Since 1963, the Turkish Demographic and Health Survey (TDHS) has functioned as the major database for information on the demographic and health status of Turkey. Since 1993, Hacettepe University’s Department of Public Health has been compiling TDHS data. TDHS’ 1998 data has recently been reanalyzed to evaluate contraception, abortion and maternal health services in Turkey. The 1998 study was originally conducted under the auspices of the Hacettepe-WHO Collaboration Center, the Turkish Family Health and Planning Foundation, the United Nations Population Fund (UNFPA) and HUWRIC. The reanalysis was conducted at HUWRIC, with the assistance of our staff, and provides deeper insight into issues such as contraceptive use dynamics, attitudes towards contraception, future contraceptive use, induced abortions, and the use of ante-natal, natal and post-natal services in Turkey. The results of the reanalysis have been disseminated widely at meetings and presentations at the MOH and local levels. In 2002, the results were published as English and Turkish reports, and were distributed to MOH clinics, universities, non-governmental organizations and other related parties. The reanalysis suggested interesting relationships between socio-demographic and cultural characteristics (such as geography, socio-economic status, religious beliefs, native language, and women’s status), and the dynamics related to contraceptive use, abortion, and use of maternal health services. The results continue to serve as an important database in shaping policy decisions regarding contraception, abortion and maternal health services. The results also emphasize areas in which further research and service improvement are required.
2. “Globalization and Women’s Health Symposium”- co-sponsored by HUWRIC and the Ankara Medical Association, March 6 - 7, 2004.
The symposium consisted of two panel sessions and an imbedded conference, and focused on the effects of globalization on women’s health. HUWRIC’s Board of Directors and Women Studies Group presented on numerous topics during the symposium.
3. Study on Factors Influencing the Sexual and Reproductive Health of Adolescents/Young Adults in Turkey
The sexual and reproductive health of Turkish adolescents and young adults has not received any attention until quite recently. The exclusion of adolescents, young and unmarried people from sexual and reproductive health services is partially due to the cultural circumstances of Turkey. The sexual/reproductive health (S/RH) attitudes and behaviors of adolescents and young adults and their families are primarily influenced by the social values and cultural norms of Turkish society. Because adolescent and unmarried adult sexuality is still a taboo subject in many Turkish social circles, a tradition of silence continues, even for college and university students. This study was conducted between 2000 and 2002 with the collaboration of WHO/HRP-HQ. Its objectives were: 1) to identify the S/RH knowledge, perceptions, attitudes, risk behaviors and contraceptive practices of adolescents at universities; 2) to determine the level of reproductive health/family planning service utilization and the expectations of S/RH services among university students; 3) to identify underlying socio-cultural factors influencing attitudes towards, and practices about, sexuality and reproduction; and 4) to identify the knowledge, attitudes, counseling skills, information, education and communication needs of health personnel who provide S/RH services to university students. Two universities, one in Ankara and the other in Diyarbakır, were selected to reflect the differing socio-cultural, ethnic, and historical backgrounds of Turkey. Both qualitative and quantitative methods were used, including self-administered surveys for students, semi-structured in-depth interviews with health care personnel and key informants, and student-based focus groups.
This research has pioneered our understanding of the sexual and reproductive health situation of Turkish adolescents and young adults. It has also provided important insight into the lives of Turkish youth, and the kinds of services they desire. For instance our research illustrated that young adults in Turkey do not have sufficient knowledge about sexual and reproductive health, and a great majority had never used any S/RH services, including university and external service units. Those who had received some form of S/RH service (18% of those surveyed in Ankara, and 10% of those surveyed in Diyarbakir) had used private clinics or hospitals. The study also demonstrated that “virginity” is still a very important issue for students residing in both demographic regions, and that a significant number of students believe that sex is not a natural part of dating. The stigmatization of women participating in pre-marital sex was also widespread, while male involvement in pre-marital sex was accepted to a certain degree. These young adults were not knowledgeable about sexually transmitted diseases, and did not know how to use existing S/RH services.
