Turkey - Demographic and Health Survey - 2004

Publication date: 2004

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: hips@hacettepe.edu.tr; 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: reports@macroint.com; 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 i 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 ii 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 Table of Contents iii 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 8.4 Planning Status of Births .104 CHAPTER 9 INFANT AND CHILD MORTALITY 9.1 Assessment of Data Quality .107 9.2 Levels and Trends in Infant and Child Mortality .109 9.3 Differentials in Infant and Child Mortality .110 9.4 Perinatal Mortality.113 9.5 High-risk Fertility Behaviour .114 CHAPTER 10 ANTENATAL CARE AND DELIVERY ASSISTANCE 10.1 Antenatal Care .117 10.2 Number and Timing of Antenatal Care Visits.120 10.3 Components of Antenatal Care .121 10.4 Place of Delivery and Assistance During Delivery.123 10.5 Characteristics of Delivery .127 CHAPTER 11 VACCINATION AND CHILD HEALTH 11.1 Vaccination of Children .131 11.2 Prevalence and Treatment of Acute Respiratory Infection and Fever.135 11.3 Smoking Status of Mothers .137 CHAPTER 12 INFANT FEEDING PRACTICES AND CHILDREN’S AND WOMEN’S NUTRITIONAL STATUS 12.1 Initiation of Breastfeeding.139 12.2 Breastfeeding Status by the Age of Child .141 12.3 Duration and Frequency of Breastfeeding.143 12.4 Types of Complementary Food .144 12.5 Iodization of Household Salt .146 12.6 Nutritional Status of Children .147 12.7 Nutritional Status of Mother.151 CHAPTER 13 KNOWLEDGE OF HIV/AIDS 13.1 Knowledge of AIDS and Other STDs .155 13.2 Sources of Information about AIDS.157 Table of Contents iv 13.3 Knowledge of Ways to Prevent AIDS.158 13.4 Perception of Risk of AIDS.161 REFERENCES.163 APPENDIX A LIST OF PERSONNEL .165 APPENDIX B SURVEY DESIGN.167 B.1 Sample Design and Implementation.167 B.2 Sample Frame.168 B.3 Stratification .168 B.4 Sample Allocation .171 B.5 Sample Selection .172 B.6 Questionnaire Development and Pretest .174 B.7 Data Collection Activities .176 B.8 Data Processing and Analysis .177 B.9 Calculation of Sample Weights .178 B.10 Coverage of the Sample.183 APPENDIX C SAMPLING ERRORS .187 APPENDIX D QUALITY OF THE DATA .211 APPENDIX E QUESTIONNAIRES.219 List of Tables and Figures | v LIST OF TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews.15 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence.18 Table 2.2 Population by age from selected sources .19 Table 2.3 Household composition.20 Table 2.4 Children's living arrangements and orphanhood.21 Table 2.5.1 Educational attainment of household population: males.23 Table 2.5.2 Educational attainment of household population: females .24 Table 2.6 School attendance ratios.26 Table 2.7.1 Grade repetition rates .28 Table 2.7.2 Grade dropout rates .29 Table 2.8 Household characteristics.30 Table 2.9 Household durable goods .32 Figure 2.1 Population Pyramid .18 Figure 2.2 Age-specific Attendance Rates .25 CHAPTER 3 WOMEN’S CHARACTERISTICS AND STATUS Table 3.1 Background characteristics of respondents .34 Table 3.2 Educational attainment by background characteristics .35 Table 3.3 Employment status .37 Table 3.4 Decision on use of earnings and contribution of earnings to household expenditures .39 Table 3.5 Women's control over earnings .40 Table 3.6 Women’s attitude toward wife beating .41 Table 3.7 Child care while working .43 CHAPTER 4 FERTILITY Table 4.1 Current fertility.46 Table 4.2 Fertility by background characteristics .48 Table 4.3 Trends in fertility.49 Table 4.4 Age-specific fertility rates .50 Table 4.5 Fertility by marital duration .51 vi | List of Tables and Figures Table 4.6 Children ever born and living.52 Table 4.7 Birth intervals .54 Table 4.8 Age at first birth .55 Table 4.9 Median age at first birth by background characteristics.56 Table 4.10 Teenage pregnancy and motherhood.58 Figure 4.1 Age-specific Fertility Rates by Urban-Rural Residence .47 Figure 4.2 Trends in Fertility.50 Figure 4.3 Age-specific Fertility Rates during the Last 20 Years .51 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .60 Table 5.2 Knowledge of contraceptive methods by background characteristics .61 Table 5.3 Ever use of contraception.62 Table 5.4 Current use of contraception .63 Table 5.5 Current use of contraception by background characteristics .64 Table 5.6 Trends in current use of contraception.66 Table 5.7 Trends in current use of contraception by residence and region.67 Table 5.8 Number of children at first use of contraception.68 Table 5.9 Knowledge of the fertile period .69 Table 5.10 Timing of sterilization.69 Table 5.11 Source of supply for modern contraceptive methods.70 Table 5.12 Trends in source of supply for selected modern methods .72 Table 5.13 Informed choice.73 Table 5.14 Contraceptive discontinuation rates .74 Table 5.15 Reasons for discontinuation of contraception .75 Table 5.16 Future use of contraception .76 Table 5.17 Preferred method of contraception for future use .76 Table 5.18 Reasons for not using contraception .77 Figure 5.1 Current Use of Family Planning by Region and Method.65 Figure 5.2 Current Use of Family Planning Methods, Turkey 1993, 1998, and 2003 .66 Figure 5.3 Source of Modern Contraceptive Methods .71 CHAPTER 6 ABORTIONS AND STILLBIRTHS Table 6.1 Number of abortions and stillbirths.80 Table 6.2 Induced abortions by background characteristics .81 Table 6.3 Abortions and stillbirths per 100 pregnancies.82 Table 6.4 Trends in induced abortions .82 Table 6.5 Method used before abortion.83 Table 6.6 Method used after abortion .83 Table 6.7 Reasons for induced abortion.85 Table 6.8 Timing of induced abortion.86 Table 6.9 Abortion provider .87 List of Tables and Figures | vii Table 6.10 Total abortion rates.87 Table 6.11 Total abortion rates by background characteristics.88 CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 7.1 Current marital status .90 Table 7.2 Age at first marriage.91 Table 7.3 Median age at first marriage.92 Table 7.4 Postpartum amenorrhea, abstinence, and insusceptibility.94 Table 7.5 Median duration of postpartum insusceptibility by background characteristics.96 Figure 7.1 Marital Status of Women Age 15-49 .90 Figure 7.2 Median Age at First Marriage among Women Age 25-49.93 Figure 7.3 Percentage of Births Whose Mothers are Amenorrheic, Abstaining, or Insusceptible.95 CHAPTER 8 FERTILITY PREFERENCES Table 8.1 Fertility preference by number of living children .98 Table 8.2 Fertility preference by age.99 Table 8.3 Desire to limit (stop) childbearing .100 Table 8.4 Need for family planning services .102 Table 8.5 Ideal and actual number of children.103 Table 8.6 Mean ideal number of children by background characteristics.104 Table 8.7 Fertility planning status.105 Table 8.8 Wanted fertility rates .106 Figure 8.1 Fertility Preferences of Currently Married Women Age 15-49 .99 CHAPTER 9 INFANT AND CHILD MORTALITY Table 9.1 Infant and child mortality .109 Table 9.2 Early childhood mortality rates by socioeconomic characteristics .111 Table 9.3 Early childhood mortality rates by biodemographic characteristics .112 Table 9.4 Perinatal mortality .113 Table 9.5 High-risk fertility behavior.115 Figure 9.1 Trends in Infant Mortality: Estimates for 5-Year Periods Preceding the TDHS-1993, TDHS-1998, and TDHS-2003.110 CHAPTER 10 ANTENATAL CARE AND DELIVERY ASSISTANCE Table 10.1 Antenatal care.118 Table 10.2 Number of antenatal care visits and timing of first visit .121 Table 10.3 Components of antenatal care .122 Table 10.4 Place of delivery.124 viii | List of Tables and Figures Table 10.5 Assistance during delivery .127 Table 10.6 Delivery characteristics .129 Figure 10.1 Antenatal Care by Maternal Age and Birth Order .119 Figure 10.2 Antenatal Care by Residence and Region .120 Figure 10.3 Place of delivery by Maternal Age and Birth Order .125 CHAPTER 11 VACCINATION AND CHILD HEALTH Table 11.1 Vaccinations by source of information .132 Table 11.2 Vaccinations by background characteristics .133 Table 11.3 Vaccinations in first year of life by current age .134 Table 11.4 Prevalence and treatment of symptoms of ARI and fever .136 Table 11.5 Use of smoking cigarettes .138 CHAPTER 12 INFANT FEEDING PRACTICES AND CHILDREN’S AND WOMEN’S NUTRITIONAL STATUS Table 12.1 Initial breastfeeding.140 Table 12.2 Breastfeeding status by age .142 Table 12.3 Median duration and frequency of breastfeeding.144 Table 12.4 Types of food received by children in the preceding 24 hours .145 Table 12.5 Iodization of household salt .146 Table 12.6 Nutritional status of children by background characteristics .149 Table 12.7 Anthropometric indicators of maternal nutritional status .151 Table 12.8 Nutritional status of women by background characteristics .153 Figure 12.1 Nutritional Status of Children by Age.150 CHAPTER 13 KNOWLEDGE OF AIDS Table 13.1 Knowledge of AIDS and other STDs.156 Table 13.2 Source of AIDS information .158 Table 13.3 Knowledge of ways to avoid HIV/AIDS .159 Table 13.4 Ways to avoid AIDS by background characteristics.160 Table 13.5 Knowledge of HIV/AIDS-related issues.162 APPENDIX B SURVEY DESIGN Table B.1 List of strata by region, NUTS 1 region, residence, type and province .169 Table B.2 Allocation of sample households .171 Table B.3 Distribution of sample clusters.172 Table B.4 Stages of fieldwork, completed number of clusters in each stage, and number of teams in each stages.177 Table B.5.1 Design weights and nonresponse factors .180 List of Tables and Figures | ix Table B.5.2 Design weights and nonresponse factors: half sample.181 Table B.6 Final sample weights .182 Table B.7.1 Sample implementation according to residence and region.184 Table B.7.2 Sample implementation according to NUTS 1 regions.185 APPENDIX C SAMPLING ERROS Table C.1 List of selected variables for sampling errors .190 Table C.2 Sampling errors: National Sample .191 Table C.3 Sampling errors: Urban Areas.192 Table C.4 Sampling errors: Rural Areas .193 Table C.5 Sampling errors: West Region .194 Table C.6 Sampling errors: South Region .195 Table C.7 Sampling errors: Central Region.196 Table C.8 Sampling errors: North Region .197 Table C.9 Sampling errors: East Region.198 Table C.10 Sampling errors: İstanbul .199 Table C.11 Sampling errors: West Marmara Region.200 Table C.12 Sampling errors: Aegean Region .201 Table C.13 Sampling errors: East Marmara Region .202 Table C.14 Sampling errors: West Anatolia Region.203 Table C.15 Sampling errors: Mediterranean Region .204 Table C.16 Sampling errors: Central Anatolia Region .205 Table C.17 Sampling errors: West Black Sea Region .206 Table C.18 Sampling errors: East Black Sea Region.207 Table C.19 Sampling errors: Northeast Anatolia Region .208 Table C.20 Sampling errors: Central East Anatolia Region .209 Table C.21 Sampling errors: Southeast Anatolia Region .210 APPENDIX D QUALITY OF THE DATA Table D.1 Age distribution of de facto household population .213 Table D.2 Age distribution of eligible and interviewed women .214 Table D.3 Completeness of reporting .214 Table D.4 Births by calendar years .215 Table D.5 Reporting of age at death in days .216 Table D.6 Reporting of age at death in months.217 Foreword | xi FOREWORD Hacettepe University Institute of Population Studies was established in 1967 and is the principal institution carrying out nationwide scientific studies on fertility, mortality, migration and maternal and child health issues in Turkey. Through a series of national household surveys conducted every five years, our Institute has collected highly reliable data nationwide on population characteristics and maternal and child health since 1968. These data have allowed the demographic situation in Turkey to be assessed regularly for about a four-decade period. They have been the basis on which population and health policies have been formed, service plans prepared, and the coverage and impact of these plans monitored. The 2003 Turkey Demographic and Health Survey (TDHS-2003) is the eighth national survey carried out by the Institute of Population Studies. It is a honor for our Institute to win the general approval and confidence of all people and institutions at national and international level with such a program of continuous high quality data production and successful application. The seven Demographic and Health Surveys between 1968-1998 were financially supported by various international sources. However, for the first time, the TDHS-2003 was financed by the national budget of Republic of Turkey, and further support was provided by the European Union through the reproductive health programme. This is an indicator of institutionalization and the importance of this issue in our country. Preparatory activities of the TDHS-2003 began in 2002. In the same year, a qualitative research study was conducted involving in-depth interviews with women on contraceptive use, its dynamics and induced abortion. The results of this research were presented in a meeting in April 2003, in which representatives of various organizations interested in these data participated. In the months that followed, activities relating to sampling and questionnaire design continued. Following the completion of the preparatory activities, listing and fieldwork took place between November 2003 and May 2004. The TDHS-2003 was conducted in 80 provinces and 700 places of residence which were selected in such fashion as to represent our country nationally and at the urban-rural and regional levels. Interviews were carried out with 8,075 ever-married women in 10,836 households. In June 2004, the preliminary report that included some key indicators calculated from the TDHS-2003 was published and disseminated to organizations concerned with population and maternal and child health issues. The results presented in this report show that there have been important changes in various demographic and health indicators in a more positive direction than expected. The fertility data indicate that Turkey is achieving “replacement” fertility. The survey findings also document improvements in infant and child mortality and progress in mother and child health services. xii | Foreword The contributions of university directors, the directors and experts of the public institutions and personnel of our Institute were instrumental in the realization of various stages of the TDHS-2003. I would like to express my gratitude to them for their much appreciated efforts. First of all, I would like to thank to Kemal Madenoğlu, the General Director of the State Planning Organization, and his staff who provided the financial source for the TDHS- 2003 through the national budget by putting the survey in the investment program of 2002 for the first time and who continued their supports unstintingly through the survey. I would like to express my gratitude to the Delegation of the European Union to Turkey and to Simon Mordue, the director of Financial Cooperation, Coordination and Investment, for additional financial source they provided when the financial resource from the national budget was not sufficient for the extended objectives and coverage of the survey. I would like to thank also Figen Tunçkanat for her efforts in designing and executing the project. The Ministry of Health provided extensive support the TDHS-2003 in every stage as in the previous Demographic and Health Surveys conducted by our Institute. I deeply appreciate first Prof. Dr. Recep Akdağ, the Minister of Health, and especially Dr. Mehmet Rifat Köse, General Director of the Mother and Child Health and Family Planning and his deputy Dr. M. Ali Biliker for their productive, supportive, analytical and enriching contributions. Moreover, I would like to also acknowledge the efforts of other directors and personnel in the General Directorate as well as the health directors and other health personnel in the provinces where the survey was carried out. I would like to thank Assoc. Prof. Dr. Ömer Demir, the President of the State Institute of Statistics, and Hasibe Dedeş, the director of the Survey, Analysis and Statistics Division, and other staff for their efforts and contributions in selecting the sample with scientific sensitivity. I am grateful to Ministry of Interior that provided the necessary permissions for field survey as well as province governors who supported the implementation of the survey and other province directors for their contributions. My special thanks go to Prof. Dr. Tunçalp Özgen, the Rector of Hacettepe University and authorities in the Scientific Research Unit of the University as they shared all the difficulties with us and gave valuable support in every stage of the TDHS-2003. My thanks are also due to the Steering Committee Members for their valuable contributions. I deeply appreciate all respondents who accepted to be involved in the survey and answered the questionnaires and all the team staff worked in the field, without them we were unable to conduct this survey. I would like to thank Han Raggers who ensured the data file which is a part of a structure that guarantees the TDHS-2003 be in the context of International Demographic and Foreword | xiii Health Surveys, and to Dr. Ann A. Way, the deputy director of the MEASURE DHS Program at ORC Macro and her colleagues for their important efforts in finalization of this report. We also appreciate USAID’s willingness to support the MEASURE team’s involvement in the report preparation. Finally, I extend my deepest gratitude to the technical director of the TDHS-2003 Assoc. Prof. Dr. Banu Ergöçmen, the field director Assoc. Prof. Dr. İsmet Koç, and Assoc. Prof. Dr. Attila Hancıoğlu, Assoc. Prof. Dr. Turgay Ünalan and Dr. A. Sinan Türkyılmaz who are responsible for sampling, questionnaire design, data entry and data analysis, as well as research assistants and administrative staff for their efforts. Moreover, I present my appreciation and respect to all our family members for their support and indulgence during the laborious times in and out of work days. Prof. Dr. Sabahat Tezcan Director Institute of Population Studies Hacettepe University Summary of Findings | xv SUMMARY OF FINDINGS The 2003 Turkey Demographic and Health Survey (TDHS-2003) is a nationally repre- sentative sample survey designed to provide information on levels and trends on fertility, infant and child mortality, family planning and maternal and child health. Survey re- sults are presented at the national level, by urban and rural residence, and for each of the five regions in the country. The TDHS- 2003 sample also allows analyses for some of the survey topics for the 12 geographical regions (NUTS1) which were adopted at the second half of 2002 within the context of Turkey’s move to join the European Union. Funding for the TDHS-2003 was provided initially by the Government of Turkey, as a project in the annual investment program of the State Planning Organization, and further funding was obtained from the European Union through the Turkey Reproductive Health Program implemented by the Minis- try of Health. Hacettepe University Institute of Population Studies (HUIPS) carried out the TDHS-2003 in collaboration with the General Directorate of Mother and Child Health and Family Planning, Ministry of Health. TDHS-2003 is the most recent in the series of demographic surveys carried out in Turkey by HUIPS and it is the third survey conducted as part of the worldwide Demographic and Health Sur- veys program. The survey was fielded between December 2003 and May 2004. Interviews were com- pleted with 10,836 households and with 8,075 ever-married women at reproductive ages (15-49). Ever-married women at ages 15-49 who were present in the household on the night before the interview or who usu- ally live in that household were eligible for the survey. CHARACTERISTICS OF HOUSEHOLD POPULATION Turkey has a young population structure; 29 percent of the population is under age 15. The population age 65 and over accounts for 7 percent of the total population in Turkey. The mean household size in Turkey is 4 per- sons, varying from an average of 3.9 persons in the urban areas to 4.5 persons in rural ar- eas. The majority of the population in Turkey has attended school. Among the population with schooling, about one-third of both males and females have completed at least second level primary school. The proportion of population with at least high school edu- cation is 23 percent for males and 14 per- cent for females. However, the indicators for successive cohorts show a substantial in- crease over time in the educational attain- ment of both men and women. CHARACTERISTICS OF RESPONDENTS A third of women interviewed in the TDHS- 2003 were less than 30 years of age; ninety- five percent were married at the time of interview. A significant proportion of women (17 percent) had completed at least high school. Survey results show considerable improvement in the educational levels of women in reproductive ages. While 42 percent of women had been in employment during the 12 month period xvi | Summary of Findings preceding the survey, women’s earnings meet almost none or less than half of the expenditures of households for 6 in 10 cases. Independent decision making with regard to the use of earnings show variation according to age, place of residence and level of education of women. FERTILITY BEHAVIOR Levels and Trends The findings of the TDHS-2003 indicate that if a woman was to maintain the current fer- tility rates throughout her reproductive years, she would be expected to have 2.2 children on the average by the end of her reproductive years. Women in Turkey ex- perience their prime reproductive years during their twenties with age-specific fertility peaking in the 20-29 age group. Fertility has fallen sharply in Turkey over the past several decades. Socioeconomic and Demographic Differentials The urban-rural gap in fertility levels appears to be closing. However, some re- gional differences remain. Except for South and East Anatolia, fertility is below replace- ment level. Despite a pronounced decline in fertility in recent decades, period fertility in the East is still well above three children. Fertility decreases rapidly with increasing educational level. Women with no education have on average two more children than that of women who have high school and more education. Another important trend is the steady rise in the age at first birth among women in Turkey. Younger women are much less likely than older women to have given birth to their first child while they were in their teens. Age at Marriage In Turkey, marriage is very important from a demographic perspective, because, besides being prevalent throughout the country, almost all births occur within marriage. Therefore, age at first marriage is a significant demographic indicator since it represents the onset of a woman’s exposure to the risk of pregnancy. The TDHS-2003 results document an in- crease in the median age at first marriage across age cohorts, from 19.2 years for the 45-49 age group to 21 years for the 25-29 age group. The results also show pro- nounced differences in the age at first mar- riage by educational level of women. Among women age 25-49 there is a differ- ence of almost seven years in the timing of entry into marriage between those with no education and those who has at least high school education. FAMILY PLANNING USE Family Planning Knowledge Knowledge of family planning methods is almost universal among women in Turkey. Almost all women interviewed in the survey had heard of at least one modern method. The IUD and pill are the most widely known modern contraceptive methods among women followed by the male condom, fe- male sterilization and injectables. Levels and Trends Ninety percent of both ever-married and cur- rently married women have used a family planning method at some time in their life. Overall, 71 percent of currently married women are using contraception, with 43 per- cent depending on modern methods and 29 percent using traditional methods. The IUD is the most widely used modern method (20 percent) followed by male condom (11 per- cent). Withdrawal continues to be the most widely used traditional method. Twenty six percent of currently married women report current use of withdrawal. Summary of Findings | xvii Differentials in Use The use of contraceptive methods varies by age. Current use of any method is the high- est among currently married women (81 percent) in the 30-34 age group. The use of withdrawal peaks among women in the 40- 44 age group (50 percent) while the highest level of IUD use (26 percent) is found among women age 30-34. Current use of contraceptive methods also varies according to urban rural residence, region, level of education, and number of living children. Discontinuation of Use Discontinuation of contraceptive use can highlight program areas that require im- provement as well as groups of users who have particular concerns that need to be ad- dressed. The TDHS-2003 results indicate that 40 percent of contraceptive users in Turkey stop using a contraceptive method within 12 months of starting use. The IUD, which is not generally intended as a short- term method, has the lowest discontinuation rate (11 percent). Coitus-related methods are more easily discontinued. For example, 45 percent of condom users discontinue within one year of use. Regarding future use, almost half of currently married non-users intend to use family planning at some time in the future. Provision of Services The public sector is the major source of con- traceptive methods in Turkey. Fifty-eight percent of current users obtain their contra- ceptives from the public sector. In the public sector one-third of the users obtain modern contraceptive methods from health centers or MCH/FP centers. Pharmacies are the second most commonly used source, pro- viding contraceptive methods to one-fourth of all users of modern methods. INDUCED ABORTION Overall, 22 percent of pregnancies during the five-year period before the survey termi- nated in other than a live birth. Induced and spontaneous abortions comprised the great- est share among non-live terminations, with relatively few women having had a stillbirth. There were 21 abortions per 100 pregnan- cies, of which 11 were induced. The total abortion rate (TAR) per woman is 0.4 for the five years preceding the TDHS-2003. The age-specific rates increase to a peak among women age 30-34, and decline among older women. Women living in the East region and in rural settlements are the least likely to have ever had an induced abortion. The main reason for obtaining an abortion is to stop childbearing (41 percent). Overall, a substantial proportion of abortions (73 per- cent) took place in the first month of preg- nancy. Private sector providers are preferred for having had an abortion (77 percent). The need for family planning counselling after an abortion is highlighted by the finding that, in the month following an induced abortion, 31 percent of women did not use any method and 26 percent used withdrawal. NEED FOR FAMILY PLANNING Fertility Preferences Sixty-nine percent of currently married women say they do not want to have more births in the future or are already sterilized for contraceptive purposes. An additional 14 percent of the women want to wait at least two years for another birth. Thus, four out of every five currently married women can be regarded as in need of using family planning services either to avoid or to postpone child- bearing. Among the currently married women, the mean ideal number of children is 2.5 for women indicating that most women want small families. Results from xviii | Summary of Findings the survey suggest that, if all unwanted births were prevented, the total fertility rate at the national level would be 1.6 children per woman, or 0.7 children less than the ac- tual total fertility rate. Unmet Need for Family Planning The total demand for family planning is 76 percent, and 92 percent of this demand is satisfied. The demand for limiting purposes is three times as high as the demand for spacing purposes (58 and 18 percent, re- spectively). The total unmet need among currently married women is 6 percent, lower than that recorded in the previous two surveys. CHILD MORTALITY Levels and Trends For the five years preceding the TDHS- 2003, the infant mortality rate is estimated at 29 per thousand, the child mortality rate at 9 per thousand, and the under five mortality rate at 37 per thousand. For the same period, results show that the neonatal mortality rate is higher than the postneonatal mortality rate. All the indicators of infant and child mortality have declined rapidly in recent years. Socioeconomic and Demographic Differ- entials The TDHS-2003 findings point out to significant differences in infant and child mortality between regions and by urban- rural residence. They also show that the educational level of mother is an important correlate of infant and child mortality. In addition to the differentials observed between socio-economic groups, infant and child mortality rates also correlate strongly with the young age of the mother at birth, high-birth order and short birth intervals, with children in these categories facing an elevated risk of dying compared to children in other subgroups. In addition, low weight at birth affects children’s chances of survival. MATERNAL HEALTH Care during Pregnancy Eighty-one percent of mothers received an- tenatal care during the pregnancy preceding their most recent birth in the five years pre- ceding the survey, with 75 percent receiving care from a doctor. Overall, 71 percent of women made an antenatal care visit before the sixth month of pregnancy, and more than half of the woman made more than four vis- its. Younger, low parity women, women living in urban areas and in the regions other than the East, and women with at least first primary level education are more likely to have received antenatal care compared to other women. Delivery Care and Postnatal Care In Turkey, 78 percent of all births in the five years preceding the survey were delivered at a health facility. Public sector health facili- ties were used to a much greater extent for delivery (65 percent) than private facilities. The proportion of all births delivered with the assistance of a doctor or trained health personnel is 83 percent. CHILD HEALTH Childhood Vaccination Coverage Universal immunization of children under one year of age against the six vaccine-pre- ventable diseases (tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and mea- sles) is one of the most cost-effective pro- grams in reducing infant and child morbidity and mortality. Among children age 12-23 months, 54 percent of them had received all of the recommended eight vaccines. The percentage of children who were fully vac- cinated by 12 months of age was 48 percent. Summary of Findings | xix The percentage of children who are fully vaccinated is lowest in the rural areas and in the Eastern region. The vaccination cover- age percentages are also related to mother’s education and the children’s sex and birth order. Prevalence and Treatment of ARI Acute respiratory infection (ARI) is the most prevalent disease in Turkey among children under age five during winter months. In the two weeks preceding the survey, 29 percent of children had experienced ARI, and 40 percent had fever. Four in every ten children received some kind of treatment from a health facility or a health provider for these illnesses. Among all ever-married women age 15-49, 28 percent reported that they smoke regu- larly or rarely. According to maternity status, 15 percent of pregnant women and 20 percent of breastfeeding women report that they smoke. Smoking more than 10 ciga- rettes is most common among women age 35-49. NUTRITION INDICATORS FOR CHILDREN AND WOMEN Breastfeeding and supplemental feeding Breastfeeding is almost universal in Turkey; 97 percent of all children are breastfed for some period of time. Complementary feeding is common among very young children. In the first two months of life, only 44 percent are exclusively breastfed. The median dura- tion of breastfeeding for all children is 14 months. Among children who are breast- feeding and younger than six months, 18 per- cent received infant formula. Iodization of Salt Iodine deficiency contributes to higher rates of childhood morbidity and mortality. Ac- cording to tests conducted during the survey, the table salt in 30 percent of the households did include neither iodide nor iodate. Iodized salt is not used in about half of rural house- holds. Less than half of the households in Central and Southeast Anatolia use iodized salt. Nutritional Status of Children By age five, 12 percent of children are stunted (short for their age), compared to an international reference population. Stunting is more prevalent in rural areas, in the East, among children of mothers with little or no education, among children who are of higher birth order, and among those born less than 24 months after a prior birth. Wasting is a less serious problem. Four percent of children are underweight for their age. Obesity is a problem among mothers. Ac- cording to BMI calculations, 57 percent of mothers are overweight, of which 23 percent are obese. BMI increases rapidly with age, exceeding 25.0 for the majority of women age 25 and older. HIV/AIDS KNOWLEDGE AND ATTITUDES Awareness of acquired immune deficiency syndrome (AIDS) is high in Turkey. Ninety percent of women reported having heard of AIDS. Despite this widespread awareness, 31 percent of ever-married women do not know any way to avoid AIDS. Educational level is positively related to knowing about ways of avoiding AIDS. The percentage who knows HIV/AIDS is higher among ur- ban ever-married women than among their counterparts living in rural area. R EG IO N S A N D P R O VI N C ES 01 İS TA N B U L 04 E A ST 06 M ED IT ER R A N EA N 08 W ES T 10 N O R TH EA ST 12 S O U TH EA ST 34 İs ta nb ul M A R M A R A 01 A da na B LA C K S EA A N A TO LI A A N A TO LI A 02 W ES T 11 B ile ci k 07 A nt al ya 05 A m as ya 04 A ğr ı 02 A dı ya m an M A R M A R A 14 B ol u 15 B ur du r 18 Ç an kı rı 24 E rz in ca n 21 D iy ar ba kı r 10 B al ık es ir 16 B ur sa 31 H at ay 19 Ç or um 25 E rz ur um 27 G az ia nt ep 17 Ç an ak ka le 26 E sk iş eh ir 32 Is pa rta 37 K as ta m on u 36 K ar s 47 M ar di n 22 E di rn e 41 K oc ae li 33 İç el 55 S am su n 69 B ay bu rt 56 S iir t 39 K ırk la re li 54 S ak ar ya 46 K .M ar aş 57 S in op 75 A rd ah an 63 Ş an lıu rfa 59 T ek ird ağ 77 Y al ov a 80 O sm an iy e 60 T ok at 76 Iğ dı r 72 B at m an 03 A EG EA N 81 D üz ce 07 C EN TR A L 67 Z on gu ld ak 11 C EN TR A L EA ST 73 Ş ırn ak 03 A fy on 05 W ES T A N A TO LI A 74 B ar tın A N A TO LI A 79 K ili s 09 A yd ın A N A TO LI A 38 K ay se ri 78 K ar ab ük 12 B in gö l 20 D en iz li 06 A nk ar a 40 K ırş eh ir 09 E A ST 13 B itl is 35 İz m ir 42 K on ya 50 N ev şe hi r B LA C K S EA 23 E la zı ğ 43 K üt ah ya 70 K ar am an 51 N iğ de 08 A rtv in 30 H ak ka ri 45 M an is a 58 S iv as 28 G ire su n 44 M al at ya 48 M uğ la 66 Y oz ga t 29 G üm üş ha ne 49 M uş 64 U şa k 68 A ks ar ay 52 O rd u 62 T un ce li 71 K ırı kk al e 53 R iz e 65 V an 61 T ra bz on R EG IO N S A N D P R O VI N C ES 01 W ES T 02 S O U TH 03 C EN TR A L 04 N O R TH 05 E A ST 09 A yd ın 01 A da na 03 A fy on 60 T ok at 08 A rtv in 02 A dı ya m an 62 T un ce li 10 B al ık es ir 07 A nt al ya 05 A m as ya 64 U şa k 28 G ire su n 04 A ğr ı 63 Ş an lıu rfa 16 B ur sa 15 B ur du r 06 A nk ar a 66 Y oz ga t 29 G üm üş ha ne 12 B in gö l 65 V an 17 Ç an ak ka le 31 H at ay 11 B ile ci k 68 A ks ar ay 37 K as ta m on u 13 B itl is 69 B ay bu rt 20 D en iz li 32 Is pa rta 14 B ol u 70 K ar am an 52 O rd u 21 D iy ar ba kı r 72 B at m an 22 E di rn e 33 İç el 18 Ç an kı rı 71 K ırı kk al e 53 R iz e 23 E la zı ğ 73 Ş ırn ak 34 İs ta nb ul 46 K .M ar aş 19 Ç or um 81 D üz ce 55 S am su n 24 E rz in ca n 75 A rd ah an 35 İz m ir 80 O sm an iy e 26 E sk iş eh ir 57 S in op 25 E rz ur um 76 Iğ dı r 39 K ırk la re li 38 K ay se ri 61 T ra bz on 27 G az ia nt ep 79 K ili s 41 K oc ae li 40 K ırş eh ir 67 Z on gu ld ak 30 H ak ka ri 45 M an is a 42 K on ya 74 B ar tın 36 K ar s 48 M uğ la 43 K üt ah ya 78 K ar ab ük 44 M al at ya 54 S ak ar ya 50 N ev şe hi r 47 M ar di n 59 T ek ird ağ 51 N iğ de 49 M uş 77 Y al ov a 58 S iv as 56 S iir t Introduction | 1 INTRODUCTION 1 Sabahat Tezcan 1.1 Geography Turkey occupies a surface area of 774,815 square kilometers. About three percent of the total area lies in Southeastern Europe (Thrace) and the remainder in Southwestern Asia (Anatolia or Asia Minor). Turkey has borders with Greece, Bulgaria in the Thrace and Syria, Iraq, Iran, Georgia, Armenia, and Nahcivan (Azerbaijan) in the south and east Anatolia that is also called Asia Minor. The shape of the country resembles a rectangle, stretching in the east- west direction for approximately 1,565 kilometers and in the north-south direction for nearly 650 kilometers. The three sides of Turkey are surrounded by seas: in the north, the Black Sea; in the northwest, the Sea of Marmara; in the west, the Aegean Sea; and in the south, the Mediterranean Sea. The total coastline of Turkey is around 8,333 kilometers. The Anatolian peninsula lies on an elevated steppe-like and semi-arid central plateau surrounded by mountains on all sides, except the west. The Taurus Mountains in the south and the Northern Anatolia Mountains in the north stretch parallel to the coastline, meeting in the eastern part of the country. The average altitude of the country is around 1,130 meters above sea level. However, there are vast differences in altitude among the regions, ranging from an average of 500 meters in the west to 2,000 meters in the east Anatolia. The climate is characterized by variations of temperature and rainfall, depending on topography of the country. The average rainfall is 500 millimeters; however, it ranges from 2,000 millimeters in Rize, a province on the Eastern Black Sea coast, to less than 300 millimeters in some parts of Central Anatolia. The typical climatic conditions of Turkey include dry, hot summers and cold, rainy, snowy winters especially in the central and eastern regions. In summer, temperatures do not display large variations across the country, whereas in winter, the temperature ranges from an average of –10°C in the east to +10°C in the south. 1.2 History Anatolia was dominated by the Seljuqs for almost two centuries (1055-1243) and afterwards she became the core of the Ottoman Empire, which ruled also in the Europe, Middle East and Africa for almost 6 centuries. At the end of The First World War, the Ottoman Empire demolished and immediately an effort to create a new state from the ruins of an Empire began throughout the country. The Turkish resistance movements were transformed into a complete war of independence when Mustafa Kemal landed at Samsun on 19 May 1919. The Turkish forces achieved success under very difficult conditions. The Lausanne Treaty, signed on 24 July 1923, recognized the creation of a new Turkish State with 2 | Introduction virtually the same borders as those of the National Pact of 1920 and guaranteed her complete independence. The Republic was proclaimed on 29 October 1923 in order to give the state a democratic form in the contemporary sense. Subsequently, the country’s present borders were established following the annexing of Hatay, a province on the southern border, in 1939. The founding of the Republic signified radical shifts from the previous social order as a succession of social and economic reforms. The wearing of the turban and fez that were symbols of the former order were banned and the "hat" became the official headgear (25 November 1925); the international hour and calendar systems were adopted (26 November 1925); the dervish lodges and tombs and the titles of tariqahs (sects) were abolished (25 November 1925); a modern Turkish Civil Code was introduced (17 February 1926) to replace the old civil code and the Shariah Laws which were the foundation stones of Ottoman law; the Latin alphabet was adopted instead of Arabic script (1 November 1928). The schools where mostly religion-related instruction was given were closed, and a program of compulsory education was set up which aimed at applying contemporary teaching methods. An amendment made to the Constitution in 1928 removed the clause which had stated that “the religion of the state is Islam”. A new clause was put in the Constitution in 1937 stating that Turkey is a secular state. The Surname Law was adopted on 21 June 1934. Mustafa Kemal, the founder of the new Turkish State and Republic, was given the surname of "Atatürk" (Father of the Turks). In short, the direction of change, led by Atatürk, was one away from a religious, oriental Empire to a modern, contemporary and secular Republic. Turkey did not become involved to the Second World War at the beginning but when the war was about to end, Turkey sided with the USA, Britain and the Soviet Union and declared war against Germany and Japan. However, Turkey did not take part actively in the war. Turkey signed the United Nations communiqué dated 24 January 1945. Turkey, which was officially invited to the San Francisco Conference on 5 March 1945, was among the founding members of the United Nations. From the foundation of the Turkish Republic to 1950, the country was governed by one party system. In the mid and late 1940s, new political parties formed. The first multiparty election held in 1950, the Democrat Party won, putting the Republican People's Party into the opposition. With the introduction of multi-party period, Turkey achieved a more liberal and democratic environment. Although Turkish political history included three military interventions (1960, 1971, and 1980), Turkey has succeeded in preserving a parliamentary, multi-party democratic system until today, and this makes it unique among other countries where Islam has prominence. With the foundation of the Republic, Turkey turned her face to the ‘Western world’, as establishing close relations with European countries and the United States of America. Turkey is a member of the United Nations, the Council of Europe and the North Atlantic Treaty Organization (NATO) and an associate member of the European Community. Since 2000, Turkey has achieved a noteworthy achievement in introducing new social, economic and political reforms within the context of the harmonization process with EU that was initiated with the Helsinki Summit of 1999 (State Planning Organization 2003). Turkey also maintains Introduction | 3 close relations with the countries of the Middle East, stemming from deep-rooted cultural and historical links. 1.3 Administrative Divisions and Political Organization Since the foundation of the Republic, the Turkish administrative structure has been shaped by three Constitutions (1924, 1961, and 1982). These three constitutions proclaimed Turkey to be a Republic with a parliamentary system and specified that the will of the people is vested in the Turkish Grand National Assembly (TGNA). All three constitutions adopted basic individual, social and political rights, and accepted the principle of separation of powers, namely legislative, administrative and judicial. The legislative body of the Republic is the TGNA. The TGNA is composed of 550 deputies, who are elected for five-year terms. The President of the Republic is elected by the TGNA for a seven-year term. The Prime Minister and other Cabinet Ministers compose the Council of Ministers, the executive branch of the Republic. The judiciary consists of the Court of Appeals, the Court of Jurisdictional Disputes, the Military Court of Appeals, the Constitutional Court, and the civil and military Courts. Turkey is administratively divided into 81 provinces. These are further subdivided into districts (ilçe), subdivisions (bucak), and villages (köy). The head of the province is the governor, who is appointed by the council of ministers and approved by the president of the republic and responsible to the central government. The governor, as the chief administrative officer in the province, carries out the policies of the central government, supervises the overall administration of the province, coordinates the activities of the various ministry representatives appointed by the central authority in the capital Ankara, and maintains law and order within his/her jurisdiction. A mayor and a municipal council, elected by the municipal electoral body for a term of five years, administer local government at the municipality level. Every locality with a population of more than 2,000 is entitled to form a municipal administration. Municipalities are expected to provide basic services such as; electricity, water, gas, the building and maintenance of roads, and sewage and garbage disposal facilities within the boundaries of the municipality. Educational and health services are mainly provided by the central government, but municipalities also provide health services for those who are at lower economic and social strata. 1.4 Social and Cultural Features Turkey varies in social and cultural structure, with ‘modern’ and ‘traditional’ life styles co-existing simultaneously within the society. For the inhabitants of metropolitan areas daily life is similar to the Western countries. On the other hand, people living in outskirts of urban areas and rural settlements are relatively conservative and traditional. Family ties are still strong and influential in the formation of values, attitudes, aspirations, and goals. Although laws are considered to be quite liberal on gender equality, patriarchal ideology characterizes the social life in many ways. 4 | Introduction The citizens of Turkey are predominantly Muslim. About 98 percent of the population belongs to Muslim religion, with the Sunnis forming the overwhelming majority. The rich and complex culture of the Turkish society pertains to its ethnic structure. Since the time of Ottoman Empire; Turks predominate ethnically but, in addition, there are Kurdish, Arabic, Circassian, Georgian, Greek, Armenian, and Jewish communities. One of the most striking achievements since the founding of the Republic has been the increase in both literacy and education. In 1935, only 10 percent of females and 29 percent of males were literate in Turkey. According to the 2000 census figures, the female and male literacy rates for the population age 6 and over were 81 and 94 percent, respectively (State Institute of Statistics 2003). Educational attainment has also increased dramatically. The gross primary education enrolment ratio is 96 percent; 100 percent for males and 93 for females (State Institute of Statistics 2004). Moderate advances have also been made in increasing the proportions of males and females with higher than primary-level education. In 1998, an eight- year education became compulsory in Turkey, with primary school encompassing the first 5 years and junior high school, 3 years. Despite these achievements, considerable regional and urban-rural differences in literacy and educational attainment continue to exist in the country in addition to the gender differences. 1.5 Economy After the foundation of the Turkish Republic, various economic development strategies were adopted. In the early years of the Republic, the Turkish economy was very weak since a bankrupt country was inherited from the Ottoman Empire. The economy was almost exclusively based on the agriculture, and it was totally undeveloped and poor. The creation and development of industry was clearly the first step that had to be taken to achieve a healthy and balanced economy. Throughout the 1920s liberal policies were implemented; the government promoted the development of industry through private enterprise, encouraged and assisted by favorable legislation and the introduction of credit facilities. These liberal policies continued until 1929, and moderate improvements were realized in the mechanization of agriculture. In the following decade, the state, under the so-called étatiste system, assumed the role of entrepreneur, owning and developing large sectors of agriculture, industry, mining, commerce and public works. The origins of modern industrialization in Turkey can be traced to the era of the 1930s. Although the beginnings of the industrialization drive were evident in the immediate aftermath of the formation of the republic in 1923, the real breakthrough occurred in the context of the 1930s. Although Turkey did not actually participate in the Second World War, the country was faced with heavy restraints on the economy, which slowed down the industrialization process. A "mixed economy" regime followed the war, with the transition to democracy in 1950 signifying a shift towards a more liberal economic order; private enterprise gained recognition side by side with the state economic enterprises. Also, more emphasis was placed on trade liberalization, agricultural and infrastructural development, and the encouragement of foreign capital. Introduction | 5 A series of Five-Year Development Plans were prepared beginning in the 1960s. The first of these plans became operative in 1963. A basic objective was to replace the era of unplanned and uncontrolled expansion during the 1950s. Before 1980, Turkey followed an economic policy based on the substitution of imports, and instead of importing it was aimed to manufacture those goods in the country to meet domestic demand. Newly established industrial branches were protected for long periods of time by customs tariffs and other taxes. In the 1980s, governments followed a strategy of renewing economic growth based on an export-oriented strategy. In this way, substantial economic reforms were prepared and applied beginning in January 1980. Privatization implementations were started in the country in 1984. Following the stagnation of the late 1970s, growth recovered in response to a combination of an increased flow of exports and inputs of foreign capital. The liberal economic strategy followed in the 1980s was not unique to that period. The differences between the liberal and étatiste phases are not only the nature of the trade regime and the attitude toward foreign direct investment, but also the mode of state intervention in the economy. Respectable rates of economic growth were achieved during the 1980s; however, in recent years, macro instability has manifested itself once again. Industrialization during the 1990s has been shaped by three dynamics. First, the state’s direct influence on the distribution of the resources was lessened. Second, competition gained importance, with increased emphasis on industrial performance and reconstruction of the industry. Third, general globalization and integration into the European Union gained speed. During the 1990s, privatization also gained importance as a solution to economic problems. An autonomous committee was founded in order to regulate privatization. Some of the state enterprises have been privatized within the frame of this program, and further privatization is expected. Turkey is nearly self-sufficient country in terms of its agricultural production. Wheat, barley, sugar beets, potatoes, leguminous plants and rice are grown, principally for domestic consumption, and cotton, tobacco, citrus, grapes, fig, hazelnuts, and pistachios are also grown for export. Turkey is not rich in mineral resources. One of the country's main problems is the inadequacy of primary energy resources. Copper, chromium, borax, coal, and bauxite are among the mineral resources in the country. The main industries are textiles, steel, cement, fertilizers, automotive and electrical household goods. Machinery, chemicals and some metals are imported mainly from the OECD countries. Turkey is a middle-income country at the beginning of 2000s. From 1998 onwards, Turkish authorities have made repeated affords to stabilize the economy. However, inherited economic instabilities; persistently high inflation, the systemic weakness of the financial sector and external shocks such as Russian crisis in 1998 and the earthquakes in 1999, hampered attempts to stabilize the economy. As a result, economic growth during 1997–2001 was very unstable, with periods of overheating and two sharp recessions. The financial crises in 2000 and 2001 contributed to a further deterioration in the public finance situation. Since 2001, key structural reforms have been adopted, that are intended to produce future macroeconomic stabilization within the context of the harmonization process with EU. Despite some recent progress, reducing inflation pressure, increasing export revenues, 6 | Introduction reducing unemployment problem and addressing insufficient capital for new investments remain key issues (State Planning Organization 2003; Ministry of Foreign Affairs 2004). 1.6 Regional Divisions The diverse geographical, climatic, cultural, social, and economic characteristics of different parts of the country are the basis for the conventional regional breakdown within Turkey. Five regions (West, South, Central, North, and East) are distinguished, reflecting, to some extent, differences in socioeconomic development levels and demographic conditions within the country. This regional breakdown is frequently used for sampling and analysis purposes in social surveys. The West region is the most densely settled, the most industrialized, and the most socio-economically advanced region of the country. The region includes both İstanbul, (until 1923 the capital of the Ottoman Empire), which is Turkey's largest city, and the country's manufacturing, commercial and cultural centre, and İzmir, the country's third largest city. The coastal provinces within the West region form a relatively urbanized, fast-growing area. The Aegean coast is also a major agricultural area, where cotton, and fruits mostly grapes and fig are cultivated on the fertile plains. With dry summers and mild, rainy winters, agricultural yields from the fertile soils are good. Most of the industrial establishments are situated in the West region and the region contributes most of the gross domestic product of the country. The South includes highly fertile plains and some rapidly growing industrial centers. Adana, Mersin, and Antalya are the new metropolises located in this region. Steep mountains cut off the semitropical coastal plains from the Anatolian highlands to the north. Hot, dry summers and mild, wet winters describe the climatic conditions of the region. Cultivation of cotton, sugar beets and citrus provide high incomes and export earnings; tourism centers in Antalya provide almost one–third of tourism revenue. The South region has witnessed an industrial boom and an inflow of migrants, especially from the East and Southeastern provinces in the recent decades. The Central region is a dry grazing area and includes Ankara, the capital and second largest city. Industrial production in the region is rising modestly, as minor city centers develop. Industrial production in the region specializes in cereal and related processed foods, furniture and marble. Given the dry, temperate climate, fruit tree cultivation and sheep and cattle rising are also common. The North region has a fertile coastal strip, but in most places it is only a few kilometers wide; the coastal region is relatively isolated from the inner parts of the region and the rest of the country by mountainous terrain. The region specializes in growing small-scale, labor-intensive crops like hazelnuts, tobacco and tea. The region receives large quantities of rainfall throughout the year. Zonguldak, a western province, has extensive coal mine reserves and is a centre for coal mining and the steel industry. The region has a great deal of tourism potential that has been improving recently. Introduction | 7 The East region is considered as the least developed part of the country. Rugged mountainous terrain, short summers, and the severe climate are suited to animal husbandry rather than settled farming. However, with the “Southeast Anatolia Project”, the economy in the Southeast has improved in the recent years. Atatürk Dam was built (1983–1992) and Urfa irrigation channels were constructed and water was provided to arid and semi-arid lands, leading to agricultural development in the Southeast Anatolia. In addition to economic benefits, the project is also expected to reverse the migration flow from the region to the rest of the country. Although the capacity of agriculture has increased, the region is still poor in terms of industrial production. A substantial number of villages and adjacent arable lands have been abandoned because of terrorist movements in last 20 years especially in East and Southeast Anatolia. In addition to this, large-scale development projects in the frame of Southeast Anatolia Project, natural disasters, or improved settlement policies have also led to significant migration both within and outside of the region in the last two decades. In response to these trends, the government initiated “Return to Villages and Rehabilitation Project” (RVRP) directed at this population. The main purposes of the RVRP, which covers the 14 provinces in the East and Southeast Anatolia, are to settle those who want to return to their villages on or around the lands of their former villages or on other suitable places, establish the necessary social and economic infrastructure, provide sustainable living conditions in these settlements, re- establish and vitalize the interrupted rural life, form a more balanced settlement design in the rural areas, and achieve a more rational distribution of public investments and services (State Planning Organization 2003). 1.7 Population In 1927, Turkey's population was 13.6 million according to the first national census, which was conducted four years after the establishment of the Republic. Beginning with the 1935 census, subsequent population censuses were undertaken regularly at 5-year intervals until 1990. After 1990, it was decided that population censuses would be carried out in years ending with 0 by a law. The latest, fourteenth, Population Census which was carried out on 22nd October 2000, put the population of Turkey at 67.4 million (State Institute of Statistics 2003). Turkey is among the 20 most populous countries of the world, and it is the most populous country of the Middle East and the second populous country of the Europe after Germany. According to projections, her population currently is around 71 million (Population Reference Bureau 2004). The population of Turkey continuously increased in 1927–2000 period. The annual population growth rate reached its highest value (29 per thousand) in the 1955–1960 period. The latest intercensal estimate of the population growth rate was 18 per thousand for the 1990–2000 period. According to the projections of the State Institute of Statistics (SIS), the population of Turkey is expected to reach 76 million in the year 2010 and 88 million in 2025. The total population is expected to be stabilized around mid 21st century between 95 and 98 million (State Institute of Statistics 1995). 8 | Introduction Turkey has a young population structure as a result of the high fertility and growth rates of the recent past. One-third of the population is under 15 years of age, whilst the proportion 65+ comprises only 6 percent according to 2000 national census results. However, today’s prevailing demographic forces of the population are altering the age structure in new ways. First of all, recent decades have witnessed dramatic declines especially in fertility rates. In the early 1970s, the total fertility rate was around 5 children per woman, whereas the estimates in the late 1990s indicate it has nearly halved to 2.6 children. The crude birth rate was estimated at 22 per thousand in the early 2000s. As a result, the median age of the population, which averaged around 20 years between 1940 and 1960 in Turkey, has increased continuously since 1970, reaching 24 years for male and 25 years for female population in 2000. There have been significant changes in the growth rates by age groups. The growth rates for young age groups have decreased whereas the population of older age groups has increased faster than the average for Turkey. It is expected that increase in the population size of 15–64 and 65+ will continue also in the next years while population size of youth will nearly stabilize (State Institute of Statistics 2003). There is lack of accurate, complete and continuous information on mortality in Turkey, particularly adult mortality. The information is available mainly for deaths in town and city centers and these data are also incomplete. According to reported causes of deaths, the main causes of death in order of importance are cardio–vascular diseases (46 percent), all malignancies (15 percent) and all accidents (4 percent). In contrast to adult mortality, data on child mortality have been available for a relatively long period from a series of fertility surveys. The infant mortality rate in the late 1950s was around 200 per thousand live births. It declined to about 130 during the mid-1970s and to an estimated 42 during the late 1990s. Likewise, crude death rates have also declined from around 30 per thousand in the 1940s to 7 per thousand in 1990s. The latest estimates put life expectancy in Turkey at 66 years for males and 71 for females (State Institute of Statistics 2004). Marriage, predominantly civil, is widely practiced in Turkey. Religious marriages also account for a significant proportion of the marriages; however, the main custom is to have a civil as well as a religious ceremony. The universality of marriage in Turkey is observed in the low proportions never married. According to the 2000 Population Census, in the age group 45-49 which marks the end of the reproductive ages, only two percent of females had never married, whereas the corresponding figure for males in the same age group was three percent. Marriages in Turkey are also known to be very stable. The population of Turkey has undergone an intensive process of urbanization, especially from the 1950s onwards. The share of the population living in cities, which was 25 percent in 1950, climbed to 65 percent in 2000. The rate of urbanization has been approximately 33 per thousand during the 1990-2000 period. The rapid urbanization has inevitably caused problems in the provision of services and the emergence of large areas of squatter housing in unplanned settlements around metropolitan cities. Social problems related to the adaptation to city life and culture also are evident. Turkey has had a long history of external migration. Throughout the 1960s and 1970s, the migrant flow was mainly directed to Western European countries, principally Germany. Introduction | 9 During the 1980s, however, it became more oriented towards the oil-producing countries of the Middle East. In the past two decades, the political turmoil in that region and changes in policies and practices governing the labor force in the European Union have continued to influence emigration patterns. At the same time, due to political conditions in neighboring countries, Turkey has found herself subjected to waves of asylum seekers from the Balkans, Middle East countries, and also from distant Asian and African countries (International Organization for Migration 1996). 1.8 Population and Family Planning Policies and Programs In Turkey, policies related to population have been formulated since the establishment of the Republic in 1923. During the early years of the Republic, there was a perceived need to increase fertility, since the country had suffered from heavy human losses during the First World War and the War of Independence. The defense needs of the country and the shortage of manpower, as well as high infant and child mortality rates, led Turkey to continue to follow a pronatalist population policy until the late 1950s. A number of laws directly or indirectly encouraging population growth were passed during the period. These laws included monetary awards to women with more than 5 children, tax reduction incentives, prohibitions on the advertisement, import and sale of contraceptives (except for health reasons), and prohibition of abortions on social grounds. The high population growth rates prevailing in the 1950s which led to increased numbers of illegal abortions and, as a consequence, to high maternal mortality, brought the population debate into the political agenda. High urban population growth and employment problems were also factors contributing to the new antinatalist environment in government circles. The State Planning Organization and the Ministry of Health pioneered the policy change, and the first Population Planning Law was enacted in 1965. The law mandated the Ministry of Health to have responsibility for implementing the new family planning policy. The policy allowed the importation of modern contraceptives methods, provided services at state health institutions free of charge and supported health education for couples. In addition, the State Planning Organization incorporated the notion of population planning in the First Five-Year Development Plan. In 1983, a more liberal and comprehensive Population Planning Law was passed. The new law legalized abortions (up to the tenth week of pregnancy) and voluntary surgical contraception on social and economical grounds. It also permitted the trained auxiliary health personnel to insert IUDs and included other measures to improve family planning services and mother and child health. The latest Five Year Development Plan of the State Planning Organization states that population policy seeks to reach a population structure which is in harmony with the balanced and sustainable development targets of the society. Thus, the strengthening of qualitative aspects of population including increased education and improved health levels and a reduction in unbalanced development and inequalities among regions are primary objectives of population policy (State Planning Organization 2001). 10 | Introduction 1.9 Health Priorities and Programs Mother and child health and family planning services have been given a priority status in the policies of the government in recent decades. These services gained importance due to the large proportion of women of reproductive ages and children in the Turkish population, high infant, child and maternal mortality rates, the demand for family planning services, and the limited prenatal and postnatal care. A number of programs to improve services have been implemented since 1985, with special emphasis on provinces which have been designated as priority development areas as well as on squatter housing districts in metropolitan cities, rural areas, and special risk groups. The initiatives include programs in immunization, early diagnosis and prompt treatment of childhood diarrheal diseases, acute respiratory infections, promotion of breastfeeding and growth monitoring, healthy and balanced nutrition, reproductive health, and antenatal and delivery care, and safe motherhood. IEC (Information, Education, and Communication) programs to promote the mother and child health and family planning activities are also being widely implemented. 1.10 Health Care System in Turkey The Ministry of Health is officially responsible for designing and implementing health policies and delivering health-care services nationwide. Besides the Ministry of Health, other public sector institutions and non-governmental and private organizations contribute to providing mostly curative health services. At the central level, the Ministry of Health is responsible for the implementation of curative and preventive health-care services throughout the country, within the principles of primary health care. The responsibility for delivering the services and implementing specific Primary Health Care programs is shared by various General Directorates (Primary Health Care, Mother and Child Health and Family Planning, Health Education) and by various Departments (Departments of Tuberculosis Control, Malaria Control, Cancer Control). At the provincial level, the health-care system is the responsibility of Health Directorates, under the supervision of the Governor. The provincial Health Director is responsible for delivering all primary health-care services as well as curative services. The present network of Health Centers and Health Houses was formed on the basis of "Legislation for the Socialization of Health Services" so that services and facilities are extended down to the village level. A substantial proportion of villages have health centers or health houses, and sites were located so as to provide easy access to other villages. The simplest element of the socialized health services is the Health House, which serves a population of 2,500-3,000 and is staffed by a midwife. The Health Center serves a population of 5,000-10,000 and is staffed by a team consisting of a physician(s), a nurse(s), a health officer, midwives, an environmental health technician, medical secretary and a driver. Health Centers mainly offer integrated, polyvalent primary health-care services. Mother and Child Health and Family Planning Centers and Tuberculosis Dispensaries also offer primary preventive health services. Introduction | 11 This network of health facilities is responsible for delivering primary health care services, maternal and child health, family planning, and public health education services. These health facilities are also the main sources of the health information system. 1.11 Objectives and Organization of the Survey 1.11.1 Objectives The 2003 Turkish Demographic and Health Survey (TDHS–2003) is the latest in a series of national-level population and health surveys that have been conducted by the Hacettepe University Institute of Population Studies (HUIPS), in the last four decades. The primary objective of the TDHS-2003 is to provide data on socioeconomic characteristics of households and women, fertility, mortality, marriage patterns, family planning, maternal and child health, nutritional status of women and children, and reproductive health. The survey obtained detailed information on these issues from a sample of ever-married women in the reproductive ages (15-49). The TDHS-2003 was designed to produce information in the field of demography and health that to a large extent can not be obtained from other sources. Specifically, the objectives of the TDHS-2003 included: • Collecting data at the national level that allows the calculation of demographic rates, particularly fertility and childhood mortality rates; • Obtaining information on direct and indirect factors that determine levels and trends in fertility and childhood mortality; • Measuring the level of contraceptive knowledge and practice by method, region, and urban-rural residence; • Collecting data relative to mother and child health, including immunizations, prevalence and treatment of acute respiratory tract infections among children under five, antenatal care, assistance at delivery, and breastfeeding; • Measuring the nutritional status of children under five and of their mothers; and • Collecting data at the national level on elderly welfare, knowledge of sexually transmitted diseases (STDs) and AIDS, and usage of iodide salt. The TDHS-2003 information is intended to contribute data to assist policy makers and administrators to evaluate existing programs and to design new strategies for improving demographic, social and health policies in Turkey. Another important purpose of the TDHS- 2003 is to sustain the flow of information for the interested organizations in Turkey and abroad on the Turkish population structure in the absence of reliable and sufficient vital registration system. 12 | Introduction 1.11.2 Administration and Funding of the Survey The TDHS-2003 was implemented by HUIPS, in collaboration with the General Directorate of Mother and Child Health and Family Planning of the Ministry of Health. HUIPS began preparations to carry out the survey as far back as 2001, and the fieldwork of the survey was conducted between December 2003 and May 2004. Financial support for the TDHS-2003 was mainly provided through the national budget as a three-year advanced project in the investment program of the State Planning Organization. In this respect, the TDHS-2003 is significantly different from the previous demographic and health surveys carried out by the Institute which were all conducted through international sources of funding. Moreover, the TDHS-2003 was supported for the first time as a project in the frame of the European Union “Turkey Reproductive Health Program”, implemented by the General Directorate of Mother and Child Health and Family Planning of the Ministry of Health. A steering committee consisting of the academic staff of HUIPS and representatives of the General Directorate of Mother and Child Health and Family Planning of the Ministry of Health, the State Planning Organization and the State Institute of Statistics participated in all phases of the project. The persons involved in the various activities of the TDHS–2003 are listed in Appendix A. 1.11.3 Questionnaires Two main types of questionnaires were used in the TDHS-2003: the Household Questionnaire and the Individual Questionnaire for ever-married women of reproductive ages. The contents of the questionnaires were based on the International MEASURE/DHS+ survey project model questionnaires and on the questionnaires that had been employed in previous Turkish population and health surveys. In developing the questionnaire, close attention was paid to obtaining the data needed for program planning in Turkey as specified during consultations with population and health agencies. Additionally input was obtained from other institutions studying on demographic and health issues. Ensuring the comparability of the TDHS–2003 findings with previous demographic surveys, particularly with TDHS–1993 and TDHS–1998, was an important goal during questionnaire development. A pretest of questionnaire was conducted in July 2003 and based on the pretest results, some minor modifications were made to the questionnaires. The Household Questionnaire was used to enumerate all members of and visitors1 to the selected households and to collect information relating to the socio-economic level of the households. In the first part of the household questionnaire, basic information was collected on the age, sex, educational attainment, marital status, working status and relationship to the head of household of each person listed as a household member or visitor. The objective of the first 1 Persons who were not usual household members but who were present in that household on the night before the interview were identified as “visitors” and included in the household roster in order to obtain de facto survey population. Introduction | 13 part of the Household Questionnaire was to obtain basic socio-economic information for Turkish households as well as to identify women who were eligible for the Individual Questionnaire. Some additional information on never-married women in 15–49 ages listed in the household schedule was provided at the end of this part. The second part of the household questionnaire was devoted to collecting data on welfare of the elderly, if any, in the households. In this part, there are questions on the income, health insurance and physical capabilities (i.e. ability to carry on daily activities for all persons age 60 and over living in the household. In the third part, questions were included on the dwelling unit and on the ownership of a variety of consumer goods. Also in this part, İstanbul Metropolitan Household Module was included which covers questions about tenure, and the availability of electricity, piped-water, and natural gas in the households located in the urban places of İstanbul metropolitan area. In the final part of the Household Questionnaire questions were included about the storage of the salt used for cooking at home. Salt-related questions were asked in the half of the sampled clusters, and salt iodization tests were applied in the interviewed households in these clusters. The Individual Questionnaire covered the following information: • Background characteristics • Reproductive history • Marriage • Knowledge and use of contraceptive methods • Other information relating to contraception • Abortions and causes • Maternal health care and breastfeeding • Immunization and acute respiratory infections • Fertility preferences • Husband’s background characteristics • Women’s work and status • Knowledge of sexually transmitted diseases and AIDS • Maternal and child anthropometry The calendar module in the Individual Questionnaire was used to record on a monthly basis fertility, contraceptive use and marriage events for six and a half years beginning from January 1998 up to the survey month. English versions of the two questionnaires can be seen in Appendix E. 1.11.4 Sample The sample design and sample size of the TDHS-2003 makes it possible to perform analyses for Turkey as a whole, for urban and rural areas and for the five demographic regions of the country (West, South, Central, North and East). The TDHS-2003 sample is of sufficiently size to allow for analysis on some of the survey topics at the level of the 12 geographical 14 | Introduction regions (NUTS 1) which were adopted at the second half of the year 2002 within the context of Turkey’s move to join the European Union. Among these 12 regions, İstanbul and the Southeastern Anatolian Project regions (GAP in Turkish initials), due to their special situations were oversampled. Most results in this report are presented for five demographic regions as used in the previous surveys and for İstanbul and GAP region2. In addition for a number of indicators results are presented in detail for the 12 geographical regions, whenever the numbers of observations are sufficient (see Appendix B for detailed information). In the selection of the TDHS-2003 sample, a weighted, multi-stage, stratified cluster sampling approach was used. The distribution of the target sample of the survey was based on the results of the 2000 General Population Census. Sample selection for the TDHS-2003 was undertaken in three stages. The sampling units at the first stage were settlements. The frame for the selection of primary sampling units was prepared using the results of the 2000 General Population Census. In the sampling frame, settlements were divided into two groups; one including those settlements with populations more than 10,000 as “urban”, and the other, including settlements less than 10,000 as “rural”. In the survey design, the selection of the settlements in each cluster was done with probability proportional to their population size. For the second stage of sample selection, structure schedule data that was collected in the year 2000 for settlements with a municipality and updated in 2002 by the State Institute of Statistics was used. Using the updated household lists, a fixed number of households were selected in each cluster by systematic random sampling method (25 in clusters located in settlements over 10,000, 15 in those less than 10,000, and 12 in the İstanbul metropolitan clusters). All ever- married women at ages 15-49 who generally live in the selected households and/or were present in the household on the night before the interview were eligible for the Individual Questionnaire. A more technical and detailed description of the TDHS-2003 sample design, selection and implementation is presented in Appendix B. 1.11.5 Fieldwork and Data Processing The TDHS-2003 data collection was carried out by 14 teams3. Each team was consisted of 3-5 female interviewers, one male measurer, one field editor and a team supervisor. The Institute’s academic staff had visited teams in the field as regional coordinators during the survey. A three-week training course was given to the field staff in November 2003. The main fieldwork began in the first week of December 2003 and completed in the middle of May 2004. The fieldwork was planned to take into consideration the seasonal conditions in Turkey. 2 İstanbul province and Southeast Anatolia (GAP) region constitute the two regions of NUTS 1 geographical regions. 