İsmet Koç

International Migrants' Remittances and Welfare Status of the Left‐Behind Families in Turkey

In this study, micro implications of remittances are examined based on the data from the 1996 Turkish International Migration Survey (TIMS-96), part of a comprehensive study of Eurostat and the Netherlands Interdisciplinary Demographic Institute (NIDI). Results of the study imply that migrant savings are generally used for satisfying basic consumption needs. Patterns of expenditures suggest that for 12 percent of all the households receiving remittances, about 80 percent used remittances to improve their standard of living. Considering the variation by regions, it is observed that households in less-developed regions spent more on daily expenses than those in developed regions. This suggests that daily expenses of households in less developed regions depend significantly on remittances received by households. Moreover, remittances have a positive impact on household welfare; households receiving remittances are found to be better off than nonremitting households. This suggests that migration and remittances have positive indirect effects on incomes of emigrant households. A considerable part of the relevant literature argues that remittances are mostly spent on consumption, housing and land and are not used for productive investment that would contribute to long-run development. This conclusion often rests on arbitrary definitions of “productive investments.” Access to better nutrition and allocation of more resources to education are, without question, forms of productive investment. Although emigration does not serve as a solution to the problems of national development, it is evident that remittances generate considerable welfare effects, at least for the remittance-receiving population.

PREVALENCE AND SOCIODEMOGRAPHIC CORRELATES OF CONSANGUINEOUS MARRIAGES IN TURKEY

The aim of this study was to determine the prevalence and sociodemographic correlates of consanguineous marriages in Turkey using data derived from the 2003 Turkey Demographic and Health Survey (TDHS-2003). Demographic surveys conducted in the last 40 years consistently show that Turkey is a country with a high level of consanguinity. In the latest demographic survey (TDHS-2003), a nationally representative sample of 8075 ever-married women, consanguineous marriages accounted for 22% of the total, which is equivalent to a mean coefficient of inbreeding (alpha) of 0.011. There are changing secular profiles in the rates of consanguinity in general and of the specific sub-types of cousin marriages in particular in Turkey. The prevalence of first cousin marriages among all consanguineous marriages presents a steady decline from one marriage cohort to the next. The changes observed over time may be attributable to several factors such as the increase in educational level of women, the nuclearization of the family system, the mobility from rural to urban settings, a better socioeconomic status of families, an increase in womens labour force participation in formal sectors, lower fertility rates resulting in a smaller number of cousins available for marriage, and an increased awareness of the effects of consanguineous unions on child health in cases where there is an inherited recessive disease in the family. Any attempts to discourage consanguinity at the population level appear to be inappropriate and undesirable, especially when the consanguineous union remains an integral part of the cultural and social life of Turkey. Nevertheless the WHO-recommended approach to minimizing the negative effects of consanguinity on child health should be followed, i.e. the identification of families with a high risk of a genetic disease and the provision of prospective genetic counselling.

Determinants of contraceptive use and method choice in Turkey.

In this study, the determinants of contraceptive use and method choice are examined based on various variables, classified as individual, cultural, fertility and contextual. The data used came from the 1993 Turkish Demographic and Health Survey. The main finding is that there exists a positive association between the educational level of both spouses and the use of contraceptive methods in Turkey. After all individual, cultural, fertility and contextual variables are controlled, a womans education is a stronger predictor of method use and method choice than that of her husband. Increasing the educational level of women may be the most effective means of advancing family planning acceptance and increasing the demand for contraceptive services in Turkey. The study also shows that, to a great extent, contraceptive use and choice of modern method depend on the sex of a couples living children, implying some preference for sons, although generally women prefer to have children of both sexes.

Increased Cesarean section rates in Turkey

The aim of this study was to examine the trend in Cesarean section deliveries and the factors associated with Cesarean sections in Turkey. Data come from the ever-married women questionnaire of the 1998 Turkish Demographic and Health Survey (TDHS-98). During the decade preceding the TDHS-98, the proportion of deliveries by Cesarean section increased from 5.7% to 20.8%. When only hospital births were considered, the percentage of Cesarean deliveries for the year 1998 was found to be 26.1%. The estimated rate for the year 2001 was around 30% (i.e. double the maximum rate of Cesarean sections defined by the World Health Organization). Logistic regression analysis performed for the births occurring in the most recent period of 1993–98 revealed that the highest Cesarean section rate was strongly associated with maternal education, maternal age, place of delivery, number with prenatal care and household welfare. These findings imply that women with higher socioeconomic status are more likely to accept Cesarean section than women with lower socioeconomic status. The trend of increasing Cesarean section rates is a problem in itself, but more importantly it may indicate that Turkey is headed toward a more costly medical delivery system. For all of these reasons, the reduction of Cesarean section rates should be a priority for any reproductive health program in Turkey in order to improve the quality of prenatal care and to reduce the number of maternal deaths and morbidity.

Menarcheal age in Turkey: Secular trend and socio-demographic correlates

Background: Menarche is an important indicator for assessing the developmental status of pubertal girls. Despite its importance, there is no nationwide information on menarcheal age in Turkey. Aim: This paper is the first attempt to examine age at menarche for Turkey as a whole. The aim is to present the secular trend of menarcheal age and variations across different socio-demographic groups. Methods: Data were employed from the Turkey Demographic and Health Survey, 2008. Mean menarcheal ages were estimated for birth cohorts and socio-demographic sub-groups. The pace of decline in menarcheal age has been estimated using multiple linear regression analysis, controlling for year of birth and other variables. Results: Mean age at menarche was estimated as 13.30 (95% CI = 13.26–13.35). It was estimated as 13.17 years (95% CI 12.95–13.38) for the youngest birth cohort (1989–1993), as opposed to 13.44 (95% CI 13.37–13.52) years for the cohort born in 1959–1968. Conclusion: Regression analysis indicated a decrease of 1.44 months per decade, providing evidence of a secular trend in menarcheal age in Turkey. Further results suggested childhood place of residence, education, welfare status and number of siblings to be significantly associated with menarcheal age.