One outcome of this study was the recommendation of improved university socio-medical healthcare centers, especially in terms of their provision of youth-friendly S/RH services. This recommendation included retraining center personnel in order to minimize stigmatization and to ensure the confidentiality of student services. Student participation in the design of these services, and the adaptation of different service models and procedures for different regions based on their social and cultural characteristics and needs were also recommended. The use of peer education to improve S/RH knowledge among adolescents and young adults was another important suggestion derived from this research.
As described below, the results of this study formed the basis of an intervention study on Turkish university socio-medical healthcare centers.
4. An Intervention Study to Provide Sexual and Reproductive Health Services for Students at University Healthcare Centers, and an Evaluation of Its Impact
This intervention study was designed as a response to the Study on Factors Influencing the Sexual and Reproductive Health of Adolescents/Young Adults in Turkey Study, which was conducted with the collaboration of WHO/RHR-Geneva. In Turkey, approximately 2 million young adults attend universities. Students receive free healthcare services from university socio-medical centers. Based on the findings of the adolescent sexual and reproductive health study, it is clear that the current level of service provision at these centers does not meet student needs. The university socio-medical healthcare centers do not provide any reproductive and sexual health counseling services or any other form of reproductive healthcare. Students are at an increasingly higher risk of unwanted pregnancies, sexually transmitted diseases, and other reproductive problems. Although the socio-cultural environment has been changing in Turkey, Turkish society still is focused on traditional gender roles which promote the stigmatization of pre-marital sexual relationships especially for women. An increase in the age of first marriage, improved levels of female education, and increased participation of women in the work are essential in challenging traditional value systems, gender roles and expectations.
The objectives of this study were identified as: 1) the development of youth-friendly reproductive/sexual health and psychological counseling services at university socio-medical healthcare centers; 2) the development of information, education and communication (IEC) material for enhanced sexual and reproductive health knowledge among university students; 3) the provision of all modern contraceptive methods at university socio-medical healthcare centers (including combined oral contraceptives, injectables, condoms and IUDs); and 4) the integration of the reproductive/sexual health services into routine healthcare services.
In order to achieve these objectives, ten Sexual and Reproductive Health Counseling Units were established in eight universities: Bilkent and Hacettepe in Ankara; Dicle in Diyarbakır; Osmangazi in Eskişehir; Boğaziçi, Yeditepe and Koç in Istanbul; and Ege in Izmir. At each university, two physicians and two psychologists were given special training on youth counseling, specifically on sexual and reproductive healthcare problems. Simultaneously, comprehensive-approach group counseling programs were established at these centers in order to deal with tobacco, alcohol and drug problems, and nutrition and fitness issues. A new registration system was also developed at these centers for follow-up, monitoring and evaluation purposes. The project began in 2002 and terminated at the end of 2005.
In 2005, these socio-medical healthcare centers initiated peer education programs in sexual and reproductive health. Youth groups will be formed to address the healthcare problems identified by the youth themselves. An interim evaluation was conducted at Hacettepe University’s Beytepe Campus at the end of 2004. This evaluation demonstrated the impact of establishing a youth-friendly counseling unit at a university healthcare center, and made suggestions to improve healthcare provision.
The most striking finding of this study was that as on-campus youth-friendly services increased, so did the overall student utilization of the entire university’s health services network. A report detailing our findings was prepared, published, and disseminated. It is currently being used as a guide in the evaluation of other university healthcare centers in Turkey.
5. Evaluation of the SRH Knowledge, Views and Behavior of University Seniors at HU’s Beytepe Campus
In 2001-2002, a new study was developed as a part of the previous WHO collaborative study on SRH. It was designed to evaluate the change in SRH attitudes/behaviors of Hacettepe University-Beytepe students as they progressed from their Freshman to their Senior year. In this study, 1798 Seniors were surveyed using the same questionnaire, in combination with a few additional questions. The results of this study were published and disseminated.
According to the survey, the utilization of the healthcare center increased significantly, and awareness of the YFCS remained relatively high; however, despite all our interventions, student SRH knowledge was still not at desired levels. Among university Seniors, gender stereotypes and discrimination remained widespread, indicating the prominence of these social values. This study advised that efforts to improve university student SRH knowledge should be initiated as soon early as possible.