3 The fieldwork of the TDHS-2003 was started with 14 teams in December 2003. In order to finalize the fieldwork in the remaining provinces, 19 new teams were formed gradually among the teams that completed their work and returned. Introduction | 15 Therefore, in the first months the fieldwork was concentrated in the provinces located in the West, the South and the Central Anatolia regions where winter conditions would have a minimum affect on the survey. The North and the Eastern Anatolia provinces were included to the fieldwork later as weather conditions improved. The fieldwork was finalized without any interruptions in the planned period. The completed questionnaires in the field were returned to the Institute of Population Studies in Ankara for data processing. The office editing staff checked all questionnaires returned from the field. Those questions which had not been pre-coded and questions with open-ended answers were coded by the office team. After this, the data entry and editing were done using microcomputers and CSPro (Census and Survey Processing System) software. During data entry process, full verification was reached by entering each questionnaire to the computers twice by different data editors. The office editing and data processing activities began in January 2004 (three weeks after the beginning of the fieldwork) and were completed at the end of May 2004. The results of the household and individual questionnaires are summarized in Table 1.1. Information is provided on the overall coverage of the sample, including household and individual response rates. In all, 13,049 households were selected for the TDHS-2003. At the time of listing phase of the survey, 11,659 households were considered occupied and, thus, available for interview. Of the 11,659 occupied households, 93 percent (10,836 households) were successfully interviewed. The main reasons the field teams were unable to interview some households were because some dwelling units that had been listed were found to be vacant at the time of the interview or the household was away for an extended period. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates by urban-rural residence, Turkey 2003 Result Urban Rural Total Household interviews Dwellings sampled 9,754 3,295 13,049 Households found 8,718 2,941 11,659 Households interviewed 7,956 2,880 10,836 Household response rate 91.3 97.9 92.9 Individual interviews Eligible women 6,259 2,188 8,447 Eligible women interviewed 5,976 2,099 8,075 Eligible women response rate 95.5 95.9 95.6 In the interviewed 10,836 households, 8,447 women were identified as eligible for the individual interview, i.e. they were ever-married, in reproductive ages (15-49) and present in the household on the night before the interview. Interviews were successfully completed with 8,075 of these women (95.6 percent). Among the eligible women not interviewed in the survey, the principal reason for non-response was the failure to find the women at home after repeated visits to the household. 16 | Introduction A more complete description of the fieldwork, coverage of the sample, and data processing is presented in Appendix B. Household Population and Housing Characteristics | 17 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 İsmet Koç and Attila Hancıoğlu The objective of this chapter is to provide a demographic and socioeconomic profile of the TDHS-2003 sample and a descriptive assessment of the environment in which women and children live. This is accomplished by examining the general characteristics of the households in the sample. Information is presented on the age, sex, and education of the household population, as well as on housing facilities and household possessions. The profile of the TDHS-2003 households provided in this chapter will help in understanding the results presented in the following chapters. In addition, it may provide useful input for social and economic development planning. 2.1 Characteristics of the Household Population The questionnaire for the TDHS-2003 included two questions distinguishing between the de jure population (persons who usually live in selected household) and the de facto population (persons who spent the night before the interview in the household). The differences between these populations are small. However, since past surveys and censuses were based on de facto populations, and since the sampling probabilities were based on de facto population information, tabulations for the household data presented in this chapter are based on the de facto definition, unless otherwise stated. A household was defined as a person or group of persons living together and sharing a common source of food. 2.1.1 Age and Sex Composition Table 2.1 presents the percent distribution of the de facto population by age, according to urban-rural residence and sex. The table shows the effects of past demographic trends on the structure of the Turkish population and indicates the context in which a variety of demographic processes are operating. The total de facto population in the selected households was 42,851 persons. In general, the survey results show that females outnumber males in Turkey (51 and 49 percent respectively). The proportion of females is slightly higher in rural areas (52 and 48 percent). The information on sex and age distribution is used to construct a population pyramid describing the TDHS-2003 household population (Figure 2.1). The pyramid has a wide base, with a large concentration (29 percent) of the population under 15 years of age. This pattern is typical of countries that have experienced relatively high fertility in the recent past. The effect of recent fertility declines is evident in the fact that the proportions of children under age 5 and age 5 to 9 are smaller than the proportion age 10 to 14. The proportion under age 15 is greater in the rural population than in the urban population (Table 2.1). The differences in the urban-rural age distributions reflect the lower recent fertility in urban areas compared with rural areas. 18 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Turkey 2003 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 9.8 8.5 9.1 10.4 9.5 9.9 10.0 8.8 9.4 5-9 9.7 9.4 9.5 11.1 9.9 10.5 10.1 9.5 9.8 10-14 9.6 9.5 9.6 11.4 9.9 10.6 10.2 9.7 9.9 15-19 10.4 9.3 9.8 9.0 10.1 9.6 10.0 9.6 9.8 20-24 8.6 9.9 9.3 7.1 9.3 8.3 8.1 9.7 8.9 25-29 8.6 9.5 9.0 6.2 6.5 6.4 7.8 8.5 8.2 30-34 8.2 7.9 8.0 6.1 6.7 6.4 7.5 7.5 7.5 35-39 7.0 7.1 7.0 5.8 6.4 6.1 6.6 6.9 6.7 40-44 6.6 6.8 6.7 5.9 5.5 5.7 6.4 6.4 6.4 45-49 5.8 5.4 5.6 5.1 4.7 4.9 5.6 5.2 5.4 50-54 4.5 4.9 4.7 4.4 4.8 4.6 4.5 4.9 4.7 55-59 3.5 3.1 3.3 4.3 4.0 4.2 3.8 3.4 3.6 60-64 2.3 2.6 2.5 3.5 3.4 3.5 2.7 2.9 2.8 65-69 1.9 2.4 2.2 3.2 3.4 3.3 2.3 2.8 2.5 70-74 1.7 1.7 1.7 2.8 2.8 2.8 2.0 2.1 2.1 75-79 1.0 1.1 1.0 2.1 1.8 1.9 1.4 1.3 1.3 80 + 0.6 0.9 0.8 1.5 1.2 1.3 0.9 1.0 1.0 Don't know/missing 0.1 0.0 0.0 0.1 0.0 0.1 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 14,314 14,894 29,208 6,528 7,116 13,644 20,842 22,010 42,851 Figure 2.1 Population Pyramid 6.0 4.0 2.0 0.0 2.0 4.0 6.0 0-4 10-14 20-24 30-34 40-44 50-54 60-64 70-74 80+ Age Percent Male Female TDHS-2003 Household Population and Housing Characteristics | 19 The population age 65 and over accounts for 7 percent of the total population in Turkey. The share of elderly population is approximately 6 percent in urban areas, as opposed to over 9 percent in the rural areas. The percentage of elderly has risen to the highest proportion in the demographic history of Turkey. This may mainly be attributable to two factors: the rapid decline in fertility and increased life expectancy at all ages. Table 2.2 presents a comparison of the distribution of the household population by broad age groups for the last three demographic surveys and the last two censuses carried out in 1990 and 2003. The dependency ratio, defined as the ratio of the non-productive population (persons under age 15 and age 65 and over) to the population age 15-64, is calculated based on these figures. The dependency ratio, which was above 65 at the time of the 1990 Population Census, had declined to 56 at the time of the TDHS-2003. The decline reflects a significant decrease in the burden placed on persons in the productive ages to support older and younger household members. Table 2.2 also indicates that the median age of household population is 24.7 years, 2.5 years higher than the median age in 1990. Both changes in dependency ratio and in the median age of population are consistent with the gradual aging of the population that occurs as fertility declines. Table 2.2 Population by age from selected sources Percent distribution of the population by age group, selected sources, Turkey 1990-2003 Age group CP 1990 TDHS-1993 TDHS-1998 CP 2000 TDHS-2003 Less than 15 35.0 33.0 31.5 29.8 29.1 15-64 60.7 61.4 62.6 64.5 64.0 65 and + 4.3 5.5 5.9 5.7 6.9 Total 100.0 100.0 100.0 100.0 100.0 Median age 22.2 23.1 24.3 24.8 24.7 Dependency ratio 64.7 62.7 59.7 55.1 56.3 Sources: 1990 and 2000 Census of Population (CP), TDHS-1993, TDHS-1998 and TDHS-2003 2.1.2 Household Composition Table 2.3 presents the distribution of households in the TDHS-2003 sample by sex of the head of the household and by the number of household members. These characteristics are important because they are often associated with socioeconomic differences between households. For example, female-headed households frequently are poorer than households headed by males. In addition, the size and composition of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavorable health conditions. Unlike earlier tables, Table 2.3 is based on de jure members, i.e. usual residents. The household head is female in 13 percent of households. Although there is little variation in the proportion of female-headed households by residence, female-headed households are more common in urban areas (13 percent) than in rural areas (11 percent). There are on average 4 persons per household. More than four in ten households have fewer than four members, while another quarter of the households have five members, and 20 | Household Population and Housing Characteristics one-third of households has six or more members. In general, rural households are larger than urban households. For example, less than five percent of urban households have eight or more members, compared with 11 percent of rural households. Household size varies from an average of 3.9 persons in the urban areas to 4.5 persons in rural areas. Table 2.3 Household composition Percent distribution of households by sex of head of household and by household size, according to urban-rural residence, Turkey 2003 Characteristic Urban Rural Total Sex of head of household Male 87.0 88.6 87.5 Female 13.0 11.4 12.5 Total 100.0 100.0 100.0 Number of usual members 0 0.3 0.4 0.3 1 6.3 6.3 6.3 2 16.5 17.3 16.8 3 21.8 13.7 19.4 4 26.3 19.3 24.2 5 14.5 15.0 14.7 6 6.8 10.6 7.9 7 3.4 6.1 4.2 8 1.9 3.8 2.4 9+ 2.2 7.5 3.8 Total 100.0 100.0 100.0 Number of households 7,643 3,193 10,836 Mean size 3.9 4.5 4.1 Note: The table is based on de jure members, i.e., usual residents. 2.2 Fosterhood and Orphanhood Foster children are children under 18 years of age who are not living with either of their biological parents. Orphaned children are children under 18 years of age who have lost one or both of their biological parents. To measure the prevalence of child fostering and orphanhood, four questions were asked in the Household Questionnaire on the survival and residence of the parents of children under 18 years of age. Information on children’s living arrangements and orphanhood is presented in Table 2.4. In Turkey, 92 percent of children under age 18 live with both parents. The proportion of children living with both parents decreases with increasing age. Children living in the North are somewhat less likely to live with both parents than children in other regions. Household Population and Housing Characteristics | 21 Table 2.4 Children's living arrangements and orphanhood Percent distribution of de jure children under age 18 by children's living arrangements and survival status of parents, according to background characteristics, Turkey 2003 Living with mother but not father Living with father but not mother Not living with either parent Background characteristic Living with both parents Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Miss- ing Total Number of children Age <2 98.5 1.0 0.2 0.1 0.1 0.2 0.0 0.0 0.0 0.0 100.0 1,457 2-4 95.8 2.0 0.5 0.4 0.1 0.7 0.1 0.1 0.0 0.3 100.0 2,509 5-9 94.6 2.1 1.4 0.5 0.3 0.8 0.2 0.0 0.1 0.1 100.0 4,199 10-14 91.1 2.5 3.2 0.5 0.8 1.5 0.1 0.0 0.1 0.0 100.0 4,326 15-17 83.1 3.3 4.7 0.9 1.7 5.4 0.2 0.4 0.2 0.2 100.0 2,717 Sex Male 92.4 2.4 2.2 0.5 0.7 1.4 0.1 0.1 0.1 0.1 100.0 7,729 Female 91.8 2.3 2.3 0.5 0.6 2.1 0.2 0.1 0.1 0.1 100.0 7,478 Residence Urban 91.8 2.5 2.0 0.7 0.5 2.0 0.1 0.1 0.1 0.1 100.0 9,976 Rural 92.6 1.9 2.6 0.1 0.8 1.3 0.2 0.2 0.1 0.1 100.0 5,231 Region West 92.2 2.5 1.6 0.6 0.5 2.1 0.1 0.0 0.1 0.2 100.0 4,926 South 91.5 3.1 1.8 0.6 0.8 1.9 0.1 0.0 0.1 0.1 100.0 2,102 Central 91.8 2.9 2.4 0.5 0.4 1.6 0.1 0.0 0.2 0.1 100.0 3,066 North 90.5 1.8 2.1 0.5 1.1 3.1 0.5 0.2 0.1 0.1 100.0 1,076 East 93.0 1.4 3.1 0.3 0.8 1.0 0.1 0.3 0.1 0.0 100.0 4,038 NUTS 1 Region İstanbul 92.2 2.0 1.7 0.5 0.4 2.7 0.1 0.0 0.1 0.2 100.0 2,285 West Marmara 90.3 2.5 1.8 1.0 0.6 2.5 0.2 0.2 0.3 0.6 100.0 472 Aegean 91.7 3.2 2.0 0.7 0.4 1.7 0.0 0.0 0.0 0.3 100.0 1,607 East Marmara 93.5 2.2 1.8 0.6 0.8 0.9 0.2 0.0 0.0 0.0 100.0 1,071 West Anatolia 92.6 2.9 1.7 0.6 0.5 1.5 0.1 0.0 0.2 0.0 100.0 1,344 Mediterranean 91.5 3.1 1.8 0.6 0.8 1.9 0.1 0.0 0.1 0.1 100.0 2,102 Central Anatolia 90.8 3.3 3.1 0.4 0.7 1.4 0.1 0.1 0.2 0.0 100.0 854 West Black Sea 90.4 3.5 1.7 0.5 0.3 3.3 0.1 0.1 0.0 0.1 100.0 874 East Black Sea 91.3 0.7 2.3 0.4 1.6 2.4 0.9 0.2 0.2 0.0 100.0 560 Northeast Anatolia 91.9 2.2 4.2 0.3 0.3 0.8 0.0 0.3 0.0 0.0 100.0 689 Central East Anatolia 93.5 0.8 3.1 0.1 0.8 1.0 0.2 0.5 0.0 0.0 100.0 1,128 Southeast Anatolia 93.0 1.4 2.8 0.4 0.9 1.1 0.1 0.1 0.1 0.1 100.0 2,221 Total 92.1 2.3 2.2 0.5 0.6 1.8 0.1 0.1 0.1 0.1 100.0 15,207 Six percent of children live with only one parent–5 percent with their mothers and 1 percent with their fathers. Three percent of children live with only one parent because the other parent is dead. Foster children–children not living with either parent–account for only 2 percent of children under 18, and orphaned children–children who have lost one or both parents–account for 3 percent. The proportion of orphaned children at age 15-17 is approximately 7 percent. 2.3 Education of the Household Population The educational level of household members is among the most important characteristics of the household because it is associated with many phenomena including reproductive behavior, use of contraception, and the health of children. Results from 22 | Household Population and Housing Characteristics household interviews can be used to look at both educational attainment among household members and school attendance among children and young adults. 2.3.1 Educational Attainment of Household Members Primary education in Turkey starts at age 6 and continues for 8 years. Eight years of education is considered as basic education and has been compulsory since 1997. High school, which includes another three years of schooling, is not compulsory. Tables 2.5.1 and 2.5.2 present data on the educational level of the household population age 6 and over for males and females, respectively. The results confirm that there is a gap in educational attainment between males and females. Overall, about 77 percent of males in the TDHS-2003 households have completed at least first level primary school, compared with 61 percent of females. However, among the population with any schooling, over one-third of males as well as females have completed at least second level primary school. The median number of years of schooling for men is 4.8 which is about 0.5 year higher than the median level for women (4.3 years). An examination of the changes in educational indicators over successive cohorts indicates that there have been substantial increases over time in the educational attainment of both men and women. For example, the median number of years of schooling is 9 years for males age 20-24 years, compared with 4.9 years in the 40-44 age group. Women have experienced substantial improvements in education as well. As a result, the differentials in educational attainment between males and females have narrowed among younger cohorts. Urban residents are more likely to have attended school and to have remained in school for a longer period than rural residents. Gender differences in educational attainment are also less evident in rural than in urban areas. The median number of years of schooling is 4.5 years among rural men, compared with 4.0 years among rural women. The difference is much bigger in urban areas, where the median years of schooling are 5.4 and 4.5, respectively for men and women. Gender differences in the likelihood of attending school are greatest in the East, and least in the West. In the East, 85 percent of men have ever attended school, compared with about 61 percent of women. In the West, the gap is much smaller, with nearly 85 percent of women having had some education, compared with 95 percent of men. Household Population and Housing Characteristics | 23 Table 2.5.1 Educational attainment of household population: Males Percent distribution of the de facto male household population age six and over by highest level of education attended or completed, according to background characteristics, Turkey 2003 Background characteristic No education/ Primary incomplete First level primary Second level primary High school and higher Missing Total Number of males Median number of years Age 6-9 99.3 0.2 0.0 0.0 0.5 100.0 1,706 0.4 10-14 36.6 53.4 9.9 0.1 0.0 100.0 2,119 4.7 15-19 5.0 19.0 55.0 21.0 0.1 100.0 2,078 8.0 20-24 3.6 33.0 15.7 47.6 0.2 100.0 1,696 9.1 25-29 4.0 41.1 11.7 42.8 0.4 100.0 1,636 7.5 30-34 4.6 46.9 12.9 35.3 0.3 100.0 1,572 6.4 35-39 6.5 48.1 15.5 29.5 0.5 100.0 1,379 5.4 40-44 6.3 53.8 11.2 28.0 0.6 100.0 1,338 4.9 45-49 8.6 53.5 9.4 28.1 0.5 100.0 1,166 4.8 50-54 12.9 55.4 7.2 23.8 0.7 100.0 931 4.7 55-59 21.1 53.6 9.5 14.9 0.9 100.0 785 4.6 60-64 32.5 45.9 5.3 15.2 1.2 100.0 557 4.4 65+ 53.5 34.9 3.0 6.7 1.9 100.0 1,369 2.5 Residence Urban 19.8 36.3 15.4 28.1 0.4 100.0 12,638 5.4 Rural 30.5 45.6 13.2 10.1 0.7 100.0 5,713 4.5 Region West 18.8 42.3 13.9 24.5 0.4 100.0 7,221 4.9 South 24.6 40.2 15.5 19.0 0.8 100.0 2,376 4.8 Central 19.2 38.3 16.0 26.1 0.4 100.0 4,021 5.0 North 22.9 38.9 16.3 21.2 0.7 100.0 1,409 4.8 East 36.5 32.7 13.6 16.5 0.6 100.0 3,324 4.5 NUTS 1 Region İstanbul 17.6 40.1 15.1 26.6 0.6 100.0 3,244 5.1 West Marmara 20.0 45.5 13.9 19.8 0.9 100.0 752 4.8 Aegean 21.2 45.0 12.5 21.2 0.1 100.0 2,423 4.8 East Marmara 17.2 40.2 15.4 27.2 0.0 100.0 1,619 5.2 West Anatolia 17.3 36.4 15.4 30.7 0.2 100.0 1,696 5.7 Mediterranean 24.6 40.2 15.5 19.0 0.8 100.0 2,376 4.8 Central Anatolia 20.3 38.8 15.6 24.3 1.0 100.0 1,031 4.9 West Black Sea 22.7 40.6 16.5 19.5 0.6 100.0 1,173 4.8 East Black Sea 23.9 37.0 16.4 22.0 0.8 100.0 714 4.8 Northeast Anatolia 29.3 33.7 15.9 20.4 0.7 100.0 607 4.7 Central East Anatolia 35.7 30.6 13.5 19.6 0.6 100.0 962 4.6 Southeast Anatolia 39.4 33.6 12.9 13.5 0.5 100.0 1,755 4.4 Total 23.2 39.2 14.7 22.5 0.5 100.0 18,351 4.8 24 | Household Population and Housing Characteristics Table 2.5.2 Educational attainment of household population: Females Percent distribution of the de facto female household population age six and over by highest level of education attended or completed, according to background characteristics, Turkey 2003 Background characteristic No education/ Primary incomplete First level primary Second level primary High school and higher Missing Total Number of females Median number of years Age 6-9 99.6 0.1 0.0 0.0 0.3 100.0 1,691 0.4 10-14 38.5 51.5 9.9 0.0 0.1 100.0 2,126 4.6 15-19 14.9 28.7 41.6 14.8 0.0 100.0 2,103 7.4 20-24 12.3 43.5 9.7 34.5 0.0 100.0 2,137 4.9 25-29 13.2 48.3 7.4 31.1 0.0 100.0 1,876 4.8 30-34 18.0 55.0 7.3 19.7 0.0 100.0 1,647 4.6 35-39 22.6 54.4 6.4 16.5 0.1 100.0 1,508 4.5 40-44 30.0 48.9 5.1 15.9 0.1 100.0 1,408 4.4 45-49 33.9 49.3 4.7 12.1 0.0 100.0 1,135 4.3 50-54 54.5 32.3 3.3 9.6 0.3 100.0 1,070 2.5 55-59 66.2 24.9 2.3 6.0 0.6 100.0 743 0.0 60-64 68.3 23.5 1.9 5.3 0.9 100.0 636 0.0 65+ 82.6 12.7 1.5 2.4 0.0 100.0 1,576 0.0 Residence Urban 33.8 36.4 10.8 18.8 0.2 100.0 13,368 4.5 Rural 48.8 40.1 6.6 4.4 0.2 100.0 6,293 4.0 Region West 31.5 40.7 10.0 17.6 0.2 100.0 7,520 4.5 South 40.9 35.9 10.1 12.8 0.3 100.0 2,601 4.3 Central 31.8 42.0 10.9 15.3 0.0 100.0 4,431 4.5 North 38.2 38.5 9.8 13.1 0.3 100.0 1,531 4.3 East 60.2 26.6 6.1 6.9 0.2 100.0 3,579 1.8 NUTS 1 Region İstanbul 30.5 39.4 10.5 19.2 0.4 100.0 3,295 4.6 West Marmara 30.8 46.3 9.2 13.5 0.2 100.0 822 4.5 Aegean 32.1 42.7 9.1 16.1 0.0 100.0 2,610 4.5 East Marmara 32.4 41.1 10.9 15.4 0.2 100.0 1,652 4.5 West Anatolia 27.7 39.6 12.3 20.4 0.1 100.0 1,881 4.6 Mediterranean 40.9 35.9 10.1 12.8 0.3 100.0 2,601 4.3 Central Anatolia 38.1 40.3 9.5 12.1 0.0 100.0 1,157 4.3 West Black Sea 34.4 44.3 9.2 11.9 0.3 100.0 1,308 4.4 East Black Sea 43.1 32.2 10.6 13.9 0.2 100.0 756 4.2 Northeast Anatolia 52.4 30.7 7.5 9.2 0.2 100.0 667 3.2 Central East Anatolia 59.8 25.5 5.8 8.7 0.2 100.0 1,044 1.6 Southeast Anatolia 63.2 25.8 5.7 5.1 0.2 100.0 1,868 1.3 Total 38.6 37.6 9.5 14.2 0.2 100.0 19,661 4.3 Household Population and Housing Characteristics | 25 2.3.2 School Attendance Ratios The TDHS-2003 collected information on current school attendance for the population age 6-24 years. Figure 2.2 presents the percentage of the population in this age range that was attending school at the time of the survey. The comparatively low age-specific attendance rate for children age 6 reflects that some of these children had not had their sixth birthday at the time the school year started and thus were not eligible to attend school. Overall, the majority of children of both sexes age 15 and under were attending school. However, Figure 2.2 shows that school attendance rates are generally higher among boys than among girls. The gender gap in school attendance increases somewhat with age, particularly among the post-first level primary ages (i.e., 11-24 years). Table 2.6 provides net attendance ratios (NAR) and gross attendance ratios (GAR) by residence and region according to sex and school level. The NAR for primary school is the percentage of the primary school-age (6-13 years) population that is attending primary school. The NAR for high school is the percentage of the high school age (14-16 years) population that is attending high school. By definition, the NAR cannot exceed 100 percent. The GAR for primary school is the total number of primary school students of any age, expressed as the percentage of the official primary school age population. The GAR for high school is the total number of high school students up to age 24, expressed as the percentage of the official high school age population. If there are significant numbers of over-age and under-age students at a given level of schooling, the GAR can exceed 100 percent. Children are considered to be attending school currently if they attended at any point during the current school year. TDHS-2003 Figure 2.2 Age-Specific Attendance Rates 0 10 20 30 40 50 60 70 80 90 100 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age Percent Male Female 26 | Household Population and Housing Characteristics Table 2.6 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population by level of schooling and sex, according to background characteristics, Turkey 2003 Net attendance ratio Gross attendance ratio Background characteristic Male Female Total Male Female Total Gender Parity Index PRIMARY SCHOOL Residence Urban 91.5 89.2 90.3 100.4 94.3 97.3 0.94 Rural 88.8 82.8 85.9 100.4 88.0 94.5 0.88 Region West 93.9 93.5 93.7 102.8 98.0 100.3 0.95 South 91.7 90.0 90.8 99.3 94.8 97.1 0.95 Central 91.2 90.7 91.0 99.8 96.6 98.1 0.97 North 93.3 90.4 91.9 101.5 96.6 99.1 0.95 East 84.8 73.0 79.1 98.4 78.5 88.8 0.80 NUTS 1 Region İstanbul 94.6 92.3 93.4 102.3 96.9 99.4 0.95 West Marmara 94.7 91.7 93.1 103.7 95.2 99.2 0.92 Aegean 92.2 95.6 93.8 102.7 101.6 102.2 0.99 East Marmara 95.1 88.9 92.0 105.3 94.0 99.6 0.89 West Anatolia 91.2 91.2 91.2 100.3 94.4 97.2 0.94 Mediterranean 91.7 90.0 90.8 99.3 94.8 97.1 0.95 Central Anatolia 92.4 94.8 93.6 100.0 100.0 100.0 1.00 West Black Sea 90.6 92.0 91.3 98.5 102.1 100.3 1.04 East Black Sea 92.0 88.2 90.2 98.2 91.6 95.0 0.93 Northeast Anatolia 88.1 78.9 83.6 97.0 86.5 91.9 0.89 Central East Anatolia 81.6 73.3 77.6 101.4 79.1 90.6 0.78 Southeast Anatolia 85.4 70.9 78.5 97.3 75.7 87.0 0.78 Total 90.6 87.0 88.8 100.4 92.2 96.3 0.92 HIGH SCHOOL Residence Urban 60.9 57.1 59.0 89.9 76.6 83.4 0.85 Rural 38.3 28.1 33.3 62.6 37.9 50.4 0.61 Region West 56.7 56.2 56.5 83.8 76.4 80.4 0.91 South 56.2 47.0 51.5 85.5 63.8 74.4 0.75 Central 61.2 59.4 60.3 86.9 76.7 81.6 0.88 North 61.6 53.7 57.9 95.2 75.1 85.7 0.79 East 36.6 22.8 29.7 62.5 31.0 46.8 0.50 NUTS 1 Region İstanbul 58.6 57.4 58.1 86.7 73.7 80.5 0.85 West Marmara 60.9 60.5 60.7 86.7 85.8 86.3 0.99 Aegean 44.3 48.9 46.6 66.4 66.2 66.3 1.00 East Marmara 59.3 56.5 58.1 91.4 85.0 88.5 0.93 West Anatolia 70.5 69.8 70.1 91.8 85.0 88.2 0.93 Mediterranean 56.2 47.0 51.5 85.5 63.8 74.4 0.75 Central Anatolia 56.6 57.0 56.8 81.3 75.5 78.4 0.93 West Black Sea 63.1 46.0 54.1 100.2 62.7 80.5 0.63 East Black Sea 68.3 67.6 68.0 104.1 102.1 103.2 0.98 Northeast Anatolia 49.5 32.4 41.1 79.9 44.0 62.3 0.55 Central East Anatolia 35.6 23.0 29.3 66.1 31.0 48.6 0.47 Southeast Anatolia 32.8 19.5 26.1 54.3 26.6 40.4 0.49 Total 53.0 46.9 50.0 80.4 63.0 71.8 0.78 Household Population and Housing Characteristics | 27 Table 2.6 shows that 89 percent of primary school age children in Turkey are attending primary school. The NAR is higher in urban areas than in rural areas (90 and 86 percent, respectively), as is the GAR (97 and 95 percent, respectively). There is significant variation between the East and other regions: the NAR in the East is 79 percent while it is over 90 percent in all other regions. At the high school level, the NAR is 50 percent and the GAR is 72 percent. Regional disparities at the high school level are even more pronounced than at the primary school level: the NAR, for example, ranges from a low of 26 percent in Southeast Anatolia, to a high of 70 percent in West Anatolia. The Gender Parity Index (GPI) represents the ratio of the GAR for females to the GAR for males. It is presented for both the primary and high school levels and offers a summary measure of the extent to which there are gender differences in attendance rates. A GPI of less than 1 indicates that a smaller proportion of females than males attend school. The GPI for primary school is 0.92 and for high school is 0.78. Although there is little urban-rural differential at the primary school level, there is significant difference at the high school level. Once again, regional differentials are significant; the data indicate that girls residing in the eastern part of Turkey are particularly disadvantaged. Gender disparities by age in school attendance at any level are also shown in Figure 2.2. 2.3.3 Repetition and Dropout Rates The repetition rate is the percentage of students in a given grade the previous school year who are repeating that grade in the current school year. The dropout rate is the percentage of students who were enrolled in school in the previous school year but were not attending school during the current school year. By asking about the grade that children were attending during the previous school year, it is possible to calculate dropout rates and repetition rates. Repetition and dropout rates approach zero where students nearly always progress to the next grade at the end of the school year. Repetition and dropout rates often vary across grades, indicating points in the school system where students are not regularly promoted to the next grade or they decide to drop out of school. Although an automatic promotion policy does not operate officially in Turkey, very few primary school students repeat grades. Table 2.7.1 indicates that apart from first grade, at which 3 percent are repeating, the rates for grades 2 to 8 are all below 2 percent. 28 | Household Population and Housing Characteristics Table 2.7.1 Grade repetition rates Repetition rates for the de jure household population age 6-24 years by school grade, according to background characteristics, Turkey 2003 School grade Background characteristic 1 2 3 4 5 6 7 8 Sex Male 3.4 2.1 1.4 1.1 1.2 0.7 2.3 2.1 Female 2.7 1.4 0.1 1.6 0.5 1.5 0.5 0.6 Residence Urban 3.0 1.9 0.6 1.6 1.0 0.8 1.5 1.3 Rural 3.1 1.4 1.2 0.8 0.6 1.3 1.4 1.8 Region West 3.4 2.1 0.6 0.8 0.3 0.0 0.9 2.2 South 4.2 1.7 2.0 2.8 3.4 1.7 1.5 0.5 Central 0.0 2.3 0.0 1.8 0.0 2.2 3.3 1.3 North 0.0 3.6 0.0 1.1 1.5 1.5 0.6 2.2 East 4.8 0.5 1.3 1.1 0.8 0.8 0.4 0.8 NUTS 1 Region İstanbul 0.0 4.4 1.2 1.6 0.8 0.0 2.2 1.4 West Marmara 3.0 0.0 0.0 0.0 0.0 0.0 0.0 2.4 Aegean 6.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 East Marmara 5.0 2.0 0.0 0.8 0.0 0.0 1.3 6.9 West Anatolia 0.0 0.0 0.0 2.2 0.0 2.1 2.1 0.0 Mediterranean 4.2 1.7 2.0 2.8 3.4 1.7 1.5 0.5 Central Anatolia 0.0 0.0 0.0 1.9 0.0 1.9 6.7 0.0 West Black Sea 0.0 8.0 0.0 1.3 1.1 3.8 1.3 5.1 East Black Sea 0.0 0.0 0.0 0.0 1.4 0.0 1.3 0.0 Northeast Anatolia 5.5 0.0 3.7 0.0 0.0 0.0 0.0 0.0 Central East Anatolia 3.0 0.0 0.0 0.0 1.4 1.7 0.0 0.0 Southeast Anatolia 5.2 0.8 1.1 2.0 0.7 0.6 0.8 1.8 Total 3.1 1.8 0.8 1.4 0.9 1.0 1.4 1.5 As Table 2.7.2 indicates, dropout rates are also low (2 percent or less) from grades 1 through 7. At the eighth grade, the dropout rate increases to 20 percent. The reason for the high dropout rate at grade 8 is probably because many of the students who complete the 8- year compulsory primary school do not or are unable to move to the next educational level (i.e., high school). There is variation in the rates by residence. For example, rural children are more than two times as likely as urban children to drop out of school at grade 8. Differentials in the dropout rate by region are small. However, at grade 8, significant differentials exist in dropout rates by NUTS 1 regions. Household Population and Housing Characteristics | 29 Table 2.7.2 Dropout rates Dropout rates for the de jure household population age 6-24 years by school grade, according to background characteristics, Turkey 2003 School grade Background characteristic 1 2 3 4 5 6 7 8 Sex Male 0.0 0.3 0.0 0.2 1.7 1.0 0.0 19.1 Female 0.4 0.5 0.8 1.9 2.6 1.3 0.0 21.3 Residence Urban 0.0 0.7 0.2 1.0 1.8 0.9 0.0 14.8 Rural 0.6 0.0 0.8 1.2 2.8 1.7 0.0 32.0 Region West 0.0 1.1 0.0 1.5 1.5 0.0 0.0 17.8 South 0.0 0.0 0.0 0.9 0.5 2.1 0.0 20.7 Central 0.0 0.0 0.0 0.0 2.0 0.0 0.0 19.9 North 1.7 0.0 2.8 2.2 0.0 1.6 0.0 21.5 East 0.3 0.3 0.8 1.0 4.9 3.1 0.0 22.9 NUTS 1 Region İstanbul 0.0 2.2 0.0 0.8 1.2 0.0 0.0 13.6 West Marmara 0.0 0.0 0.0 0.0 0.0 0.0 0.0 25.1 Aegean 0.0 0.0 0.0 0.0 2.4 0.0 0.0 31.6 East Marmara 0.0 0.0 0.0 6.5 2.6 0.0 0.0 13.5 West Anatolia 0.0 0.0 0.0 0.0 0.0 0.0 0.0 17.2 Mediterranean 0.0 0.0 0.0 0.9 0.5 2.1 0.0 20.7 Central Anatolia 0.0 0.0 0.0 0.0 0.0 0.0 0.0 19.8 West Black Sea 0.0 0.0 3.7 0.0 3.5 0.0 0.0 21.9 East Black Sea 2.5 0.0 0.0 4.4 0.0 3.2 0.0 12.1 Northeast Anatolia 0.0 0.0 0.8 0.9 3.3 5.3 0.0 24.8 Central East Anatolia 0.0 0.0 1.3 1.2 2.7 5.1 0.0 18.2 Southeast Anatolia 0.5 0.4 0.5 1.0 7.0 1.3 0.0 25.4 Total 0.2 0.4 0.4 1.0 2.1 1.1 0.0 20.0 2.4 Housing Characteristics The TDHS-2003 gathered information on housing characteristics such as sources of drinking water and time to the nearest water source, type of toilet facilities, main material of the floor, and the number of sleeping rooms in the house. These characteristics are highly correlated with health and are also indicative of socioeconomic status. Table 2.8 presents this information by urban–rural residence. 30 | Household Population and Housing Characteristics Table 2.8 Housing characteristics Percent distribution of households by housing characteristics, according to urban- rural residence, Turkey 2003 Housing characteristic Urban Rural Total Source of drinking water Piped water in house/garden 64.1 16.5 50.1 Public piped water outside house/garden 0.5 0.1 0.4 Public well 0.6 1.8 0.9 Well in house/garden 0.7 6.4 2.4 Piped surface water in house/garden 2.5 60.6 19.6 Spring/public fountain 4.5 10.9 6.4 River/stream/pond/lake/dam 0.0 0.2 0.1 Rainwater 0.0 0.1 0.0 Tanker truck 0.3 0.2 0.3 Bottled water 26.4 2.8 19.5 Water station 0.2 0.1 0.2 Other 0.1 0.2 0.1 Missing 0.1 0.0 0.0 Total 100.0 100.0 100.0 Time to water source Percentage <15 minutes 96.1 93.0 95.2 Sanitation facility Flush toilet 92.7 35.7 75.9 Open pit 1.8 22.9 8.0 Closed pit 5.0 38.5 14.8 No facility, bush/field/public toilet 0.2 1.1 0.5 Other 0.3 1.8 0.7 Missing 0.1 0.0 0.1 Total 100.0 100.0 100.0 Flooring material Earth 0.8 12.0 4.1 Wood planks 10.8 27.1 15.6 Parquet/polished wood 22.1 4.9 17.1 Karo 10.4 4.5 8.6 Cement 22.5 42.0 28.3 Carpet 8.6 4.0 7.2 Marley 21.1 3.3 15.8 Mosaic 2.8 1.0 2.3 Other 0.9 1.0 0.9 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Persons per sleeping room 1-2 77.5 64.9 73.8 3-4 18.5 25.4 20.5 5-6 2.8 6.8 4.0 7+ 0.5 2.1 1.0 Don’t know/missing 0.7 0.8 0.7 Total 100.0 100.0 100.0 Mean number of persons per sleeping room 2.2 2.6 2.3 Number of households 7,643 3,193 10,836 Household Population and Housing Characteristics | 31 Overall, about half of the households get their drinking water from pipes, mainly within their dwelling. The source for drinking water differs considerably by residence. Among urban households, 64 percent get drinking water from pipes in their residence, and less than 1 percent obtains water from a public tap. The second most common source of drinking water in urban areas is bottled water (26 percent), while 5 percent obtain drinking water from a spring/public fountain. Around two-thirds of rural households report having piped water; however, for nearly half of these households, the source for the piped water is a river, stream or other surface water. More than one in ten rural households obtains water from a spring. Households in rural Turkey are somewhat more likely to be relying on well water than households in urban Turkey (8 percent and 1 percent respectively). Households with no access to drinking water within their own premises were also asked about the time required to fetch water. Overall, 95 percent of households have access to water within 15 minutes. As expected, there is better access to water in urban areas than in rural areas. The lack of availability of sanitary facilities poses a serious health problem. Two- thirds of households have modern sanitation facilities in Turkey. Modern sanitation facilities are much more common in urban areas (93 percent) than in rural areas (36 percent). Twenty-three percent of households have a traditional pit toilet or improved pit toilet (7 percent in urban areas, and 61 percent in rural areas). With regard to flooring, more than a quarter of the TDHS-2003 households live in dwellings with cement floors, and 17 percent in dwellings with a polished wood floor. Another 16 percent have wood planks as flooring material in their dwelling. There are substantial differences in the flooring materials in urban and rural dwellings. Among rural households, 42 percent have a cement floor, compared with about 23 percent of urban households. Wood and marley are also common as a flooring material in urban households: about a half of urban households live in dwellings with wood or marley floors. Twelve percent of households in rural areas have earth floors, compared to less than 1 percent of households in urban areas. Information on the number of rooms that a household uses for sleeping was collected to determine the extent of crowding. Table 2.8 shows that approximately 74 percent of households have one or two persons per sleeping room, and 21 percent have three to four persons per sleeping room. On average, there are 2.3 persons per sleeping room in Turkey. Rural households have more people per sleeping room than urban households (2.6 and 2.2 persons per sleeping room, respectively). 2.5 Household Durable Goods The availability of durable consumer goods is a good indicator of household socio- economic level. Moreover, particular goods have specific benefits. For example, having access to a television exposes household members to innovative ideas, and a refrigerator prolongs the wholesomeness of foods. Table 2.9 presents the availability of selected consumer goods by residence. 32 | Household Population and Housing Characteristics Table 2.9 Household durable goods Percentage of households possessing various durable consumer goods, by urban- rural residence, Turkey 2003 Durable consumer goods Urban Rural Total Refrigerator 96.4 89.5 94.3 Gas or electric oven 78.9 53.0 71.3 Washing machine 86.5 58.8 78.3 Iron 91.3 70.2 85.1 Vacuum cleaner 85.1 52.9 75.6 Television 96.8 89.8 94.7 Telephone 81.5 75.2 79.6 Cellular phone 74.2 50.4 67.2 None of the above 0.4 2.6 1.0 Microwave oven 9.1 2.7 7.2 Dishwasher 28.9 5.7 22.1 Blender/mixer 47.2 19.9 39.2 DVD/VCD player 38.8 14.6 31.7 Video camera 4.4 1.3 3.5 Digiturk/CINE 5/satellite antenna 12.0 19.6 14.3 Air conditioner 6.1 1.4 4.7 Video 8.9 3.4 7.3 Cable TV 8.6 0.4 6.2 Camera 40.3 18.5 33.9 CD player 22.7 7.6 18.2 Computer 15.4 2.6 11.6 Internet 8.4 1.2 6.3 Car 28.1 20.3 25.8 Taxi/minibus/commercial vehicles 4.7 6.6 5.3 Tractor 1.7 19.6 7.0 Motorcycle 3.3 7.6 4.5 Bicycle 20.9 15.3 19.3 Number of households 7,643 3,193 10,836 Most of the population in Turkey enjoys the convenience of electrical appliances. Television sets and refrigerators are present in more than nine in ten households, while almost eight in ten households have a telephone. More than seven in ten households own an oven, a vacuum cleaner or a washing machine. Ownership of various durable goods varies by place of residence, with higher proportions of ownership for all items reported among households in urban areas as compared to rural areas. Women’s Characteristics and Status | 33 WOMEN’S CHARACTERISTICS AND STATUS 3 Attila Hancıoğlu and Banu Akadlı Ergöçmen The purpose of this chapter is to provide a description of the situation of women in Turkey. This information is useful for understanding the context of reproduction and health and as indicators of the status of women and women’s empowerment. Distributions of interviewed women by various demographic and socioeconomic characteristics are shown in the tables that follow. The main background characteristics that will be used in subsequent chapters, such as age at the time of interview, region, urban-rural residence and education are examined. In addition, information is provided on women’s employment and work status. 3.1 Background Characteristics A description of the basic characteristics of women interviewed in the TDHS-2003 is provided in Table 3.1. The table includes distributions of ever-married women interviewed in the survey, by age, marital status, urban-rural residence, region of residence, and education. Women were asked two questions in the individual interview to assess their age: "In what month and year were you born?" and "How old are you?" Interviewers were trained to probe in situations in which respondents knew neither their age nor date of birth; as a last resort, interviewers were instructed to record their best estimate of the respondent's age. The data on age indicate that a third of women interviewed are less than 30 years of age. The lower proportions in the first two age groups, 15-19 and 20-24 are a result of the ever-married sample; significant proportions of women have not married by these ages. The decline at the upper end of the age categories, on the other hand, is a result of high fertility in the past; the figures imply that successively larger cohorts of women entered the reproductive age groups during the recent decades. Ninety-five percent of women were married at the time of interview, while the rest were either divorced/separated (3 percent) or widowed (2 percent). These figures indicate the rarity of marital dissolution in Turkey. Seventy-one percent of ever-married women live in urban areas. In regard to regional distribution, 4 in every 10 women live in the West, while only 7 percent of ever-married women in the country reside in the North region. With regard to NUTS 1 regions, almost a fifth of ever-married women are in İstanbul, followed by 14 percent in the Aegean and 13 percent in the Mediterranean region. 34 | Women’s Characteristics and Status Table 3.1 Background characteristics of respondents Percent distribution of women by background characteristics, Turkey 2003 Number of women Background characteristic Weighted percent Weighted Unweighted Age 15-19 2.9 238 240 20-24 12.9 1,045 1,080 25-29 18.3 1,480 1,516 30-34 18.4 1,489 1,506 35-39 17.6 1,420 1,410 40-44 16.5 1,330 1,297 45-49 13.3 1,073 1,026 Marital status Married 95.0 7,672 7,686 Divorced/separated 2.9 237 208 Widowed 2.1 166 181 Residence Urban 71.2 5,752 5,976 Rural 28.8 2,323 2,099 Region West 40.7 3,286 2,331 South 12.7 1,028 1,113 Central 23.1 1,867 1,484 North 7.3 590 901 East 16.2 1,305 2,246 NUTS 1 Region İstanbul 18.2 1,470 1,163 West Marmara 4.3 348 384 Aegean 14.3 1,157 549 East Marmara 8.8 710 556 West Anatolia 9.7 784 466 Mediterranean 12.7 1,028 1,113 Central Anatolia 5.8 471 502 West Black Sea 6.3 513 615 East Black Sea 3.6 291 481 Northeast Anatolia 3.0 245 535 Central East Anatolia 4.8 389 566 Southeast Anatolia 8.3 671 1,145 Education No education/Prim. incom. 21.8 1,761 2,032 First level primary 53.7 4,339 4,120 Second level primary 7.4 601 585 High school and higher 17.0 1,374 1,338 Total 100.0 8,075 8,075 The distribution of women by levels of education is striking, and provides clues as to the recent significant changes in reproductive and health behavior in Turkey. While one in every five women has no education or has not completed first level primary school, a significant proportion (17 percent) has completed at least high school. Comparing these figures with the TDHS-1993 results, one finds that women in reproductive age groups today are far more educated than 10 years ago. The proportion of women who have completed at least second level primary school increased from 15 percent in 1993 to 24 percent in 2003, a Women’s Characteristics and Status | 35 relative increase of about 60 percent. On the other hand, the proportion of women who have not completed first level primary school declined from 34 percent to 22 percent in the same period. 3.2 Respondents’ Level of Education by Background Characteristics Table 3.2 shows the distribution of women by the highest level of education attended or completed, according to selected characteristics. The table is shown to clarify the relationship between education and other explanatory or background variables used in later tabulations. Differences in the educational composition of respondents from different age groups, regions, and urban-rural backgrounds are of particular interest. Table 3.2 Educational attainment by background characteristics Percent distribution of women by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Turkey 2003 Background characteristic No education/ Primary incomplete First level primary Second level primary High school and higher Total Number of women Median years of schooling Age 15-19 26.6 49.8 15.9 7.6 100.0 238 4.5 20-24 14.1 56.7 12.3 16.9 100.0 1,045 4.7 25-29 13.8 53.6 8.0 24.5 100.0 1,480 4.7 30-34 18.4 56.5 7.3 17.8 100.0 1,489 4.6 35-39 23.0 55.5 6.0 15.5 100.0 1,420 4.5 40-44 29.6 50.2 5.4 14.8 100.0 1,330 4.4 45-49 32.8 50.0 4.7 12.5 100.0 1,073 4.4 Residence Urban 18.3 50.9 9.0 21.8 100.0 5,752 4.7 Rural 30.5 60.8 3.6 5.0 100.0 2,323 4.3 Region West 14.6 56.0 8.7 20.7 100.0 3,286 4.7 South 23.6 53.1 7.9 15.4 100.0 1,028 4.5 Central 13.2 62.8 7.2 16.9 100.0 1,867 4.6 North 19.6 57.0 6.5 16.9 100.0 590 4.6 East 51.8 33.9 4.9 9.4 100.0 1,305 0.0 NUTS 1 Region İstanbul 14.2 55.3 9.1 21.4 100.0 1,470 4.7 West Marmara 10.3 64.1 9.1 16.5 100.0 348 4.6 Aegean 16.1 58.3 6.8 18.7 100.0 1,157 4.6 East Marmara 13.6 56.9 9.8 19.7 100.0 710 4.7 West Anatolia 12.0 56.8 8.3 22.9 100.0 784 4.7 Mediterranean 23.6 53.1 7.9 15.4 100.0 1,028 4.5 Central Anatolia 18.0 63.6 6.1 12.3 100.0 471 4.5 West Black Sea 12.4 67.6 5.5 14.6 100.0 513 4.6 East Black Sea 25.5 49.4 7.3 17.9 100.0 291 4.5 Northeast Anatolia 42.1 39.3 5.1 13.4 100.0 245 4.2 Central East Anatolia 50.2 34.1 5.2 10.5 100.0 389 0.0 Southeast Anatolia 56.3 31.9 4.6 7.2 100.0 671 0.0 Total 21.8 53.7 7.4 17.0 100.0 8,075 4.6 36 | Women’s Characteristics and Status Owing to increases and spread of education in recent decades in Turkey, older women are less educated than younger women. A third of women in the final age group have had no educational level completed, but this proportion declines to 14 percent in the 20-24 and 25-29 age groups. A striking 25 percent of women in the latter age group have completed at least high school. Urban women in Turkey are much more likely to have higher education than their rural counterparts. Thirty one percent of rural women have no educational level completed, compared to only 18 percent of urban women. Conversely, while 22 percent of urban women have completed at least high school, this figure is a mere 5 percent in rural areas. The least educated women are in the East region, particularly in Central East Anatolian and Southeast Anatolian NUTS 1 regions, where the median years of schooling is 0.0, compared with the national average of 4.6 years. On the other hand, women in half of the NUTS 1 regions have more than 4.5 median years of schooling. In İstanbul and West Anatolia, more than a fifth of women have completed at least high school. 3.3 Employment and Occupation The TDHS-2003 collected information on the current employment of women. Employment, like education, can be a source of empowerment of women, particularly if it is accompanied with control over income. However, because women may not perceive some of their activities–such as unpaid family work–as employment, it can be difficult to collect information on the subject. In the TDHS-2003, a number of questions were asked about employment to ensure that informal or potentially ill-defined activities were captured. Table 3.3 indicates that 42 percent of women report being employed during the 12- month period before the interview. The majority of these women (27 percent) were working at the time of the survey. The proportion of women not employed during the 12 months preceding the survey is inversely correlated with women’s age–younger women tend to be employed less than their older counterparts. A strong association exists between employment and marital status–employment among women not currently married is substantially higher than among currently married women, possibly as a result of women assuming the role of breadwinner in the absence of a husband. As expected, childbearing has an impact on employment, where nulliparous women are more likely to be employed than women who have children. Also shown in the table is the finding that women in the North are economically more active than their counterparts in other regions. The lowest level of employment is among women in the Central and East regions. The distribution by NUTS 1 regions reveals that more than half of women in the West Marmara, Aegean, West Black Sea, and Northeast Anatolia, and two-thirds of women in the East Black Sea region are employed at any time during the last 12 months. The table also shows that current employment is more common among better educated women (38 percent). Women’s Characteristics and Status | 37 Table 3.3 Employment status Percent distribution of women by employment status, according to background characteristics, Turkey 2003 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not employed in 12 months preceding the survey Don't know/ missing Total Number of women Age 15-19 18.7 18.2 63.1 0.0 100.0 238 20-24 18.4 15.7 65.9 0.1 100.0 1,045 25-29 24.1 14.5 61.4 0.0 100.0 1,480 30-34 27.7 16.0 56.3 0.0 100.0 1,489 35-39 35.5 12.4 52.2 0.0 100.0 1,420 40-44 30.4 14.2 55.3 0.0 100.0 1,330 45-49 25.0 14.8 60.2 0.0 100.0 1,073 Marital status Married or living together 26.1 14.6 59.2 0.0 100.0 7,672 Divorced/separated/widowed 43.9 15.2 40.9 0.0 100.0 403 Number of living children 0 30.1 22.9 46.9 0.1 100.0 736 1-2 27.6 12.7 59.7 0.0 100.0 4,234 3-4 24.7 15.6 59.7 0.0 100.0 2,312 5+ 28.0 14.7 57.4 0.0 100.0 794 Residence Urban 21.7 11.1 67.2 0.0 100.0 5,752 Rural 40.1 23.6 36.3 0.0 100.0 2,323 Region West 27.8 14.7 57.5 0.0 100.0 3,286 South 25.3 15.6 59.1 0.0 100.0 1,028 Central 24.9 13.8 61.2 0.0 100.0 1,867 North 32.3 27.2 40.4 0.1 100.0 590 East 26.8 9.4 63.7 0.0 100.0 1,305 NUTS 1 Region İstanbul 24.3 9.3 66.4 0.0 100.0 1,470 West Marmara 29.8 21.7 48.5 0.0 100.0 348 Aegean 37.1 19.8 43.1 0.0 100.0 1,157 East Marmara 25.2 11.5 63.3 0.0 100.0 710 West Anatolia 21.9 11.3 66.8 0.0 100.0 784 Mediterranean 25.3 15.6 59.1 0.0 100.0 1,028 Central Anatolia 20.4 13.5 66.1 0.0 100.0 471 West Black Sea 25.0 27.9 47.0 0.1 100.0 513 East Black Sea 36.2 28.8 34.9 0.0 100.0 291 Northeast Anatolia 42.1 9.5 48.4 0.0 100.0 245 Central East Anatolia 29.4 5.9 64.6 0.2 100.0 389 Southeast Anatolia 19.8 11.4 68.8 0.0 100.0 671 Education No education/Prim. incomp. 26.3 14.5 59.2 0.0 100.0 1,761 First level primary 24.6 16.8 58.7 0.0 100.0 4,339 Second level primary 21.1 9.9 69.0 0.0 100.0 601 High school and higher 38.2 10.4 51.3 0.1 100.0 1,374 Total 27.0 14.7 58.3 0.0 100.0 8,075 38 | Women’s Characteristics and Status 3.4 Decision on Use of Earnings The status of women correlates strongly with their independence in making decisions on the use of their earnings. Table 3.4 shows that around 38 percent of women make their own decisions about the use of their earnings, half of women decide jointly with their husband or others, and 10 percent are not involved in the decisions. Independent decision making with regard to the use of earnings is higher among older women, while 26 percent of women in age group 15-19 have no say in how their earnings are to be used. Independent decision making is also higher among women not currently married, and correlated positively with increasing numbers of children. While urban women are more in control of their earnings, women in the East constitute the group of women in the country with the least say in the use of their earnings. This is particularly highlighted in Southeast Anatolia. A very small proportion of women with high school or more education declared that they do not have a say in the decision on use of earnings (1 percent). Close to two-thirds of these women take such decisions with their husbands or others (63 percent), while independent decision making is the least common among women with less education: women who have no education or have not completed the first level primary school cite others to a larger extent as prime decision-makers in the use of their earnings. Table 3.4 also shows the proportion of household expenditures met by women’s earnings, as perceived by women. In general, women’s earnings meet almost none or less than half of the expenditures of households for 57 percent of cases. Women whose earnings meet half or more of household expenditures account for 42 percent. Women’s earnings are particularly important contributions to household expenditures in cases when the woman is not currently married. Women whose earnings meet all expenditures are mostly women at comparatively older ages, women who are divorced, separated or widowed; nulliparous women; and women with higher education. Although regional variation is not very pronounced, more than 40 percent of women living in the West and North regions meet all or more than half of the expenditures with their earnings. Table 3.5 shows the relationship between the decision on how earnings of women are used and the proportion of household expenditures met by women’s earnings. The table is confined to currently married women since the numbers of women who were not married at the time of interview was too low to allow meaningful analyses. The table shows an interesting relationship between the two variables. In cases when the woman’s earnings do not contribute significantly to meeting the household expenditures, independent decision making among women is more common (56 percent) than the national average (32 percent). Conversely, it is interesting to note that in cases when the woman’s earnings meet all of the household’s needs, significant proportions of women still decide on how their earnings will be used jointly with their husband (55 percent) or have no say in how they will be used–for 9 percent of women, husbands make the decision, for 6 percent, others. Women’s Characteristics and Status | 39 Table 3.4 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Turkey 2003 Person deciding how earnings are used Proportion of expenditures met by earnings Background characteristic Self only Jointly Someone else only Missing Total Almost none/ none Less than half Half or more All Missing Total Number of women Age 15-19 (28.4) (45.4) (26.2) (0.0) 100.0 (25.9) (51.6) (22.5) (0.0) (0.0) 100.0 45 20-24 33.0 54.1 12.8 0.0 100.0 16.4 41.9 34.3 5.4 2.0 100.0 195 25-29 32.7 59.8 7.5 0.0 100.0 13.5 41.0 35.0 9.2 1.2 100.0 376 30-34 35.9 56.6 7.2 0.3 100.0 13.6 48.7 28.0 8.6 1.1 100.0 398 35-39 41.7 46.6 11.4 0.3 100.0 11.0 46.9 29.7 11.0 1.4 100.0 407 40-44 41.3 48.5 10.2 0.0 100.0 9.3 43.6 35.9 9.7 1.6 100.0 365 45-49 41.1 48.9 10.0 0.0 100.0 10.1 41.0 36.1 11.0 1.7 100.0 207 Marital status Married or living together 32.0 57.1 10.7 0.1 100.0 12.7 46.1 33.4 6.4 1.3 100.0 1,782 Divorced/separated/ widowed 84.6 12.3 3.1 0.0 100.0 10.0 31.2 24.3 32.4 2.0 100.0 210 Number of living children 0 37.0 55.9 7.1 0.0 100.0 12.8 30.7 41.7 13.7 1.1 100.0 267 1-2 36.5 55.9 7.6 0.1 100.0 11.3 44.7 33.8 9.1 1.1 100.0 1,177 3-4 39.8 44.2 15.7 0.2 100.0 13.7 50.8 26.9 6.9 1.7 100.0 445 5+ 42.2 38.8 19.1 0.0 100.0 18.7 51.5 17.0 8.1 4.7 100.0 103 Residence Urban 40.3 53.8 5.9 0.1 100.0 10.7 42.8 36.2 9.2 1.1 100.0 1,551 Rural 27.9 47.5 24.3 0.2 100.0 18.6 50.7 19.3 9.0 2.4 100.0 442 Region West 36.8 54.7 8.5 0.0 100.0 10.9 43.5 34.9 9.6 1.0 100.0 1,048 South 37.0 50.4 11.8 0.8 100.0 15.0 46.8 28.5 8.1 1.7 100.0 254 Central 38.7 51.8 9.5 0.0 100.0 12.7 47.3 31.0 8.5 0.5 100.0 405 North 47.8 46.1 6.1 0.0 100.0 14.4 44.2 31.8 9.5 0.0 100.0 121 East 32.9 46.9 20.3 0.0 100.0 15.9 41.6 27.0 8.9 6.6 100.0 165 NUTS 1 Region İstanbul 44.3 49.4 6.4 0.0 100.0 10.0 40.8 39.9 8.3 1.0 100.0 455 West Marmara 22.2 67.3 10.6 0.0 100.0 18.2 34.6 37.7 8.4 1.1 100.0 102 Aegean 30.3 54.5 15.2 0.0 100.0 10.4 51.2 27.9 9.3 1.2 100.0 428 East Marmara 40.3 56.2 3.5 0.0 100.0 9.9 48.3 30.0 11.9 0.0 100.0 173 West Anatolia 37.1 59.7 3.2 0.0 100.0 8.0 43.7 37.8 9.9 0.6 100.0 176 Mediterranean 37.0 50.4 11.8 0.8 100.0 15.0 46.8 28.5 8.1 1.7 100.0 254 Central Anatolia 45.6 46.6 7.8 0.0 100.0 21.6 41.6 27.3 8.5 1.0 100.0 82 West Black Sea 46.4 44.4 9.2 0.0 100.0 20.4 40.0 29.0 10.6 0.0 100.0 96 East Black Sea 48.6 46.8 4.6 0.0 100.0 10.4 44.5 35.8 9.3 0.0 100.0 60 Northeast Anatolia 38.4 54.5 7.1 0.0 100.0 27.0 41.3 26.0 3.1 2.5 100.0 32 Central East Anatolia 45.7 42.5 11.8 0.0 100.0 19.1 45.9 25.8 6.0 3.3 100.0 44 Southeast Anatolia 24.5 46.3 29.2 0.0 100.0 10.5 39.5 27.9 12.4 9.8 100.0 89 Education No educ./Prim.incom. 34.7 43.2 21.7 0.3 100.0 12.2 47.5 27.9 8.2 4.2 100.0 314 First level primary 39.1 48.8 12.0 0.0 100.0 16.0 52.7 23.3 6.9 1.1 100.0 932 Second level primary 40.4 52.8 6.8 0.0 100.0 16.7 42.7 30.4 10.2 0.0 100.0 149 High school and higher 36.0 62.6 1.3 0.2 100.0 6.0 30.8 49.6 12.9 0.8 100.0 598 Total 37.6 52.4 9.9 0.1 100.0 12.4 44.6 32.4 9.2 1.4 100.0 1,992 Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. 40 | Women’s Characteristics and Status Table 3.5 Women's control over earnings Percent distribution of currently married women who received cash earnings for work in the past 12 months by person who decides how earnings are used, according to the proportion of household expenditures met by earnings, Turkey 2003 Contribution to household expenditures Self only Jointly with husband Jointly with someone else Husband only Someone else only Missing Total Number of women Almost none/none 55.7 31.6 0.0 11.1 1.2 0.5 100.0 227 Less than half 33.5 54.1 0.4 10.1 1.9 0.0 100.0 822 Half or more 22.1 71.9 0.2 5.3 0.5 0.0 100.0 595 All 30.3 55.2 0.0 9.0 5.5 0.0 100.0 114 Missing (11.5) (26.8) (0.0) (42.9) (14.2) (4.6) 100.0 24 Total 32.0 56.9 0.2 9.0 1.8 0.1 100.0 1,782 Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. 3.5 Domestic Violence: Women’s Attitudes towards Being Subject to Physical Violence Recent years have witnessed an increasing interest in violence against women, in particular domestic violence. Domestic violence against women is acknowledged worldwide as a violation of the basic human rights of women. Tolerance and experience of domestic violence form significant barriers to the empowerment of women and women’s autonomy in all spheres of social life and have adverse consequences for women’s health, health-seeking behavior, and the health of their children. In the TDHS-2003, women were asked a number of questions on their attitudes regarding especially physical violence, which is one of the special types of domestic violence, with regard to whether they viewed physical violence as justified under given circumstances. Women were asked whether a husband would be justified in beating his wife for each of the following reasons separately: if she burns the food, if she argues with him, if she spends too much money, if she neglects the children, and if she refuses to have sex with him. Table 3.6 gives the percentages of ever-married women who agree with the specified reasons for wife beating by background characteristics. Thirty-nine percent of women accept at least one reason as a justification for wife beating. Women are most likely to think that wife beating would be justified in cases when the woman argues with the husband (29 percent), spends too much money (27 percent) and neglects the children (23 percent). Only 6 percent of women agree that wife beating would be justified if the woman burns the food. Younger women, currently married women, and women with high fertility are more likely than their counterparts to think that wife beating is justified for at least one of the reasons. Women’s Characteristics and Status | 41 Table 3.6 Women's attitude toward wife beating Percentage of women who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Turkey 2003 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Spends too much money Neglects the children Refuses to have sex with him Agrees with at least one specified reason Number of women Age 15-19 8.3 52.4 38.7 33.1 21.5 63.0 238 20-24 4.9 31.2 28.5 23.4 12.6 40.2 1,045 25-29 3.4 25.0 21.9 19.9 12.2 35.3 1,480 30-34 4.8 26.9 24.1 22.7 12.8 37.0 1,489 35-39 7.3 30.0 29.3 23.6 19.1 40.3 1,420 40-44 7.2 28.1 29.1 23.8 19.6 39.2 1,330 45-49 7.0 30.2 28.5 24.8 21.5 39.8 1,073 Marital status Married or living together 5.7 29.5 27.3 23.2 16.3 39.6 7,672 Divorced/separated/widowed 7.1 21.7 21.8 23.4 15.2 31.5 403 Number of living children 0 5.9 30.0 26.9 24.0 14.5 37.9 736 1-2 3.7 22.9 20.7 18.2 11.1 31.8 4,234 3-4 6.5 33.3 31.0 26.8 19.9 44.7 2,312 5+ 14.8 48.6 49.4 38.8 35.2 63.6 794 Residence Urban 3.3 22.2 20.3 18.9 12.0 32.1 5,752 Rural 12.0 46.0 43.7 33.7 26.8 56.6 2,323 Region West 3.5 22.9 21.0 19.2 12.6 32.5 3,286 South 4.6 31.1 30.7 24.8 17.4 43.2 1,028 Central 7.0 34.0 30.0 24.6 16.5 42.9 1,867 North 4.6 24.5 25.0 23.5 15.0 35.5 590 East 11.3 37.9 36.0 29.7 25.1 49.2 1,305 NUTS 1 Region İstanbul 1.6 17.7 16.7 15.2 9.5 26.8 1,470 West Marmara 4.8 24.2 23.9 21.1 12.2 35.0 348 Aegean 8.5 37.2 32.6 28.6 20.2 46.7 1,157 East Marmara 2.8 21.9 19.4 18.4 13.1 31.3 710 West Anatolia 6.7 27.7 25.4 21.1 12.1 35.1 784 Mediterranean 4.6 31.1 30.7 24.8 17.4 43.2 1,028 Central Anatolia 4.8 36.1 30.7 25.9 17.8 47.8 471 West Black Sea 5.3 28.7 28.5 24.2 15.3 39.6 513 East Black Sea 3.8 23.6 22.7 20.9 14.5 33.7 291 Northeast Anatolia 12.8 38.5 37.7 30.9 25.2 50.4 245 Central East Anatolia 10.0 34.2 33.2 28.6 21.9 45.9 389 Southeast Anatolia 11.6 39.8 37.1 30.0 26.9 50.6 671 Education No education/Prim. incomp. 14.9 49.2 47.5 38.5 33.2 62.1 1,761 First level primary 4.6 30.6 28.0 24.4 15.7 42.1 4,339 Second level primary 0.7 13.2 10.4 11.2 4.4 20.8 601 High school and higher 0.2 5.3 5.2 5.0 1.7 8.8 1,374 Employment Not employed 5.1 28.1 25.6 22.4 15.4 38.2 5,892 Employed for cash 3.0 21.5 22.1 18.4 11.2 30.3 1,339 Employed not for cash 15.3 47.8 45.2 36.7 30.6 60.7 842 Total 5.8 29.1 27.0 23.2 16.3 39.2 8,075 42 | Women’s Characteristics and Status There are differences in terms of justification of violence between women who live in urban versus rural areas, and between women living in different regions. While 57 percent of women in rural areas think that wife beating would be justified in at least one of the circumstances specified, the proportion drops to 32 percent for urban women. For both urban and rural women, arguing with the husband is the most often agreed reason for wife beating. Almost half of women in the East agree with at least one of the circumstances specified (49 percent). In two NUTS 1 regions in the western areas of the country, Northeast Anatolia and Southeast Anatolia, the proportion is above 50 percent. The proportion drops to 33 percent in the West and 36 percent in the North. The proportion is at its lowest in İstanbul. The table clearly shows the importance of women’s education in the elimination of wife beating, although it is still interesting that even among women who have completed at least high school (have completed at least 11 grades), 9 percent agree to wife beating for some reason. Among women with little or no education, two-thirds of women (62 percent) agree with at least one specified reason for wife beating. The most common reason cited by these women is arguing with the husband (49 percent) and spending too much money (48 percent). As expected, women who are not employed in the formal sector but who are possibly employed in the family business justify wife beating more than their counterparts (61 percent). 3.6 Child Care While Working Table 3.7 focuses on the welfare of children under six years of age whose mothers are employed. Of women who worked in the 12 months prior to the survey, 63 percent had no children under 6 years of age. For the 37 percent of women who have one or more children, childcare is an important issue in participating in the labor force. Overall, in Turkey the main source of child care is either the mother or the relatives. The proportion of institutional care is very small with less than 5 percent. Relatives constitute a substantial proportion in taking care of children. In 37 percent of the cases, the mother takes care of children indicating that she is either taking the child with her to work or she is working at home. In one fifth of the cases it is the husband’s mother (21 percent) who takes care of the children under 6 years of age while their mother is at work. It is seen that besides the mother and mother-in-law, an older female child sometimes takes the responsibility (10 percent) for her brother(s)/sister(s). If it is the mother who takes care of the children less than six years of age, then these women are more likely to be rural women, women who do not have education above second level primary school, women living in the South and East regions and those who work on an occasional basis. It is worth noting that having an agricultural or non agricultural occupation does not cause much difference in terms of child care for children less than six while mother is at work (36 and 38 percent respectively). On one hand, the results reflect the presence of intra-family solidarity in childrearing; on the other, they also underline the patriarchal structure of the society. When persons other than the mother are considered, it is the husband’s mother rather than the woman’s mother who is taking care of children. Women’s Characteristics and Status | 43 3.7 Child care while working Percentage of employed women with and without a child under six years of age and percent distribution of employed mothers of a child under six years of age by person who cares for child while mother is at work, according to background characteristics, Turkey 2003 Child's caretaker while mother is at work Background characteristic No chil- dren under 6 years One or more chil- dren Respon- dent Hus- band/ part- ner Older female child Wo- man's mother Hus- band's mother Older male child Other rel- ative Ser- vant, hired help Institu- tional care No work since birth Other Miss- ing Total Number of women Residence Urban 67.4 32.6 34.0 2.7 7.4 13.4 16.5 0.5 5.4 7.6 8.9 2.9 0.4 0.3 100.0 1,887 Rural 58.2 41.8 40.2 2.3 13.5 4.8 26.2 1.6 7.5 0.5 0.3 2.2 0.8 0.2 100.0 1,479 Education No educ./Prim. 60.2 39.8 39.8 0.7 28.3 3.2 15.7 3.4 6.6 0.0 0.0 0.7 1.3 0.4 100.0 718 First level prm. 64.6 35.4 44.4 3.1 7.3 8.9 24.4 0.3 7.2 0.7 0.3 2.7 0.6 0.1 100.0 1,793 Second level prm. 63.1 36.9 43.7 7.7 1.5 9.1 21.2 1.6 7.2 0.0 4.0 3.3 0.0 0.6 100.0 187 High school and higher 63.4 36.6 13.3 1.6 0.2 16.2 20.2 0.0 4.4 18.5 21.3 4.0 0.0 0.4 100.0 668 Region West 72.3 27.7 30.1 2.3 6.4 15.6 20.8 1.0 5.6 6.2 7.4 4.2 0.2 0.2 100.0 1,398 South 59.4 40.6 47.2 2.8 7.5 9.4 17.6 1.3 5.3 3.4 2.4 1.9 0.3 0.9 100.0 421 Central 63.0 37.0 35.7 3.3 7.2 9.3 24.1 0.8 7.3 4.1 5.6 1.8 0.7 0.0 100.0 724 North 63.9 36.1 34.9 4.8 11.8 2.3 31.1 0.9 7.4 1.8 3.4 1.2 0.0 0.3 100.0 351 East 40.5 59.5 43.1 0.6 20.2 2.7 17.4 1.3 7.2 2.3 1.6 2.0 1.5 0.1 100.0 473 NUTS 1 Region İstanbul 73.1 26.9 34.7 2.5 8.5 11.9 11.7 2.1 4.8 6.6 12.1 5.0 0.0 0.0 100.0 494 West Marmara 71.7 28.3 26.1 1.6 10.0 14.1 28.6 2.3 3.2 7.9 0.0 3.2 1.6 1.6 100.0 179 Aegean 72.1 27.9 30.8 3.2 3.2 15.6 30.0 0.0 3.6 4.4 5.9 3.3 0.0 0.0 100.0 659 East Marmara 71.7 28.3 18.0 2.3 4.7 16.1 27.5 1.4 14.5 8.6 4.2 2.6 0.0 0.0 100.0 261 West Anatolia 58.3 41.7 35.0 0.0 8.2 14.7 13.0 1.0 9.4 4.8 10.3 2.6 1.0 0.0 100.0 260 Mediterranean 59.4 40.6 47.2 2.8 7.5 9.4 17.6 1.3 5.3 3.4 2.4 1.9 0.3 0.9 100.0 421 Central Anatolia 57.7 42.3 33.9 5.4 14.2 7.2 25.5 0.0 3.5 2.4 3.7 3.0 1.2 0.0 100.0 159 West Black Sea 69.3 30.7 40.9 4.2 4.3 1.7 33.2 0.0 8.3 2.3 3.3 1.9 0.0 0.0 100.0 271 East Black Sea 56.7 43.3 39.9 6.2 13.9 3.0 24.5 1.4 7.2 1.5 2.0 0.0 0.0 0.5 100.0 189 Northeast Anatolia 46.7 53.3 60.7 0.0 11.2 1.9 16.2 1.2 4.5 1.0 1.4 1.4 0.0 0.5 100.0 126 Central East Anatolia 41.9 58.1 35.5 0.0 26.6 2.6 17.4 0.7 7.2 1.5 3.0 2.2 3.2 0.0 100.0 137 Southeast Anatolia 35.7 64.3 38.7 1.3 20.9 3.1 17.9 1.7 8.5 3.5 0.9 2.2 1.3 0.0 100.0 209 Occupation Agricultural 61.1 38.9 35.7 1.6 14.9 6.5 28.8 1.3 7.8 0.2 0.0 2.1 0.5 0.4 100.0 1,323 Non-agricultural 64.8 35.2 38.2 3.1 7.2 10.9 16.0 0.9 5.5 6.7 7.9 2.9 0.7 0.2 100.0 2,042 Continuity of employment All year 65.9 34.1 28.8 1.8 11.7 10.1 20.0 0.5 5.7 8.3 9.2 2.9 0.7 0.2 100.0 1,705 Seasonal 61.8 38.2 39.0 2.1 11.4 5.7 27.4 1.2 8.3 0.1 0.7 2.8 0.8 0.4 100.0 1,203 Occasional 58.0 42.0 58.3 5.4 4.3 12.9 11.0 2.3 4.7 0.3 0.0 0.8 0.0 0.0 100.0 454 Missing * * * * * * * * * * * * * * 100.0 4 Total 63.3 36.7 37.1 2.5 10.4 9.0 21.3 1.1 6.5 4.0 4.6 2.6 0.6 0.3 100.0 3,366 Note: An asterisk indicates a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility | 45 FERTILITY 4 İsmet Koç and Erhan Özdemir This chapter looks at a number of fertility indicators including levels, patterns, and trends in both current and cumulative fertility; the length of birth intervals; and the age at which women initiate childbearing. Information on current and cumulative fertility is essential in monitoring the progress and evaluating the impact of the population program in Turkey. The data on birth intervals are important since short intervals are strongly associated with childhood mortality. The age at which childbearing begins may also have a major impact on the health and well-being of both the child and the mother. Data on childbearing patterns were collected in the TDHS-2003 in several ways. First, each woman was asked a series of questions on the number of her sons and daughters living with her, the number living elsewhere, and the number who may have died. Next, a complete history of all of the woman’s births was obtained, including the name, sex, month and year of birth, age, and survival status for each of the births. For living children, a question was asked about whether the child was living in the household or away. For dead children, the age at death was recorded. 4.1 Current Fertility The level of current fertility is one of the most important topics in this report because of its direct relevance to population policies and programs. Measures of current fertility presented in this chapter include age-specific fertility rates, the total fertility rate, the general fertility rate, and the crude birth rate. These rates are generally presented for the three-year period preceding the survey. The three-year period was chosen for calculating these rates (rather than a longer or a shorter period) to provide the most current information, to reduce sampling error, and to avoid problems of the displacement of births. Age-specific fertility rates are useful in understanding the age pattern of fertility. Numerators of age-specific fertility rates are calculated by identifying live births that occurred in the 1 to 36 months preceding the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year age groups) of the mother at the time of the child’s birth. The denominators of these rates are the number of woman-years lived in each of the specified five-year age groups during the 1 to 36 months preceding the survey. Although information on fertility was obtained only for ever-married women, the age- specific rates are presented for all women regardless of marital status. Data from the household questionnaire on the age structure of the population of never-married women were used to calculate the all-women rates. This procedure assumes that women who have never been married have had no children. 46 | Fertility The total fertility rate (TFR) is a useful measure for examining the overall level of current fertility. TFR is a construct of the age-specific rates computed by summing the age- specific rates and multiplying by five. It can be interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed age-specific rates. The general fertility rate (GFR) represents the annual number of births in a population per 1,000 women age 15-44. The crude birth rate (CBR) is the annual number of births in a population per 1,000 persons. Both measures are based on the birth history data for the three-year period before the survey and the age-sex distribution of the household population. Current estimates of fertility levels by residence are presented in Table 4.1. The total fertility rate indicates that if fertility rates were to remain constant at the level prevailing during the three-year period before the TDHS-2003 (approximately June 2001 to May 2004), a woman in Turkey would bear 2.23 children during her lifetime. In rural areas, the TFR is 2.65 births per woman, and decreases around two children (2.06) in urban areas. When compared with evidence from previous demographic surveys, the urban-rural gap in fertility levels appears to be closing in Turkey. Table 4.1 and Figure 4.1 show that women in Turkey experience their prime reproductive years during their twenties. According to current age schedule of fertility, the average woman in Turkey will have one child by age 25 and two children by age 30. At every age rural women bear more children than urban women. The rural age-specific fertility rates rise sharply from age 15-19 to the peak at age 20-24, and then gradually decline. On the other hand, the urban age-specific fertility rates assume a more gradual pattern, an indication both Table 4.1 Current fertility Age-specific and cumulative fertility rates, general fertility rate, and crude birth rate for the three years preceding the survey, by urban- rural residence, Turkey 2003 Age group Urban Rural Total 15-19 44 47 46 20-24 126 161 136 25-29 126 158 134 30-34 71 94 78 35-39 33 48 38 40-44 11 16 12 45-49 0 6 2 TFR 15-49 2.06 2.65 2.23 TFR 15-44 2.06 2.62 2.22 GFR 15-44 74 90 79 CBR 19 21.1 19.7 Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population Fertility | 47 of delayed marriage and some deliberate attempt to postpone or terminate births by urban women. Figure 4.1 Age-specific Fertility Rates by Urban-Rural Residence 0 30 60 90 120 150 180 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age Births per 1,000 women Urban Rural Total Table 4.1 also presents two other summary measures of fertility: the crude birth rate and the general fertility rate. The crude birth rate in Turkey is 19.7 births per 1,000 population. As with TFR, there is a slight differential in this rate by residence: 19 births per 1000 in urban areas versus 21.1 births per 1,000 in rural areas. The general fertility rate of 79 indicates that 1,000 women age 15-44 would have 79 live births per year. The GFR also indicates a significant urban-rural difference. 4.2 Fertility Differentials Table 4.2 highlights TFRs for the three years preceding the survey by background characteristics. The greatest regional variation in fertility is seen between East region and the rest of Turkey. With a TFR of 3.65, women in eastern part of Turkey have a TFR that is about one and a half births more than women elsewhere in Turkey who exhibit TFRs below 2.1, known as replacement level, with the exception of South region, which exhibits slightly over replacement fertility. Among the NUTS 1 regions, the fertility is below the replacement level (1.83) in İstanbul, while in the Southeast Anatolia it is twice the level of replacement fertility. Table 4.2 also shows the mean number of children ever born (CEB) to women age 40- 49. Trends in fertility can be inferred by comparing the TFR (a measure of current fertility) with the number of CEB (a measure of completed fertility). If fertility is stable over time in a population, the TFR and the mean CEB for women 40-49 will be similar. If fertility levels have been falling, the TFR will be substantially lower than the mean CEB among women age 40-49. The comparison of the TFR with the mean CEB among women 40-49 in Table 4.2 TDHS-2003 48 | Fertility suggests that fertility has fallen sharply in Turkey over the past several decades. Women age 40-49 had an average of 3.5 births during their lifetime, over one birth more than women bearing children will have at the current rates. The decline in fertility implied by a comparison of the TFR with completed fertility has been greater in rural than in urban areas. The largest implied decline in fertility by region is observed in East region, where the TFR was approximately 2 and a half births lower than the mean number of children ever born to women 40-49. Table 4.2 presents marked differences in fertility levels and trends by education. The TFR decreases rapidly with increasing educational level, from 3.7 births among women with no education to 1.4 births among women who had completed high school or higher. The differentials in completed fertility across educational groups are even more striking. The mean number of children ever born is 5 among women age 40-49 with no education, compared with 2 among women who have completed high school or higher. With regard to the trend in fertility, the decline in fertility implied by a comparison of the TFR with the mean CEB is substantial for women with no education. Another indicator of current fertility, the percentage of women who are currently pregnant, is included in Table 4.2. Overall, slightly more than 4 percent of the TDHS-2003 respondents were pregnant at the time of the survey. Women living in the eastern part of Turkey have the highest percentage currently pregnant (7 percent), while the percentage is Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by background characteristics, Turkey 2003 Background characteristic Total fertility rate1 Percentage currently pregnant Mean number of children ever born to women age 40-49 Region West 1.88 3.1 2.90 South 2.30 4.1 3.72 Central 1.86 3.9 3.43 North 1.94 2.9 3.41 East 3.65 6.9 6.07 Selected NUTS 1 Regions İstanbul 1.83 2.9 3.09 Southeast Anatolia 4.19 6.7 6.61 Education No educ./Prim. incomp. 3.65 5.6 4.98 First level primary 2.39 4.1 3.21 Second level primary 1.77 2.3 2.54 High school and higher 1.39 3.8 1.96 Total 2.23 4.1 3.54 1 Women age 15-49 years Fertility | 49 lowest in the West and North regions (3 percent). Surprisingly, the percentage of women who were pregnant is higher for women with a high school or higher education than for women with a secondary education. This may be due at least in part to the fact that, on average, highly-educated women are younger than women in the other education categories and thus more likely to be in the family-building stage than other women. 4.3 Fertility Trends Trends in fertility can be assessed in several other ways. TFR estimates from the TDHS-2003 can be compared with estimates obtained in earlier surveys. Fertility changes can also be examined by using data from the birth histories obtained from the TDHS-2003 respondents to look at the trend in age-specific fertility rates for successive five-year periods before the survey. 4.3.1 Comparison with Previous Surveys Table 4.3 shows the TFR estimates from a series of surveys conducted in Turkey during the period 1978 through 2003. The surveys vary in the timeframes for which the TFR estimates are available. For example, the rates from the 1978, 1988 and 1993 surveys are based on births in a one-year period before the survey, while the rates for the TDHS-1998 and TDHS-2003 surveys are based on a three-year period before the interview date. Table 4.3 Trends in fertility Age specific fertility rates (per 1,000 women) and total fertility rate, the 1978 Turkey Fertility Survey, the 1988 Turkey Population and Health Survey, and the 1993, 1998 and 2003 Turkey Demographic and Health Surveys Age TFS- 1978 TPHS- 1988 TDHS- 1993 TDHS- 1998 TDHS- 2003 15-19 93 45 56 60 46 20-24 259 193 179 163 136 25-29 218 183 151 150 134 30-34 154 102 94 93 78 35-39 101 55 38 42 38 40-44 38 19 12 13 12 45-49 2 7 0 1 2 TFR 15 49 4.33 3.02 2.65 2.61 2.23 Note: 1978, 1988 and 1993 rates refer to the year before the survey; 1998 and 2003 rates refer to the 3-year period before the survey. As Table 4.3 and Figure 4.2 show, fertility levels have declined almost continuously in Turkey over the past 25 years, from a level of 4.3 births per woman at the time of the TFS- 1978 to 2.2 births per woman at the time of the TDHS-2003. The decline in fertility was especially rapid during the period between the 1970s and the 1980s. After the TFR reached a level of below 3 births per woman at the time of the TDHS-1993, the pace of fertility decline slowed somewhat, and stabilized around 2.6 births on average in the 1990s. However after a stabilization period in fertility during the 1990s, TDHS-2003 puts forward a fertility decline by 50 | Fertility 15 percent in the period of 1998 and 2003. The fertility level reached by Turkey in 2000s is slightly over the replacement level of fertility. Figure 4.2 Trends in Fertility 0 50 100 150 200 250 300 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Mother's age Births per 1,000 women TFS-1978 TPHS-1988 TDHS-1993 TDHS-1998 TDHS-2003 4.3.2 Retrospective Data from TDHS-2003 Birth Histories Fertility trends can also be investigated using retrospective data from the birth histories collected from respondents in a single survey. The age-specific fertility rates shown in Table 4.4 and Figure 4.3 were generated from the birth history data collected in the TDHS- 2003. The numerators of the rates are classified by five-year segments of time preceding the survey and the mother’s age at the time of birth. Because women age 50 years and over were not interviewed in the TDHS-2003, the rates for older age groups become progressively more truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years and more prior to the survey, because women in that age group would have been 50 years or older at the time of the survey. Table 4.4 Age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age, Turkey 2003 Number of years preceding the survey Mother's age 0-4 5-9 10-14 15-19 15-19 51 61 86 83 20-24 142 180 200 222 25-29 141 156 159 187 30-34 84 103 96 [113] 35-39 38 37 [45] 40-44 12 [12] 45-49 [2] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Fertility | 51 Figure 4.3 Age-specific Fertility Rates during the Last 20 Years 0 50 100 150 200 250 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Mother's age Births per 1,000 women 0-4 5-9 10-14 15-19 The results in Table 4.4 and Figure 4.3 confirm that fertility has fallen substantially among all age groups, with the most rapid relative decline occurring in the 15-19 age group. Overall, the cumulative fertility rate for women age 15-34 decreased by one birth, from 3.0 births per woman during the period 15-19 years before the survey to 2.1 births per woman in the five-year period preceding the survey. Table 4.5 presents fertility rates for ever-married women by duration since first marriage for five-year periods preceding the survey. The decline in fertility has occurred at all marital durations; however, the decline is greatest among women with longer marital durations. Fertility within the first several years of marriage typically remains resistant to change, even when fertility is declining, because fertility decline usually begins among older Table 4.5 Fertility by marital duration Fertility rates for ever-married women by duration since first marriage in years, for five-year periods preceding the survey, Turkey 2003 Number of years preceding the survey Marriage duration at birth 0-4 5-9 10-14 15-19 0-4 278 293 324 334 5-9 154 177 170 213 10-14 89 99 110 153 15-19 41 56 78 [111] 20-24 17 27 [49] [117] 25-29 9 [16] [38] Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. TDHS-2003 52 | Fertility women who want to stop childbearing, not among young couples postponing births. Table 4.5 indicates rapid declines in fertility for all marital durations of five or more years, and a 17 percent decline for marriages of less than five years. 