This article was downloaded by: [Ondokuz Mayis Universitesine]On: 03 September 2015, At: 00:25Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: 5 Howick Place, London, SW1P 1WG

Click for updates

Health Care for Women InternationalPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/uhcw20

An Implication of Health Sector Reformfor Disadvantaged Women's Strugglefor Birth Control: A Case of KurdishRural–Urban Migrant Women in Van,TurkeyMiki Suzuki Hima & Ayşe Gündüz Hoşgörb

a Department of Sociology, Ondokuz Mayis University, Samsun,Turkeyb Department of Sociology, Middle East Technical University, Ankara,TurkeyAccepted author version posted online: 15 Aug 2013.Publishedonline: 17 Oct 2013.

To cite this article: Miki Suzuki Him & Ayşe Gündüz Hoşgör (2015) An Implication of Health SectorReform for Disadvantaged Women's Struggle for Birth Control: A Case of Kurdish Rural–UrbanMigrant Women in Van, Turkey, Health Care for Women International, 36:9, 969-987, DOI:10.1080/07399332.2013.827196

To link to this article: http://dx.doi.org/10.1080/07399332.2013.827196

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &

Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

Health Care for Women International, 36:969–987, 2015Copyright © Taylor & Francis Group, LLCISSN: 0739-9332 print / 1096-4665 onlineDOI: 10.1080/07399332.2013.827196

An Implication of Health Sector Reform forDisadvantaged Women’s Struggle for Birth

Control: A Case of Kurdish Rural–UrbanMigrant Women in Van, Turkey

MIKI SUZUKI HIM

Department of Sociology, Ondokuz Mayis University, Samsun, Turkey

AYSE GUNDUZ HOSGOR

Department of Sociology, Middle East Technical University, Ankara, Turkey

In this article, we examine how socioeconomically disadvantagedwomen are affected by health sector reform and family planningpolicy changes in Turkey through a case study of Kurdish women’sstruggles for birth control. In Turkey, a family planning programbecame relatively marginalized in primary health care services asa result of health sector reform as well as a shift of population policytoward a moderately pronatal approach. We argue that an emerg-ing health care system would leave disadvantaged women unableto benefit from contraceptives and would perpetuate reproductivehealth inequalities between women in the country.

The impact of globalization on women’s health is intricate. While global-ization contributes to transnationalizing and enriching the women’s healthmovement, a global capitalist economy compels worldwide reforms in thehealth sector, many of which seem to be causing adverse effects on women,the poor, and the disadvantaged. Rosalind Petchesky (2003) points out thatthe 1994 International Conference for Population and Development (ICPD)in Cairo was already symptomatic of this complexity. On the one hand, theidea of population control was replaced by the rights-based approach, andthe indivisibility of primary health care, poverty alleviation, and women’s em-powerment were recognized as a result of global feminist struggles. On the

Received 8 February 2013; accepted 17 July 2013.Address correspondence to Miki Suzuki Him, Department of Sociology, Ondokuz Mayis

University, Kurupelit, Atakum 55139, Samsun, Turkey. E-mail: mikihim@omu.edu.tr

969

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

970 M. S. Him and A. G. Hosgor

other hand, a growing macroeconomic trend of the introduction of marketmechanisms into the health sector was unchallenged in the Cairo Programmeof Action and, indicatively, the amounts of resources for primary health care,poverty alleviation, and women’s empowerment were left unspecified. Fiveyears later, reproductive and sexual health was placed within the context ofhealth sector reform (HSR) instead of primary health care in the 5-year re-view and appraisal of the implementation of the ICPD Programme of Action(ICPD+5). It can be problematic for women’s health because it is observedthat HSRs tend to be color, class, and gender blind and “treat all individualsand groups as presumptively the same, not different—consumers in a globalhealth commodity market” (Petchesky, 2003, p. 169). Although HSRs are of-ten criticized for deepening health inequality (Gelormino, Bambra, Spadea,Bellini, & Costa, 2011) or risking it (Agartan, 2012a; Whitehead, Dahlgren, &Evans, 2001), it is not sufficiently studied at the empirical level which groupof people are affected by reforms in what way in a particular society.

In this article, we examine Kurdish rural–urban migrant women’s strug-gle for birth control during a transitional period of population policy inTurkey. Turkey is a fast-growing country which has been forcefully inte-grated into the global political economy. It set out HSR in the 1980s, butsubstantial changes were enforced during the last decade. The impacts ofarguably color-, class-, and gender-blind HSR on different groups in societyhave yet to be known in Turkey. To initiate a discussion, we attempt to ex-plore the impact of HSR on Kurdish women’s access to contraceptives froma feminist perspective, that is, a perspective that is inspired by a political andethical commitment for women, grounded in women’s experience, informedby feminist theories, and accountable to women (Ramazanoglu & Holland,2002). We investigate specifically two related issues: whether the populationand family planning policy changes at the turn of the century had a negativeimpact on socioeconomically disadvantaged Kurdish women in Turkey; ifthey had, in what way the women were affected by the policy changes. Inorder to answer these research questions, we first outline recent changesin population policy and the state of Kurdish women’s health in Turkey;second, we examine women’s experiences of family planning services in re-lation to those changes; and last, we argue that a recent development of HSRhas a negative impact particularly among the most disadvantaged Kurdishwomen and perpetuates reproductive health inequalities in the country.

HISTORICAL BACKGROUND

Shifts in Family Planning Programs in Turkey

Turkey’s population policy has been antinatalist since the early 1960s. It hasbeen swinging between the developmentalist desire to keep up with inter-national population policy and the nationalist desire to force back externalinfluences and maintain the principle of nonintervention into the private

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 971

sphere. A more active family planning program was enforced in the mid-1980s, however, when it was found out that the country’s population growthrate, which had been steadily declining after 1960, rose again (Franz, 1994).In 1986, the General Directorate for Mother-Child Health and Family Plan-ning (ACSAP) launched a countrywide campaign for family planning. Nurseswere sent out to small towns and villages to promote contraceptives—theintrauterine device (IUD) in particular.

