Examining expert views on maternal mortality in Turkey: A qualitative study.

BACKGROUND: Maternal mortality ratio is one of the significant indicators of a country's healthcare quality and development. In recent years, Türkiye has made significant advancements in maternal and child health services. However, it has been discussed that stagnation has been observed in recent years, and the migration from Syria and the COVID-19 pandemic have significantly overshadowed this success. The purpose of this study is to evaluate the current situation of the maternal mortality level in the country based on the experiences and views of experts working in this area. METHODS: Key informant interviews were conducted with a purposive sample of academics, representatives of public institutions, and NGOs to understand the mechanisms of success in maternal mortality in the 1990s. Thematic analysis was used to understand the reasons for the stagnation of the decline in maternal mortality and to develop recommendations for reducing maternal mortality. RESULTS: Twenty-five key informant interviews were conducted. Positive developments contributing to the success of maternal mortality, problems and obstacles hindering further progress and suggestions/recommendations are the themes of this research. The key informants highlighted the health transformation policies, the lack of data on the impact of COVID-19, recent migration on maternal mortality, inadequate education and training on sexual and reproductive health (SRH), the absence of rights-based policies, and gender equality as critical issues in current policies. CONCLUSION: The outcomes of this study underline the importance of the availability, accessibility, and quality of SRH services and empowering women, girls, families, and communities to eliminate preventable maternal mortality levels.

Intimate Partner Violence During Pregnancy in Turkey: Determinants From Nationwide Surveys.

Domestic violence has severe consequences for women, both psychologically and physiologically. Violence during pregnancy is even riskier, endangering women's lives and the lives of their fetuses. A nationwide survey in Turkey in 2014 revealed that 7% of women who have experienced a pregnancy were exposed to physical violence perpetrated by an intimate partner during pregnancy. In this study, the risk and protective factors for this particular type of violence and how it can be addressed in Turkey are discussed using nationally representative data for the first time. Data are obtained from surveys conducted in 2008 and 2014 on domestic violence against women. The analysis is based on multinomial regression models in which the dependent variable consists of three groups of women: those who have not been exposed to intimate partner violence (IPV), those whose have been exposed to physical IPV but not during pregnancy, and those who have been exposed to physical IPV during pregnancy. In this way, the factors that have a significant effect on this severe form of violence can be identified. Our findings show that earlier age of first intercourse; the nature of first intercourse; men's affairs; men's controlling behaviors over women; men's use of alcohol, drugs, or gambling; and experience with violence in the family are all significant factors for IPV during pregnancy. Women's empowerment and the restructuring of the unequal power relations between women and men should be targeted to eradicate the problem in the long run. It is concluded that, for the time being, it is crucial to ensure that legal procedures for domestic violence function well and that health institutions are key components in identifying pregnant women exposed to violence and in guiding them toward institutional and social support mechanisms.

Intimate partner violence and the relation between help-seeking behavior and the severity and frequency of physical violence among women in Turkey.

This study explores the severity and frequency of physical violence from an intimate partner experienced by 15- to 59-year-old women and their help-seeking behavior by using data from the "National Research on Domestic Violence Against Women in Turkey." Chi-square tests and logistic regression analyses were conducted to compare the relationship between severity and frequency of violence and women's characteristics. Of all ever-partnered women, 36% have been exposed to partner violence; almost half of these experienced severe types of violence. Women used informal strategies to manage the violence instead of seeking help from formal institutions. Help-seeking behavior increases with increased severity and frequency of violence.

The use of withdrawal among birth limiters in Iran and Turkey.

Despite a decline infertility, an increase in contraceptive prevalence, and a wide expansion of family planning programs in Iran and Turkey, a large proportion of "birth limiters" rely on withdrawal to avoid pregnancy. Adopting a comparative approach, this study draws on data from the 2000 Iran DHS and 2003 Turkey DHS to examine the determinants of the practice of withdrawal among birth limiters. Multivariate logistic regression analyses were employed to estimate the likelihood of withdrawal use among two representative samples of birth limiters. Higher education and wealth were associated with greater likelihood of withdrawal use among birth limiters in Iran, while an inverse association was found in Turkey. Older age was positively associated with withdrawal in both countries, whereas having more than four children was inversely related to use. Study results suggest that family planning and reproductive health programs in Iran and Turkey should be aware of the groups that have high rates of withdrawal use, should educate couples in the effective use of withdrawal, and should encourage the use of more effective modern methods and emergency contraceptives when appropriate.

What puts women at risk of violence from their husbands? Findings from a large, nationally representative survey in Turkey.

A large, nationally representative, cross-sectional survey was conducted in Turkey in 2008. In this survey, which used the WHO (World Health Organization) study module on violence, information about lifetime and current violence (past 12 months) was obtained using weighted, stratified, and multistage cluster sampling. This article describes factors associated with physical or sexual violence experienced by ever-married women, aged 15 to 49, from their current or most recent husbands in the 12 months before the survey. Logistic regression analysis is used to describe the risk and protective factors from a considerable range of explanatory variables. The findings confirm that many factors are similar to the experiences of other countries. The physical or sexual violence experienced by ever-married women from their husbands was 15.1%. The violence experienced by women is significantly positively associated with early childhood abuse experiences of both women and their husbands; marriages decided by families or others; husband's behaviors such as drunkenness, adultery, controlling women's behavior, and preventing contact with women's family and friends. The age of the women, their contribution to the household income, support from women's families, women's acceptance of male authority, and nonpartner violence experience as well as regional differentials also affect the risk of violence. No significant associations were found with the employment status of women and men or education difference. This study, as one of the largest surveys ever conducted on the issue of domestic violence using face-to-face interviews, demonstrated how the patriarchal family structure still affects women's lives in Turkey. This is particularly significant, given Turkey's setting between traditional and modern values.