Turkey - Women in development (Vol. 2 of 2) : Annexes

Report No. 1 0299-TU Turkey Women in Development Report (In Two Volumes) Volume II: Annexes September 25, 1992 Country Operations Division Country Department I Europe and Central Asia Regional Office FOR OFFICIAL USE ONLY tOpanen ofte Word- flank ,rhi~ document has a rsricted distribution anid may be used by recipients oinly in theperformance of theirofficial duties. Its contents may not otherwise be disclosedvwihout World Bank authorization.  FOR OV1ICIAL UhI ONLY Yu D Oi U.roa This document has a rfstlcted distributon and may be used by recipients only in tho paffornco of their of 0chldutiea Its contents may not otherwise be discksed without World Bak autborin.  huu TM LEGAL ENVIRCONIEN Rags A. $reatmet of Won Under the General Legal Framework............. 1 (L) The 1982 Constitution ...... (11 a) Law of ...................... b C. 2 *) Law of ro 3 b) Law of FamIly.*.... .................... .......... 4 c) Law of Suc o . 0. . 0 . S d) Law of Property ................... .......... 6 e) Law of Obligations ................... *#e*o99....... 6 (LiL) The Law on Banks and Credit Regulations......... ......... 6 (iv) AbortLons Laws... *.***.** 6 (v) Education ... 7 (vi) Nationality Laws .............. o.o--o,...oooooo 7 (vIl) Laws on PolLtLeal Rlghts of7Wom . .... . 7 B. Recent InstLtutLonal Arrang .. t. 8 (L) The Dlrectorate general of Women's Status and Problems.e.* 8 (Li) The Faully Research St t . l.u. . 9 C. InternatLonal Conventions RatLfLed by Turkey..................... 10 (i) ConventLon on the BlimLiatLon of All Forms of DLscriminatLon Against Wome............................ * 10 (LL) Relevant LO Conventions ...... 11 (iLL) uropan SocLal Charter.................................; 12 D. Treatment of Women at Work Under Relevant LegLslation...O.. **&... 13 (L) Contractual Personnel ........... ...... 14 (LL) CLvll Servnts ... 14 (iLi) Workers ............. * 15 Lack of Job S iis.. t y 1S LLLtations on the ResLguatLon by tho Workereowoeeeo 16 ProhibltLons and RestrictLons concerning Trade Determination of the Minimus ...................... 16 Weekly Hours of W rr . 16 (iv) Female-Specific Legal Provisions..........eo..e......... 17 ProtectLon of Reproductlve and Maternal Functlons*..... 17 ProhibitLons or RestrLitions on the Employment of Women ia SpecifLc Ty"es of Work................... 18 Underground and Underwater W@rkO....................... 18 NAght aDnr Workw................................... 19 Heavy and Dang rous Work ............. -** ................... . ... 19 |. CEclslo$ ........... @ *** .. -@- ..*** ....................19  TURlY WOMEN IN DEVELPMEN PEPORT TH LEGAL ENVIRONMENT A. Treatment of Women Under the General Leaal Framework 1. This annex examines the treatment of women under the countrys legal framework# both as the law La wrltten and as it la carrled out in practLoe, in llght of traditional, cultural practLces. It also attempts both to LdentLfy speclfLc constraints to the ablilty of women to contribute to the development process that are Lmbodded ln the legal framework and to LndLcate whre remedLal measures could lmprove the treatment of women. The annx addresses the posLtLon of women under the 1982 ConstLtutLon, the Clvl. Code and specific legal areas that affect womens contrlbutlon to the economlc process, namely the Laws on Banklng and Credit, EducatLon and Labor Legislation. Wlth rempect to the latter, the annex addresses not only the constraLnts to women but to workers, ln general, and ldentlfloe remedial masures The annex also addresses the Government's performace ln meetLng lts obligatlons under the relevant lnterventlonal conventions whlih the country has ratified. (i) 9a2 Constitution 2. The relevant articles of the 1982 Constltutlon pertaLinng to omen &res Artiles 10, 41, 49, 50 and 70. in brlef, these are: 1rticle 10. E aualLt Before the Law All lndlvlduals are equal wlthout dLacrimLnatLon before the law, Lrrespective of language, race, color, sex, politleal opLnLon, phllosophlcal belLef, relLgLon and sect, or any such conslderatlons. No prlvilege shall be granted to any lndivldual, family, group or class. State organs and admaLnstratlve authorLtLes shall act ln compliance wlth the prLneLple of equality before the law ln all their proceedings. Article 412 Protection of the Family The famlly is the foundatlon of TurkLsh society and the State is to take the necessary measures and establiah the necessary organliatLon to ensure the peace and welfare of the famlly, especLally the protectLon of the mother and chlldren. Thli artLcle also specLfLes the State's responaLbliLty for education and famLly plannLng. Article 49. RaLaU and Duty to Work Zveryone has the rLght and duty to work. The State shall take the necessary measures to improve the standard of livlng of workers, to protect and to improve the general condltlons of labor, and to create an envlronment conduclve to full-employment. The State shall take facliLtatLng and protectlng measures to maintain harmonlous employer-employee relations.  -2 AIL 1 Artileli 50: WorCkine Condition and the Riaht to Rest and Lieisur No one shall be requlred to perform work unsuited to his age, sex or capacity. Minors, women and persons with physlcal or mental dLeabllitles, shall enjoy speclal protectlon with regard to workLng condltions. All worlkers have the right to rest and lelsure. Rights and conditlons relating to pald holidays and leave shall be regulated by law. Ar,ticle 70: Entry Into Publie Siervice Every Turk has the right to enter the public service. No critcria other than qualification for the office concerned shall be taken lnto consideration for recruitment into the public service. 3. As can be seen from the above articles, the 1982 Constitution specifies equallty before the law and prohibits discrlmination based on sex. Everyone has the rlght and duty to work and the State ls obliged to establish protective measures for all those in the paid labor market. No one shall be required to perform work unsuLtable to hli age, capacLty or sex and women are to enjoy special protectLon regardLng working conditions. In the case of applications for public servLce, no discrimination can be made other than the qualifications necessary for the type of work to be performed. Occupations closed to women are, therefore, open to dlsocussion in the light of this provision. In the case of dLscrimLnation based on sex, an applicant may apply to the courts for the annulment of the administratlve act and can claLm unconstLtutionality of such dlsorlmination.1' In practice, however, few claims are filed, reflecting that only a mlnority of educated women are willing to seek legal redress. (ii) The CLIvi Code 4. The Turkish Clvll Code was adapted from the Swiss Civil Code in 1926. This constLtuted an important break wlth traditLon and religLous norms. The secularizatlon of law, put lnto effect by AtatUrk, the founder of modern Turkey, was a milestone ln Turkey's socLal development. 5. To better understand the posltlon of women in Turkey, the Lmpact of the early Republican era reforms need to be taken into account.Y Today* Turkey remains the only Islamic country whlch has elLminated the Shariat as such, women's position before the law is the most egalitarLan of Islamic countries. By elLminating segregation and differential legal treatment of women the reforms cleared the way for comprehenslve changes in the posltLon of 1/ In Turkey, citizens may not apply to the ConstitutLonal Court directly but durlng a trial in the lower courts, can bring a claim of unconstitutionallty and if the court finds the claim serious, may send it to the ConstLtutLonal Court. S See Kagitcibayi ln OECD and GOT, 1989.  - 3 - women. Specifically, they paved the way for women to enter all walks of llte, Including public offloe and the professLons. At the tlme, women were glven strong enoouragement and support to enter all fields. in the 1920s, when even the BBC and many American radio statlons could not consLder the employment of a woman announcer, TurkLsh radLo employed women as both announcers and technLolana.m In Parliament, the number of female deputles reached a peak of 18 ln 1934. Although fLrst admltted to academlc posltlons ln 1932-33, by 1946-47, 44% of all faculty ln the Faculty of Natural SceLnces and 22% of the HumanitLes Faculty were women.J 6. Today, amongt the professions there remaLns a marked absence of sex-typing, which li thought to be the result of th encouragement to women in the early RepubiLcan era. Nonetheless, and while the educated urban Turkish woman li well-represented ln the professLons and pubiLc offlce compared to many mLddle-Lneom developing countrLes, there appears to have been a deciLne ln thelr particlpatLon between the early 1950. and mid-1980. The positLon and status of the majority of Turklsh women, Lncluding thelr legal standing, however, appears to have changed little sLnce the beginnLng of the RepubiLcan era* 7. While the provLiLons of the CLvil Code regarding women's lsues were progressive at the time of adoptlon some have proved to be LnoufficLent for soclety today. Accordingly, 8wltutrland passed slgnlficant amendments regarding women's rights ln 1984. In Turkey, a commissLon was appointed to prepare amendment proposals and although lts report was submitted ln 1984, to date, the Ministry of Justice has not brought lt before the Assembly ln the form of a law proposal. The new Government lntends to do thie ln the near future. s. The Clvil Code conaLsts of five books addressing the Law of Persons, Law of Family, Law of Znheritance, Law of Property and the Law of ObiLgatLons; these books are considered separately below. a) Law of Persono 9. The relevant provLiLons relating to women are as follows: - All persons are the subject of rights (Article 8). - The Turkish law makes a distinction between the ability to be the subject of rights and the capacity to act. There are different degrees of capacity - full capacity, limited capacity, partlal dlsability and full Lncapacity. A marriLd woman li considered as one wlth partlal dLeability, wlth her capacity limlted only ln casos explicitly cited by the law. - Majority is acquired at age 18 or upon marrlage (Article 11). Y Kirby (1960). V Mee Acar ln OECD and GO, 1989.  -4- ANNX 1 - A marrLed woman has her husband's domLcile. She is allowed to have a domlclle other than her husband's, when the doomlcle of the husband is not known or the wife is entltled to llve separately (Article 21). b) LZIflL1l 10. The relevant provislons can be summarized as followos - Ingagement taken place with the reciprocal promises of the partles to marry. It is considered as a contract but not an enforceable contract. it does not compel any of the partles to marry (ArtLele 82,83). - Major persons may get married without the consent of the statutory representatives. The marrLage age li 17 for boys and 15 for glrls, but they need to have the wrltten approval of their statutory representatives. Under extraordlnary conditLons, a 1S year-old-boy or a 14 year-old-glrl may marry wlth the permlsslon of the court (Article 88,90). - A waltlng period of 300 days (the maximum pregnancy period) is speclfied for a divorced woman before she may remarry. Xn case of confinement, the walting perlod ends. If a woman proves that she's not pregnant or lf the former spouses want to remarry, the waiting period may be shortened by the judge (ArtLcle 95). - Only clvll marriages performed by authorLzed marrlage officers are considered as valid. After the clvil marrLage, if the spouses so desLre, a religLous marrLage (lmam marriage) li permltted (Article 108,110). Nonetheless, roligious marrLages wlthout a civil marrlage are prevalent; neither the wlfe nor the chlldren of relLgLous marrLages, however, are recognLzed under the law. Thus, from time to time amnesty laws are enacted whlch permit the regLstratLon of such marriages and the children thereof. TurkLsh famLly law le based on the concept of the tradLtional family ln whlch the husband is the head of the famlly and responelble for supporting the family and the wlfe is the homemaker (Article 152). By law the wlfe is requlred to bear her husband's surname (ArtLele 153). The husband has the legal standing to represent the famlly, whereas the wlfe can represent the family only for contLnuLng needs of the famlly (Article 155). In case the wlfe mLouses her rlght to represent the famlly, thls rlght can be lifted by her husband agaLnst which the wife can apply to the court (ArtLcle 155-158). The wlfe cannot become a guarantor for her husband's debts unless she le  ANNX 1 permitted by a court decision (Act.169). Article 159, which required a wife to obtain her husband's permission to perform any type of paid work, was annulled by the Conutitutiir - Court on the basis of unconstltutionality in November 2- - The matrimon- . property system provi-'3s for the separation of property such that each spouse retains the ownership and administration of all his present and future property capital and income (Article 170). Each spouse retains control of his individual earnings and is solely responsible for his own debts incurred before or after the marriage. In case of divorce, each spouse takes back his own property. While this system of property separation works well in general, it is the practice ln Turkey to have the immovable property acquired during the marriage registered in the husband's name, which creates difficulty for the wife in case of the death of the husband or divorce. - Grounds for dlvorce are the same for both spouses. The judge has wide discretionary powers in deciding custody of the children and the amount of support. After divorce, the ex-wife resumes her maiden name, although with cause and the permission of the judge, she may carry her ex-husband's name (Article 141). - The Family Law also includes provisions regarding the parent-chlld relationship. Both spouses have authority over the children, but in case of d'spute, the husband's vlews prevail (Article 263). A child born outside of marriage is considered an illegitimate child and carries the mother's surname. With acknowledgement by the father or a court decilsion, a legal relationship can be established between the father and the child (Article 290-305). - If a woman is appointed as a guardian or curator by a judge, she may refuse the guardianship or curatorship whereas a man may not (Article 366, 381). c) Law of succession 11. The Law of succession does not distinguish female and male heirs. However, ln order to avoid partition of agricultural land, the court will grant ownership to the heir most able to manage the land. In the case that there is more than one heir desirous, male children are given priority (ArtLcle 597-598).  -6- AXUM 1 12. The surviving spouse, as an helr, shares the estate wlth the livLng blood relatlves of the deceased (Lf any), the portlon varylng accordLng to the closeness of the other helrs. if the survlvLag spouse Lnherits together wlth the descendants, the survlvor receLves one-quarter of the estate.I if there are no descendants, the survlvlng spouse Lnherits together wlth the parents of the deceased and thelr descendants and the survlvor's share lncreases to 1/2, and to 3/4 lf the survlvor lnherlts together wlth the grandparents of the deceased (ArtLcle 444) The lnherLtance laws, per so, make no dltLnctLoAn between husband and wlfe or sons and daughters. d) of netv 13. The Law of Property accords women equal right to hold tLtle, convey land and abliLty _o record property ownershLp. a) Law _f Oliaatians 14. The Law of Obligations covers contracts and tortsl there ls no dLitLnctLon between males and females. (iLi) The La. on Ranks *nd Credit ReaulatioMs 15. The Law on Banks and Credlt Regulatlons does not contain any proviolon supportLng dLecrimLnatLon by gender. However, due to Artlcle 159 of the Clvil Code, which was annulled in November 1990, the banks required a married woman to obtaLn her husband's permassLon ln case of her obtalning credlt for her work or business. It is assumed that thLs requirement will cease wlth the annulment of ArtLile 159, siace legally it L now without foundatlon. (iv) Abortion Lw 16. Under the TurkLih CrlmLnal Code, abortion is a crlme and the sentence for wllingly abortLng a chlld li 1 to 4 years of imprLsonment (Article 469). However an exception li provided by the Law on Populatlon Plannlng (1983)1 up to the tenth week of pregnancy, a woman can demand abortlon (Article 5). lf the woman is married, she must have her husband's approval and ln the case of a single minor, the statutory representatLve's approval le necessary (Article 6). After the tenth week, abortlon is permitted on medloal grounds Lf the pregnancy threatens the health of the woman or would result ln the chlld beLng seriously disadvantaged (Article 5). The change in the abortion laws is not an outcome of the women'" movement but of Government's population policies. V Thi ArtLele on usufructuary rlghtswas amended on November 14, 1990.  -7- (v) ducation Lam. 17. According to Artiole 42 of the ConstLtution "No one shall be deprLved of the rlght of learning and education. Primary education is compulsory for all cLtlzens of both sexes and is free of charge In State schools". This La also stated ln the Law on Primary Schooling and Education (No. 10705). Primary education lasts for five years and covers children from the 6-14 age group. Beginning in the 1988-89 academic year, the duration of compulsory prLmary educatlon was extended to eight years and in the year 2000, it will be extended to ten years. The new Government has affirmed its support of the extensLon of compulsory education to eight years and emphasizes that the education has to have a secular nature (Government Program, November 1991, p. 45). Thus, the laws regarding unlversal schooling do not contribute to the lower educational attainment of women in Turkey. (vi) NationalityLva^fX 18. Accordlng to the Turklsh Nationality Code, children born of Turkish fathers and/or mothers acquire Turkish nationality at birth (Article 1). Turkey, however, has made a reservation to Article 9 of the Convention on the ElimLnation of All Forms of DiLcrimination against Women (CEDAW) granting woen equal rlghts wlth men regarding nationality, since the articles regarding acquisLtLon or loss of Turkish nationality by means other than birth differ for women and men. For example, a. foreign woman married to a Turkish man can acquire TurkLih nationality Lf she declares her willingness in written form and forwards it to the marriage officer at the time of her marriage or to the Turkish authoritLes ln case the marriage has been concluded by foreign authorities abroad (Article 5,42). However, in the case of a Turkish woman married to a foreign husband, the man may acquire Turkish nationality by applylng to the Mlnlstry of InterLor and obtaining a proposal of the Ministry and a decision of the Councll of Ministers (Article 7). Also a Turkish woman married to a foreigner loses Turkish nationality if her husband's national law attributes nationality to her and she declares her willingness to acquire the husband's nationality (Article 19). This article does not apply to a Turkish man marrLed to a foreign woman. (viL) Law. on Polltical Rlahks of Women 19. The right to vote and to be elected was first granted to Turkish women for local electlons ln 1930, and subsequently for national elections in 1934. Bighteen women entered parliament in 1934, forming 4.5% of the total number of parliamentarians and with the exception of Finland, this was then the highest percentage in the world. This, however, is the highest percentage ever reached in TurkeyA/ i Zn the new Government, 8 out of 45C deputies are women.  ANX 1 20. The 1982 Constitution, wLthin lts pollcy of depolitisatLon, proscrlber the formatLon of women', or youth branches by the polltlial parties on tho grounds that they are dlscrlminatory (Article 68/6). This is apparently belng reversed by the new Government. It is also signiflcant that to promote women'es Lnvolvement ln politice, the SHP Party in 1990 LnstLtuted a quota of 25% for women for its central admlnlitratlve organs. B. Reaent rnstitutional Arranoements 21. In the mLd-1980's, women's role ln Turkey became a -- A central issue, largely as a result of two dlametrically opposed groups cne right wlng, and ln response to thLi group's efforts to retradltionlIze TurkLsh culture, the women's movement. In response to these groups, the Government established in December 1989 the FamLly Research Institute, under the Prime Ministry, charged wlth preservlng and strengthening the TurkLsh famlly and ln Aprll 1990, the Dlrectorate General of Women's Status and Problems under the Mlnltry of Labor, charged wlth strengthenLng the posltion of women in Turkey.U (i) MM Direto$rft. aeneral of Women's Status and Problems 1DGWSP) 22. The establishment of the Dlrectorate under the Prlme MLnistry was announced ln a statutory decree published ln the Official Gazette of April 20, 1990. On submission to the National Assembly ln June 1990, the decree was approved wlth some amendments; namely, its attachment to the Minlitry of Labor. The dutles of the Directorate are as follows (ArtLcle 2): a) to prepare polLcies and programs that conform to AtatUrk's princlples and reforms, for the protection and development of women's status and for the resolution of women's problems; b) to provide for the integration of women Lnto soclety through particLpation in social, economic and politlcal decisLonsl c) to compile studies made in Turkey or abroad on the status and problems of women d) to compile stati.etcal data by age and gender to serve as a basis for the re_elution of problems related to women; @) to help facliltate cooperation and coordination between concerned agencLes, support voluntary organizations actlve in this field and follow all activihies of local governments regarding women; I The Directorate was transferred to the Prime Ministry ln June 1991 and ln November 1991 a Mlnistry for Women and Family was established. See Chapter V for details.  -9- f) to follow, support and dlrect educatlon actlvltles for woman especially those of local governments, and to create a public Lnterest in women's status and problems; 9) to provlde for Turkey's partlilpatlon and oordination ln lnternatlonal workshops; and h) to be involved ln aotivities of documentatlon, pubiloatlon and presentatLon. The organizatLonal struoture of the Dlrectorate calls for four dlvlsions, nu;lys economlc and soclal problems; legal and cultural status; external relations; and personnel and flnance. The dutles of each dlvlilon are lLsted ln the law. ProvLsion-was made for 20 personnel, of whloh a are hlgher level, includLng the dlrector-general. (LL) Tb- Famllv Rsgarch Institutte IIRf 23. The Institute was establshed through a statutory decree of December 1989 wlth the objective to undertake research and develop and implement projects to protect and strengthen the Lntogrity of the Turkish family so as to Lncrease lts soclal welfare. The FRI is also empowered to help formulate a national polliy regardlng the family (ArtLile 1). The duties conferred upon the InotLtute are as follows (ArtLile 3)a a) to analyze the existing family structure; problems lnternal to the famLly; economic, social and cultural influences on the family; and to prepare educatLonal programs on such lisues; b) ln coordination wlth the Minlstry of Educatlon to prepare programs to strengthen the family in all respects and, ln partlcular, ln regards to famlly budgetLng; 0) to analyze the lmpact of cultural change and mlgratlon on the family; d) to coordinate with foundations, assoclatlons, federations and voluntary organLzations lnvolved in famlly Lssues; el to Lnvestlgate the impact and the results of the famlly planning programs and assist in the development of a natlonal pollcy; f) to conduct joLnt studles wlth prlvate and public Lnstitutions and to support those studies deemed approprlate to determine public oplnlon regarding famlly problems; and 9) to investigate the problems of the TurkLsh families working abroad. The InstLtute consdsts of the Famlly Research Board and the FamLly Research Institute Dlrectorate (Article 4). ProvLsLon was made for a staff of 132; as of March 1991, 7S hlgher level staff were ln place.  - 10 - NX C. International Conventions RatifLed by T,rkev (i) Convention on the Elimination of All Forms of DisarLmination Against Womn 24. Turkey ratified the Convention on the ElimLnatLon of All Forms of Discrimination Against Women (CEDAW) ln 1985. The Conventlon defines "discrimination against women" as "any distinctlon, excluslon or restriction made on the basis of sex which has the effect or purpose of lmpairing or nui.lifjlng the recognition, enjoyment or exercise by women, irrespectLve of their marital status, on a basis of equality of men and women, of human rights and fundamental freedoms in the political, economic, social, cultural, civil or any other field" (Article 1). 25. Turkey has made reservations tot Aticle 9 - granting women equal rights with men regarding nationality; 15/2 - according women a legal capaclty identical to that of men; 15/4 - accordlng to men and women the same rights regarding movement of persons, residence and domicilet 16/1 (c) - according to men and women the same rights and responsibilLties durlng marrLage and at lts dissolution; 16/1 (d) - same rights and responsibilities as parents, irrespective of their marital status, in matters relating to their chlldren; 16/1 (f) - same rights and responsibilitles with regard to guardianship, wardship, trusteeship and adoption of children; 16/1 (9) - the same personal rights as husband and wife, including the right to choose a family name, a profession and an occupation. 26. To become effective according to 2urkish law, these reservations are required to be published in the Official Gazette. However, to date, they have not been published and therefore the Conventlon is regarded as effective without the reservations. 27. Turkey, as a party to the Convention undertakes "to pursue by all appropriate means and without delay a policy of elimLnating discrimlnatLon against women" (Article 2). "Appropriate means" also lnclude "all appropriate legislative measures". To date, no steps have been taken to comply wlth the Convention although the new Government has stated its intentLons to reviaLt the reservations (Government Program, November 1991, p.53). The major contradictions can be stated as follows: - Article 11: This envisages the elimination of dLserimLnation against women in the field of employment. However, notwithstandLng the neutrality of the Constitutlon, there remaln instances wLthin Government of discrimination. For instance, the established administrative practice of the Ministry of Justice limiting the number of women to be admitted as judges and public prosecutors (para. 4 above). Another non-compliance wlth the Artlcle 11 is that the women's employment office (legal provision for whlch was made within the Labor Placement Office) is not yet operational, although a technical cooperation project with the IWO was agreed to make it  - 11 - operational I There is also a need for a legal mehanlim to seek redress for employmnt dLisrLmination. Inaotment of necessary legal mechanisms along wlth the establishment of legal advloe bureau will help provide an effective vehlele for the women to obtaln redress against employment dLscerilnation. Womn worklng ln low-wage jobs without social securlty, in partloular, need legal assistano and support ln purouLng their rlghts under existing labor logLilation. This has to be regarded as one of the major issues to be addressed by the Directorate General of Women's Status and Problems. - ArtLele 11/2-as This prohlblts dismissals on the'grounds of pregnancy or of maternlty leave. However, under the TurkLih Labor Law, employers can lay-off women workers because of prgnancy or conflnement. - Artlale 11/2-cs Thli emphasiLes the development of chlld-care facilLties. Under the Regulation on Conditions of Work for Pregnant or Nursing Workers and Nursing Rooms and Day Nurserles, workplaces employing between 100 and 150 women workers are to establish nursing rooms while those ploying more than 150 women workers have to establish day nurserLes consistlng of a nursLng room and a creche. Employers circumvent the regulations, however, by restrLctLng the number of female employees below the legal mlnimum. - Article 21/1-d: Thli cltes the prLnciple of "equal pay for work of equal value". The Turkish Labor Law speaks of the principle of "equal pay for equal work" whleh has a narrower scope (Artlcle 26). - AXrJg.2 13/as This addresses the rlght to famLly benefits. However in Turkey, when both spouses are employed, only the husband is entitled to the family and birth benefits. (ii) Relevant IW Conventlons 28. To date, Turkey has ratified 29 of the approximately 172 1LW conventlons (as of November 1991). Of the ILO conventLons regarding worklng women, Turkey has ratified only Conventions No. 45 (Underground Work, 1935), 100 (Squal Remuneration, 1951), 111 (DLscrimination-Employment and Occupatlon, 1956) and 122 (Employment Policy, 1964). SpecifLcallys - Convention 2.--. : prohlblts employment of women ln underground work in any mlne. The TurkLih Labor Law prohlbits underground work for women and also for men below the age of 18 (Artlcle 68). QY Draft report to the Government of Turkey of the 1W technlcal mlsslon "Towards a Program on Neglected Workercs Women and Chlld Workers", Condltlons of Work and Welfare Facliltles Branch, WorkLng Conditlons and Bnvironment Department, Geneva, November 1990, p.76.  - 12 - - Convention No. 100: states the prlnclple of "equal pay for work of equal value", whereas ln Turkey there io the prlnclple of wequal pay for equal work" (para. 27 above). - Convention No. 121: concerns dlscrimlnation ln respect of employment and occupation. According to the fifth artLele, the member states undertake "to repeal any statutory provislons and modlfy any administratLve lnstructlons or practices whlch are inconsistent wlth the policy of equal opportunlty and treatment". One of the clted obllgations is that the government agencies should apply non- discrimina%ory employment policles in all thelr actlvitles. Turkey has been criticLzed on several occaslons by the ILO for not meetlng the requirement of the Convention.V - Conventlon No. 122: the second article cites the alms of the employment policy, among which lo the *freedom of cholce of employment and the fullest possible opportunity for each worker to qualLfy for, and to use hle skills and endowments in, a job for which he is well suited, irrespective of race, color, sex, rellgion, political opinion, national or social origin". 29. To date, Turkey has made limlted progress in implementlng the internatlonal labor conventions relatlng to women.1y However, the new Government's program (p.33) states that Turkish labor legislatlon wlll be harmonlzed with IO conventions. A technical cooperatLon project developed by an ILO technical mission upon the request by the Government of Turkey is ln progress which aims at enhancing the ability of the MinLitry of Labor and SocLal SecurLty to address the problems of both chlld and female labor. (iLL) Rurogean social Charter 30. Turkey ratifled the European Social Charter ln 1989. The Charter lays down two baslc undertakings: one, a contractlng member state must "undertake to consider Part I of the Charter as a declaration whlch it will pursue by all approprlate means"; and two, lt must conslder ltself bound in their entirety by at least ten articles or forty-flve paragraphs of the 19 articles of Part II and of this minimum, at least five have to be selected out of seven specified artLiles (Article 20). Turkey has accepted 11 artLcles in thelr entirety and 46 paragraphs have been accepted. 