In this period, however, many eastern and southeastern provinces wereaffected by the intensified conflict between the Kurdistan Worker’s Party(PKK)—a paramilitary ethnic nationalist organization—and the state securityforces. Many public institutions, including health centers (community-basedpublic clinics), were closed. Due to the effects of political instability, thediscrepancy of fertility rate between the eastern and southeastern regionsand the rest of the country widened during the 1990s (Yucesahin & Ozgur,2008). In response to the situation, ACSAP launched a so-called reachingout program that focused on women in the eastern and southeastern re-gions as well as rural women and urban migrant women and squatters inthe late 1990s (Franz, 1994). IUDs, oral contraceptives, and condoms weredistributed without charge, and free family planning counseling service wasprovided at health centers. Furthermore, in the 1997 development program,the role of ACSAP was redefined according to the framework of reproductivehealth in place of population control in response to the paradigm change ofinternational population policy after the 1994 ICPD and an increase in familyplanning clinics in hospitals was declared (Ozberk, 2003).

The efforts to promote the accessibility of family planning services en-countered a series of financial and political obstacles in a short time. TheUnited States, the single largest donor, partially withheld funding from inter-national family planning programs after the re-institution of the Mexico CityPolicy in 2001 (Crane & Dusenberry, 2004). In the same year, an economiccrisis hit Turkey. In 2002, the center–right Justice and Development Party(JDP) came to power. The JDP government kept its distance from antina-tal population policy on the grounds of the projections that indicated thegradual aging of the country’s population. In particular, PM Recep TayyipErdogan habitually urged the public to have at least three children “not tofall into the trap as Western countries did” (National Television-MicrosoftNetwork-National Broadcasting Company, 2008).

In the meantime, the JDP government accelerated the process of HSR.Turkey’s reform plan aims at expanding health services, increasing efficiency,and limiting the rising costs in the health sector at the same time as manyother reform plans in developing countries (Keyder, 2007). Family planningservices, which usually neither raise money nor involve serious disease,were among the foremost areas that were downsized (Ciceklioglu, 2010).The Minister of Health indicated the state’s withdrawal from a family plan-ning program referring to the liberalization of international population policy

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

972 M. S. Him and A. G. Hosgor

from birth control to reproductive health (Guner, 2006). On the one hand, theMinistry of Health and ACSAP launched the Reproductive Health Programmein coordination with the European Union in 2003. One of the goals of thiscomprehensive program was to reduce the inequality between regions andsettlement areas and enhance the reproductive rights of individuals (Gen-eral Directorate for Mother-Child Health and Family Planning, 2005). Thus,efforts for expanding services seem to be continued. On the other hand,the Ministry attempted gradual centralization of family planning services toACSAP centers, which are located only in provincial centers. In this way, theservices were attempted to be distributed more efficiently with less cost. Thisimplementation, however, assumes socially undifferentiated rational individ-uals who choose the best-equipped health institutions and are capable ofaccessing them. It was reported that many health centers in peripheral areasbecame equipped with fewer types and a lower quantity of contraceptivedevices in the early 2000s (Karahan, Yuksel, & Erbaydar, 2007). Nurses wereno longer sent to villages and squatter areas for the promotion of familyplanning despite the fact that basic reproductive health inequalities of accessto contraceptives by region, settlement area, educational level, and ethnicitystill persisted (Dinc, 2007; Erbaydar, 2003; Eser, Dinc, Oral, & Ozcan, 2005;Isık & Pınarcıoglu, 2006; Koc, Hancioglu, & Cavlin, 2008; Yavuz, 2006).

Reproductive Health and Kurdish Women in Turkey

Kurds are the second largest ethnic group after Turks in Turkey. It is es-timated that they comprise approximately 15% of the national population(Konda Research and Consultancy, 2011). Many Kurds have experienced alife in an environment of socioeconomic and cultural (and often physical)insecurities over the last three decades (Icduygu, Romano, & Sirkeci 1999):More than two-thirds of Kurdish people live in less developed eastern andsoutheastern regions (Sirkeci, 2005). The conflict between PKK and the se-curity forces damaged the livelihood of many Kurds in rural areas in theregions. As a result of the conflict, approximately one million individualswere displaced between 1986 and 2005 (Hacettepe University Institute ofPopulation Studies, 2006).

The 1993 and 2003 indicators of the Demographic and Health Survey,which included the data regarding ethnic groups for the first time since thesurvey was conducted in the country, revealed the considerable socioeco-nomic and health disadvantage of Kurdish women. According to Sirkeci’sanalysis of the data (Sirkeci, 2005), Kurdish women who had no formal edu-cation made up 80% of the 25 or older age group, 53% of the ages of 20–24,and 30% of the ages of 15–19 in 1993, while the corresponding nationalfigures were 43%, 14%, and 7%, respectively. Forty-three percent of Kurdishwomen had no access to tap water in the house, and 11% of them used a

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 973

shared toilet or had no access to a indoor toilet facility. The correspondingfigures were 37% and 3% for Turks. Koc and his colleagues’ study (2008)shows that Kurdish women who gave birth at a hospital amounted to 49%,while most Turkish women had hospital births. The proportion of Kurdishchildren whose mother received antenatal care was 14% in comparison with65% for Turkish children. Kurdish women’s fertility rate was 4.07 in 2003,while it was 1.88 for Turkish women. In the same year, 47% of Kurdishwomen were not using contraceptives. The corresponding figure for Turk-ish women was 26%. Koc and his colleagues argue that it is not only thatKurdish women were more disadvantaged than Turkish women in terms ofreproductive health but also that the ethnic gaps widened during the decadewhile the rural–urban gap was significantly narrowed.

It can be said that reproductive health inequality between Kurdishwomen and Turkish women is related to the intersection of multiple disad-vantages of regional inequalities, poverty, political instability, displacement,and, consequently, an environment of insecurities. In the following sections,we examine the way in which Kurdish women’s struggles for birth controlwere affected by policy changes of the family planning program.