4.4 Children Ever Born and Living Table 4.6 presents the distribution of all women and of currently married women by the total number of children ever born. The distribution is the outcome of each woman’s lifetime fertility. It reflects the accumulation of births over the past 30 years and therefore its relevance to the current situation is limited. However, the information is useful in looking at how average family size varies across age groups and for looking at the level of primary infertility. Since only ever-married women were interviewed in the TDHS-2003, information on the reproductive histories of never-married women is not available. However, virtually all births in Turkey occur within marriage; thus, in calculating these fertility measures for all women, never-married women were assumed to have had no births. The marked differences between the results for currently married women and for all women at the younger ages are due to the comparatively large numbers of never-married women in those age groups who, as noted, are assumed to have had no births. Table 4.6 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number of children ever born and living, according to five-year age groups, Turkey 2003 Number of children ever born Mean number of Age of mother 0 1 2 3 4 5 6 7 8 9 10+ Total percent Number of women Mean number of CEB living children ALL WOMEN 15-19 94.3 4.8 0.6 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,003 0.07 0.07 20-24 61.8 22.5 11.5 3.1 0.8 0.3 0.0 0.0 0.0 0.0 0.0 100.0 2,101 0.59 0.57 25-29 27.9 24.0 28.8 11.2 4.5 2.1 0.5 0.4 0.5 0.0 0.0 100.0 1,849 1.54 1.48 30-34 13.4 14.8 32.4 20.4 9.2 3.7 2.4 2.0 0.8 0.7 0.2 100.0 1,622 2.39 2.25 35-39 8.3 9.6 30.4 23.5 12.9 6.0 3.5 2.2 1.3 1.0 1.3 100.0 1,481 2.93 2.69 40-44 5.3 5.6 28.5 23.3 13.6 8.7 6.1 2.8 2.2 1.3 2.5 100.0 1,371 3.44 3.11 45-49 4.3 5.8 25.2 21.7 16.5 10.1 5.5 3.7 2.1 1.6 3.7 100.0 1,089 3.67 3.23 Total 36.1 13.4 21.1 13.1 7.0 3.7 2.1 1.3 0.8 0.5 0.8 100.0 11,517 1.84 1.69 CURRENTLY MARRIED WOMEN 15-19 51.5 40.8 5.5 1.7 0.5 0.0 0.0 0.0 0.0 0.0 0.0 100.0 237 0.59 0.56 20-24 23.4 44.9 23.2 6.2 1.7 0.6 0.0 0.0 0.0 0.0 0.0 100.0 1,019 1.20 1.15 25-29 9.4 29.6 36.5 14.2 5.7 2.7 0.7 0.5 0.2 0.0 0.0 100.0 1,435 1.95 1.87 30-34 4.9 15.1 36.1 22.8 10.4 4.0 2.6 2.6 1.1 0.8 0.2 100.0 1,423 2.65 2.49 35-39 3.8 8.4 32.2 25.0 13.9 6.5 3.8 2.4 0.4 1.1 1.4 100.0 1,333 3.13 3.88 40-44 2.3 4.7 29.2 24.8 14.4 9.4 5.8 3.1 5.0 1.4 2.6 100.0 1,223 3.59 3.25 45-49 2.6 5.6 25.8 22.4 16.5 10.4 5.7 3.7 4.9 1.7 3.5 100.0 1,001 3.75 3.30 Total 8.7 18.5 30.4 19.0 10.1 5.3 3.0 1.9 1.9 0.8 1.2 100.0 7,671 2.64 2.43 Fertility | 53 Table 4.6 shows that on the average a woman in Turkey has given birth to 1.84 children. Out of that number, 1.69 children are still alive, indicating that 6 percent of the children ever born to TDHS-2003 respondents have died. The number of children that women have borne increases directly with age, reflecting the natural family-building process. Women age 45-49, who are approaching the end of their childbearing period, have had an average of 3.8 births. Reflecting the high levels of fertility prevailing during the 30-year period when those women were bearing children, approximately 4 percent of women in the cohort have had 10 or more births. As expected, the proportion surviving declines with increasing age of mother. Among women age 45-49, the mean number of children ever born is almost a half child greater than the mean number of surviving children. The percentage of women in their forties who have never had children provides an indicator of the level of primary infertility –the proportion of women who are unable to bear children at all. Since voluntary childlessness is rare in Turkey, it is likely that married women with no birth are unable to bear children. The TDHS-2003 results suggest that primary fertility is low; less than 3 percent of married women age 45-49 report that they have had no children. 4.5 Birth Intervals A birth interval is the period between two successive live births. Research has shown that children born soon after a previous birth (i.e., within 24 months) are at greater risk of illness and death than those born after a longer interval. In addition, short birth intervals may have consequences for other children in the family. The occurrence of closely spaced births gives the mother insufficient time to restore her health, which may limit her ability to take care of her children. The duration of breastfeeding for the older child may also be shortened if the mother becomes pregnant. Table 4.7 shows the percent distribution of non-first births in the five years preceding the survey by length of the previous birth interval. Birth intervals are relatively long, with about three-quarters of all non-first births occurring at least two years after the previous birth. Approximately a half of births took place at least three years after a prior birth. The median interval is approximately 36 months, which is about a year longer than the minimum interval considered safe. Although the majority of non-first births are appropriately spaced, 27 percent were born too soon after a prior birth, i.e., within 24 months of a previous birth. Younger women have shorter birth intervals than older women. The median interval varies from 23 months among the small number of births to women age 15-19 to 45 months among births to women age 30-39. Birth intervals vary significantly with the child’s birth order. The lowest birth orders (2-3 births) show the least likelihood of being born soon after the previous birth. Birth intervals are markedly different depending on the survival status of the prior birth; the average interval is about 8 months longer in cases where the prior birth is alive than when that child has died (36 months and 28 months, respectively). 54 | Fertility Table 4.7 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Turkey 2003 Number of months since previous birth Background characteristic 7-17 18-23 24-35 36-47 48+ Total Number of births Median number of months since previous birth Age of mother 15-19 (32.0) (28.8) (35.7) (3.5) (0.0) 100.0 23 22.8 20-29 16.8 17.6 27.7 13.7 24.3 100.0 1,333 30.2 30-39 9.0 9.9 19.9 13.2 48.0 100.0 1,194 44.6 40+ 9.8 7.9 16.6 10.7 55.1 100.0 169 56.1 Birth order 2-3 12.5 12.3 22.0 13.6 39.6 100.0 1,780 38.8 4-6 13.7 15.4 24.0 12.6 34.2 100.0 656 33.0 7+ 15.6 18.6 33.2 11.5 21.2 100.0 283 28.0 Sex of prior birth Male 13.7 13.7 22.2 13.6 36.8 100.0 1,352 36.2 Female 12.4 13.7 25.1 12.7 36.0 100.0 1,368 35.4 Survival of prior birth Living 12.1 13.6 23.9 13.1 37.3 100.0 2,565 36.2 Dead 29.0 15.5 19.5 14.8 21.2 100.0 154 27.6 Residence Urban 11.2 12.1 22.6 12.9 41.1 100.0 1,704 39.4 Rural 16.2 16.3 25.3 13.6 28.5 100.0 1.016 31.4 Region West 9.5 12.1 20.1 10.5 47.8 100.0 782 45.0 South 12.8 10.1 24.6 14.8 37.7 100.0 362 38.0 Central 11.3 12.0 18.9 13.2 44.5 100.0 497 41.2 North 12.3 12.9 22.1 14.7 38.1 100.0 175 37.8 East 17.5 17.5 29.2 14.5 21.3 100.0 903 29.3 NUTS 1 Region İstanbul 6.8 10.7 24.2 11.0 47.3 100.0 362 45.0 West Marmara 5.9 8.3 16.5 11.9 57.5 100.0 67 56.3 Aegean 13.8 11.1 12.3 9.3 53.6 100.0 215 50.4 East Marmara 14.4 18.1 18.8 12.7 36 100.0 202 34.4 West Anatolia 9.0 10.8 22.2 13.1 44.8 100.0 231 42.4 Mediterranean 12.8 10.1 24.6 14.8 37.7 100.0 362 38.0 Central Anatolia 10.3 12.4 19.8 11.6 46 100.0 149 41.6 West Black Sea 14.7 10.9 20.2 11.1 43 100.0 132 39.3 East Black Sea 9.1 15.5 20.4 18.4 36.6 100.0 96 39.0 Northeast Anatolia 16.3 15.4 24.4 15.6 28.3 100.0 142 32.4 Central East Anatolia 18.0 19.2 26.4 11.4 25 100.0 233 29.0 Southeast Anatolia 17.6 17.4 31.7 15.6 17.7 100.0 529 28.6 Education No educ./Prim. inc. 18.4 18.0 29.5 12.8 21.3 100.0 925 28.0 First level primary 11.3 12.2 21.7 12.6 42.2 100.0 1,389 39.7 Second level primary 3.9 9.2 19.2 16.3 51.4 100.0 151 48.7 High school and higher 8.6 9.1 15.5 15.7 51.1 100.0 254 48.6 Total 13.1 13.7 23.6 13.2 36.4 100.0 2,720 35.8 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. Fertility | 55 As Table 4.7 shows, the median birth interval in urban areas is 39 months, compared with 31 months in rural areas. There is 16-month difference between women in the western part of Turkey, who have the longest birth interval, and those in the eastern part of Turkey who have the shortest birth interval (45 months and 29 months respectively). Consistent with this finding, in all the NUTS 1 regions of the eastern part of Turkey, the median birth interval is nearly 30 months. There exists a clear association between the woman’s educational level and the average birth interval. The median birth interval is slightly over four years for women with high school or higher education as opposed to just over than the interval considered minimum safe for women with no education. 4.6. Age at First Birth The age at which childbearing begins has important demographic consequences for society as a whole as well as for the health and welfare of mother and child. In many countries, postponement of first births has contributed greatly to overall fertility decline. Table 4.8 presents the distribution of women by age at first birth, according to their current age. For women under age 25 the median age at first birth is not shown because less than 50 percent of women in those ages had given birth at the time of the survey. The results in Table 4.8 suggest that there has been a steady rise in the age at first birth among women in Turkey. Women in younger cohorts are much less likely than older women to have given birth to their first child while they were in their teens. For example, among women age 45-49, 38 percent had become a mother before age 20, while only 28 percent of women age 25-29 had given birth to their first child before age 20. Overall, Table 4.8 shows that the median age at first birth ranges from a low of 21 years among women age 45-49 to 23 years among women age 25-29. These cohort changes that parallel with the increase in the median age at first marriage took place during the same period (see Chapter 7). Table 4.8 Age at first birth Percentage of women who gave birth by specific exact ages, and median age at first birth, by current age, Turkey 2003 Percentage who gave birth by exact age Current age 15 18 20 22 25 Percentage who have never given birth Number of women Median age at first birth 15-19 0.2 NA NA NA NA 94.3 2,003 a 20-24 0.4 7.8 21.1 NA NA 61.8 2,101 a 25-29 1.0 12.2 27.5 42.9 63.5 27.9 1,849 22.9 30-34 0.9 13.5 30.0 50.0 69.9 13.4 1,622 22.0 35-39 1.4 14.0 32.2 52.1 71.7 8.3 1,481 21.7 40-44 2.7 19.7 39.7 58.9 79.3 5.3 1,371 20.9 45-49 2.2 17.3 37.5 59.1 79.4 4.3 1,089 21.1 NA = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group Table 4.9 presents trends in the median age at first birth across age cohorts for key sub-groups. The measures are presented for women age 25-49 years to ensure that half of the 56 | Fertility women have already had a birth. Overall, the median age at first birth is approximately 22 years for women 25-49. However, there are wide differences in the age at which women first gave birth among the various sub-groups. Urban women started childbearing one year later than their rural counterparts. On average, women in Eastern region had their first birth one and a half years earlier than women in the West region. Looking at the patterns by education within age groups, highly educated women had their first birth about two years later than women with less than a primary education. Table 4.9 Median age at first birth by background characteristics Median age at first birth among women 25-49, by current age and background characteristics, Turkey 2003 Current age Background characteristic 25-29 30-34 35-39 40-44 45-49 All women age 25-49 Residence Urban 23.2 22.2 22.1 21.1 21.4 22.1 Rural 22.2 21.7 21.0 20.6 20.4 21.1 Region West 23.3 22.3 22.3 21.4 21.4 22.2 South 23.0 22.3 22.9 22.2 22.2 22.4 Central 22.7 21.8 20.8 20.5 20.5 21.2 North 23.4 22.5 22.4 20.9 20.9 22.2 East 22.0 21.0 20.4 19.9 19.9 20.8 NUTS 1 Region İstanbul 23.5 22.8 22.0 21.0 21.5 22.3 West Marmara 24.0 22.0 21.5 21.8 21.0 22.0 Aegean 23.7 22.4 22.3 21.2 20.8 22.1 East Marmara 22.4 21.7 22.2 20.6 21.5 21.7 West Anatolia 23.0 21.7 21.5 22.1 21.2 22.0 Mediterranean 23.0 22.3 22.9 21.6 22.2 22.4 Central Anatolia 22.0 21.6 20.4 19.8 21.2 20.6 West Black Sea 22.7 22.6 22.0 21.5 20.2 21.8 East Black Sea 23.4 22.4 21.5 21.0 20.9 21.9 Northeast Anatolia 21.8 21.0 21.0 20.9 20.4 21.1 Central East Anatolia 22.7 21.4 19.9 20.4 20.1 20.9 Southeast Anatolia 21.7 20.7 20.4 19.5 19.2 20.6 Education No educ./Pri. incomp. 20.4 20.3 20.6 20.2 20.2 20.1 First level primary 21.6 21.4 21.1 20.9 20.9 20.2 Second level primary 22.2 22.8 22.3 22.1 22.1 22.3 High school and higher a 26.9 25.3 24.5 24.5 a Total 22.9 21.9 21.7 20.9 21.1 21.8 Note: The medians for cohorts 15-19 and 20-24 could not be determined because some women may still have a birth before reaching age 20 or 25, respectively. a Median ages at first birth for women with high school and higher education in the age groups 25-29 and 25-49 cannot be calculated because less than half of these women had a first birth before age 25. Fertility | 57 4.7 Teenage Pregnancy and Motherhood Teenage fertility is a major health concern because teenage mothers and their children are at high risk of illness and death. Childbearing during the teenage years also frequently has adverse social consequences, particularly on female educational attainment since women who become mothers in their teens are more likely to curtail education. Using information from the TDHS-2003, Table 4.10 shows the percentage of women age 15-19 who are mothers or who are pregnant with their first child. The overall level of teenage childbearing is approximately 8 percent, of which 6 percent already have given birth and 2 percent are pregnant with their first child. This percentage is slightly lower than that recorded in the TDHS-1998 when the proportion of teenagers who had begun childbearing was 10 percent. Table 4.10 shows that the proportion of women who have begun childbearing rises rapidly throughout the teenage years, from 1 percent among 16-year-olds to 3 percent among 17-year-olds, 8 percent among 18-year-olds, and 17 percent among 19-year-olds. There is no clear association between teenage childbearing and urban-rural residence. In terms of region, East region has the highest level of teenage childbearing (9 percent), while the North region has the lowest (3 percent). Surprisingly, Aegean region has the highest level of teenage childbearing with 13 percent. The level of teenage fertility is strongly associated with women’s educational level. The proportion of women age 15-19 who are pregnant or who have already given birth decreases from about 15 percent among women with less than primary education to 3 percent among women with at least high school education. 58 | Fertility Table 4.10 Teenage pregnancy and motherhood Percentage of teenagers 15-19 who are mothers or pregnant with their first child, by background characteristics, Turkey 2003 Percentage who are: Background characteristic Mothers Pregnant with first child Percentage who have begun childbearing Number of teenagers Age 15 0.0 0.2 0.2 388 16 0.9 0.4 1.3 425 17 3.5 1.8 5.3 410 18 8.2 3.2 11.4 412 19 17.2 3.5 20.7 368 Residence Urban 5.6 2.0 7.7 1,302 Rural 5.9 1.3 7.2 712 Region West 5.7 1.4 7.1 572 South 6.6 1.3 7.9 286 Central 6.1 1.4 7.5 501 North 2.0 0.7 2.7 147 East 6.0 3.1 9.1 505 NUTS 1 Region İstanbul 5.2 2.3 7.5 262 West Marmara 5.8 0.0 5.8 61 Aegean 11.5 1.2 12.7 195 East Marmara 2.8 0.9 3.7 166 West Anatolia 4.9 1.6 6.4 209 Mediterranean 6.6 1.3 7.9 286 Central Anatolia 4.0 0.6 4.7 129 West Black Sea 4.6 2.1 6.8 127 East Black Sea 0.5 0.0 0.5 75 Northeast Anatolia 3.8 2.3 6.1 98 Central East Anatolia 6.5 3.0 9.4 139 Southeast Anatolia 6.6 3.5 10.1 270 Education No educ./Pri. incomp. 10.6 3.9 14.5 302 First level primary 11.4 2.5 13.9 559 Second level primary 1.6 0.7 2.3 888 High school and higher 1.6 1.4 3.0 313 Total 5.7 1.8 7.5 2,003 Note: The sum of the absolute values does not add up to the total value in the last four variables due to use of the ever-married factors. Family Planning | 59 FAMILY PLANNING 5 Turgay Ünalan, İsmet Koç, and Sabahat Tezcan This chapter presents TDHS-2003 results relative to contraceptive knowledge, attitudes, and use. The chapter begins with an appraisal of the knowledge of different contraceptive methods before moving on to a consideration of past and current practice. For users of periodic abstinence and all ever-married women, knowledge of the ovulatory cycle is examined. For those relying on sterilization, the timing of method adoption is reviewed as well. Special attention is focused on source of contraception, informed choice, nonuse, reasons for discontinuation, and intention to use in the future. 5.1 Knowledge of Family Planning Methods Awareness of family planning methods is crucial in decisions on whether to use a contraceptive method and which method to use. Acquiring knowledge about fertility control is an important step toward gaining access to and then using a suitable contraceptive method in a timely and effective manner. To obtain data on contraceptive kowledge, TDHS-2003 respondents were first asked to name the means or methods by which couples could delay or avoid pregnancy. If the respondent failed to mention any of the methods listed in the questionnaire, the interviewer described the method and asked whether the respondent recognized it. Using this approach, information was collected for modern and traditional methods. Other traditional or ‘folkloric’ methods mentioned by the respondent were also recorded. No questions were asked to elicit information on depth of knowledge of these methods (e.g., on the respondent’s understanding of how to use a specific method). Therefore, in the analyses that follows, knowledge of a family planning method is defined simply as having heard of a method. Table 5.1 shows the level of knowledge of contraceptive methods among ever-married women and currently married women by specific method. Knowledge of at least one family planning method is almost universal among ever-married women and among currently married women. Almost all women interviewed in the survey know about at least one modern method. The most widely known modern contraceptive methods among ever-married women are the IUD (98 percent), the pill (98 percent), male condom (90 percent), female sterilization (90 percent), and injectables (82 percent) while the least known methods are female condom (14 percent) and emergency contraception (16 percent). Similarly, the most widely known modern contraceptive methods among currently married women are IUD (98 percent), the pill (98 percent), male condom (90 percent), female sterilization (90 percent), and injectables (83 percent) while the least known methods are female condom (13 percent) and emergency contraception (16 percent). Among traditional methods, withdrawal method is the most widely recognized one (94 percent for both ever-married and currently married women). The mean number of methods known is a rough indicator of the extent of knowledge of family 60 | Family Planning planning methods. On average, each ever-married woman and currently married woman know 8.5 methods. Table 5.1 Knowledge of contraceptive methods Percentage of ever-married women and of currently married women who know any contraceptive method, by specific method, Turkey 2003 Method Ever- married women Currently married women Any method 99.7 99.8 Any modern method 99.5 99.5 Female sterilization 89.7 89.8 Male sterilization 40.2 40.2 Pill 97.8 97.8 IUD 98.2 98.3 Injectables 82.1 82.5 Implants 43.0 43.3 Male condom 89.7 90.0 Female condom 13.5 13.4 Diaphragm 45.6 45.7 Emergency contraception 16.2 16.1 Any traditional method 97.7 97.7 Periodic abstinence 49.7 49.7 Withdrawal 93.7 93.9 Lactational amenorrhea method (LAM) 84.1 84.3 Folk method 8.2 8.1 Mean number of methods known 8.5 8.5 Number of women 8,075 7,672 Table 5.2 shows the percentage of currently married women who know any method of contraception and any modern method by backgound characteristics. Knowledge of any method and of any modern method is almost universal in all subgroups of background characteristics ranging from 98 to 100 percent. Family Planning | 61 Table 5.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women who know at least one contraceptive method and who know at least one modern method, by background characteristics, Turkey 2003 Background characteristic Knows any method Knows any modern method1 Number of women Age 15-19 98.4 98.0 237 20-24 99.8 99.5 1,019 25-29 99.9 99.8 1,435 30-34 99.9 99.9 1,423 35-39 99.6 99.6 1,333 40-44 99.8 99.2 1,223 45-49 99.8 99.3 1,001 Residence Urban 99.9 99.7 5,437 Rural 99.5 99.0 2,235 Region West 99.9 99.6 3,106 South 99.7 99.5 981 Central 99.6 99.4 1,770 North 99.8 99.8 561 East 99.7 99.3 1,253 NUTS 1 Region İstanbul 99.9 99.9 1,405 West Marmara 99.8 99.1 329 Aegean 99.5 98.6 1,079 East Marmara 100.0 100.0 669 West Anatolia 100.0 100.0 742 Mediterranean 99.7 99.5 981 Central Anatolia 99.6 99.4 446 West Black Sea 100.0 100.0 492 East Black Sea 99.6 99.6 275 Northeast Anatolia 99.9 99.5 234 Central East Anatolia 99.5 98.5 378 Southeast Anatolia 99.7 99.6 642 Education No education/Primary incomplete 99.1 98.2 1,664 First level primary 100.0 99.9 4,158 Second level primary 100.0 100.0 570 High school and higher 100.0 99.9 1,280 Total 99.8 99.5 7,672 1Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, diaphragm, and emergency contraception 62 | Family Planning 5.2 Ever Use of Family Planning Methods The TDHS-2003 collected data on the level of ever use of family planning methods, which is defined as the use of a contraceptive method at any time during a woman’s reproductive years. To obtain these data, respondents were asked if they had ever used for each of the methods that they knew. Table 5.3 shows the percentages of ever-married and currently married women who have ever used any contraceptive method by specific method and age. Overall, the results indicate that 90 percent of both ever-married and currently married women have used a family planning method at some time. Across age groups, the lowest level of ever use of any family planning method is observed among ever-married and currently married women age 15-19, while after age 25 the percentages are around or above 90 percent. Table 5.3 Ever use of contraception Percentage of ever-married women and of currently married women who have ever used any contraceptive method, by specific method and age, Turkey 2003 Modern method Traditional method Current age Any Any modern Fe- male ster. Male ster. Pill IUD Inject- ables Im- plants Male con- dom Female con- dom Dia- phragm Emer- gency contra- cep- tion Any tradi- tional Perio- dic absti- nence With- draw- al LAM Folk Number of women EVER-MARRIED WOMEN 15-19 65.0 33.7 0.0 0.0 12.8 8.1 3.6 0.0 20.9 0.0 1.3 0.0 56.9 6.0 54.2 9.3 1.4 238 20-24 82.6 56.7 0.4 0.0 17.0 22.7 4.0 0.2 36.9 0.0 1.6 0.0 66.8 5.8 61.2 11.5 1.0 1,045 25-29 90.8 73.0 2.4 0.0 31.4 38.4 6.9 0.1 42.6 0.0 2.8 0.5 71.8 8.1 65.6 13.5 1.0 1,480 30-34 92.9 79.1 6.1 0.0 35.9 49.4 5.9 0.0 44.5 0.2 4.3 0.6 71.4 7.8 64.8 15.7 1.4 1,489 35-39 91.6 79.0 7.9 0.1 38.9 51.3 4.9 0.0 41.2 0.1 8.2 0.6 70.1 10.9 62.0 16.9 1.9 1,420 40-44 92.8 77.9 10.4 0.1 42.6 50.9 4.6 0.1 31.9 0.0 7.8 1.2 70.0 9.7 61.1 18.9 3.1 1,330 45-49 88.9 74.8 6.4 0.3 45.1 45.6 4.3 0.0 29.4 0.1 10.2 0.7 67.7 12.1 56.7 19.4 4.6 1,073 Total 89.6 73.0 5.6 0.1 34.8 42.8 5.2 0.1 37.8 0.1 5.7 0.6 69.5 9.0 62.0 15.8 2.1 8,075 CURRENTLY MARRIED WOMEN 15-19 65.0 33.8 0.0 0.0 12.8 8.1 3.6 0.0 21.0 0.0 1.3 0.0 56.8 6.0 54.1 9.3 1.4 237 20-24 82.6 56.6 0.4 0.0 16.8 22.8 3.9 0.2 37.0 0.0 1.6 0.0 67.2 5.7 62.1 11.4 1.1 1,019 25-29 91.3 73.6 2.4 0.0 31.7 38.6 7.1 0.1 43.2 0.0 2.9 0.5 72.2 8.2 66.0 13.7 0.9 1,435 30-34 93.7 79.7 6.2 0.0 35.6 50.2 5.8 0.0 45.1 0.3 4.4 0.5 72.5 7.7 65.8 15.9 1.4 1,423 35-39 92.0 79.3 8.3 0.1 38.5 51.8 5.1 0.0 41.8 0.1 7.9 0.5 71.2 10.6 63.3 17.3 2.0 1,333 40-44 93.4 78.1 10.9 0.1 42.5 50.8 4.6 0.1 32.6 0.0 8.2 1.2 70.6 9.4 62.4 18.9 3.2 1,223 45-49 89.8 75.3 6.5 0.3 45.5 46.1 4.3 0.0 30.1 0.1 9.9 0.7 69.4 12.4 58.3 19.5 4.3 1,001 Total 90.0 73.2 5.7 0.1 34.6 42.9 5.2 0.1 38.4 0.1 5.6 0.6 70.3 8.9 63.0 15.9 2.0 7,672 LAM = Lactational amenorrhea method More than 60 percent of women report ever use of withdrawal. Among modern method users of ever-married and currently married women, the IUD is the most commonly adopted (43 percent) followed by the male condom and pill (35 and 38 percent respectively). Experience using LAM (Lactational Amenorrhea Method) is reported by nearly 16 percent of women. Results related with LAM may be interpreted with caution since women may be confusing the method with traditional breastfeeding practices, despite the fact that the stress was made in the questionnaire to prevent such a confusion. Family Planning | 63 5.3 Current Use of Contraception The data on the current use of family planning is among the most important information collected in the TDHS-2003 since it provides insight into one of the principal determinants of fertility and serves as a key measure for assessing the success of the national family planning program. Table 5.4 shows the percent distribution of currently married women by current use of specific family planning methods according to age. Overall, 71 percent of currently married women are using contraception, with 43 percent depending on modern methods and 29 percent using traditional methods. The most widely used method is withdrawal (26 percent). Among modern methods, IUD is the most widely used method (20 percent) followed by male condom (11 percent). The use of contraceptive methods varies by age. Current use of any method is lower among currently married women age 15-19 (44 percent), rising to as high as 81 percent among currently married women in the 30-34 age group, and then dropping to 50 percent among currently married women age 45-49. The use of withdrawal peaks among women in the 40-44 age group (50 percent) while the highest level of IUD use (26 percent) is found among women age 30-34. Table 5.4 Current use of contraception Percent distribution of currently married women by contraceptive method currently used, according to age, Turkey 2003 Modern methods Traditional methods Current age Any Any modern Fe- male ster. Male ster. Pill IUD In- ject- ables Male con- dom Dia- phragm Any trad- itional Perio- dic absti- nence With- draw al LAM Folk Not currently using Total Number of women 15-19 44.3 16.9 0.0 0.0 4.0 6.2 0.3 6.4 0.0 27.5 1.8 24.8 0.8 0.0 55.7 100.0 237 20-24 59.2 31.4 0.4 0.0 5.0 15.8 0.7 9.2 0.4 27.9 0.6 25.7 1.5 0.1 40.8 100.0 1,019 25-29 74.8 47.2 2.4 0.0 7.4 23.1 0.4 13.4 0.5 27.6 0.7 25.7 0.9 0.2 25.2 100.0 1,435 30-34 80.9 51.6 6.2 0.0 5.9 25.6 0.5 13.0 0.5 29.3 0.8 27.7 0.6 0.2 19.1 100.0 1,423 35-39 80.7 51.2 8.3 0.1 4.3 25.1 0.6 12.0 0.9 29.4 1.0 27.8 0.3 0.4 19.3 100.0 1,333 40-44 76.4 44.6 10.9 0.1 3.3 19.2 0.1 10.0 1.0 31.8 1.6 29.5 0.1 0.6 23.6 100.0 1,223 45-49 49.9 25.8 6.5 0.3 1.3 11.1 0.0 5.7 0.9 24.2 2.1 20.9 0.0 1.2 50.1 100.0 1,001 Total 71.0 42.5 5.7 0.1 4.7 20.2 0.4 10.8 0.6 28.5 1.1 26.4 0.6 0.4 29.0 100.0 7,672 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method Table 5.5 shows that the current use of contraceptive methods varies according to residence, region, level of education, and number of living children. Currently married women living in urban areas are more likely to be using any contraceptive method than women in rural areas (74 percent and 65 percent respectively). Current use is lowest in the East (58 percent) and highest in the West and the Center (74 percent). With regard to NUTS 1 regions, current use is lowest in the Southeast Anatolia (56 percent) and highest in West Anatolia (79 percent). 64 | Family Planning Table 5.5 Current use of contraception by background characteristics Percent distribution of currently married women by contraceptive method currently used, according to background characteristics, Turkey 2003 Modern method Traditional method Background characteristic Any Any mod- ern Fe- male ster. Male ster. Pill IUD In- ject- ables Male con- dom Dia- phragm Any tradi- tional Perio- dic absti- nence With- draw- al LAM Folk Not currently using Total Num- ber of wo- men Residence Urban 73.6 45.8 5.9 0.1 5.0 21.5 0.4 12.1 0.8 27.8 1.2 25.7 0.5 0.4 26.4 100.0 5,437 Rural 64.5 34.4 5.1 0.0 3.9 17.2 0.3 7.4 0.4 30.1 0.8 28.1 0.9 0.3 35.5 100.0 2,235 Region West 74.2 45.7 6.1 0.1 4.8 21.0 0.2 12.7 0.8 28.6 1.2 26.6 0.2 0.6 25.8 100.0 3,106 South 70.8 44.8 6.1 0.1 3.9 21.9 0.5 11.3 1.0 26.0 1.4 23.6 0.8 0.2 29.2 100.0 981 Central 74.2 46.6 5.0 0.0 5.3 25.2 0.4 10.2 0.5 27.6 1.2 25.7 0.4 0.3 25.8 100.0 1,770 North 71.9 32.5 9.4 0.0 3.1 10.8 0.0 8.3 0.8 39.4 1.5 37.5 0.2 0.2 28.1 100.0 561 East 57.9 31.4 3.7 0.0 4.9 14.3 1.0 7.4 0.2 26.5 0.5 24.0 1.8 0.3 42.1 100.0 1,253 NUTS 1 Region İstanbul 76.1 45.9 6.0 0.0 5.5 21.6 0.2 11.9 0.7 30.2 1.5 27.8 0.3 0.7 23.9 100.0 1,405 West Marmara 77.9 43.6 5.9 0.0 3.2 19.7 0.2 13.9 0.7 34.3 1.7 31.0 0.8 0.8 22.1 100.0 329 Aegean 70.2 45.0 5.6 0.3 5.1 20.5 0.0 12.9 0.7 25.2 0.7 24.0 0.2 0.3 29.8 100.0 1,079 East Marmara 72.0 45.4 6.0 0.1 5.7 21.4 0.3 11.0 0.9 26.6 0.4 25.2 0.2 0.8 28.0 100.0 669 West Anatolia 79.3 51.4 4.9 0.0 4.8 27.6 0.7 12.5 0.8 28.0 1.8 25.7 0.5 0.0 20.7 100.0 742 Mediterranean 70.8 44.8 6.1 0.1 3.9 21.9 0.5 11.3 1.0 26.0 1.4 23.6 0.8 0.2 29.2 100.0 981 Central Anatolia 72.1 46.3 5.8 0.0 4.8 26.2 0.0 9.2 0.3 25.8 1.3 24.0 0.3 0.3 27.9 100.0 446 West Black Sea 71.8 38.1 9.7 0.0 3.7 15.7 0.2 8.0 0.8 33.7 0.6 32.4 0.2 0.5 28.2 100.0 492 East Black Sea 70.7 26.2 5.7 0.0 2.2 9.2 0.0 8.5 0.6 44.5 2.3 41.9 0.0 0.3 29.3 100.0 275 Northeast Anatolia 64.5 34.1 3.3 0.0 4.7 17.1 1.7 7.0 0.3 30.4 0.8 26.1 2.0 1.4 35.5 100.0 234 Central East Anatolia 57.2 31.8 3.1 0.0 5.5 15.5 0.5 7.0 0.2 25.3 0.3 24.8 0.2 0.0 42.8 100.0 378 Southeast Anatolia 55.9 30.1 4.1 0.0 4.6 12.5 0.9 7.9 0.1 25.9 0.5 22.7 2.6 0.0 44.1 100.0 642 Education No educ. /Prim. inc. 56.7 29.9 6.5 0.0 3.9 13.4 0.7 4.5 0.8 26.9 0.4 24.8 1.1 0.6 43.3 100.0 1,664 First level primary 74.7 43.4 5.9 0.1 4.1 22.5 0.3 9.7 0.7 31.3 1.0 29.3 0.6 0.4 25.3 100.0 4,158 Secondary level primary 77.4 50.8 4.8 0.3 7.3 25.2 0.0 13.0 0.3 26.5 0.3 25.6 0.4 0.2 22.6 100.0 570 High school and higher 74.5 52.2 4.1 0.1 6.5 19.4 0.3 21.3 0.5 22.4 2.9 19.3 0.1 0.1 25.5 100.0 1,280 Number of living children 0 18.2 8.5 0.2 0.0 2.7 0.3 0.2 5.0 0.0 9.7 0.8 8.9 0.0 0.0 81.8 100.0 680 1-2 77.7 46.8 3.2 0.0 5.8 22.6 0.3 14.4 0.6 30.8 1.4 28.6 0.5 0.2 22.3 100.0 4,006 3-4 77.9 46.9 9.9 0.1 3.8 23.5 0.2 8.1 1.2 31.0 0.9 28.7 0.8 0.6 22.1 100.0 2,227 5+ 62.4 36.8 11.5 0.1 3.6 15.8 1.1 4.7 0.1 25.6 0.3 23.5 0.8 1.0 37.6 100.0 759 Total 71.0 42.5 5.7 0.1 4.7 20.2 0.4 10.8 0.6 28.5 1.1 26.4 0.6 0.4 29.0 100.0 7,672 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method The level of current use of family planning increases significantly with education from 57 percent among women who never attended school or not complete the first level of primary school to 75 percent among women at the first level of primary school, and remains above 70 percent at higher educational levels. Contraceptive use is also associated with the number of living children a woman has. Eighteen percent of currently married women with no children use family planning for postponing purposes. Use levels increase to 78 percent for women with one or two and three or four children, then drop off to 62 percent for women with five or more children. Family Planning | 65 Figure 5.1 shows the most commonly used methods by region. Withdrawal use rates range from 24 percent in the South to 38 percent in the North. For the pill and IUD, the lowest rates are in the North and the highest rates are in the Center. Use of male condom, on the other hand, is lowest in the East and highest in the West. Female sterilization is most common in the North and least common in the East. 5.4 Trends in Current Use of Family Planning The results from the TDHS-2003, as well as those from earlier demographic surveys, can be used to examine the changes that have taken place in the level and pattern of contraceptive use in Turkey over the past 15 years. Table 5.6 highlights the trend in family planning use at the national level between 1988 and 2003. The data show that contraceptive use in Turkey increased siginificantly in the last survey after staying at around 63 percent for the prior three surveys. The use of modern methods has increased over the last 15 years, from 31 percent in 1988 to 43 percent in 2003. With respect to specific methods, use of IUD, female sterilization, and male condom all rose over this period, while use of withdrawal remained at the same level. Figure 5.2 also highlights the trend in family planning use for selected methods between 1993 and 2003. These data also indicate that although the level of traditional method use remained almost unchanged, there was significant change in the level of use of modern methods since 1993 from 35 percent in 1993 to 43 percent in 2003. The pace of the change in modern method use was particularly rapid in the last five years preceding the TDHS-2003. Most of the increase during the period is due to greater rates of use of female sterilization and male condom. Figure 5.1 Current Use of Family Planning by Region and Method 0 10 20 30 40 50 60 70 80 90 100 West South Central North East Pill IUD Male condom Female Sterilization Withdraw al Other Not Using 66 | Family Planning Table 5.6 Trends in current use of contraception Percent distribution of currently married women by contraceptive method currently used, TPHS-1988, TDHS-1993, TDHS-1998, and TDHS-2003 Contraceptive method TPHS-1988 TDHS-1993 TDHS-1998 TDHS-2003 Any method 63.4 62.6 63.9 71.0 Any modern method 31.0 34.5 37.7 42.5 Pill 6.2 4.9 4.4 4.7 IUD 14.0 18.8 19.8 20.2 Male condom 7.2 6.6 8.2 10.8 Female sterilization 1.7 2.9 4.2 5.7 Other modern methods 2.0 1.3 1.1 1.1 Any traditional method 32.3 28.1 26.1 28.5 Periodic abstinence 3.5 1.0 1.1 1.1 Withdrawal 25.7 26.2 24.4 26.4 Other traditional methods 3.1 0.9 0.6 1.0 Not currently using 36.6 37.4 36.1 29.0 Total 100.0 100.0 100.0 100.0 Figure 5.2 Current Use of Family Planning Methods, Turkey 1993, 1998, and 2003 26 1 28 3 7 19 5 35 24 1 26 4 8 20 4 38 26 1 29 6 11 20 5 43 Withdrawal Periodic abstinence Any traditional Female sterilization Male condom IUD Pill Any modern Percent using method TDHS-1993 TDHS-1998 TDHS-2003 Family Planning | 67 Table 5.7 shows the trend in contraceptive use by residence and region during the last 10 years. Both urban and rural areas shared in the increase in use of modern methods during this period. The regional trends are somewhat more mixed. Overall, except for the North, the use of modern methods increased in all regions from 1993 to 2003. Traditional method use increased in the North and, especially in the East, while it did not change significantly in other regions. Table 5.7 Trends in current use of contraception by residence and region Percentage of currently married women 15-49 currently using any method, a modern method, and a traditional method, by residence and region, TDHS-1993, TDHS-1998, and TDHS-2003 TDHS-1993 TDHS-1998 TDHS-2003 Residence and region Any method Any modern method Any traditional method Any method Any modern method Any traditional method Any method Any modern method Any traditional method Residence Urban 66.2 38.9 27.3 66.7 40.8 25.2 73.6 45.8 27.8 Rural 56.1 26.8 29.3 58.1 31.4 26.0 64.5 34.4 30.1 Region West 71.5 37.3 34.2 70.5 40.5 29.2 74.2 45.7 28.6 South 62.8 36.7 26.0 60.3 35.1 24.6 70.8 44.8 26.0 Center 62.7 36.6 26.1 68.3 42.8 24.7 74.2 46.6 27.6 North 64.2 29.8 34.4 67.0 35.2 31.5 71.9 32.5 39.4 East 42.3 26.3 16.0 42.0 26.7 15.2 57.9 31.4 26.5 Total 62.6 34.5 28.1 63.9 37.7 25.5 71.0 42.5 28.5 5.5 Number of Children at First Use of Contraception Women who reported that they had used family planning methods at some time were asked about the number of children they had when they first used family planning. These data are useful in identifying the stage in the family-building process when women begin using family planning as well as their motivation for adopting family planning. Table 5.8 presents the percent distribution of ever-married women who have ever used a contraceptive method by the number of living children at the time of the first use of family planning, according to current age. Overall, 24 percent of ever-married women began using contraception before they gave birth, and an additional 48 percent began after having one child. Early use of family planning is higher among younger women; half of ever-married women age 15-19 started contraceptive use before they began having children compared with 12 percent of ever-married women age 45-49. The pattern suggests that younger women are increasingly adopting family planning to delay or space births, while older women are adopting family planning to limit births. 68 | Family Planning Table 5.8 Number of children at first use of contraception Percent distribution of ever-married women who have ever used contraception by number of living children at the time of first use of contraception, according to current age, Turkey 2003 Number of living children at time of first use of contraception Current age 0 1 2 3 4+ Missing Total Number of women 15-19 49.8 46.5 3.7 0.0 0.0 0.0 100.0 155 20-24 42.0 49.8 6.2 1.5 0.4 0.2 100.0 863 25-29 35.1 50.6 8.9 3.2 1,9 0.3 100.0 1,343 30-34 25.0 52.1 13.3 4.5 4.7 0.5 100.0 1,383 35-39 17.0 46.3 21.5 7.5 7.2 0.5 100.0 1,301 40-44 14.1 45.4 17.7 11.0 1.3 0.5 100.0 1,234 45-49 12.1 43.3 22.6 9.7 12.1 0.2 100.0 955 Total 24.4 48.1 14.9 6.1 6.1 0.4 100.0 7,233 5.6 Knowledge of the Fertile Period The successful use of natural family planning methods depends largely on an understanding of when during the menstrual cycle a woman is most likely to conceive. An elementary knowledge of reproductive physiology is thus the foundation for the successful practice of coitus-associated methods such as withdrawal, and especially, periodic abstinence. To investigate women’s knowledge about their fertile period, TDHS-2003 respondents were asked whether there are certain days a woman is more likely to become pregnant if she has sexual intercourse. Those who responded affirmatively to that question were asked whether this time is just before the period begins, during the period, right after the period ends, or halfway between two periods. Table 5.9 provides the results for all users of periodic abstinence and nonusers of periodic abstinence. Overall, only 27 percent of ever-married women reported the correct timing of the fertile period. Another 29 percent stated they did not know the correct timing and rest reported an incorrect timing. Among users of periodic abstinence, 63 percent reported the correct timing of the fertile period. Family Planning | 69 Table 5.9 Knowledge of the fertile period Percent distribution of ever-married women by knowledge of the fertile period during the ovulatory cycle, according to current use and nonuse of periodic abstinence, Turkey 2003 Perceived fertile period Users of periodic abstinence Nonusers of periodic abstinence All ever-married women Just before her period begins 0.0 2.0 2.0 During her period 1.3 0.6 0.6 Right after her period has ended 24.3 20.9 20.9 Halfway between two periods 63.2 26.2 26.6 Other 6.1 2.7 2.7 No specific time 2.0 18 17.8 Don’t know 3.1 29.6 29.3 Total 100.0 100.0 100.0 Number of women 86 7,989 8,075 5.7 Timing of Female Sterilization Table 5.10 shows the distribution of sterilized women by age at the time of their sterilization, according to years since operation. The results indicate that, as in TDHS-1998, around two-thirds of ever-married women who are sterilized had the operation between age 25 and 34. The median reported age at sterilization was 31.6 years (31.8 in the TDHS-1993 and 31.7 in the TDHS-1998). Table 5.10 Timing of sterilization Percent distribution of sterilized ever-married women by age at the time of sterilization, and median age at sterilization, according to the number of years since the operation, Turkey 2003 Age at time of sterilization Years since operation <25 25-29 30-34 35-39 40-44 45-49 Total Number of women Median age1 <2 8.8 29.9 40.5 15.1 5.6 0.0 100.0 82 30.9 2-3 4.0 23.0 28.4 35.7 7.2 1.7 100.0 100 32.5 4-5 7.3 11.3 42.1 27.8 11.5 0.0 100.0 50 33.3 6-7 8.1 15.9 41.6 28.9 5.5 0.0 100.0 64 32.4 8-9 (13.6) (18.1) (46.6) (21.7) (0.0) (0.0) 100.0 40 (32.0) 10+ 9.7 49.7 28.6 12.0 0.0 0.0 100.0 113 a Total 8.1 28.2 35.7 22.9 4.7 0.4 100.0 449 31.6 a = Not calculated due to censoring 1 Median ages are calculated only for women sterilized at less than 40 years of age to avoid problems of censoring. Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. 70 | Family Planning 5.8 Sources for Family Planning Methods Table 5.11 documents the main sources of contraception for current users. Such information of modern methods is important for family planning program managers and implementers. The public sector remains the major source of contraceptive methods in Turkey, providing methods to 58 percent of current users. The private sector provides contraception to approximately 40 percent, and 2 percent of modern method users are served by non-medical shops and markets. Table 5.11 Source of supply for modern contraceptive methods Percent distribution of current users of modern contraceptive methods by most recent source of supply, according to specific methods, Turkey 2003 Source of supply Pill IUD Male condom Female sterilization All modern methods1 Public sector 30.6 71.3 34.1 82.0 57.7 Government/hospital 0.4 12.0 0.5 37.6 11.2 Maternity house 0.0 8.1 0.6 13.6 5.9 MCHFP center 3.1 8.0 2.9 0.7 5.0 Health center 23.5 37.0 29.6 0.0 27.9 Health house 1.0 0.2 0.4 0.0 0.3 SSK hospital/dispensary 1.6 5.0 0.0 23.6 5.8 University hospital 1.0 0.7 0.1 5.8 1.3 Other public 0.0 0.3 0.1 0.8 0.3 Private medical 67.5 27.6 59.3 16.3 39.7 Private hospital 0.0 4.2 0.0 13.9 3.9 Private polyclinic 0.0 2.5 0.0 0.4 1.3 Private doctor 1.2 18.7 0.1 1.9 9.4 Private nurse/midwife 0.0 0.4 0.0 0.0 0.2 Pharmacy 66.4 1.8 58.8 0.0 24.8 Other private medical 0.0 0.0 0.3 0.3 0.1 Other private 1.2 0.8 5.9 0.3 2.1 Market/shop 0.0 0.0 5.5 0.0 1.4 Friend/relatives 1.1 0.1 0.1 0.0 0.2 Traditional midwife 0.0 0.1 0.2 0.0 0.1 NGO/CSO 0.3 0.6 0.0 0.3 0.3 Other 0.8 0.2 0.5 0.8 0.4 Don't know/Missing 0.6 0.0 0.3 0.6 0.2 Total 100.0 100.0 100.0 100.0 100.0 Number 361 1,551 826 449 3,271 1Includes users of injectables, diaphragm, and male sterilization NGO: Non-governmental organization, CSO: Civil society organization Family Planning | 71 Figure 5.3 Source for Modern Contraceptive Methods Health/MCH FP center 32% Government hospital 11% Other public 14% Private doctor 9% Pharmacy 25% Other private 6% Other 3% In the public sector, 33 percent of the users obtained their modern contraceptive methods from health centers or MCHFP centers, 11 percent from government hospitals, and 6 percent from SSK hospitals. In the private medical sector, the pharmacy is the most commonly used source, providing contraceptive methods to one-fourth of all users of modern methods. Female sterilizations were conducted most commonly in government hospitals (38 percent), followed by SSK hospitals (24 percent), private hospitals (14 percent), and government maternity house (14 percent). Pills and condoms are obtained primarily from pharmacies (66 and 59 percent, respectively) and health centers (24 and 30 percent, respectively). In the case of the IUD, most users obtained the IUD from the public institutions (71 percent), and more than one in four IUD users obtained the method from a private sector provider. Table 5.12 compares the distribution of users of selected methods by the service provider reported in the TDHS-2003 with the distribution reported in the TDHS-1998. The share of the public sector has substantially increased over the last five years in the case of all methods, except the IUD. For example, the percentage of women obtaining pill from a public sector provider increased from 26 percent in 1998 to 31 percent in 2003. This implies a 19 percent increase within the last five years. TDHS-2003 72 | Family Planning Table 5.12 Trends in source of supply for selected modern methods Percent distribution of current users of the pill, IUD, male condom, and female sterilization, by source of supply, TDHS-1998 and TDHS-2003 Female sterilization Pill IUD Male condom Source of supply TDHS- 1998 TDHS- 2003 TDHS- 1998 TDHS- 2003 TDHS- 1998 TDHS- 2003 TDHS- 1998 TDHS- 2003 Public sector 76.9 82.0 26.0 30.6 71.8 71.3 27.7 34.1 Private sector 20.8 16.3 73.6 67.5 27.5 27.6 66.8 59.3 Other 2.3 1.7 0.4 1.9 0.7 1.1 5.5 6.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 5.9 Informed Choice Ensuring women receive the information they need to make an informed choice about the contraceptive method that they will adopt is key aspect of high quality family planning services. Family planning providers should inform all method users of potential side effects and what they should do if they encounter signs of a problem. This information assists users in coping with side effects and decreases unnecessary discontinuation of temporary methods. Users of temporary methods should also be informed of the choices they have with respect to other methods. In the TDHS-2003, women currently using a modern method of contraception were asked whether they were informed of the possible side effects of the method they are using, and if so, whether they were informed of what they should do if they experience any side effects, and whether they were informed of other methods that could be used. Table 5.13 presents information on three aspects of informed choice. Fifty-four percent of users were informed about potential side effects of their method, 44 percent were told what to do if they experience any side effects, and just a third were given information about other family planning method options. These figures indicate that there is much scope for improving the quality of family planning services throughout the country. With regard to current method, pill and IUD users appear to be better informed than users of other methods. Family planning providers in the urban areas are more likely to inform contraceptive users about the method side effects or problems, what to do if they experience side effects and other contraceptive options than their rural counterparts. Women in the North generally appear to have less access to information than women in other regions. As expected, women with high school education are better informed than women with little or no education. Family Planning | 73 Table 5.13 Informed choice Among current users of modern contraceptive methods who adopted the current method in the five years preceding the survey, percentage who were informed about the side effects of the method used, percentage who were informed what to do if side effects were experienced, and percentage who were informed of other methods that could be used for contraception by method used and background characteristics, Turkey 2003 Background characteristic Informed about side effects or problems of method used1 Informed what to do if experienced side effects1 Informed by a health or family planning worker of other methods that could be used1 Method used Female sterilization 36.8 27.5 25.9 Pill 54.1 38.3 33.0 IUD 59.1 50.3 31.2 Injectables (28.6) (23.2) (26.4) Residence Urban 56.1 46.7 34.1 Rural 48.5 36.0 19.9 Region West 56.1 46.6 33.9 South 56.3 46.4 29.4 Central 49.9 40.2 26.7 North 44.9 30.2 25.6 East 58.2 46.5 31.9 NUTS 1 Region İstanbul 57.9 48.0 37.8 West Marmara (49.7) (42.1) (20.5) Aegean 51.5 37.5 24.6 East Marmara 62.2 57.0 39.9 West Anatolia 56.1 46.6 32.4 Mediterranean 56.3 46.4 29.4 Central Anatolia 44.6 35.1 18.9 West Black Sea 33.7 23.6 21.4 East Black Sea (42.6) (29.9) (28.3) Northeast Anatolia (44.3) (33.2) (18.0) Central East Anatolia 51.1 43.1 26.3 Southeast Anatolia 69.7 55.2 42.4 Education No education/Primary incomplete 39.9 32.3 24.0 First level primary 52.0 42.0 24.6 Second level primary 58.5 50.6 41.6 High school and higher 71.9 57.6 48.8 Total 54.3 44.2 30.7 1 Among users of female sterilization, pill, IUD, and injectables Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. 74 | Family Planning 5.10 Discontinuation of Contraceptive Use The demographic impacts of contraceptive use depend not only on its prevalence but also on the effectiveness of use. In countries like Turkey where ideal family size has declined and contraceptive prevalence has risen, contraceptive effectiveness becomes an increasingly important determinant of fertility. In addition to its demographic impact, the analysis of contraceptive discontinuation is important because it aids policy makers and health professionals in their efforts to improve service delivery. This can highlight program areas that require development, as well as groups of users who have particular concerns that need to be addressed. Table 5.14 Contraceptive discontinuation rates First-year contraceptive discontinuation rates by reason for discontinuation, according to method, Turkey 2003 Reason for discontinuation Contraceptive method Method failure To become pregnant Switched to another method Other reason All reasons Pill 5.5 7.2 29.8 11.7 54.2 IUD 1.5 0.6 6.2 2.3 10.6 Injectables 3.2 5.0 52.9 17.6 78.6 Male condom 5.7 9.9 26.2 3.2 44.9 LAM 18.6 1.9 43.6 11.5 75.5 Periodic abstinence 19.7 14.2 15.3 5.0 54.1 Withdrawal 13.1 9.1 15.1 3.7 41.1 All methods 8.6 6.8 19.4 5.1 39.8 LAM = Lactational amenorrhea method Table 5.14 presents first-year contraceptive discontinuation rates by reason for discontinuation, according to the method discontinued. The discontinuation rate refers to the proportion of women who have started using a contraception method at some time in the 5 years prior to the survey, but then stopped using that method within 12 months of having started it. The rate is calculated using information from the reproductive event calendar included in the TDHS-2003. In the calendar, all segments of contraceptive use between January 1998 and the date of interview were recorded along with reasons for any discontinuation of use during the period. The results indicate that 40 percent of contraceptive users in Turkey stop using a contraceptive method within 12 months of starting use. One would expect the rates to vary by method by virtue of the nature of the methods. For example, the IUD is not generally intended as a short-term method, and so a low discontinuation rate of 11 percent is to be expected. On the other hand, coitus-related methods are more easily discontinued: 45 percent of condom users discontinued within one year of use. The one-year discontinuation rate is as high as 79 percent for injectables, 54 percent for the pill, and 41 percent for withdrawal. Around a half of those who discontinued use switched to another method. Although one might assume that the desire to become pregnant might be one of the main reasons for Family Planning | 75 discontinuing use of a method of contraception, only 7 percent of users discontinued within 12 months of initiating use for that reason. Another 9 percent of users stopped using as a result of method failure, and the remaining 5 percent stopped due to other reasons. Switching to another method accounts for an especially large portion of the relatively high discontinuation of the injectable, LAM and the pill (53 percent, 44 percent, and 30 percent, respectively). Method failure accounted for a substantial portion of the discontinuation of traditional methods (LAM, periodic abstinence and withdrawal). Table 5.15 presents the distribution of all discontinuations during the five years prior to the survey by main reason for discontinuation according to the method used. The desire to become pregnant accounted for one-fifth of all discontinuations. Side effects and health concerns were frequently mentioned as reasons for discontinuation of modern methods. Method failure was more common among withdrawal users (35 percent) than modern method users. However, 17 percent of condom discontinuations and 12 percent of pill discontinuations also were due to method failure. Table 5.15 Reasons for discontinuation of contraception Percent distribution of contraceptive method discontinuations in the five years preceding the survey by main reason for discontinuation, according to specific methods, Turkey 2003 Reason for discontinuation Pill IUD Diaphragm Male condom Withdrawal All methods1 Became pregnant 12.4 4.9 18.7 16.8 35.2 22.1 Wanted to become pregnant 17.4 18.8 18.1 26.9 25.2 21.5 Husband disapproved 0.9 0.2 1.7 11.6 2.2 3.0 Side effects 33.7 37.9 5.9 0.6 0.2 13.1 Health concerns 6.4 7.9 1.9 0.7 0.9 3.0 Access/Availability 2.6 0.0 3.2 4.7 0.0 1.2 Wanted a more effective method 2.6 0.4 5.7 12.7 18.3 11.9 Inconvenient to use 3.1 0.7 14.4 5.0 0.3 1.7 Infrequent sex 4.2 0.4 6.2 1.6 4.0 2.7 Cost 2.5 0.1 0.0 0.8 0.0 0.5 Fatalistic 0.1 0.0 5.3 0.2 0.0 0.2 Menopause 1.8 4.1 6.3 2.6 3.0 2.8 Marital dissolution 1.9 6.0 1.7 1.2 1.6 2.4 Other 6.8 16.4 9.1 9.0 4.2 9.5 Missing 3.6 2.2 1.8 5.5 4.8 4.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 858 1,119 61 1,023 2,536 6,273 1 Includes discontinuations of injectables, periodic abstinence, and folk methods 5.11 Intention to Use Contraception Among Non-Users The intentions of women to use a method of contraception in the future provide a basis for forecasting potential need for contraceptives. To obtain information on the intentions, the TDHS-2003 survey asked currently married non-users of contraception whether they planned to use a method of contraception within next 12 months or at some time in the future. Table 5.16 presents the results according to the number of living children the nonusers have. Overall, 47 percent of currently married non-users do not intend to use a method of 76 | Family Planning contraception at any time in the future. Additionally, 4 percent say that they are unsure of their intent or the timing about future use. On the other hand, around half of currently married women who are not using a contraceptive method intend to use family planning at some time in the future; 32 percent state that they intend to use a method within next 12 months, and 16 percent intend to use later. The percentage of married women who do not intend to use a method of family planning increases as the number of living children increases, from 27 percent among women with one child up to 61 percent among women with four or more children. Table 5.16 Future use of contraception Percent distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children, Turkey 2003 Number of living children1 Future use of contraception 0 1 2 3 4+ Total In next 12 months 9.8 41.3 38.1 32.6 30.8 31.5 Use later 42.3 23.1 7.4 3.2 4.5 15.6 Unsure about timing 1.7 2.4 1.9 0.8 0.3 1.5 Unsure about use 3.9 3.5 1.7 2.0 2.4 2.7 Does not intend 41.7 27.2 49.2 59.8 60.9 47.4 Missing 0.5 2.5 1.5 1.5 1.1 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 384 492 507 333 512 2,228 1 Includes current pregnancy As Table 5.17 presents, 38 per- cent of non-users who intend to use a method at some time in the future report they would adopt the IUD. The pill is the most popular method of contraception for future use. Female sterilization is preferred by 10 percent of non-user women as a third preferred method of contraception for future use. The proportion preferring the IUD and the pill do not vary substantially with age; however, older nonusers are twice as likely as nonusers under age 30 to prefer female sterilization. Table 5.17 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to age, Turkey 2003 Age Method <30 30+ Total Female sterilization 7.1 16.4 9.9 Pill 11.4 11.2 11.4 IUD 38.8 35.3 37.8 Injectables 6.5 8.7 7.1 Implants 1.3 1.3 1.3 Male condom 8.0 5.1 7.1 Diaphragm 0.1 0.4 0.2 LAM 0.1 0.5 0.2 Periodic abstinence 0.0 0.5 0.1 Withdrawal 9.1 7.3 8.6 Other 1.6 0.8 1.4 Unsure 15.8 12.6 14.9 Missing 0.1 0.0 0.1 Total 100.0 100.0 100.0 Number 761 320 1,080 LAM = Lactational amenorrhea method Family Planning | 77 5.12 Reasons for Non-Use of Contraception Table 5.18 presents the reasons nonusers give for having no intention to use family planning by age. Nonusers who do not intend to use in the future are mainly over age 30 (90 percent), and their reasons for nonuse are quite different from the reasons of younger nonusers. Three in four of nonusers over age 30 are not exposed to pregnancy: 42 percent had a hysterectomy or are menopausal, and 32 percent reported that they are infecund. On the other hand, the most common reason for not intending to use a method among younger non- users is reported as being infecund (45 percent). Table 5.18 Reasons for not using contraception Percent distribution of women who are not using a contraceptive method and who do not intend to use in the future by main reason for not using, according to age, Turkey 2003 Age Reason for not using contraception <30 30+ Total Fertility-related reasons 54.7 85.2 82.2 Not having sex 4.0 5.7 5.5 Infrequent sex 0.6 2.2 2.1 Menopausal/hysterectomy 0.0 42.0 37.9 Subfecund/infecund 45.2 32.0 33.3 Husband infecund 4.9 3.3 3.5 Opposition to use 25.1 3.8 5.9 Husband opposed 6.0 0.8 1.3 Religious prohibition 4.9 1.4 1.7 Fatalistic 9.7 1.5 2.3 Embarrassed 4.6 0.1 0.6 Lack of knowledge 1.4 0.6 0.7 Knows no method 1.4 0.6 0.7 Method-related reasons 2.8 2.0 2.1 Health concerns 1.1 1.4 1.3 Fear side effects 0.0 0.3 0.2 Cost too much 1.6 0.4 0.5 Other 13.6 7.1 7.7 Don't know 2.4 1.0 1.2 Missing 0.0 0.2 0.2 Total 100.0 100.0 100.0 Number 103 955 1,055 Abortions and Stillbirths | 79 ABORTIONS AND STILLBIRTHS 6 Sabahat Tezcan and Alanur Çavlin Bozbeyoğlu This chapter presents information on induced abortions, spontaneous abortions, and stillbirths. Stillbirths and spontaneous abortions are important maternal health indicators. The practice of induced abortion can have adverse effects on the health of women. Induced abortions have additional significance for family planning services since one important goal of family planning is to eliminate unwanted pregnancies. Women may resort to induced abortions either when they have accessibility and availability problems for contraceptive services or when there are other psychosocial barriers that keep them back from using contraceptive methods to avoid unwanted pregnancies or when the pregnancy occur as a result of contraceptive failure. In Turkey, induced abortion has always been important in fertility regulation, even before the legalization on socioeconomic grounds in 1983 with the enactment of the new population planning law. This law provided safe abortion on request during the first ten weeks of gestation for every woman who needed the service. Since the law was enacted, induced abortion has been available to women at government hospitals for a nominal fee and from the private sector. In the TDHS-2003, questions were included to determine the total number of induced and spontaneous abortions and stillbirths in the lifetime of women. In the calendar module, detailed information on the duration of each pregnancy ending in an abortion and on the place where abortion occurred was collected for each pregnancy terminated since January 1998. In addition, women who reported ever having a pregnancy ending in a miscarriage/abortion or stillbirth were asked about the month and year in which the last such pregnancy terminated. For last pregnancies that ended in an induced abortion, information was collected on the main reason for the abortion. The TDHS-1998 had included a similar question. However, unlike the TDHS-1998 question, the TDHS-2003 employed an open-ended question to collect this information. For this report, the responses to the open-ended question are categorized into 6 groups including the reasons related to concerns about the health of the woman and child, the woman’s desire not to have another pregnancy at all, concern that the pregnancy was too close to a prior pregnancy, and other reasons (e.g., economic or familial). 6.1 Life-time Experience with Pregnancy Terminations Table 6.1 shows the distribution of ever-married women by the total number of abortions (induced and spontaneous) and stillbirths that they reported ever having had during their reproductive lives. Overall, the table shows that, while relatively few women have had a stillbirth (4 percent), nearly one-fifth of ever-married women reported ever having had a 80 | Abortions and Stillbirths spontaneous abortion and 24 percent have ever had an induced abortion. Among the women who had had an induced abortion, more than 58 percent had had only one induced abortion. Table 6.1 Number of abortions and stillbirths Percent distribution of ever-married women by number of abortions (spontaneous and induced) and stillbirths, Turkey 2003 Abortions Number of terminations Spontaneous Induced Stillbirths None 79.2 76.1 96.0 1 14.6 13.8 3.5 2 3.9 6.3 0.3 3 1.5 2.3 0.1 4 0.4 0.8 0.0 5 or more 0.3 0.8 0.1 Total 100.0 100.0 100.0 Mean number 0.3 0.4 <0.1 The woman’s age and the number of living children she has are strongly associated with the likelihood that a woman will have had an induced abortion. Table 6.2 shows that the percentage of ever-married women ever having had an induced abortion varies from less than 5 percent among women under age 25 up to 41 percent among women age 45-49, with the proportion rising markedly among women age 30 and older. The percentage of ever-married women who have had an induced abortion also increases steadily with the number of living children, from 3 percent of women with no living children to a peak of 33 percent among women with three or four children. As Table 6.2 shows, the proportion of women ever have had an abortion is higher among urban than rural women (26 percent and 19 percent, respectively). Women in the East region (14 percent) are the least likely to have ever had an induced abortion and women in the Central (28 percent) and West (27 percent) regions are the most likely to report an induced abortion. Considering the pattern for the NUTS 1 regions, the proportion of women ever having had an induced abortion is lowest in Southeast Anatolia (10 percent) and the highest in West Black Sea (31 percent). There is little variation in the proportion of women with an induced abortion by education. 6.2 Current Levels and Trends in Abortion Rates Table 6.3 shows the rates of abortions (spontaneous and induced) and stillbirths per 100 pregnancies for the five-year period prior to the TDHS-2003. The table reveals that, during this period, 23 percent of pregnancies among ever-married women terminated in other than a live birth. Induced and spontaneous abortions have higher share among non-live terminations. Only about one out of every 100 pregnancies ended in a stillbirth, while there were 21 abortions per 100 pregnancies, of which 11 were induced. Abortions and Stillbirths | 81 Table 6.2 Induced abortions by background characteristics Percentage of ever-married women ever having had an induced abortion, by selected background characteristics, Turkey 2003 Background characteristic Ever had an induced abortion Number of women Age 15-19 4.5 238 20-24 4.2 1,045 25-29 12.3 1,479 30-34 21.4 1,488 35-39 30.7 1,420 40-44 37.8 1,330 45-49 41.0 1,073 Number of living children 0 2.7 736 1 13.4 1,603 2 27.4 2,630 3 33.2 1,566 4 32.6 746 5 or more 27.2 794 Residence Urban 26.0 5,752 Rural 18.7 2,323 Region West 26.8 3,286 South 21.9 1,028 Central 27.9 1,867 North 21.7 590 East 13.9 1,305 NUTS 1 Region İstanbul 28.2 1,470 West Marmara 22.1 348 Aegean 29.6 1,157 East Marmara 22.3 710 West Anatolia 26.7 784 Mediterranean 21.9 1,028 Central Anatolia 23.7 471 West Black Sea 30.6 513 East Black Sea 20.2 291 Northeast Anatolia 23.4 245 Central East Anatolia 14.8 389 Southest Anatolia 9.9 671 Education No education/Prim.incomp 21.3 1,761 First level primary 24.9 4,339 Second level primary 23.2 601 High school and higher 24.8 1,374 Total 23.9 8,075 82 | Abortions and Stillbirths Table 6.4 presents the trends in the levels of in- duced abortions during the period between the TDHS- 1993 and TDHS-2003. Overall, the results suggest that there was a substantial decline in level of induced abor- tions during the period covered in the surveys, from 18 abortions to 11 abortions per 100 pregnancies. The level of induced abortions also declined for most of the sub- groups. For instance, among urban women, there were 13 induced abor- tions per 100 pregnancies at the time of the TDHS-2003 compared to a rate of 21 abortions per 100 pregnancies in the TDHS-1993. With regard to the regions, the proportion of women who have had an induced abortion is the least in the East region as it was in TDHS-1998. The largest absolute de- clines in the percentages of women who have had an induced abortion are observed in the West (from 25 abor- tions per 100 pregnancies in the TDHS-1993 to 15 in the TDHS-2003) and in the North (from 17 abortions per 100 pregnancies in the TDHS- 1993 to 9 in the TDHS-2003). Com- pared with the findings of the previous surveys, abortion rates within the various educational categories also have decreased, with the decline being greatest for women with secondary level primary or higher education. As a result, educational differentials in abortion rates appear to be closing in Turkey. Table 6.3 Abortions and stillbirths per 100 pregnancies Number of abortions (spontaneous and induced) and stillbirths per 100 pregnancies during the five-year period before the survey, Turkey 2003 Outcome Number per 100 pregnancies Abortions 21.3 Spontaneous 10.0 Induced 11.3 Stillbirths 1.3 Table 6.4 Trends in induced abortions Trends in the number of induced abortions per 100 pregnancies during the five-year period before the survey, TDHS-1993, TDHS-1998, and TDHS-2003 Background characteristic TDHS- 1993 TDHS- 1998 TDHS- 2003 Age 15-19 3.8 5.8 3.4 20-24 8.3 7.7 5.6 25-29 20.4 12.6 9.5 30-34 27.9 23.3 19.1 35-39 36.2 33.4 25.5 40-44 47.1 42.5 33.7 45-49 47.6 66.2 27,6 Residence Urban 21.3 16.1 13.2 Rural 12.4 11.6 7.2 Region West 24.9 18.0 14.7 South 16.3 13.7 10.2 Central 19.8 16.7 14.9 North 17.0 15.6 8.8 East 8.7 7.6 5.2 NUTS 1 Region İstanbul NA NA 15.1 West Marmara NA NA 13.0 Aegean NA NA 20.4 East Marmara NA NA 7.4 West Anatolia NA NA 15.5 Mediterranean NA NA 10.2 Central Anatolia NA NA 10.0 West Black Sea NA NA 17.0 East Black Sea NA NA 6.3 Northeast Anatolia NA NA 10.8 Central East Anatolia NA NA 4.4 Southeast Anatolia NA NA 3.9 Education No education/Prim. incomplete 13.9 11.8 8.3 First level primary 19.4 15.1 11.5 Second level primary 22.6 17.3 12.8 High school and higher NA NA 14.8 Total 18.0 14.5 11.3 a For TDHS-1993 and TDHS-1998 this category refers to secondary+. Abortions and Stillbirths | 83 6.3 Patterns of Contraceptive Use Prior to and After Induced Abortion TDHS-2003 calendar can be utilized to examine the women’s use of contraception before and after an induced abortion. An examination of the patterns of contraceptive use before a woman has an abortion is important because pregnancies that end in abortions are often result from the use of ineffective contraceptive methods or from the failure to use methods effectively as well as from not using contraception at all. According to the TDHS- 2003 results, all of these factors are related to abortion in Turkey. As Table 6.5 shows, in the case of around one-fourth of the abortions during the five-year period prior to the survey, the woman was not using any contraceptive method in the month before she became pregnant. Among abortions in which con- traception was used immediately prior to the pregnancy, women were more likely to be using a traditional than a modern method. Almost a half of the abortions oc- curred following a period of use of with- drawal (46 percent), while 23 percent occurred as the women was using a modern method, in particular the condom (10 percent), the pill (6 percent) or the IUD (5 percent). Information on the use of contra- ception in the month following an abortion is presented in Table 6.6. Women did not use any contraceptive method in the month following abortion in the case of almost one-third of the abortions in the five-year period before the survey, and they initiated use of a traditional method, principally withdrawal, in the case of somewhat more than one-quarter of the abortions. Overall, modern family planning methods were adopted in the month following the preg- nancy termination in the case of 40 percent of abortions. In comparison with the mix of methods used before abortion, this repre- sented a substantial increase in the use of modern methods. The IUD was the most popular method among women adopting a modern method after an abortion, followed by the pill and condom. Table 6.5 Method used before abortion Method used within one month before pregnancy for the last abortion reported in the five years preceding the survey, Turkey 2003 Method Percentage using method before abortion Pill 6.1 IUD 5.0 Injection 0.3 Diaphragm 0.8 Male condom 10.4 Lactational amenorrhea method 2.3 Periodic abstinence 3.5 Withdrawal 46.1 Other 1.1 No method 24.4 Total 100.0 Number 552 Table 6.6 Method used after abortion Method used within one month after pregnancy for the last abortion reported in the five years preceding the survey, Turkey 2003 Method Percentage using method after abortion Female sterilization 1.5 Male sterilization 0.2 Pill 10.3 IUD 15.9 Injection 1.6 Diaphragm 1.0 Male condom 9.4 Periodic abstinence 1.3 Withdrawal 26.4 Other 0.7 No method 30.7 Unknown 1.1 Total 100.0 Number 552 84 | Abortions and Stillbirths 6.4 Reasons for Induced Abortion The reasons women gave for having their last induced abortion are presented in Table 6.7. Four of every ten women had the abortion because they did not want to have another child. An additional 17 percent ended the pregnancy because it followed a previous pregnancy too closely. Thus, more than half of women who had an abortion wanted to space or limit their births at the time of the abortion. Among women citing other reasons for the abortion, the majority indicated that they ended the pregnancy because of economic problems or problems within family. Health problems were the main reason for the decision to have the last abortion among 12 percent of the women. As the age of women increases, the proportion of women who had an abortion because they did not want another child also increases. The desire to delay (space) a wanted birth or concerns about health were cited somewhat more frequently as the reasons for ending the pregnancy among women under age 35 than among older women. There is comparatively little variation between urban and rural areas in the reasons women gave for having an abortion, with around 40 percent of both urban and rural women saying that they had an abortion because they did not want another child. Urban women are somewhat more likely than rural women to say they had an abortion because it followed a prior pregnancy too closely. In turn, rural women cite other concerns (principally related to economic issues or familial problems) more often than urban women. Looking at regional patterns, the East and North regions have the highest percentage of women reporting they had the abortion because they did not want another child (46 percent and 45 percent respectively) and the West Region has the lowest percentage (39 percent). Women in the West were the most likely to cite a concern about spacing pregnancies as the reason for abortion. Women in the Central region tended to give economic and familial reasons somewhat more often than women in the other regions. The desire to limit births is the most frequently reported reason for abortion in all educational categories. Women with higher education are somewhat more likely than women in the other education categories to say that they had terminated the pregnancy because the period since the previous pregnancy was too short. The proportion citing economic or familial reasons for abortion is inversely related to a woman’s educational level. Abortions and Stillbirths | 85 Table 6.7 Reasons for induced abortion Percent distribution of ever-married women who ever had an induced abortion by reason for last induced abortion, according to background characteristics, Turkey 2003 Health related to: Background characteristic Mother Child Mother and child Didn’t want another Previous pregnancy just ended Other Total Number of women Age 15-19 * * * * * * 100.0 12 20-24 (2.7) (7.7) (0.0) (28.2) (25.3) (36.1) 100.0 43 25-29 9.8 4.3 0.8 37.8 20.4 26.9 100.0 170 30-34 5.0 4.3 1.7 34.1 23.0 32.0 100.0 305 35-39 7.0 3.2 1.9 36.9 16.9 33.7 100.0 408 40-44 8.7 3.3 1.3 45.0 14.2 27.4 100.0 458 45-49 5.7 1.8 1.0 47.5 13.1 31.0 100.0 401 Residence Urban 7.0 3.4 1.3 41.1 18.2 28.9 100.0 1,386 Rural 6.5 2.8 1.6 39.4 13.2 36.5 100.0 409 Region West 7.1 2.6 1.3 38.9 20.6 29.6 100.0 819 South 9.4 6.0 2.0 39.9 13.6 29.1 100.0 208 Central 4.9 3.0 0.8 41.1 13.6 36.2 100.0 489 North 6.5 4.5 1.5 45.1 16.6 25.8 100.0 117 East 9,3 3.4 2.3 46.0 14.1 24.8 100.0 162 NUTS 1 Region İstanbul 8.0 4.0 1.7 33.7 22.0 29.8 100.0 388 West Marmara 7.5 5.8 1.1 43.2 19.9 22.5 100.0 73 Aegean 4.4 0.3 1.1 41.6 18.9 33.6 100.0 319 East Marmara 6.1 1.2 1.4 46.9 17.4 27.1 100.0 145 West Anatolia 5 2.9 0.9 47.3 13.3 29.7 100.0 194 Mediterranean 9.4 6.0 2.0 39.9 13.6 29.1 100.0 208 Central Anatolia 7.5 4.4 0.0 42.5 11.9 33.8 100.0 103 West Black Sea 2.5 4.5 0.4 33.3 15.8 43.5 100.0 149 East Black Sea 10.3 3.7 2.2 45.2 14.2 24.5 100.0 54 Northeast Anatolia 8.3 2.9 2.9 43.1 11.8 31.1 100.0 51 Central East Anatolia 8.7 1.2 0.0 44.0 17.9 28.3 100.0 51 Southest Anatolia 10.8 5.8 3.9 50.2 12.8 16.5 100.0 60 Education No education/Prim.incomp. 9.6 2.5 2.2 42.2 9.1 34.5 100.0 341 First level primary 6.0 3.3 1.1 39.3 17.6 32.8 100.0 1,001 Second level primary 7.9 2.7 0.3 40.2 22.2 26.7 100.0 130 High school and higher 6,5 4.5 1.8 43.7 21.7 21.3 100.0 322 Total 6.9 3.3 1.4 40.7 17.0 30.6 100.0 1,795 Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. An asterisk indicates a figure is based on fewer than 25 unweighted cases and has been suppressed. 86 | Abortions and Stillbirths 6.5 Timing of Induced Abortions Although abortions are legal for up to 10 weeks of pregnancy (2.5 months), it is safer for a woman to have an abortion as early as possible. Table 6.8 shows the distribution of ever- married women with an induced abortion in the five-year period before the survey by the number of months that the woman was pregnant at the time of the last abortion. Overall, 73 percent of the abortions occurred in the first month of pregnancy and 22 percent in the second month of pregnancy. Thus, only five percent of induced abortions were performed outside of the recommended time limit. Urban women and women in the Central and South regions are more likely to have had the abortion after the second month of pregnancy than women living in the other regions. Table 6.8 Timing of induced abortion Percent distribution of ever-married women who had an induced abortion in the 5 years preceding the survey by number of months pregnant at time of last abortion, according to place of residence, Turkey 2003 Number of months pregnant Residence and region 1 2 3+ Total Number of women Residence Urban 72.0 22.4 5.6 100.0 437 Rural 78.7 19.9 1.5 100.0 115 Region West 70.6 25.1 4.3 100.0 245 South 73.6 21.2 5.2 100.0 69 Central 76.9 17.3 5.8 100.0 145 North (73.1) (22.8) (4.1) 100.0 27 East 76.1 20.3 3.6 100.0 66 Selected NUTS 1 Regions İstanbul 73.0 23.9 3.2, 100.0 121 Southeast Anatolia (65.8) (27.9) (6.4) 100.0 28 Total 73.4 21.9 4.7 100.0 552 6.6 Abortion Provider Table 6.9 presents information on the abortion provider. Nearly four in five women who had an induced abortion in the five-year period preceding the survey reported the abortion took place at a private doctor’s office (57 percent) or at a private hospital or clinic (21 percent). Reliance on the private sector for abortion services was greater in the TDHS- 2003 than in the TDHS-1998. Women seeking abortion services from public sector providers were more likely to report that they had obtained the abortion at a hospital than from a health center. Rural women were somewhat more likely than urban women to have had the abortion performed at private doctor’s office rather than hospitals or clinics. Highest preference of private hospital and clinic is observed among women living in İstanbul. The proportion obtaining abortion services at a private doctor’s office or a private clinic or hospital little variation by region, from 74 percent in the Central to 80 percent in the West Region. Abortions and Stillbirths | 87 Table 6.9 Abortion provider Percent distribution of ever-married women with recent induced abortions by place of provision, according to place of residence, Turkey 2003 Abortion provider Residence and region Govern- ment hospital Maternity hospital Health center SSK hospital Private hospital/ clinic Doctor's office Uni- versity hospital Other Missing Total Number of women Residence Urban 10.3 5.1 0.6 3.8 24.3 51.3 2.4 2.9 0.2 100.0 473 Rural 4.8 5.6 0.0 4.3 7.9 76.5 0.0 0.7 0.0 100.0 123 Region West 9.2 2.1 0.6 4.3 33,8 45.7 2.1 2.2 0.0 100.0 264 South 11.1 4.5 0.8 0.8 10.2 67.5 1.4 2.3 1.4 100.0 71 Central 9.9 9.3 0.0 5.2 11.6 61.9 2.1 0.0 0.0 100.0 162 North (6.5) (6.3) (1.5) (8.9) (3.5) (73.3) (0.0) (0.0) (0.0) 100.0 27 East 6.5 7.7 0.4 0.8 11.8 66.6 1.6 4.5 0.0 100.0 73 Selected NUTS 1 Regions İstanbul 13,9 0,0 1,3 4,6 47,6 26,8 4,2 1,6 0,0 100.0 130 Southeast Anatolia 7,6 3,8 0,0 1,8 21,1 55,9 3,9 5,8 0,0 100.0 31 Total 9.2 5.2 0.5 3.9 20.9 56.5 1.9 1.8 0.2 100.0 597 6.7 Age-specific and Total Abortion Rates Abortion rates for the five-year period preceding the survey are shown in Table 6.10 by place of residence. Age-specific rates represent the probability that a woman of a particular age will have an abortion during a one-year period. These rates are shown per 1,000 women. A useful summary index of the age-specific abortion rates is the total abortion rate (TAR). This rate is analogous to the total fertility rate (TFR). The TAR is the average lifetime number of abortions a woman would have if she experience the current age-specific abortion rates. Table 6.10 Total abortion rates Age-specific and cumulative abortion rates for the five year period preceding the survey by urban-rural residence, Turkey 2003 Current age Urban Rural Total 15-19 2 2 2 20-24 12 4 9 25-29 19 9 16 30-34 23 19 22 35-39 18 15 17 40-44 8 6 8 45-49 1 2 1 TAR 15-49 0.42 0.29 0.38 TAR 15-44 0.41 0.28 0.37 TAR = Total abortion rate expressed per woman 88 | Abortions and Stillbirths The TAR per women is found to be 0.4 for the five years preceding the TDHS-2003. The age-specific rates increase to a peak among women age 30-34, and decline among older women. The rates of abortion are higher in urban than rural settlements at all ages, except the 15-19 cohort where the level is the same. Total abortion rates by background characteristics are shown in Table 6.11. Central Region has the highest average number of abortion per women while the North has the lowest (0.47 and 0.23 respectively). Differences in TAR are modest by education. Table 6.11 Total abortion rates by background characteristics Total abortion rate for the five year period preceding the survey by background characteristics, Turkey 2003 Background characteristic TAR 15-49 Residence Urban 0.42 Rural 0.29 Region West 0.41 South 0.32 Central 0.47 North 0.23 East 0.29 Selected NUTS 1 Regions İstanbul 0,42 Southeast Anatolia 0,24 Education No education/ Primary incomplete 0.36 First level primary 0.37 Second level primary 0.40 High school and higher 0.39 Total 0.38 TAR = Total abortion rate expressed per woman Other Proximate Determinants of Fertility | 89 OTHER PROXIMATE DETERMINANTS OF FERTILITY 7 Banu Akadlı Ergöçmen and Mehmet Ali Eryurt This chapter addresses the principal factors other than contraception that affect a woman's risk of becoming pregnant, namely, nuptiality, postpartum amenorrhea, and abstinence from sexual relations. Marriage is an indicator of exposure of women to the risk of pregnancy and, thus, is important for the understanding of fertility. Populations in which age at marriage is low tend to experience early childbearing and high fertility. Therefore, an increase in the average age at which women marry can help to explain the trends in fertility levels. Measures of other proximate determinants of fertility including the duration of postpartum amenorrhea and postpartum abstinence are also important in understanding fertility patterns. 