The Turkey National Maternal Mortality Study

Objective Complications during pregnancy, delivery and puerperium are the most widespread causes of death and disability among women of reproductive age in developing countries. In most of these, reliable estimates of maternal mortality are lacking. This paper aims to report Turkeys basic maternal mortality indicators derived from the National Maternal Mortality Study (NMMS). Methods The data originate from NMMS which was an implementation of a Reproductive Age Mortality Study (RAMOS) data-collection strategy. Maternal mortality rates and ratios were estimated, and information was gathered for improving the existing recording and reporting systems. Burial data by age and sex were collected prospectively over a 12 month period. Interviews with household members, health care providers, and reviews of facility records were then used to classify the deaths as pregnancy-related or maternal or otherwise. Results A national pregnancy-related mortality ratio of 38 (± 2.8) and a maternal mortality ratio of 29 (± 2.5) per 100,000 live births were found. The NMMS shows that 59% of all pregnant women died from direct maternal causes, 16% from indirect causes and 23% from co-incidental causes. Conclusion Maternal mortality is highest in regions with a poorer network of good roads, harsher winter conditions and longer distances to the next secondary level health facility which provides comprehensive obstetric emergency care services.

Internal Migration and Fertility in Turkey: Kaplan-Meier Survival Analysis

Starting from the mid-twentieth century, Turkey has experienced a remarkable fertility decline. Total period fertility declined from the level of 6 or 7 to the almost replacement level by 2003. Similarly, in the 1950s onwards internal migration gathered speed and transformed Turkey from a predominantly rural country to a mainly urban one in less than half a century. Fertility and migration were mutually reinforcing processes in Turkey. Considering this relationship, the study aims to compare fertility behaviours of migrants with those of nonmigrants at both origin and destination areas. The data source is the 2003 Turkey Demographic and Health Survey. A nonparametric descriptive survival analysis technique, Kaplan-Meier survival analysis, was employed. Kaplan-Meier survival curves of transition to first, second and subsequent births were compared by migration status. Survival curves of second and subsequent births for rural-to-urban and urban-to-rural migrant women are similar to the curves at the place of destination rather than place of origin. This result reveals that adaptation theory, rather than socialization theory, is more explanatory in the case of Turkey. Kaplan-Meier survival estimates showed that rural native and rural-to-rural migrant women experience all the events related with family formation earlier in their life cycle.

Demography of Ethnicity in Turkey

Throughout its history, the land of Turkey welcomed many cultures and societies. Modern Turkey was founded on the land of Ottoman Empire, and took over a complex, rich multi-cultural, multiethnic social structure. Therefore studying socio-demographic characteristics of different ethnic groups in Turkey has a special importance.

THE CAUSAL RELATIONSHIP BETWEEN CONSANGUINEOUS MARRIAGES AND INFANT MORTALITY IN TURKEY.

Turkey has high levels of infant mortality and consanguineous marriages. It has had a high level of infant mortality for its economic level for many years. Over recent decades, although adult mortality rates have not been very different from those of other countries with similar socioeconomic structures, its life expectancy at birth has remained low due to its high infant mortality rate. This has been called the Turkish Puzzle. According to the Turkey Family Structure and Population Issues Survey, 27% of women had a consanguineous marriage in 1968. Subsequent Turkish Demographic and Health Surveys (TDHSs) found the rate of consanguineous marriages to be stagnated at 22-24%, with a resistance to reduction. According to the TDHS-2008, 24% of women had a consanguineous marriage. Numerous studies in various countries of the world have indicated that consanguineous marriages, particularly of first-degree, have the effect of increasing infant mortality. The main aim of this study was to assess the causal impact of consanguineous, particularly first-degree consanguineous, marriages on infant mortality, controlling for individual, cultural, bio-demographic and environmental factors. Data were merged from four Turkish DHS data sets (1993, 1998, 2003 and 2008). Multivariate analysis revealed that first-degree consanguineous marriages have increased infant mortality by 45% in Turkey: 57% in urban areas and 39% in rural areas. The results indicate that there is a causal relationship between consanguineous marriages and infant mortality. This finding should be taken into account when planning policies to reduce infant mortality in Turkey, and in other countries with high rates of consanguineous marriage and infant mortality.

Avoidable Factors Contributing to Maternal Deaths in Turkey

Women’s deaths during pregnancy or 42 days after the termination of pregnancy are called maternal deaths. For developing countries, maternal deaths continue to be significant in number. This study represents the avoidable factors contributing to maternal deaths in Turkey using the results of the National Maternal Mortality Study conducted in 2005. According to this nationally representative study, the maternal mortality ratio is 29 per 100,000 live births which is lower than for all regions of the developing world, and at about the same level as those of the Commonwealth of Independent States (CIS) and East Asia. In this study, avoidable factors are categorized into four groups: household and community factors, health service provider factors, health service supply factors and other avoidable factors. The results indicate two striking findings. Firstly, the significant impact of household and community level factors on maternal mortality compared to the impact of health service providers and health supply factors. This finding indicates that women’s position in their community and in their household is the most problematic issue when it comes to preventing maternal deaths. The second striking result of this study is that there exists a clear need to adopt different strategies for the elimination of maternal deaths in different localities and regions. Although the impact of health service supply factors on maternal mortality were limited among the avoidable factors, the problems of reaching health facilities due to a lack of transportation and long distances between home and the health facility were frequently mentioned obstacles in rural areas.