METHOD

This is an interpretive analysis of a case study of Kurdish rural–urban mi-grant women’s reproductive practices in the city of Van, Turkey. Our re-search was guided by grounded theory, which is considered to be effectivefor exploratory qualitative study (Glaser & Strauss, 1967). In a course of re-search, we accumulated cases through constant comparable selection withtheoretical sensitivity to socioeconomic embeddedness of reproduction. Wecollected data by literature search, participatory observation, and in-depthinterviews with 40 married women in a rural–urban migrant neighborhoodcalled Doluca neighborhood.1 One of the authors (M.S.H.) conducted par-ticipatory observation on irregular but frequent visits to the neighborhoodduring an extensive period between 2007 and 2009. She conducted in-depthinterviews between February and June in 2008 after a 2-month pilot study inspring 2007. Interview participants were selected by the snowball samplingmethod. M.S.H. asked questions in Turkish and interviewed non-Turkishspeakers with the assistance of chosen or agreed-upon interpreters. All in-terpreters except one (a neighbor) were participants’ grown-up daughtersor female relatives instead of a third-party translator due to our concern forwomen’s general wariness of outsiders. Most interviews were conducted inparticipants’ houses. All interviews were recorded by a voice recorder withtheir permission. Interviews took from half an hour to 3 hours.

1 The name of the neighborhood is a pseudonym.

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

974 M. S. Him and A. G. Hosgor

We analyzed the transcriptions of interviews and field notes by in- andcross-case examinations. First, we read and reread a transcription of eachparticipant’s account. We then constructed a table of her family planningand childbirth history and part of her life story in order to understand herfamily planning practices and nonpractices within social contexts in whichshe lived. Second, we compared the tables of all participants in order to seekcommon and divergent stories, understand shared and unique experiences,and comprehend the relationship between their experiences and the socialmilieu in which they lived. Third, we examined participants’ experienceschronologically in relation to national family planning policy in order to findany indications of an impact of the policy change on women’s lives.

This research is based on a feminist perspective. We aimed at makingthe voices of a certain group of women heard and shed light on a particularaspect of their life in detail. Our methodological choices, however, engen-dered some limitations. First, the findings cannot be generalized even forthe neighborhood studied, but a purpose of the research is to generate anew proposition that is tentative but grounded in detailed qualitative data.Second, we were obliged to use interpreters for interviewing non-Turkishspeakers due to M.S.H.’s lack of knowledge of the Kurdish language. Al-though most non-Turkish speakers seemed to be relaxed and willing to talkabout their experiences as much as Turkish-speaking women, the use of in-terpreters discouraged some of them from telling their stories fully. During anumber of interviews, they mentioned that they had much more to tell if theinterpreter knew Kurdish. Besides, the use of family and community mem-bers as interpreters may have increased non-Turkish speakers’ vulnerability.Even though women consented to their presence as interpreters becausethey always talked about “everything” with them, there were some occa-sions when an interpreter spoke on behalf of a participant because “theyalways talked about everything with each other.” Third, the issue of sexualand reproductive rights in conflict settings is an increasing concern amongfeminist scholars. We hoped to reach some information about the conflict’seffect on childbearing. Most participants, however, witnessed the conflict inchildhood. Old women did not talk about it in detail. People did not read-ily talk about the issue because of its nature and the time that had passed.Pertaining to this issue, further research is necessary.

Description of the Field

An environment of insecurity and a disempowering environment forwomen. Van is located at the east end of Turkey, between the Iranian bor-der and Lake Van, the largest lake in the country. It is one of the provinceswhere a large number of Kurdish people reside. Partly because of its periph-eral geographical location and partly because of the conflict and mass dis-placement, socioeconomic development remained sluggish in the province.

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 975

Statistical data show that women in Van are considerably disadvantaged incomparison with other women in Turkey. For example, 64% of Van womenaged 25 or more were illiterate, and their fertility rate was 6 in 2,000 (StateInstitute of Statistics, 2002).

The Doluca neighborhood consisted of 2,500 households and 20,000residents at the time of the research. The neighborhood was first formed bya few rural–urban migrant families in the early 1970s. It grew to be one ofthe largest squatter areas in Van, however, after the settlement of conflict-induced migrants between the late 1980s and the late 1990s. It was locatedabout 20 km away from the city center. Public services, such as water,electricity, and public transportation, began to be provided in the late 1990safter the mass migration. A health center was opened in the neighborhoodin spring 2008. Until then, Doluca women generally went to a health centerin another neighborhood or an ACSAP center at the city center for familyplanning services.

A sense of communal solidarity hardly exists among the people in theneighborhood. Relationships between neighbors beyond the limited numberof relative-neighbors were rather distant. One of the reasons could be theperceived heterogeneity of the neighborhood in comparison with home vil-lages, which mostly consisted of patrilineal kin. At the time of displacement,villagers could not migrate together but dispersed wherever they could go.Hence, the neighborhood was mostly comprised of migrant families fromdifferent villages of Van and neighboring provinces. The people generallyshared a sense of solidarity under Kurdish identity, but unrelated neighborsrarely had an occasion to come together and continued to keep a distancefrom one another in daily life.

Under the circumstances where even neighbors were seen as strangers,Doluca women were strictly guarded by kinsmen who shared family honor,or namus. Namus (Kurdish) or namus (Turkish) is a complex of honorclosely associated with the virtue of women (Sev’er & Yurdakul, 2001). Malehonor is vulnerable to his female kin’s virtue. It can be easily damaged byother men’s contact (sexually, physically, verbally, or even imaginary) withhis female relatives. Women are expected to restrain their movement so asnot to expose themselves to strange men on the one hand; men anxiouslywatch for their movement, on the other. Traditionally, in many parts ofTurkey, the movement of women who are in reproductive ages is confinedwithin a specific social boundary (e.g., a village or a neighborhood), andtheir existence beyond the boundary requires companions to guard them(Delaney, 1991). Within this social boundary, however, they are relativelyfree in movement (Erman, 1997; Fallers & Fallers, 1976). They take advan-tage of sexual segregation and cultivate their own autonomous networkswith other women who not only share joys and sorrows with them but alsoexchange information and accompany them when they want to go out with-out their husbands and in-laws (Sirman, 1995). The skills to cultivate their

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

976 M. S. Him and A. G. Hosgor

own social network, especially nonkin network, which is more egalitarianthan kin network, play a significant role in deciding their well-being withinthe patrilocal living arrangement in which they marry in as the “strangerbride” (Kandiyoti, 1988).

