, etc. In result, the
rates of drug use and homosexuality are comparatively lower than other regional
countries, according to the results of academic studies. It implies a relatively lower
risk of STD or HIV/AIDS infections.
Although existing health care system has serious problems and it requires a radical
reform, it still embraces a significant amount of trained personnel and ample health
infrastructure as well as considerable institutional experience.
Preventive measures taken, especially after the establishment of the National AIDS
Commission, contributed controlling the spread of virus and significantly prevented
its infiltration into general public.
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9. Gender equality and development
The ICPD Programme of Action brings the statement of how gender equality, equity
and empowerment of women is related to building a sustainable, just and developed
society. The implementation of population and development programs in this context
needs two critical steps; one is the adoption of a right-based approach to enable
women to secure and safeguard their reproductive and sexual rights and the other is
adopting gender sensitive perspective in programs.
With the establishment of the Turkish Republic over 75 years ago and its ensuing
growth, Turkish women acquired legal rights and freedoms before some Western
countries. However, the traditional structure of society prevented from truly enjoying
their legal rights, and the existing laws were inadequate to keep pace with the
changing conditions in the country and around the world. The Civil Law of 1926
assures legal equality between men and women in relation to individual rights and
inheritance. All political rights were granted to women with the enactment of the
Municipalities Law in 1930 and with the earned right to elect and be nominated for
parliamentary representation in 1935. However, women in Turkey do not still
consider politics within their area of work and the presence of women in the national
parliament and local administration is very low.
Civil society in Turkey has accelerated its efforts to include women to policy dialogue
in the past five years. Very recently, the Association for Support and Training of
Women Candidates (KADER) has been established and received positive support
from various social groups of society. On the official side, there are limited initiatives
for establishing an obligatory system for women representatives in the popular
elections to promote the political participation.
The Convention on the Elimination of All Forms of Discrimination Against Women
(CEDAW) outline principles and standards for achieving equality between men and
women in every fields. Since 1991, Turkey has included in its programs the revision
of internal procedures, withdrawal of the reservations, and development of policies
consistent with organisations such as the United Nations, the European Council, ILO,
OECD, and the European Security and Co-operation Conference regarding women.
The Turkish Constitution fully provides for equality of the sexes. The provisions that
are contrary to the principals of gender equality in Turkish Civil law, labour law and
regulations, the penal code and the citizenship law are in the process of revision by
the parliament. Recently, new revisions have been made by the parliament in the
provisions regarding inheritance, maiden name and tax in order to reverse the
undesirable conditions against women. When the legal framework is considered as a
whole, it can be said that some improvement has been made in the laws since 1994.
The General Directorate for Women’s Status and Problems was established in 1990,
and the Under-Secretariat for Women was established in 1991 to raise the social
status of women, to put into effect international conventions, and to implement the
targets and policies of the development plan. The Directorate has been implementing
a national program for the enhancement of women’s integration in development.
Women NGOs are co-operating with the Directorate to advocate women’s concern
regarding the legal system. The gender-based researches and data collection realised
19
by the Directorate are the initial steps for establishing a documentation centre.
Universities have established centres and developed programs aiming to contribute to
efforts towards the improvement of the status of women.
The education of women and the subsequent creation of awareness are essential
factors for women to be able to take possession of their earned legal rights. Although
75 years have passed since the establishment of the Turkish Republic the desired
educational conditions and reduction in educational disparity between the sexes have
not been achieved.
The increasing of mandatory primary education from five years to eight years in 1997
is of great significance, especially since it will eventually change the traditional
reluctance towards sending girls to school for additional years. NGOs in Turkey have
advocated for the mandatory eight-year primary education and continue to advocate
raising social consciousness for the education of girl child.
Whereas school attendance rates of girls and boys are close for the primary school
level, girls’ participation in all levels of post-primary school education lags behind
that of boys, with the differential growing in proportion to the rising level of
education. The Ministry of National Education has been providing vocational and
technical training programs to young girls and women to strengthen their capabilities
to produce market goods or to look for professional opportunities.
Although there are no obstructive provisions in the laws, the level of education and
the lack of qualifications required for employment and the inadequacy of mechanism
that facilitate entry into the work force, women’s inclusion in labour is much lower
than men’s. On the other hand, participation of women in labour for particularly
industrial production is of great importance for the improvement of women’s status
and the national economy.