6. A Case Study on the Integration of Gender Sensitivity into Turkish Health Policy: Phases I and II
Phase I
Recently, Hacettepe University Women’s Research and Implementation Center (HUWRIC), the HU-WHO Collaboration Center, and the World Health Organization Regional Office for Europe conducted a joint study in seven European and Central Asian countries. HUWRIC completed a case study on gender and reproductive health policies in Turkey. First, baseline information on existing national gender and health policies was examined. The HUWRIC team then analyzed 5 major pieces of legislation: the Turkish Constitution; the Common Healthcare Law; the Socialized Health Care Services Law; the First Population Planning Law; and the Second Population Planning Law. Each analysis focused on the integration of gender perspectives in unwanted pregnancies and family planning. In-depth interviews with key informants were also conducted. The results revealed that in general, attention was given to sex differences in problem definition, agenda setting and policy design. However, older legislation overemphasized the traditional reproductive role of women: they were mainly treated as demographic statistics, and were not given reproductive agency. Newer legislation has given women the right to regulate their own fertility. It was also encouraging to discover that laws enacted after 1980 are more gender sensitive.
Although the results of this study were promising in terms of mainstreaming gender into reproductive healthcare policy, the problem of implementing these policies at the grassroots level still remains. In order to begin the implementation process, HUWRIC and the HU-WHO Collaboration Center formulated Phase II of this project.
Phase II
One of the missions of HUWRIC is to mainstream gender into all aspects of healthcare provision. Gender mainstreaming, especially to ensure high-quality reproductive healthcare for both men and women, has been a priority in HUWRIC’s research, project and advocacy activities.
This study was designed to provide an in-depth model for the implementation of gender- sensitive reproductive health policies. Key informants were interviewed from different regions of Turkey in order to reflect differing geographic and socio-cultural factors. The interviews focused on “Population Planning Law # 2827.” Interview topics included the demand and availability of government-funded abortion; the proportion of men and women who can afford contraceptives; and the level of autonomy women exercise in making reproductive decisions. This research was conducted in 2004 with financial support from UNFPA.
In this phase, a medical doctor with an MSc in social anthropology, and a sociologist with a PhD, collected qualitative data from 4 Turkish provinces: Diyarbakır, Mardin, Ankara and Istanbul. All collected data was analyzed by the research team.
The report for Phase I was printed by WHO-Euro in English. The comprehensive report for the whole study was prepared and published by Hacettepe University in 2006, in Turkish. The results of the study were shared at a meeting held at Hacettepe University in 2006.
7. Health Behaviors Through a Gender Perspective: A Project Conducted in Saraycık Village, Sincan District, Ankara
In conjunction with the Contemporary Life Association, HUWRIC examined the health behaviors of women living in Saraycık Village, located in the Sincan District of Ankara, using qualitative gender research techniques.
8. Development of National Gender Sensitivity Indicators
A study was conducted by the General Directorate of the Status of Turkish Women. Several HUWRIC staff members and the HU-DSO Collaboration Center on Sexual and Reproductive Health participated in this study. Gender-sensitive healthcare indicators were drafted for national data collection, and incorporated into several international agreements complied by Turkish legislators.
9. Peer Education Program to Increase Young Adult Awareness of Healthcare Issues
Peer education has recently been used as an effective behavioral change strategy. Many studies have demonstrated that peers can influence adolescent attitudes and behaviors. The main objective of the peer education study was to use a “peer education” model to educate young adults about sexual and reproductive healthcare services. This peer study, which serves as a component of the “Study on Factors Influencing the Sexual and Reproductive Health of Adolescents/Young Adults in Turkey,” was conducted with the support of Hacettepe University’s Rectorship. This project increased student healthcare center utilization by integrating Youth Counseling Units into university healthcare centers. A group of eleven healthcare providers was trained by the UNFPA for one week. Peer educators also benefited from the training programs.