Unlike village women and conventional migrant women in other partsof the country, however, Doluca women take great care to walk aroundminimally even within the neighborhood. In the neighborhood, women’ssocial boundary shrinks to houses, courtyards, or blocks at most. They areoften warned by the husband and in-laws to refrain from mutual supportwith women in other households. They are thus deprived of cultivating theirown autonomous networks with other women. In the context of patrilocalresidence, their daily company usually is limited to their husbands’ unmar-ried sisters and nieces and brothers’ wives who live together or next door.Generally, they are in-laws unless they are married to relatives, which wasnot very common among the participants. Accordingly, the autonomy oftheir already limited relations with other women is partial.

Furthermore, a nuclear household arrangement was increasingly preva-lent in the Doluca neighborhood. As a matter of fact, maintaining an ex-tended household is one of the most plausible strategies to maximize thefamily budget in recent years when only irregular work or precarious bordertrade is available to unskilled workers due to increasing privatization anduse of subcontractors in public institutions. An extended household of thefather and the sons’ families means multiple wage earners in a household. Tomaintain an extended household is not easy, however, in the urban contextin which there is neither land nor livestock from which the members of thehousehold collectively benefit. Extended household arrangement was there-fore a privilege of the family of cooperative brothers each of whom had arelatively secure job and none of whom was seen as a burden to the others.Actually, many couples left home not for conjugal freedom but because ofa conflict over meager economic resources with the husband’s father’s andbrothers’ families. In a nuclear household arrangement, not only the sonbut also his wife gained certain autonomy. It could enhance her isolation,however, in the neighborhood where a nonrelative women’s network wasdifficult to form. It was commonly addressed by many participants, “Nobodyhas to like anybody. Nobody has to help anybody.” Thus, those who werenot on good terms with in-laws could be considerably dependent on theirhusband or socially isolated.

Characteristics of Participants

The mean age of the participants was 31, ranging from 18 to 51. The ma-jority of the participants were under the age of 40. Nineteen participantswere voluntary migrants, 15 participants were forced migrants, and 6 partic-ipants moved from a village to the city for marriage. More than half of the

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 977

participants migrated from a village to a city with their natal family beforemarriage. The mother tongue of all participants was the Kurmanji dialectof the Kurdish language. Seventeen women out of 40 participants did notknow or knew very little Turkish. Twenty-three participants were illiterate,and almost two-thirds had no schooling at all. No participants went to highschool. Two-thirds of the participants married under the age of 17. Sixteenparticipants lived with their parent(s)-in-law and often also brothers-in-law’sfamilies. The rest, 60% of the participants, lived in the nuclear household,but many of them had their in-laws in next door or in the same block. Noneof the participants engaged in wage work. Most of their husbands workedin the informal sector, such as day labor and illicit border trade. Only threeparticipants had health insurance covered by the Social Security Institution,five participants had no health insurance at all, and the rest had “GreenCard,” a type of health insurance provided by the state for the low-incomecitizen who cannot afford to pay a premium.

FINDINGS

Improved Access to Family Planning Services in the Late 1990s

During the interviews, older women told stories about their or other women’ssecret attempts to induce miscarriage when they were in the village, suchas jumping off from a high place, carrying heavy loads, riding horses, andtaking herbs that were believed to be abortive. Ayse, a 51 year-old participantconfessed, “We used to ride a horse when we were pregnant. It shakes likethis. I used to pray for miscarriage. But it didn’t happen.” She took abortiveherbs when she conceived her sixth child: “I thought it’s enough, becauselife was very hard in village. Women also worked very hard like men.” Sheused injectables 6 years after migration as her neighbors recommended. Sheregretted not using any of the other methods, which she did not know aboutat that time, because she believed that she had been sickly since havingthe injections: “My husband could have asked around about contraceptivesfor me if he was concerned at that time.” The stories suggest that womensought a way to control their reproduction well before they knew aboutfamily planning and biomedical devices of contraception. Unfamiliarity withthe city, lack of literacy, insufficient Turkish, strict social control over womenin an environment of insecurities, and decline of a women’s network aftermigration prevented women from accessing both traditional knowledge andpublic health services in the early days of migration.

At the time of the research, all participants knew most contraceptivemethods available in Turkey, that is, tubal ligation, the pill, IUD, injectables,condoms, the lactational amenorrhea method, and withdrawal. Two thirdsof the participants used at least one biomedical contraceptive method (IUD44.4%, pill 40.7%, condom 30%, injectables 29.6%, tubal ligation 7.4% and

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

978 M. S. Him and A. G. Hosgor

cervical cap 3.7%). The relative prevalence of attempts at contraceptionamong women is owed to the nurses from a health center who used tovisit women in their houses for the promotion of family planning as well asvaccinations for children. Most women said that they learned about contra-ception from visiting nurses or other women who learned about contracep-tion from visiting nurses. Nurses used to visit the neighborhood intensivelyat the end of the 1990s and the beginning of the 2000s when the nationalfamily planning program targeted women in squatter areas and the easternand southeastern regions. The people in the neighborhood were skepticalabout nurses and contraceptives at the beginning since it was probably thefirst time that state workers came to their houses and provided serviceswithout charge. Many people considered the promotion of contraceptives aswell as vaccination as the state’s adverse plan of sterilizing Kurdish women.A decade later, however, women were laughing at those days: “What didthey say? They said we would be infertile. A poor nurse went mad here.She’s a nurse, not an enemy. She also said, ‘I’m not your enemy. I’m herefor your health”’ (Ceylan, 28 years old). They remembered those nurses withappreciation for their sincerity and caring, as the following case shows.