The educational content and the curricula present women within the framework of
their traditional roles and promote gender stereotypes. This cliché, which defines
women in their traditional role, needs to be eliminated form all levels of the education
system and replaced by an approach that represents women and men as individuals
who enjoy equal rights and bear equal responsibility for all aspects of life.
Turkish women are unable to utilise the legal advantages available to them in many
areas of law because they are unfamiliar with the existing laws and therefore cannot
exercise their rights. Informing women about their legal rights through training
activities is important, and considerable responsibility awaits NGOs in this respect. In
a similar context, a great need also exist for NGOs to continue activities supporting
the eight-year primary education system and to advocate raising mandatory primary
education to 11 years.
Voluntary women’s organisations in Turkey bear the common goal of ensuring
women’s active participation in all phases of social life, increasing sensitivity to
women’s problems, and exerting pressures on the institution and agencies concerned
to accomplish this objective. The co-operation and communication among these
NGOs need to be encouraged at national and international level. Networking
initiatives following ICPD which aims to unite members’ knowledge, capability and
20
resources increases the chances of developing and implementing gender specific
programs with a holistic approach.
The Eight Five-Year Development Plan (1996-2000) prepared by the State Planning
Organisation addresses the need to raise women’s social status through widening their
fields of involvement and benefit from equal opportunities, raising the level of
education and enabling their participation in development process, working life and
decision making.
10. Behavioral change communication and advocacy and information and
communication technology as tools for population and development and
poverty reduction
The Programme of Action adopted at the 1994 International Conference on
Population and Development places people at the centre of development and cause for
the involvement of communities and individuals in formulation and implementation
of population and development policies and programmes. The growing emphasis on
community involvement in development brings a new dimension to advocacy work,
underscoring the importance of advocacy at the community level. The recognition in
ICPD Programme of Action and in the Action Plan adopted at Fifth World Women
Conference, that people, especially the youth and women, should be principal
decision makers on reproductive health, reproductive rights and gender issues,
transforms the perception of advocacy from being and activity almost exclusively
addressed to few top-level influential individuals to a process in which communities
and individuals are potential advocates.
As in many other countries, advocacy has played an important role in Turkey prior to
beginning of the national population/family-planning programme in mid-1960.
Reversal of population policies and removal of legal barriers to the availability of
contraceptives, required considerable effort by the proponents of family planning for
convincing decision-makers. Similarly, the second legislative reform in 1983, which
facilitated expansion of contraceptive service delivery as well as legalising surgical
contraception and safe abortion, was made possible through intensive advocacy work
among policy-makers and parliamentarians.
Since mid-1970s, advocacy efforts for improvement of women’s conditions have
intensified and expanded. Both public institution and women’s groups and
organisations have been actively promoting changes in policies and laws as well as
social change for elimination of barriers to gender equality and equity. Efforts for
legal change have particularly concentrated on changing the Turkish Civil Code many
provisions of which was contrary to the principal of gender equality. Several
Women’s organisations have played an active role in the preparation of a bill for this
purpose.
Elimination of violence against women, especially in the family has been another
issue on which a great deal of publicity has been generated by women'’ group. These
efforts and the work undertaken by General Directorate on the Status and Problems of
Women have culminated in the enactment of a law that prohibits against women.
21
Several special programs have been carried out to strengthen IEC components of
reproductive health care services. Under these programs, three training and
communication centres have been established which produce IEC materials like
brochures, flip books, video films, slides as well as providing training for the health
personnel on how to produce and use IEC materials effectively. These centres are
located in the three different geographic areas in Turkey, which cover all provinces.
As a result of the joint effort of public institutions and NGOs, over 2 million
adolescent girls have attended IEC programmes on reproductive health. The local and
national media have also contributed much to these advocacy efforts.
11. Data, research and training
Turkey has a series of censuses and surveys used for implementation, monitoring and
evaluation of government programmes. However existing vital registration system is
inefficient as regards to its context due to deficiencies in infrustructure and
organization. So, the need for development and extension of this system throughout
the country on the basis of field studies for collecting and recording data regarding
vital events in all the settlements, persists. VIII. Five Year Development Plan puts
forward the objective that “country-wide vital data registration system so as to be
used by all sectors and structural arrangements to ensure coordination, cooperation
and flow of information among concerning institutions shall be concluded within the
plan period. Research towards monitoring of development in population structure
shall be encouraged.”.