7.1 Current Marital Status In the TDHS-2003, some information on never-married women was collected with a module included in the household questionnaire. In the individual questionnaire, nuptiality questions for ever-married women were included in a separate section. In this section, in addition to the basic questions on marital status and age at marriage that are included in the standard DHS questionnaire, there were also questions about family formation, religious marriages, and consanguinity. Unlike, the standard DHS questionnaire, ever-married women were not asked about the age at which they initiated sexual activity, for cultural reasons. Table 7.1 and Figure 7.1 show the distribution of all women age 15-49 by their marital status at the time of the survey. Overall, 67 percent of all women are currently married1 and 30 percent are never married. The proportions of women who are widowed and divorced are above 1 percent and the proportion separated is less than 1 percent. Looking at the age patterns, it is clear that marriage is almost universal in Turkey. The proportion of never-married women declines rapidly with age, from 88 percent among teenagers to 20 percent among women in their late twenties. Among women age 30 and older fewer than 1 in 10 women have never married, and the proportion never married among women age 45-49 who are nearing the end of the reproductive years is less than 2 percent. As expected, the proportion widowed increases with age, from less than 1 percent of women under age 30 to 5 percent among women at ages 45-49. The percentage of women who are divorced is markedly higher among women age 30-44 (although still less than 3 percent) than in the other age groups. 1The term married refers both to "currently married" and "currently in union." 90 | Other Proximate Determinants of Fertility Table 7.1 Current marital status Percent distribution of women by current marital status, according to age, Turkey 2003 Marital status Current age Never married Married Widowed Divorced Separated Total Number of women 15-19 88.1 11.9 0.0 0.0 0.0 100.0 2,003 20-24 50.2 48.5 0.1 0.6 0.5 100.0 2,101 25-29 20.0 77.6 0.5 1.3 0.7 100.0 1,849 30-34 8.2 87.7 0.9 2.4 0.8 100.0 1,622 35-39 4.1 90.0 1.8 2.6 1.6 100.0 1,481 40-44 3.0 89.2 4.4 2.5 0.9 100.0 1,371 45-49 1.5 91.9 5.0 1.0 0.7 100.0 1,089 Total 29.9 66.6 1.4 1.4 0.7 100.0 11,517 Figure 7.1 Marital Status of Women Age 15-49 Widowed 1% Divorced/Not living together 2% Never married 30% Married 67% Overall, there has been a slight decrease in the percentage of women currently married over the past five years, from 69 percent based on the TDHS-1998 to 67 percent in TDHS-2003. Much of this trend appears to be due to the postponement of marriage among younger women. The proportion of women who have never married increased in all age groups between the surveys, except the 45-49 age group. The increases were especially marked in the 20-24 and 25- 29 age groups (11 percentage points and 7 percentage points, respectively) 7.2 Age at First Marriage In Turkey, marriage demographically is very important, because, besides being prevalent throughout the country almost all births occur within marriage. Therefore, age at first marriage is a significant demographic indicator since it represents the onset of a woman’s exposure to the risk of pregnancy. TDHS-2003 Other Proximate Determinants of Fertility | 91 As shown in Table 7.2, the median age at first marriage is 20 among women 25-49, indicating that half of the women in those age groups married before that age. A steady increase is observed in the median age at first marriage, from 19.2 years for the 45-49 age group to 21 years for the 25-29 age group. There has been a marked decline in getting married at very young ages. For example, the percentage of women married by age 15 has dropped from 8 percent among women age 45-49 to 2 percent among women 20-24. Table 7.2 Age at first marriage Percentage of women who were first married by specific exact ages and median age at first marriage, according to current age, Turkey 2003 Percentage first married by exact age: Current age 15 18 20 22 25 Percen- tage never married Number of women Median age at first marriage 15-19 1.4 NA NA NA NA 88.1 2,003 a 20-24 2.2 18.4 33.1 NA NA 50.2 2,101 a 25-29 3.6 23.1 40.4 58.5 73.3 20.0 1,849 21.0 30-34 4.4 27.3 46.4 64.1 80.8 8.2 1,622 20.4 35-39 5.7 28.7 50.6 66.3 82.0 4.1 1,481 20.0 40-44 8.3 37.4 58.3 73.3 86.2 3.0 1,371 19.2 45-49 8.3 34.7 58.0 76.4 88.5 1.5 1,089 19.2 20-49 5.0 27.0 46.0 NA NA 17.6 9,514 20.5 25-49 5.7 29.5 49.6 66.7 81.3 8.4 7,413 20.0 NA = Not applicable a Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group Although the median is a convenient summary measure, not all changes in age at marriage are necessarily reflected in the median. Cohort trends in age at marriage can be more thoroughly examined by comparing the percentages who first marry at specific ages for successive 5-year age groups. These percentages confirm that substantial changes have occurred in the age at which women marry in Turkey over the past several decades. The percentages of women married at each specific age are all lower for the younger cohorts than for the older cohorts. For example, among women age 45-49, 58 percent married by age 20, whereas only 40 percent of women age 25-29 married by age 20. Table 7.3 and Figure 7.2 present differentials in the median age at first marriage among women age 25-49 by residence, region and education. Looking at the residence patterns, urban women marry slightly later than their rural residence counterparts (20.3 years and 19.4 years respectively). This pattern is observed for all age groups. The regional comparisons indicate that women get married earliest in the East and Central regions (19 years and 19.5 years, respectively) and latest in the South region (20.7 years). When the results for the NUTS 1 regions are examined, Mediterranean is the region with the highest median age (21.3 years) at marriage, whereas Central Anatolia has the lowest median age (19.1 years). Within regions, the median ages at first marriage for younger women are higher compared with those of the older age groups. For example, the median age at marriage in the 25-29 age group at Central East Anatolia is 23.7 years, five years later on average than the ages at marriage reported for women 35 and above in the same region. Likewise in İstanbul, West Marmara and 92 | Other Proximate Determinants of Fertility East Black Sea regions, half of the women in the 25-29 age group married after age 23, which is three or four years later than women age 35 and over married in the same regions. Table 7.3 Median age at first marriage Median age at first marriage among women age 25-49 by current age, according to background characteristics, Turkey 2003 Current age Background characteristics 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 21.3 20.5 20.3 19.4 19.7 20.3 Rural 20.4 20.1 19.5 18.8 18.5 19.4 Region West 21.3 20.6 20.6 19.6 19.7 20.4 South 21.1 20.8 21.0 19.7 20.4 20.7 Central 20.8 19.9 19.3 18.9 18.7 19.5 North 21.4 20.6 20.7 19.5 19.4 20.3 East 20.3 19.3 18.4 18.1 17.8 19.0 NUTS 1 Region İstanbul 23.0 21.4 20.3 19.5 19.8 20.9 West Marmara 23.1 20.2 19.8 19.1 18.9 20.4 Aegean 22.2 21.3 20.7 19.9 19.3 20.6 East Marmara 21.6 20.4 20.5 19.3 19.5 20.3 West Anatolia 21.9 20.1 19.8 19.8 19.7 20.4 Mediterranean 22.5 21.3 21.8 19.9 20.6 21.3 Central Anatolia 20.8 20.1 18.7 18.2 19.1 19.1 West Black Sea 22.1 22.4 20.9 19.9 19.0 20.6 East Black Sea 23.2 20.6 20.2 19.2 19.4 20.4 Northeast Anatolia 20.9 19.8 19.2 19.0 18.4 19.7 Central East Anatolia 23.7 20.2 18.3 18.5 18.3 20.0 Southest Anatolia 21.1 19.6 18.8 17.8 16.9 19.3 Education No education/Prim.incomp. 18.4 18.8 18.4 17.5 17.7 18.0 First level primary 19.8 19.7 19.5 18.9 19.0 19.4 Second level primary 22.1 21.7 21.4 21.4 20.7 21.7 High school and higher a 25.2 24.4 24.5 23.5 24.8 Total 21.0 20.4 20.0 19.2 19.2 20.0 a Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group As expected, there is positive association between the median age at first marriage and educational level of respondents. The differences between women who have completed at least high school and other women are especially pronounced. The median age at first marriage among women attending high school or higher is 24.8 years, almost 7 years higher than the median age among women with less than primary education (Table 7.3). Within educational categories, the relationship between the woman’s age at first marriage and her current age is not uniform. For women with primary or higher education, the age at marriage increases from older cohorts to younger ones. For women with no education, however, while the median age at marriage generally increases from the older to younger cohorts, the pattern is not as uniform. Other Proximate Determinants of Fertility | 93 7.3 Postpartum Amenorrhea, Postpartum Abstinence, and Insusceptibility The period of postpartum amenorrhea is the interval between childbirth and the return of menstruation. How long after child birth the protection from conception lasts depends on the length and intensity of breastfeeding and on how long it takes the woman to resume sexual intercourse. The percentage of births whose mothers are postpartum amenorrheic, abstaining, and postpartum insusceptible at the time of the survey is presented in Table 7.4 by the number of months since birth. Women are considered as insusceptible if they are not exposed to the risk of pregnancy, either because they are amenorrheic or are still abstaining from sexual intercourse following a birth. The estimates of the median and mean durations shown in the table are calculated from these current status proportions. To calculate these averages the data were grouped by two-month intervals to minimize fluctuations in the estimates. The results in Table 7.4 indicate that 92 percent of women are amenorrheic immediately following the delivery, but this value decreases to 57 percent starting from the second month after birth. The median duration of postpartum amenorrhea is about 3.4 months. In Turkey, the period of sexual abstinence after birth traditionally lasts 40 days. The estimates of postpartum abstinence in Table 7.4 are in accordance with this tradition. Of all mothers, 86 percent abstain from sexual relations immediately following a birth. However, starting from the second month after a birth, the contribution of abstinence to the period of Figure 7.2 Median Age at First Marriage among Women Age 25-49 20 19 20 21 20 20 19 Urban Rural West South Central North East Residence Region Median age in years TDHS-2003 94 | Other Proximate Determinants of Fertility insusceptibility is greatly reduced. At 2-3 months following a birth, the percentage of abstaining mothers decreases to 13 percent and by 6-7 months, to 7 percent (Figure 7.3). Table 7.4 Postpartum amenorrhea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Turkey 2003 Percentage of births for which the mother is Number of months since birth Amenorrheic Abstaining Insusceptible Number of births < 2 92.2 85.6 97.1 96 2-3 57.1 12.7 60.9 129 4-5 38.4 7.0 42.3 151 6-7 27.4 2.0 27.4 146 8-9 12.7 2.0 14.0 120 10-11 13.0 2.3 14.3 113 12-13 5.8 1.8 7.6 142 14-15 1.1 0.0 1.1 104 16-17 2.6 0.0 2.6 141 18-19 0.7 1.4 2.1 137 20-21 3.0 0.0 3.0 107 22-23 0.6 2.4 3.0 133 24-25 0.0 3.2 3.2 110 26-27 0.3 1.0 1.2 125 28-29 0.0 2.3 2.3 167 30-31 0.0 0.0 0.0 145 32-33 0.4 1.1 1.5 159 34-35 0.0 0.0 0.0 155 Total 13 5.7 14.5 2,380 Median 3.4 1.9 3.8 NA Mean 5.4 2.8 5.9 NA NA = Not applicable Corresponding with the results of the previous surveys conducted in 1993 and 1998, findings from the TDHS-2003 show that the period of postpartum amenorrhea is comparatively longer than the period of postpartum abstinence. Postpartum amenorrhea therefore appears as the principal determinant of the length of postpartum insusceptibility to pregnancy in Turkey. For example, at 2-3 months following a birth, women are more than four times as likely to be amenorrheic as to be abstaining. As seen in Figure 7.3 the proportion of mothers who are amenorrheic drops sharply during the first year after a birth. At about 12-13 months, the proportion of mothers who are amenorrheic drops sharply to 6 percent and by 14-15 months only one percent of mothers are still amenorrheic while none of the mothers abstaining. Thus, virtually all women are susceptible to pregnancy by the second year after giving birth. Other Proximate Determinants of Fertility | 95 Table 7.5 shows the median duration of postpartum amenorrhea, abstinence, and insusceptibility by background characteristics of mothers. In Turkey, the average duration of postpartum abstinence does not vary greatly according to the mother’s age and residence. Somewhat greater variation is observed, however, among regions and with the level of mother’s education. For example, postpartum abstinence seems to be practised longer in the Aegean, East Marmara, and Central Anatolia than in other regions. İstanbul and Southeast Anatolia have the lowest median durations for postpartum abstinence (1.6 months). Differences in the duration of postpartum amenorrhea by age, region, and level of education, although small, are worth highlighting. Women above age 30, women living in the East region, and women with less than primary education have the longest median duration for postpartum amenorrhea (3.9 months, 3.8 months, and 4.4 months, respectively). The shortest duration for postpartum amenorrhea is observed in the West Marmara region (0.8 months). The median number of months for postpartum amenorrhea is 4.4 months among women who do not have education, while it is 2.8 months for women with at least high school education. Figure 7.3 Percentage of Births Whose Mothers are Amenorrheic, Abstaining, or Insusceptible 0 10 20 30 40 50 60 70 80 90 100 < 2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-27 28-29 30-31 32-33 34-35 Months Since Birth Percent Amenorrheic Abstaining Insusceptible TDHS-2003 96 | Other Proximate Determinants of Fertility Tablo 7.5 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey , by background characteristics, Turkey 2003 Background characteristic Amenorrheic Abstaining Insusceptible Number of births Mother’s age <30 3.3 1.9 3.5 1,626 30+ 3.9 1.9 4.5 754 Residence Urban 3.5 1.8 4.0 1,571 Rural 3.3 1.9 3.4 809 Region West 3.6 2.0 4.1 789 South 3.1 1.7 3.5 317 Central 3.2 1.9 3.7 456 North 2.4 1.9 2.5 144 East 3.8 1.7 3.9 674 NUTS 1 Region İstanbul 3.4 1.6 3.6 365 West Marmara 0.8 2.0 4.7 74 Aegean 2.8 2.2 3.7 247 East Marmara 3.4 2.2 3.6 195 West Anatolia 3.7 2.0 4.7 182 Mediterranean 3.1 1.7 3.5 317 Central Anatolia 3.8 2.2 3.9 134 West Black Sea 2.0 1.9 2.1 116 East Black Sea 4.7 1.8 4.7 75 Northeast Anatolia 2.9 1.9 3.2 105 Central East Anatolia 3.5 1.8 3.5 172 Southest Anatolia 4.1 1.6 4.1 397 Education No education/Prim.incomp. 4.4 1.7 4.4 481 First level primary 3.2 1.9 3.6 1,288 Second level primary 3.3 2.0 3.6 488 High school and higher 2.8 1.9 4.6 123 Total 3.4 1.9 3.8 2,380 Note: Medians are based on current status In Turkey, differentials in the median duration of postpartum insusceptibility reflect the combined effects of amenorrhea and abstinence. They exhibit a pattern similar to those for amenorrhea. In general, women over age 30, urban women, women living in the West, and educated women are insusceptible for relatively longer periods. Fertility Preferences | 97 FERTILITY PREFERENCES 8 Turgay Ünalan and Sutay Yavuz This chapter addresses the following questions, which allow an assessment of the need for contraception. Does the respondent want more children? If so, how long would she prefer to wait before the next child? If she could start afresh, how many children in all would she want? To what extent do unwanted or mistimed pregnancies occur? What effect would the prevention of such pregnancies have on the fertility rates? Interpretation of data on fertility preferences has always been the subject of controversy. Survey questions have been criticized on the grounds that answers are misleading because: a) they reflect unformed, ephemeral views, which are held with weak intensity and little conviction; and b) they do not take into account the effect of social pressures or the attitudes of other family members, particularly the husband, who may exert a major influence on reproductive decisions. Questions about fertility preferences were asked of women in half of the households in the sample of the TDHS-2003. Therefore, the total number of cases in the tables is different than that of tables in other chapters. For a detailed explanation see Appendix B. 8.1 Desire for More Children In order to understand future fertility preferences, currently married women were asked: “Would you like to have another child or would you prefer not to have any more children?” If they did indeed want another child, they were asked: “How long would you like to wait from now before the birth of another child?” If the woman had not yet had any children, these questions were appropriately rephrased. The inclusion of women who are currently pregnant complicates the measurement of views on future childbearing. For these women, the question on desire for more children was rephrased to refer to desire for another child after the one that they are expecting. To take into account the way in which the preference variable is defined for pregnant women, the results are classified by number of living children, including the current pregnancy as equivalent to a living child. In some cases, the answers of pregnant women with respect to preferred waiting time before the next birth may have included the remaining gestation period of the current pregnancy, and thus, may not be strictly comparable with the answers of non-pregnant women. Also, women who have been sterilized for contraceptive purposes were not asked about their desire for another child. However, for purposes of the fertility preference analysis, these women are classified as wanting no more children. Table 8.1 presents the percentage distribution of currently married women by desire for more children according to the number of living children. The table shows the potential 98 | Fertility Preferences need for contraceptive services for spacing as well as for limiting births. As Table 8.1 and Figure 8.1 show, 69 percent of currently married women expressed that they do not want to have more births in the future or were already sterilized for contraceptive purposes. Furthermore, 14 percent of the women stated that they want to wait for another birth at least two years. Therefore, about four out of every five currently married women can be regarded as in need of using family planning services either to avoid or to postpone childbearing. The proportion of currently married women who are undecided about having another child is only 3 percent. Findings from the previous TDHS-1998 show similar patterns, with slightly less desire to cease childbearing. The desire for another child in the future decreases in relation to the increase in the number of living children. Among women with one living child, 67 percent want to have another child in the future. This percentage decreases rapidly to 12 percent among women with two children, 4 percent with three children and 3 percent with four or more children. The strong desire to stop childbearing appears when women have had two living children and remains at high levels at higher order parities. Table 8.1 Fertility preference by number of living children Percent distribution of currently married women (subsample) by desire for more children, according to number of living children, Turkey 2003 Number of living children1 Desire for more children 0 1 2 3 4+ Total Have another soon2 70.4 17.9 3.9 1.2 2.0 9.9 Have another later3 15.5 47.1 7.8 2.6 0.8 13.6 Have another, undecided when 2.8 1.9 0.4 0.3 0.6 0.9 Undecided 0.3 5.9 4.4 1.3 0.8 3.1 Want no more 1.5 25.5 76.4 80.8 80.4 63.4 Sterilized 0.0 0.0 4.1 9.5 12.1 5.7 Declared infecund 9.4 1.6 2.6 4.0 2.7 3.1 Missing 0.0 0.1 0.4 0.4 0.4 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 241 763 1,312 785 776 3,876 1 Includes current pregnancy 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years Fertility Preferences | 99 Table 8.2 presents the distribution of currently married women by the desire for more children according to current age. The proportion wanting more children decreases sharply with age. While 78 percent of women in the youngest cohort want more children, by age group 30-34, the proportion drops to only 19 percent. The desire to space births is concentrated among women under age 25. The proportion of women who prefer to limit childbearing increases rapidly with age, from 19 percent among women age 15-19 to 83 percent among women age 40-44. Table 8.2 Fertility preference by age Percent distribution of currently married women (subsample) by desire for more children, according to age, Turkey 2003 Current age Desire for More children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon1 26.0 17.4 13.6 13.0 6.9 2.1 1.6 9.9 Have another later2 46.0 46.8 23.2 5.8 1.8 0.3 0.0 13.6 Have another, undecided when 6.2 0.8 1.8 0.6 0.3 0.2 0.2 0.9 Undecided 2.5 5.0 7.3 3.7 1.6 0.1 0.2 3.1 Want no more 19.2 29.6 50.6 68.3 77.5 82.8 78.2 63.4 Sterilized 0.0 0.2 2.8 7.8 8.9 8.9 5.7 5.7 Declared infecund 0.0 0.0 0.2 0.7 2.8 5.1 13.5 3.1 Missing 0.0 0.1 0.4 0.1 0.2 0.5 0.6 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 119 540 698 716 690 640 473 3,876 1 Wants next birth within 2 years 2 Wants to delay next birth for 2 or more years Table 8.3 presents the percentage of currently married women who want no more children by number of living children and background characteristics. The largest differences Figure 8.1 Fertility Preferences of Currently Married Women Age 15-49 Want child soon, 10% Want child later, 14% Wants, unsure timing, 1% Undecided, 3%Want no more, 63% Sterilized, 6% Declared infecund, 3% TDHS-2003 100 | Fertility Preferences in the proportions of currently married women who want to stop childbearing are observed for those with two children. Overall, the same proportion of urban and rural women wants to terminate childbearing. More women living in the North region (73 percent) desires to stop childbearing compared to those living in the East region (63 percent). The percentage of currently married women who want no more children further decreases to 61 percent in the Southeastern Anatolia. Education is known to be negatively associated with the desire to stop childbearing. The proportion of women who want no more children decreases as the level of education increases (from 75 to 51 percent). However, the fact that the effect of education diminishes when these women are analyzed by their number of living children suggests that the reason uneducated or less educated women are more likely to want to stop childbearing is that they already have more children than the educated women. The same pattern was also noted in the TDHS-1998. Table 8.3 Desire to limit (stop) childbearing Percentage of currently married women (subsample) who want no more children, by number of living children and selected background characteristics, Turkey 2003 Number of living children1 Background characteristic 0 1 2 3 4+ Total Residence Urban 1.5 27.8 81.8 92.1 93.6 69.2 Rural 1.5 17.5 76.6 86.8 91.0 69.2 Region West 0.8 32.0 85.7 91.4 96.4 70.0 South (3.0) 17.8 79.8 87.9 94.0 68.6 Central (2.6) 27.6 82.2 93.2 91.0 71.7 North * (22.6) 77.7 92.7 94.2 72.8 East (1.6) 6.8 54.1 82.0 89.7 62.6 Selected NUTS 1 Regions İstanbul 0.0 31.2 84.3 95.1 98.6 68.1 Southeast Anatolia * 2.3 45.1 (75.1) 89.5 60.8 Education No educ./Prim. incomp. (6.1) (21.8) 65.7 79.8 89.3 74.9 First level primary 1.0 22.5 81.5 91.5 94.6 72.3 Second level primary 1.4 28.8 81.3 94.9 100.0 61.1 High school and higher 0.0 30.4 88.7 * * 50.5 Total 1.5 25.5 80.5 90.3 92.6 69.2 1 Includes current pregnancy Notes: Women who have been sterilized are considered to want no more children. Parentheses indicate that a figure is based on 25-49 unweighted cases. An asterisk indicates a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility Preferences | 101 8.2 Need for Family Planning Services This section discusses the extent of need and potential demand for family planning services. Unmet need for family planning refers to fecund women who either wish to postpone the next birth (spacers) or who wish to stop childbearing altogether (limiters), but are not using a contraceptive method. Pregnant women are considered to have an unmet need for spacing or limiting if their pregnancy was mistimed or unwanted, respectively. Similarly, amenorrhoeic women are classified as having unmet need if their last birth was mistimed or unwanted. Women who are currently using a family planning method are said to have a met need for family planning. The total demand for family planning services comprises those who fall in the met need and the unmet need categories. Table 8.4 shows the percentage of currently married women with unmet need, met need and the total demand for family planning services by selected background characteristics. The total demand for family planning is 76 percent, and 92 percent of this demand is satisfied. The demand for limiting purposes is three times as high as the demand for spacing purposes (58 and 18 percent, respectively). Among all currently married women, the demand of 6 percent of women are not met. Total unmet need is lower than that recorded in TDHS-1993 (12 percent) and TDHS-1998 (10 percent), when the percentage of demand satisfied was 84 percent and 87 percent respectively. Unmet need is higher among women age 15-29 and women living in rural residences. Unmet need by region varies from 3 percent of women in the West to 15 percent of women in the East. According to NUTS 1 regions, the lowest unmet need is in the West Anatolia and the highest is in Central East Anatolia. Since educated women are more likely to use a contraceptive method than uneducated women, unmet need decreases and the percentage of demand satisfied increases with increasing educational level. 8.3 Ideal Number of Children Another attitudinal dimension of childbearing considered in the TDHS-2003 is the total number of children a woman would ideally like to have, if it were entirely up to her. Respondents who had no children were asked how many children they would like to have if they could choose the number of children to have in their whole life. Those who had living children were asked about the number of children they would choose if they could start their childbearing again. There is usually a correlation observed between actual and ideal number of children. The reason is twofold. First, to the extent that women implement their preferences, those who want larger families tend to achieve larger families. Second, women may adjust their ideal number of children upwards as their actual number of children increases. It is also possible that women with large families have larger ideal sizes because of attitudes they acquired 20 or 30 years ago. 102 | Fertility Preferences Table 8.4 Need for family planning services Percentage of currently married women (subsample) with unmet need for family planning, met need for family planning, and the total demand for family planning services, by selected background characteristics, Turkey 2003 Unmet need for family planning1 Met need for family planning2 Total demand for family planning3 Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percen- tage of demand satisfied Number of women Age 15-19 11.7 3.9 15.6 40.5 7.5 48.0 56.5 12.2 68.8 77.3 119 20-24 8.7 2.5 11.2 39.0 20.1 59.2 50.5 23.9 74.4 84.9 555 25-29 3.0 3.0 6.0 30.2 43.1 73.3 34.3 46.7 81.0 92.6 717 30-34 0.7 3.7 4.3 12.5 64.9 77.4 13.7 69.3 83.0 94.8 748 35-39 0.7 4.0 4.7 5.2 73.2 78.4 6.0 78.0 84.0 94.4 726 40-44 0.1 4.3 4.3 0.7 69.3 70.0 0.8 73.6 74.4 94.2 705 45-49 0.0 4.6 4.6 1.1 47.4 48.5 1.1 51.9 53.0 91.4 507 Residence Urban 2.1 2.6 4.8 16.6 55.2 71.8 19.5 58.2 77.7 93.8 2,881 Rural 2.8 6.2 8.9 12.1 48.9 61.1 15.8 56.2 72.0 87.6 1,197 Region West 1.4 2.0 3.4 16.0 56.3 72.3 17.8 58.6 76.3 95.5 1,652 South 2.7 3.8 6.5 15.5 52.2 67.7 19.2 56.5 75.7 91.4 513 Central 2.2 2.2 4.4 14.3 58.6 72.9 17.6 60.8 78.4 94.4 962 North 1.0 5.1 6.1 13.8 53.6 67.4 15.4 59.5 74.8 91.9 298 East 5.0 9.4 14.5 15.4 39.1 54.4 21.9 50.5 72.4 80.0 653 NUTS 1 Regions İstanbul 1.4 2.4 3.8 19.1 55.8 74.8 21.1 58.2 79.2 95.2 715 West Marmara 0.4 3.7 4.1 17.2 63.1 80.3 17.7 67.4 85.1 95.2 178 Aegean 2.6 0.7 3.3 11.1 55.0 66.1 14.2 56.3 70.5 95.4 588 East Marmara 1.4 2.3 3.7 13.8 57.2 71.0 15.9 59.6 75.4 95.0 373 West Anatolia 1.2 1.1 2.3 15.7 62.6 78.3 17.3 63.7 81.0 97.1 413 Mediterranean 2.7 3.8 6.5 15.5 52.2 67.7 19.2 56.5 75.7 91.4 513 Central Anatolia 3.2 3.9 7.1 16.3 50.9 67.1 21.2 55.1 76.3 90.6 239 West Black Sea 0.7 3.2 3.9 13.1 58.6 71.8 14.2 62.6 76.8 94.9 254 East Black Sea 1.3 6.9 8.2 14.8 49.8 64.6 17.2 57.0 74.1 88.9 151 Northeast Anatolia 2.7 9.8 12.5 16.2 39.4 55.6 20.2 51.7 71.9 82.6 120 Central East Anatolia 5.9 10.9 16.8 14.5 39.4 53.8 22.3 52.6 74.9 77.6 201 Southeast Anatolia 5.4 8.4 13.8 15.6 38.8 54.4 22.2 48.9 71.1 80.6 332 Education No educ./Prim. incomplete 3.6 9.2 12.7 6.5 48.1 54.6 10.4 58.3 68.7 81.5 671 First level primary 2.0 3.0 4.9 13.4 57.5 70.9 16.2 61.2 77.4 93.6 2,327 Second level primary 2.5 1.8 4.3 24.2 50.0 74.2 27.5 51.9 79.4 94.6 830 High school and higher 1.6 1.9 3.5 26.8 39.5 66.3 29.8 41.8 71.6 95.1 249 Total 2.3 3.7 6.0 15.3 53.3 68.6 18.4 57.6 76.0 92.1 4,078 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrheic women whose last birth was mistimed, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning but say they want to wait two or more years for their next birth. Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrheic women whose last child was unwanted, and women who are neither pregnant nor amenorrheic and who are not using any method of family planning but want no more children. Excluded from the unmet need category are menopausal or infecund women. 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 Total demand for family planning includes pregnant or amenorrheic women who became pregnant while using a method (method failure). Despite the likelihood that some rationalization occurs in the determination of ideal number of children, respondents often state ideals that are lower than their actual number of surviving children. Table 8.5 shows the distribution of respondents by ideal number of children and mean ideal number of children according to actual number of living children. Fertility Preferences | 103 Except for women with no children, there is a positive relationship between the actual and ideal number of children. The mean ideal number of children is 2.5 for both ever-married and currently married women. The table indicates that most women want small families. The mean ideal number of children increases from 2.2 for women with one child to 3.1 for women with four or more children. More than half of the respondents (57 percent) stated two children as the ideal number while only 17 percent of women consider four or more children as ideal. The mean ideal number of children among currently married women has remained about the same for the last 3 surveys (2.4 in TDHS-1993 and 2.5 in TDHS-1998). Table 8.5 Ideal and actual number of children Percent distribution of currently married women (subsample) by ideal number of children and mean ideal number of children for ever-married women and currently married women, according to number of living children, Turkey 2003 Number of living children1 Ideal number of children 0 1 2 3 4+ Total 0 1 6.8 10.6 5.2 5.8 3.2 6.1 2 64.3 63.8 65.4 47.4 42.3 56.9 3 17.5 16.7 17.9 28.8 16.2 19.5 4 6.0 6.5 9.4 14.9 26.2 13.0 5 1.5 1.0 0.3 1.0 4.1 1.4 6+ 2.7 0.1 0.5 0.9 5.1 1.5 Non-numeric response 0.8 0.3 0.7 0.8 2.4 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 266 831 1,369 809 803 4,078 Ever-married women Mean ideal number 2.4 2.2 2.3 2.6 3.1 2.5 Number of women 264 829 1,359 803 784 4,038 Currently married women Mean ideal number 2.4 2.2 2.3 2.6 3.1 2.5 Number of women 239 760 1,305 779 757 3,840 1 Includes current pregnancy. Note: The means exclude women who gave non-numeric responses. Table 8.6 presents the mean ideal number of children for ever-married women by age and selected background characteristics. The mean ideal number of children does not vary significantly by age. It is equal to or less than the overall mean up to age group 30-34 and for older ages, it is just above the overall mean (2.6 children). Although there is little difference by residence, some regional variations are apparent. The mean ideal number of children is lowest in West and Central regions while it is the highest in the East (2.3 children and 3.1 children, respectively). The mean ideal number of children is negatively correlated with education. Women with no or less education have higher ideal sizes. The difference between ever-married women with no education and those who have high school or higher education is nearly one child. 104 | Fertility Preferences Table 8.6 Mean ideal number of children by background characteristics Mean ideal number of children for currently married women (subsample) by age and selected background characteristics, Turkey 2003 Current age Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 2.3 2.5 2.3 2.5 2.5 2.5 2.6 2.5 Rural (2.6) 2.4 2.5 2.7 2.8 2.8 2.7 2.7 Region West (2.2) 2.3 2.1 2.4 2.3 2.3 2.3 2.3 South * 2.7 2.5 2.6 2.9 2.9 3.2 2.8 Central (2.1) 2.3 2.2 2.3 2.3 2.5 2.5 2.3 North * (2.1) (2.2) (2.4) 2.5 2.7 (2.7) 2.5 East (2.9) 2.8 2.7 3.1 3.7 3.3 3.6 3.1 Selected NUTS 1 Regions İstanbul * 2.3 2.2 2.4 2.3 2.5 2.3 2.3 Southeast Anatolia * 3.2 3.1 3.4 3.9 (3.4) * 3.4 Education No educ./Prim. incomplete * 3.0 2.9 3.3 3.5 2.9 3.1 3.1 First level primary 2.4 2.5 2.3 2.5 2.5 2.6 2.5 2.5 Second level primary (2.3) 2.3 2.2 2.2 2.2 2.3 2.4 2.3 High school and higher * (2.0) 2.2 2.2 2.3 (2.4) * 2.2 Total 2.4 2.5 2.3 2.5 2.6 2.6 2.6 2.5 Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. An asterisk indicates a figure is based on fewer than 25 unweighted cases and has been suppressed. 8.4 Planning Status of Births In TDHS-2003, ever-married women were asked a series of questions about each child born in the preceding five years and any current pregnancy, to determine whether the pregnancy was wanted then, wanted at a later time, or unwanted. These questions form a particularly powerful indicator of the degree to which couples successfully control childbearing; the data can also be used to gauge the effect on fertility of the prevention of unwanted births. The questions on fertility planning are extremely demanding. The respondent is required to recall accurately her wishes at one or more points in time during the last five years and to report them clearly and honestly. The danger of rationalization is present; an unwanted conception may well become a cherished child. Despite these potential problems of comprehension, recall, and truthfulness, results from many surveys have proved surprisingly plausible. Respondents are willing to report unwanted conceptions, although some postpartum rationalization probably occurs. The results presented here are likely to underestimate the proportion of births that were unplanned at the time of conception. Table 8.7 presents the percent distribution of births in the five years preceding the survey and current pregnancies by fertility planning status, according to birth order and mother’s age at birth. Two in three births were wanted at the time of conception, an additional 14 percent were wanted but at a later time, and 20 percent were not wanted at all. Comparison with the TDHS-1998 indicates that birth planning patterns have not changed significantly. Fertility Preferences | 105 Table 8.7 Fertility planning status Percent distribution of births (including current pregnancy) in the five years preceding the survey by fertility planning status, according to birth order and mother's age at birth, Turkey 2003 Wanted then Wanted later Not wanted Missing Total Number of births1 Birth order1 1 88.7 10.2 0.9 0.2 100.0 1,567 2 67.4 24.3 7.6 0.4 100.0 1,269 3 53.4 14.8 31.2 0.5 100.0 725 4+ 37.1 5.9 56.3 0.7 100.0 1,043 Age at birth <19 82.2 13.9 3.9 0 100.0 559 20-24 70.5 19.2 9.9 0.4 100.0 1,601 25-29 63.8 13.5 22.1 0.5 100.0 1,359 30-34 58.7 8.3 32.3 0.7 100.0 689 35-39 44.7 4.1 51.2 0.0 100.0 313 40-44 25.3 0.0 74.7 0.0 100.0 79 45-49 * * * * 100.0 5 Total 65.6 13.9 20.1 0.4 100.0 4,604 1 The birth order and number of births include current pregnancies. Notes: This is a birth-based rather than a woman-based table and presented for all births of ever- married women instead of the sub-sample of women. An asterisk indicates a figure is based on fewer than 25 unweighted cases and has been suppressed. Birth order is strongly associated with the planning status of birth. The proportion of births that were wanted at the time of conception decreases with increasing birth order, while the percentage not wanted at all increases. While 89 percent of first births were wanted at the time of conception, more than half of fourth order or higher order births were unwanted. The planning status of births is also associated with the age of mother. In general, older mothers tend to have a smaller percentage of children who are wanted at conception. The percentage of unwanted births increases with mother’s age at birth. Another way of measuring the extent of unwanted fertility is to estimate what the fertility rate would be if all unwanted births were avoided. This is known as the wanted fertility rate and is calculated in a similar manner as the total fertility rates presented in Chapter 4. The Lightbourne method of calculating a “wanted” birth is used for Table 8.8. Under the Lightbourne method, a birth is considered wanted if the number of living children at the time of conception was less than the current ideal number of children, as reported by the respondent. Births classified as unwanted according to the above definition are omitted from the numerator and the remainder is cumulated to form a wanted total fertility rate, which is analogous to the conventional fertility rate. This rate represents the level of fertility that theoretically would result if all unwanted births were prevented. 106 | Fertility Preferences Table 8.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey by background characteristics, Turkey 2003 Background characteristic Total wanted fertility rate Total fertility rate Residence Urban 1.5 2.1 Rural 2.6 2.7 Region West 1.6 1.9 South 1.8 2.3 Central 1.3 1.9 North 1.3 1.9 East 1.9 3.7 Selected NUTS 1 Regions İstanbul 1.4 1.8 Southeast Anatolia 2.2 4.2 Education No education/Prim. incomplete 2.1 3.7 First level primary 1.9 2.4 Second level primary 1.2 1.8 High school and higher 1.0 1.4 Total 1.6 2.2 Note: The total wanted fertility rates were calculated based on information from women in the subsample only while the total fertility rates which are the same as those presented in Chapter 4 are based on the entire sample. The wanted total fertility rates are calculated for a sub-sample of ever-married women only. According to the results presented in Table 8.8, if all unwanted births were prevented, the total wanted fertility rate would be 1.6 children per woman, or 0.7 children less than the actual total fertility rate (27 percent lower than the actual fertility level). The total wanted fertility rate is lower than that recorded in TDHS-1998 (1.9 children) and TDHS-1993 (1.8 children). Table 8.8 also shows that the gap between actual and wanted fertility rates is highest among rural women, women living in the East region and women who have no education. Infant and Child Mortality | 107 INFANT AND CHILD MORTALITY 9 Attila Hancıoğlu and İlknur Yüksel Alyanak Estimates of levels, trends and differentials in neonatal, post-neonatal and child mortality are important for monitoring and evaluating ongoing health programs and for formulating future policies. Levels of infant and child mortality are not only indicators related to health conditions, but are generally regarded as important indicators of the level of development of a society. Infant mortality rates and under-five mortality rates are used to assess the level of development, commonly as part of composite indexes. Infant and under-5 mortality rates appear in almost all international indicator sets on development, including those of the Millennium Development Goals. This section focuses on the findings of the TDHS-2003 with respect to mortality during infancy and early childhood. The results of the TDHS-2003 are critical for the reassessment of policies and strategies for the improvement of survival chances of children in Turkey, since estimates from the vital registration system are not available. The section also includes estimates of perinatal mortality and examines the risk factors for births in Turkey. Estimates in this chapter were computed by using the birth history data derived from the individual questionnaire. All ever-married female respondents in the TDHS-2003 were asked to provide a complete birth history, including the sex, birth date, survival status, and current age or age at death for each of their live births. The data were used to calculate five measures of infant and child mortality, namely: • Neonatal mortality, the probability of dying in the first month of life • Post-neonatal mortality, the probability of dying after the first month of life but before the first birthday • Infant mortality (1q0), the probability of dying in the first year of life • Child mortality (4q1), the probability of dying between the first and fifth birthday • Under-five mortality (5q0), the probability of dying before the fifth birthday. Perinatal mortality estimates were computed by using data from the birth history, as well as the demographic calendar. The latter was used to collect information on stillbirths. 9.1 Assessment of Data Quality Infant and child mortality rates are subject to both sampling and non-sampling errors. The measurement of sampling errors is relatively easy, but non-sampling errors are difficult to detect and correct for. Non-sampling errors cover a wide range of errors, involving under- reporting of births and deaths, errors by the interviewers in recording responses, and the like. International research has shown that infant and child mortality estimates from sample surveys 108 | Infant and Child Mortality are susceptible to such errors. The first step in the consideration of the TDHS-2003 mortality data is to look for evidence of non-sampling errors in order to assess whether information collected in the survey on infant and child mortality are of acceptable quality. One of the most powerful interviewing tools for collecting information on births and deaths is the birth history. However, birth histories are subject to respondent recall errors, and these errors may result in biased rates and trends over time. Therefore, a preliminary assessment of the quality of birth history data is made in this section with respect to completeness and accuracy of date reporting, heaping of age at death, and sex-selective omission of births. A commonly encountered problem in birth history data is unreported birth dates and ages at death. Interviewers were required to obtain full information on birth dates (i.e., month and year of birth) for births occurring since January 1998 (for which calendar data was collected). Table D.4 in Appendix D shows that complete information on birth dates were collected for virtually all births occurring since 2001 and for nearly 94 percent of births during 1998-2000. There is somewhat greater deterioration in the completeness of birth date information the further back one goes from the survey date, but the percentage is above 90 percent for births occurring since 1985. Overall, the percentage of live births in the 15 years preceding the survey for which information on year of birth was missing is 4 percent. Both month and year of birth were missing for about one percent of all live births in the 15-year period before the TDHS-2003. Less than one percent of deaths recorded in the birth histories lacked an age at death. The TDHS-2003 data appear to be of good quality with respect to the completeness of the information collected on dates of birth and ages at death. A further assessment of the data in regard to quality of birth dates does not reveal any systematic evidence of heaping. A pattern observed in previous surveys, the transference of births by interviewers out of the period for which health and calendar data were collected, does not seem to have happened in TDHS-2003. The calendar year ratios for the year 1998, the first year to be included in the health and calendar sections, are higher than 100, pointing to excess of births rather than a deficit (Table D.4 in Appendix D). A closer inspection of the birth history data from the TDHS-2003 also reveals that heaping of ages at death was also minimal. In sample surveys, a commonly observed phenomenon is the heaping of age at death on convenient digits, for example on 6, 12, 18 or 24 months. This phenomenon may lead to the calculation of biased rates, especially if, as a net result, deaths are shifted from one age segment used in computing mortality rates to another. In this regard, one critical shift would be to record infant deaths as child deaths, by respondents heaping the age at death on 12 months, or by interviewers recording ages of death as "1 year". This seems to have not occurred in a considerable degree in the TDHS-2003, particularly for the last 10 year period (Table D.6 in Appendix D). A simulation model was applied to the data to see if the heaping of age at death on 12 months would bias estimates of infant mortality. The results indicated that any bias in the infant mortality rate from heaping would be less than 5 percent. The rates presented here are therefore calculated directly by assigning all deaths reported at 12 months or "1 year" to the post-infant age period. Infant and Child Mortality | 109 One further check that was performed to assess the reliability of birth history data was to calculate sex ratios at birth for all live births. These ratios are expected to fluctuate around 105 male births per 100 female births. Table D.4 in Appendix D shows that the overall sex ratio for all births in the birth history is 104.4, which is in line with expectations. The sex ratio of live births during the 2000-2004 period is also in line with expectations, at 105.4. For earlier periods, fluctuations are observed in sex ratios at birth, without any systematic over or under reporting of males or females. 9.2 Levels and Trends in Infant and Child Mortality The first panel of Table 9.1 presents infant and child mortality rates for periods 0-4, 5-9, and 10-14 years preceding the TDHS-2003. The first two of these periods largely correspond to the five-year periods preceding the TDHS-1998, which are shown in the lower panel of the table, thus enabling comparisons between the two surveys1. The estimated infant mortality rate for the most recent period (0-4 years preceding the survey) is 29 per 1,000 live births. Some 59 percent of infant deaths occurred during the neonatal period (i.e. during the first four weeks of life). Child mortality is found to be approximately 9 per 1,000. The results also show that the probability of dying before the fifth birthday is around 37 per 1,000. Most of the deaths before the first birthday in Turkey occur before completing the first month of life. In other words, as observed in the TDHS-1998, the pattern where neonatal mortality rates exceed post-neonatal mortality rates is continuing. An examination of the variation in mortality rates by age segments also reveals that a large proportion of under-five deaths occur before the first birthday (78 percent). Table 9.1 Infant and child mortality Neonatal, post neonatal, infant, child and under-five mortality rates by five-year periods preceding the TDHS-2003 and TDHS-1998 Years preceding survey Neonatal mortality (NN) Post neonatal mortality (PNN) Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) TDHS-2003 0-4 17 12 29 9 37 5-9 24 22 47 10 56 10-14 34 25 59 11 69 TDHS-1998 0-4 26 17 43 10 52 5-9 30 24 54 14 67 1 The TDHS-2003 fieldwork was completed between December 2003 and May 2004; a somewhat longer data collection period was in effect compared to the TDHS-1998. The latter was completed during the summer and autumn months of 1998. On the average, the median reference date of estimates from the TDHS-2003 would differ by about 4 months from the estimates of the TDHS-1998, when five year period preceding each of the surveys is considered. 110 | Infant and Child Mortality The figures in Table 9.1 point out to a relatively fast pace of decline in infant and child mortality rates in Turkey. For the two most recent periods, major declines in neonatal mortality (29 percent) and post-neonatal mortality (45 percent) have taken place. In general, a decline of about 38 percent in the infant mortality rate, and a decline of about 34 percent in the under-five mortality rate are implied by the results of the TDHS-2003. These declines are somewhat faster than those observed in the TDHS-1998. Using information from prior surveys, Figure 9.1 shows that the infant mortality rate has declined from 53 deaths per 1,000 live births in 1993 to 29 deaths per 1,000 in 2003. Table 9.1 also presents comparable mortality estimates from the TDHS-1998. Such comparisons are useful for further assessing the quality of data, as well as confirming the observed trends. Since the two surveys are approximately five years apart, the estimates for the 5-year periods preceding the two surveys overlap to a large extent. The estimates for the 5-9 year period preceding the TDHS-2003 are comparable with the estimates for the 0-4 year period preceding the TDHS-1998. The same comparability is also applicable to 10-14 and 5-9 year periods preceding the TDHS-2003 and TDHS-1998 respectively. The consistency between the two surveys is impressive. In none of the estimates does one find a difference of more than 5 per thousand. Such differences are negligible and in fact imply full agreement between two sets of independent estimates in sample surveys. 9.3 Differentials in Infant and Child Mortality Table 9.2 presents the mortality rates by urban-rural residence, region, and level of mother's education for the five-year period preceding the survey. The figures should be interpreted with caution, since they are based on a small number of observations and are, Figure 9.1 Trends in Infant Mortality Estimates for 5-Year Periods Preceding the TDHS-1993, TDHS-1998, and TDHS-2003 29 23 53 9 61 26 17 43 10 52 17 12 29 9 37 0 10 20 30 40 50 60 70 80 90 100 Neonatal Post-neonatal Infant Child Under-5 Mortality Rates Deaths per 1,000 1993 1998 2003 Infant and Child Mortality | 111 therefore, statistically unstable. The infant mortality rate in the rural areas is about 70 percent higher than in urban areas (39 and 23 per 1,000, respectively). Most of the difference is attributable to differences in the post-neonatal mortality. In rural areas, the excess of neonatal mortality over post-neonatal mortality is smaller than in urban areas. Table 9.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, post-neonatal, infant, child, and under-five mortality for the five-year period preceding the survey by socioeconomic characteristics, Turkey 2003 Socioeconomic characteristic Neonatal mortality (NN) Post neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under- five mortality (5q0) Residence Urban 15 8 23 7 30 Rural 21 18 39 11 50 Region West 15 7 22 8 30 South 19 10 29 2 30 Central 10 10 21 12 33 North 20 14 34 14 48 East 23 18 41 7 49 Selected NUTS 1 Regions İstanbul 16 4 19 13 32 Southeast Anatolia 21 16 38 9 46 Education No education/Prim. incomplete 29 22 51 13 63 First level primary 14 11 25 8 33 Second level primary and higher 15 3 18 6 24 1 Computed as the difference between infant and neonatal mortality rates Infant and under-five mortality rates are higher than the national average in the North and East regions. In all regions, neonatal mortality exceeds post-neonatal mortality, with the exception of the Central region where the two rates are equal. Similar findings are also applicable for under-5 mortality rates. However, the child mortality rate for the South region is exceedingly low, most probably due to chance fluctuations, a characteristic often found in survey data especially in cases when the phenomenon under consideration falls within the definition of a rare event. The strong relationship between survival chances of children and the level of education of their mothers is once again revealed by the TDHS-2003. For all measures of mortality, probabilities of dying are lower for children of mothers with higher educational levels. For instance, the infant mortality rate among children of mothers who have had no education or had not completed primary school is 51 per thousand, where the same rate is only 18 per thousand among children of women with second level primary or higher education. 112 | Infant and Child Mortality Table 9.3 shows differentials in infant and child mortality by various biodemographic characteristics. In order to base the calculations on sufficient numbers of deaths and exposure, the rates are calculated for the 10-year period before the survey. Table 9.3 Early childhood mortality rates by biodemographic characteristics Neonatal, post-neonatal, infant, child, and under-five mortality for the ten-year period preceding the survey by biodemographic characteristics, Turkey 2003 Biodemographic characteristic Neonatal mortality (NN) Post neonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under- five mortality (5q0) Sex of child Male 22 18 39 9 48 Female 20 16 36 9 45 Mother’s age at birth < 20 20 27 47 13 60 20-29 20 16 35 7 42 30-39 25 15 40 10 50 40-49 11 15 26 55 79 Birth order 1 15 13 27 5 33 2-3 20 16 36 9 44 4-6 25 22 47 16 62 7+ 45 35 80 15 94 Previous birth interval2 < 2 years 39 35 74 16 89 2 years 23 16 38 11 49 3 year 14 12 25 9 34 4 years or more 16 11 27 7 34 Size at birth3 Small or very small 20 15 36 NA NA Average or larger 13 9 22 NA NA NA= not applicable 1 Computed as the difference between the infant and child mortality rates 2 Excludes first-order births 3 Refers for the five-year period before the survey The influence of various biodemographic characteristics on survival chances of infants is well known, and the TDHS-2003 results confirm most of the expected relationships. Male mortality rates are higher than those for females during all age segments, as expected. Table 9.3 also shows that children of teenage mothers, high-birth-order children, and children born following a short birth interval face elevated risks of dying than those in other subgroups. Particularly notable are differentials by birth interval, where infant mortality rates are as high as 74 per thousand among children born after a birth interval of less than 2 years. Children’s weight at birth is also closely associated with their chances of survival. Children reported by mothers as “small or very small” at birth were 53 percent more likely to die during the neonatal period compared with children whose birth weight was reported as being “average or larger than average.” Infant and Child Mortality | 113 9.4 Perinatal Mortality The TDHS-2003 asked women to report on pregnancy losses and the duration of the pregnancy for each loss, for all such pregnancies ending since January 1998 through to the interview date. Pregnancy losses occurring after seven completed months of gestation (stillbirths) plus deaths to live births within the first seven days of life (early neonatal deaths) constitute perinatal deaths. When the total number of perinatal deaths is divided by the total number of pregnancies reaching seven months gestation, the perinatal mortality rate is derived. Table 9.4 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five- year period preceding the survey, by background characteristics, Turkey, 2003 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother’s age at birth <20 7 8 28 525 20-29 19 31 19 2,668 30-39 20 12 36 908 40-49 2 1 * 79 Previous pregnancy interval in months First pregnancy 13 10 19 1,244 <15 6 14 42 463 15-26 13 7 23 865 27-38 3 8 22 520 39+ 13 13 24 1,088 Residence Urban 29 29 21 2,752 Rural 19 23 29 1,429 Region West 12 14 19 1,354 South 7 8 27 564 Central 10 7 20 822 North 1 4 (19) 253 East 19 20 33 1,187 Selected NUTS 1 Regions İstanbul 4 6 16 647 Southeast Anatolia 9 9 27 679 Mother’s education No education/Prim. incomplete 17 18 38 905 First level primary 26 22 21 2,259 Second level primary 5 11 19 820 High school and higher 0 2 (8) 196 Total 48 52 24 4,180 1 Stillbirths are foetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months’ duration. Note: Figures in parentheses are based on less than 250 unweighted pregnancies. 114 | Infant and Child Mortality Table 9.4 shows perinatal mortality rates, according to demographic and socioeconomic characteristics. The perinatal mortality rate is estimated at 24 per thousand during the 5 years preceding the TDHS-2003. As expected, the perinatal mortality rate exhibits a U-shaped relationship with the age of the mother, with the rate declining to 19 per thousand when the mother’s age is 20-29. Pregnancies after a short pregnancy interval are also expected to be at high perinatal risk; in Turkey, the perinatal mortality rate is as high as 42 per thousand when the pregnancy interval is less than 15 months. Perinatal mortality rates are higher in rural areas (29 per thousand) compared with urban areas (21 per thousand). The rate is higher in the South and East region than the national average. Once again, a strong relationship is evident between mother’s education and perinatal mortality risks. For women in the lowest education category, perinatal mortality rate is as high as 38 per thousand, but declines to a level almost a third of the national average for pregnancies of women with high school or more education. 9.5 High-risk Fertility Behaviour As the findings in the previous section indicate, a strong relationship exists between a mother's pattern of fertility behavior and her children's survival chances. Infants and young children born to very young mothers or to older mothers, born after a short birth interval, or born after their mothers have already had many children, face higher mortality risks. In the following analysis, mothers are classified as "too young" if they were less than 18 years old at the time of the birth, and "too old" if they were 34 or older at the time of the birth. A "high birth order" is one occurring after three or more previous births. A "short birth interval" is defined as a birth occurring less than 24 months after a previous birth. In the analysis of birth intervals, only children whose preceding birth interval was less than 24 months are included, even though a short birth interval also increases the risk of dying for the previous child at the beginning of the interval. The latter relationship is subject to reverse causality in that the death of an earlier child may cause the subsequent interval to be short. Column 1 in Table 9.5 shows the percentage of children born in the five years preceding the survey who were in specific risk categories. Risk ratios are also presented for each of the risk categories (see column 2, Table 9.5). A risk ratio here is defined as the ratio of the proportion dead among children in a risk category, to the proportion dead among children not in any high-risk category. Thirty-nine percent of children born in the five years preceding the survey were at elevated risk of dying at the time of their birth. First births to women between ages 18-34 are not included in this figure since they are considered to be in an unavoidable risk category. Among all children, 27 percent had an increased risk due to a single risk category, and 13 percent had an increased risk due to multiple factors. It is evident from the table that high birth order and short birth intervals are major factors contributing to elevated risks of mortality. Some 23 percent of children born in the last five years were of high birth orders, while 18 percent were born after a short interval. Infant and Child Mortality | 115 Children whose mothers were in a single high-risk category faced more than twice the risk of dying than those children whose mothers were not in any of the risk categories. For those in a multiple high-risk category, relative mortality risks were up to 3 times the risks faced by children not in any risk category (Column 2, Table 9.5). The table shows that children born after a short birth interval faced 2.5 times higher risk of dying compared to those in the no-risk category. The findings also show that children born into any of the risk categories face up to 240 percent higher mortality risks. Table 9.5 High-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of dying, and the percent distribution of currently married women at risk of conceiving a child with an elevated risk of dying, by category of increased risk, Turkey 2003 Background characteristic Percentage of births Risk ratio Percentage of currently married womena Not in any high-risk category 30.6 1.00 29.0b Unavoidable risk category (First births) 30.4 1.14 7.1 Single high-risk category Mother's age <18 3.1 1.78 0.2 Mother's age >34 2.5 1.49 17.8 Birth interval <24 months 10.0 2.49 7.4 Birth order >3 10.9 1.98 8.7 Subtotal 26.5 2.11 34.1 Multiple high-risk category Age <18 & birth interval <24c months 0.3 2.04 0.0 Age >34 & birth interval <24 months 0.3 0.00 0.3 Age >34 & birth order >3 4.9 2.54 25.4 Age >34 & birth interval <24 months and birth order >3 0.9 3.74 1.1 Birth interval <24 months and birth order >3 6.0 3.52 3.0 Subtotal 12.5 3.03 29.1 In any high-risk category 39.0 2.40 63.9 Total 100.0 - 100.0 Number of births 4,132 - 7,672 Note: Risk ratio is the ratio of the proportion dead of births in a specific high-risk category to the proportion dead of births not in any high-risk category. a Women were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth less than 15 months ago, and latest birth of order 3 or higher. b Includes sterilised women c Includes the combined categories Age <18 and birth order >3. The final column of Table 9.5 includes the distribution of currently married women according to category of increased risk they would have been in if they had conceived at the time of the survey. A woman's current age, time elapsed since last birth, and parity are used to determine into which category her next birth would have fallen if she had conceived at the time 116 | Infant and Child Mortality of the survey. For example, if a woman age 37 who had five children and had had her last birth three years before the survey were to have become pregnant, she would have fallen into the multiple risk category of being too old (34 or older) and at too high a parity (4 or more children). Women who have been sterilized are categorized as not being in a high-risk category. Sixty-four percent of women who were married at the time of the TDHS-2003 were found to be at risk of conceiving a child with an increased risk of dying. Twenty-nine percent of women fell into none of the risk categories while another 29 percent of women fell into a multiple risk category. As shown in the second column of the table, if a woman in this category were to conceive, the survival chances of a child would be considerably lower than those of births to women not in the risk categories. The largest group of women fell into the multiple risk category where the child to be born would have had, at the time of birth, a mother who was older than 34 and who already had at least three births. Antenatal Care and Delivery Assistance | 117 ANTENATAL CARE AND DELIVERY ASSISTANCE 10 Banu Akadlı Ergöçmen and Yadigar Coşkun This chapter presents the TDHS-2003 findings concerning antenatal care and delivery assistance, which are areas of importance to maternal and child health. The results on antenatal care and assistance at delivery are based on data collected from mothers on all live births that occurred in the five years preceding the survey. Aspects of antenatal care (ANC) that are examined include the type of provider, number of visits made, components of the antenatal care, and the stage of pregnancy at the time of the first visit. Similarly, the delivery services are described according to the person assisting and the type and place of delivery. 10.1 Antenatal Care Table 10.1 shows the percent distribution of women who had a live birth in the five years preceding the survey by ANC provider during pregnancy for the most recent birth, according to the background characteristics and birth order of the child. The interviewers were instructed to record all persons a woman had consulted for care if more than one source of ANC was mentioned for the same pregnancy. However, for this tabulation, only the provider with the highest qualifications is considered if there were more than one provider. It should be considered, however, that the quality of antenatal services is not reflected in these figures. As seen in Table 10.1, 81 percent of the mothers had at least one ANC visit from trained health personnel during the pregnancy of their most recent birth in the five years preceding the survey. Three-quarters of the mothers received care from the doctor. On the other hand, nearly one-fifth of the mothers did not receive any ANC. To compare the results with those of the previous survey conducted in 1998, not only the most recent birth but all live births in the five years preceding the survey must be taken into account. This comparison indicates an 11 percentage point increase (from 60 to 71 percent) in the proportion of mothers seeing a doctor for ANC in the five years from 1998 to 2003. Furthermore, proportion of mothers who did not receive any ANC decreased from 32 to 23 percent between the two surveys. There are marked differences in ANC by background characteristics. Younger mothers are more likely to seek ANC from trained health personnel than women over age 35 (Figure 10.1). In the case of 30 percent of the births to women age 35 and over, the mother did not receive any ANC. The differences in the proportions of live births with ANC according to birth order are also striking. As birth order increases proportions of live births that have 118 | Antenatal Care and Delivery Assistance received ANC declines. Children of birth order three or lower are almost twice more likely to have received ANC than births of order six or higher. Table 10.1 Antenatal care Percent distribution of ever-married women who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth, according to background characteristics, Turkey 2003 Background characteristic Doctor Nurse/ midwife Traditional birth attendant/ other No one Missing Total Number of women Age at birth <20 79.4 5.9 0.3 14.4 0.0 100.0 326 20-34 76.4 5.4 0.1 17.8 0.3 100.0 2,523 35-49 63.3 6.1 0.5 30.0 0.0 100.0 316 Birth order 1 89.3 3.6 0.1 7.0 0.0 100.0 1,000 2-3 77.0 6.9 0.2 15.6 0.3 100.0 1,465 4-5 58.3 5.4 0.4 35.1 0.7 100.0 417 6+ 43.5 5.2 0.2 51.1 0.0 100.0 283 Residence Urban 83.5 4.6 0.2 11.6 0.2 100.0 2,172 Rural 57.7 7.6 0.3 34.2 0.3 100.0 992 Region West 85.8 5.4 0.1 8.5 0.2 100.0 1,119 South 79.6 5.3 0.1 14.6 0.4 100.0 426 Central 75.4 7.3 0.3 16.6 0.5 100.0 673 North 78.4 6.2 0.6 14.8 0.0 100.0 192 East 57.0 4.0 0.2 38.8 0.0 100.0 754 NUTS 1 Region İstanbul 89.5 1.6 0.2 8.7 0.0 100.0 537 West Marmara 86.2 5.8 0.0 8.0 0.0 100.0 108 Aegean 75.2 12.6 0.0 12.2 0.0 100.0 330 East Marmara 87.1 3.7 0.0 8.1 1.1 100.0 260 West Anatolia 78.4 6.8 0.6 13.7 0.6 100.0 296 Mediterranean 79.6 5.3 0.1 14.6 0.4 100.0 426 Central Anatolia 71.6 8.3 0.0 19.6 0.4 100.0 185 West Black Sea 74.0 9.4 0.0 16.6 0.0 100.0 166 East Black Sea 80.3 4.6 1.1 13.9 0.0 100.0 102 Northeast Anatolia 49.9 7.1 0.0 43.0 0.0 100.0 131 Central East Anatolia 51.0 5.0 0.4 43.7 0.0 100.0 212 Southeast Anatolia 62.4 2.4 0.1 35.0 0.0 100.0 410 Education No education/Primary incom. 47.5 5.9 0.8 45.7 0.1 100.0 696 First level primary 78.0 6.6 0.0 15.1 0.3 100.0 1,665 Second level primary 88.7 5.6 0.0 5.7 0.0 100.0 260 High school and higher 97.1 1.5 0.0 1.1 0.3 100.0 543 Total 75.4 5.5 0.2 18.6 0.2 100.0 3,164 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. Antenatal Care and Delivery Assistance | 119 There are substantial residential and regional variations in ANC (Figure 10.2). Mothers living in urban settlements are more likely to have ANC from a doctor than those living in rural areas (84 percent and 58 percent, respectively). For one-third of rural births in the five years preceding the survey, the mother did not receive any ANC at the most recent birth. Antenatal care coverage exceeds 80 percent in all regions except the East, where it was received by 61 percent of the mother at the most recent births in the five years prior to the survey. Especially in the Northeast and Central East Anatolia only 6 in 10 women received ANC at their recent birth in the last five years. The use of antenatal care services is strongly associated with mother’s education. Almost all births to women with at least high school level education received antenatal care, while only half of births to women with less than primary education (53 percent) received any antenatal care. In all regions, the proportion of doctor providing ANC is markedly more than the other health personnel. In Turkey, younger, low parity women, women living in urban areas and in the regions other than the East, and women with at least first primary level education are more likely to have received ANC compared to other women. Figure 10.1 Antenatal Care by Maternal Age and Birth Order 0% 20% 40% 60% 80% 100% <20 20-34 35+ 1 2-3 4-5 6+ Maternal age Birth order Doctor Other Health Personnel No ANC TDHS-2003 120 | Antenatal Care and Delivery Assistance 10.2 Number and Timing of Antenatal Care Visits Antenatal care is most beneficial when it is sought early in pregnancy and is continued throughout a pregnancy. The first antenatal visit should take place before the third month of pregnancy. The advantage of early detection of pregnancy is that a woman’s normal baseline health status can be assessed, making early diagnosis of any abnormalities easier. The total number of antenatal visits is also important in assessing the adequacy of ANC. According to the recommended schedule, antenatal care visits should be done monthly until 28 weeks' gestation (7th month), then every two weeks until 36 weeks, and then every week until 40 weeks or delivery. Regular visits allow proper monitoring of the mother and child throughout pregnancy. Table 10.2 presents information on the timing and number of visits made to health providers for the most recent birth in the five years preceding the survey by residence. Overall, more than half of women made more than four ANC visits. The table shows that there is significant residential difference both in the timing and the number of visits made for ANC. The percentage of urban women who made four or more ANC visits is almost twice that of rural women. Proportion of women who did not receive any ANC are only 12 percent in the urban areas whereas this is one-third for those living in rural areas. Table 10.2 indicates that many women in Turkey are aware of the importance of an early visit for ANC visit. Overall 71 percent of women made an ANC visit before the sixth month of their most recent pregnancy in the five years preceding the survey. More women in urban areas (80 percent) seek ANC before the sixth month of pregnancy compared to women in rural areas (52 percent). Reflecting the greater tendency among rural women to delay seeking care, the median duration of pregnancy at the first antenatal visit is 2.6 months in urban areas and 3.5 months in rural areas. Figure 10.2 Antenatal Care by Region and Residence 0% 20% 40% 60% 80% 100% Urban Rural West South Central North East Residence Region Doctor Other Health Personnel No ANC TDHS-2003 Antenatal Care and Delivery Assistance | 121 Table 10.2 Number of antenatal care visits and timing of first visit Percent distribution of ever-married women who had a live birth in the five years preceding the survey by the number of antenatal care (ANC) visits for the most recent birth and the timing of the first visit, according to urban-rural residence, Turkey 2003 Number and timing of ANC visits Urban Rural Total Number of ANC visits None 11.6 34.2 18.6 1 5.8 11.2 7.5 2-3 17.8 21.5 18.9 4+ 63.7 32.5 53.9 Don’t know/missing 1.1 0.6 0.9 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 11.6 34.2 18.6 <4 66.5 37.8 57.5 4-5 13.5 14.6 13.8 6-7 6.2 9.6 7.2 8+ 2.0 2.9 2.3 Don’t know/missing 0.3 0.9 0.5 Total 100.0 100.0 100.0 Median months pregnant at first visit (for those with ANC) 2.6 3.5 2.8 Number of women 2,172 992 3,164 10.3 Components of Antenatal Care Pregnancy complications are an important source of maternal and child mortality and morbidity. Thus, the effectiveness of ANC to ensure safe motherhood depends on the tests and measurements done during the checkups. In TDHS-2003, information was collected about the components of the ANC among women who received ANC for the most recent birth in the five years preceding the survey. Among the most recent births in the last five years that involved some type of antenatal care, three in four women reported that they had their weight measured, while only 31 percent had their height measured as a part of the ANC checkup (Table 10.3). Eighty-nine percent of the mothers had their blood pressure measured, which is one of the most important that a woman receives during the ANC. Urine and blood sample were taken for 73 and 77 percent of women respectively. More than 90 percent of women reported that ultrasound was performed and the heartbeat of the baby was listened to. Women who had an internal examination and had their abdomen measured are 34 and 46 percent respectively. 122 | Antenatal Care and Delivery Assistance Table 10.3 Components of antenatal care Percentage of ever-married women with a live birth in the five years preceding the survey who received antenatal care for the most recent birth by content of antenatal care, and percentage of ever-married women with a live birth in the five years preceding the survey who received iron tablets or syrup during the most recent pregnancy, according to background characteristics, Turkey 2003 Background characteristic Weight measured Height measured Blood pressure measured Blood sample taken Urine sample taken Abdomen measured Baby's heart- beat Ultra- sound Internal exam- ination Number of women receiving ANC Received iron tablets or syrup Number of women Age at birth <20 71.6 24.5 82.4 75.3 69.7 42.5 90.2 90.5 32.7 279 64.5 326 20-34 76.8 32.2 89.5 77.8 73.3 46.1 92.0 90.4 33.3 2,067 66.7 2,523 35-49 64.1 29.5 88.2 70.4 69.9 52.7 86.6 90.7 36.8 221 45.8 316 Birth order 1 83.2 36.1 90.5 86.0 81.2 48.3 93.4 94.6 41.4 930 77.2 1,000 2-3 77.1 30.2 89.5 74.8 69.6 46.3 92.1 89.9 29.3 1,232 68.1 1,465 4-5 56.7 23.9 83.2 63.0 61.1 45.4 88.5 83.7 30.0 267 46.0 417 6+ 39.3 19.2 78.0 61.2 63.8 34.5 75.9 80.3 25.3 138 26.8 283 Residence Urban 78.7 32.8 90.1 80.0 76.8 47.2 92.5 93.4 35.6 1,917 71.4 2,172 Rural 64.6 26.2 84.2 67.6 60.3 43.7 87.9 81.8 27.5 650 49.1 992 Region West 84.2 34.5 91.1 83.3 78.5 52.4 94.9 94.4 40.0 1,022 76.5 1,119 South 76.3 33.8 93.2 73.0 66.9 40.7 91.3 89.6 26.0 362 67.8 426 Central 78.9 32.6 89.0 79.7 73.4 45.8 93.1 87.3 33.9 558 65.7 673 North 68.1 23.5 86.1 80.3 78.5 47.1 95.2 91.0 26.7 164 71.2 192 East 52.0 22.1 79.7 60.9 61.0 37.6 79.8 86.0 27.1 461 41.6 754 NUTS 1 Region İstanbul 79.9 25.4 90.5 82.4 79.3 51.8 93.2 97.9 40.0 490 75.3 537 West Marmara 93.2 42.3 96.4 85.7 74.9 54.6 96.9 93.6 33.1 99 83.9 108 Aegean 86.6 49.7 91.3 85.2 76.4 54.4 96.1 86.9 46.2 290 68.5 330 East Marmara 87.7 29.9 89.8 85.0 83.1 45.2 96.5 93.1 37.3 236 78.9 260 West Anatolia 78.7 30.6 90.3 82.3 77.2 44.8 92.7 91.3 34.8 254 67.1 296 Mediterranean 76.3 33.8 93.2 73.0 66.9 40.7 91.3 89.6 26.0 362 67.8 426 Central Anatolia 74.1 36.7 82.9 70.3 63.2 53.5 91.5 82.7 25.5 148 64.3 185 West Black Sea 71.6 27.0 91.1 78.0 72.2 47.2 94.2 88.1 30.7 138 70.4 166 East Black Sea 69.8 26.2 85.2 79.8 79.8 42.0 96.4 91.5 25.4 88 72.5 102 Northeast Anatolia 61.7 18.4 88.6 61.5 60.0 44.0 84.7 83.2 29.3 75 32.3 131 Central East Anatolia 56.9 27.5 81.5 66.8 71.3 42.2 76.2 82.0 28.1 120 38.3 212 Southeast Anatolia 47.1 20.8 76.5 58.0 56.7 33.8 80.0 88.6 26.0 267 46.3 410 Education No education/Primary incomplete 43.8 20.3 76.9 55.5 55.8 37.4 77.7 77.9 30.0 377 32.6 696 First level primary 75.6 28.5 87.4 75.9 70.9 46.1 92.1 90.8 31.4 1,409 67.4 1,665 Second level primary 80.3 31.0 94.6 83.4 76.0 41.5 94.3 92.5 32.4 246 83.4 260 High school and higher 93.5 45.6 97.0 91.4 87.5 55.2 97.5 97.5 42.3 536 86.8 543 Total 75.1 31.1 88.6 76.9 72.6 46.3 91.3 90.5 33.5 2,567 64.4 3,164 Antenatal Care and Delivery Assistance | 123 Women age 20-34 were more likely than older or younger women to receive all components of ANC except an ultrasound examination, abdominal measurement, and an internal examination. An inverse relationship is observed with an increase in the birth order. Women who were pregnant with their first child were more likely to receive all components of ANC. A similar pattern is seen by urban-rural residence, in which urban women were more likely than their rural counterparts to receive the components of ANC. Regional variations in the components of ANC are marked. In general, women living in the West, especially those living in West Marmara, received the ANC components more often than women living in other regions. However, women living in the East Region had the lowest percentages for the components of ANC among all regions. Among NUTS 1 regions the lowest percentages for most of the components of antenatal care are observed for women living in the Southeast. However, listening to baby’s heartbeat and performance of ultrasound are lowest in the Central East Anatolia, whereas measurement of height and receiving iron tablets are lowest in the Northeast. Women with higher education were more likely to have received all routine components of ANC than less educated women. For instance, more than 90 percent of women with high school and higher level of education had their weight and blood pressure measured, blood sample taken, baby’s heartbeat listened to and were examined through ultrasound during their most recent birth in the five years prior to the survey. Unfortunately, women who had no education or did not complete primary education constitute the group with the lowest percentages benefiting from the components of ANC. Even a substantial difference can be observed in favor of women with at least a first level primary education in receiving the tests, measurements and other components of ANC compared with that of the women who have less than primary education. All respondents who gave birth in the five years preceding the survey, regardless of whether or not they received ANC were asked if they received iron tablets or syrup during the last pregnancy. Sixty-four percent of the women indicated that they received iron tablets or syrup. 