Ceren2 was a 21-year-old young mother of three children. She left schoolin the third grade. She was literate and spoke fluent Turkish. She was froma village in Tatvan, which is 150 km away from Van. She married an unem-ployed man with low vision against her will when she was still 15 years old.Ceren and her husband moved out from her father-in-law’s house soon aftershe had the first child because she did not get along well with her mother-in-law. Before she conceived the second child, she used an IUD, the pill,and an injectable. She was forced to give up using an IUD because of pelvicinfection, the pill because of stomach aches, and an injectable because ofnausea. She learned about contraceptives from a visiting nurse;

There was one nurse who was coming to the neighborhood. She waspassing by in front of my house. I went to her. I asked her, “Are you anurse?” She said, “Yes, I’m a nurse.” I said, “Well, it’s a bit embarrassing,but can I ask you something?” She said, “Of course, please.” I said, “Ihave one child. I don’t want another child. I want another after my childgrows up. I have economic hardship, too.” She said, “I’ll help you.” Sincethen, she came to me all the time. She was so nice. I liked her so much.So, she showed me (how to prevent pregnancy). (But) none (of thecontraceptives) worked for me. Then, she told me to go to a specialistphysician. Well, you go physicians, but they don’t treat you well.

Although Ceren intended to use an IUD after the birth of her secondchild, her neighbors told her not to use it because of her earlier health

2 All interviewees’ names are pseudonyms.

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 979

problems. None of her neighbors agreed to accompany her to a health center.Eventually, the visiting nurse took her to a health center, but she learned thatshe was already pregnant with her third child. She felt desperate. Nurses atthe health center persuaded her to continue the pregnancy and use an IUDafter giving birth to the child. Ceren left her children with her husband, wentto a health center by herself, and had an IUD inserted before the “40 daysafter birth” (the period during which a new mother is recommended not tohave sexual intercourse or to go out but to rest). Ceren was using an IUD for3 years at the time of the interview, yet she was suffering abdominal painsand bloating due to a pelvic infection. A doctor advised her to remove thedevice once, but she refused to do it for fear of another pregnancy.

Ceren was one of many women in the Doluca neighborhood wholearned about contraceptives, developed strategies for accessing the pub-lic sphere, and became accustomed to seeing nurses and doctors with theencouragement and help of visiting nurses during the short period of thereaching-out program. As a matter of fact, many women continued to expe-rience unintended or unwanted pregnancies despite nurses’ support and theuse of contraceptives. One of the most frequent reasons for failed contracep-tion was the inconsistent use of contraceptives. The most prevalent reasonfor giving up contraceptives was side effects. All injectables users abandonedthe method after the first or the second injection because of discomforts suchas amenorrhea, bloating, or backache. Nine out of 12 IUD users removedit after a while because of pelvic infection. Four out of 11 pill users gaveit up because of excessive bleeding or stomachache. Those women werestill seeking the method they could use to prevent pregnancy in a healthfulmanner until the time they wanted to have another child. Nonetheless, theylearned the way to access health services in the process of repeated attemptsto find effective contraception despite multiple disadvantages as a group ofwomen with limited economic, social, and cultural capital. In the next sec-tion, we will show a case of women who still could not benefit from familyplanning services.

Differentiation Among Women After the Reaching Out Program

Nurses no longer visited the neighborhood for a promotion of family plan-ning at the time of the research. Women said, “Nurses do not come to theneighborhood in recent years. Instead, women go to visit them now.” Theyalso said, “Everyone knows about contraceptives in these days.” The remarkmay indicate that special health services for these women are no longernecessary. In reality, however, there were women who still could not accesshealth services and could not benefit from contraceptives.

Among the participants of this research, 13 women never used eithertraditional or modern contraceptive methods. Esra (18 years old) was notusing any contraceptive method because she became pregnant within the

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

980 M. S. Him and A. G. Hosgor

first days of marriage and her husband was imprisoned before she gave birthto the first child. Fatmagul (38 years old) had three miscarriages and had nochildren. She wanted a child desperately. Asya (21 years old) had a 2-year-old daughter. She did not use contraceptives because she misunderstood thedoctor who told her that she could not have more than three children dueto her caesarean section. She believed that she was incapable of the fourthpregnancy. Perihan (21 years old), Yaren (32 years old), Eylem (47 yearsold), and Yıldız (49 years old) considered contraception to be sinful andexpressed their willingness to have as many children as God gave them.

The other six women did not use contraceptives despite their willing-ness to use birth control. These women were slightly but in a significant waydifferent from the other participants. They did not have the means of ac-cessing family planning services that the other neighborhood women used:Turkish fluency; literacy; female relatives, neighbors, or an antinatal protec-tive husband who is actively involved in family planning instead of theirwives. Five of these six women did not know Turkish at all or could speakvery little Turkish. Five women were illiterate. None had formal education.Last, but not least, they all had a very weak and limited women’s network.They generally did not have female relatives whom they could ask to ac-company them to a health center and to look after their small children whilethey went out. All of them lived in a nuclear household. Two women had norelatives at all in the same block. The other women had sisters-in-law andbrothers-in-laws’ wives next door, but they were not on good terms withthem. The husbands were not cooperative about family planning. Some hus-bands wanted as many children as possible despite considerable economicdifficulties. Some were not helpful with their wives in general.

Hava, for instance, was a 32-year-old mother of one daughter and fivesons. She had four stillbirths and one miscarriage. She was heavily pregnantwhen M.S.H. interviewed her. She had had 12 pregnancies in 16 years.M.S.H. saw Hava for the first time when she was taking wool out of duvetsand spreading it in front of her house. M.S.H. was going to see a woman withYasemin, one of the participants, for an interview. On the way back from theinterview, Hava was still working. M.S.H. asked Yasemin who she was. Shewas one of her relatives (the father’s nephew’s wife). Yasemin added thatthey hardly saw each other although her house was just a hundred metersaway from Hava’s house. Nonetheless, Yasemin asked Hava to have aninterview with M.S.H. Hava did not know Turkish at all. M.S.H. interviewedHava through Yasemin’s translation.

Hava migrated to Van with her family in the early 1990s when she wasabout 15 years old because of an intensification of the conflict and economicdifficulties in their village. They returned to the village after a year, and Havamarried a man in another village. Soon after that, her husband’s village wasaffected by the conflict. Hava migrated to Van again with her husband andhis family. Hava and her husband separated from his father’s household soon

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 981

after they had the first child because she could not get along well with hermother-in-law. A few years later, her in-laws returned to the village whileher mother moved from the village to another neighborhood in Van. Havacould not go and see her mother because of the difficulty of traveling withher small children. Hava’s husband had no regular job. He sold some goodson the street from time to time.

