Turkish Demographic and Health Survey 1993

Abstract

The 1993 Turkish Demographic and Healtb Survey (TDHS) is a nationally representative survey of ever-married women less than 50 years old. The survey was designed to provide information on fertility levels and trends, infant and child mortality, family planning, and maternal and child bealth. Tbe TDItS was conducted by the Hacettepe University Institute of Population Studies under a subcontract tbrougb an agreement between tbe General Directorate of Mother and Cbild Health and Family Planning, Ministry of tlealth and Macro International Inc. of Calverton, Maryland. Fieldwork was conducted from August to October 1993. Interviews were carried out in 8,619 households and witb 6,519 women. Fertilit~ in Turkey is continuing to decline. If Turkish women maintain current fertility rates during their reproductive years, they can expect to have all average of 2.7 children by tbe end of their reproductive years. The highest fcrtility rate is obse~'ed for the age group 20-24. Tbere are marked regional differences in fertility rates, ranging from 4.4 children per woman in the East to 2.0 children per woman in tbe West. Fertility also varies widely by urban-rural residence and by education level. A woman living in rural areas will have almost one child more than a woman living in an urban area. Women wbo bave no education have almost one child more tban women who have a primary-level education and 2.5 children more than women wilh secondary-level education. The first requirement of success ill family planning is the knowledge of family planning methods. Knowledge of any method is almost universal among Turkish women and almost all tbose who know a method also know the source of the metbod. Eighty percent of currently married women have used a method sometime in tbeir life. One third of currently married women report ever using tbe IUD. Overall, 63 percent of currcntly married women are currently using a metbod. The majority of these women are modern method users (35 percent), but a very substantial proportion use traditional methods (28 percent). rbe I UD is the most commonly used nloderu method (I 9 percent), lbllowed by the condom (7 percent) and the pill (5 percent). Regional differences are substantial. The level of current use is 42 percent in tile East, 72 percent in tile West and more than 60 percent in tile other three regions. "File common complaints about tile methods are side efl'ects and health concerns; tbese are especially prevalent for the pill and IUD. A basic knowledge of reproductive plDsiology is necessary, especially in tile use of coitus-related methods. However, only 22 percent of cver-married v, olnen kDow the correct time of ovulation. Information on the sources of methods is important for plamling the services. The majority of users (55 percent) obtain the methods from government services. Primary health care units are tile major public sector suppliers (35 percent) and pllarmacies are the major private sector suppliers (26 percent). Tile discontinuation rate of the IUD is the lowest among all inelhods. Intbrmation on tile intentions of current non-users was also collected tbr the cstimation of futnre dcmand. Of this group, 46 percent do not intend to use any method in the future ,,,dlereas 45 percent havc the intention to use. Of lbe latter women, the majority report that their method of choice v, ill be the IUD. Abortion rates have decreased slightl) since 1990. The decrease is observed tbr induced abortions rather than spontaneous abortions. For tile 3ear preceding tile survey, the abortion rate is 29 per 100 pregnancies, tile induced abortion rate is 18 per 100 pregnancies and the spontaneous abortion rate is 12 per 100 pregnancies. The abortion incidence is twice as high in tile Central, Southern and Northern regions and ahnosl three times as high in the Western region compared to tile Eastern region. "I'here have been 1.5 stillbirths per 100 pregnancies in the last five years preceding tile survey. Overall, 72 percent of women bad had no abortions, 15 percent had one abortion, 8 percent had two abortions and 5 percent had three or more abortions. There is a very important oppontmit) for family plamling cotmselling after an abortion, ttowever, the results show that this opporttmity is not ulilised well. In tile month after an induced abortion. XV 39 percent of women did not use any inethod and 27 percent used withdrawal. The main reason for obtaining an abortion was the desire not to have any more children (58 percent). Overall, 44 percent of abortions took place in the first month of pregnanc)~ 31 percent in the second month, 13 percent in tile third inonth and 12 percent in tile fourth or later months of pregnancy. Some 67 percent of abortions were perlbrmed by private physicians and 27 percent were perlbrmed in tile government hospitals: there are no significant differences between regions in terms of the .place ",,,llere induced abortions are performed. The age at first marriage is one of the important determinants of fertility. "FI)HS results suggest tbat there has been an increase over the past 20 years in tile age at first marriage in Turkey. "File median age at first marriage among ~omen age 25-29 is 20 )'ears compared to 18.3 )'ears among women age 45-49. There are differences in the