10.4 Place of Delivery and Assistance during Delivery Hygienic conditions during delivery and proper medical attention reduce the health risks to mothers and children. The TDHS-2003 collected information on the place of delivery and the person assisting delivery for all children born in the five years preceding the survey. Overall, 78 percent of all births were delivered at a health facility (Table 10.4), representing a 5 percentage points increase (from 73 percent) in the level since 1998. Public sector health facilities were preferred for delivery to a much greater extent (65 percent), than privately run health facilities (13 percent). Home deliveries constitute one fifth of the births in the five years preceding the survey. 124 | Antenatal Care and Delivery Assistance Table 10.4 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics, Turkey 2003 Health facility Background characteristic Public sector Private sector Home Other Missing Total Number of births Age at birth <20 68.0 10.6 20.8 0.6 0.0 100.0 518 20-34 65.6 13.3 20.6 0.3 0.3 100.0 3,257 35-49 59.5 12.5 27.7 0.3 0.0 100.0 357 Birth order 1 72.6 18.2 9.2 0.0 0.0 100.0 1,397 2-3 69.4 12.7 17.4 0.3 0.3 100.0 1,796 4-5 50.6 6.7 41.0 1.0 0.8 100.0 532 6+ 41.8 3.9 53.6 0.6 0.0 100.0 407 Residence Urban 68.2 17.4 14.1 0.2 0.2 100.0 2,722 Rural 59.9 4.4 35.0 0.5 0.4 100.0 1,410 Region West 62.5 29.0 8.1 0.2 0.1 100.0 1,342 South 70.4 8.1 20.6 0.4 0.5 100.0 557 Central 85.7 2.5 10.9 0.6 0.3 100.0 813 North 83.7 1.6 13.3 0.6 0.9 100.0 252 East 48.0 6.4 45.5 0.1 0.0 100.0 1,168 NUTS 1 Region İstanbul 43.7 48.2 8.0 0.0 0.0 100.0 643 West Marmara 90.7 5.8 3.5 0.0 0.0 100.0 124 Aegean 80.7 8.7 10.6 0.0 0.0 100.0 392 East Marmara 80.0 12.0 5.8 1.3 0.9 100.0 328 West Anatolia 87.2 2.8 9.2 0.8 0.0 100.0 349 Mediterranean 70.4 8.1 20.6 0.4 0.5 100.0 557 Central Anatolia 77.7 3.3 18.3 0.0 0.7 100.0 232 West Black Sea 91.0 1.6 5.9 0.9 0.5 100.0 202 East Black Sea 77.2 1.7 19.9 0.3 0.9 100.0 137 Northeast Anatolia 58.0 7.2 34.8 0.0 0.0 100.0 185 Central East Anatolia 46.4 2.7 50.9 0.0 0.0 100.0 314 Southeast Anatolia 46.0 7.9 45.9 0.2 0.0 100.0 670 Education No education/Primary incomplete 42.8 5.5 51.1 0.4 0.2 100.0 1,099 First level primary 74.5 11.7 13.2 0.3 0.2 100.0 2,112 Second level primary 69.5 23.8 6.3 0.1 0.3 100.0 307 High school and higher 71.9 24.9 2.7 0.2 0.3 100.0 615 Antenatal care visits1 None 45.0 4.9 49.5 0.7 0.0 100.0 590 1-3 71.6 8.1 19.7 0.6 0.0 100.0 838 4+ 75.0 20.7 4.2 0.0 0.0 100.0 1,706 Don’t know/missing (67.3) (13.1) (2.0) (0.0) (17.6) 100.0 30 Total 65.3 12.9 21.2 0.3 0.2 100.0 4,132 1Includes only the most recent birth in the five years preceding the survey. Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. Antenatal Care and Delivery Assistance | 125 Younger women (less than age 35) are more likely to deliver at a health facility (79 percent) than older women (72 percent). Likewise, lower birth order of the child is associated with greater likelihood of delivery at a health facility (Figure 10.4). The percentage of women delivering at a health facility declines as the birth order increases. For instance, 91 percent of women deliver their first child at a health facility, which is twice the woman with birth order six or more. The number of antenatal care visits is also positively associated with health facility delivery. Ninety-six percent of the most recent deliveries with more than four ANC visits have been delivered at a health facility while only half of the deliveries without any ANC visit took place at a health institution. The level of education is strongly related to the utilization of health institutions for delivery. The proportion of births delivered in a health facility increases from 48 percent among births to women with no education to 97 percent among births to women with high school or higher level education. Furthermore, more than half of the women with either no education or less than primary education delivered at home. The results indicate a preference towards the private sector as the women’s level of education increases. For instance, one- fourth of the deliveries whose mothers have at least secondary level education are delivered at a health facility run by the private sector, compared with 6 percent of deliveries whose mothers have no education. There are apparent regional and residential differences. A child born in an urban area is 1.3 times more likely to have been delivered at a health facility than a rural child. In all regions except the East region, where nearly half of the births took place at home, the majority of births are delivered in health facilities. The West region exhibits the highest percentage (92 percent) for the deliveries that took place at a health institution, followed by the Central region (88 percent). The West region is dissimilar in terms of utilizing the health facilities of the private sector; in this region 3 in every 10 deliveries took place at the private Figure 10.3 Place of Delivery by Maternal Age and Birth Order 0 10 20 30 40 50 60 70 80 <20 20-34 35-49 1 2-3 4-5 6+ Maternal Age Birth Order Percent Public sector Private sector Home TDHS-2003 126 | Antenatal Care and Delivery Assistance sector which is more than twice the national average. Furthermore, in İstanbul, the share of the private sector (48 percent) is more than that of the public sector (44 percent). Unlike İstanbul, the majority of the births (91 percent) are delivered at health institutions of the public sector in the West Marmara and West Black Sea regions. The type of assistance a woman receives during the birth of her child depends to great extent on the place of delivery. Births that are delivered outside the health facility are much less likely to receive assistance from a doctor or other trained health professional. The proportion of all births delivered with the assistance of a doctor or trained health personnel is 83 percent (Table 10.5). Maternal age and child’s birth order are associated with type of assistance at delivery. Older women and women who have already had a number of births are less likely to receive assistance from medical personnel. Mother’s education is also closely tied to medical supervision at delivery. Almost all women with high school or more education received medical assistance at delivery. Assistance from medical personnel during delivery is higher than the national average in all regions except the East. In the West region almost all deliveries are attended by a health professional. In addition to the regional and residential variation in assistance during delivery, there are differences in the percentage of deliveries assisted by a doctor. For instance, in the East region, where medical personnel assisted 60 percent of the deliveries, doctors assisted with 21 percent of the births. The likelihood of delivery under a doctor’s supervision is 1.9 times greater for urban women compared to rural women. Traditional birth attendants assisted with the 9 percent of all deliveries. However, older women, women with birth order 6 or more, women living in rural areas and in the East –in particular Southeast and Central East Anatolia- and women who do not have education are more likely to receive delivery assistance from traditional birth attendants with percentages higher than the national average. Antenatal Care and Delivery Assistance | 127 Table 10.5 Assistance during delivery Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, according to background characteristics, Turkey 2003 Background characteristic Doctor Nurse/ midwife Traditional birth attendant Relative/ other No one Don’t know/ missing Total Number of births Age at birth <20 40.2 42.7 8.2 7.7 1.2 0.0 100.0 518 20-34 47.8 35.8 8.5 7.2 0.3 0.4 100.0 3,257 35-49 46.1 31.6 11.9 8.9 1.4 0.0 100.0 357 Birth order 1 60.2 33.7 3.9 2.1 0.1 0.0 100.0 1,397 2-3 48.1 38.7 6.7 5.6 0.6 0.3 100.0 1,796 4-5 26.8 38.1 17.5 15.5 0.7 1.4 100.0 532 6+ 20.2 32.4 23.0 22.7 1.6 0.1 100.0 407 Residence Urban 55.6 34.7 4.8 4.3 0.4 0.2 100.0 2,722 Rural 29.5 39.4 16.5 13.3 0.8 0.5 100.0 1,410 Region West 66.0 29.3 1.2 3.0 0.1 0.3 100.0 1,342 South 40.1 48.7 7.3 3.2 0.4 0.5 100.0 557 Central 56.9 34.1 2.5 5.7 0.4 0.3 100.0 813 North 45.2 41.3 7.9 3.8 1.0 0.9 100.0 252 East 20.9 38.8 22.6 16.4 1.0 0.2 100.0 1,168 NUTS 1 Region İstanbul 83.1 12.2 1.7 2.5 0.3 0.3 100.0 643 West Marmara 52.2 45.6 0.6 1.6 0.0 0.0 100.0 124 Aegean 53.1 41.5 0.6 4.8 0.0 0.0 100.0 392 East Marmara 51.0 43.4 0.8 3.5 0.3 0.9 100.0 328 West Anatolia 68.2 24.8 1.8 4.7 0.5 0.0 100.0 349 Mediterranean 40.1 48.7 7.3 3.2 0.4 0.5 100.0 557 Central Anatolia 37.7 48.3 6.2 6.7 0.4 0.7 100.0 232 West Black Sea 50.6 42.7 1.8 3.4 1.0 0.5 100.0 202 East Black Sea 44.0 36.7 11.9 6.3 0.3 0.9 100.0 137 Northeast Anatolia 20.4 49.5 14.7 14.2 1.2 0.0 100.0 185 Central East Anatolia 22.0 31.1 25.6 20.7 0.6 0.0 100.0 314 Southeast Anatolia 20.6 39.5 23.4 15.0 1.2 0.3 100.0 670 Education No education/Prim. incomplete 21.1 33.8 23.0 20.6 0.9 0.6 100.0 1,099 First level primary 49.2 41.9 4.5 3.6 0.5 0.2 100.0 2,112 Second level primary 57.9 38.5 2.0 0.9 0.3 0.3 100.0 307 High school and higher 78.3 20.2 1.1 0.2 0.0 0.3 100.0 615 Total 46.7 36.3 8.8 7.4 0.5 0.3 100.0 4,132 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 10.5 Characteristics of Delivery Table 10.6 indicates that, according to the mother’s reports, 21 percent of babies born in Turkey in the five years preceding the survey were delivered by caesarean section. This 128 | Antenatal Care and Delivery Assistance percentage confirms that a major increase of 7 percentage points have taken place (from 19 percent) in caesarean section since 1998. Caesarean sections are more common among births to older women, women with lower birth orders, women residing in urban areas and in the West and North regions, and more educated women. It is also noteworthy that 3 in every 10 first births in the five-year period preceding the survey were delivered by caesarean section. The prevalence of caesarean sections is above 30 percent in İstanbul, in the West Marmara and East Black Sea regions In TDHS-2003, respondents were asked whether their baby had been weighed at birth, and if so, how much the baby weighed. For 70 percent of the babies born in the five years preceding the survey, a birth weight was reported. A majority of the babies (62 percent) are reported to have weighed at least 2.5 kg or more. However, among births for which a birth weight was reported, 11 percent (8 percent of all births) were reported to have a weight less than 2.5 kilograms, the cut-off point below which a baby is considered to be low birth weight. Children classified as low-birth-weight births, are considered to have a higher than average risk of early mortality. Babies were more likely to be classified as low birth weight in the Aegean, Mediterranean, and West and East Black Sea regions compared to other regions. The subjective assessment of the mother about the size of the baby at birth was also taken. Mothers’ evaluation of the size of the baby at birth is also shown in Table 10.6. According to the mothers’ subjective evaluation of birth size, most of the babies (71 percent) are reported as average or larger, 12 percent of all births were reported to be very small and 17 percent were considered to be smaller than average. Relatively higher percentages are observed for babies regarded as very small among births to younger and older women, births with birth order above four and births to women without education. Regional estimates of subjective assessment of ‘very small’ vary from a low of 5 percent in the West Anatolia to a high of 19 percent in Central East and Southeast Anatolia. It is also noteworthy that one-fourth of the mothers in the West Black Sea region reported the babies born in the five years preceding the survey as ‘smaller than average’. Antenatal Care and Delivery Assistance | 129 Table 10.6 Delivery characteristics Percentage of live births in the five years preceding the survey delivered by caesarean section, and percent distribution by birth weight and by mother’s estimate of baby’s size at birth, according to background characteristics, Turkey 2003 Birth weight Size of child at birth Background characteristic Delivery by Cae- sarean section Not weighed Less than 2.5 kg 2.5 kg or more Don’t know/ missing Total Very small Smaller than average Average or larger Don’t know/ missing Total Number of births Age at birth <20 11.5 28.3 9.8 58.7 3.2 100.0 13.3 18.6 67.4 0.6 100.0 518 20-34 22.5 23.6 7.5 63.9 5.1 100.0 10.7 16.2 72.3 0.8 100.0 3,257 35-49 24.0 32.1 8.7 52.9 6.3 100.0 16.1 18.8 64.6 0.5 100.0 357 Birth order 1 28.8 12.2 10.0 73.5 4.2 100.0 11.3 19.3 68.8 0.6 100.0 1,397 2-3 21.5 20.5 6.6 68.9 4.0 100.0 8.6 14.6 76.0 0.8 100.0 1,796 4-5 11.2 45.4 8.3 39.6 6.7 100.0 16.7 16.1 65.9 1.3 100.0 532 6+ 7.2 61.0 5.3 24.3 9.4 100.0 18.1 17.9 63.8 0.2 100.0 407 Residence Urban 25.6 16.4 7.8 71.8 4.1 100.0 10.1 15.1 74.0 0.8 100.0 2,722 Rural 12.9 41.3 8.0 44.0 6.6 100.0 14.1 19.9 65.4 0.6 100.0 1,410 Region West 30.7 6.5 7.9 83.6 2.0 100.0 7.3 13.1 79.1 0.5 100.0 1,342 South 20.7 19.8 11.6 62.9 5.7 100.0 16.2 14.0 68.3 1.4 100.0 557 Central 20.9 11.6 9.1 76.2 3.2 100.0 6.1 22.2 70.3 1.4 100.0 813 North 31.1 14.3 10.2 71.9 3.6 100.0 12.5 16.2 70.5 0.9 100.0 252 East 8.7 60.0 4.7 25.9 9.4 100.0 17.5 18.6 63.8 0.2 100.0 1,168 NUTS 1 Region İstanbul 34.3 6.5 9.6 83.1 0.8 100.0 8.2 14.3 77.1 0.4 100.0 643 West Marmara 39.7 3.5 7.3 84.2 5.0 100.0 10.2 10.8 79.0 0.0 100.0 124 Aegean 27.8 7.0 11.9 78.4 2.7 100.0 5.8 21.7 72.3 0.3 100.0 392 East Marmara 22.3 8.0 5.1 84.9 2.0 100.0 5.6 8.4 84.6 1.4 100.0 328 West Anatolia 20.6 9.7 6.4 80.6 3.4 100.0 5.2 19.8 74.4 0.6 100.0 349 Mediterranean 20.7 19.8 11.6 62.9 5.7 100.0 16.2 14.0 68.3 1.4 100.0 557 Central Anatolia 16.4 16.7 5.7 73.2 4.4 100.0 9.1 16.9 72.6 1.4 100.0 232 West Black Sea 27.8 6.1 10.5 80.2 3.2 100.0 7.0 24.8 65.6 2.6 100.0 202 East Black Sea 30.9 23.3 10.6 61.8 4.3 100.0 15.1 14.4 69.6 0.9 100.0 137 Northeast Anatolia 9.8 49.8 7.3 38.5 4.4 100.0 10.3 17.5 71.8 0.3 100.0 185 Central East Anatolia 7.4 60.4 3.8 27.9 7.9 100.0 19.2 16.6 64.1 0.0 100.0 314 Southeast Anatolia 9.0 62.7 4.4 21.4 11.5 100.0 18.6 19.8 61.4 0.3 100.0 670 Education No education/ Primary incom. 7.6 60.3 6.3 24.3 9.1 100.0 17.7 19.0 62.7 0.6 100.0 1,099 First level primary 19.9 15.8 9.3 70.4 4.5 100.0 10.4 17.0 71.5 1.0 100.0 2,112 Second level primary 24.6 6.5 5.7 86.6 1.2 100.0 9.2 12.9 77.4 0.5 100.0 307 High school/ higher 48.5 1.9 6.7 90.4 0.9 100.0 5.0 13.5 81.2 0.3 100.0 615 Total 21.2 24.9 7.9 62.3 4.9 100.0 11.5 16.7 71.1 0.7 100.0 4,132 Vaccination and Child Health | 131 VACCINATION AND CHILD HEALTH 11 Sabahat Tezcan and Elif Kurtuluş Yiğit This chapter presents findings concerning vaccination of children of 12-23 months, acute respiratory infection among children under age five and smoking status of ever-married women. Data were obtained for all live births that occurred in the five years preceding the survey. 11.1 Vaccination of Children Universal immunization of children under one year of age against the six vaccine- preventable diseases (tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and measles) is one of the most cost-effective programs in reducing infant and child morbidity and mortality. To be fully immunized, a child should receive the following vaccinations before the first birthday: one dose of BCG, three doses of DPT and polio, and one dose of measles vaccine. BCG, which is given at second month of life or at first clinical contact, protects against tuberculosis. DPT protects against diphtheria, pertussis, and tetanus. DPT and polio (OPV) each require three vaccinations at approximately six, ten and 14 weeks of age; however, since this regime is not always followed, emphasis is given on getting all three doses by the time the child reaches 12 months of age. Measles should be given at or soon after the child reaches nine months. It is recommended that children receive the complete schedule of vaccinations before 12 months of age. Children who receive protection against all six vaccine-preventable illnesses are considered fully vaccinated. In TDHS-2003, information on vaccination status was collected for all children born in the five years preceding the survey. However, the data presented here are restricted to children who were alive at the time of the survey fieldwork. To obtain vaccination data for each eligible child, mothers were asked whether they had a vaccination card for the child, and if so, to show the card to the interviewer. The dates of the vaccinations were copied from the card to the questionnaire. Mothers were also asked whether the child has been given any vaccination not recorded on the card. If the vaccination card was not available for the child, then the mother was asked a number of questions in order to determine the vaccination status of the child for each specific vaccine. In case of DPT and polio, the mother was asked to report the number of doses of the vaccine that the child had received. 11.1.1 Coverage of Children Age 12-23 Months Information on vaccination coverage is presented in Table 11.1 according to the source of information used to determine coverage, i.e., the child’s vaccination card or the 132 | Vaccination and Child Health mother’s report. Data are presented for children age 12-23 months, by which age the child should be fully vaccinated. The information was gathered from a vaccination card in the case of 54 percent of children while mothers gave the information for the remaining cases. For children whose information was based on the mother’s report, the proportion vaccinated during the first year of life (12 percent) is lower than that for children with a written record of vaccination (43 percent). The OPV coverage rate for children without a written record is somewhat higher than that of the DPT coverage rate. Table 11.1 Vaccinations by source of information Percentage of children 12-23 months who have received specific vaccines at any time before the survey, by source of information, and the percentage vaccinated by 12 months of age, Turkey 2003 Percentage of children receiving: Source of information BCG DPT1 DPT2 DPT3 Polio1 Polio2 Polio3 Measles All1 None Number of children Vaccinated at any time before the survey Vaccination card 51.5 51.9 50.7 48.5 52.2 50.8 48.4 48.9 42.5 0.0 402 Mother's report 36.2 36.6 25.1 15.9 42.5 32.0 20.7 30.5 11.7 2.8 346 Either source 87.7 88.5 75.8 64.4 94.7 82.8 69.1 79.4 54.2 2.8 749 Vaccinated by 12 months of age2 86.2 86.9 74.0 62.2 92.5 80.4 66.5 71.2 48.0 4.4 749 1 Children who are fully vaccinated (i.e., those who have received BCG, measles, and three doses of DPT and polio). 2 For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. Taking into account both the card information and the mother’s report, Table 11.1 shows that 54 percent of the children had received all of the recommended eight vaccines at some time before the survey. Only 3 percent had not received any vaccination at all. For the remaining 43 percent, the complete schedule of vaccinations was not received. The percentage of children who were fully vaccinated by 12 months of age was 48 percent. 11.1.2 Coverage Rates by Background Characteristics Vaccination coverage rates for children in the 12-23 month age group are presented in Table 11.2 by background characteristics. There are definite differences in vaccination coverage by place of residence. The percentages of children receiving the first dose of OPV are equal (95 percent) for children living in urban and rural residences. However the percentages receiving the second and third doses of OPV fall to 78 and 53 for rural children compared with 85 and 77 percent of urban children. The three DPT doses are higher for children of urban residences than for children of rural residences. As a result of high drop-out rates, coverage in rural children for the third dose of DPT falls to 48 percent compared with 73 percent of urban children. BCG and measles coverage rates are also lower for rural children than for urban children. Overall, 63 percent of the urban children are fully vaccinated which is much higher than the proportion for rural children (37 percent). Considering regional differences, the percentage fully vaccinated is lowest in the East (35 percent). In all other regions, at least six in ten children are fully vaccinated. The data in Vaccination and Child Health | 133 Table 11.2 also verify the fact that drop-out rates for DPT and Polio are markedly high in the East compared to other regions. The proportion of children whose mothers showed a vaccination card also was significantly lower in the East (31 percent) than other regions. Mother’s educational status is related to the likelihood that a child will be vaccinated. The percentage of children who are fully vaccinated varies from 26 percent among children whose mothers have no education to 69 percent among children whose mothers have at least high school education. The DPT/OPV drop-out rates are higher for children of mothers with no education than for other children; for example, DPT coverage rates among children of women with no education fall from 63 percent in the case of the first dose to 35 percent for the third dose. Only 45 percent of children of women with no education received a measles vaccination, and only 64 percent received a BCG vaccination. Table 11.2 Vaccinations by background characteristics Percentage of children 12-23 months who had received specific vaccines by the time of the survey (according to the vaccination card or the mother's report), and the percentage with a vaccination card, according to background characteristics, Turkey 2003 Percentage of children receiving: DPT Polio Background characteristic BCG 1 2 3 1 2 3 Measles All1 None Percentage with vacci- nation card Number of children Child's sex Male 89.0 87.4 78.0 66.3 95.8 85.1 73.9 80.0 57.7 2.7 56.6 381 Female 86.4 89.6 73.5 62.4 93.6 80.4 64.0 78.8 50.6 2.9 50.7 367 Birth order 1 92.3 92.0 83.5 72.9 96.0 87.5 78.1 84.4 62.4 1.0 65.1 253 2-3 92.0 93.5 79.6 69.8 95.7 85.0 71.2 86.5 59.8 2.1 54.6 340 4-5 83.8 78.4 59.1 41.0 93.8 71.9 57.0 68.5 33.8 3.2 30.7 93 6+ 52.2 61.8 48.7 35.0 85.6 67.5 38.8 36.5 21.5 13.0 37.6 63 Residence Urban 92.6 91.2 80.9 72.6 94.7 85.3 76.9 84.4 62.9 2.4 63.2 503 Rural 77.7 82.9 65.4 47.5 94.7 77.5 53.0 69.1 36.5 3.5 34.4 246 Region West 95.5 94.3 81.3 72.6 95.2 87.4 79.1 88.9 63.0 1.4 65.1 271 South 95.2 96.5 83.3 71.4 98.8 84.3 70.6 81.1 60.2 0.0 62.4 89 Central 95.6 93.8 83.0 72.1 96.4 86.0 73.6 90.3 61.0 1.7 57.5 138 North (91.5) (95.8) (85.6) (70.7) (93.8) (85.8) (71.0) (84.5) (60.1) (2.8) (64.7) 41 East 68.6 72.5 58.9 44.4 91.4 73.5 52.2 58.2 34.8 6.5 30.8 210 Selected NUTS 1 Region İstanbul 92.3 92.3 77.5 72.5 89.7 83.6 78.2 85.8 62.3 3.0 70.4 127 Southeast Anatolia 70.9 73.8 57.2 43.4 93.0 69.8 52.2 56.7 35.0 5.5 32.9 118 Education No education/Prim. incomp. 63.8 62.9 48.9 35.0 88.2 70.6 44.6 45.0 26.1 9.5 31.6 173 First level primary 93.7 94.7 79.1 69.3 97.0 85.4 73.9 88.9 60.9 1.1 55.4 389 Second level primary 98.2 100.0 90.5 72.9 93.1 83.1 70.0 93.1 61.2 0.0 67.7 53 High school and higher 97.2 98.9 95.3 84.8 97.2 90.7 86.5 90.8 68.5 0.0 72.1 133 Total 87.7 88.5 75.8 64.4 94.7 82.8 69.1 79.4 54.2 2.8 53.7 749 1 Children who are fully vaccinated (i.e., those who have received BCG, measles, and three doses of DPT and polio). 134 | Vaccination and Child Health A child’s birth order is also related to vaccination coverage rates. Children of high birth order tend to have lower coverage than children of lower birth order. The percentage fully vaccinated among first order births is 62 percent compared with 34 percent of children of birth order 4-5, and 22 percent for children of birth order six or more. There is a difference between vaccination coverage among male and female children in favor of males. 11.1.3 Vaccination in First Year of Life by Current Age Table 11.3 presents information on children 12-59 months and shows the percentage of children who have a vaccination record as well as the percentage who have received each vaccine during the first year of life according to information from the vaccination card or mother’s recall. As was the case in earlier tables, the distribution of vaccinations during the first year of life for children whose information was based on the mother’s recall was assumed to be the same as that for children for whom a vaccination record was available. Table 11.3 Vaccinations in first year of life by current age Among children 12-59 months, the percentage with a vaccination card and the percentage who have received each vaccine before their first birthday, according to current age of the child, Turkey 2003 Current age of child in months Vaccine 12-23 24-35 36-47 48-59 All children 12-59 months Vaccination card seen by interviewer 53.7 30.9 23.2 17.4 30.7 Percentage vaccinated at 0-11 months1 BCG 86.2 84.3 81.6 83.8 84.7 DPT 1 86.9 83.9 83.0 81.7 84.5 DPT 2 74.0 66.7 64.2 61.9 67.0 DPT 3 62.2 52.9 52.2 51.6 55.3 Polio 1 92.5 91.5 88.7 90.6 91.5 Polio 2 80.4 76.3 75.0 73.7 76.8 Polio 3 66.5 60.1 59.9 60.9 62.6 Measles 71.2 70.2 66.8 72.9 71.0 All vaccinations2 48.0 43.2 41.5 44.6 45.0 No vaccinations 4.4 7.1 9.7 7.6 6.6 Number of children 749 845 829 833 3,255 1 Information was obtained either from a vaccination card or from the mother if there was no written record. For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as that for children with a written vaccination record. 2 Children who have received BCG, measles, and three doses each of DPT and polio vaccines The proportion of children for whom vaccination cards were seen declines with increasing age of child, from 54 percent among children age 12-23 months to 17 percent among children age 48-59 months. This suggests that either there has been an increase in vaccination levels in the recent past or the mothers did not keep the vaccination cards for older children. Similarly, the proportion of children who had received each vaccine during the Vaccination and Child Health | 135 first year of life are higher for children age 12-23 months than for children in the 24-35 and 36-47-month age groups. 11.2 Prevalence and Treatment of Acute Respiratory Infection and Fever Acute respiratory infection (ARI), primarily pneumonia, is a common cause of morbidity and mortality during infancy and childhood. ARI is still the most prevalent disease in Turkey among children under age five especially during winter months. Early diagnosis and prompt treatment with proper antibiotics can prevent a large proportion of these ARI deaths. In the TDHS-2003, the prevalence of ARI was estimated by asking mothers whether their children below five years of age had been sick with a cough accompanied by short, rapid breathing in the two weeks preceding the survey. For children who had experienced these symptoms, questions were asked about the type of the treatment given and use of health facility or health provider. It should be noted that morbidity data are subjective since the information is based on mother’s perception of her child’s illness without any medical diagnosis. Furthermore, the timing of the TDHS-2003 fieldwork should be taken into consideration when assessing these findings, since the fieldwork took place in the peak season for ARI, mainly between December 2003 and May 2004. As the prevalence of ARI is subject to seasonality, the results do not represent the average annual prevalence of ARI. Table 11.4 shows the percentage of children under five years of age with ARI symptoms and percentage of children under five years with a fever during the two weeks preceding the survey. Since no distinction was made in the questionnaire for treatment sought for symptoms of ARI and fever, the table shows a single column for the percentage of children with symptoms of ARI and/or fever for whom treatment was sought. This table also includes an additional background characteristic for the mother -her smoking status- since smoking is known to cause and/or aggravate symptoms of ARI. This variable has no known relationship to fever and as such is not applicable for fever. Overall 29 percent of children had experienced ARI at some time in the two weeks preceding the survey. Children under two years of age, especially those 6-11 and 12-23 months old, are more likely than older children to have had ARI. There is little variation in ARI prevalence by sex and residence. The prevalence of ARI is higher among children in the North and East (33 percent) and children whose mothers did not attend school (35 percent) and whose mothers smoke (31 percent) than among other children. Regarding fever, 40 percent of the children had fever during the two weeks preceding the survey. The prevalence of fever was highest among children in 6-11 months (55 percent), children living in the East (50 percent), and children whose mothers did not attend school (51 percent). 136 | Vaccination and Child Health Table 11.4 Prevalence and treatment of symptoms of ARI and fever Percentage of children under five years who had a cough accompanied by short, rapid breathing (symptoms of ARI), percentage who had fever in the two weeks preceding the survey, and percentage with symptoms of ARI and/or fever for whom treatment was sought from a health facility or provider, by background characteristics, Turkey 2003 Background characteristic Percentage of children with symptoms of ARI Percentage of children with fever Number of children Among children with symptoms of ARI and/or fever, percentage for whom treatment was sought from a health facility/provider1 Number of children Age in months <6 26.3 32.6 372 47.0 160 6-11 36.8 55.2 371 48.8 234 12-23 32.2 47.9 749 45.5 421 24-35 30.4 40.8 845 39.0 410 36-47 29.7 36.6 829 38.1 381 48-59 20.7 32.5 833 32.3 323 Child's sex Male 29.7 40.1 2,062 43.8 1,001 Female 27.8 40.2 1,987 37.9 928 Residence Urban 28.3 38.6 2,651 47.8 1,253 Rural 29.7 43.1 1,347 28.3 676 Region West 29.1 33.6 1,305 49.3 581 South 25.4 36.7 542 36.7 253 Central 23.3 38.0 791 47.7 354 North 33.0 43.7 242 42.9 124 East 32.9 50.0 1,118 30.6 617 NUTS 1 Region İstanbul 36.5 39.6 625 46.3 323 West Marmara 19.2 32.0 119 (56.8) 48 Aegean 25.3 27.3 383 57.2 145 East Marmara 16.3 27.3 317 46.4 110 West Anatolia 20.0 36.5 346 44.7 149 Mediterranean 25.4 36.7 542 36.7 253 Central Anatolia 34.7 45.8 221 46.4 119 West Black Sea 25.5 44.1 193 52.0 97 East Black Sea 37.7 42.1 133 37.7 68 Northeast Anatolia 31.1 50.7 176 27.8 99 Central East Anatolia 28.4 46.5 300 31.6 153 Southeast Anatolia 35.5 51.4 642 30.9 365 Education No education/Primary incom. 34.7 50.9 1,044 25.1 599 First level primary 29.1 38.7 2,051 45.5 982 Second level primary 22.6 33.2 302 56.1 127 High school and higher 20.5 29.5 601 55.4 221 Mother’s smoking status Smokes cigarettes 31.3 NA 1,004 48.1 483 Does not smoke 28.0 NA 2,998 38.6 1,443 Total 28.8 40.1 3,998 41.0 1,929 ARI = Acute Respiratory Infection; NA = Not applicable 1Excludes pharmacy, shop, and traditional practitioner Note: Parentheses indicate that a figure is based on 25-49 unweighted cases. Vaccination and Child Health | 137 Four in every ten children with ARI and/or fever episodes received some kind of treatment from a health facility or a health provider. The proportion for whom treatment was sought are highest for children in the first year of life (around 48 percent), for male children (44 percent), for children living in urban areas (48 percent), for children in the West region (49 percent), and for children whose mothers completed second level primary (56 percent) or high school and higher (55 percent). 11.3 Smoking Status of Mothers Cigarette smoking is hazardous to human health. Its use adversely affects women’s health status and may affect children’s health. During pregnancy its use increases the risk of having a small or low birth weight baby and may increase the susceptibility to acute respiratory illnesses among children. Table 11.5 ascertains the prevalence of smoking among women and frequency of cigarette smoking among women by background characteristics. Among all ever-married women age 15-49, 28 percent reported that they smoke rarely or regularly. Looking at the age patterns, smoking is most common among women age 20-34. Urban women are more likely to smoke than rural women (33 percent and 15 percent, respectively). Women living in the West and those who have completed at least high school are more likely to smoke (32 and 44 percent respectively). According to maternity status, 15 percent of pregnant women and 20 percent of breastfeeding women report that they smoke regularly. The majority of smokers age 35-49 smoke more than 10 cigarettes daily (52 percent). Smoking more than 10 cigarettes is most common among smokers living in the West (47 percent), and smokers with at least high school education (45 percent). Among pregnant women, 41 percent smoke 3-5 cigarettes, 14 percent smoke 6-9 cigarettes, and 15 percent smoke 10 or more cigarettes. Similarly among breastfeeding women, 29 percent smoke 3-5 cigarettes, 17 percent smoke 6-9 cigarettes, and 23 percent smoke 10 or more cigarettes daily. A comparison of the TDHS-2003 results with the findings from the TDHS-1993 indicates that, in the last ten years, smoking has become more common among women. Overall, the proportion of ever-married women who smoke has risen by more than 50 percent, from 18 percent to the 28 percent. 138 | Vaccination and Child Health Table 11.5 Use of smoking cigarettes Percentage of ever-married women who smoke cigarettes rarely/regularly and percent distribution of cigarette smokers by number of cigarettes smoked per day, according to background characteristics, Turkey 2003 Number of cigarettes smoked per day Background characteristic Percentage who smoke cigarettes Number of women 0 1-2 3-5 6-9 10+ Don’t know/ missing Total Number of cigarette smokers Age 15-19 16.5 238 (1.5) (22.5) (43.8) (13.3 (19.3) (0.0) 100.0 39 20-34 30.1 4,014 3.2 21.5 26.9 14.0 34.2 0.1 100.0 1,210 35-49 25.7 3,824 2.1 17.4 18.0 10.6 51.8 0.1 100.0 984 Residence Urban 32.8 5,752 2.1 17.8 22.0 13.1 44.8 0.1 100.0 1,885 Rural 14.9 2,323 6.0 30.1 29.9 9.3 24.7 0.0 100.0 347 Region West 32.3 3,286 1.7 17.1 22.0 12.5 46.7 0.0 100.0 1,063 South 26.7 1,028 6.7 17.2 22.5 14.8 38.6 0.2 100.0 274 Central 25.8 1,867 2.1 23.5 24.1 12.1 37.9 0.4 100.0 481 North 21.5 590 3.8 28.6 25.7 9.6 32.4 0.0 100.0 127 East 22.1 1,305 2.9 21.8 26.3 12.3 36.7 0.0 100.0 288 NUTS 1 Region İstanbul 36.9 1,470 1.9 15.7 21.2 12.8 48.5 0.0 100.0 542 West Marmara 30.5 348 1.8 14.6 30.1 11.2 42.3 0.0 100.0 106 Aegean 25.7 1,157 1.8 21.6 18.1 12.9 45.6 0.0 100.0 297 East Marmara 26.9 710 1.2 18.4 26.9 11.3 42.2 0.0 100.0 191 West Anatolia 34.5 784 0.8 21.3 23.4 10.1 43.7 0.6 100.0 270 Mediterranean 26.7 1,028 6.7 17.2 22.5 14.8 38.6 0.2 100.0 274 Central Anatolia 20.5 471 2.5 27.7 24.0 16.5 29.3 0.0 100.0 97 West Black Sea 20.1 513 5.7 26.5 22.9 12.1 32.8 0.0 100.0 103 East Black Sea 21.8 291 5.0 30.1 31.4 8.8 24.8 0.0 100.0 63 Northeast Anatolia 21.9 245 6.6 19.8 34.2 7.2 32.2 0.0 100.0 54 Central East Anatolia 21.8 389 1.0 28.4 29.3 14.4 26.9 0.0 100.0 85 Southeast Anatolia 22.3 671 2.7 18.8 21.7 13.0 43.8 0.0 100.0 150 Education No education/Primary incom. 18.4 1,761 2.1 25.4 22.9 8.0 41.7 0.0 100.0 324 First level primary 24.5 4,339 3.1 22.0 22.9 12.8 39.2 0.0 100.0 1,065 Second level primary 40.1 601 2.4 9.8 27.1 16.5 43.5 0.7 100.0 241 High school and higher 43.9 1,374 2.5 16.7 22.6 12.8 45.4 0.1 100.0 603 Maternity status Pregnant 15.0 472 3.7 26.6 41.1 13.9 14.6 0.0 100.0 71 Breastfeeding 19.6 929 4.5 26.1 29.4 17.3 22.7 0.0 100.0 182 Not pregnant/breastfeeding 29.7 6,674 2.5 18.9 22.1 12.0 44.4 0.1 100.0 1,980 Total 27.6 8,075 2.7 19.7 23.3 12.5 41.7 0.1 100.0 2,233 Feeding Practices and Nutrition Status | 139 INFANT FEEDING PRACTICES AND CHILDREN’S AND WOMEN’S NUTRITIONAL STATUS 12 Elif Kurtuluş Yiğit and Sabahat Tezcan The TDHS-2003 obtained information relating to the nutritional status of children, including infant feeding practices, duration and intensity of breastfeeding, the types of the complimentary foods given, and whether or not a bottle with a nipple was used. To further assess the nutritional status of all children under the age of five and women age 15-49, anthropometric (height and weight) data were also collected. Infant feeding practices affect the health of both the child and the mother. With respect to child, they relate directly to the nutritional status, which in turn influences the risk of morbidity and mortality of young children. In the case of the mother, breastfeeding has an effect on the period of postpartum amenorrhea, which in turn leads to longer birth intervals and lower fertility levels. The magnitude of the effects is influenced by both the duration and intensity of breastfeeding, and by the age at which the child receives supplemental foods and liquids. Maternal nutrition status also has important implications for the health of the mother as well as that of the child. A woman who is in poor nutritional health has a greater risk of having an adverse pregnancy outcome and is more likely to give birth to underweight babies. 12.1 Initiation of Breastfeeding Breastfeeding of infants is among the most important factors contributing to the maintenance of growth. Breast milk contains all the nutrients needed by children in the first 4-6 months of life. Moreover, breast milk is clean and always available at just the right temperature, and it promotes a close mother-child relationship. In addition, it provides some immunity to disease through the mother's antibodies, helps in reducing the prevalence of nutritional deficiencies, and food-borne infections. Table 12.1 shows the percentage of children born in the five years before the survey according to breastfeeding status and the timing of the initial breastfeeding by selected background characteristics. Breastfeeding is almost universal in Turkey; 97 percent of all children are breastfed for some period of time. Due to the large percentage of children ever breastfed, differentials in the proportion of children breastfed by background characteristics are quite small. 140 | Feeding Practices and Nutrition Status Table 12.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and among children ever breastfed, percentage who started breastfeeding within one hour and within one day of birth and percentage who received a prelacteal feed, by background characteristics, Turkey 2003 Percentage breastfeeding: Background characteristic Percentage ever breastfed Number of children Within 1 hour of birth Within 1 day of birth1 Percentage who received a prelacteal feed2 Number of children ever breastfed Child’s sex Male 96.4 2,132 53.7 83.2 40.3 2,056 Female 97.3 2,000 54.2 84.0 38.4 1,946 Residence Urban 96.9 2,722 57.2 86.1 38.3 2,639 Rural 96.7 1,410 47.6 78.7 41.3 1,363 Region West 96.5 1,342 60.4 89.6 31.5 1,295 South 97.3 557 50.0 81.5 41.0 542 Central 96.9 813 63.2 87.0 35.3 787 North 96.6 252 60.8 86.9 27.6 244 East 97.1 1,168 40.6 74.7 52.8 1,134 NUTS1 Region İstanbul 96.8 643 57.8 88.6 35.4 622 West Marmara 96.9 124 69.8 91.5 28.7 120 Aegean 97.1 392 56.2 85.9 31.9 380 East Marmara 95.0 328 68.8 89.6 30.3 311 West Anatolia 98.4 349 66.1 90.1 31.7 344 Mediterranean 97.3 557 50.0 81.5 41.0 542 Central Anatolia 96.5 232 58.6 88.6 39.4 224 West Black Sea 93.6 202 62.3 87.3 24.0 189 East Black Sea 98.3 137 59.0 86.0 30.0 135 Northeast Anatolia 95.5 185 45.9 92.2 22.1 177 Central East Anatolia 98.6 314 36.3 73.9 48.4 309 Southeast Anatolia 96.8 670 41.2 70.4 63.3 648 Education No education/Primary incom. 97.1 1,099 39.1 73.3 51.2 1,067 First level primary 96.7 2,112 59.2 86.6 34.8 2,041 Second level primary 97.7 307 57.1 91.2 30.0 299 High school and higher 96.6 615 60.8 88.0 38.4 594 Assistance at delivery Health professional3 96.7 3,430 58.2 86.8 36.7 3,317 Traditional birth attendant 98.8 362 34.9 68.5 55.4 358 Other 96.2 305 31.3 68.7 51.6 294 No one (93.8) 22 (46.2) (85.0) (40.2) 21 Missing * 13 * * * 13 Place of delivery Health facility 96.6 3,234 58.5 86.8 36.3 3,124 At home 97.7 876 37.7 72.5 51.1 857 Other * 13 * * * 12 Missing * 9 * * * 9 Total 96,8 4,132 53.9 83.6 39.4 4,002 Note: Table is based on all births whether the children are living or dead at the time of interview. 1 Includes children who started breastfeeding within one hour of birth. 2 Children given something other than breast milk during the first three days of life before the mother started breastfeeding regularly. 3 Doctor, nurse/midwife, or auxiliary midwife Note: An asterisk indicates a figure is based on fewer than 25 unweighted cases. Parentheses indicate a figure is based on 25-49 unweighted cases. Feeding Practices and Nutrition Status | 141 Early initiation of breastfeeding is of benefit to both mother and infant. Suckling stimulates production of oxytocin, a hormone that causes the mother's uterus to contract. The first breast milk, colostrum, protects the newborn infant from infections because of its high concentration of antibodies. Information from the TDHS-2003 on the timing of initiation of breastfeeding for all children indicates that initiation to breastfeeding is rather late (Table 12.1). Only 54 percent of ever-breastfed children were started breastfeeding as early as within one hour of birth, and 16 percent are not put to the breast within 24 hours of their birth. These proportions are almost identical to those reported in the TDHS-1998 indicating that there has been little recent change in the overall patterns with respect to the initiation of breastfeeding. Increases in the proportions of children for whom breastfeeding was initiated early occurred in the West, Central and North regions since 1998 (data not shown in tables). Despite the increases, marked variations in the timing of initiation of breastfeeding still remain across regions and education subgroups. The percentage of children who started breastfeeding within one hour of birth is highest in the Central region (63 percent) and lowest in the East region (41 percent). The percentage of children of whom breastfeeding was initiated within an hour of birth varies from 39 percent for births to mothers with no education to 61 percent for births to mothers with at least high school education. The proportion of children who started breastfeeding within first day of birth also varies by region and education. The East, where mothers are usually less educated and are more likely to give birth without the assistance of a medically trained person, has the lowest proportion; 25 percent of all children in this region were not put to the breast during the first day. Looking at the education patterns, 27 percent of children of mothers with no education did not start breastfeeding within first day of their birth compared with 12 percent of births to the most highly educated mothers. Prelacteal feeding is the practice of giving other liquids to an infant during the period immediately after birth before mother’s milk is flowing freely. Table 12.1 shows this practice is common in Turkey. Overall, forty percent of children were received a prelacteal feed. This percentage is highest for children living in the Southeast Anatolia (63 percent). 12.2 Breastfeeding Status by the Age of the Child UNICEF and WHO recommend that children be exclusively breastfed (i.e, without receiving other liquids or solid foods or plain water) during the first 6 months of life and those children be given solid or mushy supplements beginning with the seventh month of life. While complementary feeding is acceptable after the first 6 months, breastfeeding is recommended to be continued through the second year of life. Use of bottles with nipples is not recommended at any age. The percent distribution of living children by breastfeeding status at the time of the survey is shown in Table 12.2. The child’s breastfeeding status is based on information collected in the survey on feeding practices in the last 24 hours before the interview. "Exclusively breastfed" refers to children who receive breast milk only. "Children who are fully breastfed" includes those who are exclusively breastfed and those who receive only plain water in addition 142 | Feeding Practices and Nutrition Status to breast milk. Table 12.2 also shows the percentage who drank anything from a bottle with a nipple in the day or night before the interview. Table 12.2 Breastfeeding status by age Percent distribution of the youngest children under three years living with the mother by breastfeeding status and percentage of children using a bottle with a nipple, according to age in months, Turkey 2003 Breastfeeding and consuming: Age in months Not breastfeeding Exclusively breastfed Plain water only Water- based liquids/ juice Other milk Comple- mentary foods Total Percentage using a bottle with a nipple Number of children <2 1.8 43.5 32.0 15.2 6.4 1.1 100.0 16.4 95 2-3 6.2 15.7 30.9 17.2 21.5 8.5 100.0 39.1 129 4-5 13.4 10.6 15.0 10.8 35.6 14.6 100.0 47.5 148 6-7 18.8 1.8 2.4 4.4 38.5 34.1 100.0 55.5 143 8-9 29.0 1.4 3.0 0.7 23.7 42.2 100.0 62.0 118 10-11 31.5 0.5 1.5 7.7 14.0 44.7 100.0 48.7 109 12-15 44.8 0.0 0.1 2.3 14.0 38.8 100.0 56.9 244 16-19 67.5 0.0 1.2 1.7 7.1 22.5 100.0 55.2 267 20-23 75.7 0.0 0.0 0.2 3.7 20.4 100.0 49.3 238 24-27 89.5 0.0 0.0 0.2 1.6 8.7 100.0 41.6 230 28-31 92.5 0.0 0.0 0.4 0.4 6.6 100.0 33.3 310 32-35 95.7 0.0 0.0 1.0 0.0 3.3 100.0 35.2 305 <6 7.9 20.8 24.9 14.2 23.2 9.0 100.0 36.6 372 6-9 23.4 1.7 2.6 2.7 31.9 37.7 100.0 58.4 261 Note: Breastfeeding status refers to a “24-hour” period (yesterday and last night). Children classified as breastfeeding and consuming plain water only consume no supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, water-based liquids/juice, other milk, and complementary foods (solids and semi-solids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus children who receive breast milk and water-based liquids and who do not receive complementary foods are classified in the water- based liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. Table 12.2 indicates that complementary feeding is common among very young children. In the first two months of life, only 44 percent are exclusively breastfed, a figure which is low but significantly higher than that found in the TDHS-1998 (14 percent). The table also shows that a substantial proportion of children in this age range (47 percent) are predominantly breastfed (i.e., they receive only water, water-based liquids or juices in addition to breast milk). However, 23 percent of children are being given other supplements within the first two months of birth. By age 2-3 months, only 16 percent of children are exclusively breastfed. The percentage of children receiving supplements increases to 78 percent among children 2-3 months of age. The table shows that, after the sixth month, feeding with other milk and complementary foods is more common than breastfeeding. By 12-15 months, 45 percent of children are not breastfed. Early introduction of supplementary food increases the risk of gastrointestinal infections, which is one of the leading causes of infant mortality in Turkey. Bottle-feeding is also discouraged among very young children, because it contributes to an increased risk of gastrointestinal infections. Table 12.2 shows that, among children less than six months of age the percentage of using a bottle with a nipple is 37 percent and that increases to a peak of 62 percent among children age 8-9 months. Feeding Practices and Nutrition Status | 143 12.3 Duration and Frequency of Breastfeeding Table 12.3 shows the median duration of any, exclusive and predominant breastfeeding. The median duration of breastfeeding for all children is 14 months, which is two months longer from the median reported in 1998. There are some differences in breastfeeding durations among subgroups. Women living in the East are breastfeeding their children 15 months, longer than any other region while in the West and North regions, median durations of less than 11 months are observed. Women who never attended school are breastfeeding for nearly 15 months, at least 5 months longer on average than more educated women. The median durations of any breastfeeding in İstanbul and Southeast Anatolia (14.6 and 14.4 months respectively) are higher than the median found for all children born in the three years preceding the survey. Median durations for exclusive breastfeeding are very short, around less than one month for all subgroups. There are small variations in the median duration of predominant breastfeeding. Male children, children living in rural areas, children from the East region, and those whose mothers have no education are likely to have a somewhat longer period of predominant breastfeeding. The frequency of breastfeeding also influences the health of mothers and children through its effect on the length of postpartum amenorrhea. Table 12.3 presents information on the frequency of breastfeeding as indicated by the percentage of children under 6 months of age who were breastfed six or more times in the 24 hours preceding the survey. Ninety-one percent of children under 6 months of age were breastfed 6 times or more in the 24-hour period preceding the survey. The percentage of children breastfed 6 times or more is lowest in the South region (85 percent) and highest among children of mothers who completed second level primary education (99 percent). On the average, children were breastfed 6 times in day time and 5 times at evening and night. 144 | Feeding Practices and Nutrition Status 12.4 Types of Complementary Foods Table 12.4 shows the percentage of breastfeeding and non-breastfeeding children who received different types of supplements. Because children may have received more than one type of supplement, the percentages do not add to 100. Among children who are breastfeeding and younger than 6 months, 18 percent received infant formula. The percentage that were given infant formula peaks at 32 percent for infants age 6-7 months and then decreases to 21 percent for those age 8-9 months who are increasingly being given other fluids. For non-breastfeeding children, the numbers of observations are small for the first year of life; however, the results for this group also suggest that infant formula is commonly given in the first months of life, with other types of milk being given more often as baby grows older. Table 12.3 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, percentage of breastfeeding children under six months living with the mother who were breastfed six or more times in the 24 hours preceding the survey, and mean number of feeds (day/night), by background characteristics, Turkey 2003 Median duration (months) of breastfeeding1 Breastfeeding children under 6 months2 Any Ex- clusive Predom- inant3 Number of children Percentage breastfed 6+ times in last 24 hours Mean number of day feeds Mean number of night feeds Number of children Child’s sex Male 14.1 0.7 3.4 1,248 92.5 6.2 5.1 181 Female 14.0 0.6 2.9 1,154 88.5 6.0 4.7 158 Residence Urban 13.8 0.7 2.9 1,585 93.1 6.3 5.0 217 Rural 14.2 0.7 3.7 817 86.2 5.8 4.8 121 Region West 10.5 0.8 3.1 794 88.4 5.6 4.7 104 South 13.9 0.5 3.0 321 (85.4) (5.8) (5.2) 40 Central 15.2 0.7 3.0 459 (92.5) (5.4) (4.2) 66 North 10.8 0.5 0.7 147 (86.1) (5.1) (7.4) 21 East 14.7 0.6 3.7 680 94.5 7.4 5.6 106 Selected NUTS 1 Regions İstanbul 14.6 0.6 2.7 367 (97.5) (6.1) (4.5) 42 Southeast Anatolia 14.4 0.6 3.1 401 96.5 7.7 5.8 66 Education No education/Prim. incom. 14.5 0.6 4.0 602 92.3 7.1 5.1 81 First level primary 14.2 0.7 3.3 1,236 87.4 5.7 4.7 174 Second level primary 15.2 0.7 2.6 178 (98.8) (6.4) (6.0) 34 High school and higher 10.6 0.5 2.2 386 93.6 5.8 4.7 49 Median for all children 14.0 0.7 3.2 2,402 90.6 6.1 4.9 338 Mean for all children 14.9 2.1 4.8 NA NA NA NA NA Note: Median and mean durations are based on current status. NA = Not applicable 1It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding. 2Excludes children who do not have a valid answer on the number of times breastfed 3Either exclusively breastfed or received breast milk and plain water, water-based liquids, and/or juice only (excludes other milk) Note: Parentheses indicate a figure is based on 25-49 unweighted cases. Feeding Practices and Nutrition Status | 145 In summary, although breastfeeding is universal in Turkey, exclusive breastfeeding is not widely practiced. In the first sixth months, only one child out of five is exclusively breastfed. Early introduction of infant formula and other liquids is common, and bottle-feeding is a comparatively popular feeding practice. Results of the TDHS-2003 imply that ongoing efforts of national and international organizations to promote appropriate infant feeding practices must be increased. Table 12.4 Types of food received by children in the preceding 24 hours Percentage of youngest children under three years of age living with the mother who received specific types of food in the 24 hours before the interview, by breastfeeding status and child's age in months, Turkey 2003 Age (in months) Infant formula Other milk/ cheese/ yoghurt Other liquids1 Any solid or semisolid food Number of children BREASTFEEDING CHILDREN <2 4.6 3.1 17.7 1.2 94 2-3 15.1 16.9 28.3 7.5 121 4-5 30.7 37.8 46.7 16.8 127 6-7 31.8 66.3 70.5 42.0 116 8-9 21.0 78.4 82.5 58.2 83 10-11 14.7 66.4 89.3 65.2 74 12-15 15.3 76.5 95.5 69.6 134 16-19 10.1 75.5 93.3 70.5 87 20-23 0.8 78.6 98.8 83.8 48 24-35 9.3 65.0 98.3 84.0 48 <6 18.0 20.9 32.2 9.2 342 6-9 27.3 71.3 75.5 48.7 199 NON-BREASTFEEDING CHILDREN <2 * * * * 3 2-3 * * * * 8 4-5 (58.3) (68.2) (50.0) (16.9) 25 6-7 (49.6) (81.5) (71.1) (37.7) 30 8-9 (42.9) (82.5) (80.3) (30.1) 37 10-11 (26.0) (82.0) (68.3) (57.0) 40 12-15 17.6 89.5 92.1 78.9 116 16-19 6.6 84.4 90.8 72.3 195 20-23 3.2 78.9 94.2 78.6 195 24-35 2.7 80.4 95.4 83.6 820 <6 (57.9) (63.5) (42.8) (11.7) 36 6-9 45.9 82.1 76.2 33.5 67 Note: Breastfeeding status and food consumed refer to a “24-hour” period (yesterday and last night). An asterisk indicates a figure is based on fewer than 25 unweighted cases. Parentheses indicate a figure is based on 25-49 unweighted cases. 1 Does not include plain water 12.5 Iodization of Household Salt 146 | Feeding Practices and Nutrition Status The disorders induced by dietary iodine deficiency constitute a major global nutrition concern contributing to higher rates of childhood morbidity and mortality. Iodine deficiency is one of the main causes of children’s mental retardation and psycho-motor growth. In addition, iodine deficiency has been shown to increase the probability of stillbirth and miscarriage during pregnancy. It also results in low level of school success and insufficiency in working performance because of its negative effects on mental growth. The international convention to overcome the problem of iodine deficiency is the salt iodization. About half of the sampled households in the TDHS-2003 were asked questions about the use of salt and the medium within which it is kept. Firstly, information was received on the kind of pot in which salt used for cooking was kept. Then a small sample of the salt was taken and tested to find out whether salt was iodized. In the situations that there was no iodide in the salt, it was examined for iodate. The changes in the color of salt after dropping test solution and degree of change in color were recorded. The test results are presented in Table 12.5. Table 12.5 Iodization of household salt Percent distribution of households (subsample) with salt tested for iodine content, by level of iodine in salt (parts per million), percentage of households tested, and percentage of households with no salt, according to background characteristics, Turkey 2003 Iodine content among households tested Background characteristic None Po- tassium Iodized <15 ppm Po- tassium Iodate >=15 ppm Po- tassium Iodate Miss- ing Total Number of house- holds Per- centage with salt tested Per- centage with salt not tested Per- centage with no salt/ missing infor- mation Total Number of house- holds Residence Urban 21.2 69.3 4.7 4.1 0.7 100.0 3,762 97.7 2.1 0.2 100.0 3,850 Rural 50.9 33.4 9.0 6.1 0.5 100.0 1,541 96.5 2.9 0.6 100.0 1,596 Region West 19.2 70.7 5.8 4.0 0.4 100.0 2,273 97.8 1.9 0.3 100.0 2,325 South 38.9 50.1 5.0 5.1 0.9 100.0 670 96.3 3.6 0.2 100.0 696 Central 36.0 54.7 4.5 4.2 0.7 100.0 1,224 98.2 1.4 0.4 100.0 1,246 North 14.4 70.9 5.5 7.6 1.7 100.0 400 96.4 3.5 0.1 100.0 415 East 52.8 31.1 9.8 6.0 0.4 100.0 735 96.3 3.2 0.5 100.0 763 NUTS 1 Region İstanbul 9.5 82.9 2.6 4.3 0.6 100.0 945 96.7 3.2 0.0 100.0 977 West Marmara 23.1 63.6 8.5 3.7 1.1 100.0 279 98.8 0.8 0.4 100.0 282 Aegean 28.5 57.9 10.2 3.4 0.0 100.0 811 98.6 0.8 0.6 100.0 823 East Marmara 25.6 65.8 2.5 6.1 0.0 100.0 480 98.0 2.0 0.0 100.0 489 West Anatolia 24.8 66.5 3.7 4.2 0.9 100.0 541 98.5 1.1 0.4 100.0 549 Mediterranean 38.9 50.1 5.0 5.1 0.9 100.0 670 96.3 3.6 0.2 100.0 696 Central Anatolia 57.3 34.8 4.9 2.8 0.3 100.0 294 97.0 2.0 0.9 100.0 303 West Black Sea 25.3 60.1 6.8 5.8 1.9 100.0 346 98.1 1.9 0.0 100.0 353 East Black Sea 17.4 71.2 3.4 6.3 1.7 100.0 202 95.7 4.1 0.2 100.0 211 Northeast Anatolia 42.3 41.1 11.1 5.2 0.2 100.0 146 96.5 2.7 0.7 100.0 151 Central East Anatolia 58.0 28.9 10.4 2.7 0.0 100.0 212 94.6 5.1 0.3 100.0 224 Southeast Anatolia 53.9 28.4 8.9 8.1 0.6 100.0 377 97.1 2.2 0.6 100.0 388 Total 29.8 58.9 5.9 4.7 0.6 100.0 5,302 97.4 2.3 0.3 100.0 5,446 Feeding Practices and Nutrition Status | 147 In the TDHS-2003, a salt test was completed successfully in 97 percent of the households eligible for the test. It was found that in 30 percent of the households, where test was done, the salt did include neither iodide nor iodate. In other words, in these households, salt was not iodized. In 59 percent of the households, the household was observed to have salt with potassium iodide while in 5 percent of the households the salt contained potassium iodate (>=15 ppm). There are important differences among the types of place of residences and regions in terms of the availability of iodized salt. Iodized salt is not used in about half of rural households. In contrast, in urban areas, four-fifths of households use iodized salt. Use of iodized salt is more common in the West and the North regions when compared with other regions. In İstanbul, 9 of every 10 households use iodized salt. In contrast, less than half of the households in Central East and Southeast Anatolia use iodized salt. 12.6 Nutritional Status of Children One of the major contributions of the TDHS to the study of child health status is the anthropometric data collected for all children under five years of age. Both weight and height (length) measurements were obtained for each child. Employing this information, standard indices are used to describe the nutritional status of the children: height-for-age, weight-for- height, and weight-for-age. In any large population, there is obviously a natural variation in height and weight. This variation approximates a normal distribution. For purposes of analyzing anthropometric data, it is standard practice, thus, to use a reference population. The reference population serves as a point of comparison, facilitating the examination of differences in the anthropometric status of subgroups in a population and of changes in nutritional status over time. For the TDHS-2003 the nutritional status of children in the survey population is compared against an international reference population defined by the U.S. National Center for Health Statistics (NCHS) and accepted by the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO). The use of the international reference population is based on the finding that well- nourished young children of all population groups (for which data exist) follow very similar growth patterns before puberty. As recommended by the World Health Organization (WHO) the evaluation of nutritional status involves three indices. The height-for-age index provides an indicator of linear growth retardation among children. Children who are more than two standard deviations below the median of the reference population in terms of height-for-age may be considered stunted (short for their age), or chronically malnourished. Children who are below minus three standard deviations (-3 SD) from the median of the reference population are considered severely stunted. Stunting reflects the outcome of a failure to receive adequate balanced nutrition over a long period of time and is also affected by recurrent and chronic illness. Thus, height-for-age, represents a measure of the long-term effects of malnutrition in a population and does not vary appreciably according to the season of data collection. Stunted children are not immediately obvious in a population; a stunted three-year-old child could look like a well-fed two-year-old. 148 | Feeding Practices and Nutrition Status The weight-for-height index measures body mass in relation to body length. Children who are more than two standard deviations below the median of the reference population in terms of their weight-for-height may be considered too thin (“wasted”) or acutely malnourished. Severe wasting represents the failure to receive adequate balanced nutrition in the period immediately before the survey and may be the result of recent illness episodes, especially diarrhea, or of seasonal variations in food supply. Weight-for-age index takes into account both acute and chronic malnutrition and often is used to monitor nutritional status on a longitudinal basis. It is a useful tool in clinical settings for continuous assessment of nutritional progress and growth. Children whose weight-for-age is below minus two standard deviations from the median of the reference population are classified as "underweight". Table 12.6 shows how the percentage of children under five years of age classified as malnourished according to the height-for-age, weight-for-height, and weight-for-age indices varies with the child's age and selected demographic characteristics. For purposes of comparison in the reference population, only 2.3 percent of children fall below minus two (-2 SD) for each of the three indices. In the TDHS-2003, all children under five years of age whose mother was interviewed are included in the anthropometric data collection. However, not all eligible children are included in the results presented here; height or weight measurements are missing for 8 percent of eligible children (see Table D.3 in Appendix D). In addition, since two of the indices (height- for-age and weight-for-age) are influenced by the accuracy of the reporting of the child's age, only one percent of children were excluded from the calculation because the month and year of birth was not known. Hence, height and weight data are shown for 92 percent of the eligible children. Table 12.6 shows that one in 8 children under age 5 is stunted (i.e. short for their age) with more than one-quarter of these children classified as severely stunted. On the other hand comparatively few children are wasted; less than one percent of children under age five have a weight-for-height z-score below -2SDs. Looking at the weight-for-age index, 4 percent of children under age 5 are underweight. Figure 12.1 and Table 12.6 shows the percentages of children under five years classified as malnourished according to three anthropometric indices of nutritional status of children by child’s age in months. Plotted values in the figure are smoothed by a five-month moving average. The proportion of children stunted increases sharply in the first year of life, then remains in the 10-15 percent range until age three when it exceeds 15 percent. The proportion underweight increases to 5 percent at the end of age one and stabilize around 3-7 percent levels. Finally the figure shows, the percentages of children who are wasted are at very low levels across all ages. Feeding Practices and Nutrition Status | 149 Table 12.6 Nutritional status of children by background characteristics Percentage of children under five years of age who are classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by selected background characteristics, Turkey 2003 Height-for-age Weight-for-height Weight-for-age Background characteristic Percentage below -3 SD Percentage below -2 SD1 Percentage below -3 SD Percentage below -2 SD1 Percentage below -3 SD Percentage below - 2 SD1 Number of children Child's age (in months) <6 0.3 2.2 0.4 1.2 0.2 0.8 334 6-9 3.0 5.6 0.0 0.8 0.0 1.7 247 10-11 2.8 10.8 0.4 1.5 1.9 5.7 103 12-23 1.4 12.4 0.4 0.8 0.5 2.9 702 24-35 3.5 12.2 0.7 1.0 1.3 5.2 755 36-47 6.0 15.4 0.0 0.3 0.3 5.1 750 48-59 5.3 15.4 0.2 0.3 0.6 4.1 777 Sex of child Male 2.9 10.9 0.4 1.0 0.6 3.2 1,890 Female 4.5 13.6 0.1 0.4 0.7 4.7 1,778 Birth order 1 2.0 7.2 0.3 0.5 0.3 2.1 1,225 2-3 2.4 10.3 0.2 0.7 0.5 3.3 1,614 4-5 7.4 21.1 0.8 1.7 2.1 8.2 468 6+ 9.7 26.0 0.0 0.4 1.0 7.1 361 Birth interval First birth 2.0 7.2 0.3 0.5 0.3 2.1 1,239 Under 24 months 7.7 21.0 0.5 1.4 2.0 7.0 1,614 24-47 months 4.9 16.0 0.0 0.7 0.3 5.2 468 48+ months 1.7 8.9 0.3 0.5 0.6 2.8 361 Residence Urban 2.6 9.0 0.3 0.7 0.6 2.8 2,414 Rural 5.6 18.4 0.3 0.8 0.8 5.9 1,254 Region West 0.6 5.5 0.5 0.7 0.5 1.9 1,186 South 2.7 10.4 0.2 0.4 0.2 2.8 499 Central 2.6 9.5 0.3 0.8 0.8 2.9 727 North 3.7 13.0 0.2 0.7 0.0 2.2 218 East 8.3 22.5 0.1 0.8 1.1 7.7 1,038 NUTS 1 Region İstanbul 0.9 6.1 0.3 0.7 0.4 1.3 572 West Marmara 1.0 7.3 0.7 0.7 0.7 6.3 113 Aegean 1.6 6.6 0.0 0.8 0.8 1.2 346 East Marmara 0.4 3.4 1.1 1.6 1.1 3.0 284 West Anatolia 2.2 9.8 0.4 0.4 0.4 2.7 311 Mediterranean 2.7 10.4 0.2 0.4 0.2 2.8 499 Central Anatolia 1.6 9.6 0.4 0.4 0.8 2.4 204 West Black Sea 3.1 9.1 0.0 0.6 0.0 3.0 182 East Black Sea 4.3 16.9 0.3 0.3 0.0 2.3 118 Northeast Anatolia 6.7 16.8 0.2 1.3 0.9 6.7 166 Central East Anatolia 10.1 26.6 0.0 0.3 1.3 9.6 280 Southeast Anatolia 8.0 22.1 0.2 0.9 1.0 7.1 592 Education No education/Prim. incom. 9.1 25.3 0.1 1.0 1.1 8.3 975 First level primary 2.1 9.0 0.3 0.6 0.6 2.7 1,895 Second level primary 1.7 5.6 0.8 0.8 0.0 1.8 275 High school and higher 0.2 2.9 0.2 0.5 0.2 0.9 524 Total 3.6 12.2 0.3 0.7 0.6 3.9 3,668 Note: Figures are for children born in the period 0-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as malnourished if their z- scores are below minus two or minus three standard deviations (-2 SD or -3 SD) from the median of the reference population. 1 Includes children who are below -3 SD 150 | Feeding Practices and Nutrition Status As a whole, the youngest children show little evidence of malnutrition. However, the proportion classified as stunted exhibits a steady increase starting in the first year of life. Among children 24-59 months of age, around 15 percent are classified as stunted. By age 5, around 15 percent of the children are chronically malnourished, with five percent considered as severely stunted. These patterns reflect inadequate unbalanced feeding practices and/or the presence of recurrent and chronic infections. The fact that the undernutrition percentages increase with the increasing birth order is important. For example, a little more than one-fourth of children of birth order six or above and one-fifth of children of birth orders four and five are stunted. Birth interval also is related to the prevalence of stunting. Children who are born with an interval of less than two years are much more prone to be stunted. Of these children, 21 percent are stunted and 8 percent are severely stunted. Table 12.6 also shows the percentage of children under five years of age classified as malnourished according to the three anthropometric indices by selected socio-economic characteristics. There are particularly striking differences in the percentage classified as stunted according to the mother's level of education. The percentage of children whose mothers have a high school education or higher who are below the -2 SD cut-off point (3 percent) is close to that seen for the reference population (2.3 percent). In contrast, almost one-fourth of children whose mothers lack formal education are classified as stunted. There are also urban-rural and regional differences. Stunting is more common in rural (18 percent) than in urban residences (9 percent). The highest level of stunting is seen in the East region (23 percent) and the lowest Figure 12.1 Nutritional Status of Children by Age 0 5 10 15 20 25 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58 Age in months Percent Stunted Wasted Underw eight TDHS-2003 Feeding Practices and Nutrition Status | 151 levels are in the West and Central regions (6 and 10 percent, respectively). Similar trends are observed for the weight-for-height and weight-for-age indices. A comparison of the TDHS-2003 findings with the results of the TDHS-1998 indicates that there has been an improvement in the nutritional status of children in Turkey during the five-year period between the surveys. For example, the proportion found to be stunted in the TDHS-2003 survey is 4 percentage points lower than the level observed in TDHS-1998 (16 percent). Further improvements in the nutritional status of Turkish children are dependent upon reducing the numbers of children exposed to the key risk factors, especially short birth intervals and high parity. An intersectoral approach is necessary to discourage mothers from introducing supplementary food too early, to train mothers on the timely introduction of appropriate supplementation, and to assist couples to keep the number of children within their desired limits and ensure optimal birth spacing through effective family planning. 12.7 Nutritional Status of Mothers In order to assess women’s nutritional status, women who had given birth in the five-year period before the interview were weighed and their heights measured using the same equipment used to obtain children’s measurements (i.e. an electronic scale and wooden height board). For all women with a birth in the five- year period before the survey Table 12.7 presents the distributions as well as the means and standard deviations for three anthropometric indicators for eligible women: height, weight, and body mass index. Indicators based on a woman's weight-for-height exclude pregnant women and women with a birth within the 2 months preceding the interview. The table shows that anthropometric Table 12.7 Anthropometric indicators of maternal nutritional status Percent distribution and mean and standard deviation for women who had a birth in the five years preceding the survey, by selected anthropometric indicators (height, weight, and body mass index (BMI)), Turkey 2003 Indicator Total Total plus missing Height (cm) 135-139.9 0.1 0.1 140-144.9 1.7 1.7 145-149.9 9.7 9.5 150-154.9 26.3 25.8 155-159.9 34.8 34.0 160-164.9 19.0 18.6 165-169.9 6.8 6.7 170-174.9 1.4 1.4 >= 180 0.0 0.0 Missing - 2.2 Total 100.0 100.0 Mean 156.7 - Standard deviation 5.7 - Number of women 3,094 3,164 Weight (kg) 35-39.9 0.2 0.2 40-49.9 8.7 8.5 50-59.9 31.0 30.4 60-69.9 28.1 27.5 >= 70 32.0 31.3 Missing - 2.1 Total 100.0 100.0 Mean 65.0 - Standard deviation 12.7 - Number of women 2,782 2,843 BMI (kg/m2) 12.0-15.9 (Severe) - - 16.0-16.9 (Moderate) 0.0 0.0 17.0-18.4 (Mild) 1.8 1.8 18.5-20.4 (Normal) 7.6 7.4 20.5-22.9 (Normal) 17.8 17.4 23.0-24.9 (Normal) 15.8 15.5 25.0-26.9 (Overweight) 16.3 15.9 27.0-28.9 (Overweight) 12.7 12.4 29.0-29.9 (Overweight) 5.3 5.2 >= 30.0 (Obese) 22.7 22.3 Missing - 2.1 Total 100.0 100.0 Mean 26.5 - Standard deviation 5.1 - Number of women 2,782 2,843 Note: The weight and BMI measures exclude pregnant women and those who are less than 3 months postpartum. 152 | Feeding Practices and Nutrition Status measures are available for most of the eligible women, with height or weight measurements missing for 2 percent of respondents. Balanced nutrition during childhood and the adolescent period has a positive impact on linear growth, whereas poor nutrition and experience of a severe illness, particularly in early childhood, can affect growth negatively. In turn, maternal height is useful in predicting the risk of delivery complications since short stature is frequently associated with a small pelvis size. The height below which women are considered to be at risk of such complications is in the range of 140-150 centimeters, with 145 centimeters being the widely accepted cutoff for identifying maternal malnutrition. According to the TDHS-2003 results (Table 12.8), the mean height for mothers was 157 centimeters, one centimeter higher than the mean reported in the TDHS-1998. Two percent of mothers were shorter than 145 centimeters, and 12 percent were below 150 centimeters. The mean maternal weight was 65 kilograms. Nearly one-third (32 percent) of mothers weighed more than 70 kilograms. The body mass index (BMI) assesses the relation between height and weight and is calculated by dividing the weight in kilograms by the squared height in meters. A body mass index of less than 18.5 is used to identify cases of chronic malnutrition although there is no standard definition of obesity BMI higher than 25.0 is often used to identify women with problems of overweight and obesity. In the TDHS-2003, the mean BMI of non-pregnant mothers was 26.5. The mothers’ BMI fell below 18.5 in less than 2 percent of cases. Fifty-seven percent of the mothers had a BMI above 25.0, including 23 percent who had a BMI of at least 30. Table 12.8 shows the nutritional status of mothers by selected background characteristics. Younger generations of women appear to be taller than women age 35 and over. More educated women are taller compared to less educated women. Mothers who have had no education or did not complete primary education are, on the average, 3.4 centimeters shorter than those with high school education or more. BMI increases rapidly with age exceeding 25.0 for the majority of women age 25 and older. Body mass index also appears to be related with the educational levels. Residential variations in the BMI are comparatively small; the mean BMI is highest in the North (27.2) and lowest in the West and East (26.2 in both regions). In İstanbul, the percentage of women with a BMI of 25 and higher is 58, which is almost the same as the percentage for all women in Turkey. Mothers with no education had an average BMI of 27 while mothers with high school education or more had an average BMI of 25. Feeding Practices and Nutrition Status | 153 Table 12.8 Nutritional status of women by background characteristics Among ever-married women age 15-49, mean height, percentage under 145 cm, mean body mass index (BMI), and percentage with specific BMI levels, by background characteristics, Turkey 2003 Height BMI1(kg/m2) Background characteristic Mean height in cm Per- centage below 145 cm Num- ber of women BMI1 (kg/ m2) 18.5– 24.9 (normal) <18.5 (thin) 17.0 - 18.4 (mildly thin) 16.0 – 16.9 (mod- erately thin) >= 25.0 (over- weight/ obese) 25.0 – 29.9 (over- weight) >= 30.0 (obese) Number of women Age 15-19 158.3 0.0 114 23.3 65.6 4.8 4.8 0.0 29.5 27.3 2.2 94 20-24 157.2 1.8 755 24.7 54.9 3.2 3.2 0.0 42.0 30.5 11.4 645 25-29 157.1 2.1 1,021 25.9 44.3 1.8 1.7 0.1 53.9 35.9 18.0 916 30-34 156.3 1.1 712 27.5 31.8 1.1 1.1 0.0 67.1 38.6 28.5 660 35-39 155.7 2.7 343 29.2 24.7 0.5 0.5 0.0 74.8 31.4 43.4 323 40-44 155.5 3.3 123 29.1 25.2 0.5 0.5 0.0 74.3 34.5 39.8 120 45-49 151.3 7.7 26 31.9 16.9 2.3 2.3 0.0 80.8 16.2 64.6 25 Residence Urban 157.1 1.9 2,113 26.5 40.7 1.9 1.9 0.0 57.4 34.6 22.7 1,943 Rural 155.9 1.9 980 26.4 42.2 1.8 1.7 0.1 56.0 33.3 22.7 839 Region West 157.2 1.9 1,088 26.2 43.2 1.4 1.4 0.0 55.4 35.8 19.6 1,017 South 157.0 1.6 420 26.7 40.4 1.8 1.8 0.0 57.8 33.2 24.6 379 Central 156.4 1.5 662 26.9 37.3 3.0 3.0 0.0 59.8 34.1 25.7 601 North 156.1 2.4 185 27.4 36.1 1.4 1.4 0.0 62.5 34.3 28.2 171 East 156.3 2.1 738 26.2 43.5 1.7 1.5 0.1 54.8 32.5 22.3 615 Selected NUTS 1 Regions İstanbul 157.1 1.1 5,210 265 41.0 1.4 1.4 0.0 57.6 37.4 20.2 491 Southeast Anatolia 156.5 2.5 3,990 26.5 39.6 1.6 1.6 0.0 58.8 34.9 23.9 329 Education No educ./Prim. incom. 155.2 3.2 684 27.1 38.1 1.1 1.1 0.0 60.8 31.4 29.4 582 First level primary 156.5 1.8 1,635 26.9 37.4 1.9 1.8 0.1 60.8 36.5 24.3 1,477 Second level primary 158.2 1.6 258 25.3 49.9 2.2 2.2 0.0 47.9 33.3 14.6 242 High school and higher 158.6 0.3 517 25.2 52.2 2.5 2.5 0.0 45.3 31.1 14.2 481 Total 156.7 1.9 3,094 26.5 41.2 1.8 1.8 0.0 57.0 34.2 22.7 2,782 1 Excludes pregnant women and women with a birth in the preceding 2 months Knowledge of AIDS | 155 KNOWLEDGE OF HIV/AIDS 13 A. Sinan Türkyılmaz, Turgay Ünalan and H. Yaprak Civelek The TDHS-2003 included questions1 to assess the level of awareness of sexually transmitted diseases (STDs), particularly HIV/AIDS. In addition, for women knowing about AIDS, there was an effort to assess the knowledge and attitudes of respondents regarding transmission mechanisms and prevention of infection with the HIV virus. To obtain these data, ever-married women aged 15-49 were asked whether they knew about any STDs and, if so, to name the STDs about which they had heard. If they did not mention AIDS, they were asked directly they knew about the disease. All ever-married women knowing about AIDS were then asked questions about their sources of information about AIDS, the ways through which the HIV virus is transmitted to a person, their knowledge of means of avoiding the disease, their opinion about the possibility of getting the HIV virus from a healthy-looking person, and mother-to child transmission. 13.1 Knowledge of AIDS and Other STDs Table 13.1 shows the percentages of ever-married women who have heard of AIDS, who believe that there is a way to avoid HIV/AIDS and who know about other STDs by background characteristics. According to TDHS-2003, 88 percent of ever-married women have heard about AIDS and two-thirds of the women believe that there is a way to avoid AIDS. The proportion knowing about AIDS is less than 80 percent only for the youngest age group of ever- married women (77 percent); for all other age groups knowledge of AIDS is close to 90 percent. Younger women are also much less likely to believe that AIDS can be avoided. As expected, ever-married women living in urban areas are more knowledgeable about AIDS than their rural counterparts. One in four women has not heard about AIDS in rural areas compared to less than one in ten urban women. Half of the women living in rural areas do not believe that there is a way to avoid HIV/AIDS. There are important regional differentials in both AIDS knowledge and in the level of awareness that AIDS is preventable. More than 90 percent of ever-married women living in the Central and West regions have heard of AIDS, whereas the figure declines to 69 percent in the East region. Similarly, the Central and West regions have the highest proportions believing that AIDS can be avoided (72 percent and 69 percent, respectively) and the East region has the lowest proportion (43 percent). For NUTS 1 regions, while 72 percent of the 1 Questions about STDs and AIDS were asked of women in half of the households in the sample of the TDHS- 2003. Therefore, the total number of cases in the tables is different than that of tables in other chapters. For a detailed explanation see Appendix B. 156 | Knowledge of AIDS ever-married women living in the West Anatolia believe that HIV/AIDS is avoidable, this percentage is 44 for women living in the Central East Anatolia. In İstanbul, this percentage increases to the highest value, 79 percent, whereas it is as low as 40 percent in Southeast region. Table 13.1 Knowledge of AIDS and other STDs Percentage of ever-married women (subsample) who have heard AIDS, who believe there is a way to avoid HIV/AIDS, and who know about at least one other STD (sexually transmitted diseases) by background characteristics, Turkey 2003 Background characteristic Has heard of AIDS Believes there is a way to avoid HIV/AIDS Knows other STD(s) Number of women Age 15-19 76.7 36.9 17.9 119 20-24 89.7 61.2 22.8 555 25-29 89.9 66.3 28.3 717 30-39 87.2 66.7 34.6 1,474 40-49 88.5 68.3 34.8 1,212 Residence Urban 92.8 72.5 35.4 2,881 Rural 77.0 48.7 21.9 1,197 Region West 92.3 71.9 34.9 1,652 South 88.7 66.7 33.9 513 Central 93.5 69.3 29.5 962 North 88.5 63.9 25.5 298 East 69.1 43.3 26.2 653 NUTS 1 Region İstanbul 96.2 78.5 41.2 715 West Marmara 92.0 68.2 31.3 178 Aegean 85.7 62.2 28.2 588 East Marmara 92.3 69.8 31.4 373 West Anatolia 94.2 71.8 32.0 413 Mediterranean 88.7 66.7 33.9 513 Central Anatolia 95.1 69.7 27.1 239 West Black Sea 92.3 67.0 25.7 254 East Black Sea 90.2 67.3 26.9 151 Northeast Anatolia 81.4 53.5 29.3 120 Central East Anatolia 68.4 43.8 23.1 201 Southeast Anatolia 65.0 39.4 27.0 332 Education No education/Primary incomplete 62.5 36.3 21.1 891 First level primary 93.5 67.2 26.6 2,218 Second level primary 98.7 78.9 40.3 322 High school and higher 99.6 93.0 57.6 647 Total 88.1 65.5 31.4 4,078 Knowledge of AIDS | 157 When knowledge of AIDS is assessed by NUTS 1 regions, it is obvious that a much more significant proportion of ever-married women living in the Central East Anatolia and the South East Anatolia Region lack information on AIDS when compared to women in the other regions. On the other hand, only 4 percent of women who lives in Istanbul region have not heard about AIDS. The level of education is closely related to knowledge of AIDS. Almost all ever- married women with secondary or higher education have heard of AIDS, while this figure declines to 63 percent for women with less than primary education. Only 36 percent of ever- married women with less than first level primary believe that there is a way to avoid HIV/AIDS. Finally, it is noteworthy that, irrespective of region, place of residence, of educational level and age, AIDS is more widely known than other STDs. This is likely in part due to the fact that the TDHS-2003 questionnaire included a general question on knowledge of STDs and did not prompt women by naming specific STDs except in the case of AIDS. Nevertheless the results indicate relatively low levels of awareness of STDs other than AIDS among ever-married women in Turkey. 