31. Turkey has made the following reservations to Part It of the Charters Artlile 2 - the right to just condltions of work; 3 - the rlght to safe and healthy worklng condltions; 4/1 - to recognlze the rlght of workers to a reuneratlon such as will glven them and thelr families a decent standard of 21 For lnetance, WLO (November 1990). ly For lnstance, Turkey has not ratlfled the ILO Maternlty Protectlon ConventLon (RevLsed) 1952.  -13- ANNEX 1 livLngi 4/2 - to recognLze the right of workers to an lncreased rate of remuneration for overtlme work, subject to exceptLons ln partlcular cases; 4/4 - to recognLze the right of all workers to a reasonable perlod of notlce for termlnatlon of employment; S - the rlght to organizej 6 - the rlght to bargain colloctLvelyi 7/1 - to establih a minimum age of employment of 1S years; 7/2 - to establish a hlgher mlnimum age of employment for dangerous or unhealthy occupatlons; 7/7 - to provlde employed persons under 18 years of age with not less than three weeks' annual leave with pay; 7/10 - to ensure speclal protectlon agaLnst physical and moral dangers to whlch children and young persons are exposed; 8 - the rlght of employed women to protectlon; 15 - the rlght of physlcally or mentally dlsabled persons to vocatLonal tralnlng, rehabilitation and social resettlement. 32. rt is noteworthy that Artlcle 8 on the right of employed women to protectlon has not been accepted ln lts entirety sLnce for women civil servants, the maternity leave is less than that requLred by the Charter and because there is no job securlty for women workers dlsmiosed on grounds of pregnancy or confLnement.ly D. Treatment of Women at Work Under Relevant LeaLslation 33. Thls aectLon addresses the legislation coverlng employed women in the paid urban labor market. Women in agriculture are not covered since there is no agrlcultural labor law. This reflects the continulng pressures of the large landowners and is widely considered to be one of the major shortcomings of the TurkLsh labor laws. It is also useful to note here, that until June 1989 the Mlnimum Wage Board of the NOL set a lower minimum wage for agricultural workers. Women working in the informal urban sector (domestics, homebased workers) are also not covered by protective labor legislatLon. 34. It needs also to be noted that employees ln the pald urban market are not covered by a olngle soclal securlty system and that coverage, ln general, is very limlted. The Republic of Turkey Retirement Fund covers clvll servants and contractual personnel, the Social Security Institution covers workers and Bag-Kur covers the self-employed and housewives. To date, efforts to comblne the three schemes have not been successful. The new Government has announced ln lts program (pp.33-34) that the social security sytem will be reformed and harmonLzed. 35. There are three maln categories of paid employment: contractual personnel, civil servants and workers. ly Turkey has not ratlfied the ILO Maternlty Protection Conventlon (RevLsod), 1952, prohiblting dLamisals during maternity leave but has not made a reservation to Art. 11/2-a of the Charter on prohibition of dismissals on the grounds of pregnancy or maternlty leave.  - 14 - (i) Contractual Pereonnel 36. Contractual personnel is a rolatlvely new category of employment coverlng state economlc enterprises. The fLrst two statutory decrees regulating contractual personnel (Decrees No. 233 and 308) were found unconstLtutLonal by the ConstLtutLonal Court ln December 1988 mLnce they contradLit ArtLeles 7, 10, 91. 124 and 128 of the Constitution. The subsequent statutory decree (No. 399), which became effectlve on January 29, 1990 repeated most of the rcitLcLsed artLoles and those deemed unconstitutLonal ln prevlous decrees. Zn Aprll 1991, the ConstitutLonal Court annulled 21 of the 71 artLcles of decree. None of these decrees provlded any protectlon to women ln terms of thelr reproductive functions. For the tlme being there remains consLderable uncertaLnty and ambiguity for contractual personnel. 37* When employment as contractual personnel was fLrst introduced, lt was pralsed within Government cLrcles for providing better employment conditlons and hlgher salaries, especially for well qualifled admLniLtratlve and technLcal personnel, thus mLnimLaing losses of quallfied personnel to the prlvate sector. In practlce, however, the decree became a means of classifyLng the majority of the personnel, Lneluding workers, as contractual personnel. Although personnel promoted to contractual personnel status galned hlgher wages, they were left without protective legislatlon or job securlty and the rlghts to unLonLie, collectlve bargainlng, or to strlke. To data, approximately 200,000 workers have been classLfied as contractual personnel. (LL) Civl Servants 38. The quallflcatlons of eivll servants, procedures governlng thelr appointments, dutles and powars, thelr rlghts and responsLbilLtLes, salarles and allowances, and other matters related to their status are regulated by the Civil Servants Law (No. 657). Clvll servants have no trade unlon freedomsW but unlike contractual personnel, they enjoy job securLty. The Clvll Servants Law makes no dletinction based on gender as to employment or conditions of work.W The Law does provlde for the protectlon of the reproductive and maternal functLons of women clvll servants. Artlcle 104 of the Law states that they are entltled to a maternity leave of three weeks before and six weeks after confinement. On return to work they are entltled to a nursing break of 1 1/2 hours a day for slx months. Following conflnement by his wlfe, the male clvll servant li also entLtled to a leave of three days. If the woman cLvll servant so requests, she will be entitled to an unpaid leave of six months following maternlty leave (ArtLcle 108). When both of the 13 The new Government has announced lts LntentLons to permlt unionLzatLon of clvll servants. IV In February 1992 the laws changed such that unlform age of retirement provieions were lntroduced for men and women. Untll this time women were able to retire earlier than men.  - 15 - spouses are civil servants, famlly allowance and birth allowance is paid to the husband (Artlele 203, 207). In the event that a civll servant spouse is appointed abroad, the other civll servant spouse has the right to request leave without pay up to four years. {114 ) 1rgw 39. While both men and women have to be protected agaLnst inadequate, unsafe or dangerous working conditions, lt is incroeasngly held in Turkey today by legislators that the only justifLed dlfforential in treatment of workers by gender is that related to maternlty protectlon and that this should be regulated in a way which reflects the shared responsibility of both men and women. such a position wlll slowly help to change the strongly-held attitudes that the proper role of women is as mothers and homemakers. The main defects of the Turklsh labor relations system needlng to be abrogated or amended are briefly addressed below. Lack of Job Security 40. One of the major defects of the Turklih Labor Laws is that there is no job security for workers, exceptlng trade union representatives. Dismissal of workers has been legislated as an absolute right of employers, who may lay- off a worker for any reason whatsoever. The MinLitry of Labor, however, has submitted to Parliament for approval legLilatLon that would provide security; approval is anticipated in the near future.o The worker may be entitled to certain types of compensation, but cannot demand reinstatement in the event of an abusive or discriminative dismissal Because the burden of proof falls on the worker, employers usually claim "immoral conduct on the part of the worker" as grounds for dismissal, in order to avoid giving any type of compensation. In most cases, a laid-off worker will refrain from applying to the court not only because of the expense and time involved, but also because other workers do not want to stand wLtness against the employer. This lack of job security reflects closely on the effectiveness of the trade unions. The Turkish Labor Laws define a "worker" as Zany person working under a labor contract in any job for wages". The term many job" denotes that private and public sector workers, manual and intellectual workers are subject to the same labor laws. ly The ILO Convention governing dismissals (No. 158) has not been ratified by Turkey. The draft legislation, however, is consistent with the convention. 1V For details see: sUral, Nurhan, "Trade Union Freedoms withln the context of Protection Against Anti-Unlon Discrimination", Human Rights Journal, Ankara 1991.  - 16 - Limitations on the Resignation by the Worker 41. A worker employed with a labor contract for an lndefinlte period has to reslgn either according to Artlile 13 (termination through a notice period) or 16 (terminatLon with a just cause). Article 16 lists three types of just causes which aret health (work being hazardous to the worker's health and unknown at the time of employment), the immoral conduct of the employer and force majeure (workplace not functioning for a period of more than a week due to unforesioen reasons such as flre, flood or breakdown of the machlnes). It is only when the worker resigns accordlng to the Article 16 that he is entitled t( severance pay. For any other cause, whether just or unjust, the worker hao to resign according to Article 13 and recelves no severance pay. Entitlement to severance pay is extremely important because of the lack of a natlonal scheme of unemployment insurance or assistance. The new Government plan. to establish a national scheme of unemployment insurance (Program, p.34). There is only one exception to Article 13; namely, when a woman resigns within a year of her marrlage and because of her marriage, she is entitled to severance pay. This exception was brought in 1983, not with the idea of protecting the woman but in an attempt to promote her reslgnatlon after the marriage so as to create vacancies for the unemployed. Prohlbitions and Restrlctions Concernina Trade Union Freedgms 42. Of the two most cited ILO conventions on trade union freedoms (No. 87 and 98), Turkey has ratified Convention No.