Hava heard about contraception from other women when she stayed inVan with her family. She knew about condoms, injectables, IUDs, pills, andtubal ligation. She said that one or two children was enough for her becauseshe could not afford looking after six children as she wanted. It did notmatter to her husband because he did not give birth and was not involved inchildcare. She added, “It’s my sin after all,” since she, as the mother, couldnot take care of children. She never used a contraceptive because she did notknow how to go to a clinic. In fact, she could not go anywhere outside theneighborhood by herself. She was illiterate, did not know Turkish, and hadno friend and relative who was capable of and willing to help her to get acontraceptive. Yasemin tried to explain Hava’s situation: “She doesn’t knowhow to go anywhere. Nobody has got to take her to a clinic. For instance, ifshe uses pills, who’s gonna go and buy a packet every month for her?” Havagave birth to her children at home on her own. Most participants gave birthto their first children at home with the help of female relatives, but generallythey had births in the hospital in later years. Yasemin said, “There was noone (who could take her to a hospital). Nobody came for her.” Yasemin’syounger sister took Hava to a hospital when she gave birth to the youngestchild 3 years ago because “she went to school for 4 years, she knew things,and she was single then.”

Many Doluca women took advantage of limited cultural capital (Turk-ish fluency, literacy, or self-reliance) and cultivated social capital (supportiverelationship with other women or the husband) in time. They managed toaccess family planning services if not necessarily successful contraception.For example, Ceren, who was mentioned in the previous section, lived in themidst of nonrelatives unlike many other participants, but she was fluent inTurkish and had self-confidence in communicating with strangers. She hadthe courage to talk to and rely on a nurse who visited the neighborhood. Shecultivated social skills through difficult but a little different life circumstancesfrom the others, having worked in a sweatshop in Istanbul in childhood,forced marriage, the mother-in-law’s persistent abuse, and a life with the dis-abled but caring husband without familial support. Some women, however,were deprived of most opportunities to learn Turkish, literacy, and othersocial skills required in the public sphere and of empowering social rela-tions as in the case of Hava. Such women remained unable to access familyplanning services. Zehra, one of those who never used a contraceptive, wasfluent in Turkish but she was isolated even in the household. She was not ongood terms with her in-laws. Her husband was the only son. There were no

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

982 M. S. Him and A. G. Hosgor

women, such as the husband’s brothers’ wives, with whom she could ally.Her husband became estranged from her soon after marriage and broughtthe second wife in their house after she had the fourth child. Gulbet was onfairly good terms with her husband and in-laws, but she did not have thecourage to use a contraceptive because her husband wanted many childrenand she was very anxious about the side effects of contraceptives. She knewvery little Turkish. It seems that lack of Turkish language skills made it evendifficult for her to trust and try public health services and a contraceptiveprovided in an unfamiliar Turkish-speaking environment despite lack of herhusband’s support.

DISCUSSION

The case of the Doluca neighborhood indicates that the economizationof family planning policy in a process of HSR had a negative impact onsocioeconomically disadvantaged Kurdish women. The worldwide HSRstransformed the politics of health into a managerial issue. The frameworkof “basic health care for all” was replaced with a cost-effective approachof market mechanism. This regressive (from a feminist perspective) movemarginalized the Cairo agenda because reproductive health and rights areseen as “special interest” programs in terms of the neoliberal manageriallogic of “the greatest good for the greatest number” (Standing, 2002). HSRspromoted the privatization of the health sector and turned it into a commod-ified system (Petchesky, 2003). The commodified health system assumes anindividualistic understanding of the rational consumer who makes choicesfor his or her own good. It appears that privatization increased accessibilityand widened medical options for “the wise consumer–patient” who is wellinformed of health problems, knows what to choose among a range ofmedical options, and can afford the cost of noncovered services. The health“choices” of the disadvantaged women, however, are restricted by poverty,cultural and social disadvantages, and patriarchal constraints. Under thecommodified health system, they are not citizens who are entitled to qualityhealth care without condition but “the incompetent consumer” who cannotmanage their health despite the availability of a range of health services.

Turkey’s HSR seeks both marketization and universalization at the sametime. It is true that the rising number of hospitals and clinics and the nearuniversalization of health insurance coverage (96% in 2010) over the lastdecades considerably increased the accessibility and usage of health ser-vices (Agartan, 2012b). Tuba Agartan (2012a) argues that expansion of cov-erage and improvements in equity are taking place alongside managerial re-forms and privatization in Turkey. She also observes, however, that Turkey’sHSR failed to eliminate health inequality between women by maintainingemployment-based health insurance in the country where 70% of women

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 983

are outside formal labor markets (Agartan, 2012b). To benefit from the ex-panded health services, not only money but also cultural and social capitalsare required. Family planning services are provided without charge in healthcenters and ACSAP centers. Poverty may not affect accessibility, therefore,but cultural and social capitals are important factors for women’s access tothe services especially in cases where service providers are located out ofthe range of their social boundary.

Turkey’s health policy recognizes a problem of regional as well as gen-der inequalities in reproductive health and the importance of women’s repro-ductive rights for more than a decade. As mentioned above, when a conceptof reproductive and sexual health replaced a notion of population controlin Turkey’s family planning policy, raising the number of family planningclinics and promoting women’s accessibility to contraceptives were advisedin the 1997 development program. Family planning policy, however, waseconomically and politically “liberalized” in a process of HSR. The JDP gov-ernment abandoned the active promotion of birth control in the previousdecades on the one hand; it tries to adopt a more diversified program ofreproductive and sexual health, which includes preventive measures againstsexually transmitted diseases and reproductive and sexual health educationfor men and the youth, on the other hand (General Directorate for Mother-Child Health and Family Planning, 2005). This seems to keep pace with theCairo agenda, but it does not necessarily benefit women when the aims ofHSR were prioritized. What seems to have happened in reality was that fam-ily planning services are relatively marginalized in primary health care underthe rhetoric of the paradigmatic shift from population control to reproductivehealth. Accordingly, while women who are economically and socioculturallyadvantaged appear to enjoy expanded insurance coverage and choices inhealth services, our research suggests that the most disadvantaged womenremain unable to access even a health clinic in a community.