13.2 Sources of Information about AIDS For ever-married women, television is the leading source of information on AIDS. According to the Table 13.2, 96 percent of ever-married women who knew about AIDS received information about AIDS from television, 24 percent from newspapers or magazines, 19 percent from friends or relatives, 6 percent from health workers and 5 percent from radio broadcasts. It is notable that, even among young women, schools are not major sources of information. This may reflect the fact that the sample includes only ever-married women, many of whom are no longer in school even in the younger cohorts. The proportions of women citing the various sources does not vary much by age group, residence and region but there are significant differences by educational level. Especially noteworthy in this regard are the higher percentages in high school or higher education group who mention the radio, newspaper/magazines, pamphlets/posters and school/teachers as sources compared to less educated women. 158 | Knowledge of AIDS Table 13.2 Source of AIDS information Percentage of ever-married women (subsample) knowing about AIDS by the source of AIDS information, according to background characteristics, Turkey 2003 Sources of information about AIDS Background characteristic Radio TV News- papers/ magazines Pam-- phlets/ posters Health Work- ers School/ teachers Hus- band Friends/ relatives Work place Mean number of sources Number of ever- married women knowing about AIDS Age 15-19 2.6 89.7 11.5 2.3 10.6 8.0 2.8 19.1 0.0 1.5 92 20-24 3.0 95.4 12.5 1.9 7.2 3.3 3.1 21.8 0.3 1.5 501 25-29 4.1 96.4 23.9 2.7 6.3 2.9 2.6 20.5 0.4 1.6 650 30-39 7.0 96.6 26.3 1.9 7.5 1.6 2.6 18.3 0.5 1.6 1,294 40-49 4.0 95.8 26.0 2.2 4.0 0.5 1.8 18.5 0.5 1.5 1,082 Residence Urban 5.8 96.8 27.8 2.6 7.0 2.4 2.1 19.0 0.6 1.6 2,699 Rural 2.2 93.6 11.1 0.8 4.2 0.4 3.3 20.1 0.0 1.4 920 Region West 5.0 97.1 28.6 2.7 7.4 2.0 2.3 20.8 0.6 1.7 1,540 South 5.0 97.6 24.5 1.9 6.2 2.2 4.6 18.1 0.2 1.6 459 Central 5.0 95.9 20.5 1.6 6.1 1.9 1.6 17.1 0.4 1.5 904 North 4.5 92.9 18.5 2.6 3.3 1.8 1.4 26.7 0.8 1.5 263 East 4.7 92.8 14.3 0.9 4.6 1.2 2.8 15.2 0.0 1.4 454 NUTS 1 Region İstanbul 6.2 97.6 32.0 3.6 7.0 2.8 1.9 15.0 0.5 1.7 685 West Marmara 4.6 96.7 28.0 2.0 2.9 1.0 1.7 18.3 0.0 1.6 166 Aegean 3.4 96.1 23.1 1.5 7.8 1.6 2.2 25.2 0.8 1.6 514 East Marmara 4.1 97.9 25.3 2.3 9.1 1.5 2.4 23.9 0.6 1.7 353 West Anatolia 9.1 97.5 27.4 3.0 6.2 0.9 1.7 18.6 0.4 1.6 393 Mediterranean 5.0 97.6 24.5 1.9 6.2 2.2 4.6 18.1 0.2 1.6 459 Central Anatolia 0.5 91.4 12.8 0.4 2.7 2.7 3.0 18.1 0.4 1.3 225 West Black Sea 3.6 96.3 16.1 1.1 7.0 3.0 0.8 16.9 0.0 1.4 233 East Black Sea 4.4 89.5 19.3 3.8 4.4 1.5 2.0 33.9 1.5 1.6 136 Northeast Anatolia 4.3 88.8 13.6 1.3 3.8 2.0 5.3 24.5 0.0 1.4 97 Central East Anatolia 0.9 95.4 16.7 0.9 3.4 0.9 3.3 16.7 0.0 1.4 138 Southeast Anatolia 7.3 93.0 13.0 0.8 5.7 1.1 1.4 10.0 0.0 1.3 218 Education No education/Prim. incom 2.0 91.8 4.2 0.0 3.5 0.0 1.8 23.3 0.0 1.3 560 First level primary 3.3 96.4 16.3 0.8 5.0 0.2 2.4 19.8 0.2 1.4 2,086 Second level primary 3.4 98.5 31.9 2.4 9.4 2.3 3.7 16.5 0.3 1.7 321 High school and higher 13.3 97.1 59.3 8.1 11.4 8.9 2.4 15.3 1.7 2.2 652 Total 4.9 96.0 23.5 2.1 6.3 1.9 2.4 19.3 0.4 1.6 3,619 13.3 Knowledge of Ways to Prevent AIDS Although AIDS is generally known by ever-married women, knowledge of ways to avoid it appears to be poor among a substantial minority of the group. Overall, nearly one of three ever-married women did not know of AIDS or if the disease could be avoided (Table 13.3). An additional 7 percent of ever-married women believe that there are no ways of preventing the contraction of the disease (4 percent) or they cannot name any ways to avoid AIDS (3 percent). Knowledge of AIDS | 159 Table 13.3 Knowledge of ways to avoid HIV/AIDS Percentage of ever-married women (subsample) who spontaneously mention ways to avoid HIV/AIDS, Turkey 2003 Ways to avoid HIV/AIDS Percentage Does not know of AIDS or if AIDS can be avoided 30.9 Believes no way to avoid AIDS 3.6 Does not know specific way 2.6 Use condoms 21.9 Limit sex to one partner/stay faithful to one partner 21.5 Avoid sex with prostitutes 19.3 Avoid sex with homosexuals 0.4 Avoid blood transfusions 5.2 Control before blood transfusions 17.8 Use sterilized injections 4.3 Avoid kissing 2.1 Avoid mosquito bites 0 Use sterilized tools 4.2 Other 13.3 Number of women 4,078 Ever-married women who stated that AIDS is preventable mentioned a number of avenues to avoid the disease. Twenty-two percent of the women indicated that the disease can be prevented by using condoms. Other common responses were that AIDS can be prevented by having sex with one partner (22 percent), by avoiding sex with prostitutes (19 percent), and by avoiding blood transfusions (18 percent). A small percentage of women cited avoiding use of sterilized injections (less than 5 percent) as ways to avoid getting AIDS. Table 13.4 shows the differentials in the knowledge of ways to avoid AIDS among ever-married women. Older women are better informed about ways to avoid AIDS than younger women. Women living in urban areas appear to be better informed than their counterparts living in rural areas; around 70 percent of urban women are able to cite at least one way to avoid AIDS compared to less than half of rural women. In general, women living in the East region are among the least likely to cite a way to avoid AIDS; only around 40 percent can name a means for preventing AIDS. In Southeast Anatolia region, 62 percent of women do not know any way of avoiding this disease. The proportions of women mentioning specific ways to prevent AIDS also vary by age, residence, region and educational level. For example, only 9 percent of women living in rural areas mention use of a condom compared to 27 percent of urban women. Among the 12 NUTS 1 regions, the proportions mentioning “using condoms” are higher among women from the western regions than among women from other regions. The percentage of women who cite using condoms as a way to avoid AIDS also varies markedly by education, from 6 percent for women in the lowest educational category to 51 percent for women for those with the highest educational qualifications. The proportions mentioning other means to avoid AIDS show similar variation with the background characteristics in Table 13.4. For example, the percentage of women who cite 160 | Knowledge of AIDS “having only one sex partner” as a means of avoiding AIDS varies from 13 percent in the East region to 25 percent in the West region. The proportion of women who declared “avoid sex with prostitutes” is 31 percent in East Black Sea region. Table 13.4 Ways to avoid AIDS by background characteristics Percentage of ever-married women (subsample) by ways to avoid AIDS, according to background characteristics, Turkey 2003 Background characteristic Use con- doms Have only one sex Partner Avoid sex with prosti- tutes Avoid sex with homo- sexuals Avoid trans- fusions Avoid kissing Avoid mos- quito bites Other ways Don't know1 Number of women Age 15-19 5.5 13.2 5.4 0.0 0.8 1.3 0.0 11.1 69.4 119 20-24 20.0 20.1 14.8 0.1 4.3 1.0 0.0 24.0 43.4 555 25-29 27.6 17.8 17.4 0.4 5.7 1.6 0.0 34.4 36.5 717 30-39 23.4 24.1 20.4 0.6 5.7 2.1 0.0 33.5 34.9 1,474 40-49 19.3 21.9 22.5 0.3 5.2 3.1 0.1 35.7 33.9 1,212 Residence Urban 27.4 24.7 20.1 0.4 6.2 2.5 0.0 36.9 29.9 2,881 Rural 8.7 13.6 17.3 0.3 2.8 1.1 0.1 21.5 54.3 1,197 Region West 28.0 24.9 20.0 0.1 6.9 2.6 0.0 37.5 30.2 1,652 South 23.1 21.6 21.0 1.8 4.9 2.5 0.0 31.4 34.6 513 Central 19.1 22.5 20.6 0.0 4.6 2.1 0.0 34.2 34.4 962 North 17.9 17.5 21.0 1.1 3.8 1.8 0.3 31.9 37.9 298 East 11.6 13.1 13.6 0.3 3.0 0.6 0.0 17.6 59.7 653 NUTS 1 Region İstanbul 32.1 31.8 19.8 0.0 8.5 3.7 0.0 38.7 22.7 715 West Marmara 24.1 19.7 11.4 0.0 4.1 1.5 0.4 37.3 37.4 178 Aegean 21.9 18.6 19.4 0.0 3.6 1.8 0.0 34.3 40.5 588 East Marmara 27.4 23.4 23.7 0.4 8.4 2.3 0.0 34.3 32.1 373 West Anatolia 22.1 26.6 20.7 0.0 5.4 3.0 0.0 37.7 31.1 413 Mediterranean 23.1 21.6 21.0 1.8 4.9 2.5 0.0 31.4 34.6 513 Central Anatolia 16.8 17.6 24.0 0.0 4.1 1.2 0.0 30.5 35.0 239 West Black Sea 16.1 18.9 14.5 1.3 5.0 2.0 0.4 36.7 36.5 254 East Black Sea 15.5 13.5 30.6 0.0 2.4 0.8 0.0 32.2 34.1 151 Northeast Anatolia 16.0 12.4 20.1 0.0 2.2 1.3 0.0 24.0 49.1 120 Central East Anatolia 10.2 9.5 14.9 0.3 3.1 0.9 0.0 17.8 61.7 201 Southeast Anatolia 10.9 15.5 10.5 0.4 3.2 0.2 0.0 15.1 62.4 332 Education No education/Prim. incom. 5.5 10.3 15.3 0.0 1.4 1.0 0.0 12.0 65.6 891 First level primary 18.3 22.0 20.4 0.5 5.1 2.0 0.1 30.3 36.1 2,218 Second level primary 34.5 25.3 22.7 0.5 6.2 3.2 0.0 41.4 23.5 322 High school and higher 50.8 33.1 19.1 0.5 10.5 3.4 0.0 62.8 7.8 647 Total 21.9 21.5 19.3 0.4 5.2 2.1 0.0 32.3 37.0 4,078 1 Includes those women do not know of AIDS or if AIDS can be avoided, who believe there is no way to avoid AIDS, and who do no know any specific way to avoid AIDS Knowledge of AIDS | 161 13.4 Perception of Risk of AIDS The TDHS-2003 collected information on women’s attitude about whether a healthy- looking person might have AIDS and of the ways in which mother-to-child transmission may occur. Table 13.5 presents these results. Six of ten ever-married women state that a healthy-looking person could have AIDS. Ever-married women living in the West region, those living in urban areas, and those with higher educational qualifications are more likely to know that it is possible for a person with AIDS to look healthy. Younger women are also more knowledgeable about this fact compared to their older counterparts. While the proportion of ever married women in İstanbul and East Marmara regions who indicated that a healthy looking person could have the AIDS virus is 75 and 73 percent respectively, in Aegean, West Anatolia, and Mediterranean regions the percentages of having the same opinion are about 57 percent. For ever-married women living in Southeast Anatolia Region, this proportion declines to 39 percent. Slightly more than half of ever-married women believed that the HIV virus can be transmitted from a mother to a child during the delivery and through breastfeeding. Two- thirds of women agree that transmission can occur during pregnancy. The proportions show similar patterns for residence and regions as in other comparisons. Considering residential differentials, urban residents and residents of the West region and of the western NUTS1 regions have the highest proportions aware of mother-to-child transmission routes while rural residents and residents of the East region and of the eastern NUTS1 regions have the lowest proportions aware of these transmission routes. Educational qualifications are also strongly related to knowledge with regard to the mechanisms through which the HIV virus can be transmitted from a mother to a child. Seven in ten of ever-married woman who have high school or higher education indicated that the HIV virus can be transmitted from mother to child during pregnancy and 83 percent of them indicated that this is possible during delivery. In contrast, around four in ten women in the lowest category know about these transmission routes. 162 | Knowledge of AIDS Table 13.5 Knowledge of HIV/AIDS-related issues Percentage of ever-married women (subsample) who gave specific responses to questions on various HIV/AIDS-related issues, according to background characteristics, Turkey 2003 Percentage who say HIV/AIDS can be transmitted from a mother to a child Background characteristic Percentage who say a healthy- looking person can have the AIDS virus During delivery During pregnancy Through breast- feeding Number of women Age 15-19 51.2 42.6 50.8 43.5 119 20-24 65.9 47.7 65.3 53.6 555 25-29 67.0 50.8 66.5 44.9 717 30-39 58.9 51.6 68.5 46.8 1,474 40-49 58.0 52.8 64.8 51.2 1,212 Residence Urban 67.6 55.6 70.5 49.4 2,881 Rural 44.5 40.0 55.5 46.6 1,197 Region West 67.7 52.5 68.7 48.0 1,652 South 56.9 48.8 66.4 48.8 513 Central 62.3 56.2 72.1 51.9 962 North 62.2 53.5 68.5 55.1 298 East 43.6 40.2 49.2 42.2 653 NUTS 1 Region İstanbul 74.7 56.2 72.0 49.9 715 West Marmara 63.3 53.0 69.4 50.0 178 Aegean 57.4 48.2 63.8 43.7 588 East Marmara 72.6 50.3 67.7 50.5 373 West Anatolia 57.9 56.5 73.7 47.9 413 Mediterranean 56.9 48.8 66.4 48.8 513 Central Anatolia 61.4 57.5 75.6 57.5 239 West Black Sea 65.2 53.7 65.8 54.8 254 East Black Sea 63.0 61.5 75.7 59.4 151 Northeast Anatolia 51.3 51.0 63.3 49.7 120 Central East Anatolia 46.4 42.9 51.8 45.8 201 Southeast Anatolia 39.1 34.6 42.5 37.4 332 Education No education/Primary incomplete 33.3 36.3 44.3 41.1 891 First level primary 61.4 50.6 67.8 52.4 2,218 Second level primary 76.5 58.2 80.2 54.0 322 High school and higher 88.9 69.1 83.3 42.9 647 Total 60.8 51.0 66.1 48.6 4,078 References | 163 REFERENCES Hacettepe University Institute of Population Studies, (1989), 1988 Turkish Population and Health Survey, HUIPS, Ankara. Hacettepe University Institute of Population Studies and Macro International Inc., (1999). Turkey Demographic and Health Survey 1998, HUIPS, Ankara. International Organization for Migration. 1996. Migration Information Programme: Transit Migration in Turkey. Reports in Migration Information Programme (MIP), International Organization for Migration. Budapest, Hungary. Ministry of Foreign Affairs. 2004. Turkish Economy, Website: http://www.mfa.gov.tr/ grupd/default.htm, September 7, 2004. Ministry of Health, Hacettepe University Institute of Population Studies, and Macro International Inc. (1994). Turkey Demographic and Health Survey 1993, HUIPS, Ankara. Population Reference Bureau. 2004. 2004 World Population Data Sheet. Washington D.C. State Institute of Statistics (SIS). 1995. The Population of Turkey, 1923–1994 Demographic Structure and Development. Ankara: SIS. State Institute of Statistics (SIS). 2003. 2000 Census of Population: Social and Economic Characteristics of Population. Ankara: SIS. State Institute of Statistics (SIS). 2004. Population and Development Indicators. Web site: http://nkg.die.gov.tr, September 7, 2004. State Planning Organization (SPO). 2001. Long-Term Strategy and Eight Year Development Plan 2001–2005. SPO, Ankara State Planning Organization (SPO). 2003. Türkiye’nin Avrupa Birliğine Katılım Sürecine İlişkin 2003 Yılı İlerleme Raporu (2003 Regular Report on Turkey’s Progress Towards Accession). SPO, General Directorate of the Relations with the European Union, Ankara. Appendix A | 165 LIST OF PERSONNEL APPENDIX A Project Director Prof. Dr. Sabahat Tezcan Technical Director Assoc. Prof.Dr. Banu Akadlı Ergöçmen Field Director Assoc. Prof. Dr. İsmet Koç Field Assistant Elif Kurtuluş Yiğit Field Coordinators Yadigar Coşkun Alanur Çavlin Bozbeyoğlu Sutay Yavuz H. Yaprak Civelek Mehmet Ali Eryurt İlknur Yüksel Alyanak Erhan Özdemir Data Processing Han Raggers Assoc. Prof. Dr. Turgay Ünalan Yadigar Coşkun Listing Dr. A. Sinan Türkyılmaz Assoc. Prof. Dr. Attila Hancıoğlu İlknur Yüksel Alyanak Sampling Dr. A. Sinan Türkyılmaz Assoc. Prof. Dr. Attila Hancıoğlu Assoc. Prof. Dr. İsmet Koç Questionnaire Design Assoc. Prof. Dr. Attila Hancıoğlu Assoc. Prof. Dr. İsmet Koç Alanur Çavlin Bozbeyoğlu Steering Committee Prof. Dr. Sabahat Tezcan HUIPS Director Dr. Mehmet Rifat Köse Ministry of Health MCH/FP General Director Kemal Madenoğlu State Planning Organization Social Sectors and Coordination General Director Assoc. Prof. Dr. Ömer Demir State Institute of Statistics Director Assoc. Prof.Dr. Banu Akadlı Ergöçmen HUIPS Deputy Director Tuncer Kocaman State Planning Organization Population Section Dr. Mehmet Ali Biliker Ministry of Health MCH/FP Deputy General Director Technical Committee Assoc. Prof. Dr. Attila Hancıoğlu Assoc. Prof. Dr. Turgay Ünalan Assoc. Prof. Dr. İsmet Koç Dr. A. Sinan Türkyılmaz MEASURE DHS (Review) Dr. Ann Way Dr. Alfredo Aliaga 166 | Appendix A FIELD AND DATA ENTRY STAFF ALAZ ERDOST ALİ AŞKER ALİ FUAT ŞENGÜL ALTAN SUNGUR ARDA AYDOST ARZU KELLECİ ASLI AYDEMİR ASLIHAN DERMAN ASLIHAN Z. KOPUZLU AYFER BOZKURT AYGEN ÇIPLAK AYLİN GÜLTEPE AYNUR DEDE AYŞE KILIÇ BELKIS İNCE BİRGÜL ÖZ BUKET ULUTÜRK BURCU BAŞKAYA BURCU ERSOY BÜLENT KAPLAN CEREN TOPGÜL CEVAHİR BUĞU ÇİĞDEM ADEMHAN D. CEREN KOÇAK DENİZ CEVHER DENİZ ÇOŞKUN DERYA KAMİLOĞLU DERYA TAŞÇENE DİDEM CEYHUN DUYGU KILIÇ DUYGU YILDIRIM EBRU AĞACAN EBRU HANBAY EMEL BOLAT EMEL KARATAŞ ERHAN KURTARIR EYLEM ARAS FATMA CÜRÜL FERHAN ÖZKAN FEYAZ MART FİGEN TEZOL FİLİZ EĞİN FİLİZ TAŞKAYA GÜLŞAH OĞUZ GÜROL YAĞCIER HACER TAŞÇENE HALE ARATAN HASAN HAKANOĞLU HÜSNİYE KIZILÖZ IŞIK AYDENİZ İLAY ERTETİK KASIM KARAASLAN KAZIM TUĞ MEHMET DÖNMEZ MEHTAP DEMİRCİ M. TUĞÇE MORKOÇ MELİKE KUŞ MERAL ALADAĞ MİSKET ŞAHAN NECLA YAŞAR NEDİM UYKUCU NEJAT BARİBOĞLU NERMİN GÜNGÖR NİHAL ATALAN NİSA ARSLAN NURTEN YOĞUNALİ OKTAY DERYAOĞLU OLCAY AKYOL ÖZGE ERTÜRK ÖZGÜR ASLAN ÖZGÜR ONUR ÖZLEM HANCER ÖZLEM TUNA ÖZÜM DİNÇER PELİN ÇAĞATAY PERVİN ABDALOĞLU PINAR ÖZCAN REMZİYE AYDENİZ SATI ŞEKER SELDA ŞAHİN SELDA TUNCER SELVİ TOGAY KILIÇ SENEM AYSEL ER SERDAR İLBAY SERDAR ŞENGÜL SERKAN ULUSDOYURAN SERPİL KADIOĞLU SEVGİ BANDIRMA SEVİLAY ŞAFAK SEYLAN D. AVŞAR SEYNUR CÜREBAL SİBEL YILDIRIM SİRAY ŞEKERCİ SONER ATATANIR SONER Ç. BABADAĞ SÜLEYMAN SARIHAN SÜLEYMAN ŞENOL TÜLAY AĞCA TÜLAY ALPOĞLU UFUK GÖBEL ÜLKER GÖBEL ÜLKÜ OKTAY YASEMİN ŞEKER YONCA YAŞAR LISTING STAFF ALPER KULAÇ ALPER ÜSTÜNER BAYRAM ZENGİN BÜLENT YILBAŞ ENGİN BEDİR ENGİN İŞGİN ERSAN KALUÇ FARUK AYGÜN GÖKHAN AKARKEN GÜNAY YILMAZ H. İBRAHİM ALBAYRAK H. VOLKAN SOYSEÇKİN HASAN KETEN İLHAN ALBAYRAK İLKER SÖZER KADİR ÖZDEMİR M. FARUK YEŞİL METE KELLECİ MİTHAT DAĞLI MURAT ERDOĞMUŞ MUSTAFA DOĞURDU ÖZGÜR GÜÇER SERKAN FİDANCIOĞLU SONER KOZAKLI SÜLEYMAN POLAT ŞEFİK COŞKUN TURGAY ZENGİN UMUT NEBİOĞLU ÜMİT ARPACI YASİN ORBAY Appendix B | 167 SURVEY DESIGN APPENDIX B A. Sinan Türkyılmaz, Attila Hancıoğlu and İsmet Koç The major features of sample design and implementation for the Turkish Demographic and Health Survey, 2003 (TDHS-2003) are described in this section. Sample design features that are discussed include: target sample size, choice of domains, sampling stages, stratification, degree of clustering, and the relationship of design decisions to the nature of the sample frame1. Aspects of the sample implementation include the cartographic and listing work that was needed to update, improve, or generate the ultimate sample lists of households or individuals, as well as the procedures for the final household selection. This section also presents information on fieldwork, including descriptions of the recruitment and training of interviewers, the composition of interviewing teams, quality control procedures, and various practical problems encountered. Response rates2 for urban and rural areas and regions are presented. An account is also given of the data processing and analysis, including a description of the calculation of the final weighting factors (design and non-response weights). B.1 Sample Design and Implementation A weighted, multistage, stratified cluster sampling approach was used in the selection of the TDHS-2003 sample. The sample was designed in this fashion because of the need to provide estimates for a variety of characteristics for various domains. These domains, which are frequently employed in the tabulation of major indicators from the survey, are: • Turkey as a whole; • Urban and rural areas (each as a separate domain); • Each of the conventional major five regions of the country, namely the West, South, Central, North, and East regions • The 12 NUTS 13 regions, for selected indicators which are based on sufficient number of observations The major objective of the TDHS-2003 sample design was to ensure that the survey would provide estimates with acceptable precision for these domains for most of the important demographic characteristics, such as fertility, infant and child mortality, and contraceptive prevalence, as well as for the health indicators. The different populations covered by the TDHS- 1 For an additional description of these aspects of sample designs for DHS surveys, see the DHS Sampling Manual, Basic Documentation Series, No. 8, pp. 59-66, 1996. 2 For a more complete discussion of the calculation of response rates, see the DHS Sampling Manual, Basic Documentation Series, No. 8, pp. 55-57, 1996. 3 Information is provided on NUTS regions in the sections that follow. 168 | Appendix B 2003 survey were defined as the total population for the Household Questionnaire and all ever-married women younger than age 50 for the Individual Questionnaire. The aim was to survey these populations by designing a sample of households and interviewing an adult member of the household in order to collect information on household members. All ever-married women age 15-49 in the household who were identified as eligible in the household schedule were interviewed. In addition, some information was collected for households and women in a sub- sample of one-half of all households. B.2 Sample Frame Different criteria have been used to describe "urban" and "rural" settlements in Turkey. In the demographic surveys of the 1970s, a population size of 2,000 was used to differentiate between urban and rural settlements. In the 1980s, the cut-off point was increased to 10,000 and, in some surveys in the 1990s, to 20,000. A number of surveys used information on the administrative status of settlements in combination with population size for the purpose of differentiation. The urban frame of the TDHS-2003 consisted of a list of provincial centers, district centers, and other settlements with populations larger than 10,000, regardless of administrative status. The rural frame consisted of all district centers, sub-districts and villages not included in the urban frame. The urban-rural definitions of the TDHS-2003 are identical with those in the TDHS-1998. Initial information on all settlements in Turkey was obtained from the 2000 General Population Census. The results of 2000 General Population Census provided a computerized list of all settlements (provincial and district centers, sub-districts and villages), their populations and the numbers of households. B.3 Stratification Currently Turkey is divided administratively into 81 provinces. For purposes of selection in prior surveys in Turkey, these provinces have been grouped into five regions. This regional breakdown has been popularized as a powerful variable for understanding the demographic, social, cultural, and economic differences between different parts of the country. The five regions, West, South, Central, North, and East regions, include varying numbers of provinces. Information on provinces in each of these regions is provided in Table B.1. In addition to the conventional five geographic regions, a new system of regional breakdown was adopted in late 2002. In accordance with the accession process of Turkey to the European Union, the State Planning Office and the State Institute of Statistics constructed three levels of NUTS regions, which have since become official (Law No. 2002/4720). “NUTS” stands for “The Nomenclature of Territorial Units for Statistics”. NUTS is a statistical region classification that is used by member countries of European Union (EU). The 81 provinces were designated as regions of NUTS 3 level; these were further aggregated into 26 regions to form the NUTS 2 regions. NUTS 1 regions were formed by aggregating NUTS 2 regions into 12 regions. Appendix B | 169 Table B.1 List of strata by region, NUTS 1 region, residence, type and province, Turkey 2003 Stratum Region NUTS 1 Region Type Province 1 West İstanbul Urban/Metropol/Slum İstanbul 2 West İstanbul Urban/Metropol/Non-slum İstanbul 3 West İstanbul Urban İstanbul 4 West İstanbul Rural İstanbul 5 West West Marmara Urban Edirne, Kırklareli, Tekirdağ, Balıkesir, Çanakkale 6 West West Marmara Rural Edirne, Kırklareli, Tekirdağ, Balıkesir, Çanakkale 7 West Aegean Urban/Metropol İzmir 8 West Aegean Urban İzmir, Aydın, Denizli, Muğla, Manisa 9 West Aegean Rural İzmir, Aydın, Denizli, Muğla, Manisa 10 Central Aegean Urban Afyon, Kütahya, Uşak 11 Central Aegean Rural Afyon, Kütahya, Uşak 12 West East Marmara Urban/Metropol Bursa 13 West East Marmara Urban Bursa 14 West East Marmara Rural Bursa 15 West East Marmara Urban/Earthquake Kocaeli, Sakarya, Yalova 16 West East Marmara Rural/Earthquake Kocaeli, Sakarya, Yalova 17 Central East Marmara Urban Bilecik, Eskişehir 18 Central East Marmara Rural Bilecik, Eskişehir 19 Central East Marmara Urban/Earthquake Bolu, Düzce 20 Central East Marmara Rural/Earthquake Bolu, Düzce 21 Central West Anatolia Urban/Metropol Ankara 22 Central West Anatolia Urban Ankara, Konya, Karaman 23 Central West Anatolia Rural Ankara, Konya, Karaman 24 South Mediterranean Urban/Metropol Adana 25 South Mediterranean Urban Antalya, Burdur, Isparta, Adana, İçel, Hatay, K. Maraş, Osmaniye 26 South Mediterranean Rural Antalya, Burdur, Isparta, Adana, İçel, Hatay, K. Maraş, Osmaniye 27 Central Central Anatolia Urban Kırşehir, Nevşehir, Niğde, Aksaray, Kırıkkale, Kayseri, Sivas, Yozgat 28 Central Central Anatolia Rural Kırşehir, Nevşehir, Niğde, Aksaray, Kırıkkale, Kayseri, Sivas, Yozgat 29 North West Black Sea Urban Zonguldak, Bartın, Karabük, Kastamonu, Sinop, Samsun 30 North West Black Sea Rural Zonguldak, Bartın, Karabük, Kastamonu, Sinop, Samsun 31 Central West Black Sea Urban Çankırı, Amasya, Çorum, Tokat 32 Central West Black Sea Rural Çankırı, Amasya, Çorum, Tokat 33 North East Black Sea Urban Artvin, Giresun, Gümüşhane, Ordu, Rize, Trabzon 34 North East Black Sea Rural Artvin, Giresun, Gümüşhane, Ordu, Rize, Trabzon 35 East Northeast Anatolia Urban Erzincan, Erzurum, Bayburt, Ağrı, Kars, Ardahan, Iğdır 36 East Northeast Anatolia Rural Erzincan, Erzurum, Bayburt, Ağrı, Kars, Ardahan, Iğdır 37 East Central East Anatolia Urban Bingöl, Elazığ, Malatya, Tunceli, Bitlis, Hakkari, Muş, Van 38 East Central East Anatolia Rural Bingöl, Elazığ, Malatya, Tunceli, Bitlis, Hakkari, Muş, Van 39 East Southeast Anatolia Urban Adıyaman, Gaziantep, Kilis, Diyarbakır, Şanlıurfa, Mardin, Siirt, Batman, Şırnak 40 East Southeast Anatolia Rural Adıyaman, Gaziantep, Kilis, Diyarbakır, Şanlıurfa, Mardin, Siirt, Batman, Şırnak 170 | Appendix B Two of the NUTS 1 regions, İstanbul and the Southeastern Anatolia, were given special attention in the sample design process and a comparatively larger share of the total sample was allocated to these regions to ensure that statistically sound estimates for a larger number of indicators would be obtained than would be the case for the remaining 10 NUTS 1 regions. Policymakers, researchers and other concerned circles had voiced interest in information on demographic and health indicators for İstanbul and the Southeastern Anatolian regions in the past. Furthermore, as an add-on study, the İstanbul metropolitan area was designated by UN- Habitat as one of the mega-cities in their International Slum Survey series. In co-operation with UN-Habitat, HUIPS wished to be able to produce estimates for slum4 and non-slum areas within İstanbul; for this reason, the total sample size for İstanbul was kept at a relatively high magnitude. One of the priorities of the TDHS-2003 was to produce a sample design that was methodologically and conceptually consistent with the designs of previous demographic surveys carried out by the Hacettepe Institute of Population Studies. In surveys prior to the TDHS-1993, the five-region breakdown of the country was used for stratification. In TDHS-1993, a more detailed stratification taking into account subregions was employed to obtain a better dispersion of the sample. The criteria for subdividing the five major regions into subregions were the infant mortality rates of each province, estimated from the 1990 Population Census using indirect techniques.5 Using the infant mortality estimates as well as geographic proximity, the provinces in each region were grouped into 14 subregions at the time of the TDHS-1993. The sub-regional division developed during the TDHS-1993 was used in TDHS-1998. However, the new NUTS regions necessitated further steps for sample design, namely that the sample design of the TDHS-2003 would allow using the conventional five regions as well as the NUTS 1 regions as sample domains. The conventional five regions cannot be obtained by aggregating the 12 NUTS 1 regions. To ensure both regional breakdowns were served by the sample design, 20 mutually exclusive strata had to be created, which, when appropriately aggregated, would produce the five conventional regions or the NUTS 1 regions. It became clear during this exercise, however, that if slight modifications were made to the boundaries of the 5 regions a smaller number of strata would be sufficient for reflecting both breakdowns in the sample design. More specifically, changing the regions to which only 6 provinces out of 81 were included would make it possible to construct 15 strata and serve the same purpose. This exercise was undertaken; also, a series of statistical tests were carried out to make sure that the modification to the regional boundaries would not make any difference in terms of regional indicators. As a result of these considerations and exercises, 40 separate strata were created for the sample design of the TDHS-2003. This included the designation of 15 “divisions” by urban and rural stratum, the two strata within İstanbul (slum and non-slum), and metropolitan cities as mutually exclusive strata. The stratification also makes possible to combine provinces, which were affected by the earthquake in 1999. 4 For convenience purposes, the term “slum” is used to refer to irregularly formed/developed housing areas, irrespective of whether they are subsequently regularized or not. These areas are known to predominantly house lower middle income and poor households. 5 See Hancıoğlu, A. 1991. Indirect estimation of mortality from information on the survival status of a close relative: Turkey 1970-1985, Unpublished Doctoral Dissertation, Hacettepe Institute of Population Studies, Ankara. Appendix B | 171 B.4 Sample Allocation The target sample size of the TDHS-2003 was set at 13,160 households, some 30 percent larger than that of the TDHS-1998. This increase is mainly related with the designation of new strata, the special attention given to İstanbul and Southeast Anatolia region, and with the adjustment of optimum allocation among the NUTS 1 regions. The targeted number was allocated among the five major regions as similar as possible to the TDHS-1998 (Table B.2). However, since İstanbul and Southeast Anatolia regions are over-sampled, the number of observations is higher for West and East regions relative to the previous survey. It was also aimed to target not less than 740 households for each NUTS 1 region. Based on previous experience in sample surveys, the target number of 13,160 households was expected to yield about 11,000 completed household interviews. Table B.2 Allocation of sample households Number of targeted households by region for last three DHS surveys in Turkey Regional categories TDHS-1993 TDHS-1998 TDHS-2003 Region West 2,700 2,800 4,330 South 1,700 1,800 1,840 Central 2,100 2,100 2,450 North 1,500 1,500 1,580 East 2,000 1,800 2,960 Total 10,000 10,000 13,160 NUTS 1 Regions İstanbul - - 2,080 West Marmara - - 740 Aegean - - 1,000 East Marmara - - 1,040 West Anatolia - - 890 Mediterranean - - 1,840 Central Anatolia - - 740 West Black Sea - - 1,030 East Black Sea - - 840 Northeast Anatolia - - 740 Central East Anatolia - - 740 Southeast Anatolia - - 1,480 Total 13,160 Note: The number of households for TDHS-1993 and TDHS-1998 are not given NUTS 1 regions has been used since 2002. To have an adequate representation of clusters within each of the five major regions, it was decided to select 25 households per standard urban segment (under the assumption of each cluster consisting of 100 households) and 15 households per standard rural segment. One exception to this was the selection of 12 households from the two urban segments in İstanbul (slum and non-slum). It was also determined that any of the strata should consist of at least 4 172 | Appendix B clusters, in order to make easier the sampling error calculations. On this basis, the total number of selected standard segments by regions is shown in Table B.3. Table B.3 Distribution of sample clusters Number of clusters by region, NUTS 1 Regions and urban-rural residence, Turkey 2003 Regional categories Urban segments (Population > 10000) (Cluster size= 25 HHs) Rural segments (Population < 10000) (Cluster size= 15 HHs) Number of segments Region West* 230 44 274 South 52 36 88 Central 68 50 118 North 44 32 76 East 80 64 144 NUTS 1 Regions İstanbul* 164 4 168 West Marmara 20 16 36 Aegean 28 20 48 East Marmara 32 16 48 West Anatolia 26 16 42 Mediterranean 52 36 88 Central Anatolia 20 16 36 West Black Sea 28 22 50 East Black Sea 24 16 40 Northeast Anatolia 20 16 36 Central East Anatolia 20 16 36 Southeast Anatolia 40 32 72 Total 474 226 700 *The cluster size is 12 households for the 160 metropolitan segments of İstanbul. B.5 Sample Selection Selection Procedures For the first-stage sample selection, settlements were grouped within each of the 40 strata, and a systematic random sample of settlements with probability proportional to size (PPS) based on the 2000 General Population Census was selected from the settlement lists. The output from this first stage of the selection was a list of all of the settlements included in the TDHS-2003 sample along with the number of clusters to be drawn from each settlement. The first stage selection for the two strata of İstanbul metropolitan area was performed by using a more detailed settlement list due to the need for stratification of the city into slum-and non-slum strata. Quarters of İstanbul were classified as slum or non-slum using expert opinion, simply to create probabilistic stratification and taking care of selection probabilities. Similar to settlement selection in other strata in the sample, quarters were selected systematically from these two strata in the first stage. Appendix B | 173 In Turkey, settlements are not divided into small area units with well-defined boundaries (e.g., census enumeration areas) that can be used for conducting surveys. For some settlements, however, household lists were available from the Structure Schedules that were prepared in 2000 by municipalities in collaboration with the State Institute of Statistics (SIS). Some of these lists were updated in 2002. For 563 clusters, SIS was able to provide household lists from the Structure Schedules. For those settlements, the household lists were subdivided into segments of approximately 100 households with the exception of the two İstanbul metropolitan strata, where the segments included approximately 50 households. The list of these segments constituted the frame for the selection of the 563 clusters. For each of the selected clusters, SIS provided a list of the dwellings units with their full addresses (quarter, area, avenue/street, building and door number). SIS was not able to provide household lists from the Structure Schedules for settlements without municipalities from which 137 clusters were to be drawn for the TDHS-2003. For these settlements, the list of households had to be prepared in the field. In the case of small settlements (less than 250 households), the entire settlement was listed. In the case of the small number of settlements in which there were more than 250 households, 250 households were listed and an estimate of the remaining number of households in the settlement was obtained through a quick count. Listing and Mapping Activities Although the SIS had dwelling lists for many clusters, they did not have the corresponding maps. For this reason, the selected clusters had to be formed with streets that were not always adjacent to each other. Moreover, the lists provided by the SIS did not reflect changes that may have occurred during the period from the 2000 or 2002 to the survey date. Two types of changes were possible: those that could be updated during listing, such as the construction of a new building on the street, a change in the use of a building (e.g., a flat can be used as an office instead of a dwelling), or changes in the names of streets, and those that were more problematic, e.g., the appearance of new quarters in urban centers. In an effort to develop strategies for dealing with these as well as other possible problems that might arise, a pilot listing activity was undertaken in the capital, Ankara, before the actual listing activity began. The final listing forms, sketch map formats, and listing and mapping manuals were developed based on this pilot activity. Forty university students/graduates were trained for the main listing activity. Listing teams were formed following a three-day training program in the beginning of November 2003. Each team was provided with maps describing the location of the settlements they were expected to visit, as well as other materials needed for the listing. Sixteen listing teams were formed, each including one mapper and one lister. The listing operation started on 5th of November and it was carried under the supervision of the research assistants and regional coordinators from the Hacettepe Institute of Population Studies. The cluster (standard segment) size was around 100 households (50 households for İstanbul metropolitan) for most of the clusters in urban areas. Only five urban clusters had extremely low numbers of households; in order to obtain 100 households in these clusters, 174 | Appendix B adjacent streets were added to the original cluster. In some of the selected villages, the total populations were too small, and the original cluster did not include 100 households. In these cases, the village that was nearest to the selected village was included in the sample, and the names of these villages were provided to the listing teams; the lists of 100 households were completed from the two neighboring villages. The listing operation was implemented in three stages due to seasonal conditions and completed in April 2004. Overall, the quality of the listing work produced by the listers was good although it varied somewhat largely in response to problems the listing teams experienced in working in some geographic areas. Finally, ten clusters were not listed due to problems of accessibility; information on these clusters is presented later in this Appendix. B.6 Questionnaire Development and Pre-test Questionnaires Two main types of questionnaires were used to collect the TDHS-2003 data: the Household Questionnaire and the Individual Questionnaire for ever-married women of reproductive ages. The contents of these questionnaires were based on the DHS Model "A" Questionnaire, which was designed for the DHS program for use in countries with high contraceptive prevalence. Additions, deletions and modifications were made to the DHS model questionnaire in order to collect information particularly relevant to Turkey. Attention also was paid to ensuring the comparability of the TDHS-2003 findings with previous demographic surveys carried out by the Hacettepe Institute of Population Studies. In the process of designing the TDHS-2003 questionnaires, national and international population and health agencies were consulted for their comments. All TDHS-2003 questionnaires were developed in Turkish and translated into English. English versions of the Household and Individual questionnaires are reproduced in Appendix E. The Household Questionnaire was used to enumerate all usual members of and visitors to the selected households and to collect information relating to the socioeconomic position of the households. In the first part of the Household Questionnaire, basic information was collected on the age, sex, educational attainment, recent migration and residential mobility, employment, marital status, and relationship to the head of household of each person listed as a household member or visitor. The objective of the first part of the Household Questionnaire was to obtain the information needed to identify women who were eligible for the individual interview as well as to provide basic demographic data for Turkish households. The second part of the Household Questionnaire included questions on never married women age 15-49, with the objective of collecting information on basic background characteristics of women in this age group. The third section was used to collect information on the welfare of the elderly people. The final section of the Household Questionnaire was used to collect information on housing characteristics, such as the number of rooms, the flooring material, the source of water, and the type of toilet facilities, and on the household's ownership of a variety of consumer goods. This section also incorporated a module that was only administered in İstanbul metropolitan households, on house ownership, use of municipal facilities and the like, as well as a module that was used to collect information, from one-half of households, on salt iodization. In households where salt was present, test kits Appendix B | 175 were used to test whether the salt used in the household was fortified with potassium iodine or potassium iodate, i.e. whether salt was iodized. The Individual Questionnaire for ever-married women obtained information on the following subjects: ƒ Background characteristics ƒ Reproduction ƒ Marriage ƒ Knowledge and use of family planning ƒ Maternal care and breastfeeding ƒ Immunization and health ƒ Fertility preferences ƒ Husband's background ƒ Women’s work and status ƒ Sexually transmitted diseases and AIDS ƒ Maternal and child anthropometry. The Individual Questionnaire also included a monthly calendar, which was used to record fertility, contraception, and marriage for a period of 6 to 6.5 years (depending on the month of interview) beginning in January 1998 up to the survey month. In addition, fieldwork teams measured the heights and weights of children under age five and of all women at ages 15-49. Pre-test In July 2004, a three-day pre-test was conducted to ensure that the questions in the TDHS- 2003 questionnaires were in a logical sequence, that the wording of the questions was comprehensible, appropriate and meaningful, and that the pre-coded answers were adequate. Eleven interviewers were trained at the Hacettepe Institute of Population Studies for a period of ten days. The training period included both classroom training and interviews in the field. The interviewers were mostly university students and graduates. In addition to the interviewers, research assistants, who would later become supervisors and regional coordinators, also received training. Fieldwork for the pre-test was carried out in one district in central Ankara, one district in squatter housing areas of Ankara, and one village in Ankara province. A total of 176 households and 123 ever-married women interviews were completed during the pre-test. Frequency distributions and cross tabulations were obtained shortly after the completion of the interviews. Based on the evaluation of these results and on the feedback obtained from the interviewers, as well as from the Ministry of Health, several minor changes were made to the TDHS-2003 questionnaires. 176 | Appendix B B.7 Data Collection Activities Staff Recruitment and Training Candidates for the positions of interviewers, field editors, supervisors and measurers were solicited in announcements sent to all universities in Ankara. All candidates for the field staff positions were interviewed in four groups by the staff of the Institute of Population Studies using interview guidelines prepared for this purpose. Individuals who met a number of the requirements and had the necessary qualifications were accepted into the training program. All candidates for the field staff positions were at least high school graduates and the majority was university students and university graduates. Previous survey experience was not among the qualifications for the candidates for the position of interviewers in order to ensure that the trainees had no biases that might result from their previous experience. Approximately 120 applicants were accepted for the training program. Training of the candidates for the fieldwork positions was conducted in November 2003 for three weeks at the Hacettepe Institute of Population Studies. The training program included general lectures related to the demographic situation in Turkey, family planning and mother and child health, questionnaire training, role playing and mock interviews, field practice in areas not covered in the survey and quizzes to test the progress and capabilities of the candidates. A variety of materials were used during the training sessions, including manuals for supervisors and editors, and for interviewers. All trainees received the same classroom training during the first two weeks of the training period; at the end of the third week, supervisors, field editors, and measurers were selected from among the candidates, and a number of unsuccessful candidates were eliminated at this stage. Separate classroom training sessions were organized for supervisors, field editors, and measurers. After the completion of classroom training, a two-day pilot study was conducted in the urban and rural areas of Ankara to complement the training program. Based on the performance of candidates during the training and pilot study, 98 individuals were selected for the main fieldwork activities. Fieldwork Fieldwork for the TDHS-2003, including initial interviews, call-backs and re-interviews began in the first week of December 2003, and was completed at the middle of May 2004. Fieldwork teams visited 80 of the 81 provinces in Turkey. Appendix B | 177 Fieldwork activities were com- pleted in four stages (Table B.4). In the first stage, data collection was carried out by 14 teams, each consisting of a supervisor, a field editor, a measurer, and 4 or 5 female interviewers, depending on the workload of that specific team. The first stage of the fieldwork was completed by the end of January 2004, at which point a number of fieldwork staff, as agreed initially, discontinued working in the field. Six new teams were set up from among the staff of the 14 teams that had worked in the first stage of fieldwork. In the first two stages, 60 per- cent of all clusters were covered by fieldwork teams. The teams at the second and following stages had the same composition as those in the first stage. These teams continued with data collection activities until the mid of May 2004. The fieldwork was planned by taking into consideration the climatic conditions in Turkey. Therefore, in the first months the fieldwork was concentrated in the provinces located in the West, the South and the Central Anatolia regions where the winter conditions were expected not to have adverse effects on field operations. The North and the Eastern Anatolia provinces were included to the fieldwork as time passed. The fieldwork was finalized without any interruptions in the period under consideration. Senior academic staff of the Institute was responsible for visiting the fieldwork teams in turn, checking the quality of data collected, and reporting periodically to the field director in Ankara. A total of 700 clusters were selected for the TDHS-2003 sample. Of these, interviews were successfully completed in 688 clusters. Due to problems of access, 10 clusters were not listed and, consequently, were not visited by the fieldwork teams; in addition, two clusters that had been listed could not be visited by the fieldwork teams. B.8 Data Processing and Analysis The questionnaires were returned to the Hacettepe Institute of Population Studies by the fieldwork teams for data processing as soon as interviews were completed in a province. The office editing staff checked that the questionnaires for all the selected households and eligible respondents were returned from the field. The data were entered and edited on microcomputers using the Census and Survey Processing System (CSPro) software. CSPro is designed to fulfill the census and survey data processing needs of data-producing organizations worldwide. CSPro is developed by MEASURE partners, the U.S. Bureau of the Census, ORC Macro's MEASURE DHS+ project, and SerPro S.A. CSPro allows range, skip, and consistency errors to be detected and corrected at the data entry stage. The machine entry and editing activities were initiated within three weeks after the beginning of the fieldwork, and were completed a week after the completion of the fieldwork. Table B.4 Stages of fieldwork, completed number of clusters in each stage, and number of teams in each stages Completed Stages Percentage of clusters Number of clusters Number of teams First 45.5 313 14 Second 15.0 103 6 Third 21.8 150 8 Fourth 17.7 122 5 Total 100.0 688 33 178 | Appendix B During data entry process, full verification was reached by entering each questionnaire to the computers twice by different data editors. B.9 Calculation of Sample Weights As mentioned earlier, the TDHS-2003 sample is not a self-weighted one. In particular, a disproportionate number of sample units were chosen from some of the strata, since there would have been inadequate numbers of observations for these areas if the target number of households had been proportionally allocated across regions. The following describes the procedure for calculating the weights to be used in the analysis of the TDHS-2003 results. Since the final selection was not implemented proportionally in strata, and since there was some variation in urban and rural non-response rates, separate weights are calculated for each of the 40 strata. The major component of the weight is the reciprocal of the sampling fraction employed in calculating the number of units in that particular stratum: Wh = 1 / fh The term f (h), the sampling fraction at the hth stratum, is the product of the probabilities of selection at every stage in a stratum: f h = P1h * P2h * P3h where Pih is the probability of the sample unit in the i-th sample stage for the h-th strata. A second component taken into account in the calculation of the weights is the level of nonresponse for the household and the individual interviews. The adjustment for household nonresponse is equal to the inverse value of: Rhh = Completed households/Eligible households. Eligible households include households where interviews were completed, households where there were no competent respondents, households where interviews were postponed and eventually not completed, refusals, and those dwellings that were not found by the fieldwork teams. Similarly, the adjustment for non-response in the women’s survey is equal to the inverse value of: Rww = Completed women questionnaires/Eligible women. Approximately half of the households were selected for some sets of questions for both in household questionnaires and in individual questionnaires. The rule for the selection of a household for a half sample was very simple. If the cluster was even-numbered, then the households whose number was even were selected for half samples or vice versa. A separate set Appendix B | 179 of sampling weights was calculated for the half samples by following procedures similar to those described above. For the half samples, the adjustment for nonresponse is defined as: Rhs = Completed questionnaires for half samples/Eligible households (women) for half sample The weights for the subregions regions and the factors compensating for nonresponse are shown in Table B.5.1 for women and Table B.5.2 for half sample. The weights for the TDHS-2003 also include an adjustment for the 12 missing clusters. The unadjusted weights for the households were calculated by multiplying the above factors for each stratum; they were then standardized by multiplying these weights by the ratio of the number of completed interviewed households to the total unadjusted weighted number of households. A similar standardization procedure was followed in obtaining the weights for the individual women’s and half sample data. The final weights for households and individual women and the half sample are shown in Table B.6. 180 | Appendix B Table B.5.1. Design weights and nonresponse factors Design weights and nonresponse factors by strata for the women, Turkey 2003 Strata Region NUTS 1 Region Residence Inverse of sampling fraction Household level Women level 1 West İstanbul Urban/Metropol/Slum 1160555 / 960 891 / 779 672 / 630 2 West İstanbul Urban/Metropol/Non-slum 1587651 / 960 870 / 682 478 / 449 3 West İstanbul Urban 24989 / 100 68 / 63 52 / 50 4 West İstanbul Rural 76858 / 60 46 / 46 35 / 34 5 West West Marmara Urban 469931 / 500 410 / 391 285 / 269 6 West West Marmara Rural 362247 / 240 220 / 218 119 / 115 7 West Aegean Urban/Metropol 685892 / 400 348 / 300 195 / 183 8 West Aegean Urban 686133 / 150 144 / 137 96 / 94 9 West Aegean Rural 667273 / 240 211 / 204 139 / 135 10 Central Aegean Urban 202772 / 150 129 / 127 94 / 89 11 Central Aegean Rural 211704 / 60 48 / 47 50 / 48 12 West East Marmara Urban/Metropol 352876 / 400 348 / 300 225 / 200 13 West East Marmara Urban 129118 / 100 83 / 75 46 / 46 14 West East Marmara Rural 109307 / 60 33 / 33 27 / 26 15 West East Marmara Urban/Earthquake 377921 / 100 90 / 86 70 / 62 16 West East Marmara Rural/Earthquake 148605 / 60 56 / 56 39 / 38 17 Central East Marmara Urban 182284 / 100 86 / 85 68 / 65 18 Central East Marmara Rural 65446 / 60 45 / 45 21 / 21 19 Central East Marmara Urban/Earthquake 47999 / 100 80 / 77 57 / 55 20 Central East Marmara Rural/Earthquake 83237 / 60 55 / 55 44 / 43 21 Central West Anatolia Urban/Metropol 915073 / 500 451 / 386 287 / 260 22 Central West Anatolia Urban 431779 / 150 128 / 124 99 / 99 23 Central West Anatolia Rural 298404 / 240 173 / 172 116 / 107 24 South Mediterranean Urban/Metropol 276431 / 400 361 / 349 276 / 270 25 South Mediterranean Urban 1052242 / 900 808 / 734 593 / 557 26 South Mediterranean Rural 681896 / 540 470 / 446 302 / 286 27 Central Central Anatolia Urban 523267 / 500 457 / 438 354 / 343 28 Central Central Anatolia Rural 373756 / 240 210 / 205 162 / 159 29 North West Black Sea Urban 336258 / 500 427 / 395 275 / 267 30 North West Black Sea Rural 318422 / 240 207 / 204 156 / 153 31 Central West Black Sea Urban 224473 / 200 180 / 176 138 / 136 32 Central West Black Sea Rural 201222 / 90 82 / 82 60 / 59 33 North East Black Sea Urban 310851 / 600 497 / 474 362 / 355 34 North East Black Sea Rural 349165 / 240 203 / 199 136 / 126 35 East Northeast Anatolia Urban 212359 / 500 462 / 452 392 / 384 36 East Northeast Anatolia Rural 218260 / 240 200 / 199 158 / 151 37 East Central East Anatolia Urban 371366 / 500 478 / 449 383 / 371 38 East Central East Anatolia Rural 257644 / 240 227 / 220 208 / 195 39 East Southeast Anatolia Urban 756933 / 1000 922 / 877 762 / 742 40 East Southeast Anatolia Rural 356146 / 480 455 / 449 416 / 403 Appendix B | 181 Table B.5.2 Design weights and nonresponse factors: half sample Design weights and nonresponse factors by strata for the half samples, Turkey 2003 Strata Region NUTS 1 Region Residence Inverse of sampling fraction Household level Women level 1 West İstanbul Urban/Metropol/Slum 2 * 1160555 / 960 437 / 387 330 / 307 2 West İstanbul Urban/Metropol/Non-slum 2 * 1587651 / 960 438 / 346 234 / 216 3 West İstanbul Urban 2 * 24989 / 100 35 / 32 30 / 29 4 West İstanbul Rural 2 * 76858 / 60 21 / 21 17 / 16 5 West West Marmara Urban 2 * 469931 / 500 209 / 201 147 / 138 6 West West Marmara Rural 2 * 362247 / 240 112 / 111 61 / 61 7 West Aegean Urban/Metropol 2 * 685892 / 400 169 / 151 96 / 91 8 West Aegean Urban 2 * 686133 / 150 72 / 69 49 / 48 9 West Aegean Rural 2 * 667273 / 240 106 / 104 78 / 76 10 Central Aegean Urban 2 * 202772 / 150 65 / 65 49 / 46 11 Central Aegean Rural 2 * 211704 / 60 21 / 20 23 / 23 12 West East Marmara Urban/Metropol 2 * 352876 / 400 175 / 150 106 / 95 13 West East Marmara Urban 2 * 129118 / 100 44 / 41 27 / 27 14 West East Marmara Rural 2 * 109307 / 60 17 / 17 13 / 12 15 West East Marmara Urban/Earthquake 2 * 377921 / 100 44 / 43 39 / 36 16 West East Marmara Rural/Earthquake 2 * 148605 / 60 27 / 27 22 / 22 17 Central East Marmara Urban 2 * 182284 / 100 45 / 44 38 / 37 18 Central East Marmara Rural 2 * 65446 / 60 23 / 23 11 / 11 19 Central East Marmara Urban/Earthquake 2 * 47999 / 100 41 / 41 30 / 30 20 Central East Marmara Rural/Earthquake 2 * 83237 / 60 28 / 28 22 / 22 21 Central West Anatolia Urban/Metropol 2 * 915073 / 500 228 / 195 148 / 137 22 Central West Anatolia Urban 2 * 431779 / 150 67 / 66 51 / 51 23 Central West Anatolia Rural 2 * 298404 / 240 85 / 84 69 / 62 24 South Mediterranean Urban/Metropol 2 * 276431 / 400 179 / 169 134 / 133 25 South Mediterranean Urban 2 * 1052242 / 900 408 / 380 311 / 292 26 South Mediterranean Rural 2 * 681896 / 540 234 / 224 145 / 134 27 Central Central Anatolia Urban 2 * 523267 / 500 228 / 216 170 / 165 28 Central Central Anatolia Rural 2 * 373756 / 240 106 / 102 86 / 85 29 North West Black Sea Urban 2 * 336258 / 500 206 / 191 136 / 129 30 North West Black Sea Rural 2 * 318422 / 240 101 / 100 77 / 76 31 Central West Black Sea Urban 2 * 224473 / 200 94 / 92 73 / 72 32 Central West Black Sea Rural 2 * 201222 / 90 41 / 41 28 / 27 33 North East Black Sea Urban 2 * 310851 / 600 252 / 246 191 / 187 34 North East Black Sea Rural 2 * 349165 / 240 103 / 100 70 / 64 35 East Northeast Anatolia Urban 2 * 212359 / 500 230 / 225 183 / 179 36 East Northeast Anatolia Rural 2 * 218260 / 240 100 / 99 81 / 77 37 East Central East Anatolia Urban 2 * 371366 / 500 239 / 222 194 / 190 38 East Central East Anatolia Rural 2 * 257644 / 240 112 / 109 109 / 104 39 East Southeast Anatolia Urban 2 * 756933 / 1000 458 / 439 375 / 369 40 East Southeast Anatolia Rural 2 * 356146 / 480 229 / 225 209 / 202 182 | Appendix B Table B.6. Final sample weights Final weights by strata, Turkey 2003 Strata Region NUTS 1 Region Residence Household weight in entire sample Women weight in entire sample Household weight in half sample Women weight in half sample 1 West İstanbul Urban/Metropol/Slum 1.032975 1.076474 1.025306 1.071969 2 West İstanbul Urban/Metropol/Non-slum 1.596013 1.659981 1.592331 1.677833 3 West İstanbul Urban 0.268666 0.272980 0.273714 0.275406 4 West İstanbul Rural 0.956966 0.962433 0.962123 0.994289 5 West West Marmara Urban 0.775002 0.802196 0.772645 0.800518 6 West West Marmara Rural 1.137929 1.150401 1.143873 1.112580 7 West Aegean Urban/Metropol 1.485965 1.546953 1.441432 1.479031 8 West Aegean Urban 3.591818 3.583791 3.585003 3.559570 9 West Aegean Rural 2.291544 2.305124 2.270295 2.266295 10 Central Aegean Urban 1.025788 1.058475 1.015326 1.051955 11 Central Aegean Rural 2.692010 2.739621 2.782636 2.706509 12 West East Marmara Urban/Metropol 0.764496 0.840259 0.773033 0.838945 13 West East Marmara Urban 1.067484 1.042909 1.040752 1.012279 14 West East Marmara Rural 1.814642 1.841054 1.824420 1.922384 15 West East Marmara Urban/Earthquake 2.954615 3.259059 2.904523 3.060484 16 West East Marmara Rural/Earthquake 1.850288 1.855263 1.860258 1.809366 17 Central East Marmara Urban 1.377795 1.408203 1.400228 1.398730 18 Central East Marmara Rural 0.814869 0.796109 0.819259 0.796846 19 Central East Marmara Urban/Earthquake 0.372553 0.377212 0.360515 0.350652 20 Central East Marmara Rural/Earthquake 1.036388 1.036076 1.041972 1.013466 21 Central West Anatolia Urban/Metropol 1.597460 1.722755 1.607218 1.688764 22 Central West Anatolia Urban 2.219800 2.168697 2.194777 2.134732 23 Central West Anatolia Rural 1.067723 1.130884 1.079977 1.169028 24 South Mediterranean Urban/Metropol 0.534028 0.533328 0.549772 0.538752 25 South Mediterranean Urban 0.988958 1.028638 0.969779 1.004624 26 South Mediterranean Rural 1.052607 1.085906 1.049071 1.104133 27 Central Central Anatolia Urban 0.815738 0.822517 0.829705 0.831461 28 Central Central Anatolia Rural 1.191784 1.186317 1.215547 1.196202 29 North West Black Sea Urban 0.543111 0.546506 0.544785 0.558634 30 North West Black Sea Rural 1.005744 1.001856 1.006473 0.991819 31 Central West Black Sea Urban 0.857532 0.850111 0.861320 0.849391 32 Central West Black Sea Rural 1.670282 1.659488 1.679282 1.693834 33 North East Black Sea Urban 0.405822 0.404297 0.398618 0.396006 34 North East Black Sea Rural 1.108709 1.169152 1.125501 1.197338 35 East Northeast Anatolia Urban 0.324309 0.323444 0.326088 0.324255 36 East Northeast Anatolia Rural 0.780347 0.797725 0.788514 0.806783 37 East Central East Anatolia Urban 0.590703 0.595771 0.600574 0.596441 38 East Central East Anatolia Rural 0.827499 0.862345 0.828494 0.844570 39 East Southeast Anatolia Urban 0.594489 0.596458 0.593126 0.586280 40 East Southeast Anatolia Rural 1.032975 1.076474 1.025306 1.071969 Appendix B | 183 B.10 Coverage of the Sample The results of sample implementation for the household and the individual interviews for the country as a whole, for urban and rural areas, and for the five regions of Turkey are shown in Tables B.7.1 and for NUTS 1 regions in Table B.7.2 The results indicate that, of the 13,049 households selected, the TDHS fieldwork teams successfully completed interviews with 10,836 (83 percent). The main reasons that eligible households were not interviewed were that some of the listed dwelling units were found to be vacant at the time of the interview or the household was away for an extended period. A total of 11,659 households were located and visited, of which 10,836 households were successfully interviewed. Overall, the household response rate was calculated as 93 percent. The household response rate was higher in rural areas than in urban areas and highest in the East, North and South regions. Among NUTS 1 regions the response rates in İstanbul is the lowest with 84 percent whereas it is more than 98 percent in Northeast Anatolia. In the interviewed households, 8,477 eligible women were identified, of whom 96 percent were interviewed. Among the small number of eligible women not interviewed in the survey, the principal reason for non-response was the failure to find the woman at home after repeated visits to the household. The eligible woman response rate was similar in urban and rural areas; the rates for the five regions were 3 percent within each other. Surprisingly, the response rate for eligible women in İstanbul (95 percent) is not the lowest value among the NUTS 1 regions. The response rates of 12 NUTS 1 ranged between 93 and 98 percent. The highest response rate was calculated for the West Blacksea region and the lowest was calculated for the West Anatolia region. The overall response rate for women in the TDHS-2003 was calculated as 89 percent. It ranged from 83 percent in the Central region to 93 percent in the East region. In terms of NUTS 1 regions, the overall response rates ranged from 79 percent (İstanbul) to 96 percent (Northeast Anatolia region). 184 | Appendix B Table B.7.1 Sample implementation according to residence and region Percent distribution of households and eligible women by results of the household and individual interviews, and household, eligible women and overall response rates, according to urban-rural residence and region, Turkey 2003 Residence Region Result Urban Rural West South Central North East Total Selected households Completed (C) 81.6 87.4 79.0 85.1 83.0 80.2 89.2 83.0 Household present but no competent respondent at home (HP) 2.9 1.2 3.4 3.1 2.1 1.8 1.3 2.5 Postponed (P) 0.1 0.0 0.1 0.0 0.1 0.0 0.0 0.0 Refused (R) 4.4 0.4 6.3 2.4 2.0 1.8 1.7 3.4 Dwelling not found (DNF) 0.3 0.2 0.4 0.6 0.0 0.3 0.2 0.3 Household absent (HA) 5.0 7.4 4.7 4.2 8.0 9.9 3.6 5.6 Dwelling vacant/address not a dwelling (DV) 5.4 3.1 5.5 4.6 4.6 6.0 3.6 4.8 Dwelling destroy (DD) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Partly completed (PC) 0.2 0.1 0.3 0.1 0.1 0.1 0.1 0.1 Other (O) 0.1 0.2 0.3 0.1 0.1 0.1 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100 Number of sampled households 9,754 3,295 4,267 1,797 2,433 1,587 2,965 13,049 Household response rate (HRR) 1 91.3 97.9 88.3 93.3 95.1 95.4 96.4 92.9 Eligible women Completed (EWC) 95.5 95.9 94.1 95.0 95.7 97.0 96.9 95.6 Not at home (EWNH) 2.4 3.1 3.1 2.7 2.7 2.5 2.0 2.6 Postponed (EWP) 0.1 0.0 0.1 0.0 0.2 0.0 0.0 0.1 Refused (EWR) 1.3 0.0 1.7 1.0 0.7 0.1 0.6 1.0 Partly completed (EWPC) 0.4 0.3 0.6 0.9 0.3 0.0 0.2 0.4 Other (EWO) 0.3 0.6 0.4 0.3 0.3 0.4 0.3 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100 Number of women 6,259 2,188 2,478 1,171 1,550 929 2,319 8,447 Eligible women response rate (EWRR)2 95.5 95.9 94.1 95.0 95.7 97.0 96.9 95.6 Overall response rate (ORR)3 87.1 93.9 83.0 88.7 91.0 92.5 93.4 88.8 Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, postponed, refused, dwelling not found and Partly completed. The eligible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed and "other." The overall response rate is the product of the household and woman response rates. 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C ____________________________ C + HP + P + R + DNF + PC 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC _______________________________________________ EWC + EWNH + EWP + EWR + EWPC + EWO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EWRR Appendix B | 185 Table B.7.2 Sample implementation according to NUTS 1 regions Percent distribution of households and eligible women by results of the household and individual interviews, and household, eligible women and overall response rates, according to NUTS 1 regions, Turkey 2003 Result İstan- bul West Mar- mara Ae- gean East Mar- mara West Ana- tolia Mediter- ranean Cen- tral Ana- tolia West Black Sea East Black Sea North- east Ana- tolia Central East Ana- tolia South- east Ana- tolia Total Selected households Completed (C) 76.4 84.6 81.8 79.0 79.0 85.1 86.7 82.8 79.5 91.2 90.3 87.8 83.0 Household present but no competent respondent at home (HP) 5.3 0.4 1.7 1.8 3.6 3.1 2.0 1.2 2.4 0.3 3.1 1.0 2.5 Postponed (P) 0.1 0.0 0.0 0.0 0.2 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 Refused (R) 8.7 1.7 4.1 3.9 4.3 2.4 0.9 2.1 0.8 0.8 1.5 2.3 3.4 Dwelling not found (DNF) 0.3 0.7 0.3 0.4 0.0 0.6 0.1 0.4 0.0 0.3 0.1 0.1 0.3 Household absent (HA) 3.8 8.6 5.7 6.3 7.3 4.2 7.1 7.6 11.1 4.8 3.0 3.4 5.6 Dwelling vacant/address not a dwelling (DV) 4.5 3.9 5.5 8.4 5.4 4.6 3.0 5.7 6.1 2.5 1.9 5.0 4.8 Dwelling destroy (DD) 0.0 0.0 0.2 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Partly completed (PC) 0.4 0.1 0.4 0.1 0.0 0.1 0.0 0.1 0.0 0.1 0.1 0.0 0.1 Other (O) 0.5 0.0 0.2 0.1 0.0 0.1 0.0 0.1 0.1 0.0 0.0 0.3 0.2 Total 100 100 100 100 100 100 100 100 100 100 100 100 100 Number of sampled households 2,05 6 720 996 1,028 863 1,797 742 1,035 847 714 741 1,510 13,04 9 Household response rate (HRR) 83.7 96.7 92.6 92.7 90.7 93.3 96.4 95.6 96.1 98.3 94.9 96.3 92.9 Eligible women Completed (EWC) 94.0 95.0 95.6 93.1 92.8 95.0 97.3 97.8 96.6 97.3 95.8 97.2 95.6 Not at home (EWNH) 2.8 3.2 1.9 4.7 4.6 2.7 1.6 1.9 2.6 2.4 3.0 1.3 2.6 Postponed (EWP) 0.2 0.0 0.0 0.0 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 Refused (EWR) 1.8 0.7 1.6 1.7 1.4 1.0 0.4 0.2 0.0 0.0 0.3 1.1 1.0 Partly completed (EWPC) 0.8 0.5 0.3 0.0 0.6 0.9 0.4 0.0 0.0 0.0 0.2 0.3 0.4 Other (EWO) 0.3 0.5 0.5 0.5 0.0 0.3 0.4 0.2 0.8 0.4 0.7 0.2 0.4 Total 100 100 100 100 100 100 100 100 100 100 100 100 100 Number of women 1,23 7 404 574 597 502 1,171 516 629 498 550 591 1,178 8,447 Eligible women response rate (EWRR) 94.0 95.0 95.6 93.1 92.8 95.0 97.3 97.8 96.6 97.3 95.8 97.2 95.6 Overall response rate (ORR) 78.7 91.9 88.6 86.3 84.2 88.7 93.8 93.5 92.9 95.7 90.9 93.6 88.8 Appendix C | 187 SAMPLING ERRORS APPENDIX C A. Sinan Türkyılmaz The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the TDHS-2003 to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the TDHS-2003 is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the TDHS-2003 sample is the result of a three-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the TDHS-2003 is the ISSA Sampling Error Module (SAMPERR). This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance in which: 188 | Appendix C in which where h represents the stratum which varies from 1 to H, mh is the total number of enumeration areas selected in the hth stratum, yhi is the sum of the weighted values of variable y in EA i in the hth stratum, xhi is the sum of the weighted number of cases in EA i in the hth stratum, and f is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent replications are thus created. In the TDHS, there were 688 non- empty clusters. Hence, 688 replications were created. The variance of a rate r is calculated as follows: in which where r is the estimate computed from the full sample of 688 clusters, r(i) is the estimate computed from the reduced sample of 687 clusters (ith cluster excluded), and k is the total number of clusters. In addition to the standard error, SAMPERR computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. SAMPERR also computes the relative error and confidence limits for the estimates. Sampling errors for the TDHS-2003 are calculated for a number of variables considered to be of primary interest. Results for women are presented in this appendix for the country as a whole, for urban and rural areas, for each of the five regions, and for the twelve NUTS1 regions. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table C.1. Tables C.2-C.21 present the value of the statistic (R), its standard error (SE), ⎥⎦ ⎤⎢⎣ ⎡ ⎟⎠ ⎞⎜⎝ ⎛ ∑∑ - z m z 1-m m x f-1 = var(r) h 2 h2 hi m =1ih h H =1h 2 h x r. - y = z and ,x r. - y = z hhhhihihi ) r - r ( ) 1-k ( k 1 = var(r) i 2 k =1i ∑ r ) 1-k ( - r k = r (i)i Appendix C | 189 the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In general, the relative standard errors for most estimates for the country as a whole are small, except for estimates of very small proportions. There are some differentials in the relative standard errors for the estimates for sub-populations. For example, for the contraceptive prevalence rate (CPR), i.e. the proportion of currently married women aged 15-49 who were using any method of contraception at the time of the interview, the relative standard error for the country as a whole, for urban areas, and for rural areas are 0.6 percent, 0.7 percent, and 1.3 percent, respectively. To obtain the 95 percent confidence limits for the CPR, one adds and subtracts twice the standard error to the sample estimate, i.e. 0.710 ± 2x0.006. The results indicate that there is a high probability (95 percent) that the true value of the CPR for the country as a whole lies between 69.8 percent and 72.1 percent. 