* 98. The 1982 Constitution, the Trade Unions Law and the Collectlve Labor Agreements, Strikes and Lockouts Law, however, either prohibit or restrict trade union freedoms, thus contradicting the cited ILO conventions. Turkey has also placed reservations to Article 5 and 6 of the European Social Charter on the rights to organize and bargain collectively. Determination of the Minimum Wage 43. The minimum wage is determined by the Minimum Wage Board in the MOL at least once every two years. The board has representatives from the largest worker's confederation, the employers, confederation and the State; in the event there is no agreement, the State and Employers' representatives have the required majority to decide the minimum wage. The minimum wage is determined by considering the minimum essential needs of a single worker; in July 1991 the minimum gross wage for those aged sixteen and above was set at TL801,000 (US$195), the net amount being around TL502,911 (US$123). Turkey has made a reservation to Artlcle 4/1 of the European Social Charter concerning minimum wages (para. 33 above). Weeklv Hours of Work 44. The worklng week of 45 hours is high when compared with other European countries. Turkey has made a reservation to Article 2/1 of the European Social Charter envisaging a reduction in the working hours only to the extent that increases in productivity and other relevant factors permit.  - 17 - ANNEX 45. Turkey has made a reservation to Article 3 of the European Social Charter on the right to safe and healthy working conditions. Occupational health and safety are considered to be in need of urgent improvements in 1990, 168,000 industrial accidents occurred, 1,500 workers lout their lives and 3,000 workers becam-- permanently disabled, while the number of workdays lout due to such accldents exceeded 2 million according to the Social Securlty OrganLzation. (Lv) Pemale-Soeciflc Lecal Provlslons 46. It should be noted that Turkey has made a reservation to Article 8 of the European Social Charter on the right of employed women to protection. a) Protection of ReDroductive and Maternal Functions 47. The reprsductive and maternal functions of women workers are protected primarily by the Labor Law and the 1987 Regulation on Conditions of Work for Pregnant or Nursing Workers and Nursing Rooms and Day Nurseries. Specifically, the worker, upon request, is entitled to a leave of absence from work as necessary for medical examinations during the first three months of pregnancy and once a month thereafter (Regulation, Article 4). Women are entitled to a paid maternity leave of six weeks before and six weeks after confinement. These periods can be increased depending on the nature of the job and the health of the worker as stated in a medical report. Upon her request, the worker will be granted an unpaid leave of 6 months after maternity leave, which is not taken into consideration ln the calculation of paid annual leave (Labor Law, Article 70; Regulation, Article 3). It should be noted that'an employer can lay off a woman because of her pregnancy or confinement. In this case, a notice period is added to the paid maternity leave (Labor Law, Article 17/lb). This contradicts Article 11/2a of the Convention on the Elimination of All Forms of Discrimination Against Women. 48. Performance of work by women workers after confinement mentioned in the Regulation on Heavy and Dangerous Works, requires a medical'report statlng that there are -o health obstacles to the woman worker starting work followlng maternlty leave (Regulation, Article 5). 49. 'In workplaces employing more than 100 women workers, nursing workers are entitled to a nuroLna break of 45 minutes before and 45 minutes after regular breaks ln order to nurse their babies in either the nursing rooms or day nurseries. This entitlement is for a period of one year. At workplaces employing less than 100 women workers, nursing workers are entitled to two nursing breaks, each of 45 minutes. One is to be used before the regular break and the other before the work is over (Regulation, Article 6). Nursing breaks are consldered part of the working time (Labor Law, Article 62/ldi Regulation, Article 6/3). 50. Workplaces employing between 100-150 women workers regardless of their age or marital status, have to establish nursina rooms no more than 250 meters away from the workplace. Workplaces employing more than 150 women  - 18 - workers, regardless of thelr age or marital status, have to establlsh day nurseries consistLng of a nursino room and a areche for the oare of chlldren between 0-6 years of age. If tho day nursery ie farther than 250 meters, the employer has to provide transportation. Employers may share this obligation with each other or may make arrangements with established and satlsfactory nurseries (Regulatlon, Artlcle 7). b) Prohibition. or ReutriatLons on the Nmnlovment of Women ln SpecLfLc Types of Work 51. All types of underground and underwater work are prohLbLted for women of all ages (Labor Laws, Article 68). ThLi article has not been challenged so far, the main reason boing the general description of such work as "mens work". Nlaht Work 52. "Night" is deflned as the porlod comprising of at most 11 consecutive hours between lOsOC p.m. and at the earliest 6:00 a.m.. There are partlal exemptions from thie rule; there can be dlfferent start and stop hours, dependlng on the nature of the work performed or dlfferences Ln climate and customs. Workers can work at most 7.S hours for the night shift (Labor Law, Article 65). Women are prohibLted from nlght work ln industry with the exception of occupations in accordance with the RegulatLon prepared by the Ministries of Labor, Industry and Commerce (Article 69). Specifieally, women over 18 years of age may be employed for lndustrial work of a continuous nature that requires skllful handling and quickness but is not physically strenuous. The followLng actLvltLes are deemed to be windustrial" (Article 6) and women are prohLblted: - Work of all klnds in the exploratLon and extractlon of mlnerals from the earth, and work ln stone, sand and line quarries and the like; - Industries ln whlch raw materlals or partly manufactured or flnished goods are processed, cleaned, altered, ornamented or prepared for salel - All operatlons Lnvolved in the erection, repalring, dlemantling and wrecking of plant, faciltLes or equLpment; - The construction, repaLr, alteration and demolitlon of bullding and all lndustrlal activities connected therewLthl - The construction and repalr of roads, rallways, tramways, harbors, canals, piers, tunnels, bridges, sewers, wells, underwater salvage and the drainage of swmps;  - 19 _ - The generation, transformation, and transaLnsLon of eleotricLty and motive power of all kLnds, and operations connected wlth the LnstallatLons and distrLbutLons - The constructlon and operation of gas works and water works; - Telephone, telegraph, radio and televLaLon LnstallatLonsg - The bulldlng, repalrlng, alteratlon and breaklng up of shLps; - The transportatlon of passengers, goods and anlmals by land, air or water; - The loadLng, unloading and handling of goods at rallway statlons, warehouses, quays, harbors and aLrports; - Printing operatLons: An employer wlshing to hlre women for nlghtwork has to apply to the Regional Labor Dlrectorate in wrlting. The Directorate investlgates the workplace to ensure that lt complies wlth the conditlons laid down by the Regulation and if satiLfactory, Lisues a permit whlch may be revoked if worklng condltlons change. 8multaneously, women employees are requlred to bring a medlial report from a public health center certlfyLig that there are no medical obstacles to night work. The employer s reqpired by law to provlde transportatLon for women employed ln nlght work. Heavy and Dangerous Work 53. The Regulation on Heavy and Dangeroras Work lists the type of work covered and specLfLes whlch occupations may be performed by women. To perform such work every worker has to obtaln a medical report stating that he is physlcally approprlate for and capable of lts performance and these medlcal reports must be kept ln the health flles of the workers (ArtLele 3). Women are excused from the performance of heavy and dangerous works durlng the3.r menstruation per$odg, regarded as a perLod of flve days, whlch begLns wit- notification by the woman worker (Article 4). B. ConcluoLons 54. Whlle Turkey remaLne the only IslamLc country to have elimlnated the Sheria, and notwithstandlng the gender-neutral character of the 1982 Constltutlon and the 1926 Clvll Code adopt ed from Switzerland, there are a number of areas in whlch the legal framework constrains womeni" full partLclpatLon. SpecLflcally, there are two articles Ln the ConstLtutLon: Artlcle 41 on the Protectlon of the vamLly mandates that the State shall take the necessary measures and establish the necessary organLzatLon to ensure the peace and welfare of the family and the protectlon of the mother and chlldren; and ArtLcle 50 on Worklng ConditLons and the Rlght to Rest and LeLoure states OmLnors and women' shall enjoy special protectlon regardLng workLng  - 20 - ANNEX 1 condltions. Whlle seemingly paternallitlc, these artclces are lese than benlgn ln practlce. Although dlscrlmlnatlon is proscrLbed, the dlfflcultles ln practlce of obtaining legal redress, underpln the need for a legal mechanLem to provide redress for employment dlocrlmlnatlon and also for the need to provlde legal assistance to applicants. ThLi li regarded as one of the major lisues for the DOWSP to address. 5S. The civll code also does not provide for the full equality of women. Articles 151-158 on the famlly defLne the husband as the head of household, who determines domlcile and whose vlews provail on family matters in case of dispute. ConsLderatLon should be given to an early revlew by the MinLstry of Justlce and presentation to the Assembly of the proposals regardlng these artLeles prepared by the 1984 commisLson on reform of the Civll Cods. The annulment ln 1990 of ArtLele 159 whlch requLred that a woman obtaln her husband's permlsolon to work, represents a major stop forward for TurkLsh women. The laws on Educatlon, Property, BankLng and Credlt RegulatLon do not appear to pose lesues Ln terms of differential treatment of women. The Laws of SuccessLon (Ln partlcular, relatlng to agrlcultural land) and Natlonality do however treat women dlfferently and the former especially, msy constrain women's partLclpatLon given that women constLtute 50% of the agricultural labor force. Enforcement of exlsting laws, however, needs further consideration. For lnstance, the number of chlldcare centers ln enterprLses (Chapter III) and the low proportion of clvil marriages registered ln rural areas are lndlcatlve of the need for enforcement. 