One of the most important characteristics of Turkey is the high population growth
rate in urban areas due to the internal migration. Turkey plans to carry out migration
surveys in metropolitan areas. These surveys will improve regional data within the
country.
Turkey continue to provide technical assistance to the countries in its region in the
field of population and development by The International Training Centre for
Population and Development, which is supported by UNFPA.
Turkey needs to improve data on health statistics, ageing population, living standards
and environmental data to analyze interrelationship between population and
sustainable development.
In cooperation with United Nations Population Fund, State Institute of Statistics has
been implementing project on establishing data bank for population and development
indicators. Through this project, technical documentation has been prepared to
evaluate population and development indicators, international definations, data
sources and their limitations. Besides, researches on development data collection
system on international migration, elderly, youth have been going on.
Data processing of 2000 Population Census has been finished. Population-related data
for local areas ( province, district and villages level) is available to examine variations
between local areas. Results of 2000 population census will be main source for
population and development data bank to give information at the local level.
22
Turkey has been implementing some statistical projects in collaboration with the
international organizations to improve and strengthen existing statistical system in
different field of statistics by receiving training and consultancy services, and
acquisition of equipment. In this context, a Project on “Upgrading the Research and
Data Analysis Capacity in the field of International Migration Statistics and
Population Dynamics” financed by UNFPA has been successfully completed in 2001.
Furthermore, a series of simultaneous projects including tourism (MED-TOUR),
migration (MED-MIGR) and social (MED-SOC) statistics under the EuroMediterranean Statistical Cooperation (MEDSTAT) Program has been implementing
during the recent years. The State Institute of Statistics (SIS) of Turkey has taken
responsibility as an institution providing MED training programs to the partner
countries.
In the last few years, labour force survey and household budget survey conducted in
Turkey have been introduced to the participants from the statistical offices of Central
Asian and Caucasian Countries. In addition, many consultants have been assigned to
assist their counterparts on data collection and data processing in different field of
statistics.
12. Partnership and resources
The involvement of civil society in population and development issues especially in
provision of reproductive health information and services as well as the promotion of
advocacy and social mobilisation efforts in order to carry forward the goals of
Programme of Action has become more essential in Turkey.
It has been more recognised in Turkey that to implement the conceptual shift to an
approach highlighting human centred development and the life-cycle concept of
sexual and reproductive health within a wider framework of sustainable human
development, a broad-based collaboration among Governments, the international
community NGOs and the private sector is getting importance.
NGOs and private institutions have long been included in all phases of the
formulation, implementation, monitoring and / or assessment of policies, plans and
programmes in areas such as reproductive health, gender equality and protection of
environment.
After the ICPD, Government of Turkey has continued to get the increasing
involvement of NGO and private sector representation in all aspects of national
development programmes especially in the promotion of reproductive health and
rights, and for the realisation of human rights including equality and equity.
Collaboration among public and private institutions and NGOs through the National
Family Planning Advisory Board is ongoing. In addition, involvement of civil society
in population and development activities is encouraged as a policy that is clearly
stated in government programmes and development plans.
23
NGOs, private sector and universities took part in preparation of the Seventh FiveYear Development Plan by participating in specialised expert commissions. The Plan
envisages the active participation of NGOs and private sector, particularly in IEC
activities. The Strategic Plan for Women's Health and Family Planning was prepared
under the sponsorship of Ministry of Health with the contribution of above-mentioned
sectors. In addition: NGOs have been taking part in ICPD Follow up Committee of
Government and those NGOs working in reproductive health have been implementing
Government sub-contracted projects on reproductive and sexual health.
The Government (MoH) has initiated programmes such as safe motherhood, certain
IEC programmes particularly for adolescents, STD/HIV protection, in cooperation
with NGOs. Some RH/FP projects are supported by MoH but implemented by NGOs
while some NGO projects are completely independent of government.
Although the Government has increasingly recognised the role of the NGOs, the
capacity of the NGOs is still generally under-estimated.
Due to the rapid changes of Government's high level bureaucrats, NGOs have to
reintroduces/ re-establish themselves and fight continuously for the issues to remain
on the national agenda.
Private sector is already playing an active role. They have been operating clinics,
hospitals, involving in marketing of drugs and contraceptives and providing
information/counselling services. In addition, some new measures have been taken in
the Strategic Plan of Ministry of Health for National Women's Health and Family
Planning to extend the role of the private sectors in reproductive health care services.
24