As accounted above, Doluca women were additionally disempoweredin the course of migration and consequent social changes. They are deprivedof cultural and social capitals to take advantage of the marketization ofhealth sector and to survive the economization of the health care system. Ascheme for expanding family planning services to the disadvantaged groupsof women was short lived. It was especially so for socioeconomically dis-advantaged Kurdish rural–urban migrant women because the reaching-outprogram was withdrawn when they had just begun to benefit from familyplanning services but before they were empowered enough to use contracep-tives effectively. While the program was delivered in a manner that was in-strumental to the goal of fertility reduction, visiting nurses effectively reachedwomen who had difficulty in going out and accessing family planningservices. It seems to have filled a latent need for birth control among manyDoluca women who had to give birth one after another despite parental con-cerns for providing children with sufficient food, clothing and educational

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

984 M. S. Him and A. G. Hosgor

opportunities. Further continuation of the program might have helpedmany Doluca women practice birth control more effectively, and may havehelped the most disadvantaged women, who had not been able to benefitfrom the program, access contraceptives. In other words, the “liberalization”of the family planning policy had a negative influence on socioeconomicallydisadvantaged Kurdish women.

The women who had never used a contraceptive method were thosewho were deprived of the benefits of state institutions such as formal ed-ucation on the one hand; they were particularly affected negatively by anenvironment of insecurities and consequent social changes, such as alien-ated neighbors, a degeneration of extended household, strict social controlover women’s mobility and sexuality, and a decline of women’s network, onthe other hand. In the disempowering environment for women, apparentlyinsignificant cultural and social capitals like language skills, literacy, and co-operative or supportive relationship with relative–neighbors and the husbandcan be a significant means of empowerment in accessing public services. Tothe contrary, as seen in the case of Hava, not having a relative–neighborto help could mean considerable vulnerability and significant consequences,such as a deprivation of health care access for women. Forming a nuclearhousehold does not necessarily result in the wife’s independent but socialisolation when she is not empowered enough to take advantage of indepen-dence from the authority of senior members of the family.

CONCLUSION

This research confirms the argument that the best attainable reproductivehealth cannot be achieved solely by expanding health services, but is con-tingent upon the social environment in which women live (Jacobson, 2000).It seems that the introduction of a market mechanism into the health sectorfor the sake of efficiency results in marginalizing the Cairo agenda and wouldfail to reduce reproductive health inequalities between women in Turkey.It seems to have left economically, culturally, and socially disadvantagedwomen excluded from basic health services. Marginalizing enabling familyplanning services that help women exercise reproductive rights regardlessof women’s differences would perpetuate reproductive health inequalitiesbetween women in the country.

We argue that especially for women who are deprived of critical culturaland social capitals and live in such a disempowering environment, a publichealth program that is designed for the enhancement of women’s empower-ment is indispensable in the age of marketization of the health sector. Whilerecognizing the difficult double task of expanding health care services to allsegments of society and curbing rising public expenditure in Turkey’s HSR,we advocate two things: reactivation of a reaching-out program that sends

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 985

health workers to the most disadvantaged group and helps them to accesshealth care services; and a transformation of a health center in disadvantagedcommunities into a women-friendly neighborhood clinic that is sensitive tolocal culture and socioeconomic conditions, responds to local needs, andwelcomes reproductive and sexual health consultation. For instance, in theDoluca neighborhood and probably in other Kurdish neighborhoods, theavailability of health services in Kurdish (by employing Kurdish-speakinghealth personnel or an interpreter) can be an important empowering pro-gram for minority women. Socially marginalized women tend to feel intim-idated in the presence of nurses and doctors who speak in formal Turkish,often in an authoritative manner. In many cases, the health center is the firstpublic institution they visit for their own well-being, which is regularly dis-regarded in the family environment where the mother’s sacrificial dedicationto others is taken for granted. If the marketization of health care services re-sponds to the demands of expanding middle-class consumers, it is the state’sresponsibility to respond to the specific needs of the disadvantaged citizen.

REFERENCES

Agartan, T. I. (2012a). Marketization and universalism: Crafting the right balance inthe Turkish healthcare system. Current Sociology, 60, 456–471.

Agartan, T. I. (2012b). Toplusal cinsiyet ve saglık reformu: Politikalar ve etkileri[Gender and health reform: Policies and impacts]. In S. Dedeoglu and A. Y.Elveren (Eds.), Turkiye’de refah devleti ve kadın [Welfare state and women inTurkey] (pp. 251–277). Istanbul, Turkey: Iletisim Yayınları.

Ciceklioglu, M. (2010). Saglık reformlarının kadın saglıgına etkisi [The impact ofhealth reform on women’s health]. In S. Solmaz (Ed.), II. Kadın Hekimlik veKadın Saglıgı Kongresi: Kadını Gormeyen Bilim ve Saglık Politikaları [The 2ndConference of Women Physicians and Women’s Health: Science and HealthPolicies Which do not See Women] (pp. 84–87). Ankara, Turkey: Rulo OfsetMatbaacılık.

Crane, B. C., & Dusenberry, J. (2004). Power and politics in international fundingfor reproductive health: The U.S. global gag rule. Reproductive Health Matters,12(24), 128–137.

Delaney, C. (1991). The seed and the soil: Gender and cosmology in Turkish villagesociety. Berkeley, CA: University of California Press.

Dinc, G. (2007). Fertility preferences, contraceptive behaviors and unmet needs: Agap between urban and suburban parts of a city. European Journal of Contra-ception and Reproductive Health Care, 12(1), 86–94.

Erbaydar, T. (2003). Utilization of prenatal care in poorer and wealthier urbanneighbourhoods in Turkey. European Journal of Public Health, 13, 320–326.

Erman, T. (1997). Squatter (gecekondu) housing versus apartment housing: Turk-ish rural-to-urban migrant residents perspectives. Habitat International, 28(1),91–105.