56. The major concern wlthln the legal framework, however, li the labor leglilatlon. Whlle many of the labor iLsues relate to both men and women, (for lnstance, job securlty) many regulatlons introduced for the protectlon of women contrlbute to constrainlng women to tradLtional, and generally low- paylng occupatlons. To date, Turkey has ratlfled 29 of the approximately 172 ;LO conventions and, in partlcular, has made limlted progress in lmplementlng conventions relatlng to women. Similarly, Turkey has ratified the European Social Charter. Progress ln compliance wlth the Charter, and the Charter's Actlon Program that ls close to being fLnalLied with far-reaching labor recommendatlons, li necessary. Progress ln labor legLslatLon under both the ILO conventlons and the Charter wlll be lmportant for Turkey's acceptance to the EC. Existing protective legislatlon needs to be re-evaluated. Also, women would benefLt from the extenslon of legislatLon concerning worklng condltlons to all workers, partlcularly homebased workers, and those ln the lnformal and agricultural sectors, and to the lntroductlon of leglilatlon for part-time and flexLtLme employment. In all of these areas, the DGWSP has an important role to play.  - 21 - -aw_o FerJULty. Nutritio Mit N-saith Isauss of ymN~  -22- -aw mm astma or a. Volpatio ftends, 195o -2000......2................... .. ..... 25 fri s ln Beo 2tios.....6....... ........ ... .. .. . ..... .. .. 26 Ag Distributlo of Female Population.................... 26 5Ltxit SptaRcyo........................ ............ ........... 27 . Mbgtmlltt~ gatLo .................................................... 28 Natewnal *Dvtalit3y 2at. and Its D*te&i.nants9*e9*9*...... 29 PrLnatal 3ar.......9. -*.- - ...........-.... 2 Deliwory and Pout Natal Care........ 33 C$ wartUlity. ..... 34 D. fal 1y Planning Programs and Contraceptive Use................. 36 Fe Adelt Rea s....................t................9.9.9.9...... 44 -. Conulusion and Arles Lot Znterventi@n......................... 46 11Z23or 1 .........................9..99999999999.9.9.9....... 999999 49  - 23 - List of fables Table t Total otpulation by Cemus Tears and Ofowth tate of Populationby Rural Areass 19S0-1990.................. 25 Table 2o Age Group Spewifc Sfe Ratio* 1970. 1965, 1990............ 26 Table 3# nho Percentage Distribution of Uovisehold Member by 5-3ear Age Groups and S7u.........o........... 3 Table 4d Life Dxpectancy at Birth and at Age St 1985-1990 and 19- X9 37 Table St Life Uupectanoy At Age 5, 19SoS20-10 2 Table 6i Child/Woanu Rates by Urban/Rural Areas (1950- $S) . . Table 7i Causes of Maternal Deaths Basned on Nospital Records, -,--19S219 6 .................................................... 30" fMtr 1ah sosoptlacrs 1921998*o ... 30 Table S. Distribution of Abortions (Per 1000 Pregnancies) Table 9u Averge Uaemoglobin Levels Ln Pregnat nd Lactating Women by Region, 1974..........e................ 33 Table 10 Sbotal ftrtlhity Rate by Region and Sottleuet Type 1963 and 198 6............................................ 33 Table 1l1 The Percentage Distribution of Sver-Marrled Wome Accordiog to the Number of Chlldren Desired by Som Dackgroud Vaniables...................................... 34 Table 12s The Percentage Dlstribution of Pregnant or Uxposed Women Who Desired More Cbhldre Accordlng to Sex Preference by Number of Livlog Cblldren and Livlog Sons ee 35 Table 13s fTred of Currently Used ContraceptLve Metbods by isposed WomNe A CowparLson Of Three National nertlihty surveys (Percentage DLstrLbution) ................................ 37 Table 148 Prevalence of Aneula la Adult Wom eo...................... 36 Table 1Ss Goltre Index and the Arithmtic Mean of Second Deree Goltre Prevalence by Sex and Region............... 39 Table 168 3valuatlon of Adults' Weights Accordiag to Standard Welghts by 8ez........................................... 39  * *re 0 eS * * ~- * *~ * t * * **" * * *i * * *5 S * pu  - 21 - ANNEX 2 ?URRRY IOE N DRELPN -YREPORT A. Pealatlon fronds. 19S0 - 2,00 1. 8ince the establshment of the Turklih Republic ln 1923, two dlvergLng population polLeLes have been followed: the pro-natalLt pollcy encouragLng high birth rates, whlch remLned valid untll 1965, and the anti-natalLst polLcy reflected in the Populatlon PlannLng Law, pursued sLnce 1965. OILE Is Total Population by Census Years and Growth R*t. of Population by ural Areas, 1950-1990 Year Population Urban Pop. late of Anmat Incras (millions) a X of Total Total Urban Rural 1950 20.9 25.04 .1T 2.25 2.15 195S 24.1 28.79 2.78 5.57 1.75 960 27.$ 31.92 2.85 4.92 1.95 1965 31.4 34.42 2.46 3.97 1.71 1970 35.6 36.45 2.52 4.73 1.25 1975 40.3 41.81 2.50 4.18 1.38 1980 44IT 43.91 2.07 3.05 1.33 1985 50.7 51.03 2.49 6.26 -1.06 1990 57.0 59.10 2.35 3.59 0.68 Sourcet GOmernmunt of Turkey (CT). 2. NotwithstandLng the pro-natallet polLcies, population growth remained low untll 1940. DurLng the Second World War, wlth a great number of men moblised, population growth declLned sharply and then accelerated in the 1950s. Simultaneously, there was a rapid acceleration ln migration from rural to urban areas. Since 1975, the populatlon growth rate has stabliLzed around 2.4% (GT)g if the populatlon growth rate remaLns at this rate. Turkey's population will be 71.3 mllion ln the year 2000.  - 26 - 5rends in Sex Ratlo 3. Table 2 below LndLcates age specLflc sex ratLos by years ULL2: Age Group Spectf l Sex Ratio. 1970. 1985. 1990 1970 1985 1990 0-4 102.6 104.4 103.5 S-9 105.1 105.3 105.2 10-14 109.1 107.6 105.2 15-19 106.7 103.1 107.4 20-24 110.4 103.6 102.6 25-29 96.0 103.6 103.1 30-34 87.4 104.4 103.2 35-39 101.8 103.0 104.0 40-44 102.4 98.9 102.4 4S-49 114.3 97.5 98.1 50-54 66.5 103.6 95.9 6S-59 112.8 100.0 100.7 60-64 89.9 96.8 96.0 65-69 100.7 64.3 91.8 70-74 63.2 69.2 79.1 75-79 74.9 80.4 75.8 80-64 53.0 71.6 - 85 + 48.4 59.5 - TOTAL 102.3 102.7 102.4 Source: ST. a ocuparLson of the sex ratLos (males to females) for 1970-1990 shows an excess of men over women below age 30. The excess dimLnishes over time and Ls attributed, in part, to an improvement ln age doclaratLon brought about by better education. Urban/rural ratios, however, show a greater excess of males Ln urban areas (Ln 1970, ratLos were 133 for ages 15-19 and 157 for ages 20-24), reflecting the primarlly male urban migration whlch accelerated in the 1960.. Ae Distribution of Female PoZulation 4. Table 3 shows the percentage dLstribution of household members by 5-year age groups and sex$  - 27 - ANNEX 2 TJALE 3: The Percentage Distribution of Household M4embers by 5-Year Age Groups and Sex Males Females Sex Ratio. 0-4 11.0 10.5 104 5-9 12.0 12.1 99 10-14 11.7 11.2 104 15-19 10.4 11.0 94 20-24 9.3 9.8 95 25-29 8.2 7.9 104 30-34 7.3 7.1 103 35-39 6.0 5.7 105 40-44 5.0 4.6 109 45-49 3.9 3.9 102 50-54 3.7 4.3 86 55-59 3.9 3.9 102 60-64 2.9 3.1 93 65+ 4.3 4.6 93 Unknown 0.3 0.2 123 TOTAL 100.0 100.0 Sample Size 15787 15814 100 Source: nacettepe University Institute of Population Surveys (HIPS), 1989. The low ratio at ages 15-24 may be explained by the absence of males at home at those ages for educational purpose or military service, since institutional opulations were not included in the household members list in the Hacettepe UniversLty Institute of Population Survey (HIPS, 1989). As expected, the ratio is low after age 50. LLfe-Lxwectancy 5. Table 4 summarizes available data on life expectancy at birth and at age 5 but, silnce data on life expectancy at birth are limited, the report focuses on life expectancy at age 5 (Table 5). TABLE 4: Life Expectancy at Birth and at Age 5. 1985-1990 and 1990-1995 Years Life exnectancv at birth Life exnectanov at 5 Hale Female Male Female 1985-1990 63.2 68.1 64.1 68.4 1990-1995 65.1 70.3 64.7 69.3 Source: Kocaman. 1989.  - 28 - ANI= 2 6. The followlng table gives the data on life expectanoy at age 5 between 1950-1990. TABLE S: Life Expectancy At Age 5. 1950-1990 Periods LJfe exonctamx Kale Female 1950-55 57.8 59.1 1955-60 60.4 61.9 1960-65 60.9 63.8 1965-70 61.6 64.4 1970-75 62.3 65.6 197S-80 62.9 66.5 1980-85 63.4 67.3 1985-90 64.1 68.4 Source: SPO. Social Indicators. 1990. Between 1935-50, life expectancy at age 5 lncreased by 6-years for males and 10 years for females and between 1950-90 an Improvement of about 6 years for males and 9 years for females can be observed (CT). 3. MortaiLty Ratio ChildaWoman Ratlo 7. The chlld/woman ratio le the number of live chlldren under age 5 per woman aged 15-49. Though it has some limitations, lt may be used as an LndLcator of gross dlfferences in fertility (Campbell, 1983). TABLE 6: Child/Woman Ratios by Urban/Rural Areas (1950-85) 1950 1955 1960 1965 1970 1975 1980 1985 Urban .444 .512 .533 .520 .520 .532 .488 .440 Rural .657 .746 .760 .74 .737 .695 .643 .560 Total .609 .694 .700 .676 .657 .625 .567 .500 Difference 213 234 227 224 217 163 155 128 Source: Adopted from the estimates of Cert. 1989.  - 29 - a LX 2 The chlld/woman ratlo ln both rural and urban areas has steadlly decllned since 1960 as well as the rural-urban dlfferential (Table 6). 8. Although gender-opeclfic dlfferences in child mortallty rates could be estimated from the life expectancy of females as a percentage of males, the data, particularly for chlldren in age group 1-4, is not published by gender, so, it is not possible to lnterpret mortality rates accordLng to sex dLfferences.l/ However, many studies underline the preference for sons (Table 12 below; HIPS, 1989i 8ztfirk, 1974/1990; SUmbUloglu, 1976/1990; Ermumcu, 1984/1990) and show the proportion preferring a glrl decreases wlth an increaslng number of livlng chlldron. The studies also show that in famllies wlthout male children the level of contraceptlve use is very low. Analysis of the number of dead chlldren and soclocultural variables, wLthout taking lnto conslderation the number and sex of living childron, also lndlcates the number of dead chlldren as the most important determinant of fertillty behavlor (HIPS, 1989). When sociocultural factors and the sex of dead children were taken lnto account, the number of dead male children emerges as an lmportant determlnant. Another indlcator worth mentloning is the exprossLon of some health center physlcians: "For male chlldren they usually ask us: "Tell me doctor, is there any need to take thls boy to a private physician?" (Aksit, 1989, Bivas).V Theme flndlngs imply that sex preferences of famliles are obvious and affect the morbidity and mortality. 