190 | Appendix C Table C.1 List of selected variables for sampling errors, Turkey 2003 Variable Estimate Base population Urban residence Proportion Ever married women 15-49 No education Proportion Ever married women 15-49 With secondary education or higher Proportion Ever married women 15-49 Currently married (in union) Proportion Ever married women 15-49 Currently pregnant Proportion All women 15-49 Children ever born Mean All women 15-49 Children surviving Mean All women 15-49 Children ever born to women 40-49 Mean All women 15-49 Knowing any contraceptive method Proportion Currently married women 15-49 Knowing any modern contraceptive method Proportion Currently married women 15-49 Ever used any contraceptive method Proportion Currently married women 15-49 Currently using any contraceptive method Proportion Currently married women 15-49 Currently using a modern method Proportion Currently married women 15-49 Currently using pill Proportion Currently married women 15-49 Currently using IUD Proportion Currently married women 15-49 Currently using condom Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using female sterilization Proportion Currently married women 15-49 Currently using periodic abstinence Proportion Currently married women 15-49 Currently using withdrawal Proportion Currently married women 15-49 Obtained method from public sector source Proportion Currently married women 15-49 Want no more children Proportion Currently married women 15-49 Want to delay birth at least 2 years Proportion Currently married women 15-49 Ideal number of children Mean Ever married women 15-49 Mothers received medical care at delivery Proportion Births in last 5 years Child having health card, seen Proportion Children 12-23 months Child received BCG vaccination Proportion Children 12-23 months Child received DPT vaccination (3 doses) Proportion Children 12-23 months Child received polio vaccination (3 doses) Proportion Children 12-23 months Child received measles vaccination Proportion Children 12-23 months Child fully immunized Proportion Children 12-23 months Height-for-age (-2SD) Proportion Children 0-47 months Weight-for-height (-2SD) Proportion Children 0-47 months Weight-for-age (-2SD) Proportion Children 0-47 months BMI < 18.5 Proportion Ever married women 15-49 Has heard of HIV/AIDS Proportion Ever married women 15-49 Knows about condoms Proportion Ever married women 15-49 Knows about limiting partners Proportion Ever married women 15-49 Total fertility rate (last 3 years) Rate Women-years of exposure to child-bearing Neonatal mortality (last 5 years) Rate Number of births exposed to death Post-neonatal mortality (last 5 years) Rate Number of births exposed to death Infant mortality (last 5 years) Rate Number of births exposed to death Child mortality (last 5 years) Rate Number of births exposed to death Under-five mortality (last 5 years) Rate Number of births exposed to death Appendix C | 191 Table C.2 Sampling errors: National Sample, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.712 0.006 8075 8075 1.192 0.008 0.700 0.724 No education 0.218 0.008 8075 8075 1.777 0.037 0.202 0.234 With secondary education or higher 0.245 0.009 8075 8075 1.793 0.035 0.227 0.262 Currently married (in union) 0.950 0.003 8075 8075 1.121 0.003 0.945 0.955 Currently pregnant 0.041 0.002 12138 11517 1.049 0.056 0.036 0.046 Children ever born 1.838 0.049 12138 11517 0.789 0.027 1.740 1.937 Children surviving 1.691 0.045 12138 11517 0.795 0.027 1.601 1.782 Children ever born to women 40-49 3.544 0.059 2379 2460 1.274 0.017 3.427 3.661 Knowing any contraceptive method 0.998 0.000 7686 7672 0.757 0.000 0.997 0.999 Knowing any modern contraceptive method 0.995 0.001 7686 7672 0.878 0.001 0.994 0.997 Ever used any contraceptive method 0.900 0.004 7686 7672 1.291 0.005 0.891 0.909 Currently using any contraceptive method 0.710 0.006 7686 7672 1.154 0.008 0.698 0.721 Currently using a modern method 0.425 0.006 7686 7672 1.110 0.015 0.412 0.437 Currently using pill 0.047 0.003 7686 7672 1.098 0.056 0.042 0.052 Currently using IUD 0.202 0.005 7686 7672 1.184 0.027 0.191 0.213 Currently using condom 0.108 0.004 7686 7672 1.245 0.041 0.099 0.116 Currently using injectables 0.004 0.001 7686 7672 1.028 0.190 0.002 0.005 Currently using female sterilization 0.057 0.003 7686 7672 1.093 0.051 0.051 0.063 Currently using periodic abstinence 0.011 0.001 7686 7672 1.043 0.112 0.009 0.014 Currently using withdrawal 0.264 0.006 7686 7672 1.270 0.024 0.251 0.277 Obtained method from public sector source 0.577 0.013 3128 3271 1.455 0.022 0.551 0.603 Want no more children 0.635 0.009 3894 3873 1.210 0.015 0.616 0.654 Want to delay birth at least 2 years 0.136 0.006 3894 3873 1.166 0.047 0.123 0.148 Ideal number of children 2.510 0.020 4029 4038 1.183 0.008 2.469 2.551 Mothers received medical care at delivery 0.830 0.013 4533 4132 1.678 0.015 0.805 0.855 Child having health card, seen 0.537 0.026 807 749 1.397 0.048 0.486 0.589 Child received BCG vaccination 0.877 0.015 807 749 1.203 0.017 0.848 0.907 Child received DPT vaccination (3 doses) 0.644 0.022 807 749 1.267 0.035 0.599 0.688 Child received polio vaccination (3 doses) 0.691 0.019 807 749 1.131 0.028 0.652 0.729 Child received measles vaccination 0.794 0.019 807 749 1.288 0.024 0.755 0.833 Child fully immunized 0.542 0.023 807 749 1.256 0.043 0.496 0.589 Height-for-age (-2SD) 0.122 0.007 4028 3668 1.161 0.056 0.108 0.136 Weight-for-height (-2SD) 0.007 0.002 4028 3668 1.179 0.231 0.004 0.010 Weight-for-age (-2SD) 0.039 0.004 4028 3668 1.168 0.101 0.031 0.047 BMI < 18.5 0.018 0.003 2922 2782 1.093 0.151 0.013 0.024 Has heard of HIV/AIDS 0.881 0.008 4078 4078 1.591 0.009 0.865 0.897 Knows about condoms 0.219 0.008 4078 4078 1.175 0.035 0.204 0.234 Knows about limiting partners 0.215 0.008 4078 4078 1.300 0.039 0.198 0.231 Total fertility rate (last 3 years) 2.231 0.054 NA 32730 1.303 0.024 2.123 2.339 Neonatal mortality (last 5 years) 17.259 2.258 4556 4164 1.045 0.131 12.743 21.775 Post-neonatal mortality (last 5 years) 11.508 1.723 4558 4166 1.050 0.150 8.062 14.954 Infant mortality (last 5 years) 28.767 2.914 4558 4166 1.072 0.101 22.938 34.596 Child mortality (last 5 years) 8.527 1.507 4567 4176 1.068 0.177 5.513 11.540 Under-five mortality (last 5 years) 37.049 3.239 4569 4177 1.080 0.087 30.571 43.526 NA = Not applicable 192 | Appendix C Table C.3 Sampling errors: Urban Areas, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 1.000 0.000 5976 5752 NA 0.000 1.000 1.000 No education 0.183 0.009 5976 5752 1.896 0.052 0.164 0.202 With secondary education or higher 0.308 0.012 5976 5752 1.940 0.038 0.285 0.331 Currently married (in union) 0.945 0.003 5976 5752 1.125 0.004 0.939 0.952 Currently pregnant 0.037 0.003 8813 8101 1.159 0.070 0.032 0.042 Children ever born 1.727 0.044 8813 8101 0.801 0.026 1.638 1.815 Children surviving 1.605 0.041 8813 8101 0.809 0.026 1.522 1.688 Children ever born to women 40-49 3.270 0.062 1763 1761 1.304 0.019 3.147 3.393 Knowing any contraceptive method 0.999 0.000 5668 5437 0.879 0.000 0.998 1.000 Knowing any modern contraceptive method 0.997 0.000 5668 5437 0.664 0.000 0.996 0.998 Ever used any contraceptive method 0.920 0.005 5668 5437 1.393 0.005 0.910 0.930 Currently using any contraceptive method 0.736 0.007 5668 5437 1.140 0.009 0.723 0.749 Currently using a modern method 0.458 0.008 5668 5437 1.159 0.017 0.443 0.473 Currently using pill 0.050 0.003 5668 5437 1.100 0.064 0.044 0.057 Currently using IUD 0.215 0.006 5668 5437 1.173 0.030 0.202 0.228 Currently using condom 0.121 0.006 5668 5437 1.291 0.046 0.110 0.133 Currently using injectables 0.004 0.001 5668 5437 1.054 0.220 0.002 0.006 Currently using female sterilization 0.059 0.003 5668 5437 1.088 0.058 0.052 0.066 Currently using periodic abstinence 0.012 0.002 5668 5437 1.036 0.123 0.009 0.015 Currently using withdrawal 0.257 0.008 5668 5437 1.369 0.031 0.241 0.273 Obtained method from public sector source 0.564 0.015 2496 2499 1.560 0.027 0.533 0.595 Want no more children 0.635 0.011 2857 2720 1.228 0.017 0.613 0.657 Want to delay birth at least 2 years 0.143 0.008 2857 2720 1.259 0.058 0.127 0.160 Ideal number of children 2.452 0.023 2975 2857 1.246 0.009 2.405 2.498 Mothers received medical care at delivery 0.903 0.013 3062 2722 1.813 0.014 0.877 0.929 Child having health card, seen 0.632 0.031 551 503 1.438 0.049 0.570 0.693 Child received BCG vaccination 0.926 0.017 551 503 1.431 0.018 0.893 0.959 Child received DPT vaccination (3 doses) 0.726 0.027 551 503 1.382 0.038 0.671 0.780 Child received polio vaccination (3 doses) 0.769 0.023 551 503 1.235 0.030 0.723 0.815 Child received measles vaccination 0.844 0.023 551 503 1.438 0.028 0.797 0.891 Child fully immunized 0.629 0.030 551 503 1.385 0.047 0.569 0.688 Height-for-age (-2SD) 0.090 0.007 2717 2414 1.122 0.076 0.076 0.103 Weight-for-height (-2SD) 0.007 0.002 2717 2414 1.190 0.287 0.003 0.011 Weight-for-age (-2SD) 0.028 0.004 2717 2414 1.158 0.141 0.020 0.036 BMI < 18.5 0.019 0.003 2108 1943 1.078 0.174 0.012 0.025 Has heard of HIV/AIDS 0.928 0.009 3004 2881 1.925 0.010 0.909 0.946 Knows about condoms 0.274 0.010 3004 2881 1.248 0.037 0.254 0.294 Knows about limiting partners 0.247 0.010 3004 2881 1.289 0.041 0.227 0.268 Total fertility rate (last 3 years) 2.056 0.057 NA 23118 1.281 0.028 1.941 2.170 Neonatal mortality (last 5 years) 15.277 2.385 3080 2746 0.974 0.156 10.508 20.047 Post-neonatal mortality (last 5 years) 8.151 1.970 3081 2746 1.167 0.242 4.212 12.090 Infant mortality (last 5 years) 23.428 2.984 3081 2746 1.013 0.127 17.461 29.395 Child mortality (last 5 years) 7.153 1.641 3087 2753 1.083 0.229 3.872 10.434 Under-five mortality (last 5 years) 30.413 3.278 3088 2754 1.001 0.108 23.857 36.970 NA = Not applicable Appendix C | 193 Table C.4 Sampling errors: Rural Areas, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.000 0.000 2099 2323 NA NA 0.000 0.000 No education 0.305 0.017 2099 2323 1.670 0.055 0.271 0.338 With secondary education or higher 0.087 0.008 2099 2323 1.223 0.087 0.072 0.102 Currently married (in union) 0.962 0.005 2099 2323 1.109 0.005 0.953 0.971 Currently pregnant 0.050 0.005 3191 3434 1.053 0.096 0.041 0.060 Children ever born 2.093 0.125 3191 3434 1.005 0.060 1.843 2.342 Children surviving 1.886 0.111 3191 3434 0.996 0.059 1.664 2.108 Children ever born to women 40-49 4.226 0.121 616 701 1.130 0.029 3.984 4.469 Knowing any contraceptive method 0.995 0.001 2018 2235 0.664 0.001 0.993 0.997 Knowing any modern contraceptive method 0.990 0.002 2018 2235 0.952 0.002 0.986 0.995 Ever used any contraceptive method 0.853 0.009 2018 2235 1.201 0.011 0.834 0.872 Currently using any contraceptive method 0.645 0.013 2018 2235 1.204 0.020 0.619 0.671 Currently using a modern method 0.344 0.011 2018 2235 1.030 0.032 0.322 0.366 Currently using pill 0.039 0.005 2018 2235 1.093 0.120 0.030 0.049 Currently using IUD 0.172 0.010 2018 2235 1.224 0.060 0.151 0.192 Currently using condom 0.074 0.007 2018 2235 1.120 0.088 0.061 0.087 Currently using injectables 0.003 0.001 2018 2235 0.962 0.380 0.001 0.006 Currently using female sterilization 0.051 0.005 2018 2235 1.109 0.106 0.040 0.062 Currently using periodic abstinence 0.008 0.002 2018 2235 1.079 0.263 0.004 0.013 Currently using withdrawal 0.281 0.010 2018 2235 1.029 0.037 0.260 0.301 Obtained method from public sector source 0.620 0.021 632 772 1.095 0.034 0.578 0.663 Want no more children 0.635 0.017 1037 1153 1.163 0.027 0.600 0.669 Want to delay birth at least 2 years 0.117 0.009 1037 1153 0.912 0.078 0.099 0.136 Ideal number of children 2.651 0.042 1054 1181 1.099 0.016 2.567 2.735 Mothers received medical care at delivery 0.689 0.027 1471 1410 1.642 0.039 0.636 0.743 Child having health card, seen 0.344 0.041 256 246 1.259 0.118 0.263 0.425 Child received BCG vaccination 0.777 0.029 256 246 1.019 0.037 0.720 0.835 Child received DPT vaccination (3 doses) 0.475 0.038 256 246 1.125 0.080 0.399 0.551 Child received polio vaccination (3 doses) 0.530 0.035 256 246 1.038 0.066 0.460 0.601 Child received measles vaccination 0.691 0.035 256 246 1.105 0.050 0.622 0.761 Child fully immunized 0.365 0.033 256 246 1.016 0.091 0.299 0.432 Height-for-age (-2SD) 0.184 0.015 1311 1254 1.174 0.080 0.155 0.214 Weight-for-height (-2SD) 0.008 0.003 1311 1254 1.143 0.387 0.002 0.013 Weight-for-age (-2SD) 0.059 0.008 1311 1254 1.140 0.142 0.042 0.076 BMI < 18.5 0.018 0.005 814 839 1.117 0.302 0.007 0.028 Has heard of HIV/AIDS 0.770 0.017 1074 1197 1.328 0.022 0.735 0.804 Knows about condoms 0.087 0.010 1074 1197 1.118 0.110 0.068 0.107 Knows about limiting partners 0.136 0.014 1074 1197 1.296 0.100 0.109 0.163 Total fertility rate (last 3 years) 2.651 0.126 NA 9756 1.326 0.048 2.399 2.903 Neonatal mortality (last 5 years) 21.120 4.733 1476 1418 1.090 0.224 11.655 30.586 Post-neonatal mortality (last 5 years) 18.125 3.365 1477 1420 0.918 0.186 11.396 24.854 Infant mortality (last 5 years) 39.245 6.251 1477 1420 1.084 0.159 26.744 51.747 Child mortality (last 5 years) 11.266 3.088 1480 1423 1.020 0.274 5.090 17.441 Under-five mortality (last 5 years) 50.069 6.956 1481 1424 1.106 0.139 36.158 63.980 NA = Not applicable 194 | Appendix C Table C.5 Sampling errors: West Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.819 0.009 2331 3286 1.096 0.011 0.802 0.837 No education 0.146 0.011 2331 3286 1.500 0.075 0.124 0.168 With secondary education or higher 0.293 0.016 2331 3286 1.669 0.054 0.262 0.325 Currently married (in union) 0.945 0.005 2331 3286 1.038 0.005 0.936 0.955 Currently pregnant 0.031 0.004 3533 4429 1.095 0.130 0.023 0.039 Children ever born 1.633 0.063 3533 4429 0.536 0.038 1.508 1.758 Children surviving 1.518 0.057 3533 4429 0.525 0.037 1.404 1.631 Children ever born to women 40-49 2.905 0.077 720 1062 1.302 0.027 2.750 3.060 Knowing any contraceptive method 0.999 0.000 2214 3106 0.826 0.000 0.999 1.000 Knowing any modern contraceptive method 0.996 0.001 2214 3106 0.669 0.001 0.995 0.998 Ever used any contraceptive method 0.927 0.005 2214 3106 0.976 0.006 0.916 0.938 Currently using any contraceptive method 0.742 0.009 2214 3106 0.983 0.012 0.724 0.761 Currently using a modern method 0.457 0.010 2214 3106 0.938 0.022 0.437 0.476 Currently using pill 0.048 0.005 2214 3106 1.008 0.095 0.039 0.057 Currently using IUD 0.210 0.008 2214 3106 0.940 0.039 0.193 0.226 Currently using condom 0.127 0.008 2214 3106 1.080 0.060 0.112 0.142 Currently using injectables 0.002 0.001 2214 3106 0.844 0.452 0.000 0.003 Currently using female sterilization 0.061 0.006 2214 3106 1.088 0.091 0.050 0.072 Currently using periodic abstinence 0.012 0.002 2214 3106 0.989 0.193 0.007 0.016 Currently using withdrawal 0.266 0.011 2214 3106 1.141 0.040 0.245 0.287 Obtained method from public sector source 0.506 0.022 1014 1425 1.390 0.043 0.462 0.549 Want no more children 0.638 0.018 1110 1550 1.264 0.029 0.602 0.675 Want to delay birth at least 2 years 0.132 0.011 1110 1550 1.112 0.085 0.110 0.155 Ideal number of children 2.304 0.028 1166 1643 1.131 0.012 2.248 2.359 Mothers received medical care at delivery 0.954 0.012 962 1342 1.509 0.013 0.930 0.978 Child having health card, seen 0.651 0.051 188 271 1.477 0.078 0.549 0.753 Child received BCG vaccination 0.955 0.016 188 271 1.075 0.017 0.923 0.987 Child received DPT vaccination (3 doses) 0.726 0.041 188 271 1.268 0.056 0.644 0.808 Child received polio vaccination (3 doses) 0.791 0.032 188 271 1.071 0.040 0.727 0.854 Child received measles vaccination 0.889 0.025 188 271 1.118 0.028 0.839 0.940 Child fully immunized 0.630 0.043 188 271 1.220 0.068 0.545 0.716 Height-for-age (-2SD) 0.055 0.008 854 1186 0.980 0.149 0.039 0.071 Weight-for-height (-2SD) 0.007 0.003 854 1186 1.203 0.506 0.000 0.013 Weight-for-age (-2SD) 0.019 0.005 854 1186 1.048 0.256 0.009 0.029 BMI < 18.5 0.014 0.004 741 1017 0.979 0.310 0.005 0.022 Has heard of HIV/AIDS 0.923 0.015 1174 1652 1.910 0.016 0.893 0.953 Knows about condoms 0.280 0.014 1174 1652 1.103 0.052 0.251 0.309 Knows about limiting partners 0.249 0.015 1174 1652 1.182 0.060 0.219 0.279 Total fertility rate (last 3 years) 1.879 0.068 NA 12761 0.973 0.036 1.744 2.015 Neonatal mortality (last 5 years) 15.122 4.700 972 1352 1.060 0.311 5.722 24.521 Post-neonatal mortality (last 5 years) 6.965 3.128 972 1352 1.233 0.449 0.708 13.222 Infant mortality (last 5 years) 22.087 5.376 972 1352 1.064 0.243 11.335 32.839 Child mortality (last 5 years) 8.375 2.711 975 1355 0.925 0.324 2.953 13.798 Under-five mortality (last 5 years) 30.277 5.820 975 1355 1.005 0.192 18.637 41.917 NA = Not applicable Appendix C | 195 Table C.6 Sampling errors: South Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.698 0.014 1113 1028 1.047 0.021 0.669 0.727 No education 0.236 0.025 1113 1028 1.964 0.106 0.186 0.286 With secondary education or higher 0.233 0.021 1113 1028 1.695 0.092 0.190 0.276 Currently married (in union) 0.955 0.006 1113 1028 0.986 0.006 0.943 0.967 Currently pregnant 0.041 0.005 1639 1520 0.907 0.118 0.032 0.051 Children ever born 1.820 0.127 1639 1520 1.062 0.070 1.565 2.075 Children surviving 1.697 0.121 1639 1520 1.089 0.071 1.455 1.938 Children ever born to women 40-49 3.719 0.162 319 293 1.253 0.044 3.394 4.043 Knowing any contraceptive method 0.997 0.002 1061 981 0.983 0.002 0.993 1.000 Knowing any modern contraceptive method 0.995 0.002 1061 981 0.978 0.002 0.991 0.999 Ever used any contraceptive method 0.909 0.010 1061 981 1.125 0.011 0.889 0.929 Currently using any contraceptive method 0.708 0.015 1061 981 1.073 0.021 0.678 0.738 Currently using a modern method 0.448 0.017 1061 981 1.141 0.039 0.413 0.483 Currently using pill 0.039 0.005 1061 981 0.926 0.142 0.028 0.050 Currently using IUD 0.219 0.014 1061 981 1.116 0.065 0.191 0.247 Currently using condom 0.113 0.011 1061 981 1.102 0.095 0.091 0.134 Currently using injectables 0.005 0.003 1061 981 1.250 0.526 0.000 0.011 Currently using female sterilization 0.061 0.007 1061 981 0.928 0.112 0.047 0.075 Currently using periodic abstinence 0.014 0.003 1061 981 0.959 0.245 0.007 0.021 Currently using withdrawal 0.236 0.015 1061 981 1.167 0.065 0.205 0.266 Obtained method from public sector source 0.652 0.024 490 442 1.112 0.037 0.604 0.700 Want no more children 0.618 0.019 535 492 0.891 0.030 0.581 0.655 Want to delay birth at least 2 years 0.133 0.013 535 492 0.853 0.094 0.108 0.158 Ideal number of children 2.775 0.067 550 505 1.174 0.024 2.642 2.908 Mothers received medical care at delivery 0.887 0.027 594 557 1.699 0.031 0.832 0.942 Child having health card, seen 0.624 0.059 96 89 1.172 0.095 0.506 0.742 Child received BCG vaccination 0.952 0.017 96 89 0.794 0.018 0.917 0.986 Child received DPT vaccination (3 doses) 0.714 0.053 96 89 1.107 0.074 0.609 0.819 Child received polio vaccination (3 doses) 0.706 0.055 96 89 1.149 0.078 0.596 0.816 Child received measles vaccination 0.811 0.064 96 89 1.593 0.079 0.683 0.938 Child fully immunized 0.602 0.064 96 89 1.258 0.106 0.474 0.730 Height-for-age (-2SD) 0.104 0.016 533 499 1.105 0.149 0.073 0.135 Weight-for-height (-2SD) 0.004 0.003 533 499 1.066 0.702 0.000 0.010 Weight-for-age (-2SD) 0.028 0.007 533 499 1.066 0.270 0.013 0.043 BMI < 18.5 0.018 0.006 406 379 0.942 0.343 0.006 0.031 Has heard of HIV/AIDS 0.887 0.019 559 513 1.384 0.021 0.850 0.924 Knows about condoms 0.231 0.020 559 513 1.143 0.088 0.191 0.272 Knows about limiting partners 0.216 0.017 559 513 0.993 0.080 0.181 0.251 Total fertility rate (last 3 years) 2.297 0.159 NA 4158 1.429 0.069 1.979 2.616 Neonatal mortality (last 5 years) 18.870 6.174 592 555 1.126 0.327 6.521 31.219 Post-neonatal mortality (last 5 years) 9.725 3.959 593 556 1.045 0.407 1.807 17.642 Infant mortality (last 5 years) 28.595 8.108 593 556 1.215 0.284 12.379 44.810 Child mortality (last 5 years) 1.944 1.368 592 555 NA 0.704 0.000 4.680 Under-five mortality (last 5 years) 30.483 8.031 593 556 1.215 0.263 14.421 46.545 NA = Not applicable 196 | Appendix C Table C.7 Sampling errors: Central Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.678 0.014 1484 1867 1.185 0.021 0.650 0.707 No education 0.132 0.017 1484 1867 1.892 0.126 0.098 0.165 With secondary education or higher 0.240 0.018 1484 1867 1.582 0.073 0.205 0.276 Currently married (in union) 0.948 0.006 1484 1867 1.101 0.007 0.935 0.961 Currently pregnant 0.039 0.005 2090 2646 1.224 0.137 0.028 0.050 Children ever born 1.773 0.104 2090 2646 1.108 0.059 1.565 1.981 Children surviving 1.626 0.095 2090 2646 1.110 0.058 1.437 1.816 Children ever born to women 40-49 3.431 0.087 497 606 1.085 0.025 3.257 3.606 Knowing any contraceptive method 0.996 0.001 1403 1770 0.391 0.001 0.995 0.997 Knowing any modern contraceptive method 0.994 0.002 1403 1770 0.812 0.002 0.991 0.997 Ever used any contraceptive method 0.924 0.008 1403 1770 1.104 0.008 0.908 0.940 Currently using any contraceptive method 0.742 0.012 1403 1770 1.000 0.016 0.719 0.766 Currently using a modern method 0.466 0.014 1403 1770 1.077 0.031 0.437 0.495 Currently using pill 0.053 0.006 1403 1770 1.044 0.117 0.041 0.066 Currently using IUD 0.252 0.015 1403 1770 1.268 0.058 0.222 0.281 Currently using condom 0.102 0.011 1403 1770 1.308 0.103 0.081 0.124 Currently using injectables 0.004 0.002 1403 1770 1.097 0.463 0.000 0.008 Currently using female sterilization 0.050 0.006 1403 1770 0.953 0.111 0.039 0.061 Currently using periodic abstinence 0.012 0.003 1403 1770 0.886 0.218 0.007 0.017 Currently using withdrawal 0.257 0.015 1403 1770 1.260 0.057 0.228 0.287 Obtained method from public sector source 0.647 0.028 643 828 1.482 0.043 0.591 0.703 Want no more children 0.674 0.017 727 912 0.989 0.026 0.640 0.708 Want to delay birth at least 2 years 0.127 0.015 727 912 1.250 0.122 0.096 0.157 Ideal number of children 2.335 0.036 762 955 1.114 0.015 2.264 2.406 Mothers received medical care at delivery 0.910 0.023 632 813 1.640 0.026 0.863 0.957 Child having health card, seen 0.575 0.067 104 138 1.410 0.117 0.440 0.709 Child received BCG vaccination 0.956 0.020 104 138 1.001 0.021 0.917 0.995 Child received DPT vaccination (3 doses) 0.721 0.051 104 138 1.176 0.070 0.620 0.823 Child received polio vaccination (3 doses) 0.736 0.044 104 138 1.037 0.060 0.648 0.824 Child received measles vaccination 0.903 0.035 104 138 1.110 0.039 0.834 0.973 Child fully immunized 0.610 0.055 104 138 1.164 0.091 0.499 0.720 Height-for-age (-2SD) 0.095 0.011 562 727 0.895 0.120 0.072 0.117 Weight-for-height (-2SD) 0.008 0.005 562 727 1.268 0.568 0.000 0.018 Weight-for-age (-2SD) 0.029 0.007 562 727 0.994 0.239 0.015 0.043 BMI < 18.5 0.030 0.008 469 601 1.007 0.262 0.014 0.046 Has heard of HIV/AIDS 0.935 0.012 768 962 1.314 0.012 0.912 0.958 Knows about condoms 0.191 0.015 768 962 1.069 0.079 0.161 0.221 Knows about limiting partners 0.225 0.020 768 962 1.335 0.090 0.184 0.265 Total fertility rate (last 3 years) 1.864 0.098 NA 7702 1.165 0.053 1.667 2.060 Neonatal mortality (last 5 years) 10.372 4.298 640 829 1.103 0.414 1.775 18.968 Post-neonatal mortality (last 5 years) 10.169 4.132 640 829 0.976 0.406 1.905 18.433 Infant mortality (last 5 years) 20.541 6.117 640 829 1.010 0.298 8.307 32.774 Child mortality (last 5 years) 12.494 4.432 643 834 1.071 0.355 3.629 21.359 Under-five mortality (last 5 years) 32.778 7.288 643 834 1.008 0.222 18.203 47.354 NA = Not applicable Appendix C | 197 Table C.8 Sampling errors: North Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.491 0.019 901 590 1.122 0.038 0.453 0.528 No education 0.196 0.032 901 590 2.420 0.163 0.132 0.260 With secondary education or higher 0.234 0.024 901 590 1.728 0.104 0.185 0.282 Currently married (in union) 0.950 0.007 901 590 0.931 0.007 0.937 0.964 Currently pregnant 0.029 0.005 1275 868 1.079 0.183 0.019 0.040 Children ever born 1.825 0.120 1275 868 0.877 0.066 1.584 2.065 Children surviving 1.690 0.115 1275 868 0.909 0.068 1.460 1.920 Children ever born to women 40-49 3.405 0.154 339 212 1.635 0.045 3.097 3.714 Knowing any contraceptive method 0.998 0.002 852 561 1.348 0.002 0.994 1.000 Knowing any modern contraceptive method 0.998 0.002 852 561 1.348 0.002 0.994 1.000 Ever used any contraceptive method 0.920 0.012 852 561 1.284 0.013 0.896 0.943 Currently using any contraceptive method 0.719 0.015 852 561 0.946 0.020 0.690 0.748 Currently using a modern method 0.325 0.018 852 561 1.091 0.054 0.290 0.360 Currently using pill 0.031 0.007 852 561 1.117 0.212 0.018 0.045 Currently using IUD 0.108 0.014 852 561 1.277 0.126 0.081 0.135 Currently using condom 0.083 0.011 852 561 1.171 0.133 0.061 0.105 Currently using injectables 0.000 0.000 852 561 NA NA 0.000 0.000 Currently using female sterilization 0.094 0.009 852 561 0.904 0.096 0.076 0.112 Currently using periodic abstinence 0.015 0.004 852 561 1.049 0.290 0.006 0.024 Currently using withdrawal 0.375 0.015 852 561 0.905 0.040 0.345 0.405 Obtained method from public sector source 0.540 0.040 284 183 1.360 0.075 0.459 0.620 Want no more children 0.634 0.027 433 284 1.153 0.042 0.580 0.687 Want to delay birth at least 2 years 0.107 0.014 433 284 0.924 0.128 0.080 0.135 Ideal number of children 2.460 0.060 454 296 1.299 0.024 2.340 2.580 Mothers received medical care at delivery 0.865 0.065 368 252 2.957 0.075 0.734 0.995 Child having health card, seen 0.647 0.081 64 41 1.320 0.125 0.485 0.809 Child received BCG vaccination 0.915 0.046 64 41 1.311 0.051 0.822 1.000 Child received DPT vaccination (3 doses) 0.707 0.079 64 41 1.362 0.112 0.549 0.866 Child received polio vaccination (3 doses) 0.710 0.071 64 41 1.233 0.101 0.568 0.853 Child received measles vaccination 0.845 0.053 64 41 1.144 0.062 0.739 0.950 Child fully immunized 0.601 0.083 64 41 1.320 0.139 0.434 0.767 Height-for-age (-2SD) 0.130 0.033 323 218 1.608 0.254 0.064 0.195 Weight-for-height (-2SD) 0.007 0.004 323 218 0.877 0.579 0.000 0.015 Weight-for-age (-2SD) 0.022 0.010 323 218 1.272 0.461 0.002 0.043 BMI < 18.5 0.014 0.008 257 171 1.102 0.577 0.000 0.030 Has heard of HIV/AIDS 0.885 0.032 456 298 2.128 0.036 0.821 0.948 Knows about condoms 0.179 0.023 456 298 1.286 0.129 0.133 0.225 Knows about limiting partners 0.175 0.022 456 298 1.228 0.125 0.131 0.219 Total fertility rate (last 3 years) 1.942 0.119 NA 2219 1.145 0.061 1.704 2.180 Neonatal mortality (last 5 years) 20.164 7.885 374 258 1.136 0.391 4.394 35.935 Post-neonatal mortality (last 5 years) 13.800 6.992 375 259 1.181 0.507 0.000 27.784 Infant mortality (last 5 years) 33.964 11.639 375 259 1.305 0.343 10.685 57.243 Child mortality (last 5 years) 14.277 8.357 375 259 1.213 0.585 0.000 30.991 Under-five mortality (last 5 years) 47.756 15.686 376 260 1.452 0.328 16.383 79.128 NA = Not applicable 198 | Appendix C Table C.9 Sampling errors: East Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.604 0.013 2246 1305 1.248 0.021 0.578 0.630 No education 0.518 0.020 2246 1305 1.895 0.039 0.478 0.558 With secondary education or higher 0.142 0.013 2246 1305 1.817 0.094 0.116 0.169 Currently married (in union) 0.961 0.004 2246 1305 0.966 0.004 0.953 0.969 Currently pregnant 0.069 0.005 3505 2064 0.959 0.072 0.059 0.079 Children ever born 2.374 0.145 3505 2064 1.064 0.061 2.084 2.664 Children surviving 2.135 0.134 3505 2064 1.096 0.063 1.868 2.402 Children ever born to women 40-49 6.071 0.215 505 287 1.437 0.035 5.640 6.501 Knowing any contraceptive method 0.997 0.001 2156 1253 1.037 0.001 0.994 0.999 Knowing any modern contraceptive method 0.993 0.002 2156 1253 1.124 0.002 0.989 0.997 Ever used any contraceptive method 0.785 0.016 2156 1253 1.848 0.021 0.752 0.818 Currently using any contraceptive method 0.579 0.016 2156 1253 1.529 0.028 0.546 0.611 Currently using a modern method 0.314 0.013 2156 1253 1.252 0.040 0.288 0.339 Currently using pill 0.049 0.005 2156 1253 1.154 0.110 0.038 0.059 Currently using IUD 0.143 0.008 2156 1253 1.081 0.057 0.127 0.159 Currently using condom 0.074 0.006 2156 1253 1.151 0.088 0.061 0.087 Currently using injectables 0.010 0.002 2156 1253 1.049 0.230 0.005 0.014 Currently using female sterilization 0.037 0.004 2156 1253 1.031 0.114 0.028 0.045 Currently using periodic abstinence 0.005 0.002 2156 1253 1.157 0.342 0.002 0.009 Currently using withdrawal 0.240 0.014 2156 1253 1.510 0.058 0.212 0.267 Obtained method from public sector source 0.621 0.020 697 394 1.111 0.033 0.580 0.661 Want no more children 0.585 0.015 1089 635 1.035 0.026 0.554 0.616 Want to delay birth at least 2 years 0.171 0.011 1089 635 0.991 0.066 0.149 0.194 Ideal number of children 3.115 0.062 1097 639 1.408 0.020 2.990 3.240 Mothers received medical care at delivery 0.597 0.026 1977 1168 1.859 0.043 0.546 0.649 Child having health card, seen 0.308 0.033 355 210 1.352 0.107 0.242 0.374 Child received BCG vaccination 0.686 0.035 355 210 1.428 0.052 0.615 0.756 Child received DPT vaccination (3 doses) 0.444 0.036 355 210 1.380 0.082 0.371 0.516 Child received polio vaccination (3 doses) 0.522 0.034 355 210 1.272 0.065 0.454 0.589 Child received measles vaccination 0.582 0.038 355 210 1.456 0.066 0.505 0.659 Child fully immunized 0.348 0.034 355 210 1.346 0.098 0.280 0.416 Height-for-age (-2SD) 0.225 0.015 1756 1038 1.392 0.066 0.195 0.254 Weight-for-height (-2SD) 0.008 0.002 1756 1038 0.989 0.262 0.004 0.012 Weight-for-age (-2SD) 0.077 0.010 1756 1038 1.432 0.126 0.057 0.096 BMI < 18.5 0.017 0.005 1049 615 1.394 0.331 0.006 0.027 Has heard of HIV/AIDS 0.691 0.020 1121 653 1.451 0.029 0.651 0.731 Knows about condoms 0.116 0.010 1121 653 1.028 0.085 0.097 0.136 Knows about limiting partners 0.131 0.011 1121 653 1.088 0.084 0.109 0.153 Total fertility rate (last 3 years) 3.654 0.162 NA 5968 1.383 0.044 3.331 3.978 Neonatal mortality (last 5 years) 23.229 3.679 1978 1170 0.986 0.158 15.870 30.588 Post-neonatal mortality (last 5 years) 18.202 3.247 1978 1170 1.095 0.178 11.709 24.696 Infant mortality (last 5 years) 41.431 5.175 1978 1170 1.103 0.125 31.081 51.781 Child mortality (last 5 years) 7.467 2.118 1982 1172 1.171 0.284 3.231 11.703 Under-five mortality (last 5 years) 48.589 5.629 1982 1172 1.161 0.116 37.331 59.846 NA = Not applicable Appendix C | 199 Table C.10 Sampling errors: İstanbul, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.978 0.003 1163 1470 0.770 0.003 0.971 0.984 No education 0.142 0.015 1163 1470 1.436 0.104 0.112 0.171 With secondary education or higher 0.305 0.019 1163 1470 1.375 0.061 0.268 0.342 Currently married (in union) 0.956 0.007 1163 1470 1.180 0.007 0.941 0.970 Currently pregnant 0.029 0.004 1753 2014 0.986 0.151 0.020 0.038 Children ever born 1.614 0.061 1753 2014 0.577 0.038 1.492 1.736 Children surviving 1.486 0.056 1753 2014 0.583 0.038 1.374 1.599 Children ever born to women 40-49 3.094 0.119 325 424 1.167 0.038 2.857 3.331 Knowing any contraceptive method 0.999 0.001 1114 1405 0.921 0.001 0.998 1.000 Knowing any modern contraceptive method 0.999 0.001 1114 1405 0.921 0.001 0.998 1.000 Ever used any contraceptive method 0.931 0.008 1114 1405 1.024 0.008 0.915 0.946 Currently using any contraceptive method 0.761 0.013 1114 1405 0.997 0.017 0.735 0.786 Currently using a modern method 0.459 0.016 1114 1405 1.102 0.036 0.426 0.492 Currently using pill 0.055 0.008 1114 1405 1.167 0.146 0.039 0.071 Currently using IUD 0.216 0.012 1114 1405 0.969 0.055 0.193 0.240 Currently using condom 0.119 0.011 1114 1405 1.097 0.090 0.098 0.140 Currently using injectables 0.002 0.001 1114 1405 0.927 0.579 0.000 0.005 Currently using female sterilization 0.060 0.007 1114 1405 1.027 0.122 0.045 0.075 Currently using periodic abstinence 0.015 0.004 1114 1405 1.012 0.249 0.007 0.022 Currently using withdrawal 0.278 0.015 1114 1405 1.137 0.055 0.247 0.308 Obtained method from public sector source 0.408 0.024 509 651 1.097 0.059 0.360 0.456 Want no more children 0.626 0.020 542 682 0.978 0.033 0.585 0.666 Want to delay birth at least 2 years 0.140 0.015 542 682 1.039 0.111 0.109 0.171 Ideal number of children 2.339 0.043 563 711 1.186 0.018 2.253 2.426 Mothers received medical care at delivery 0.953 0.013 519 643 1.096 0.013 0.927 0.978 Child having health card, seen 0.704 0.047 98 127 1.026 0.067 0.609 0.798 Child received BCG vaccination 0.923 0.030 98 127 1.106 0.032 0.864 0.982 Child received DPT vaccination (3 doses) 0.725 0.048 98 127 1.059 0.066 0.630 0.820 Child received polio vaccination (3 doses) 0.782 0.042 98 127 1.013 0.054 0.698 0.866 Child received measles vaccination 0.858 0.036 98 127 1.022 0.042 0.786 0.929 Child fully immunized 0.623 0.053 98 127 1.086 0.085 0.517 0.729 Height-for-age (-2SD) 0.061 0.012 461 572 0.957 0.195 0.037 0.084 Weight-for-height (-2SD) 0.007 0.004 461 572 1.025 0.587 0.000 0.014 Weight-for-age (-2SD) 0.013 0.005 461 572 0.998 0.406 0.002 0.024 BMI < 18.5 0.014 0.006 395 491 0.993 0.428 0.002 0.025 Has heard of HIV/AIDS 0.962 0.008 568 715 0.960 0.008 0.947 0.978 Knows about condoms 0.321 0.024 568 715 1.248 0.076 0.272 0.370 Knows about limiting partners 0.318 0.019 568 715 0.955 0.059 0.280 0.355 Total fertility rate (last 3 years) 1.831 0.093 NA 5793 0.978 0.051 1.645 2.017 Neonatal mortality (last 5 years) 15.568 5.630 522 645 1.038 0.362 4.308 26.828 Post-neonatal mortality (last 5 years) 3.720 2.656 522 645 1.079 0.714 0.000 9.033 Infant mortality (last 5 years) 19.288 6.193 522 645 1.047 0.321 6.902 31.675 Child mortality (last 5 years) 13.023 4.831 525 648 0.973 0.371 3.361 22.685 Under-five mortality (last 5 years) 32.060 7.455 525 648 0.969 0.233 17.150 46.970 NA = Not applicable 200 | Appendix C Table C.11 Sampling errors: West Marmara Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.620 0.028 384 348 1.112 0.044 0.565 0.675 No education 0.103 0.029 384 348 1.863 0.281 0.045 0.161 With secondary education or higher 0.257 0.030 384 348 1.323 0.115 0.198 0.316 Currently married (in union) 0.945 0.012 384 348 1.064 0.013 0.920 0.969 Currently pregnant 0.028 0.009 520 465 1.225 0.330 0.009 0.046 Children ever born 1.505 0.092 520 465 0.651 0.061 1.321 1.688 Children surviving 1.419 0.091 520 465 0.687 0.064 1.237 1.600 Children ever born to women 40-49 2.512 0.136 127 120 1.191 0.054 2.240 2.783 Knowing any contraceptive method 0.998 0.002 363 329 0.945 0.002 0.993 1.000 Knowing any modern contraceptive method 0.991 0.007 363 329 1.457 0.007 0.976 1.000 Ever used any contraceptive method 0.944 0.014 363 329 1.116 0.014 0.917 0.971 Currently using any contraceptive method 0.779 0.027 363 329 1.218 0.034 0.726 0.832 Currently using a modern method 0.436 0.030 363 329 1.152 0.069 0.376 0.496 Currently using pill 0.032 0.009 363 329 0.974 0.280 0.014 0.051 Currently using IUD 0.197 0.020 363 329 0.947 0.100 0.157 0.236 Currently using condom 0.139 0.015 363 329 0.798 0.104 0.110 0.168 Currently using injectables 0.002 0.002 363 329 0.940 0.999 0.000 0.007 Currently using female sterilization 0.059 0.013 363 329 1.079 0.227 0.032 0.085 Currently using periodic abstinence 0.017 0.006 363 329 0.916 0.369 0.004 0.029 Currently using withdrawal 0.310 0.021 363 329 0.858 0.067 0.268 0.351 Obtained method from public sector source 0.559 0.058 161 143 1.465 0.103 0.444 0.674 Want no more children 0.671 0.048 193 173 1.416 0.072 0.575 0.767 Want to delay birth at least 2 years 0.127 0.031 193 173 1.271 0.240 0.066 0.189 Ideal number of children 2.147 0.042 199 178 1.021 0.019 2.064 2.230 Mothers received medical care at delivery 0.978 0.013 139 124 1.059 0.014 0.951 1.000 Child having health card, seen 0.659 0.106 28 24 1.129 0.160 0.447 0.870 Child received BCG vaccination 1.000 0.000 28 24 NA 0.000 1.000 1.000 Child received DPT vaccination (3 doses) 0.839 0.099 28 24 1.378 0.118 0.641 1.000 Child received polio vaccination (3 doses) 0.919 0.049 28 24 0.934 0.054 0.820 1.000 Child received measles vaccination 0.934 0.066 28 24 1.364 0.071 0.802 1.000 Child fully immunized 0.839 0.099 28 24 1.378 0.118 0.641 1.000 Height-for-age (-2SD) 0.073 0.018 127 113 0.824 0.253 0.036 0.110 Weight-for-height (-2SD) 0.007 0.007 127 113 0.893 0.948 0.000 0.020 Weight-for-age (-2SD) 0.063 0.023 127 113 1.084 0.371 0.016 0.109 BMI < 18.5 0.032 0.019 114 101 1.133 0.593 0.000 0.070 Has heard of HIV/AIDS 0.920 0.027 199 178 1.417 0.030 0.866 0.975 Knows about condoms 0.241 0.030 199 178 0.997 0.126 0.181 0.302 Knows about limiting partners 0.197 0.036 199 178 1.260 0.181 0.126 0.269 NA = Not applicable Appendix C | 201 Table C.12 Sampling errors: Aegean Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.617 0.022 549 1157 1.036 0.035 0.574 0.660 No education 0.161 0.021 549 1157 1.350 0.132 0.119 0.203 With secondary education or higher 0.256 0.037 549 1157 1.959 0.143 0.183 0.329 Currently married (in union) 0.933 0.009 549 1157 0.883 0.010 0.914 0.952 Currently pregnant 0.035 0.010 712 1502 1.515 0.301 0.014 0.056 Children ever born 1.667 0.111 712 1502 1.268 0.066 1.446 1.889 Children surviving 1.542 0.099 712 1502 1.264 0.064 1.343 1.740 Children ever born to women 40-49 2.756 0.150 204 425 1.523 0.054 2.456 3.056 Knowing any contraceptive method 0.995 0.000 513 1079 0.074 0.000 0.994 0.995 Knowing any modern contraceptive method 0.986 0.002 513 1079 0.436 0.002 0.981 0.990 Ever used any contraceptive method 0.906 0.011 513 1079 0.845 0.012 0.885 0.928 Currently using any contraceptive method 0.702 0.018 513 1079 0.871 0.025 0.667 0.738 Currently using a modern method 0.450 0.014 513 1079 0.638 0.031 0.422 0.478 Currently using pill 0.051 0.008 513 1079 0.797 0.151 0.036 0.067 Currently using IUD 0.205 0.015 513 1079 0.861 0.075 0.174 0.235 Currently using condom 0.129 0.015 513 1079 1.033 0.119 0.098 0.160 Currently using injectables 0.000 0.000 513 1079 NA NA 0.000 0.000 Currently using female sterilization 0.056 0.011 513 1079 1.066 0.194 0.034 0.077 Currently using periodic abstinence 0.007 0.004 513 1079 1.005 0.524 0.000 0.015 Currently using withdrawal 0.240 0.023 513 1079 1.224 0.096 0.194 0.286 Obtained method from public sector source 0.593 0.048 233 489 1.495 0.081 0.497 0.690 Want no more children 0.667 0.040 259 539 1.365 0.060 0.587 0.747 Want to delay birth at least 2 years 0.099 0.016 259 539 0.887 0.167 0.066 0.132 Ideal number of children 2.232 0.035 283 587 0.870 0.016 2.161 2.302 Mothers received medical care at delivery 0.946 0.032 181 392 1.413 0.034 0.881 1.000 Child having health card, seen 0.538 0.122 31 80 1.505 0.227 0.293 0.782 Child received BCG vaccination 0.971 0.028 31 80 1.017 0.029 0.916 1.000 Child received DPT vaccination (3 doses) 0.671 0.109 31 80 1.427 0.163 0.452 0.889 Child received polio vaccination (3 doses) 0.671 0.074 31 80 0.962 0.110 0.524 0.818 Child received measles vaccination 0.898 0.044 31 80 0.888 0.049 0.810 0.985 Child fully immunized 0.495 0.106 31 80 1.297 0.213 0.284 0.706 Height-for-age (-2SD) 0.066 0.017 160 346 0.863 0.251 0.033 0.099 Weight-for-height (-2SD) 0.008 0.008 160 346 1.192 1.027 0.000 0.024 Weight-for-age (-2SD) 0.012 0.009 160 346 1.051 0.734 0.000 0.031 BMI < 18.5 0.008 0.008 138 294 1.029 0.981 0.000 0.023 Has heard of HIV/AIDS 0.857 0.038 284 588 1.808 0.044 0.782 0.932 Knows about condoms 0.219 0.023 284 588 0.923 0.104 0.174 0.265 Knows about limiting partners 0.186 0.029 284 588 1.265 0.158 0.127 0.244 NA = Not applicable 202 | Appendix C Table C.13 Sampling errors: East Marmara Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.747 0.026 556 710 1.436 0.035 0.694 0.800 No education 0.136 0.030 556 710 2.094 0.224 0.075 0.197 With secondary education or higher 0.295 0.018 556 710 0.923 0.061 0.259 0.331 Currently married (in union) 0.942 0.010 556 710 0.985 0.010 0.922 0.961 Currently pregnant 0.041 0.008 711 986 1.015 0.184 0.026 0.056 Children ever born 1.720 0.208 711 986 1.597 0.121 1.305 2.136 Children surviving 1.603 0.174 711 986 1.449 0.109 1.254 1.951 Children ever born to women 40-49 3.253 0.112 183 231 0.998 0.034 3.030 3.476 Knowing any contraceptive method 1.000 0.000 524 669 NA 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 524 669 NA 0.000 1.000 1.000 Ever used any contraceptive method 0.928 0.013 524 669 1.158 0.014 0.902 0.954 Currently using any contraceptive method 0.720 0.019 524 669 0.990 0.027 0.681 0.759 Currently using a modern method 0.454 0.023 524 669 1.041 0.050 0.409 0.500 Currently using pill 0.057 0.008 524 669 0.833 0.149 0.040 0.073 Currently using IUD 0.214 0.015 524 669 0.853 0.071 0.184 0.245 Currently using condom 0.110 0.015 524 669 1.079 0.134 0.080 0.139 Currently using injectables 0.003 0.002 524 669 0.876 0.722 0.000 0.007 Currently using female sterilization 0.060 0.009 524 669 0.902 0.156 0.041 0.079 Currently using periodic abstinence 0.004 0.002 524 669 0.794 0.526 0.000 0.009 Currently using withdrawal 0.252 0.023 524 669 1.217 0.092 0.206 0.298 Obtained method from public sector source 0.625 0.038 241 304 1.223 0.061 0.549 0.702 Want no more children 0.631 0.035 278 353 1.216 0.056 0.560 0.701 Want to delay birth at least 2 years 0.148 0.027 278 353 1.266 0.183 0.094 0.202 Ideal number of children 2.377 0.073 288 369 1.202 0.031 2.230 2.523 Mothers received medical care at delivery 0.944 0.031 227 328 2.000 0.033 0.883 1.000 Child having health card, seen 0.579 0.128 46 63 1.822 0.220 0.324 0.835 Child received BCG vaccination 0.987 0.012 46 63 0.788 0.013 0.963 1.000 Child received DPT vaccination (3 doses) 0.697 0.049 46 63 0.754 0.070 0.599 0.796 Child received polio vaccination (3 doses) 0.851 0.046 46 63 0.904 0.054 0.760 0.943 Child received measles vaccination 0.910 0.061 46 63 1.494 0.067 0.788 1.000 Child fully immunized 0.671 0.050 46 63 0.751 0.075 0.571 0.771 Height-for-age (-2SD) 0.034 0.014 197 284 1.061 0.408 0.006 0.062 Weight-for-height (-2SD) 0.016 0.012 197 284 1.437 0.740 0.000 0.041 Weight-for-age (-2SD) 0.030 0.014 197 284 1.254 0.473 0.002 0.059 BMI < 18.5 0.029 0.015 170 231 1.184 0.510 0.000 0.059 Has heard of HIV/AIDS 0.923 0.018 292 373 1.177 0.020 0.886 0.960 Knows about condoms 0.274 0.021 292 373 0.806 0.077 0.232 0.316 Knows about limiting partners 0.234 0.039 292 373 1.571 0.167 0.156 0.312 NA = Not applicable Appendix C | 203 Table C.14 Sampling errors: West Anatolia Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.846 0.014 466 784 0.806 0.016 0.819 0.873 No education 0.120 0.027 466 784 1.815 0.228 0.065 0.174 With secondary education or higher 0.312 0.035 466 784 1.642 0.113 0.242 0.383 Currently married (in union) 0.947 0.011 466 784 1.042 0.011 0.925 0.969 Currently pregnant 0.032 0.007 704 1141 1.069 0.227 0.018 0.047 Children ever born 1.651 0.146 704 1141 0.986 0.088 1.359 1.942 Children surviving 1.549 0.135 704 1141 0.980 0.087 1.280 1.819 Children ever born to women 40-49 3.101 0.107 146 242 0.786 0.035 2.887 3.316 Knowing any contraceptive method 1.000 0.000 442 742 NA 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 442 742 NA 0.000 1.000 1.000 Ever used any contraceptive method 0.947 0.012 442 742 1.123 0.013 0.923 0.971 Currently using any contraceptive method 0.793 0.018 442 742 0.938 0.023 0.757 0.830 Currently using a modern method 0.514 0.026 442 742 1.097 0.051 0.462 0.566 Currently using pill 0.048 0.010 442 742 0.991 0.210 0.028 0.068 Currently using IUD 0.276 0.027 442 742 1.284 0.099 0.222 0.331 Currently using condom 0.125 0.022 442 742 1.383 0.174 0.082 0.169 Currently using injectables 0.007 0.004 442 742 1.011 0.575 0.000 0.015 Currently using female sterilization 0.049 0.009 442 742 0.877 0.183 0.031 0.067 Currently using periodic abstinence 0.018 0.006 442 742 0.874 0.304 0.007 0.030 Currently using withdrawal 0.257 0.027 442 742 1.303 0.106 0.202 0.311 Obtained method from public sector source 0.616 0.052 219 381 1.563 0.084 0.513 0.719 Want no more children 0.685 0.023 234 386 0.751 0.033 0.639 0.731 Want to delay birth at least 2 years 0.131 0.031 234 386 1.422 0.240 0.068 0.194 Ideal number of children 2.278 0.056 247 408 1.011 0.025 2.166 2.389 Mothers received medical care at delivery 0.930 0.031 207 349 1.600 0.034 0.867 0.993 Child having health card, seen 0.662 0.116 33 57 1.404 0.176 0.429 0.894 Child received BCG vaccination 0.970 0.030 33 57 1.006 0.031 0.910 1.000 Child received DPT vaccination (3 doses) 0.819 0.094 33 57 1.409 0.115 0.630 1.000 Child received polio vaccination (3 doses) 0.808 0.076 33 57 1.112 0.094 0.656 0.960 Child received measles vaccination 0.939 0.060 33 57 1.039 0.063 0.820 1.000 Child fully immunized 0.636 0.107 33 57 1.221 0.167 0.423 0.850 Height-for-age (-2SD) 0.098 0.020 184 311 0.852 0.200 0.059 0.137 Weight-for-height (-2SD) 0.004 0.004 184 311 0.840 1.017 0.000 0.011 Weight-for-age (-2SD) 0.027 0.008 184 311 0.689 0.302 0.011 0.043 BMI < 18.5 0.042 0.012 157 268 0.758 0.286 0.018 0.067 Has heard of HIV/AIDS 0.942 0.016 250 413 1.092 0.017 0.910 0.974 Knows about condoms 0.221 0.027 250 413 1.037 0.124 0.166 0.275 Knows about limiting partners 0.266 0.032 250 413 1.141 0.120 0.202 0.330 NA = Not applicable 204 | Appendix C Table C.15 Sampling errors: Mediterranean Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.698 0.014 1113 1028 1.047 0.021 0.669 0.727 No education 0.236 0.025 1113 1028 1.964 0.106 0.186 0.286 With secondary education or higher 0.233 0.021 1113 1028 1.695 0.092 0.190 0.276 Currently married (in union) 0.955 0.006 1113 1028 0.986 0.006 0.943 0.967 Currently pregnant 0.041 0.005 1639 1520 0.907 0.118 0.032 0.051 Children ever born 1.820 0.127 1639 1520 1.062 0.070 1.565 2.075 Children surviving 1.697 0.121 1639 1520 1.089 0.071 1.455 1.938 Children ever born to women 40-49 3.719 0.162 319 293 1.253 0.044 3.394 4.043 Knowing any contraceptive method 0.997 0.002 1061 981 0.983 0.002 0.993 1.000 Knowing any modern contraceptive method 0.995 0.002 1061 981 0.978 0.002 0.991 0.999 Ever used any contraceptive method 0.909 0.010 1061 981 1.125 0.011 0.889 0.929 Currently using any contraceptive method 0.708 0.015 1061 981 1.073 0.021 0.678 0.738 Currently using a modern method 0.448 0.017 1061 981 1.141 0.039 0.413 0.483 Currently using pill 0.039 0.005 1061 981 0.926 0.142 0.028 0.050 Currently using IUD 0.219 0.014 1061 981 1.116 0.065 0.191 0.247 Currently using condom 0.113 0.011 1061 981 1.102 0.095 0.091 0.134 Currently using injectables 0.005 0.003 1061 981 1.250 0.526 0.000 0.011 Currently using female sterilization 0.061 0.007 1061 981 0.928 0.112 0.047 0.075 Currently using periodic abstinence 0.014 0.003 1061 981 0.959 0.245 0.007 0.021 Currently using withdrawal 0.236 0.015 1061 981 1.167 0.065 0.205 0.266 Obtained method from public sector source 0.652 0.024 490 442 1.112 0.037 0.604 0.700 Want no more children 0.618 0.019 535 492 0.891 0.030 0.581 0.655 Want to delay birth at least 2 years 0.133 0.013 535 492 0.853 0.094 0.108 0.158 Ideal number of children 2.775 0.067 550 505 1.174 0.024 2.642 2.908 Mothers received medical care at delivery 0.887 0.027 594 557 1.699 0.031 0.832 0.942 Child having health card, seen 0.624 0.059 96 89 1.172 0.095 0.506 0.742 Child received BCG vaccination 0.952 0.017 96 89 0.794 0.018 0.917 0.986 Child received DPT vaccination (3 doses) 0.714 0.053 96 89 1.107 0.074 0.609 0.819 Child received polio vaccination (3 doses) 0.706 0.055 96 89 1.149 0.078 0.596 0.816 Child received measles vaccination 0.811 0.064 96 89 1.593 0.079 0.683 0.938 Child fully immunized 0.602 0.064 96 89 1.258 0.106 0.474 0.730 Height-for-age (-2SD) 0.104 0.016 533 499 1.105 0.149 0.073 0.135 Weight-for-height (-2SD) 0.004 0.003 533 499 1.066 0.702 0.000 0.010 Weight-for-age (-2SD) 0.028 0.007 533 499 1.066 0.270 0.013 0.043 BMI < 18.5 0.018 0.006 406 379 0.942 0.343 0.006 0.031 Has heard of HIV/AIDS 0.887 0.019 559 513 1.384 0.021 0.850 0.924 Knows about condoms 0.231 0.020 559 513 1.143 0.088 0.191 0.272 Knows about limiting partners 0.216 0.017 559 513 0.993 0.080 0.181 0.251 NA = Not applicable Appendix C | 205 Table C.16 Sampling errors: Central Anatolia Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.599 0.019 502 471 0.846 0.031 0.562 0.636 No education 0.180 0.026 502 471 1.517 0.145 0.128 0.232 With secondary education or higher 0.185 0.027 502 471 1.536 0.144 0.131 0.238 Currently married (in union) 0.947 0.011 502 471 1.121 0.012 0.925 0.970 Currently pregnant 0.046 0.009 717 671 1.091 0.200 0.027 0.064 Children ever born 1.940 0.155 717 671 0.827 0.080 1.631 2.249 Children surviving 1.774 0.140 717 671 0.823 0.079 1.495 2.054 Children ever born to women 40-49 3.978 0.167 165 155 1.080 0.042 3.644 4.313 Knowing any contraceptive method 0.996 0.003 474 446 0.927 0.003 0.991 1.000 Knowing any modern contraceptive method 0.994 0.003 474 446 0.944 0.003 0.988 1.000 Ever used any contraceptive method 0.906 0.013 474 446 0.992 0.015 0.879 0.933 Currently using any contraceptive method 0.721 0.023 474 446 1.109 0.032 0.676 0.767 Currently using a modern method 0.463 0.020 474 446 0.884 0.044 0.422 0.504 Currently using pill 0.048 0.011 474 446 1.141 0.233 0.026 0.071 Currently using IUD 0.262 0.022 474 446 1.092 0.084 0.218 0.306 Currently using condom 0.092 0.011 474 446 0.859 0.124 0.069 0.115 Currently using injectables 0.000 0.000 474 446 NA NA 0.000 0.000 Currently using female sterilization 0.058 0.010 474 446 0.882 0.163 0.039 0.077 Currently using periodic abstinence 0.013 0.003 474 446 0.535 0.217 0.007 0.018 Currently using withdrawal 0.240 0.015 474 446 0.747 0.061 0.211 0.270 Obtained method from public sector source 0.716 0.033 224 206 1.090 0.046 0.650 0.782 Want no more children 0.633 0.029 236 225 0.921 0.046 0.575 0.691 Want to delay birth at least 2 years 0.161 0.024 236 225 1.018 0.152 0.112 0.210 Ideal number of children 2.524 0.084 249 238 1.289 0.033 2.356 2.692 Mothers received medical care at delivery 0.860 0.050 243 232 1.746 0.058 0.760 0.960 Child having health card, seen 0.582 0.095 43 42 1.259 0.163 0.393 0.772 Child received BCG vaccination 0.914 0.045 43 42 1.070 0.049 0.824 1.000 Child received DPT vaccination (3 doses) 0.699 0.087 43 42 1.246 0.124 0.526 0.872 Child received polio vaccination (3 doses) 0.727 0.074 43 42 1.097 0.102 0.579 0.875 Child received measles vaccination 0.886 0.051 43 42 1.061 0.057 0.784 0.988 Child fully immunized 0.642 0.077 43 42 1.055 0.120 0.488 0.796 Height-for-age (-2SD) 0.096 0.017 214 204 0.811 0.176 0.062 0.129 Weight-for-height (-2SD) 0.004 0.004 214 204 0.921 0.983 0.000 0.012 Weight-for-age (-2SD) 0.024 0.009 214 204 0.897 0.390 0.005 0.042 BMI < 18.5 0.010 0.007 173 164 0.944 0.710 0.000 0.024 Has heard of HIV/AIDS 0.951 0.014 250 239 1.002 0.014 0.923 0.978 Knows about condoms 0.168 0.026 250 239 1.112 0.157 0.115 0.221 Knows about limiting partners 0.176 0.020 250 239 0.808 0.111 0.137 0.216 NA = Not applicable 206 | Appendix C Table C.17 Sampling errors: West Black Sea Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.510 0.023 615 513 1.136 0.045 0.464 0.556 No education 0.124 0.022 615 513 1.619 0.174 0.081 0.167 With secondary education or higher 0.201 0.025 615 513 1.549 0.125 0.151 0.251 Currently married (in union) 0.960 0.006 615 513 0.703 0.006 0.949 0.971 Currently pregnant 0.026 0.005 882 745 1.038 0.212 0.015 0.037 Children ever born 1.837 0.139 882 745 0.886 0.076 1.558 2.115 Children surviving 1.660 0.123 882 745 0.870 0.074 1.415 1.905 Children ever born to women 40-49 3.375 0.173 235 194 1.376 0.051 3.029 3.722 Knowing any contraceptive method 1.000 0.000 585 492 NA 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 585 492 NA 0.000 1.000 1.000 Ever used any contraceptive method 0.922 0.011 585 492 0.960 0.012 0.900 0.943 Currently using any contraceptive method 0.718 0.016 585 492 0.854 0.022 0.686 0.750 Currently using a modern method 0.381 0.020 585 492 0.984 0.052 0.341 0.420 Currently using pill 0.037 0.009 585 492 1.167 0.245 0.019 0.056 Currently using IUD 0.157 0.023 585 492 1.541 0.148 0.110 0.203 Currently using condom 0.080 0.014 585 492 1.206 0.170 0.053 0.107 Currently using injectables 0.002 0.002 585 492 1.003 0.998 0.000 0.005 Currently using female sterilization 0.097 0.014 585 492 1.106 0.140 0.070 0.124 Currently using periodic abstinence 0.006 0.003 585 492 0.996 0.531 0.000 0.012 Currently using withdrawal 0.324 0.017 585 492 0.881 0.053 0.290 0.359 Obtained method from public sector source 0.584 0.052 225 188 1.590 0.090 0.479 0.688 Want no more children 0.661 0.027 288 243 0.964 0.041 0.607 0.715 Want to delay birth at least 2 years 0.102 0.014 288 243 0.805 0.141 0.073 0.131 Ideal number of children 2.343 0.042 303 254 0.927 0.018 2.259 2.427 Mothers received medical care at delivery 0.933 0.027 235 202 1.493 0.029 0.879 0.988 Child having health card, seen 0.653 0.055 45 40 0.781 0.084 0.544 0.762 Child received BCG vaccination 1.000 0.000 45 40 NA 0.000 1.000 1.000 Child received DPT vaccination (3 doses) 0.697 0.068 45 40 1.006 0.097 0.561 0.833 Child received polio vaccination (3 doses) 0.711 0.060 45 40 0.896 0.084 0.592 0.830 Child received measles vaccination 0.905 0.053 45 40 1.253 0.059 0.799 1.000 Child fully immunized 0.646 0.075 45 40 1.072 0.117 0.496 0.797 Height-for-age (-2SD) 0.091 0.028 211 182 1.348 0.310 0.035 0.148 Weight-for-height (-2SD) 0.006 0.004 211 182 0.800 0.698 0.000 0.014 Weight-for-age (-2SD) 0.030 0.015 211 182 1.315 0.507 0.000 0.060 BMI < 18.5 0.010 0.007 176 152 0.988 0.722 0.000 0.025 Has heard of HIV/AIDS 0.923 0.019 304 254 1.263 0.021 0.884 0.961 Knows about condoms 0.161 0.025 304 254 1.163 0.153 0.112 0.210 Knows about limiting partners 0.189 0.029 304 254 1.291 0.154 0.131 0.247 NA = Not applicable Appendix C | 207 Table C.18 Sampling errors: East Black Sea Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.493 0.027 481 291 1.172 0.054 0.440 0.547 No education 0.255 0.057 481 291 2.877 0.225 0.140 0.369 With secondary education or higher 0.251 0.035 481 291 1.773 0.140 0.181 0.322 Currently married (in union) 0.947 0.012 481 291 1.171 0.013 0.923 0.971 Currently pregnant 0.036 0.008 674 425 1.079 0.221 0.020 0.052 Children ever born 1.884 0.118 674 425 0.775 0.062 1.649 2.120 Children surviving 1.755 0.122 674 425 0.869 0.070 1.510 1.999 Children ever born to women 40-49 3.650 0.165 167 91 1.361 0.045 3.319 3.981 Knowing any contraceptive method 0.996 0.004 454 275 1.422 0.004 0.987 1.000 Knowing any modern contraceptive method 0.996 0.004 454 275 1.422 0.004 0.987 1.000 Ever used any contraceptive method 0.921 0.018 454 275 1.446 0.020 0.885 0.958 Currently using any contraceptive method 0.707 0.020 454 275 0.944 0.029 0.666 0.747 Currently using a modern method 0.262 0.022 454 275 1.074 0.085 0.217 0.306 Currently using pill 0.022 0.006 454 275 0.939 0.296 0.009 0.035 Currently using IUD 0.092 0.015 454 275 1.087 0.161 0.062 0.121 Currently using condom 0.085 0.014 454 275 1.049 0.162 0.058 0.113 Currently using injectables 0.000 0.000 454 275 NA NA 0.000 0.000 Currently using female sterilization 0.057 0.012 454 275 1.129 0.215 0.033 0.082 Currently using periodic abstinence 0.023 0.008 454 275 1.078 0.329 0.008 0.038 Currently using withdrawal 0.419 0.016 454 275 0.700 0.039 0.387 0.452 Obtained method from public sector source 0.510 0.046 129 72 1.043 0.090 0.418 0.602 Want no more children 0.632 0.041 240 144 1.329 0.066 0.550 0.715 Want to delay birth at least 2 years 0.116 0.021 240 144 0.996 0.178 0.075 0.157 Ideal number of children 2.585 0.099 250 149 1.410 0.038 2.387 2.784 Mothers received medical care at delivery 0.807 0.113 211 137 3.313 0.141 0.580 1.000 Child having health card, seen 0.548 0.141 32 18 1.533 0.258 0.265 0.831 Child received BCG vaccination 0.808 0.094 32 18 1.310 0.117 0.620 0.997 Child received DPT vaccination (3 doses) 0.678 0.140 32 18 1.628 0.206 0.398 0.958 Child received polio vaccination (3 doses) 0.656 0.135 32 18 1.543 0.206 0.386 0.926 Child received measles vaccination 0.764 0.091 32 18 1.173 0.119 0.581 0.947 Child fully immunized 0.548 0.139 32 18 1.503 0.253 0.271 0.825 Height-for-age (-2SD) 0.169 0.050 185 118 1.703 0.297 0.069 0.269 Weight-for-height (-2SD) 0.003 0.003 185 118 0.824 1.008 0.000 0.010 Weight-for-age (-2SD) 0.023 0.015 185 118 1.349 0.628 0.000 0.052 BMI < 18.5 0.009 0.009 144 89 1.140 0.982 0.000 0.027 Has heard of HIV/AIDS 0.902 0.057 251 151 3.007 0.063 0.789 1.000 Knows about condoms 0.155 0.033 251 151 1.438 0.212 0.090 0.221 Knows about limiting partners 0.135 0.022 251 151 1.038 0.166 0.090 0.179 NA = Not applicable 208 | Appendix C Table C.19 Sampling errors: Northeast Anatolia Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.508 0.035 535 245 1.630 0.069 0.437 0.578 No education 0.421 0.041 535 245 1.932 0.098 0.339 0.504 With secondary education or higher 0.186 0.026 535 245 1.537 0.139 0.134 0.238 Currently married (in union) 0.955 0.006 535 245 0.695 0.007 0.942 0.967 Currently pregnant 0.059 0.009 802 382 1.000 0.160 0.040 0.078 Children ever born 2.262 0.267 802 382 1.095 0.118 1.727 2.796 Children surviving 2.002 0.236 802 382 1.094 0.118 1.530 2.474 Children ever born to women 40-49 5.513 0.456 141 61 1.632 0.083 4.600 6.426 Knowing any contraceptive method 0.999 0.001 511 234 0.849 0.001 0.996 1.000 Knowing any modern contraceptive method 0.995 0.004 511 234 1.218 0.004 0.988 1.000 Ever used any contraceptive method 0.861 0.022 511 234 1.453 0.026 0.816 0.905 Currently using any contraceptive method 0.645 0.025 511 234 1.201 0.039 0.594 0.696 Currently using a modern method 0.341 0.029 511 234 1.373 0.085 0.283 0.398 Currently using pill 0.047 0.010 511 234 1.067 0.213 0.027 0.067 Currently using IUD 0.171 0.016 511 234 0.978 0.095 0.139 0.204 Currently using condom 0.070 0.010 511 234 0.930 0.151 0.049 0.091 Currently using injectables 0.017 0.009 511 234 1.512 0.507 0.000 0.035 Currently using female sterilization 0.033 0.007 511 234 0.898 0.215 0.019 0.047 Currently using periodic abstinence 0.008 0.004 511 234 0.989 0.479 0.000 0.016 Currently using withdrawal 0.261 0.033 511 234 1.701 0.127 0.195 0.327 Obtained method from public sector source 0.634 0.039 186 80 1.110 0.062 0.555 0.713 Want no more children 0.604 0.036 246 115 1.151 0.060 0.532 0.676 Want to delay birth at least 2 years 0.158 0.028 246 115 1.205 0.178 0.102 0.214 Ideal number of children 2.855 0.093 255 119 1.229 0.032 2.669 3.040 Mothers received medical care at delivery 0.699 0.064 390 185 2.416 0.091 0.571 0.826 Child having health card, seen 0.345 0.091 73 34 1.644 0.265 0.162 0.527 Child received BCG vaccination 0.680 0.079 73 34 1.445 0.116 0.523 0.838 Child received DPT vaccination (3 doses) 0.507 0.083 73 34 1.424 0.164 0.341 0.674 Child received polio vaccination (3 doses) 0.531 0.078 73 34 1.345 0.148 0.374 0.688 Child received measles vaccination 0.636 0.087 73 34 1.551 0.137 0.462 0.811 Child fully immunized 0.378 0.074 73 34 1.311 0.196 0.230 0.527 Height-for-age (-2SD) 0.168 0.029 349 166 1.316 0.170 0.111 0.225 Weight-for-height (-2SD) 0.013 0.006 349 166 0.999 0.464 0.001 0.024 Weight-for-age (-2SD) 0.067 0.015 349 166 1.137 0.218 0.038 0.096 BMI < 18.5 0.007 0.007 242 115 1.302 0.983 0.000 0.021 Has heard of HIV/AIDS 0.814 0.030 256 120 1.246 0.037 0.754 0.875 Knows about condoms 0.160 0.020 256 120 0.852 0.122 0.121 0.199 Knows about limiting partners 0.124 0.029 256 120 1.382 0.230 0.067 0.181 NA = Not applicable Appendix C | 209 Table C.20 Sampling errors: Central East Anatolia Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.568 0.019 566 389 0.904 0.033 0.530 0.606 No education 0.502 0.034 566 389 1.614 0.068 0.434 0.569 With secondary education or higher 0.157 0.023 566 389 1.492 0.145 0.112 0.203 Currently married (in union) 0.971 0.007 566 389 1.003 0.007 0.956 0.985 Currently pregnant 0.080 0.013 872 615 1.162 0.165 0.053 0.106 Children ever born 2.235 0.226 872 615 0.991 0.101 1.784 2.686 Children surviving 2.001 0.196 872 615 0.969 0.098 1.609 2.393 Children ever born to women 40-49 5.649 0.428 131 89 1.467 0.076 4.794 6.504 Knowing any contraceptive method 0.995 0.003 549 378 1.028 0.003 0.988 1.000 Knowing any modern contraceptive method 0.985 0.006 549 378 1.097 0.006 0.974 0.997 Ever used any contraceptive method 0.789 0.019 549 378 1.117 0.025 0.750 0.828 Currently using any contraceptive method 0.572 0.026 549 378 1.238 0.046 0.519 0.624 Currently using a modern method 0.318 0.019 549 378 0.956 0.060 0.280 0.356 Currently using pill 0.055 0.012 549 378 1.227 0.218 0.031 0.078 Currently using IUD 0.155 0.014 549 378 0.916 0.091 0.127 0.184 Currently using condom 0.070 0.013 549 378 1.189 0.186 0.044 0.095 Currently using injectables 0.005 0.003 549 378 1.018 0.588 0.000 0.012 Currently using female sterilization 0.031 0.007 549 378 0.991 0.236 0.016 0.046 Currently using periodic abstinence 0.003 0.002 549 378 0.932 0.708 0.000 0.008 Currently using withdrawal 0.248 0.029 549 378 1.564 0.116 0.190 0.306 Obtained method from public sector source 0.660 0.046 183 120 1.306 0.069 0.568 0.752 Want no more children 0.601 0.033 287 196 1.148 0.055 0.535 0.668 Want to delay birth at least 2 years 0.174 0.023 287 196 1.044 0.135 0.127 0.221 Ideal number of children 2.763 0.105 292 200 1.409 0.038 2.553 2.973 Mothers received medical care at delivery 0.531 0.054 439 314 1.874 0.101 0.424 0.638 Child having health card, seen 0.244 0.045 80 58 0.970 0.186 0.153 0.335 Child received BCG vaccination 0.640 0.065 80 58 1.250 0.102 0.510 0.771 Child received DPT vaccination (3 doses) 0.427 0.047 80 58 0.863 0.109 0.334 0.520 Child received polio vaccination (3 doses) 0.517 0.048 80 58 0.889 0.094 0.420 0.614 Child received measles vaccination 0.581 0.064 80 58 1.191 0.110 0.453 0.709 Child fully immunized 0.326 0.055 80 58 1.078 0.169 0.216 0.436 Height-for-age (-2SD) 0.266 0.039 392 280 1.650 0.145 0.189 0.344 Weight-for-height (-2SD) 0.003 0.003 392 280 1.126 0.999 0.000 0.009 Weight-for-age (-2SD) 0.096 0.026 392 280 1.588 0.272 0.044 0.149 BMI < 18.5 0.024 0.016 245 171 1.663 0.678 0.000 0.056 Has heard of HIV/AIDS 0.684 0.040 294 201 1.456 0.058 0.605 0.763 Knows about condoms 0.102 0.022 294 201 1.255 0.217 0.058 0.146 Knows about limiting partners 0.095 0.018 294 201 1.046 0.188 0.059 0.131 NA = Not applicable 210 | Appendix C Table C.21 Sampling errors: Southeast Anatolia Region, Turkey 2003 Number of cases Confidence limits Variable Value R Standard error SE Un- weighted (N) Weighted (WN) Design effect (DEFT) Relative error (SE/R) R-2SE R+2SE Urban residence 0.660 0.016 1145 671 1.132 0.024 0.628 0.691 No education 0.563 0.029 1145 671 1.986 0.052 0.505 0.622 With secondary education or higher 0.118 0.020 1145 671 2.104 0.170 0.078 0.158 Currently married (in union) 0.957 0.006 1145 671 1.025 0.006 0.945 0.970 Currently pregnant 0.067 0.005 1822 1069 0.840 0.081 0.056 0.078 Children ever born 2.490 0.180 1822 1069 1.073 0.072 2.130 2.849 Children surviving 2.256 0.170 1822 1069 1.124 0.075 1.916 2.595 Children ever born to women 40-49 6.607 0.289 234 137 1.316 0.044 6.028 7.186 Knowing any contraceptive method 0.997 0.002 1096 642 0.981 0.002 0.994 1.000 Knowing any modern contraceptive method 0.996 0.002 1096 642 0.976 0.002 0.993 1.000 Ever used any contraceptive method 0.756 0.028 1096 642 2.156 0.037 0.700 0.812 Currently using any contraceptive method 0.559 0.026 1096 642 1.704 0.046 0.508 0.610 Currently using a modern method 0.301 0.019 1096 642 1.374 0.063 0.263 0.339 Currently using pill 0.046 0.007 1096 642 1.073 0.148 0.032 0.059 Currently using IUD 0.125 0.012 1096 642 1.214 0.097 0.101 0.150 Currently using condom 0.079 0.009 1096 642 1.160 0.120 0.060 0.097 Currently using injectables 0.009 0.002 1096 642 0.781 0.246 0.005 0.014 Currently using female sterilization 0.041 0.006 1096 642 1.061 0.155 0.028 0.054 Currently using periodic abstinence 0.005 0.003 1096 642 1.325 0.542 0.000 0.011 Currently using withdrawal 0.227 0.017 1096 642 1.340 0.075 0.193 0.261 Obtained method from public sector source 0.591 0.025 328 194 0.933 0.043 0.540 0.641 Want no more children 0.568 0.019 556 323 0.903 0.033 0.530 0.606 Want to delay birth at least 2 years 0.175 0.014 556 323 0.858 0.079 0.147 0.202 Ideal number of children 3.433 0.091 550 320 1.333 0.027 3.251 3.615 Mothers received medical care at delivery 0.600 0.032 1148 670 1.687 0.053 0.537 0.664 Child having health card, seen 0.329 0.048 202 118 1.427 0.145 0.234 0.424 Child received BCG vaccination 0.709 0.050 202 118 1.502 0.070 0.610 0.808 Child received DPT vaccination (3 doses) 0.434 0.056 202 118 1.575 0.129 0.322 0.545 Child received polio vaccination (3 doses) 0.522 0.050 202 118 1.407 0.096 0.421 0.622 Child received measles vaccination 0.567 0.055 202 118 1.533 0.097 0.457 0.677 Child fully immunized 0.350 0.050 202 118 1.462 0.142 0.250 0.449 Height-for-age (-2SD) 0.221 0.016 1015 592 1.146 0.073 0.189 0.253 Weight-for-height (-2SD) 0.009 0.003 1015 592 0.968 0.322 0.003 0.014 Weight-for-age (-2SD) 0.071 0.011 1015 592 1.259 0.153 0.049 0.092 BMI < 18.5 0.016 0.005 562 329 1.004 0.331 0.005 0.027 Has heard of HIV/AIDS 0.650 0.028 571 332 1.379 0.042 0.595 0.705 Knows about condoms 0.109 0.012 571 332 0.911 0.109 0.086 0.133 Knows about limiting partners 0.155 0.016 571 332 1.075 0.105 0.122 0.188 Total fertility rate (last 3 years) 4.193 0.240 NA 2976 1.381 0.057 3.714 4.672 Neonatal mortality (last 5 years) 21.094 4.374 1146 668 1.045 0.207 12.346 29.841 Post-neonatal mortality (last 5 years) 16.492 3.734 1146 668 1.002 0.226 9.025 23.959 Infant mortality (last 5 years) 37.586 5.696 1146 668 0.998 0.152 26.193 48.979 Child mortality (last 5 years) 8.526 2.409 1149 670 0.895 0.283 3.709 13.344 Under-five mortality (last 5 years) 45.792 5.748 1149 670 0.922 0.126 34.295 57.288 NA = Not applicable Appendix D | 211 QUALITY OF THE DATA APPENDIX D İsmet Koç This appendix provides an initial assessment of the quality of the TDHS-2003 data. For this purpose, a number of topics including the misreporting of ages and respondent’s recall problems are investigated. Table D.1 presents the distribution of the de facto household population by single years of age. Heaping is observed in the reporting of ages ending with 0 and 5, especially in the older ages for both males and females. The table does not show any evidence that interviewers ‘aged’ children out of the eligible range for the collection of height and weight and health data; the proportion of children reported to be five years of age at the time of the survey is almost equal to the proportions age four and six. There also appears to have been little shifting of older women past age 49, the upper limit of eligibility of individual interview. Table D.2 examines the possibility that some eligible women were not properly identified in the TDHS-2003. During the household interview, 11,815 women age 15-49 were recorded, among whom 8,255 have been married and were, therefore, eligible for individual interview. Of these women, 7,869 were successfully interviewed, yielding a response rate of 95 percent. Response rates vary slightly by age group. In particular, response rates were somewhat lower for the oldest and youngest age groups indicating that interviewers may have been somewhat less diligent in pursuing interviews with women at the two extremes of the eligible age range. Another indicator of the quality of survey data is the extent to which information is missing on key variable. Information on the completeness of reporting in connection with a set of important variables is provided in Table D.3. Among births in the 15 years preceding the survey, 4 percent are missing information on year of birth. Information on age at death is missing for just 1 percent of these births. Information regarding their age or date at first union was not obtained for less than one percent of ever-married women. Height or weight measurements are missing for approximately 8 percent of the children under age 5. Compared with data from TDHS-1998, these figures show that the extent of missing information in the survey remains very limited. Table D.4 is presented to investigate whether there is any bias in the data with regard to the reporting of births. The results suggest that there was no deliberate attempt by interviewers to reduce their work loads by shortening the interview by aging children out of the reference period. This is shown by the ratio of births in 1998 (which was the lower calendar year boundary for identifying births for which health and other data was collected) to the average of the two adjoining years (105), while that for births in 1997 it is 97. A similar pattern was found in the calendar year ratios for dead children. Sex ratios vary year without any indication of bias. Mothers seem to have better recall of dead male children than dead female children, as indicated by the much higher sex ratios for dead children. 212 | Appendix D Table D.5 shows that there is a heaping in the reporting of age at death at seven days or one week. A surplus of deaths is also reported at eight days among births in the 5-9 years preceding the survey. Additionally, a surplus in the all five-year periods is found at age at death of 15 and 20 days. The proportion of early neonatal deaths among all neonatal deaths is higher in the most recent years (73 percent) compared to 5-9 years (62 percent) preceding the survey, consistent with declining infant mortality rates. The same conclusion can be drawn from higher proportion of neonatal deaths among all deaths in Table D.6. It is interesting to note that there is no significant heaping in age at death of 12 months. Appendix D | 213 Table D.1 Age distribution of de facto household population Single-year age distribution of the de facto household population by sex (weighted), Turkey 2003 Males Females Males Females Age Number Percent Number Percent Age Number Percent Number Percent 0 370 1.7 399 1.9 37 298 1.4 249 1.2 1 348 1.6 354 1.7 38 327 1.5 324 1.6 2 404 1.8 447 2.1 39 334 1.5 271 1.3 3 414 1.9 479 2.3 40 306 1.4 335 1.6 4 404 1.8 403 1.9 41 262 1.2 203 1.0 5 408 1.9 409 2.0 42 274 1.2 260 1.2 6 408 1.9 421 2.0 43 316 1.4 284 1.4 7 432 2.0 438 2.1 44 250 1.1 256 1.2 8 439 2.0 447 2.1 45 287 1.3 280 1.3 9 412 1.9 400 1.9 46 215 1.0 195 0.9 10 433 2.0 412 2.0 47 225 1.0 253 1.2 11 439 2.0 427 2.1 48 242 1.1 235 1.1 12 376 1.7 416 2.0 49 166 0.8 205 1.0 13 453 2.1 450 2.2 50 198 0.9 235 1.1 14 424 1.9 414 2.0 51 193 0.9 152 0.7 15 387 1.8 386 1.9 52 240 1.1 189 0.9 16 445 2.0 450 2.2 53 243 1.1 191 0.9 17 468 2.1 456 2.2 54 196 0.9 165 0.8 18 435 2.0 414 2.0 55 220 1.0 212 1.0 19 369 1.7 372 1.8 56 125 0.6 145 0.7 20 442 2.0 246 1.2 57 139 0.6 125 0.6 21 364 1.7 303 1.5 58 169 0.8 161 0.8 22 484 2.2 381 1.8 59 91 0.4 142 0.7 23 435 2.0 397 1.9 60 185 0.8 132 0.6 24 411 1.9 369 1.8 61 83 0.4 110 0.5 25 409 1.9 362 1.7 62 107 0.5 97 0.5 26 412 1.9 327 1.6 63 133 0.6 120 0.6 27 343 1.6 304 1.5 64 128 0.6 97 0.5 28 374 1.7 324 1.6 65 220 1.0 173 0.8 29 337 1.5 319 1.5 66 97 0.4 81 0.4 30 414 1.9 375 1.8 67 120 0.5 81 0.4 31 305 1.4 286 1.4 68 91 0.4 75 0.4 32 311 1.4 329 1.6 69 77 0.4 67 0.3 33 334 1.5 299 1.4 70+ 971 4.4 892 4.3 34 283 1.3 284 1.4 DK/missing 4 0.0 18 0.1 35 325 1.5 307 1.5 36 224 1.0 227 1.1 Total 22,010 100.0 20,842 100.0 DK = Don’t know Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. 214 | Appendix D Table D.2 Age distribution of eligible and interviewed women De facto household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted), by five-year age groups, Turkey 2003 Interviewed women age 15-49 Age group Household population of women age 10-54 Ever-married women age 10-54 Number Percent Percentage of eligible women interviewed 10-14 2,126 1 NA NA NA 15-19 2.103 252 234 3.0 92.9 20-24 2,137 1,058 1,030 13.1 96.5 25-29 1,876 1,503 1,438 18.3 95.7 30-34 1,647 1,509 1,448 18.4 95.9 35-39 1,508 1,449 1,385 17.6 95.6 40-44 1,408 1,355 1,297 16.5 94.9 45-49 1,135 1,117 1,037 13.2 92.8 50-54 1,070 1,055 NA NA NA 15-49 11,815 8,255 7,869 100 95.2 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the household schedule. NA = Not applicable Table D.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Turkey 2003 Subject Reference group Percentage with missing information Number of cases Birth date Births in the 15 years preceding the survey Month only 3.7 12,646 Month and year 1.2 12,646 Age at death Deceased children born in the 15 years preceding the survey 0.4 673 Age/date at first union1 Ever-married women age 15-49 0.1 8,075 Respondent’s education All women age 15-49 0.0 8,075 Anthropometry Living children age 0-59 months (from the household questionnaire) Height 7.3 3,998 Weight 5.5 3,998 Height or weight 7.6 3,998 1 Both year and age missing Appendix D | 215 Table D.4 Births by calendar years Number of births, percentage with complete birth date, sex ratio at birth, and calendar year ratio by calendar year, according to living (L), dead (D), and total (T) children (weighted), Turkey 2003 Number of births Percentage with complete birth date1 Sex ratio at birth2 Calendar year ratio3 Calendar year L D T L D T L D T L D T 2004 852 26 878 99.9 97.7 99.9 114.2 98.2 113.7 NA NA NA 2003 840 37 878 100.0 100.0 100.0 111.5 117.8 111.8 NA NA NA 2002 817 27 844 99.9 96.2 99.8 93.8 182.2 95.8 100.5 82.5 99.8 2001 785 29 814 100.0 100.0 100.0 111.2 76.4 109.7 91.6 78.5 91.0 2000 898 46 943 96.1 70.9 94.3 95.2 174.9 98.0 111.8 109.4 111.7 1999 821 55 876 94.4 79.4 93.4 96.7 76.8 95.3 94.5 106.5 95.2 1998 840 58 897 93.4 75.5 92.3 104.9 90.2 103.9 104.7 108.8 105.0 1997 782 51 833 92.6 81.7 92.0 102.2 150.0 104.6 96.8 95.8 96.7 1996 778 48 826 92.9 74.1 91.8 98.1 110.3 98.8 98.5 91.5 98.1 1995 796 55 851 93.0 64.2 91.1 94.8 121 96.3 105.5 96.0 104.8 2000-2004 4,193 165 4,357 99.1 90.9 98.8 104.7 126.7 105.4 NA NA NA 1995-1999 4,016 267 4,283 93.3 74.9 92.1 99.3 105.9 99.7 NA NA NA 1990-1994 3,684 326 4,011 92.5 72.2 90.8 106 118.3 106.9 NA NA NA 1985-1989 3,180 347 3,527 91.5 77.3 90.1 109.1 107.8 109 NA NA NA <1985 2,824 545 3,369 91.2 74.6 88.5 100.5 107.1 101.5 NA NA NA All 17,897 1,651 19,547 93.9 76.4 92.4 103.8 111.0 104.4 NA NA NA NA = Not applicable 1 Both year and month of birth given 2 (Bm/Bf)x100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx-1+Bx+1)]x100, where Bx is the number of births in calendar year x 216 | Appendix D Table D.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods of birth preceding the survey (weighted), Turkey 2003 Number of years preceding survey Age at death (days) 0-4 5-9 10-14 15-19 Total 0-19 <1 23 28 44 27 122 1 12 13 22 24 72 2 4 4 12 4 24 3 8 9 16 14 47 4 4 4 5 1 14 5 1 3 2 2 7 6 0 2 1 1 4 7 5 11 11 12 39 8 0 14 0 2 6 9 0 1 0 3 4 10 2 1 2 1 6 11 0 1 0 1 2 12 2 3 1 0 6 13 0 2 0 0 2 14 0 0 1 1 2 15 3 3 7 5 18 16 1 0 0 0 1 17 1 2 3 2 8 18 0 1 1 0 2 19 2 1 0 1 3 20 2 2 3 10 16 21 1 1 0 0 2 22 0 1 0 0 1 23 0 2 0 1 3 24 0 0 0 0 2 25 2 0 0 1 0 26 0 0 0 1 1 27 0 0 0 1 1 28 0 2 2 0 4 29 0 1 4 0 5 30 0 0 1 1 2 Percent early neonatal1 73 62 74 63 68 1≤ 6 days / ≤ 30 days Appendix D | 217 Table D.6 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, for five-year periods of birth preceding the survey (weighted), Turkey 2003 Number of years preceding survey Age at death (months) 0-4 5-9 10-14 15-19 Total 0-19 <1* 71 103 137 116 426 1 11 20 11 28 71 2 4 9 16 16 45 3 9 14 16 18 57 4 3 10 11 12 36 5 4 6 10 10 30 6 5 8 9 20 42 7 3 7 11 11 32 8 2 6 6 11 25 9 0 5 5 5 16 10 1 4 1 4 10 11 0 3 1 5 9 12 3 5 13 7 28 13 1 1 1 2 5 14 3 0 2 1 6 15 1 1 2 2 6 16 1 0 0 0 1 17 0 0 0 0 0 18 3 2 4 1 10 19 2 1 0 0 3 20 0 0 0 0 0 21 0 0 0 0 0 22 0 0 1 0 1 23 0 0 0 0 0 Percent early neonatal1 63 53 58 45 54 aIncludes deaths under one month reported in days 1Under one month / under one year HACETTEPE UNIVERSITY INSTITUTE OF POPULATION STUDIES 2003 TURKISH DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD QUESTIONNAIRE IDENTIFICATION CLUSTER NO. HOUSEHOLD NO . 5 REGIONS. 12 REGIONS . PLACE OF RESIDENCE-URBAN(1)-RURAL(2) . İSTANBUL METROPOLITAN HH. - YES (1) NO (2) . PROVINCE __________________________________________ DISTRICT________________________________________ SUB-DISTRICT_______________________________________ VILLAGE ___________________________________ QUARTER __________________________________________ STREET __________________________________ NO_______ INTERWIEVER VISITS 1 2 3 FINAL VISIT DATE (DAY-MONTH) ____ ____ ____ ____ ____ ____ NAME-SURNAME OF INTERWIEVER ________________ _________________ ________________ RESULT (*) ____ ____ ____ NEXT VISIT DATE TIME ____ ____ ____ ____ ____ ____ ____ ____ TOTAL NUMBER OF VISITS (*) RESULT CODES NUMBER OF PERSONS 01 COMPLETED 02 NONE OF THE HOUSEHOLD MEMBERS OR NO ELIGIBLE MEMBER PRESENT AT HOME DURING VISITS 03 NONE OF THE HOUSEHOLD MEMBERS PRESENT AT HOME DURING THE SURVEY PERIOD 04 POSTPONED 05 REFUSED 06 DWELLING VACANT/ADDRESS NOT A DWELLING 07 DWELLING DESTROYED 08 DWELLING NOT FOUND 09 PARTLY COMPLETED 96 OTHER_______________________________ (SPECIFY) TOTAL IN HOUSEHOLD. TOTAL USUAL RESIDENTS OF HOUSEHOLD. TOTAL EVER MARRIED 15-49 WOMEN . SUPERVISOR FIELD EDITOR KEYER _________________________________ _________________________________ _________________________________ DAY-MONTH DAY-MONTH DAY-MONTH HOUR MINUTE SECTION 1 – HOUSEHOLD LIST Now I would like some information about people in this household, such as age and education. HH LINE NO HOUSEHOLD LIST ADD BY ASKING A-B-C-D-E RELATION SHIP TO HEAD OF HH HH MEMBERSHIP SEX AGE A. Would you please tell me the names of the persons living in this household beginning with the household head? B. Is there anyone who usually lives in this house but is absent at present? C. Additionally, are there persons who do not live here but who have stayed here last night? D. Are there any other persons such as small children or infants? E. Are there any others who are not members of your family but live here, such as lodgers, friends, servants? What is the relationship of . to the household head? USE CODE LIST. Does . usually live here? YES .1 NO .2 Did . sleep here last night? YES .1 NO.2 Is . male or female? MALE . 1 FEMALE . 2 How old is .? (what age has ……. completed?) OBTAIN AGE IN COMPLETED YEARS. IF OLDER THAN 95, WRITE “95”. (01) (02) (03) (04) (05) (06) (07) 01 1 2 1 2 1 2 02 1 2 1 2 1 2 03 1 2 1 2 1 2 04 1 2 1 2 1 2 05 1 2 1 2 1 2 06 1 2 1 2 1 2 07 1 2 1 2 1 2 08 1 2 1 2 1 2 09 1 2 1 2 1 2 10 1 2 1 2 1 2 IF ADDITIONAL QUESTIONNAIRE IS USED TICK HERE AND PROCEED WITH THE REST OF THE INTERVIEW ON THE ADDITIONAL FORM (03) CODES FOR RELATIONSHIP TO HOUSEHOLD HEAD 01 HEAD 02 WIFE/HUSBAND 03 SON/DAUGHTER 04 SON/DAUGHTER- IN -LAW 05 GRANDCHILD 06 PARENT 07 PARENT -IN -LAW 08 SIBLING 09 SIBLING’S SPOUSE 10 SIBLING’S CHILD 11 FATHER’S SIBLING 12 MOTHER’S SIBLING 13 STEP CHILD 14 COUSIN 15 GRAND PARENT 16 GRAND PARENT –IN- LAW 17 SIBLING –IN- LAW 18 SIBLING –IN- LAW’S SPOUSE 19 SIBLING -IN-LAW’S CHILD 20 FATHER –IN-LAW’S SIBLING 21 MOTHER-IN-LAW’S SIBLING 22 SECOND WIFE 23 HUSBAND’S SECOND WIFE 88 NOT RELATED 96 OTHER RELATIVE 98 DK 0 1 HH LINE NO PLACE OF BIRTH RESIDENCE MATERNAL SURVIVAL CHECK (04): IF PERSON USUALLY LIVES IN THIS HOUSE SKIP TO QUESTION 10. IF NOT, ASK. Where is. living now? In which province was . born? RECORD THE PROVINCE THAT PLACE OF BIRTH IS IN AT PRESENT. USE PROVINCE TRAFFIC CODES. RECORD “90” FOR ABROAD. TYPE OF PLACE OF RESIDENCE: PROVINCE CENTER.1 DISTRICT CENTER.2 SUB-DISTRICT/VILLAGE.3 ABROAD.4 Is.’s natural mother alive? ALIVE.1 DEAD.2 DK. .8 RECORD LINE NO. IF LISTED IN THE HOUSE. RECORD “96” IF LIVING ELSEWHERE. (01) (08) (09A) (09B) (09C) PLACE OF RES. PROVIN. TYPE (10) (11) 01 ________________________ 1 2 8 12 02 ________________________ 1 2 8 12 03 ________________________ 1 2 8 12 04 ________________________ 1 2 8 12 05 ________________________ 1 2 8 12 06 ________________________ 1 2 8 12 07 ________________________ 1 2 8 12 08 ________________________ 1 2 8 12 09 ________________________ 1 2 8 12 10 ________________________ 1 2 8 12 HH LINE NO PATERNAL SURVIVAL MIGRATION AND MOBILITY AGE 5 AND OVER Is.’s natural father alive? ALIVE . 1 DEAD . 2 DK . 8 RECORD LINE NO. IF LISTED IN THE HOUSE. RECORD “96” IF LIVING ELSEWHERE. Where was. living five years ago? In . (CURRENT CITY, TOWN OR VILLAGE) or in other place? SAME PLACE .1 OTHER PLACE .2 DK.8 Was . living in this house or in another house? SAME H.1 OTHER H.2 In which province was. living? RECORD THE PRESENT PROVINCE THAT PLACE OF RESIDENCE IS IN. PROVINCE TRAFFIC CODES. RECORD “90” FOR ABROAD. What type of place was it? RECORD ACCORDING TO TYPE OF PLACE OF RESIDENCE 5 YEARS BEFORE. PROVINCE CENTER. 1 DISTRICT CENTER. 2 SUB-DIST./VILLAGE. 3 ABROAD . 4 (01) (12) (13) (14) (15) (16) (17) 01 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 02 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 03 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 04 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 05 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 06 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 07 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 08 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 09 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 10 1 2 8 14 1 2 8 16 18 1 2 18 1 2 3 4 HH LINE NO LITERACY AND EDUCATION STATUS AGE 6 AND OVER SCHOOL ATTENDANCE AGE 6-24 Is . literate? YES. 1 NO . 2 DK . 8 Has . ever been to school? YES.1 NO.2 DK.8 What is the highest level of school . attended? What is the highest grade …. completed at that level? USE CODE LIST. SCHOOL GRADE Did . graduate from this school? (Did …… receive a diploma?) YES.1 NO.2 DK.8 Is . attending school this educational year? YES . 1 NO. 2 DK. 8 Which level of school and grade is . attending? USE CODE LIST. SCHOOL GRADE (01) (18) (19) (20A) (20B) (21) (22) (23A) (23B) 01 1 2 8 1 2 8 26 1 2 8 1 2 8 24 02 1 2 8 1 2 8 26 1 2 8 1 2 8 24 03 1 2 8 1 2 8 26 1 2 8 1 2 8 24 04 1 2 8 1 2 8 26 1 2 8 1 2 8 24 05 1 2 8 1 2 8 26 1 2 8 1 2 8 24 06 1 2 8 1 2 8 26 1 2 8 1 2 8 24 07 1 2 8 1 2 8 26 1 2 8 1 2 8 24 08 1 2 8 1 2 8 26 1 2 8 1 2 8 24 09 1 2 8 1 2 8 26 1 2 8 1 2 8 24 10 1 2 8 1 2 8 26 1 2 8 1 2 8 24 (20A-23A-25A) LEVEL CODES (20B-23B-25B) ) GRADE CODES 00 LESS THAN ONE YEAR/PREPARATORY LEVEL 66 MASTER/Ph.D 98 DK 1 PRIMARY SCHOOL 2 SECONDARY SCHOOL 3 PRIMARY EDUCATION 4 HIGH SCHOOL 5 UNIVERSITY 6 MASTER/Ph.D AND OVER 8 DK HH LINE NO SCHOOL ATTENDANCE AGE 6-24 WORK STATUS AGE 12 AND OVER Did . attend school last year? (2002-2003) YES. 1 NO . 2 DK . 8 Wich level of school and grade did. attend? USE CODE LIST. SCHOOL GRADE Did. work in any job in last week whether payed or unpaid? (IF NO) As you know, some people do temporary jobs; they work on their families' workplaces or fields paid or unpaid. Did . work in such kind of a job? YES.1 NO .2 You said . didn’t work in last week. If so, does …… have a job that he/she usually works? YES . 1 NO . 2 Why didn’t . work last week? USE CODE LIST. (01) (24) (25A) (25B) (26) (27) (28) 01 1 2 3 8 26 1 2 29A 1 2 34 02 1 2 3 8 26 1 2 29A 1 2 34 03 1 2 3 8 26 1 2 29A 1 2 34 04 1 2 3 8 26 1 2 29A 1 2 34 05 1 2 3 8 26 1 2 29A 1 2 34 06 1 2 3 8 26 1 2 29A 1 2 34 07 1 2 3 8 26 1 2 29A 1 2 34 08 1 2 3 8 26 1 2 29A 1 2 34 09 1 2 3 8 26 1 2 29A 1 2 34 10 1 2 3 8 26 1 2 29A 1 2 34 (28) REASON OF NOT WORKING IN LAST WEEK 01 HOLIDAY, ON VACATION 02 PREGNANCY/BIRTH LEAVE 03 SICK, UNABLE TO WORK 04 BUSINESS TRIP/EDUCATION/ TRAINING 05 UNPAID VACATION 06 NOT WORKING SEASON 07 WORKPLACE IS CLOSED, INACTIVE 96 OTHER 98 DK HH LINE NO WORK STATUS AGE 12 AND OVER IT IS GOING TO BE CODED BY SUPERVISOR/ FIELD EDITOR ECONOMIC ACTIVITY, TYPE OF WORKPLACE AND PLACE OF WORK USE CODE LISTS. What is/was . doing? RECORD TYPE OF WORK, PLACE OF WORK AND STATUS IN WORK IN DETAIL AND SKIP TO QUESTİON 30. ECONOMIC ACTIVITY POSITION AT WORK TYPE OF WORKPLACE PLACE OF WORK (01) (29A) (29B) (30) (31) (32) 01 _______________________________ 02 _______________________________ 03 _______________________________ 04 _______________________________ 05 _______________________________ 06 _______________________________ 07 _______________________________ 08 _______________________________ 09 _______________________________ 10 _______________________________ (30) POSITION AT WORK (31) TYPE OF WP (32) PLACE OF WORK 01 EMPLOYER (10+ EMPLOYEES) 02 EMPLOYER (1-9 EMPLOYEES) 03 WAGED, WORKER (REGULAR) 04 SALARIED, GOVERNMENT OFFICIAL (REGULAR) 05 DAILY WAGED (SEASONAL/TEMPORARY) 06 SELF-EMPLOYED (REGULAR) 07 SELF-EMPLOYED (IRREGULAR) 08 UNPAID FAMILY WORKER 96 OTHER 98 DK 01 GOVERNMENT 02 ASSOCIATION/ FOUNDATION/ VOLUNTEER ORGANIZATION. 03 PRIVATE 96 OTHER 98 DK 01 FARM/GARDEN 02 HOUSE (OWN) 03 HOUSE (SOMEONE ELSE’S) 04 REGULAR WORKPLACE 05 MOBILE 06 VARYING WORKPLACE 07 MARKET PLACE 96 OTHER 98 DK HH LINE NO WORK STATUS AGE 12 AND OVER Does …. pay social security when doing this job? (IF YES) According to which schedule? USE CODE LIST. What is the main reason of . for not working (What does . do? Why …. does not work?) USE CODE LIST. Is . looking for a job these days? YES . 1 NO . 2 DK . 8 When was. ‘s last attempt to find job? NEVER. 0 LAST MONTH . 1 2-3 MONTHS AGO . 2 4-6 MONTHS AGO . 3 7 MONTHS AND MORE. 4 DK. 8 (01) (33) (34) (35) (36) 01 37 1 2 8 37 0 1 2 3 4 8 02 37 1 2 8 37 0 1 2 3 4 8 03 37 1 2 8 37 0 1 2 3 4 8 04 37 1 2 8 37 0 1 2 3 4 8 05 37 1 2 8 37 0 1 2 3 4 8 06 37 1 2 8 37 0 1 2 3 4 8 07 37 1 2 8 37 0 1 2 3 4 8 08 37 1 2 8 37 0 1 2 3 4 8 09 37 1 2 8 37 0 1 2 3 4 8 10 37 1 2 8 37 0 1 2 3 4 8 (33) SOCIAL SECURITY (34) REASON FOR NOT WORKING 00 HAS NO SOCIAL SECURITY 01 SSK 02 EMEKLİ SANDIĞI 03 BAĞ-KUR 04 PRIVATE 96 OTHER 98 DK 01 WILL START NEW JOB 02 STUDENT 03 HOUSEWIFE 04 RETIRED 05 INCOME RECIPIENT 06 FAMILY WORKER 07 HANDICAPPED/SICK 08 LOOKS AFTER ELDERLY 09 LOOKS AFTER CHILD 10 WILL MARRY SOON 11 WILL BE CONSCRIPTED 12 LOOKING FOR JOB/UNEMPLOYED 13 TOO YOUNG TO WORK 14 JUST GRADUATED 15 SPOUSE/FAMILY DOES NOT ALLOW 16 JUST MIGRATED 17 NO NEED TO WORK 18 NO SKILL/EDUCATION 96 OTHER 98 DK HH LINE NO MARITAL STATUS AGE 12 AND OVER Has . ever married? YES. 1 NO . 2 What is.’s marital status? CURRENTLY MARRIED . 1 WIDOWED . 2 DIVORCED . 3 SEPARATED. 4 DK . 8 RECORD HH LINE NO OF SPOUSE. IF SPOUSE NOT IN THE HOUSEHOLD LIST, RECORD “96”. (01) (37) (38) (39) 01 1 2 47 1 2 3 4 8 46 02 1 2 47 1 2 3 4 8 46 03 1 2 47 1 2 3 4 8 46 04 1 2 47 1 2 3 4 8 46 05 1 2 47 1 2 3 4 8 46 06 1 2 47 1 2 3 4 8 46 07 1 2 47 1 2 3 4 8 46 08 1 2 47 1 2 3 4 8 46 09 1 2 47 1 2 3 4 8 46 10 1 2 47 1 2 3 4 8 46 HANE SATIR NO ELIGIBILITY FOR INDIVIDUAL INTERVIEW ELIGIBILITY TO NEVER MARRIED WOMEN’S INFORMATION FORM ELIGIBILITY TO THE WELFARE OF THE ELDERLY MODULE CIRCLE LINE NUMBER IF EVER MARRIED WOMAN AGE 15 – 49 AND SKIP TO NEXT PERSON. IF NOT SKIP TO 48. CIRCLE LINE NUMBER IF NEVER MARRIED WOMAN AGE 15 – 49 AND SKIP TO NEXT PERSON. IF NOT SKIP TO 48. CIRCLE LINE NUMBER IF PERSON IS 60 OR OVER SKIP TO NEXT PERSON (01) (46) (47) (48) 01 01 01 01 02 02 02 02 03 03 03 03 04 04 04 04 05 05 05 05 06 06 06 06 07 07 07 07 08 08 08 08 09 09 09 09 10 10 10 10 AFTER COMPLETING THE HOUSEHOLD LIST, TURN BACK TO THE COVER PAGE AND COMPLETE THE NUMBERS OF PERSONS SECTION. SECTION 1B. NEVER MARRIED WOMAN INFORMATION FORM 50 CHECK 46; IN THE HOUSEHOLD LIST, AT LEAST ONE PERSON NOBODY WAS 60 WAS RECORDED RECORDED 51 TOTAL NUMBER OF NEVER MARRIED WOMEN IN QUESTION 46 . RECORD THE NAMES AND THE LINE NUMBERS OF NEVER MARRIED WOMEN. ASK THE QUESTIONS SEPARATELY FOR EACH RECORDED WOMAN. IF THERE IS MORE THAN ONE NEVER MARREID WOMAN, BEGIN WITH THE WOMEN AT THE TOP OF LIST. IF THERE ARE MORE THAN TWO NEVER MARREID WOMEN, USE ADDITIONAL QUESTIONNAIRE. FROM Q02 NAME ____________________________ NAME ____________________________ FROM Q01 LINE NO .…………………… LINE NO …………….………. CURRENT RESIDENCE . 0 54 CURRENT RESIDENCE . 0 54 PROVINCE CENTER . 1 PROVINCE CENTER . 1 DISTRICT CENTER . 2 DISTRICT CENTER . 2 SUBDSITRICT/VILLAGE . 3 SUBDSITRICT/VILLAGE . 3 ABROAD .4 ABROAD .4 DON’T KNOW .8 54 DON’T KNOW .8 54 52 For most of the time until . was 12 years old, where did she live? _________________________ (NAME OF PLACE) Was it a province centre, district centre, a subdistrict or village ? Or did you live abroad? 53 In which province is this place now? RECORD THE NAME AND CODE OF PROVINCE. NAME PROVINCE CODE ________________________ NAME PROVINCE CODE ________________________ 54 YEAR . YEAR . How long has she been living continuously in ……. (NAME OF CURRENT PLACE OF INTERVIEW OR USUAL RESIDENCE) SINCE SHE WAS BORN . 95 57 SINCE SHE WAS BORN . 95 57 DON’T KNOW .98 DON’T KNOW .98 PROVINCE CENTER . 1 PROVINCE CENTER . 1 DISTRICT CENTER . 2 DISTRICT CENTER . 2 SUBDSITRICT/VILLAGE . 3 SUBDSITRICT/VILLAGE . 3 ABROAD .4 ABROAD .4 DON’T KNOW .8 57 DON’T KNOW .8 57 55 Where did she live before you moved here (there)? _________________________ (NAME OF THE PLACE) Was that a province centre, district centre, a subdistrict or village ? Or did you live abroad? 56 In which province is this place now? RECORD THE NAME AND CODE OF PROVINCE. NAME PROVINCE CODE ________________________ NAME PROVINCE CODE ________________________ FROM Q02 NAME ____________________________ NAME ____________________________ FROM Q01 LINE NO .…………………… LINE NO .…………………… TURKISH . 01 TURKISH . 01 KURDSIH .02 KURDSIH . 02 ARABIC . 03 ARABIC . 03 GREEK, ARMANIAN,HEBREW (LADINO). 04 GREEK, ARMANIAN,HEBREW (LADINO). 04 CIRCASSIAN, GEORGIAN, LAZ LANGUAGE. 05 CIRCASSIAN, GEORGIAN, LAZ LANGUAGE. 05 RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN. 06 RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN. 06 57 What is .’s mother tongue? RECORD ONLY ONE RESPONSE. ENGLISH, GERMAN, FRENCH. 07 ENGLISH, GERMAN, FRENCH. 07 OTHER ______________________ (SPECIFY) 96 OTHER ______________________ (SPECIFY) 96 DON’T KNOW .8 59A DON’T KNOW . 