10. Youth-Friendly Sexual and Reproductive Health Services at Five Additional Universities
In light of the favorable results obtained through the SRH studies, it was determined that SRH services should be provided at five other Turkish universities: Erciyes University – Kayseri; Cumhuriyet University – Sivas; Çukurova University – Adana; Dokuz Eylül University – İzmir; and Gazi University – Ankara. This one-year project was supported by the European Union and completed with the coordination of the HU-WHO Collaboration Center, HUWRIC, the Turkish Health and Social Welfare Foundation, and Hacettepe University AIDS Treatment and Research Center (HATAM). As part of this project, changes in the utilization of university healthcare centers, and the SRH knowledge and behavior profiles of 2500 Freshman and Sophomore Education students were evaluated.
This descriptive and interventionist study was conducted in two-phases, and completed in 2006. A significant increase was observed in both YF service awareness and student SRH knowledge.
The preliminary project report was printed, distributed, and shared at a conference held at Hacettepe University on December 15 - 16, 2006. In order to standardize physical conditions and the youth services provided, follow-up visits to the 5 universities were conducted in 2007.
11. Eliminating Violence against Women and Children
Violence against women and children has its roots in gender-biased social values. Unfortunately in Turkey, “honor killings” and other forms of violence against women and children still exist. Lately, this subject has been given increased attention by almost all national sectors, and advocacy activities by public and private organization have multiplied. In 2006, under the direction of the Grand National Assembly of Turkey, a commission was formed with the aim of determining the causes of honor killings in Turkey, and specifying preventive strategies to eliminate honor killings and other forms of violence against women and children. The commission requested an expert from HUWRIC to participate in all of its activities. The Commission started its activities, which lasted for six months, on the October 18, 2005. It organized meetings, conducted nationwide investigations, and collaborated with academics, representatives of public and private institutions, and nongovernmental organizations. At the end of the six-month period, the Commission prepared a 288-page report, which was published by the General Directorate of the Status of Turkish Women. The report was prepared by ten Parliament Members, and six counselors. It evaluated the prevalence of, and made recommendations regarding, honor killings and violence against women in Turkey. The Prime Minister’s Office asked the Commission, and its related bodies, to prepare periodic reports about their activities. The General Directorate of the Status of Turkish Women organized the first evaluation meeting on September 8, 2006. The Commission recommended more comprehensive qualitative research on violence against women in Turkey, so that the underlying causes of this violation of human rights can be exposed.
12. Women’s Status Counseling Commission
The Director and Assistant Director of HUWRIC were appointed to the Higher Education Council’s Women’s Status Commission, which was established as part of a new law issued by the General Directorate of the Status of Turkish Women. The Commission held two meetings in 2006.
13. Activities on International Women’s Day (March 8)
HUWRIC routinely organizes activities on International Women’s Day. In 2005, it organized a conference on “Women and Aging.” The main themes addressed at the symposium were “Aging Women and Gender,” “Health Concerns of Aging Women,” “Health Services,” “Social Services,” and “Aging Women and Nongovernmental Organizations.” In 2008, HUWRIC will co-sponsor a conference on “Violence Against Women.”
14. Research on Dating Violence
HUWRIC Women’s Studies Group conducted research on dating violence, which is an important public health concern that eludes the agendas of most researchers. The study, which was conducted using the voluntary answers of students studying in Ankara, is in the process of being published for dissemination.
15. The 51st session of the Commission on the Status of Women
The Commission on the Status of Women is a sub-commission of the United Nations Economic and Social Council (ECOSOC). Its focus is on gender equality and the advancement of women. Representatives of member nations meet at the United Nations in New York annually, to discuss gender equality issues, challenges, global standards, the ways to achieve those standards, and policies that will promote gender equality.
The Commission was established on June 21, 1946 with the aim of promoting women’s rights in the political, economic, civil, social and educational arenas. The Commission also makes recommendations to the Council on women’s issues requiring immediate attention.
The 51st session of the Commission on the Status of Women was held on February 26 - March 9, 2007 in New York. This year’s theme was the “elimination of all forms of discrimination and violence against the female child.” Prof. Ayşe Akın, MD, Director of HUWRIC, participated in the session as a part of the Turkish delegation. She also contributed to resolutions dealing with HIV/AIDS, female genital mutilation, and child brides.
2008 Symposium on Women's Health: Violence Against Women
2009 Symposium on Women's Health: Women and Disability
2010 Symposium on Women's Health: Migration and Women