9. Infant mortallty dlstrlbution by sex shows that 142 male infants die for every 100 female lnfants. Thls ratlo rises in the neonatal period where 166 male infants dle for every 100 female infants and falls in the postneonatal period, where 126 male infants dle for every 100 female infants (Tuncbllek, 1988). The greater occurrence of male deaths over females deaths may be due to several factors. The fact that male infants may be susceptible to a greater number of sex-linked diseases than female infants and that male infants may be relatively weak in resisting disease could both contribute to this gender dLfferentlal in lnfant deaths. Also, cultural factors such as under reportlng of female infants death may also affect these flgures. Thus, sex preference is noticeable, but detailed data representing the country's status of child morbidlty and mortality by sex is not sufficient to support unequivocally thls vlew (AkeLt and Akeit, 1989a). Maternal Mortality Rate and Its Determinants 10. Maternal mortality is the annual number of deaths of women from pregnancy-related causes durlng pregnancy or wlthln 42 days of termination of pregnancy (UNICEF, 1991). Official statlstics are not sufficient for Turkey's 1J The UN Report "World's Women: Trends and Statistics, 1970-1990", (1991, p.60) cltes mortality rates of girls aged 2-5 years as 19.5 per 1000 population and 18.4 for b)ys. V 8ulut and colleagues (1990), however could find little sex differentiation among child deaths by age ln Istanbul. Although thls can be explalned by lack of registration of female blrths ln rural areas, lt is confuslng for Istanbul.  - 30 - ANNEX 2 maternal mortality rate to be properly assessed. According to Yoner's finding. for 1974-75, the maternal mortality rate was 208 per 100 thousand (1981). A survey carried out in 1989 by the State Institute of Statistics, through the siLterhood method showed a maternal mortality rate of 134 per 100 thousand blrths for 1981 (OT). 11. The majority of maternal deaths in Turkey occur during childbirth. Surveys undertaken by the State InstLtuto of Statistics (SIS) also confirm thLi finding, pointing out that half of all maternal deaths take place during delivery, one fourth durLng pregnancy and one fourth during the puerperium, (i.e. after birth). The major medical causes of those deaths are haemorrhagia, infections and toxaemia. Maternal mortallty rates calculated on the basis of hospital births cannot reflect the country's situation as the system only provides assistance to about half of the yearly pregnancies (GT and UNICEF, 1991). Table 7 shows the distribution of maternal deaths related to medical causes for the period 1982-86, based on hospital recordS (GT): TABLE 7: Causes of Maternal Deaths Based on Hospital Records. 1982-1986 Cause of death Hospitalized Deaths Death rate (per 100.000) Toxaemia related to 15.467 256 1.665 pregnancy and confinement Infections during 3,950 21. 531 pregnancy and confinement Puerperal fever 3,561 13 365 Other complications related 100.460 157 156 to pregnancy and puerperium Hasmorrhagia related to 38,554 47 121 pregnancy and delivery Abortions 79,124 77 97 Births without complications 549,996 53 9 Source: 6T. 12. High fertility including early marriage age and frequency of pregnancies, inappropriate nutrition, under-ut$lization of existing health care services and traditional practlces, which are all partially determined by the socio-cultural and economic status of a country, exacerbate the medical causes of maternal deaths.  - 31 - ANNEX 2 13. In Turkey, only 10% of women over 45 are single, including widows, divorced and separated women. Although the average age at first marriage rose to 18.2 in 1988 from 17.6 in 1983, it is still low, particularly in Eastern Anatolia (16.3 in 1983, 17.3 in 1988) (HIPS, 1989). Early marrlages lead to early pregnancy, blrth and puerperlum, whlch all have the potentlal to affect maternal health. Short blrth intervals also affect the chld's health status. For instance, the lnfant mortality rate (IMR) le. 125 per thousand for those spacing blrths closer than 24 months (TungblIek, 1988) compared to a natlonal IMR of 61. ExcessLve fertillty glves rise to an increase ln the number of undesired pregnancles and, ln turn, leads to abortion which is harmful to women's health. The followlng table shows the lncldence of abortlons, accordlng to respondents: TABLE 8: Distribution of Abortions (Per 1000 Pregnancies). 1984-1987 Type 1984 1985 1986 1987 Induced 15.1 16.8 20.2 23.6 Spontaneous 7.6 8.7 8.1 8.2 Total 22.7 25.5 28.3 31.8 Source: HIPS. 1989. 14. If one of the rlsk factors for pregnancy, dellvery and puerperLum is also accompanied by malnutrltlon (or unbalanced nutrltlon), a threatening sLtuatLon may emerge for mother and chlld. Failure to meet pregnancy-related nutritLonal needs or to compensate for the nutrltional loss emerging from prevLous pregnancLes partlcularly wlth uhort lntervals, also Lncreases the rlsk of maternal mortallty. 15. Accordlng to a recent natlonal study (K8keal, 1977), 28% of girl. above age 5 and women had low haemoglobln levels and 74% of pregnant women. Almost 95% of pregnant women claimed that they do not change thelr dlet during pregnancy. The followlng table shows the average haemoglobln levels ln pregnant and lactating women by region:  - 32 - ANNEX 2 TABLE 9: Average Hasmoglobin Levels in Pregnant and Lactating Women by Region, 1974 Haemoglobin level g/100 ml/blood Region 7.9 & less 8.0-9.9 10.0-10.9 Total Aegean-Narmara Pregnant 7.1 29.8 29.8 66.7 Lactating 4.6 24.8 30.3 59.7 Black Sea Pregnant 40.5 47.6 7.1 95.2 Lactating 15.3 59.7 12.5 87.5 Central Anatolia Pregnant 10.5 35.6 20.9 67.2 Lactating 9.1 27.3 18.2 54.6 Mediterranean Pregnant 22.6 32.2 21.0 75.8 Lactating 14.5 34.8 30.4 79.7 Eastern Anatolia Pregnant 11.9 35.8 26.9 74.6 Lactating 3.9 24.3 26.2 54.4 Turkey Pregnant 16.1 35.1 22.7 73.9 Lactating 8.6 32.6 24.2 65.9 Source: Koksal. 1977. Below average (less than 11.0 gr/100 ml) haemoglobin levels are particularly high in the Black Sea, the Mediterranean and the Eastern part of Anatolia. Though K8ksal did not address the causes of anemia, the prevalence of thalassasmia in Turkey may be thought as a facilitating factor. 16. Utilization of health services as a contributor to maternal mortality can be discussed in terms of prenatal care and delivery: Prenatal Care 17. Within the framework of the existing system in Turkey, prenatal services are provided by health centers, health houses, maternal/child health and famlly planning centers, hospitals and prlvate physicians. At health facilities under the admlnistration of the Ministry of Health (MOH), pregnant ,women are supposed to be followed-up at least six times by midwives. DurinV routlne follow-up pregnant women are given a physical check-up, blood pressure, heLght and weight are measured, tetanus toxoid given and the necessary training (CT and UNICEF, 1991). However only 43% of all pregnant women in the country recelve prenatal care, (56% in urban and 27% in rural areas). The variation between regions, particularly between West and East, is strlking (West 62% and East 22%g  - 33 - RIPS, 1989)e These data are reasonable sance health servlces are not evenly dlitrlbuted all over the country. However, the dellvery of prenatal care varies wlth the increase of educatlonal level of the women (21% of illiterate, 32% of literate, 4S% of primary school, 70% of secondary school, 81% of hlgh school, 86% of university graduatesu HIPS, 1989). The firat prenatal care occurs on average at the beglnnLng of the seventh month, so many women recelve prenatal care only once, during the last trLmester of pregnancy. Delivery and Post Natal Care 18. A slgniflcant number of blrths still take place under unsuLtable and unhealthy conditlons outsLde of a health unit (39%; HIPS, 1989). In the rural areas more than half of deliveries take place outside a health unit (53%) and ln the Bast only one-third of blrths are dellvered at a health unlt (37%). According to the findlngs of HIPS (1989), rural dwellers are more llkely to be assLsted by traditLonal mldwives and people other than health personnel (35%), Ln comparLson to thelr urban counterparts (14%). There are vlrtually no data on post-natal care. 19. These trends suggest (i) that whlle existLng MinLitry of Health programs for safe motherhood are satLifactory, there is a need to strengthen the utliLsatLon of these programs; (LL) a need to lncrease research on prenatal, natal and postnatal care, ln terms of dellvery and proviLson of health services, and particularly wlth a vLew to LncreasLng the incldence of modern and healthy mother and chLid care (Akait T. and Oscebe 1992; Dlliz, 1978/1990)t and (LiL) a need for actual and preciLs data to analyze maternal mortallty rates and causes* TABLE 10: Total Fertility Rate by Region and Settlment Type, 1983 and 1988 Region, settlement type 1983 1988 West 2.68 3.52 South 4.59 4.47 Center 4.01 4.14 North 3.88 3.55 East 6.52 4.99 Urban 3.17 3.79 Rural 5.08 4.37 Turkey 4.05 4.04 Source: HIPS. 1989.  - 34 - ANNEX 2 20. Turkey has experlenced a signiflcant decllne in fertlilty sLnce 1960. The Total Fertllity Rate (TFR) deflned as the total number of chlldren born to women who reach 49 years of age was 6.8 in 1960 and 3.7 ln 1989 (PopulatLon Reference Bureau, 1989). In the Slxth Flve-Year Development Plan, the target is for a total fertlilty rate of 3.46 for 1990-1995. However Table 10, whlch summarLzes avallable regLonal and urban/rural fortility rates, shows a need to carefully analyze reglonal variation. There are no rellable data for fertlilty rates by reglon and socLo-economLi status in the HIPS 1988 survey whlch would permlt a correlatlon of fertillty rates with soclo-economic status. 21. The followlng two tables glve an indlcatlon of the ldeal number of children of ever-married women classLfLed by regLon, urban/rural residence, educatlon and whether the actual famlly sLze equals the desLred numbers TABLE ^1: The Percentage Distribution of Ever-Married Women According to the Number of Children Desired by Some Background Variables Ideal number of children 0 1 2 3 4 5+ Total Turkey 9.0 4.9 59.8 17.4 7.3 1.6 100.0 West 6.7 6.4 67.7 14.9 3.7 0.7 100.0 South 13.8 2.7 40.8 19.5 19.0 4.2 100.0 Central 8.8 4.6 64.2 17.6 4.0 0.9 100.0 North 8.2 6.8 64.6 16.1 3.5 0.9 100.0 East 11.0 2.8 48.6 22.0 12.7 2.9 100.0 Urban 8.3 5.4 62.2 17.1 5.8 1.2 100.0 Rural 10.0 4.3 56.6 17.9 9.2 2.0 100.0 Illiterate 9.6 4.0 43.8 22.8 15.4 4.3 100.0 Literate 7.0 4.2 56.1 23.3 7.9 1.5 100.0 Primary 9.0 4.3 66.7 15.5 4.1 0.4 100.0 Secondary 9.1 6.1 70.1 10.8 3.9 - 100.0 High 10.5 9.0 70.3 8.1 1.3 0.7 100.0 University 5.0 18.8 65.8 8.8 2.5 - 100.0 Source: HIPS. 1989. The HIPS data show that 60% of all ever-marrled women stated that they desired two chlIdren, almost 20% deslred three chlldron, and that 9% of women prefer not to have any chlldren. Compared to urban areas, women living ln rural areas have  - 35 - ANNX 2 aLmilar ldeas, but ln terms of regions, women ln the Southern and the Eastern reglons desLre two chlldren. The survey shows little difference ln the preference of women ln urban - rural areas, but the regLonal data show that a hlgher proportlon of women ln the Southern and Eastern regLons desLre both no chlldren and more than two chlldren. The survey aloo clearly reveals a deolilne in desLrel famlly size wlth rLsing levels of education. Educatlon, therefore, is a very strong factor ln determlning excess fertlilty (HIPS, 1989). 