Turkey Demographic and Health Survey 2003 Hacettepe University Institute of Population Studies Ankara, Turkey with the contributions of General Directorate of Mother and Child Health / Family Planning, Ministry of Health, Ankara, Turkey Co-funded by T.R. Prime Ministry State Planning Organization European Union October 2004 The contents of this document are the sole responsibility of Hacettepe University Institute of Population Studies and can under no circumstances be regarded as reflecting the position of the European Union. The 2003 Turkey Demographic and Health Survey (TDHS-2003) was carried out by the Hacettepe University Institute of Population Studies in collaboration with the General Directorate of Mother and Child Health and Family Planning of the Ministry of Health. Initial funding for the TDHS-2003 was provided by the Government of Turkey, as a project in the annual investment program of the State Planning Organization. Further funding was provided by the European Union through the Turkey Reproductive Health Program implemented by the Ministry of Health. TDHS-2003 is fully comparable with the models and standards developed by the worldwide Demographic and Health Surveys (MEASURE/DHS+) project. Macro International Inc. provided technical assistance on the review and formatting of the final report. Additional information about the TDHS-2003 may be obtained from Hacettepe University, Institute of Population Studies, 06100 Ankara, Turkey (telephone:312-310-7906; fax: 312-311-8141; e-mail: [email protected]; internet: www.hips.hacettepe.edu.tr). Information about the MEASURE/DHS+ project may be obtained from ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: [email protected]; internet: www.measuredhs.com). Suggested citation: Hacettepe University Institute of Population Studies, Turkey Demographic and Health Survey, 2003. Hacettepe University Institute of Population Studies, Ministry of Health General Directorate of Mother and Child Health and Family Planning, State Planning Organization and European Union. Ankara, Turkey TABLE OF CONTENTS List of Tables and Figures ...........................................................................................................v Foreword.................................................................................................................................... xi Summary of Findings ................................................................................................................xv Map of Turkey...........................................................................................................................xx CHAPTER 1 INTRODUCTION 1.1 Geography .......................................................................................................................1 1.2 History .............................................................................................................................1 1.3 Administrative Divisions and Political Organization......................................................3 1.4 Social and Cultural Features............................................................................................3 1.5 Economy..........................................................................................................................4 1.6 Regional Divisions..........................................................................................................6 1.7 Population........................................................................................................................7 1.8 Population and Family Planning Policies and Programs.................................................9 1.9 Health Priorities and Programs......................................................................................10 1.10 Health Care System in Turkey ......................................................................................10 1.11 Objectives and Organization of the Survey...................................................................11 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Characteristics of the Household Population ................................................................17 2.2 Fosterhood and Orphanhood.........................................................................................20 2.3 Education of the Household Population........................................................................21 2.4 Housing Characteristics.................................................................................................29 2.5 Household Durable Goods ............................................................................................31 CHAPTER 3 WOMEN’S CHARACTERISTICS AND STATUS 3.1 Background Characteristics...........................................................................................33 3.2 Respondents’ Level of Education by Background Characteristics ...............................35 3.3 Employment and Occupation ........................................................................................36 3.4 Decision on Use of Earnings .........................................................................................38 3.5 Domestic Violence: Women’s Attitudes towards Being Subject to Physical Violence..........................................................................................................40 3.6 Child Care While Working............................................................................................42 Table of Contents i CHAPTER 4 FERTILITY 4.1 Current Fertility.............................................................................................................45 4.2 Fertility Differentials.....................................................................................................47 4.3 Fertility Trends..............................................................................................................49 4.4 Children Ever Born and Living .....................................................................................52 4.5 Birth Intervals................................................................................................................53 4.6 Age at First Birth...........................................................................................................55 4.7 Teenage Pregnancy and Motherhood ............................................................................57 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Family Planning Methods......................................................................59 5.2 Ever Use of Family Planning Methods .........................................................................62 5.3 Current Use of Contraception........................................................................................63 5.4 Trends in Current Use of Family Planning....................................................................65 5.5 Number of Children at First Use of Contraception .......................................................67 5.6 Knowledge of the Fertile Period....................................................................................68 5.7 Timing of Female Sterilization......................................................................................69 5.8 Sources for Family Planning Methods ..........................................................................70 5.9 Informed Choice............................................................................................................72 5.10 Discontinuation of Contraceptive Use...........................................................................74 5.11 Intention to Use Contraception Among Non-Users ......................................................75 5.12 Reasons for Non-Use of Contraception.........................................................................77 CHAPTER 6 ABORTIONS AND STILLBIRTHS 6.1 Life-time Experience with Pregnancy Terminations.....................................................79 6.2 Current Levels and Trends in Abortion Rates...............................................................80 6.3 Patterns of Contraceptive Use Prior to and After Induced Abortion.............................83 6.4 Reasons for Induced Abortion.......................................................................................84 6.5 Timing of Induced Abortion..........................................................................................86 6.6 Abortion Provider..........................................................................................................86 6.7 Age-specific and Total Abortion Rates .........................................................................87 CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY 7.1 Current Marital Status ...................................................................................................89 7.2 Age at First Marriage.....................................................................................................90 7.3 Postpartum Amenorrhea, Postpartum Abstinence, and Insusceptibility .......................93 ii Table of Contents CHAPTER 8 FERTILITY PREFERENCES 8.1 Desire for More Children ..............................................................................................97 8.2 Need for Family Planning Services.............................................................................101 8.3 Ideal Number of Children............................................................................................101