age at inarriage across places of residence and regions. Even more pronounced differences are observed by educational level of women. Among '~,,omen age 25-40, there is a difference of ahnost 5 years in the timing of entry into marriage between those with little or no education and those x,,llo completed at least tile secondary level. More than two-thirds of currently married wolnen in Turkey say that they do not want ally more children. An additional 14 percent 'e, ant to ~,,ait at least two )'ears before having another child. When asked ho',~ inany children they would like to bare if the)were to start their reproductive lives all over again and be able to choose exactly, WOlnen reported an average ideal talnil) size of 2.4 children. Results from tile surve) suggest that if all unwanted births were eliminated, the total fertility rate at tile national level would bc 1.8 children per V~Olnan. nearly one child lower than the actual level of 2.7. Twenty percent ofthe births in the five ,,'ears preceding the survey were un',vanted birtbs and 12 percent of them were mistimed. The unmet need for family planning in Turke) indicates that there is potential for further increases in contraceptive use. Twelve percent of curreatl) married ~,omen are considered to be in need of family planning. These are V, Olnen who want no more children (8 percent) or who want to delay the next birth (4 percent) but are not using fimlil) planning. Data on infant and child mortalit) ffOln the fl)llS appear to be of reasonable quality according to a preliminary assesslnent of tile qualit) of birth bistor)data. [:or the five ),ears preceding tile TD[IS, tile infant mortalit) rate is estimated at 53 per thousand, tile child Inortality rate at 9 per thousand, and the under-five mortalit~ rate at 61 per thousand. For the same period, the results show that in Turkey, the neonatal mortalit) rate is higher than the postneonatal inortalit)' rate, and that all tile indicators of infant and child mortalit) have declined rapidl~ in recent )ears. The general agreelneat of the TDI-IS results with those from previous sur~,eys confirms the plausibility of the fDIIS findings. The TDItS fhldiags point to significant differences in inthnt and child mortality between regions and urban and rural areas, and show tbat tile educational level of the inother and the presence of medical inatemity care are important correlates of infant and child mortalit). In addition to the differentials observed bet~,een socioeconomic groups, infant and child mortality rates also appear to correlate strongly vJth demographic variables. Age of mother at birth and order of birth show the expected U-shaped relationship witb inlbnt and child mortality. Elevated risksof mortalit) are also apparent in the case of short birth intervals. Among the maternal health hldicators, antenatal care was received from trained health personnel by 62 percent of pregnant women. For more than half of the births, antenatal care started before the fifth month of pregnancy. Tetanus toxoid coverage for women is Io~. with 16 percent having one dose and 26 percent having two doses or more. Tile TDtlS shows that 60 percent of all deliveries took place at a health facilit). Deliveries at home are inore likely to occur without the assistance of trained health personnel. xvi One of the major child health indicators is immunisation coverage. Among children age 12-23 months, the coverage rates for BCG and the first two doses of DPT and polio were about 90 percent, with most of the children receiving those vaccines before age one. The results indicate that 65 percent of the children had received all vaccinations at some time before the survey. On a regional basis, coverage is significantly lower in the Eastern region (41 percent), followed by the Northern and Central regions (61 percent and 65 percent, respectively). Acute respiratory infections (ARI) and diarrhoea are the two most prevalent diseases of children under age five in Turkey. In the two weeks preceding the survey, the prevalence of ARI was 12 percent and the prevalence of diarrhoea was 25 percent for children under age five. Among children with diarrhoea 56 percent were given more fluids than usual. Breastfeeding in Turkey is widespread. Almost all Turkish children (95 percent) are breastfed for some period of time. The median duration of breastfeeding is 12 months, but supplementary foods and liquids are introduced at an early age. One-third of children are being given supplementary food as early as one month of age and by the age of 2-3 months, half of the children are already being given supplementary foods or liquids. By age five, almost one-filth of children arc stunted (short for their age), compared to an international reference population. Stunting is more prevalent in rural areas, in the East, among children of mothers with little or no education, among children who are of higher birth order, and among those born less than 24 months after a prior birth. Overall, wasting is not a problem. Two percent of children are wasted (thin for their height), and I I percent of children under five are underweight for their age. The survey results show that obesity is d problem among mothers. According to Body Mass Index (BMI) calculations, 51 percent of mothers are overweight, of which 19 percent are obese.