22. Table 12 shows the proportlon of exposed women who desired more chlldren and thelr sex preferences by the number of llvlng chlldren and livlng cones IABLEL12: The Percentage Distribution of Pregnant or Exposed Women Who Desired More Children According to Sex Preference by Number of Living Children and Living Sons Number of Number of Percentage who Percentage Either Total living living want a son who want a children sons daughter 0 0 28.6 17.2 54.2 100.0 1 0 71.0 3.2 25.8 100.0 1 5.3 73.7 21.0 100.0 2 0 89.2 - 10.8 100.0 1 36.5 6.4 56.8 100.0 2 5.5 87.3 7.3 100.0 3 + 0 100.0 - - 100.0 1 75.0 - 25.0 100.0 2 20.7 27.6 51.7 100.0 3 + 15.2 45.5 39.4 100.0 Source: HIPS. 1989. 23. The mean deslred family sLze, or the ldeal number of chlldren, whlch was 3.03 and 2.7 in the 1978 and 1983 surveys respectively, was found to be 2.14 in 1988. Thus, wlthln ten years, the mean number of decLred children decreased by one child. The mean number of chlldren desLred was found to increase as the number of livlng chlldren and age of the women increases and decreases as the educatlonal status of the woman or her husband Lncreases (HIPS, 1989). The 1988 survey did not reveal slgnlfLcant dLfferences in the mean number of chlldren* desLred among regLons and places of residence. Excess fertillty li said to exlit when the number of living children is greater than the deslred number. In the 1988 HIPS Survey, 44% of all ever-marrled women have more chlldren than thelr ldeal or deslred number. 24. Tradltlonally, the value of chlldren in Turkey ls closely related to economlc utility and their sex. To a large extent, this remalns the case ln many parts of Turkey. As has been dLicussed ln sectlon B above (Mortallty Rates), many studLes underllne the sex preference for sons. Accordlng to research on  - 36 - the value of chlldreni, conducted by Kagltglbas3 (1981), parents want maie chlldren mostly for economlc help and contlnuatlon of the family name In some areas, women contlnue glvlng blrth untll they reach thelr desired number of male chlldren and parents may not count daughters as chlldren on the grounds that they will go to the marltal family, and all their contrlbutLons wlth them. However, lt news that thlo pattern has been changlng ln recent years Lh favor of psychologlcal satlsfactlon of younger parents (KagV1t9baol, 19815 Akslt, T. 1990). 25. it li also necessary to mentlon here that chlldren, and partlcularly male chlldren, prove a woman'e worth. In areas where polygamous marrlages remaLn,31 and partlcularly Eastern AnatolLa (3%, HIPS, 1989) a woman prefers to glve birth to a chlld every other year, so that her husband will not "take" a new "woman". In her oplnlon, she makes her "place" (status) ln the famlly stronger (AksLt, and 8zcebe, 1991). 26. As noted in Sectlon 8 (MortalLty Rates), young age at marrLage li one of the major issues relating to hlgh fertlilty ln Turkey (Bulut, 1986). AccordLng to the 1988 HIPS data, the age of fLrst marrLage la 17.2 years Ln rural, and 18.2 ln urban areas. Mean dlfferences ln husbands, and wives ages at first marrLage is 6 years for women under the age of 20. In rural areas there remaLns a sharp transltion from chlldhood to motherhood, whereas this transltion is being prolonged in urban areas by lncreased school enrollment of glrls. Consang'iineous marriages (21% Turkey, 31% Eastern, 13% ln western Anatoliat HIPS, 1989) artN also more popular .ln adolescent couples, especlally ln rural Turkey. These also contrlbute to rural health issues. The lnoldence of tenage motherhood and consanguineous marrlages underline the need for more LnformatLon on adolescents as they face very dLfferent sets of health and fertlilty Lssues. D. Family PlannLno Programs and Contragoetiv Ue2 27. The Flrst World War and the War of Independence (1919- 23) caused maslve populatlon losses Ln Turkey. The scarclty of manpower ln agrlculture and defence forced governments to take measures to increase fertlilty. Consequently, they favored a dynamlc generatlon pollcy and aimed at the improvement of natlonal health, reductlon of death rates, control of lnfectlous dlieases and an increaslng population growth rate (GT and UNICEF, 1991). In 1931, along wlth pro-natallst pollcies, preventlve health measures, coverLng mothers and children, were also lntroduced. During thls perlod, the Ministry of Health was entrusted wlth developLng means to encourage high fertlilty and glve awards to women wlth olx or more chlldren. Imports or sales of blrth control devlces were prohlblted. The Turklsh Penal Law deflned abortion as an offence and subsequently (1936), the penalty for thls offence was lncreased. 28. After establishment of the State Plannlng OrganliatLon ln 1960, existlng populatlon policLes started to be questloned and a pollcy advocatLag low populatlon growth was Lntroduced in the FLrat Flve-Year Plan. In 1965, a S 8PO data for 1990 shows 103 marrled women for every 100 marrled men.  37 - Populatlon Planning Law was paused and tax exemptlons were introduoed for the lmport of birth control devices. The Second Five-Y-ar Development Plan went further and lntroduced family planning programs. ProvincLal family plannLng directorates were given the task of estabiLshing mobile groups to cover rural populations. The Third Developoent Plan, proposed the LntegratLon of family planning and maternal and child care services. The Population PlannLng Code, put lnto effect in 1965, was revlied ln 1983, to meet current needs. The Code reformulates the prLnoLples of family planning, Lnduced abortlon and sterilizatLon, emergency lnterventlon and productlon and provislon of contraceptives. The Code also requires the State to facliLtate family planning educatLon and LmplementatLon. 29. Even though the Law had not been changed, the peroentage of users In 1963 was 22.0. Following the First Family Planning Law 1965, contraceptive use has grown dramatically - reaching 77% of exposed women by 1988. However, as seen ln Table 13, not only the use of modern methods, but also traditLonal methods continue to lncrease and remaln higher than for modern methods - 390 agalnst 38%. Whilo thli may provide an indlcation that the proportion of exposed women using modern contraceptives will Lncrease in future and even though the overall level of contraceptive use li high, the proportion of exposed women using modern methods suggests a margin for itprovement. In fact, when the use of speclfic methods Li examined ln 1988, it is observed that withdrawal remaLns the most widely used method (31%) among exposed women. IUD use (17% of exposed women) appears to be the second most widely practiced method (a two-fold increase was observed ln the use of IUD between 1983 and 1988), followed by condom and pill (8.9% and 7.6% respectively) (HIPS, 1989). MAELE 13: Trend of Currently Usod Contraceptive Methods by Exposed uoen: A Comyarison of Three National Fertility Surveys (Percentage Distribution) 1978 1983 1988 Modern Methods: Pill 8.0 9.0 7.6 iUD 4.0 8.9 17.1 Condom 4.0 4.9 8.9 Female scientif1c* 2.0 2.9 2.2 Female sterilization - 1.3 2.1 Male sterilization - - 0.1 Injection - 0.2 0.0 Total 18.0 27.2 38.0 Traditional Methods: Withdrawal 22.0 30.1 31.1 Rhythm - 1.4 4.3 Douche 6.0 1.9 2.9 Abstinence - - 0.1 Other 4.0 0.8 0.6 Total 32.0 34.2 39.0 *Female scientific: such as foam, creams. jelly. Source: HIPS. 1989.  - 38 - ANNEX 2 S. NutrILtLon 30. Two major studies on nutritlon have been undertaken in Turkey "Nutrition, Health and Food ConsumptLon", prepared joLntly by the Ministries of Health, Education and Agrlculture, State Plannlng Organizatlon, State Instituto of Statlitics, Hacettepe Unlversity, UNICEF, PAO and the CARE Organization in 1974 (Koksal, 1977) and "Food Consumptlon and Nutrition", carrled out in three citLes (Adana, Ankara and Izmlr) jointly by the Minlotry of Agrlculture, UNICEF, Haceattepe Unlverslty and the State Instltute of Statlstics in 1984. (T8nUk et al., 1987). Although there are many small scale studles, they do not present calorlc lntake by sex and age, whlch would permlt an analyass as to whether there is any preferential lntra-household food allocatlon ln Turkey. 31. According to the fLndLngs of Tonuk (1987), the incldence of malnutrition of chLidren ie the same in both rural and urban areas (about 12%). Since the heLghts and weights of preschool children are not gender specific, the measurements obtalned were evaluated wlthout differentlatlng the sexest 18% of preschool chlldren are underweight and 2% were marasmic. Some 23% of the preschool chLidren in the villages and towns were found to suffer from retardation, compared to 11% of the preochool children livlng in the metropolltan areas (Kokual, 1977). 32. Among nutrLtional defLeLency states currently afflictlng women, anaemLa is the most widespread. Its clLnical manifestation is not spectacular and for this reason the disease li often lgnored. Recent studies have indicated that ln lron deficiency, apart from anaemia there ls lmpairment of physical stamina, learning ability and immunocompetence (Gopalan, 1990). Severe anaemla itself also adds to obstetric problems and maternal mortality. 33. As depLcted above (SectLon B, Maternal Mortality), according to the K8koal study (1977), among glrls and women above age 5, the percentage wlth very low (lses than 7.9 g) or low (8-9.9 g) haemoglobin levels was 28.3. More recent studles suggest that anaemia prevalence li around 40% ln different areas (X8ksal and Xayaklrllmaz, 1987; Isik et al. 19901 Hamzacebi et al. 1990). Some researchers polnt out that most pregnant women Ln Turkey do not change their nutritlonal hablts during pregnancy (Keksal and Kayaklrllmaz, 1985; Elmacloglu and Egemen 1989). TABLE 14: Prevalence of Anelma In Adult owen Name of researcher Research n Prevelence (X) Place Year Nlzlkac