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

986 M. S. Him and A. G. Hosgor

Eser, E., Dinc, G., Oral, A. M., & Ozcan, C. (2005). Contrasting women and children’shealth and the determinants of health in a small-sized city. Journal of UrbanHealth, 82, 666–681.

Fallers, L. A., & Fallers, M. C. (1976). Sex roles in Edremit. In J. G. Peristiany (Ed.),Mediterranean family structures (pp. 243–260). Cambridge, MA: CambridgeUniversity Press.

Franz, E. (1994). Population policy in Turkey: Family planning and migration be-tween 1960 and 1992. Hamburg, Germany: Deutsches Orient-Institut.

Gelormino, E., Bambra, C., Spadea, T., Bellini, S., & Costa, G. (2011). The effectsof health care reforms on health inequalities: A review and analysis of theEuropean evidence base. International Journal of Health Services, 41, 209–230.

General Directorate for Mother-Child Health and Family Planning. (2005). Cinselsaglık ve ureme saglgı: Saglık sektoru icin ulusal stratejiler ve eylem planı 2005-2015 [Sexual health and reproductive health: National strategic action plan forhealth sector, 2005–2015]. Retrieved from http://sbu.saglik.gov.tr/Ekutuphane/kitaplar/a%C3%A7sap9.pdf

Glaser, B. G., & Strauss A. L. (1967). The discovery of grounded theory: Strategies forqualitative research. New York, NY: Aldine.

Guner, H. (2006). Saglık Bakanı’nın Gundeminde Aile Planlaması Yok! [There isno family planning in the Agenda of Ministry of Health!]. Medimagazin. Re-trieved from http://www.medimagazin.com.tr/authors/haldun-guner/tr-saglik-bakani8217nin-gundeminde-aile-planlamasi-yok-72-9-877.html

Hacettepe University Institute of Population Studies. (2006). Turkiye goc ve yerindenolmus nufus arastırması [Turkey migration and internally displaced populationsurvey]. Ankara, Turkey: Ismat Matbaacılık Yayıncılık.

Icduygu, A., Romano, D., & Sirkeci, I. (1999). The ethnic question in an environ-ment of insecurity: The Kurds in Turkey. Ethnic and Racial Studies, 22, 991–1010.

Isık, O., & Pınarcıoglu, M. M. (2006). Geographies of a silent transition: A geograph-ically weighted regression approach to regional fertility differences in Turkey.European Journal of Population, 22, 399–421.

Jacobson, J. L. (2000). Transforming family planning programmes: Towards a frame-work for advancing the reproductive rights agenda. Reproductive Health Matters,8(15), 21–32.

Kandiyoti, D. (1988). Bargaining with patriarchy. Gender and Society, 2, 274–290.Karahan, A., Yuksel, A., & Erbaydar, T. (2007, October). Aile planlaması saglık

ocaklarının ısi degil mi? [Isn’t family planning a work of public clinics?]. Paperpresented at the 11th National Public Health Conference, Denizli, Turkey.

Keyder, C. (2007). Giris [Introduction]. In C. Keyder, N. Ustundag, T. Agartan, &C. Yoltar (Eds.), Avrupa’da ve Turkiye’de Saglık Politikaları: Reformlar, sorun-lar, tartısmalar [Health policy in Turkey and Europe: Reforms, problems anddiscussions] (pp. 15–35). Istanbul, Turkey: Iletisim Yayınları.

Koc, I., Hancioglu, A., & Cavlin, A. (2008). Demographic differentials and demo-graphic integration of Turkish and Kurdish populations in Turkey. PopulationResearch and Policy Review, 27, 447–457.

Konda Research and Consultancy. (2011). Kurt meselesi’ne algı ve beklentiler [Percep-tion and expectations in the Kurdish issue]. Istanbul, Turkey: Iletisim Yayınları.

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015

An Implication of Health Reform for Kurdish Women 987

National Television-Microsoft Network-National Broadcasting Company. (2008).Basbakan’dan Kadınlara ‘3 Cocuk’ Mesajı [A message of “3 children” fromPrime Minister to women]. Retrieved from http://arsiv.ntvmsnbc.com/news/438418.asp

Ozberk, E. (2003). Nufus politikaları ve kadın bedeni uzerindeki denetim [Populationpolicies and control over women’s body]. (Unpublished master’s thesis.) AnkaraUniversity, Ankara, Turkey.

Petchesky, R. P. (2003). Global prescriptions: Gendering health and human rights.London, England: Zed Books.

Ramazanoglu, C., & Holland, J. (2002). Feminist methodology: Challenge and choices.London. Thousand Oaks, CA: Sage.

Sev’er, A., & Yurdakul, G. (2001). Culture of honor, culture of change: A feministanalysis of honour killings in rural Turkey. Violence Against Women, 7, 964–998.

Sirkeci, I. (2005). Exploring the Kurdish population in the Turkish context. GENUS,International Journal of Demography, 56(1–2), 149–175.

Sirman, N. (1995). Friends and foe? Forging alliance with other women in a village ofWestern Turkey. In S. Tekeli (Ed.), Women in modern Turkish society: A reader(pp. 199–218). Atlantic Heights, NJ: Zed Books.

Standing, H. (2002). An overview of changing agendas in health sector reforms.Reproductive Health Matters, 10(20), 19–28.

State Institute of Statistics. (2002). The 2000 Census of Population: Social and eco-nomic characteristics of population–Province Van. Ankara, Turkey: SIS Press.

Whitehead, M., Dahlgren, G., & Evans, T. (2001). Equity and health sector re-forms: Can low-income countries escape the medical poverty trap? Lancet, 358,833–836.

Yavuz, S. (2006). Completing the fertility transition: Third birth developments bylanguage groups in Turkey. Demographic Research, 15(15), 435–460.

Yucesahin, M. M., & Ozgur, E. M. (2008). Regional fertility differences in Turkey: Per-sistent high fertility in the Southeast. Population, Space and Place, 14, 135–158.

Dow

nloa

ded

by [

Ond

okuz

May

is U

nive

rsite

sine

] at

00:

25 0

3 Se

ptem

ber

2015