8 59A TURKISH . A TURKISH . A KURDSIH .B KURDSIH . B ARABIC . C ARABIC .C GREEK, ARMANIAN,HEBREW (LADINO). D GREEK, ARMANIAN,HEBREW (LADINO). D CIRCASSIAN, GEORGIAN, LAZ LANGUAGE. E CIRCASSIAN, GEORGIAN, LAZ LANGUAGE. E RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN. F RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN. F 58 In addition to her mother tongue, which language(s) can she speak? RECORD ALL MENTIONED. ENGLISH, GERMAN, FRENCH. G ENGLISH, GERMAN, FRENCH. G OTHER ______________________ (SPECIFY) U OTHER ______________________ (SPECIFY) U KNOWS NO OTHER LANGUAGE .Y KNOWS NO OTHER LANGUAGE . Y DON’T KNOW .X DON’T KNOW . X MOTHER . FATHER. MOTHER . FATHER. 59 What is (was) mother tonge of .’s mother? What is (was) mother tonge of .’s father? USE CODES IN 57. 59A IF THERE IS OTHER NEVER MARRIED WOMAN IN THE HOUSEHOLD, RETURN 52. SKIP NEXT SECTION OTHERWISE. IF THERE IS OTHER NEVER MARRIED WOMAN IN THE HOUSEHOLD, RETURN 52OF 1ST COLUMN IN ADDITIONAL FORM. SKIP NEXT SECTION OTHERWISE SECTION 2. WELFARE OF ELDERLY 60 CHECK QUESTION 48. THERE IS RECORDED AT NOBODY IS RECORDED 120 LEAST ONE PERSON 61 TOTAL NUMBER OF ELDERLY PERSONS IN THE HOUSEHOLD LIST. ENTER THE NAME AND LINE NUMBER OF EACH PERSON 60 AND OVER LISTED IN THE HOUSEHOLD SCHEDULE. ASK QUESTIONS ABOUT EACH OF THE LISTED PERSONS SEPARATELY. BEGIN WITH THE FIRST ELDERLY ON THE HOUSEHOLD LIST. IF THERE ARE MORE THAN 2 ELDERLY, USE ADDITIONAL QUESTIONNAIRE. FROM QUESTION 02 NAME ____________________________ NAME ____________________________ FROM QUESTION 01 LINE NO …………………… LINE NO ……………………. NO LIVING CHILD. 00 64 NO LIVING CHILD. 00 62 Does ……… have any living children? (IF YES) How many? NO. OF CHILDREN . NO. OF CHILDREN . 64 SAME HOUSE. A SAME HOUSE. A SAME BUILDING/STREET OR QUARTER. B SAME BUILDING/STREET OR QUARTER. B SAME CITY/VILLAGE.C SAME CITY/VILLAGE.C CLOSE CITY/VILLAGE……. D CLOSE CITY/VILLAGE……. D DISTANT CITY/VILLAGE. E DISTANT CITY/VILLAGE.E OTHER COUNTRY. F OTHER COUNTRY.F 63 Where do……….’s own children live of his/her own? IF NECESSARY MATCH MORE THAN ONE CHOICE FOR ALL CHILDREN. DK. . X DK. . X NO LIVING STEP CHILD. 00 66 NO LIVING STEP CHILD . 00 64 Does ……… have any living step children? IF YES: How many? NO. OF STEP CHILDREN . NO OF STEP CHILDREN . 66 SAME HOUSE. A SAME HOUSE. A SAME BUILDING, STREET OR QUARTER. B SAME BUILDING, STREET OR QUARTER. B SAME CITY, VILLAGE.C SAME CITY, VILLAGE.C CLOSE CITY, VILLAGE……. D CLOSE CITY, VILLAGE……. D DISTANT CITY, VILLAGE.E DISTANT CITY, VILLAGE.E OTHER COUNTRY. F OTHER COUNTRY.F 65 Where do……….’s step children live? IF NECESSARY code MORE THAN ONE. DK. X DK. X HIMSELF/HERSELF. 01 HIMSELF/HERSELF. 01 SPOUSE.02 SPOUSE.02 CHILDREN/STEP CHILD.03 CHILDREN/STEP CHILD.03 CHILDREN IN LAW. 04 CHILDREN IN LAW. 04 SIBLING.05 SIBLING.05 GRANDCHILD. 06 GRANDCHILD. 06 SIBLING’S CHILD. 07 SIBLING’S CHILD. 07 OTHER CLOSE RELATIVE. 08 OTHER CLOSE RELATIVE. 08 DISTANT RELATIVE. 09 DISTANT RELATIVE.09 66 Who takes the main responsibility for ……….’s needs, health and welfare? NEIGHBOUR. 10 NEIGHBOUR. 10 OTHER _________________________ 96 OTHER ________________________ 96 (SPECIFY) (SPECIFY) FROM QUESTION 02 NAME ____________________________ NAME ____________________________ FROM QUESTION 01 LINE NO …………………… LINE NO ……………………. YES . 1 YES . 1 67 Does . have any income? NO . 2 69 NO . 2 69 PENSION (SELF)…………………. A PENSION (SELF)…………………. A PENSION (INDIRECT)……. B PENSION (INDIRECT)…….B OLD AGE PENSION. C OLD AGE PENSION.C RENT/INTEREST……………. D RENT/INTEREST…………….D FROM RELATIVE HERE. E FROM RELATIVE HERE.E FROM RELATIVE ABROAD.F FROM RELATIVE ABROAD. F CURRENTLY WORKING. G CURRENTLY WORKING.G OTHER _________________________ U OTHER ________________________ U 68 What are the source(s) of this income? RECORD ALL MENTIONED RESPONSES. AT LEAST ONE RECORD IS COMPULSORY. (SPECIFY) (SPECIFY) 69 Is . covered by a health insurance? Does he/she has health insurance? (IF YES) Which one? NO . SSK . EMEKLİ SANDIĞI . BAĞ-KUR . PRIVATE. YEŞİL CARD . OTHER _________________________ (SPECIFY) DK . 0 1 2 3 4 5 7 8 NO . SSK . EMEKLİ SANDIĞI . BAĞ-KUR . PRIVATE. YEŞİL CARD . OTHER ________________________ (SPECIFY) DK. . 0 1 2 3 4 5 7 8 YES . 1 73 YES .1 73 70 Is………. confined to bed? NO .2 NO .2 YES . 1 73 YES .1 73 71 Is ………. confined to chair/armchair all day long? NO .2 NO .2 YES . 1 YES .1 72 Is ……….’s daily life limited to house/flat or garden? NO . 2 NO .2 73 Does ………. do the things I will list now easily, with difficulty or only with the assitance of another person? Lying on bed-rising from bed Dressing-undressing Eating Going to and using toilet Taking a bath EASY 1 1 1 1 1 WITH DIFF. 2 2 2 2 2 WITH ASSISTANCE 3 3 3 3 3 IMPOSSIBLE 4 4 4 4 4 EASY 1 1 1 1 1 WITH DIFF. 2 2 2 2 2 WITH ASSISTANCE 3 3 3 3 3 IMPOSSIBLE 4 4 4 4 4 IF THERE IS ANOTHER ELDERLY IN THE HOUSE RETURN TO QUESTION 62; OTHERWISE, SKIP TO NEXT SECTION IF THERE IS ANOTHER ELDERLY PASS THE QUESTION 62 IN FIRST COLUMN IN ADDITIONAL QUESTIONNAIRE; OTHERWISE, SKIP TO NEXT SECTION SECTION 3. HOUSING CHARACTERISTICS 120 CHECK COVER PAGE: NO USUAL RESIDENTS IN AT LEAST ONE USUAL RESIDENT LIVING THIS HOUSE IN THIS HOUSE (TOTAL NUMBER OF (TOTAL NUMBER OF USUAL USUAL RESIDENTS>00) 123 RESIDENTS=00) 122 ASK ALL QUESTIONS OF THIS SECTION FOR THE HOUSE/DWELLING THAT HOUSEHOLD HEAD USUALLY LIVES IN. Now I will ask some questions about the dwelling that . (HOUSEHOLD HEAD) usually lives in. 123 OWNED BY A HOUSEHOLD MEMBER .1 ⎯⎯► 125 RENTED .2 LODGING.3 ⎯⎯► 125 NO RENT PAID .4 124 OTHER __________________________________________7 Does this house belong to a household member, is it rented from someone else, is it a lodging, or do you just live here without having to pay anything? (SPECIFY) 123A Do you have a tenancy agreement? YES.1 NO .2 124 To whom does this house belong? OTHER FAMILY MEMBER, RELATIVE .1 (NON-FAMILY MEMBER/NON-KIN) HOUSE OWNER.2 GOVERNMENT .3 PRIVATE ORGANISATION/FIRM.4 OTHER __________________________________________7 (SPECIFY) 125 NO .00 Does anyone from this household own any other house elsewhere? (IF YES) How many? NO. OF OWNED HOUSES . 129 PIPED WATER PIPED WATER IN HOUSE/GARDEN.11 ⎯⎯► 131 PUB. PIPED WATER OUTSIDE HOUSE/GARDEN .12 WELL WATER WELL IN HOUSE/GARDEN .21 ⎯⎯► 131 PUBLIC WELL.22 SURFACE WATER PIPED SURFACE WATER IN HOUSE/GARDEN.31 ⎯⎯► 131 SPRING/PUBLIC FOUNTAIN.32 RIVER/STREAM/POND/LAKE/DAM .33 RAINWATER .41 ⎯⎯► 131 TANKER TRUCK .51 BOTTLED WATER/DEMI JOHN/PET WATER .61 ⎯⎯► 133 WATER STATION.71 OTHER _________________________________________96 What is the source of drinking water for members of your household? (SPECIFY) 130 MINUTE. How long does it take you go there, get water, and come back? ON PREMISES .996 131 USUALLY/ALWAYS .1 SEVERAL HOURS IN A DAY .2 EVERY OTHER DAY .3 A FEW TIMES IN A WEEK.4 RARELY .5 Is water always available at this source? How frequently is it available? DK .8 132 NO .0 WATER IS BOILED .1 WATER IS CHLORINATED.2 WATER IS FILTERED .3 OTHER __________________________________________7 (SPECIFY) Do you do anything before using drinking water? Such as boiling, filtering, etc. DK .8 133 PIPED WATER PIPED WATER IN HOUSE/GARDEN.11 PUBLIC PIPED WATER OUTSIDE HOUSE/GARDEN.12 WELL WATER WELL IN HOUSE/GARDEN .21 PUBLIC WELL.22 SURFACE WATER PIPED SURFACE WATER IN HOUSE/GARDEN.31 SPRING/WATER FOUNTAIN.32 RIVER/STREAM/POND/LAKE/DAM .33 RAINWATER .41 TANKER TRUCK .51 BOTTLED WATER/DEMI JOHN/PET WATER .61 WATER STATION.71 What is the source of daily use water for hand washing, dishwashing, and laundry in this house? OTHER _________________________________________96 (SPECIFY) 137 NO FACILITY/BUSH/FIELD/PUBLIC TOILET.0 ⎯⎯► 142A INSIDE .1 OUTSIDE .2 INSIDE AND OUTSIDE.3 OTHER __________________________________________7 Is the toilet inside the house or outside? (SPECIFY) 138 FLUSH TOILET .1 OPEN PIT.2 CLOSED PIT .3 OTHER __________________________________________7 What type of toilet system do you have in your household? IF MORE THAN ONE TOILET IS USED, RECORD ACCORDING TO THE ONE INSIDE OR CLOSEST TO THE HOUSE. (SPECIFY) 139 ONLY HOUSEHOLD MEMBERS.1 Do only only the members of your household use the toilet or is it shared with other household(s)? WITH OTHER HOSEHOLD(S).2 142A How many rooms are there in your house? Would you please include bedrooms, living rooms, sitting rooms and studying rooms? NO OF ROOMS. 142B Is there a separate kitchen? NO .0 YES.1 142C Is there a separate bathroom? NO .0 YES.1 142D Except the rooms listed above, is there any other place such as pantry, and attic? (IF YES) What are they? RECORD THE TOTAL NUMBER OF SUCH PLACES. NO .0 HOW MANY . 142E From all you listed, how many rooms in your house are generally used for sleeping? ROOMS USED FOR SLEEPING . 143 NATURAL FLOOR EARTH.11 RUDIMENTARY WOOD BLANKS .21 FINISHED FLOOR PARQUET/POLISHED WOOD .31 KARO.32 CEMENT.34 CARPET.35 MARLEY .36 MOZAİC .37 OTHER _________________________________________96 What is the main material of the floor? (SPECIFY) 144 Do you have the following in the household? NO YES Refrigerator REFRIGERATOR.0 1 Gas or electric oven GAS OR ELECTRIC OVEN .0 1 Microwave oven MICROWAVE OVEN.0 1 Dishwasher DISHWASHER.0 1 Blender/Mixer BLENDER/MIXER .0 1 DVD/VCD Player DVD/VCD PLAYER .0 1 Washing Machine WASHING MACHINE .0 1 Video Camera VIDEO CAMERA .0 1 Iron IRON .0 1 Digiturk, CINE 5, Satellite Antenna etc. DIGITURK, CINE5, SATELLITE ANTENNA .0 1 Vacuum Cleaner VACUUM CLEANER.0 1 Air Conditioner AIR CONDITIONER.0 1 Television (IF YES) How many? TELEVISION.0 Video VIDEO.0 1 Cable TV CABLE TV.0 1 Camera CAMERA.0 1 CD Player CD PLAYER.0 1 Telephone TELEPHONE.0 1 Cellular phone (IF YES) How many members have cellular phone? CELLULAR PHONE.0 Computer COMPUTER .0 1 Internet INTERNET .0 1 Private Car (IF YES) How many? PRIVATE CAR.0 Taxi/Minibus/Bus/commercial vehicles TAXI/MINIBUS/BUS .0 1 Tractor TRACTOR .0 1 Motorcycle MOTORCYCLE .0 1 Bicycle BICYCLE.0 1 145 NO .0 Does any member of this household have a credit card? (IF YES) How many members have credit cards? NUMBER OF PERSONS HAVING CARDS. 146 I would like to get an estimate of the total income earned by the members of this household. Approximately, do the household members earn per month totally: 146A More than 450 million? YES.1 NO .2 ⎯⎯► 146F 146B More than 600 million? YES.1 NO .2 ⎯⎯► 147 146C More than 750 million? YES.1 NO .2 ⎯⎯► 147 146D More than 1 billion? YES.1 NO .2 ⎯⎯► 147 146E More than 3 billion? YES.1 ⎯⎯► 147 NO .2 ⎯⎯► 147 146F YES.1 Less than 300 million? NO .2 ⎯⎯► 147 146G Less than 150 million? YES.1 NO .2 İSTANBUL METROPOLITAN HOUSEHOLD MODULE 147 CHECK COVER PAGE: İSTANBUL METROPOLITAN HOUSEHOLD (1) NOT İSTANBUL METROPOLITAN 160 HOUSEHOLD (2) 147A CHECK COVER PAGE: THERE IS AT LEAST ONE NOBODY IS USUALLY PERSON USUALLY LIVING LIVING IN THIS HOUSE 160 IN THIS HOUSE 148 CHECK QUESTION 123: IF IT IS NOT A LODGING (123 = 1, 2, 4 OR 7) IF LODGING (123=3) 165 149 Does this house have formal title deeds? YES.1 ⎯⎯► 153 NO .2 DK .8 150 Does this house have allotment document for title deeds? YES.1 ⎯⎯► 153 NO .2 DK .8 151 Does the land that this house was built on have formal title deeds? YES.1 ⎯⎯► 153 NO .2 DK .8 152 NO.0 YES _____________________________________________1 (SPECIFY) Except than I asked, is there any other formal document of this house or the land that this house was built on given by government or municipality? (IF YES) What kind of a document is it? DK .8 153 IMPOSSIBLE.0 POSSIBLE HOUSE OWNER.1 GOVERNMENT/MUNICIPALITY.2 OTHER _____________________________________7 Do you think that you may be evicted from this dwelling without due legal process? (IF YES) By whom? (SPECIFY) DK .8 154 Do you pay environment and garbage tax? YES.1 NO .2 DK .8 155 Have you contracted for electricity? YES.1 NO .2 DK .8 156 Have you contracted with İSKİ? YES.1 NO .2 DK .8 157 Have you contracted for natural gas? YES.1 NO .2 DK .8 SALT IODIZATION 160 CHECK COVER PAGE: CLUSTER NO IS EVEN, AND HH NO IS ODD OR CLUSTER NO IS ODD, AND HH NO IS EVEN CLUSTER NO IS EVEN CLUSTER NO IS ODD 161 AND HH NO IS EVEN AND HH NO IS ODD 160A ITS OWN PACKAGE OPEN.11 CLOSED .12 TRANSPARENT POT HAS TAP .21 DOES NOT HAVE TAP .22 UNTRANSPARENT COLOURED POT HAS TAP .31 DOES NOT HAVE TAP .32 SALT IS NOT USED IN THE HOUSE .41 161 OTHER _________________________________________96 I want to ask questions about the salt that you use in cooking in your house. In what kind of pot do you preserve the salt that you use in cooking? ASK FOR THE POT OR THE PACKAGE THAT IS USED IN PRESERVING SALT. IF BOTH OF THEM IS AVALIABLE, RECODE BY TAKING THE POT AS THE BASE. . (SPECIFY) 160B INFORMATION ON THE PACKAGE POTASIUM IODURE .1 POTASIUM IODADE .2 NO INFORMATION .3 PACKAGE WAS NOT SEEN .4 IF SALT IS IN ITS OWN PACKAGE, LOOK FOR WHETHER SALT IS “POTASIUM IODURE” OR “POTASIUM IODADE” AND RECORD. 160C OPEN PLACE .1 CLOSED CLOSET .2 IF SALT IS PRESERVED IN A POT: Where do you usually preserve salt pot? IF SALT IS PRESERVED IN ITS OWN PACKAGE: Where do you usually preserve salt package? 160D POTASIUM IODURE TEST NOT IODIZED - 0 PPM (NO COLOUR).11 IODIZED (HAS COLOUR) .12 161 POTASIUM IODADE TEST NOT IODIZED - 0 PPM (NO COLOUR).21 LESS THAN 15 PPM (LIGHT COLOUR).22 15 PPM OR MORE (DARK COLOUR).23 NOT TESTED ____________________________________00 Now I want to test whether the salt that you use in your house is iodized or not. IF BOTH PRESERVING POT AND PACKAGE IS AVALIABLE, APPLY POTASIUM IODURE TEST AND RECORD BY TAKING SAMPLE FROM PRESERVING POT. IF SALT DOES NOT CONTAIN POTASIUM IODURE, ALSO APPLY POTASIUM IODADE TES AND RECORD. (SPECIFY) 161 LINE NO. OF THE RESPONDENT IN THE HOUSEHOLD SCHEDULE HOUSEHOLD LINE NO . 162 TURKISH.A ⎯►164S KURDISH . B ARABIC. C OTHER _________________________________________ U LANGUAGE(S) USED FOR CONDUCTING THE HOUSEHOLD QUESTIONNAIRE (SPECIFY) 163 YES.1 WAS AN INTERPRETER USED? NO .2 HOUR. 164S RECORD THE TIME MINUTE. PROVINCE TRAFFIC CODES 01 ADANA 21 DİYARBAKIR 41 KOCAELİ 61 TRABZON 02 ADIYAMAN 22 EDİRNE 42 KONYA 62 TUNCELİ 03 AFYON 23 ELAZIĞ 43 KÜTAHYA 63 ŞANLIURFA 04 AĞRI 24 ERZİNCAN 44 MALATYA 64 UŞAK 05 AMASYA 25 ERZURUM 45 MANİSA 65 VAN 06 ANKARA 26 ESKİŞEHİR 46 K.MARAŞ 66 YOZGAT 07 ANTALYA 27 GAZİANTEP 47 MARDİN 67 ZONGULDAK 08 ARTVİN 28 GİRESUN 48 MUĞLA 68 AKSARAY 09 AYDIN 29 GÜMÜŞHANE 49 MUŞ 69 BAYBURT 10 BALIKESİR 30 HAKKARİ 50 NEVŞEHİR 70 KARAMAN 11 BİLECİK 31 HATAY 51 NİĞDE 71 KIRIKKALE 12 BİNGÖL 32 ISPARTA 52 ORDU 72 BATMAN 13 BİTLİS 33 İÇEL 53 RİZE 73 ŞIRNAK 14 BOLU 34 İSTANBUL 54 SAKARYA 74 BARTIN 15 BURDUR 35 İZMİR 55 SAMSUN 75 ARDAHAN 16 BURSA 36 KARS 56 SİİRT 76 IĞDIR 17 ÇANAKKALE 37 KASTAMONU 57 SİNOP 77 YALOVA 18 ÇANKIRI 38 KAYSERİ 58 SİVAS 78 KARABÜK 19 ÇORUM 39 KIRKLARELİ 59 TEKİRDAĞ 79 KİLİS 20 DENİZLİ 40 KIRŞEHİR 60 TOKAT 80 OSMANİYE 81 DÜZCE 90 ABROAD CONVERSION OF YEARS OF BIRTH FROM RUMI CALENDAR TO GREGORIAN CALENDAR YEARS: RUMI YEARS + 584 = GREGORIAN YEAR HAS NOT HAD BIRTHDAY IN 2003 HAS ALREADY HAD BIRTHDAY IN 2003 HAS NOT HAD BIRTHDAY IN 2004 HAS ALREADY HAD BIRTHDAY IN 2004 0 2002 -- 0 2003 -- 1 2001 2002 1 2002 2003 2 2000 2001 2 2001 2002 3 1999 2000 3 2000 2001 4 1998 1999 4 1999 2000 5 1997 1998 5 1998 1999 6 1996 1997 6 1997 1998 7 1995 1996 7 1996 1997 8 1994 1995 8 1995 1996 9 1993 1994 9 1994 1995 10 1992 1993 10 1993 1994 11 1991 1992 11 1992 1993 12 1990 1991 12 1991 1992 13 1989 1990 13 1990 1991 14 1988 1989 14 1989 1990 15 1987 1988 15 1988 1989 16 1986 1987 16 1987 1988 17 1985 1986 17 1986 1987 18 1984 1985 18 1985 1986 19 1983 1984 19 1984 1985 20 1982 1983 20 1983 1984 21 1981 1982 21 1982 1983 22 1980 1981 22 1981 1982 23 1979 1980 23 1980 1981 24 1978 1979 24 1979 1980 25 1977 1978 25 1978 1979 26 1976 1977 26 1977 1978 27 1975 1976 27 1976 1977 28 1974 1975 28 1975 1976 29 1973 1974 29 1974 1975 30 1972 1973 30 1973 1974 31 1971 1972 31 1972 1973 32 1970 1971 32 1971 1972 33 1969 1970 33 1970 1971 34 1968 1969 34 1969 1970 35 1967 1968 35 1968 1969 36 1966 1967 36 1967 1968 37 1965 1966 37 1966 1967 38 1964 1965 38 1965 1966 39 1963 1964 39 1964 1965 40 1962 1963 40 1963 1964 41 1961 1962 41 1962 1963 42 1960 1961 42 1961 1962 43 1959 1960 43 1960 1961 44 1958 1959 44 1959 1960 45 1957 1958 45 1958 1959 46 1956 1957 46 1957 1958 47 1955 1956 47 1956 1957 48 1954 1955 48 1955 1956 49 1953 1954 49 1954 1955 50 1952 1953 50 1953 1954 51 1951 1952 51 1952 1953 52 1950 1951 52 1951 1952 53 1949 1950 53 1950 1951 54 1948 1949 54 1949 1950 55 1947 1948 55 1948 1949 56 1946 1947 56 1947 1948 57 1945 1946 57 1946 1947 58 1944 1945 58 1945 1946 59 1943 1944 59 1944 1945 60 1942 1943 60 1943 1944 61 1941 1942 61 1942 1943 62 1940 1941 62 1941 1942 63 1939 1940 63 1940 1941 64 1938 1939 64 1939 1940 65 1937 1938 65 1938 1939 66 1936 1937 66 1937 1938 67 1935 1936 67 1936 1937 68 1934 1935 68 1935 1936 69 1933 1934 69 1934 1935 AGE -YEAR OF BIRTH TABLE 20042003 YEAR OF BIRTH AGE DOES NOT KNOWAGE YEAR OF BIRTH DOES NOT KNOW HACETTEPE UNIVERSITY INSTITUTE OF POPULATION STUDIES 2003 TURKISH DEMOGRAPHIC AND HEALTH SURVEY EVER-MARRIED WOMEN’S QUESTIONNAIRE IDENTIFICATION CLUSTER NO . HOUSEHOLD NO . 5 REGION . 12 REGION . PLACE OF RESIDENCE URBAN (1) RURAL (2). PROVINCE __________________________________ DISTRICT ___________________________________ SUB-DISTRICT____________________________________ VILLAGE _______________________________ QUARTER __________________________________________ STREET __________________________________ NO_______ NAME-SURNAME OF WOMAN___________________________________ LINE NUMBER OF WOMAN . IF CURRENTLY MARRIED NAME-SURNAME OF HUSBAND_________________________________ LINE NUMBER OF HUSBAND. INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE (DAY-MONTH) ____ ____ ____ ____ ____ ____ INTERVIEWER'S NAME-SURNAME _________________ _________________ ________________ RESULT (*) ____ ____ ____ NEXT VISIT DAY-MONTH HOUR ____ ____ ____ ____ ____ ____ ____ ____ TOTAL NO OF VISITS (*) RESULT CODES 01 COMPLETED 02 WOMAN IS NOT AT HOME DURING VISITS 03 WOMAN IS NOT AT HOME DURING SURVEY DATE 04 POSTPONED 05 REFUSED 09 PARTLY COMPLETED 96 OTHER ______________________________ (SPECIFY) SUPERVISOR FIELD EDITOR KEYER _________________________________ _________________________________ _________________________________ DAY-MONTH DAY-MONTH DAY-MONTH HAS NOT HAD BIRTHDAY IN 2003 HAS ALREADY HAD BIRTHDAY IN 2003 HAS NOT HAD BIRTHDAY IN 2004 HAS ALREADY HAD BIRTHDAY IN 2004 0 2002 -- 0 2003 -- 1 2001 2002 1 2002 2003 2 2000 2001 2 2001 2002 3 1999 2000 3 2000 2001 4 1998 1999 4 1999 2000 5 1997 1998 5 1998 1999 6 1996 1997 6 1997 1998 7 1995 1996 7 1996 1997 8 1994 1995 8 1995 1996 9 1993 1994 9 1994 1995 10 1992 1993 10 1993 1994 11 1991 1992 11 1992 1993 12 1990 1991 12 1991 1992 13 1989 1990 13 1990 1991 14 1988 1989 14 1989 1990 15 1987 1988 15 1988 1989 16 1986 1987 16 1987 1988 17 1985 1986 17 1986 1987 18 1984 1985 18 1985 1986 19 1983 1984 19 1984 1985 20 1982 1983 20 1983 1984 21 1981 1982 21 1982 1983 22 1980 1981 22 1981 1982 23 1979 1980 23 1980 1981 24 1978 1979 24 1979 1980 25 1977 1978 25 1978 1979 26 1976 1977 26 1977 1978 27 1975 1976 27 1976 1977 28 1974 1975 28 1975 1976 29 1973 1974 29 1974 1975 30 1972 1973 30 1973 1974 31 1971 1972 31 1972 1973 32 1970 1971 32 1971 1972 33 1969 1970 33 1970 1971 34 1968 1969 34 1969 1970 35 1967 1968 35 1968 1969 36 1966 1967 36 1967 1968 37 1965 1966 37 1966 1967 38 1964 1965 38 1965 1966 39 1963 1964 39 1964 1965 40 1962 1963 40 1963 1964 41 1961 1962 41 1962 1963 42 1960 1961 42 1961 1962 43 1959 1960 43 1960 1961 44 1958 1959 44 1959 1960 45 1957 1958 45 1958 1959 46 1956 1957 46 1957 1958 47 1955 1956 47 1956 1957 48 1954 1955 48 1955 1956 49 1953 1954 49 1954 1955 50 1952 1953 50 1953 1954 51 1951 1952 51 1952 1953 52 1950 1951 52 1951 1952 53 1949 1950 53 1950 1951 54 1948 1949 54 1949 1950 55 1947 1948 55 1948 1949 56 1946 1947 56 1947 1948 57 1945 1946 57 1946 1947 58 1944 1945 58 1945 1946 59 1943 1944 59 1944 1945 60 1942 1943 60 1943 1944 61 1941 1942 61 1942 1943 62 1940 1941 62 1941 1942 63 1939 1940 63 1940 1941 64 1938 1939 64 1939 1940 65 1937 1938 65 1938 1939 66 1936 1937 66 1937 1938 67 1935 1936 67 1936 1937 68 1934 1935 68 1935 1936 69 1933 1934 69 1934 1935 AGE -YEAR OF BIRTH TABLE 20042003 YEAR OF BIRTH AGE DOES NOT KNOWAGE YEAR OF BIRTH DOES NOT KNOW 1 9 SECTION 1. RESPONDENT'S BACKGROUND 101 RECORD THE TIME HOUR-MINUTE. 105 First I would like to ask some questions about you and the place you live in. In what year and month were you born? MONTH. DOESN’T KNOW MONTH.98 YEAR . DOESN’T KNOW YEAR.9998 106 How old are you exactly? What age have you completed? CHECK ANSWERS TO 105 AND 106 USING AGE-BIRTH YEAR TABLE. IF INCONSISTENT PROBE AND CORRECT. AGE MUST BE DETERMINED! AGE IN COMPLETED YEARS . 107 YES. 1 Have you ever attended school? NO. 2 114 108 PRIMARY SCHOOL. 1 SECONDARY SCHOOL. 2 PRIMARY EDUCATION . 3 HIGH SCHOOL . 4 What is the highest level you have attended? ÜNIVERSITY . 5 GRADUATE . 6 109A What is the highest grade you have completed at that level? RECORD “0” IF THE RESPONDENT COMPLETED PREPARATORY CLASS OR SHE DID NOT COMPLETE ANY GRADE. GRADE . 109B Did you graduate (receive diploma) from this school? YES. 1 NO. 2 113 CHECK 108 AND 109A: ATTENDED SCHOOL FOR 5 OR LESS YEARS ATTENDED SCHOOL FOR 6 OR MORE YEARS 115A 114 NOT AT ALL. 0 115B WITH DIFFICULTY . 1 Can you read and understand a letter or newspaper easily, with difficulty, or not at all? EASILY . 2 115A NEVER. 0 RARELY/SELDOM . 1 ONCE-TWICE A WEEK. 2 How frequently do you read a newspaper? EVERY DAY/ALMOST EVERY DAY . 3 115B Except for formal education; YES NO Have you ever attended a literacy course? 1 2 Have you ever attended Koran course? 1 2 Have you taken any other religious education? 1 2 Have you ever attended any foreign language course(s)? 1 2 Have you ever attended computer course? 1 2 Have you ever attended typewriting course? 1 2 Have you ever attended any occupation/skill training course? 1 2 115D Have you ever smoked cigarettes or do you currently smoke? NEVER SMOKED. 1 TRIED ONCE OR TWICE . 2 115G (IF YES) How frequent? RARELY SMOKES. 3 SMOKES REGULARLY/ADDICTED. 4 SMOKED IN THE PAST/GAVE UP. 5 115E When did you begin smoking cigarettes? AGE OF BEGINNING TO SMOKE. 115F What is the average number of cigarettes do (did) you smoke in a day? AVERAGE NUMBER OF CIGARETTES. 115G Is there anybody smoking cigarettes at home YES. 1 115I (except for you)? NO. 2 115H CHECK 115D: THE WOMAN INTERVIEWED SMOKES RARELY OR REGULARLY (115D=3 OR 4) THE WOMAN INTERVIEWED HAS NEVER SMOKED, TRIED ONCE OR TWICE OR GIVEN UP (115D=1,2 OR 5) 116A 115I Are cigarettes smoked in your house in the following situations? In the living room when watching TV NO, NEVER . 0 (IF YES): Sometimes or usually? YES, USUALLY. 1 YES, SOMETIMES . 2 Around the table after meal? NO, NEVER . 0 (IF YES): Sometimes or usually? YES, USUALLY. 1 YES, SOMETIMES . 2 In the room(s) used for sleeping? NO, NEVER . 0 (IF YES): Sometimes or usually? YES, USUALLY. 1 YES, SOMETIMES . 2 116A TURKISH.01 KURDISH .02 ARABIC .03 GREEK, ARMANIAN, HEBREW (LADINO) .04 CIRCASSIAN, GEORGIAN, LAZ LANGUAGE.05 RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN.06 ENGLISH, GERMAN, FRENCH.07 OTHER ___________________________________________ 96 What is your mother tongue? RECORD ONLY ONE RESPONSE. (SPECIFY) 116B TURKISH. A KURDISH . B ARABIC . C GREEK, ARMANIAN, HEBREW (LADINO) . D CIRCASSIAN, GEORGIAN, LAZ LANGUAGE.E RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN.F ENGLISH, GERMAN, FRENCH. G OTHER ____________________________________________ U (SPECIFY) In addition to your mother tongue, which language(s) can you speak? RECORD ALL MENTIONED. KNOWS NO OTHER LANGUAGE. Y 116C What is (was) your mother's mother tongue? What is (was) your father's mother tongue? USE THE CODES IN 116A. MOTHER . FATHER. 117A Is (was) your mother literate? YES. 1 NO. 2 117B Did your mother ever attend to school? DID NOT ATTEND TO SCHOOL . 0 (IF YES) Which school did she complete? ATTENDED TO PRIMARY SCHOOL, DID NOT FINISH . 1 PRIMARY SCHOOL GRADUATE. 2 SECONDARY SCHOOL GRADUATE . 3 HIGH SCHOOL GRADUATE. 4 UNIVERSITY GRADUATE/GRADUATE EDUCATION . 5 DON’T KNOW . 8 117C How many children born to your mother are alive today, including yourself? How many of them are male, how many of them are female? NUMBER OF MALE CHILDREN ALIVE. NUMBER OF FEMALE CHILDREN ALIVE. TOTAL NUMBER OF LIVING CHILDREN . 117D Did she have any other male or female births, who died later? YES. 1 NO. 2 117F (IF NO) He/she could die just after the birth or when he/she was a young baby. DON’T KNOW .98 117E How many of them were male, how many of them were female? NUMBER OF DECEASED MALE CHILDREN . NUMBER OF DECEASEDAD FEMALE CHILDREN . SEX UNKNOWN .………. 117F Is (was) your father literate? NO. 1 YES. 2 117G Did your father ever attend school? DID NOT ATTEND SCHOOL. 0 (IF YES) Which school did he complete? ATTENDED PRIMARY SCHOOL, DID NOT FINISH. 1 PRIMARY SCHOOL GRADUATE. 2 SECONDARY SCHOOL GRADUATE . 3 HIGH SCHOOL GRADUATE. 4 UNIVERSITY GRADUATE/GRADUATE EDUCATION . 5 DON’T KNOW . 8 119A CURRENT RESIDENCE . 0 PROVINCE CENTRE . 1 DISTRICT CENTRE. 2 SUBDISTRICT OR VILLAGE . 3 ABROAD . 4 119C For most of the time until you were 12 years old, where did you live? _______________________________ (NAME OF PLACE) Was it a province centre, district centre, a subdistrict or village ? Or did you live abroad? 119B In which province is this place now? RECORD THE NAME AND CODE OF THE PROVINCE. NAME OF PROVINCE PROVINCE CODE ________________________________________ 119C YEAR . How long have you been living continuously in ……. (NAME OF CURRENT PLACE OF INTERVIEW OR USUAL RESIDENCE)? SINCE I WAS BORN .95 119G 119D PROVINCE CENTRE . 1 DISTRICT CENTRE. 2 SUBDISTRICT OR VILLAGE . 3 ABROAD . 4 119F Where did you live before you moved here (there)? _________________________________ (NAME OF THE PLACE) Was that a province centre, district centre, a subdistrict or village ? Or did you live abroad? 119E In which province is this place now? RECORD THE NAME AND CODE OF THE PROVINCE. NAME OF PROVINCE PROVINCE CODE ________________________________________ 119F PERSONAL REASONS MARRIAGE.11 EDUCATION.12 LOOKING FOR JOB.13 CHANGE OF JOB/APPOINMENT.14 RETURN TO HOMELAND.15 SPOUSAL REASONS TO ACCOMPANY HUSBAND.21 CHANGE OF JOB/APPOINMENT.22 LOOKING FOR JOB.23 HUSBAND DIED/DIVORCED .24 FAMILIAL REASONS TO JOIN PARENTS .31 What was the main reason for you to move to ………… (PLACE OF INTERVIEW OR USUAL RESIDENCE)? CHANGE OF JOB/APPOINMENT.32 LOOKING FOR JOB.33 HEALTH REASONS .41 SECURITY REASONS .51 OTHER ___________________________________________ 96 (SPECIFY) 119G CHECK 04 IN THE HOUSEHOLD QUESTIONNAIRE: THE WOMAN INTERVIEWED IS NOT A USUAL RESIDENT THE WOMAN INTERVIEWED IS A USUAL RESIDENT 200S 120A What is the number of usual members living in your house? NUMBER OF RESIDENTS . HOUSING CARACTERISTICS 123 OWNED BY A HOUSEHOLD MEMBER .1 ⎯⎯► 125 RENTED .2 LODGING.3 ⎯⎯► 125 NO RENT PAID .4 124 OTHER __________________________________________7 Does the house you usually live belong to a household member, is it rented from someone else, is it a lodging, or do you just live here without having to pay anything? (SPECIFY) 123A Do you have a tenancy agreement? YES.1 NO .2 124 To whom does your house belong to? OTHER FAMILY MEMBER, RELATIVE .1 (NON-FAMILY MEMBER/NON-KIN) HOUSE OWNER.2 GOVERNMENT .3 PRIVATE ORGANISATION/FIRM.4 OTHER __________________________________________7 (SPECIFY) 125 NO .00 Does anyone from your household own any other house elsewhere? (IF YES) How many? NO. OF OWNED HOUSES . 129 PIPED WATER PIPED WATER IN HOUSE/GARDEN.11 ⎯⎯► 131 PUB. PIPED WATER OUTSIDE HOUSE/GARDEN .12 WELL WATER WELL IN HOUSE/GARDEN .21 ⎯⎯► 131 PUBLIC WELL.22 SURFACE WATER PIPED SURFACE WATER IN HOUSE/GARDEN.31 ⎯⎯► 131 SPRING/PUBLIC FOUNTAIN.32 RIVER/STREAM/POND/LAKE/DAM .33 RAINWATER .41 ⎯⎯► 131 TANKER TRUCK .51 BOTTLED WATER/DEMI JOHN/PET WATER .61 ⎯⎯► 133 WATER STATION.71 OTHER _________________________________________96 What is the source of drinking water for members of your household? (SPECIFY) 130 MINUTE. How long does it take you go there, get water, and come back? ON PREMISES .996 131 USUALLY/ALWAYS .1 SEVERAL HOURS IN A DAY .2 EVERY OTHER DAY .3 A FEW TIMES IN A WEEK.4 RARELY .5 Is water always avaliable at this source? How frequently is it avaliable DON’T KNOW .8 132 NO .0 WATER IS BOILED.1 WATER IS CHLORINATED.2 WATER IS FILTERED .3 OTHER __________________________________________7 (SPECIFY) Do you do anything before using drinking water? Such as boiling, filtering, etc. DON’T KNOW .8 133 PIPED WATER PIPED WATER IN HOUSE/GARDEN .11 PUBLIC PIPED WATER OUTSIDE HOUSE/GARDEN.12 WELL WATER WELL IN HOUSE/GARDEN .21 PUBLIC WELL.22 SURFACE WATER PIPED SURFACE WATER IN HOUSE/GARDEN.31 SPRING/WATER FOUNTAIN.32 RIVER/STREAM/POND/LAKE/DAM .33 RAINWATER .41 TANKER TRUCK .51 BOTTLED WATER/DEMI JOHN/PET WATER .61 WATER STATION.71 What is the source of daily use water for hand washing, dishwashing, and laundry in the house you usually live? OTHER _________________________________________96 (SPECIFY) 137 Is the toilet inside the house or outside? NO FACILITY/BUSH/FIELD/PUBLIC TOILET.0 ⎯⎯► 142A INSIDE .1 OUTSIDE .2 INSIDE AND OUTSIDE .3 OTHER.7 (SPECIFY) 138 FLUSH TOILET .1 OPEN PIT.2 CLOSED PIT.3 OTHER __________________________________________7 What type of toilet system do you have in your household? IF MORE THAN ONE TOILETS ARE USED, RECORD ACCORDING TO THE ONE INSIDE OR CLOSEST TO THE HOUSE. (SPECIFY) 139 ONLY HOUSEHOLD MEMBERS.1 Is the toilet used by only the members of your household or is it shared with other household(s)? WITH OTHER HOSEHOLD(S).2 142A How many rooms are there in your house? Would you please include bedrooms, living rooms, sitting rooms and studying rooms? NO OF ROOMS. 142B Is there a separate kitchen? NO .0 YES.1 142C Is there a separate bathroom? NO .0 YES.1 142D Except the rooms listed above, is there any other place such as pantry and attic? (IF YES) What are they? RECORD THE TOTAL NUMBER OF SUCH PLACES. NO .00 HOW MANY . 142E From all you listed, how many rooms in your house are generally used for sleeping? ROOMS USED FOR SLEEPING . 143 NATURAL FLOOR EARTH.11 RUDIMENTARY WOOD BLANKS .21 FINISHED FLOOR PARQUET/POLISHED WOOD .31 KARO.32 CEMENT.34 CARPET.35 MARLEY .36 MOZAIC .37 OTHER _________________________________________96 What is the main material of the floor? (SPECIFY) 144 Do you have the following in the household? YES NO Refrigerator REFRIGERATOR.0 1 Gas or electric oven GAS OR ELECTRIC OVEN .0 1 Microwave oven MICROWAVE OVEN.0 1 Dishwasher DISHWASHER.0 1 Blender/Mixer BLENDER/MIXER .0 1 DVD/VCD Player DVD/VCD PLAYER .0 1 Washing Machine WASHING MACHINE .0 1 Video Camera VIDEO CAMERA .0 1 Iron IRON .0 1 Digiturk, CINE 5, Satellite Antenna etc. DIGITURK, CINE5, SATELLITE ANTENNA .0 1 Vacuum Cleaner VACUUM CLEANER.0 1 Air Conditioner AIR CONDITIONER.0 1 Television (IF YES) How many? TELEVISION.0 Video VIDEO.0 1 Cable TV CABLE TV.0 1 Camera CAMERA.0 1 CD Player CD PLAYER.0 1 Telephone TELEPHONE.0 1 Cellular phone (IF YES) How many members have cellular phone? CELLULAR PHONE.0 Computer COMPUTER .0 1 Internet INTERNET .0 1 Private Car (IF YES) How many? PRIVATE CAR.0 Taxi/Minibus/Bus/commercial vehicles TAXI/MINIBUS/BUS .0 1 Tractor TRACTOR .0 1 Motorcycle MOTORCYCLE .0 1 Bicycle BICYCLE.0 1 145 NONE .0 Does any member of this household have a credit card? (IF YES) How many members have credit cards? NUMBER OF PERSONS HAVING CARDS. 146 I would like to get an estimate of the total income earned by the members of this household. Approximately, do the household members earn per month totally: 146A More than 450 million? YES.1 NO .2 ⎯⎯► 146F 146B More than 600 million? YES.1 NO .2 ⎯⎯► 200S 146C More than 750 million? YES.1 NO .2 ⎯⎯► 200S 146D More than 1 billion? YES.1 NO .2 ⎯⎯► 200S 146E More than 3 billion? YES.1 ⎯⎯► 200S NO .2 ⎯⎯► 200S 146F YES.1 Less than 300 million? NO .2 ⎯⎯► 147 146G Less than 150 million? YES.1 NO .2 SECTION 2A. REPRODUCTION 200S RECORD TIME HOUR – MINUTE. 201 Now I would like to ask about all the births you have had during your life. YES.1 Have you ever given birth? NO. 2 206 202 Do you have any sons or daughters to whom you have given birth who are YES .1 living with you? NO . 2 204 203 How many sons live with you? And how many daughters live with you? IF NONE, RECORD “00”. SONS AT HOME . DAUGHTERS AT HOME . 204 Do you have any sons or daughters to whom you have given birth who are alive YES . 1 but do not live with you? NO .2 206 205 How many sons are alive but do not live with you? How many daughters are alive but do not live with you? IF NONE, RECORD “00”. SONS ELSEWHERE . DAUGHTERS ELSEWHERE . 206 Have you ever given birth to a boy or a girl who was born alive but died later? YES . 1 NO .2 208 IF NO, PROBE BEFORE RECORDING: Any baby who cried or showed signs of life but only survived a few hours or days? 207 In all, how many boys have died? And how many girls have died? IF NONE, RECORD “00”. BOYS DEAD. GIRLS DEAD. 208 SUM ANSWERS TO 203, 205, AND 207, AND ENTER TOTAL TOTAL. IF NONE, RECORD “00”. 209 CHECK 208: Just to make sure that I have this right: you have had. in TOTAL ______ live births during your life. Is this true? YES NO PROBE AND CORRECT 201-208 210 CHECK 208: HAS AT LEAST HAS NO LIVE 227 ONE LIVE BIRTH LIVE BIRTHS 211 Now I would like to talk to you about all of your births. It is very important to learn about all of your births, whether still alive or not. Please let's start with the first one you had RECORD NAMES OF ALL THE BIRTHS IN 212. RECORD TWINS AND TRIPLETS ON SEPARATE LINES MAKE SURE TO RECORD DECEASED CHILDREN FROM MULTIPLE BIRTHS BEFORE THOSE SURVIVING. 212 What name was given to your (first/next) baby? WRITE “BABY” IF THE BABY DIED BEFORE A NAME GIVEN. 213 RECORD SINGLE OR MULTIPLE BIRTH STATUS. 214 Is …. a boy or a girl? 215 In what month and year. born? PROBE: In what season was s/he born? NOTE: FOR ALL CHILDREN, THE YEAR OF BIRTH; FOR CHILDREN BORN AFTER 1998, THE MONTH OF THE YEAR OF BIRTH MUST BE DETERMINED. 216 Is …… still alive? 01 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 02 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 03 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 04 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 05 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 217 How old was . at 218 . 218A RECORD THE 219 IF DEAD: 221 his/her last birthday? RECORD AGE IN COMPLETED YEARS. MAKE CALCULATIONS FOR CONSISTENCY. Is. living with you? LINE NUMBER OF CHILD IN THE HH LIST. IF S/HE WASN'T RECORDED IN HH LIST, RECORD "00". How old was . when he/she died? IF “1” YR., PROBE: How many months old was .? RECORD DAYS IF LESS THAN 1 MONTH, MONTHS IF LESS THAN TWO YEARS OR YEARS OTHERWISE. Were there any other live births between (NAME OF PREVIOUS BIRTH) and .? AGE (IN YEARS) YES . NO . .1 .2 NEXT BIRTH DAY . MONTH . YEAR . 1 2 3 AGE (IN YEARS) YES . NO . .1 .2 SKIP TO 221 DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 AGE (IN YEARS) YES . NO . .1 .2 SKIP TO 221 DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 AGE (IN YEARS) YES . NO . .1 .2 SKIP TO 221 DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 AGE (IN YEARS) YES . NO . .1 .2 SKIP TO 221 DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 IF THE ANSWER IS YES GO AND MAKE THE CHANGES 212 What name was given to your (first/next) baby? WRITE "BABY IF THE BABY DIED BEFORE A NAME GIVEN. 213 RECORD SINGLE OR MULTIPLE BIRTH STATUS. 214 Is …. a boy or a girl? 215 In what month and year. born? PROBE: In what season was s/he born? NOTE: FOR ALL CHILDREN, THE YEAR OF BIRTH; FOR CHILDREN BORN AFTER 1998, THE MONTH OF THE YEAR OF BIRTH MUST BE DETERMINED. 216 Is …… still alive? 06 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 07 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 08 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 09 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 10 (NAME) SINGLE . MULTIPLE . .1 .2 BOY. GIRL . .1 .2 MONTH . YEAR. YES. NO. 219 .1 .2 TICK HERE IF NUMBER OF LIVE BIRTHS IS MORE THAN 10 AND CONTINUE IN ANOTHER QUESTIONNAIRE FORM 217 How old was . at 218 . 218A RECORD THE 219 IF DEAD: 221 his/her last birthday? RECORD AGE IN COMPLETED YEARS. MAKE CALCULATIONS FOR CONSISTENCY. Is. living with you? LINE NUMBER OF CHILD IN THE HH LIST. IF S/HE WASN'T RECORDED IN HH LIST, RECORD "00". How old was . when he/she died? IF “1” YR., PROBE: How many months old was .? RECORD DAYS İF LESS THAN 1 MONTH, MONTHS İF LESS THAN TWO YEARS OR YEARS OTHERWİSE. Were there any other live births between (NAME OF PREVIOUS BIRTH) and .? AGE (IN YEARS) YES . NO . .1 .2 NEXT BIRTH DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 AGE (IN YEARS) YES . NO . .1 .2 SKIP TO 221 DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 AGE (IN YEARS) YES . NO . .1 .2 SKIP TO 221 DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 AGE (IN YEARS) YES . NO . .1 .2 SKIP TO 221 DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 AGE (IN YEARS) YES . NO . .1 .2 SKIP TO 221 DAY . MONTH . YEAR . 1 2 3 YES. NO. 1 2 IF THE ANSWER IS YES GO AND MAKE THE CHANGES 223A Have you had any live births since the birth of (NAME OF LAST BIRTH)? YES . 1 NO .2 224 223B GO BACK AND MAKE THE NECESSARY CORRECTIONS. 224 COMPARE 208 WITH NUMBER OF BIRTHS IN BIRTH HISTORY ABOVE: NUMBERS ARE NUMBERS ARE SAME DIFFERENT (PROBE, RECONCILE AND MAKE NECESSARY CORRECTIONS) CHECK AND TICK: FOR EACH BIRTH: YEAR OF BIRTH (215) IS RECORDED . FOR EACH BIRTH AFTER 1998: MONTH OF BIRTH (215) IS RECORDED. . (IF ANY) FOR EACH LIVING CHILD: CURRENT AGE (217) IS RECORDED . (IF ANY) FOR EACH DEAD CHILD: AGE AT DEATH (219) IS RECORDED. FOR AGE AT DEATH 12 MONTHS OR 1 YR.: PROBED TO DETERMINE EXACT NUMBER OF MONTHS (219). 225 CHECK 215 AND ENTER THE NUMBER OF BIRTHS SINCE JANUARY 1998 IF NONE, RECORD “0”. 226 C FOR EACH BIRTH SINCE JANUARY 1998 ENTER “D” IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. LEARN THE MONTHS IN PREGNANCIES FOR EACH BIRTHS AND RECORD “H” IN EACH OF THE PRECEDING MONTHS.(NUMBER OF “H” MUST BE LESS THAN PREGNANCY MONTHS) WRITE NAME OF CHILD TO THE LEFT OF THE “D” CODE. 227 Are you pregnant now? YES . 1 NO .2 UNSURE .8 230A 228 How many months pregnant are you? C RECORD NUMBER OF COMPLETED MONTHS ENTER “H”s IN COLUMN 1 OF THE CALENDAR BEGINNING WITH THE MONTH OF INTERVIEW AND FOR TOTAL NUMBER OF COMPLETED MONTHS. MONTH . 229 At the time you became pregnant, did you want to become pregnant then, did you THEN.1 want to wait until later, or did you not want to have any more children at all? LATER.2 NOT WANT MORE CHILDREN.3 230A Have you ever had a pregnancy that ended in a miscarriage? YES . 1 NO .2 230C 230B In all, how many miscarriages have you had? NUMBER OF MISCARRIAGES. 230C Have you ever had a pregnancy that ended in an induced abortion? YES . 1 NO . 2 230E 230D In all, how many induced abortions have you had? NO. OF INDUCED ABORTION . 230E Have you ever had a pregnancy that ended in a stillbirth? YES . 1 NO . 2 230G 230F In all, how many still births have you had? NUMBER OF STILL BIRTHS . 230G CALCULATE THE TOTAL NUMBER OF COMPLETED PREGNANCIES. TOTAL NUMBER OF COMPLETED PREGNANCIES. TOTAL NUMBER OF PREGNANCIES ENDING IN MISCARRIAGES, INDUCED ABORTIONS OR STILL BIRTHS: SUM THE ANSWERS TO 230B, 230D AND 230F __________________ TOTAL NUMBER OF PREGNANCIES ENDING IN LIVE BIRTHS: SUM THE NUMBER OF SINGLE BIRTHS IN THE BIRTH HISTORY + __________________ ADD TO THAT SUM THE NUMBER OF MULTIPLE BIRTHS + __________________ TOTAL NUMBER OF COMPLETED PREGNANCIES: = __________________ 230H CHECK 230G: Just to make sure that I have this right. You have had in TOTAL _______ completed pregnancies. Is that correct? YES NO PROBE AND CORRECT 201-230G AS NECESSARY. 230I CHECK 230B, 230D AND 230F: HAD AT LEAST ONE INDUCED ABOTRION, MISCARRIAGE OR STILLBIRTH HAD NO INDUCED ABORTIONS, MISCARRIAGES OR STILLBIRTHS 234 231A Now I would like to ask about any recent induced abortions, miscarriages or stillbirths, which you have had. When did the last such pregnancy ended? MONTH . YEAR. 231B Was this an induced abortion, a miscarriage or a stillbirth? INDUCED ABORTION. 1 MISCARRIAGE……………. 2 STILLBIRTH.3 232 231C Whose decision was to end your pregnancy with an induced abortion? DOCTOR . 01 HERSELF. 02 HUSBAND. 03 WOMAN AND HUSBAND TOGETHER. 04 OTHER ____________________________ 96 (SPECIFY) 231D What was the main reason that your pregnancy to end with an induced abortion? ______________________________________ ______________________________________ _______________________ 231E Where did the operation of induced abortion take place? ____________________________________________ (NAME OF PLACE) PUBLIC SECTOR STATE/SAMPLE HOSPITAL……. MATERNITY HOUSE. MCHFP CENTRE. SSK HOSPITAL/DISPENSARY. OTHER __________________________ (SPECIFY) PRIVATE SECTOR PRIVATE HOSPITAL ……………. PRIVATE POLYCLINIC ……………. PRIVATE DOCTOR …. OTHER __________________________ (SPECIFY) UNIVERSITY HOSPITAL . VOLUNTEER ORGANIZATION/ ASSOCIATION/FOUNDATION . OTHER___________________________ (SPECIFY) 11 12 13 16 19 21 22 23 29 31 41 96 232 CHECK 231A: LAST INDUCED ABORTION/MISCARRIAGE/ LAST INDUCED ABORTION/MISCARRIAGE/ STILLBIRTH ENDED SINCE JANUARY 1998 STILLBIRTH ENDED BEFORE JANUARY 1998 234 233 How many months pregnant were you when the last pregnancy ended? MONTH . C RECORD NUMBER OF COMPLETED MONTHS FOR ALL WASTED PREGNANCIES SINCE 1998 (EXCEPT FOR LIVE BIRTHS) IN COLUMNS 1 AND 2. - PROBE TO DETERMINE HOW THE PREGNANCY ENDED (INDUCED ABORTION, MISCARRIAGE, STILL BIRTH). - IN COLUMN 1 ENTER THE APPROPRIATE CODE IN THE MONTH AND YEAR THE PREGNANCY TERMINATED. - DETERMINE THE NUMBER OF COMPLETED MONTHS AND ENTER “H” FOR THE REMAINING NUMBER OF COMPLETED MONTHS. - IF THE PREGNANCY ENDED WITH INDUCED ABORTION, ENTER THE CODE FOR THE PLACE OF INDUCED ABORTION IN COLUMN 2 OF CALENDAR IN THE MONTH THAT THE PREGNANCY TERMINATED. THEN ASK FOR DATES AND DURATIONS OF ANY OTHER PREGNANCIES BACK TO JANUARY 1998 REPEAT THE PROCEDURES AS DESCRIBED ABOVE FOR THESE PREGNANCIES. ILLUSTRATIVE QUESTIONS: - How did this pregnancy end? (Was it an induced abortion, miscarriage, or stillbirth etc.) - What was the total duration of this pregnancy? How many months pregnant were you? - Where did you have this induced abortion? 234 When did your last menstrual period start? ___________________________________ (DATE, IF GIVEN) RECORD THE ANSWER AS GIVEN. IF EXACT DATE IS GIVEN RECORD AND DO NOT MAKE ANY OTHER CALCULATIONS. DAYS AGO. WEEKS AGO. MONTHS AGO. YEARS AGO. CURRENTLY PREGNANT. IN MENOPAUSE/ HYSTERECTOMY . BEFORE LAST BIRTH. NEVER MENSTRUATED. .1 .2 .3 .4 . . . . 5 .993 .994 .995 .996 235 Think about the time between the beginning of a menstruation period and the YES .….1 beginning of the next menstruation period. NO .…….2 Are there certain days when a woman is more likely to become pregnant if she has DON’T KNOW .….8 237S sexual relations? 236 Is this time just before her period begins, during her period, right after her period has ended, or half way between two periods? JUST BEFORE HER PERIOD BEGINS . DURING HER PERIOD . RIGHT AFTER HER PERIOD HAS ENDED . HALF WAY BETWEEN TWO PERIODS . OTHER ____________________________ (SPECIFY) DON’T KNOW . 1 2 3 4 7 8 237S RECORD TIME HOUR – MINUTE. SECTION 2B. MARRIAGE 250 Are you currently married? YES, CURRENTLY MARRIED. 1 ACCEPT THOSE LIVING TOGETHER AS BEING MARRIED. NO, CURRENTLY NOT MARRIED . 2 255 Did you marry only once or more than once? (IF MORE THAN ONCE) How many times? NUMBER OF MARRIAGES. 257 CHECK 255: MONTH……………………………………………. DON’T KNOW MONTH…………………………98 YEAR………………………………. DON'T KNOW YEAR …………………………9998 MARRIED ONCE MARRIED MORE THAN ONCE In what month and year Now, let's talk about your first husband did you marry (start In what month and year did you marry living with) your husband? (start living with) your husband? 258 How old were you when you started living with your (first) husband? AGE. 259 How old was your (first) husband when you started living with him? AGE. IF THE WOMAN DOES NOT KNOW HER (FIRST) HUSBAND'S AGE AT MARRIAGE, ASK THE AGE DIFFERENCE IS THERE BETWEEN HER AND HER (FIRST) HUSBAND AND ESTIMATE HER (FIRST) HUSBAND'S MARRIAGE AGE. 263 Now I want to ask some questions about your marriage(s). CHECK 255: IF MARRIED ONLY ONCE, USE COLUMN 1. IF MARRIED MORE THAN ONCE, USE COLUMN 1 FOR THE FIRST HUSBAND, USE COLUMN 2 FOR LAST/CURRENT HUSBAND. COLUMN 1 FIRST HUSBAND NAME___________________________ COLUMN 2 LAST HUSBAND NAME___________________________ 264 In which month and year did you start living with . ? MONTH . DON’T KNOW MONTH . 98 YEAR . DON’T KNOW YEAR . 9998 265A Did you have a civil marriage ceremony with .? YES. NO . 1 2 YES. NO . 1 2 265B Did you have a religious ceremony with .? YES. NO . 1 2 YES. NO . 1 2 265C CHECK 265A AND 265B: CIVIL AND RELIGIOUS. 1 CIVIL AND RELIGIOUS. 1 ONLY CIVIL . 2 ONLY CIVIL . 2 ONLY RELIGIOUS. 3 ONLY RELIGIOUS. 3 268 268 NO CEREMONY . 4 NO CEREMONY . 4 266 Which marriage ceremony took place earlier? CIVIL CEREMONY . RELIGIOUS CEREMONY. 1 2 CIVIL CEREMONY . RELIGIOUS CEROMONY. 1 2 267 How much time elapsed between two ceremonies? RECORD “00” DAYS IF BOTH TOOK PLACE ON THE SAME DAY. IF LESS THAN ONE MONTH RECORD AS DAY, IF LESS THAN TWO YEARS RECORD AS MONTH, OTHERWISE RECORD AS YEAR. YEAR……….…………….….1 MONTH……….…………….2 DAY………………………….3 YEAR……….…………….….1 MONTH……….…………….2 DAY………………………….3 268 How was your marriage with . arranged? BY OURSELVES. 1 BY OURSELVES. 1 Did you decide together or was it arranged BY FAMILIES . 2 BY FAMILIES . 2 by your families? ESCAPED/ABDUCTED. 3 ESCAPED/ABDUCTED. 3 OTHER __________________________ 7 OTHER __________________________ 7 269 Did . or his family pay bridesmoney? (IF YES) Was it given in cash or in kind? NO. YES, IN CASH/GOLD. YES, IN KIND. YES, BOTH…………. OTHER __________________________ (SPECIFY) 1 2 3 4 7 NO. YES, IN CASH/GOLD. YES, IN KIND. YES, BOTH…………. OTHER __________________________ (SPECIFY) 1 2 3 4 7 COLUMN 1 FIRST HUSBAND NAME___________________________ COLUMN 2 LAST HUSBAND NAME___________________________ 270 When you first started to live with ……. YES . 1 YES . 1 was there anyone else living with you in your NO . 2 NO . 2 household at that time? 272 272 271 Who else was with you? Who else? RECORD ALL MENTIONED. HUSBAND’S MOTHER/FATHER . SIBLING(S). GRANDMOTHER/FATHER. OTHER RELATIVES. CHILDREN. HER MOTHER/FATHER . SIBLING(S). GRANDMOTHER/FATHER. OTHER RELATIVES. CHILDREN. NOT RELATIVES OF HER OR HER HUSBAND. OTHER__________________________ (SPECIFY) A B C D E F G H I J K U HUSBAND’S MOTHER/FATHER . SIBLING(S). GRANDMOTHER/FATHER. OTHER RELATIVES. CHILDREN. HER MOTHER/FATHER . SIBLING(S). GRANDMOTHER/FATHER. OTHER RELATIVES. CHILDREN. NOT RELATIVES OF HER OR HER HUSBAND. OTHER__________________________ (SPECIFY) A B C D E F G H I J K U 272 Are you related to .? YES . 1 YES . 1 NO . 2 NO . 2 274 274 273 What is (was) his relationship to you? FATHER'S BROTHER'S SON. FATHER'S SISTER'S SON. MOTHER'S SISTER'S SON. MOTHER'S BROTHER'S SON. OTHER __________________________ (SPECIFY) 01 02 03 04 96 FATHER'S BROTHER'S SON. FATHER'S SISTER'S SON. MOTHER'S SISTER'S SON. MOTHER'S BROTHER'S SON. OTHER __________________________ (SPECIFY) 01 02 03 04 96 274 IS MARRIAGE CONTINUING? YES 278 NO YES 279 NO 275 In which month and year did your marriage with . end? MONTH . MONTH . DON’T KNOW MONTH . 98 DON’T KNOW MONTH . 98 YEAR . YEAR . DON’T KNOW YEAR . 9998 DON’T KNOW YEAR . 9998 276 How did your marriage with . ended? Did you get divorced, did . die or did you start to live separated? WIDOWED .…………. DIVORCED . STARTED LIVING SEPARATED . 1 2 3 WIDOWED .…………. DIVORCED . STARTED LIVING SEPARATED . 1 2 3 278 IF MARRIED MORE THAN ONCE TURN BACK TO 264 TO TALK ABOUT HER LAST/CURRENT HUSBAND, IF MARRIED ONCE SKIP TO 279. SKIP TO 279. 279 C IF CURRENTLY MARRIED ENTER “X” IN THE MONTH OF INTERVIEW IN COLUMN 3 OF CALENDAR. THEN, DETERMINE MONTHS MARRIED OR IN UNION SINCE JANUARY 1998. ENTER “X” IN COLUMN 3 OF CALENDAR FOR EACH MONTH MARRIED OR IN UNION, AND ENTER “0” FOR EACH MONTH NOT MARRIED/NOT IN UNION. NOTE: AFTER YOU HAVE COMPLETED THESE, ALL THE BOXES IN COLUMN 3 FROM JANUARY 1998 TO INTERVIEW MONTH SHOULD BE FILLED. SECTION 3. CONTRACEPTION 301 Now I would like to talk about family planning. There are various methods that a married couple can use to avoid pregnancy. • CIRCLE CODE ‘1’ IN Q. 301A FOR EACH METHOD MENTIONED SPONTANEOUSLY. • THEN PROCEED DOWN COLUMN 302, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY AND ASK WHETHER SHE HAS HEARD THE METHOD. • IN Q 302, CIRCLE CODE ‘2’ IF METHOD IS RECOGNIZED AND CODE ‘3’ IF NOT RECOGNIZED. • THEN FOR EACH METHOD WITH CODE ‘1’ OR ‘2’ CIRCLED IN 301A OR 302, ASK 303. • AFTER ASKING ABOUT ALL METHODS PROCEED TO 304. SPON- TANEOUS 302 Have you ever heard this method? PROBED 303 Have you ever used this method? 301A Which ways or methods have you heard? YES YES NO 01 Have you ever had such an operation to avoid having any more children? TUBAL LIGATION Women can have an operation of tubal ligation to avoid having any more children. 1 2 3 YES . NO .……. 1 2 02 MALE STERILIZATION Has (had) your (former) husband ever had such an operation? Men can have an operation called vasectomy so that their wives would not get pregnant. 1 2 3 YES . NO .……. 1 2 03 PILL Women can avoid a pregnancy by taking a pill every day. 1 2 3 YES . NO .……. 1 2 04 IUD Women can have the so called spiral or IUD placed in them by a doctor or a nurse. 1 2 3 YES . NO .……. 1 2 05 INJECTABLES Women can have an injection by a doctor or a nurse, which stops them from becoming pregnant for certain period of time. 1 2 3 YES . NO .……. 1 2 06 IMPLANT/NORPLANT Women can have small rods placed in their arm and this can prevent pregnancy for several years. 1 2 3 YES . NO .……. 1 2 07 CONDOM Men can put a rubber sheath on their penis during sexual intercourse. 1 2 3 YES . NO .……. 1 2 08 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse. 1 2 3 YES . NO .……. 1 2 09 DIAPHRAGM, FOAM, JELLY Women can place a sponge, suppository, diaphragm, jelly or cream inside themselves before intercourse. 1 2 3 YES . NO .……. 1 2 11 LACTATIONAL AMENORRHEA METHOD (LAM) Up to 6 months after childbirth, a woman can use a method that requires that she breastfeeds frequently and that her menstrual period has not returned. 1 2 3 YES . NO .……. 1 2 12 RHYTHM Some couples can avoid having sexual intercourse on certain days of the month when the woman is more likely to become pregnant. 1 2 3 YES . NO .……. 1 2 13 WITHDRAWAL Some men pull out during sexual intercourse before climax. 1 2 3 YES . NO .……. 1 2 14 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant. 1 2 3 YES . NO .……. 1 2 15 Have you heard of any other method that women or men can use to avoid pregnancy? 1 3 ____________________________ (SPECIFY) YES . NO .……. 1 2 ____________________________ (SPECIFY) YES . NO .……. 1 2 304 CHECK 303: AT LEAST ONE NOT A SINGLE “YES” “YES” (EVER USED) 308 (NEVER USED) 305 Have you ever used anything or tried in any way to YES .1 307 delay or avoid getting pregnant? NO .2 331 306 C ENTER “0” IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. 307 What have you used or done? CORRECT 303 AND 304. IF NECESSARY CORRECT 301A AND 302. 308 Now I would like to ask you about the first time that you did TUBAL LIGATION .01 something or used a method to avoid getting pregnant. MALE STERILIZATION .02 PILL .03 What was the first method you ever used? IUD . 04 INJECTABLES .05 IMPLANT/NORPLANT .06 CONDOM . 07 FEMALE CONDOM .08 DIAPHRAGM/FOAM/JELLY .09 LACTATIONAL AMEN. METHOD .11 RHYTHM . 12 WITHDRAWAL .13 EMERGENCY CONTRACEPTION .14 OTHER _________________________________ 96 (SPECIFY) 309 Did you have any children at that time? (IF YES) How many living children did you have at that time? IF NONE, RECORD “00”. NUMBER OF CHILDREN . 310 CHECK 303: NOT HAD HAD TUBAL TUBAL 314A LIGATION LIGATION 311 CHECK 227: NOT PREGNANT PREGNANT OR UNSURE 324C 312 CHECK 250: CURRENTLY NOT MARRIED MARRIED 324B 313 Are you currently doing something or using any method YES .1 to delay or avoid getting pregnant? NO .2 325 314 Which method are you using? TUBAL LIGATION .A MALE STERILIZATION .……….B PILL .….C IUD .….D INJECTABLES .E IMPLANT/NORPLANT .…….F 314A CIRCLE “A”FOR TUBAL LIGATION. CONDOM . G FEMALE CONDOM .H DIAPHRAGM/FOAM/JELLY .I LACTATIONAL AMEN. METHOD .K RHYTHM .………. L WITHDRAWAL .M OTHER __________________________________ U (SPECIFY) 314B CHECK 314 AND 314A: HAD TUBAL NOT HAD TUBAL 315 LIGATION LIGATION 314E In what month and year was this operation performed? MONTH . YEAR . 314F CHECK 314E: HAD TUBAL LIGATION HAD TUBAL LIGATION OPERATION BEFORE OPERATION AFTER JANUARY 1998 JANUARY 1998 ENTER (1) IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 1998. C ENTER (1) IN MONTH OF THE INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE OF THE OPERATION. 315 CHECK 314 AND 314A: NOT ASKED . 00 331 TUBAL LIGATION .01 ENTER CODE FOR CURRENTLY USED METHOD. MALE STERILIZATION .………….02 324A PILL .….03 IF MORE THAN ONE METHOD IS CIRCLED IN 314 IUD .…….04 CIRCLE CODE FOR HIGHEST METHOD IN LIST. INJECTABLES .05 IMPLANT/NORPLANT .06 CONDOM . 07 FEMALE CONDOM .08 DIAPHRAGM/FOAM/JELLY .09 LACTATIONAL AMEN. METHOD .11 324A RHYTHM . 12 WITHDRAWAL .13 OTHER METHOD .96 316 When you applied to the health personnel (DOCTOR/NURSE/ YES .1 MIDWIFE) were you told about side effects or problems you might have NO . 2 324A with the method? 319 Were you ever told about side effects or problems you might have YES .1 with the method when you were informed about the method? NO . 2 321 320 Were you told what to do if you experienced side effects or problems YES .1 of the method you are currently using? NO .2 321 When you were told on the current method you are using, YES .1 were you also told about other methods of family planning? NO .2 324A C ENTER METHOD CODE FROM 314 IN CURRENT MONTH IN COLUMN 1 OF CALENDAR. THEN DETERMINE WHEN SHE STARTED USING THIS METHOD. ENTER METHOD CODE IN EACH MONTH OF USE AND THEN SKİP TO 324C. ILLUSTRATIVE QUESTIONS: When did you start using this method continuously? How long have you been using this method continuously? 324B C CHECK COLUMN 3 OF CALENDAR: IN COLUMN 1 OF CALENDAR ENTER “N” FOR MONTHS WOMAN NOT MARRIED. 324C C CHECK COLUMN 1 OF CALENDAR: THERE ARE ALL BOXES EMPTY BOXES ARE FILLED 326A 325 I would like to ask you some questions about the times you may have used a method to avoid getting pregnant during the last few years. C START WITH THE MOST RECENT USE. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE BACK TO JANUARY 1998. USE NAMES OF CHILDREN, DATES OF BIRTH, AND STARTING AND ENDING DATES OF PREGNANCIES AS REFERENCE POINTS. IN COLUMN 1, ENTER CODE IN EACH MONTH OF METHOD USE OR ”0” FOR NONUSE. ILLUSTRATIVE QUESTIONS FOR COLUMN 1: • When was the last time you used a method? Which method was that? • When did you start using that method? How long after the birth of (NAME)? • How long did you use the method then? IN COLUMN 2, ENTER CODES FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. TO DO THIS, DETERMINE THE LAST MONTH OF METHOD USE. IN COLUMN 2 ENTER THE CODE FOR DISCONTINUATION . ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT. ILLUSTRATIVE QUESTIONS FOR COLUMN 2: • Why did you stop using the (METHOD)? • Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason? IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: “How many months did it take you to get pregnant after you stopped using (METHOD)?” AND ENTER '0' IN EACH SUCH MONTH IN COLUMN 1. NOTE: PAY PARTICULAR ATTENTION FOR LONG PERIODS OF NONUSE. THERE MAY BE SOME PERIODS OF METHOD USE OR A PREGNANCY DURING THESE PERIODS NOTE: AFTER COMPLETING THIS SECTION, ALL THE BOXES IN COLUMN 1 OF CALENDAR MUST BE FILLED. . 326A CHECK 315: NOT ASKED . 00 331 TUBAL LIGATION .01 CIRCLE THE CODE OF CURRENTLY USED METHOD. MALE STERILIZATION .02 328A PILL .03 IUD .04 INJECTABLES .05 IMPLANT/NORPLANT .06 CONDOM . 07 FEMALE CONDOM .08 DIAPHRAGM/FOAM/JELLY .09 LACTATIONAL AMEN. METHOD .11 RHYTHM . 12 WITHDRAWAL .13 OTHER METHOD .96 326B Would you like to use a different method of family planning YES .1 than the one you are currently using? NO .2 327 326C Which method would you prefer to use? TUBAL LIGATION .01 MALE STERILIZATION .02 PILL .03 IUD .04 INJECTABLES .05 IMPLANT/NORPLANT .06 CONDOM . 07 FEMALE CONDOM .08 DIAPHRAGM/FOAM/JELLY .09 LACTATIONAL AMEN. METHOD .11 RHYTHM . 12 WITHDRAWAL .13 EMERGENCY PILL . 14 ANY METHOD . 77 NOT SURE .88 OTHER __________________________________ 96 (SPECIFY) 326E What is the reason that you do not use (METHOD DOCTOR DOES NOT ADVİSE .01 MENTIONED IN 326C)? EXPENSIVE .02 NOT AVAILABLE/ACCESS PROBLEMS .03 HARD TO FIND HERE .04 DON'T KNOW HOW TO OBTAIN . 05 DON'T KNOW HOW TO USE IT .06 HUSBAND OBJECTS .07 RELIGIOUS REASONS . 08 HEALTH CONCERNS………………….……………09 SIDE EFFECTS ………………………………………10 OTHER __________________________________ 96 (SPECIFY) DON’T KNOW ….98 327 CHECK 315: NOT ASKED .00 331 TUBAL LIGATION .01 CIRCLE THE CODE OF CURRENTLY USED METHOD. MALE STERILIZATION .02 328A PILL .03 IUD .04 INJECTABLES .05 IMPLANT/NORPLANT .06 CONDOM . 07 FEMALE CONDOM .08 DIAPHRAGM/FOAM/JELLY .09 LACTATIONAL AMEN. METHOD .11 RHYTHM . 12 332 WITHDRAWAL .13 OTHER METHOD .96 332 328 Where did you obtain (METHOD)? PUBLIC SECTOR GOVERNMENT/SAMPLE HOSPITAL .11 MATERNITY HOUSE .12 MCHFP CENTRE. 13 _____________________________________________________ HEALTH CENTRE .14 (NAME OF PLACE) HEALTH HOUSE . 15 SSK HOSPITAL/DISPENSARY .16 OTHER __________________________________ 19 (SPECIFY) PRIVATE SECTOR PRIVATE HOSPITAL .21 PRIVATE POLYCLINIC .22 PRIVATE DOCTOR . 23 PRIVATE MIDWIFE/NURSE .24 PHARMACY/MEDICAL STORE .25 OTHER __________________________________ 29 328A Where did tubal ligation (or vasectomy) take place? (SPECIFY) UNIVERSITY HOSPITAL . 31 VOLUNTARY ORGANIZATION/ ASSOCIATION/FOUNDATION . 41 MARKET/SHOP . 52 RELATIVE/FRIEND/NEIGHBOUR .53 TRAD. MIDWIFE/MIDWIFE GRAN .54 OTHER __________________________________ 96 (SPECIFY) 329 Do you know another place where you could have obtained YES .1 (METHOD)? NO .2 351 329A At the time of tubal ligation operation, did you know another place where you could have the operation? 330A SKIP TO 351. 331 CHECK 227: NOT PREGNANT CURRENTLY 332 OR UNSURE PREGNANT 331A CHECK 250: CURRENTLY CURRENTLY 332 MARRIED NOT MARRIED 331B What is the main reason you are not using a method of contraception FERTILITY-RELATED REASONS to avoid pregnancy? NOT HAVING SEX .11 INFREQUENT SEX .12 MENOPAUSAL/HYSTERECTOMY .13 SUBFECUND/INFECUND . 14 HUSBAND IS INFECUND .15 POSTPARTUM/BREASTFEEDING .16 WANTS (MORE) CHILDREN .17 LACK OF KNOWLEDGE KNOWS NO METHOD .21 KNOWS NO SOURCE .22 METHOD-RELATED REASONS HEALTH CONCERNS . 31 SIDE EFFECTS .32 LACK OF ACCESS/TOO FAR .33 COST TOO MUCH .34 INCONVENIENT TO USE .35 HUSBAND OPPOSED .41 RELIGIOUS REASONS . 51 FATALISTIC.61 EMBARRASSED .71 OTHER __________________________________ 96 (SPECIFY) DON’T KNOW .98 332 Do you know of a place where you can obtain YES .1 a method of family planning? NO .2 351A 333 Where is that? Any other place? PUBLIC SECTOR GOVERNMENT/SAMPLE HOSPITAL .A MATERNITY HOUSE .B ___________________________________________________ MCHFP CENTRE. C (NAME OF PLACE) HEALTH CENTRE .D HEALTH HOUSE . E SSK HOSPITAL/DISPENSARY .F OTHER __________________________________ G ___________________________________________________ (SPECIFY) (NAME OF PLACE) PRIVATE SECTOR PRIVATE HOSPITAL .H PRIVATE POLYCLINIC .I PRIVATE DOCTOR . J PRIVATE MIDWIFE/NURSE .K PHARMACY/MEDICAL STORE .L OTHER __________________________________ M (SPECIFY) UNIVERSITY HOSPITAL . N VOLUNTARY ORGANIZATION/ ASSOCIATION/FOUNDATION . O MARKET/SHOP . P RELATIVE/FRIEND/NEIGHBOUR .R TRAD. MIDWIFE/MIDWIFE GRAN .S OTHER __________________________________ U (SPECIFY) 351 CHECK 250: CURRENTLY CURRENTLY MARRIED NOT MARRIED 353 351A CHECK 314 AND 314A: CURRENTLY USING CURRENTLY NOT A METHOD USING A METHOD 356 352 Are you planning to use any family planning method to postpone or YES .1 354 avoid pregnancy in the following 12 months? NO .2 DON’T KNOW .8 353 Are you planning to use any family planning method to postpone or YES . 1 avoid pregnancy anytime in the future? NO. 2 DON’T KNOW .8 355 354 Which method do you prefer? TUBAL LIGATION .01 MALE STERILIZATION .02 PILL .03 IUD . 04 INJECTABLES .…………….05 IMPLANT/NORPLANT .06 CONDOM . 07 FEMALE CONDOM .08 DIAPHRAGM/FOAM/JELLY .09 LACTATIONAL AMEN. METHOD .11 RHYTHM . 12 WITHDRAWAL .13 OTHER __________________________________ 96 (SPECIFY) NOT SURE . 98 354A SKIP TO 356. 355 What is the main reason you don’t want to use a method of FERTILITY-RELATED REASONS contraception to avoid pregnancy ? NOT HAVING SEX .11 INFREQUENT SEX .12 MENOPAUSAL/HYSTERECTOMY .13 SUBFECUND/INFECUND . 14 HUSBAND IS INFECUND .15 LACK OF KNOWLEDGE KNOWS NO METHOD .21 KNOWS NO SOURCE . 22 METHOD-RELATED REASONS HEALTH CONCERNS .31 SIDE EFFECTS .32 LACK OF ACCESS/TOO FAR . 33 COST TOO MUCH .34 INCONVENIENT TO USE .35 HUSBAND OPPOSED .41 RELIGIOUS REASONS .51 FATALISTIC .61 EMBARRASSED .71 OTHER __________________________________ 96 (SPECIFY) DON’T KNOW .98 356 KAPAK SAYFASINA BAKIN: CLUSTER NO IS EVEN, AND HH NO IS ODD OR CLUSTER NO IS ODD, AND HH NO IS EVEN CLUSTER NO IS EVEN CLUSTER NO IS ODD 400 AND HH NO IS EVEN AND HH NO IS ODD 357 Is it appropriate or not that knowledge about the contraceptive methods APPRO INAPP- DON’T is given at; PRIATE ROPRIATE KNOW Secondary school? SECONDARY .1 2 8 High school? HIGH .1 2 8 358 Did you talk to any of your relatives or another person about YES .1 contraceptive methods in last few months? NO.2 365 359 With whom? HUSBAND .A MOTHER .B Anyone else? SISTER .D DAUGHTER .F CIRCLE ALL MENTIONED. MOTHER IN LAW . H SISTER IN LAW/BROTHER’S WIFE/ BROTHER IN LAW’S WIFE . I FRIEND/RELATIVE . K NEIGHBOUR .L OTHER __________________________________ U (SPECIFY) 365 CHECK 315: CURRENTLY USING CURRENTLY NOT A METHOD USING A METHOD/ 368 NOT ASKED 366 Who decided to use the current method you are using? HERSELF .1 You, your husband, or together? HUSBAND .2 TOGETHER .3 368 In your opinion, is it all right or not for religion to use contraceptive YES, APPROPRIATE TO RELIGION .1 370 methods? SOME METHODS ARE INAPPROPRIATE .2 NO, INAPPROPRIATE TO RELIGION .3 NOT BELIEVE IN REL., HAS NO REL. .4 370 DON’T KNOW .8 369 Which contraceptive method(s) do you think that are TUBAL LIGATION .A inappropriate to religion? MALE STERILIZATION .B PILL . C IUD . D What else? INJECTABLES .E IMPLANT/NORPLANT . F RECORD ALL MENTIONED. CONDOM . G FEMALE CONDOM .H DIAPHRAGM/FOAM/JELLY .I LACTATIONAL AMEN. METHOD .J RHYTHM . K WITHDRAWAL .L EMERGENCY PILL . M OTHER __________________________________ U (SPECIFY) INDUCED ABORTION .O 370 CHECK 250: CURRENTLY CURRENTLY NOT 372 MARRIED MARRIED 371 Does your husband thinks that any of the contraceptive methods or YES, APPROPRIATE .1 family planning in general is appropriate to religion or inappropriate? THINKS SOME METHODS ARE INAPPROPRIATE TO RELIGION . 2 NO, INAPPROPRIATE .3 HUSBAND HAS NO RELIGION……………………4 DON’T KNOW .8 372 Do you approve of induced abortion or not? APPROVE .1 DISAPPROVE .2 DEPENDS ON SITUATION .3 DON’T KNOW .8 373 Think that you are having an unwanted pregnancy in the future. YES .1 Do you prefer to have induced abortion? NO .2 DON’T KNOW .8 SECTION 4A. PREGNANCY AND BREASTFEEDING CHECK 225: ONE OR MORE LIVE BIRTHS SINCE JAN. 1998 NO LIVE BITHS SINCE JAN. 1998 400 601 401S RECORD TIME HOUR – MINUTE. 402 ENTER THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1998 IN THE TABLE ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS USE ADDITIONAL QUESTIONNAIRES- DO NOT USE THE LAST BIRTH COLUMN IN THE ADDITIONAL QUESTIONNAIRE). I would like to ask you some more questions about the health of all your children born in the past five years. We will talk about one child at a time. 403 LINE NUMBER FROM Q212. LAST BIRTH LINE NUMBER…………….……. NEXT TO LAST BIRTH LINE NUMBER…………….……. NAME___________________________ NAME___________________________ 404 FROM Q212 FROM Q216 ALIVE DEAD ALIVE DEAD 405 At the time you became pregnant with . did you want to become pregnant then, did you want to wait until later, or did you want no (more) children at all ? THEN.………………………. 407A LATER . NO MORE. 407A 1 2 3 THEN.………………………. 407A LATER . NO MORE. 407A 1 2 3 406 How much longer would you like to have waited? MONTHS……………….1 YEARS………………….2 DON’T KNOW ………………….…998 MONTHS……………….1 YEARS………………….2 DON’T KNOW ………………….…998 407A When you were pregnant with .did you see anyone for antenatal care for this pregnancy? (IF YES) Whom did you see? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. HEALTH PROFESSIONAL DOCTOR . NURSE/MIDWIFE . OTHER PERSON TRAD. MIDWIFE/GRAN . OTHER __________________________ (SPECIFY) NO ONE.……. 407C A B D U Y HEALTH PROFESSIONAL DOCTOR . NURSE/MIDWIFE . OTHER PERSON TRAD. MIDWIFE/GRAN . OTHER __________________________ (SPECIFY) NO ONE.……. 407C A B D U Y LAST BIRTH NAME___________________________ NEXT LAST BIRTH NAME___________________________ 407B Where did you go for antenatal care? RECORD ALL MENTIONED. ______________________________________ (NAME OF PLACE: LAST BIRTH) ______________________________________ (NAME OF PLACE: NEXT TO LAST BIRTH) PUBLIC SECTOR GOVT./SAMPLE HOSPITAL. MATERNITY HOUSE…………. MCHFP CENTER. HEALTH CENTER….…. HEALTH HOUSE……….……. SSK HOSPITAL/DISPANSERY .…. OTHER__________________________ (SPECIFY) PRIVATE SECTOR PRIVATE HOSP………………. PRIVATE POLYCLINIC………. PRIVATE DOCTOR .…. PRIVATE NURSE/MIDWIFE…. OTHER __________________________ (SPECIFY) UNIVERSITY HOSPITAL.………. VOLUNATRY ORGANIZATION/ FOUNDATION HOSPITAL/CLINIC. OTHER__________________________ (SPECIFY) A B C D E F G H I J K M N O U PUBLIC SECTOR GOVT./SAMPLE HOSPITAL. MATERNITY HOUSE…………. MCHFP CENTER. HEALTH CENTER….…. HEALTH HOUSE……….……. SSK HOSPITAL/DISPANSERY .…. OTHER__________________________ (SPECIFY) PRIVATE SECTOR PRIVATE HOSP………………. PRIVATE POLYCLINIC………. PRIVATE DOCTOR .…. PRIVATE NURSE/MIDWIFE…. OTHER __________________________ (SPECIFY) UNIVERSITY HOSPITAL.………. VOLUNATRY ORGANIZATION/ FOUNDATION HOSPITAL/CLINIC. OTHER__________________________ (SPECIFY) A B C D E F G H I J K M N O U SKIP TO 408. SKIP TO 408. 407C During your pregnancy with .why did you not receive antenatal care? RECORD ALL MENTIONED. NO NEED .………………. ACCESIBILITY PROBLEMS ………. DISTRUST OF INSTITUTIONS OR PERSONNEL .…. PROBLEMS IN USING HEALTH INSTITUTIONS .…. TRADITIONS .……………. MONETARY REASONS .…………. POOR SERVICE…….……………. DON’T KNOW WHERE .……. OTHER___________________________ (SPECIFY) DON’T KNOW……………………. A B C D E F G H U X NO NEED .………………. ACCESIBILITY PROBLEMS ………. DISTRUST OF INSTITUTIONS OR PERSONNEL .…. PROBLEMS IN USING HEALTH INSTITUTIONS .…. TRADITIONS .……………. MONETARY REASONS .…………. POOR SERVICE…….……………. DON’T KNOW WHERE .……. OTHER___________________________ (SPECIFY) DON’T KNOW……………………. A B C D E F G H U X SKIP TO 409F. SKIP TO 409F. 408 How many months pregnant were you with . when you first received antenatal care? MONTH………………………. DON’T KNOW ….…………….…. 98 MONTH………………………. DON’T KNOW ….…………….…. 98 LAST BIRTH NAME___________________________ NEXT LAST BIRTH NAME___________________________ 409A During your pregnancy with . when you went for the first time for antenatal care did you go because there was a problem or was it an ordinary check-up? THERE WAS A PROBLEM…….… ORDINARY CONTROL.…. OTHER __________________________ (SPECIFY) DON’T KNOW.…………………. 1 2 7 8 THERE WAS A PROBLEM…….… ORDINARY CONTROL.…. OTHER __________________________ (SPECIFY) DON’T KNOW.…………………. 1 2 7 8 409B How many times did you receive antenatal care during your pregnancy with .? NO. OF TIMES…………………. DON’T KNOW ……………….…. 98 NO. OF TIMES…………………. DON’T KNOW …………….….…. 98 409C How many months pregnant were you with . when you received antenatal care for the last time? MONTH………………………. DON’T KNOW ….…………….…. 98 MONTH………………………. DON’T KNOW ….…………….…. 98 409D In any of your antenatal checks, were you: Weighed? Measured? Blood pressure? Blood test? Urine test? Abdomen measured? Listened to baby’s heartbeat? Ultrasound? Internal examination? WEIGHED.…. MEASURED. BLOOD PRESSURE. BLOOD TEST. URINE TEST. ABDOMEN MEASURED. LISTENED TO BABY. ULTRASOUND. INTERNAL EXAM. YES .1 .1 .1 .1 .1 .1 .1 .1 .1 NO 2 2 2 2 2 2 2 2 2 WEIGHED.…. MEASURED. BLOOD PRESURE. BLOOD TEST. URINE TEST. ABDOMEN MEASURED. LISTENED TO BABY. ULTRASOUND. INTERNAL EXAM. YES .1 .1 .1 .1 .1 .1 .1 .1 .1 NO 2 2 2 2 2 2 2 2 2 409F Have you taken any of the following during ……’s pregnancy? Iron tablets? Vitamins? Follic acid? YES. NO. YES. NO. YES. NO. 1 2 1 2 1 2 YES. NO. YES. NO. YES. NO. 1 2 1 2 1 2 410 How did .’s birth occur? Was it vaginal birth or caesarean section? CAESAREAN …………………………. NORMAL (VAGINAL) BIRTH………. 411 1 2 CAESAREAN …………………………. NORMAL (VAGINAL) BIRTH………. 411 1 2 LAST BIRTH NAME___________________________ NEXT LAST BIRTH NAME___________________________ 410A Who decided to be .……’s caesarean section birth? HERSELF . DOCTOR . HERSELF AND DOCTOR. 1 2 3 HERSELF . DOCTOR . HERSELF AND DOCTOR. 1 2 3 410B What was the main reason for having a caesarean birth? MOTHER HEALTH . CHILD HEALTH . MOTHER AND CHILD HEALTH . PREVIOUS BIRTH WAS CAESAREAN . TWIN/PLURAL BIRTH . CHILD TOO BIG. MOTHER’S CHOICE . VAGINAL BIRTH FEAR. OTHER ____________________________ (SPECIFY) 01 02 03 04 05 06 07 08 96 MOTHER HEALTH . CHILD HEALTH . MOTHER AND CHILD HEALTH . PREVIOUS BIRTH WAS CAESAREAN . TWIN/PLURAL BIRTH . CHILD TOO BIG. MOTHER’S CHOICE . VAGINAL BIRTH FEAR. OTHER ____________________________ (SPECIFY) 01 02 03 04 05 06 07 08 96 SKIP TO 412. SKIP TO 412. 411 Was ……’s birth performed with an episiotomy through? YES. NO. 1 2 YES. NO. 1 2 412 Where did you give birth to .? ______________________________________ (NAME OF PLACE: LAST BIRTH) ______________________________________ (NAME OF PLACE: NEXT TO LAST BIRTH) HOME WOMAN’S HOME.…………. OTHER HOME……….………. PUBLIC SECTOR GOVT./SAMPLE HOSPITAL. MATERNITY HOUSE…………. MCHFP CENTER.……………. HEALTH CENTER……….…. HEALTH HOUSE…………….…. SSK HOSPITAL/DISPANSERY.……. OTHER __________________________ (SPECIFY) PRIVATE SECTOR PRIVATE HOSPITAL…………. PRIVATE POLYCLINIC……. PRIVATE DOCTOR…. PRIVATE NURSE/MIDWIFE…. OTHER __________________________ (SPECIFY) UNIVERSITY HOSPITAL……. VOLUNATRY ORGANIZATION/ FOUNDATION HOSPITAL/CLINIC. OTHER __________________________ (SPECIFY) 01 02 11 12 13 14 15 16 19 21 22 23 24 29 31 41 96 HOME WOMAN’S HOME.…………. OTHER HOME……….………. PUBLIC SECTOR GOVT./SAMPLE HOSPITAL. MATERNITY HOUSE…………. MCHFP CENTER.……………. HEALTH CENTER……….…. HEALTH HOUSE…………….…. SSK HOSPITAL/DISPANSERY.……. OTHER __________________________ (SPECIFY) PRIVATE SECTOR PRIVATE HOSPITAL…………. PRIVATE POLYCLINIC……. PRIVATE DOCTOR…. PRIVATE NURSE/MIDWIFE…. OTHER __________________________ (SPECIFY) UNIVERSITY HOSPITAL……. VOLUNATRY ORGANIZATION/ FOUNDATION HOSPITAL/CLINIC. OTHER __________________________ (SPECIFY) 01 02 11 12 13 14 15 16 19 21 22 23 24 29 31 41 96 LAST BIRTH NAME___________________________ NEXT LAST BIRTH NAME___________________________ 413 Who assisted with the delivery of .? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSON AND RELATIVE/FRIENDS. HEALTH PROFESSIONAL DOCTOR………………………. NURSE/MIDWIFE……………. OTHER PERSON TRADITIONAL MIDWIFE…. RELATIVE/FRIENDS…………. OTHER__________________________ (SPECIFY) NO ONE.…………………………. A B D E U Y HEALTH PROFESSIONAL DOCTOR………………………. NURSE/MIDWIFE……………. OTHER PERSON TRADITIONAL MIDWIFE…. RELATIVE/FRIENDS…………. OTHER__________________________ (SPECIFY) NO ONE.…………………………. A B D E U Y 413B CHECK 412: BIRTH IN A HEALTH INSTITUTION? YES 416 NO YES 416 NO 413C What was the main reason for not having done .’s birth in a health institution? NO REASON…………………. ACESSIBILITY PROBLEMS……. DISTRUST OF HEALTH FACILITY/PERSONNEL.…. HAPPENED SUDDENLY……….…. PROBLEMS IN USING HEALTH INSTUTION.…. EXPENSIVE……………………………. TRADITIONS……………. NO PROBLEM.……………. OTHER __________________________ (SPECIFY) DON’T KNOW…………………. 00 01 02 03 04 05 06 07 96 98 NO REASON…………………. ACESSIBILITY PROBLEMS……. DISTRUST OF HEALTH FACILITY/PERSONNEL.…. HAPPENED SUDDENLY……….…. PROBLEMS IN USING HEALTH INSTUTION.…. EXPENSIVE……………………………. TRADITIONS……………. NO PROBLEM.……………. OTHER __________________________ (SPECIFY) DON’T KNOW…………………. 00 01 02 03 04 05 06 07 96 98 416 When . was born, was he/she very large, larger than average, average, smaller than average or very small? VERY LARGE……………………. LARGER THAN AVERAGE.……. AVERAGE.………………………. SMALLER THAN AVERAGE.…. VERY SMALL.………………………. DON’T KNOW………………………. 1 2 3 4 5 8 VERY LARGE……………………. LARGER THAN AVERAGE.……. AVERAGE.………………………. SMALLER THAN AVERAGE.…. VERY SMALL.………………………. DON’T KNOW………………………. 1 2 3 4 5 8 417 Was ……weighed at birth? YES.………………………………. NO.……………………………. 419 1 2 YES.………………………………. NO.……………………………. 419 1 2 418 How much did …… weigh? RECORD WEIGHT FROM HEALTH CARD, IF AVAILABE. GRAMS FROM CARD.1 FROM RECALL.2 DON’T KNOW………………….99998 GRAMS FROM CARD.1 FROM RECALL.2 DON’T KNOW………………….99998 LAST BIRTH NAME___________________________ NEXT LAST BIRTH NAME___________________________ 419 Has your period returned since the birth of ……? YES.………………………………. 421 NO.……………………………. 422 1 2 420 Did your period return between the birth of …… and your next pregnancy? YES…….…………………………. NO.……………………………. 424 1 2 421 For how many months after birth of …… did you not have a period? MONTH………………………. DON’T KNOW …………………….…. 98 MONTH………………………. DON’T KNOW …………………….…. 98 422 CHECK 227: RESPONDENT CURRENTLY PREGNANT? NOT PREGNANT PREGNANT OR UNSURE 424 423 Have you resumed sexual relations since the birth of ……? YES.………………………………. NO.……………………………. 425 1 2 424 For how many months after the birth of …… did you not have sexual relations? MONTH………………………. DON’T KNOW ……………….…. 98 MONTH………………………. DON’T KNOW ……………….…. 98 425 Did you ever breastfeed .? YES…….…………………………. NO.……………………………. 431 1 2 YES…….…………………………. NO.……………………………. 431 1 2 426 How long after birth did you first put …… to breast? IF LESS THAN 1 HOUR, RECORD ‘00’. IF LESS THAN 24 HOURS, RECORD HOURS, OTHERWISE, RECORD DAYS. IMMEDIATELY.000 HOUR………………….….1 DAYS……………………….2 IMMEDIATELY.000 HOUR………………….….1 DAYS……………………….2 426A In the first three days after delivery, before your milk began flowing regularly, was . given anything to drink other than breast milk? YES…….…………………………. NO.……………………………. 427 1 2 YES…….…………………………. NO.……………………………. 427 1 2 426B What was given to ……? Anything else? RECORD ALL MENTIONED. MILK (OTHER THAN BREAST MILK). WATER . SUGAR WATER . SALT-SUGAR-WATER SOLUTION . FRUIT JUICE. BABY FORMULA . TEA . JUICE OF COOKED MEAL . HONEY . OTHER ____________________________ (SPECIFY). A B C D E F G H I U MILK (OTHER THAN BREAST MILK). WATER . SUGAR WATER . SALT-SUGAR-WATER SOLUTION . FRUIT JUICE. BABY FORMULA . TEA . JUICE OF COOKED MEAL . HONEY . OTHER ____________________________ (SPECIFY). A B C D E F G H I U LAST BIRTH NAME___________________________ NEXT LAST BIRTH NAME___________________________ 427 CHECK 404: CHILD ALIVE? ALIVE DEAD 429 ALIVE DEAD 429 428 Are you still breastfeeding ……? YES….……………………………. 432 NO.……………………………. 1 2 YES….……………………………. 432 NO.……………………………. 1 2 429 For how many months did you breastfeed ……? MONTH………………………. DON’T KNOW ………….…….…. 98 MONTH………………………. DON’T KNOW ………….…….…. 98 ALIVE DEAD ALIVE DEAD 431 CHECK 404: CHILD ALIVE? 434 GO BACK TO 405 IN NEXT COLUMN IF THERE IS ANOTHER BIRTH IF NO MORE BIRTHS GO TO 440. 434 GO BACK TO 405 IN ADDITONAL. QUESTIONNAIRRE IF THERE IS ANOTHER BIRTH IF NO MORE BIRTHS GO TO 440. 432 How many times did you breastfeed …… lastnight between sunset and sunrise? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. NUMBER OF NIGHTTIME FEEDINGS………………………. NUMBER OF NIGHTTIME FEEDINGS………………………. 433 How many times did you breastfeed …… yesterday during the daylight hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. NUMBER OF DAYTIME FEEDINGS………………………. NUMBER OF DAYTIME FEEDINGS………………………. 434 Did …… drink anything from a bottle with a nipple yesterday or last night? YES………………….……………. NO……………….……………. DON’T KNOW……………………. 1 2 8 YES………………….……………. NO……………….……………. DON’T KNOW……………………. 1 2 8 LAST BIRTH NAME___________________________ NEXT LAST BIRTH NAME___________________________ 435 At any time in last 24 hours was …… given any of the following? Plain water? Sugar water? Juice? Tea? Baby formula? Yogurt? Pudding? Juice of cooked meal? Turkish delight? Bottled/Boxed milk? Fresh milk? Soup? Other liquid? Any other solid or semi solid foods? PLAIN WATER.………………. SUGAR WATER………….…. JUICE.……………. TEA.…………………………. BABY FORMULA…….……. YOGURT.….………….………. PUDDING.…………………. JUICE OF COOKED MEAL…. TURKISH DELIGHT….…. BOTTLED/BOXED MILK. FRESH MILK….………………. SOUP. OTHER LIQUID.………. SOLID/SEMI SOLID FOODS.… Y 1 1 1 1 1 1 1 1 1 1 1 1 1 1 N 2 2 2 2 2 2 2 2 2 2 2 2 2 2 DK 8 8 8 8 8 8 8 8 8 8 8 8 8 8 PLAIN WATER.………………. SUGAR WATER………….…. JUICE.……………. TEA.…………………………. BABY FORMULA…………. YOGURT.….…………………. PUDDING.…………………. JUICE OF COOKED MEAL…. TURKISH DELIGHT….…. BOTTLED/BOXED MILK. FRESH MILK….………………. SOUP. OTHER LIQUID.………. SOLID/SEMI SOLID FOODS.… Y 1 1 1 1 1 1 1 1 1 1 1 1 1 1 N 2 2 2 2 2 2 2 2 2 2 2 2 2 2 DK 8 8 8 8 8 8 8 8 8 8 8 8 8 8 GO BACK TO 405 IN NEXT CLOUMN: OR, IF NO MORE BIRTHS, GO TO 440. GO BACK TO 405 IN AN ADDITIONAL QUESTIONNAIRE; OR IF NO MORE BIRTH, GO TO 440. SECTION 4B. IMMUNIZATION AND HEALTH 440 ENTER LINE NUMBER, NAME SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1998 IN THE TABLE. ASK QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS USE ADDITIONAL QUESTIONNAIRES – DO NOT USE THE LAST BIRTH COLUMN IN THE ADDITIONAL QUESTIONNAIRE, USE ”NEXT TO LAST BIRTH” CLOUMN’ AND WRITE ”SECOND ONE BEFORE THE LAST BIRTH” 441 LINE NUMBER FROM Q212. LAST BIRTH LINE NO…………….……. NEXT TO LAST BIRTH LINE NO…………….……. NAME___________________________ NAME___________________________ 442 CHECK 212: CHECK 216: ALIVE DEAD ALIVE DEAD (IF IF NO MORE BIRTHS GO TO 465S IF THERE IS MORE BIRTHS GO TO 442 IN NEXT COLUMN), IF NO MORE BIRTHS, GO TO 465S IF THERE IS MORE BIRTHS GO TO 442 IN ADDITIONAL. QUESTIONNAIRE. 443 Do you have a card where ……’s vaccination are written down? (IF YES) May I see it please? YES, SEEN . YES, NOT SEEN . 447 NO CARD . 1 2 3 YES, SEEN . YES, NOT SEEN . 447 NO CARD . 1 2 3 445 (1) COPY VACCINATION DATES FOR EACH VACCINE FROM THE CARD. PAY ATTENTION TO APPOINTMENT DAYS AND THE CONSISTENCY OF VACCINATION DATES. (2) WRITE ‘44’ IN THE DAY CLOUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN BUT NO DATE IS RECORDED. DAY MO YEAR DAY MO YEAR BCG BCG BCG Polio 1 P1. P1. Polio 2 P2. P2. Polio 3 P3. P3. DPT 1 D1. D1. DPT 2 D2. D2. DPT 3 D3. D3. MEASLES KIZ KIZ Hepatitus B 1 H1. H1. Hepatitus B 2 H2. H2. Hepatitus B 3 H3. H3. LAST BIRTH LINE NO…………….……. NEXT TO LAST BIRTH LINE NO…………….……. 446 Has …… received any vaccination that are not recorded on this card? RECORD ‘YES’ IF ONLY RESPONDENT MENTIONS BCG, POLIO 1 – 3, DPT 1 – 3, MEASLES AND/OR HEPATITUES B 1 - 3 . YES.….……………………….……. NO………………………………. 454 DON’T KNOW……………….…. 1 2 8 YES .….……………………….……. NO .………………………………. 454 DON’T KNOW .…………….…. 1 2 8 446A PROBE VACCINATIONS AT 445, RECORD ‘66’ TO DAY SECTION OF THAT VACCINATION. SKIP TO 454 PROBE VACCINATIONS AT 445, RECORD ‘66’ TO DAY SECTION OF THAT VACCINATION. SKIPTO 454 447 Did…… ever receive any vaccinations to prevent him/her from getting infectious diseases? YES .………………………………. NO .………………………………. 454 DON’T KNOW .…………….…. 1 2 8 YES .………………………………. NO .………………………………. 454 DON’T KNOW .…………….…. 1 2 8 448 Please tell me if …… received any of the following vaccinations? 448A BCG: A vaccination against tuberculosis, that is an injection in the left arm or shoulder that caused a scar? YES .………………………………. NO .………………………………. DON’T KNOW …………….…. 1 2 8 YES .………………………………. NO .………………………………. DON’T KNOW …………….…. 1 2 8 448B Polio vaccination: That is drops in the mouth? YES .………………………………. NO .………………………………. 448E DON’T KNOW…………….…. 1 2 8 YES .………………………………. NO .………………………………. 448E DON’T KNOW…………….…. 1 2 8 448C How many times? NUMBER OF TIMES……….……. NUMBER OF TIMES……….……. 448E DPT vaccination: This vaccination includes diphtheria, whooping-cough and tetanus. And it is usually given at the same time as polio drops. YES .………………………………. NO .………………………………. 448G DON’T KNOW……….…….…. 1 2 8 YES .………………………………. NO .………………………………. 448G DON’T KNOW……….…….…. 1 2 8 448F How many times? NUMBER OF TIMES……….……. NUMBER OF TIMES……….……. 448G Measles vaccination? YES .………………………………. NO .………………………………. DON’T KNOW …………….…. 1 2 8 YES .………………………………. NO .………………………………. DON’T KNOW …………….…. 1 2 8 448I Hepatitus B vaccination? YES .………………………………. NO .………………………………. 454 DON’T KNOW .………….…. 1 2 8 YES .……………………….………. NO .………………………………. 454 DON’T KNOW .………….…. 1 2 8 448J How many times? NUMBER OF TIMES……….……. NUMBER OF TIMES……….……. LAST BIRTH NAME___________________________ LAST BIRTH NAME___________________________ 454 Did ……have an illness with fever in last 15 days? YES.….……………………….……. NO.………………………………. DON’T KNOW.…………….…. 1 2 8 YES.….……………………….……. NO.………………………………. DON’T KNOW.…………….…. 1 2 8 455 Did ……have illness with cough in last 15 days? YES.….……………………….……. NO.………………………………. 457 DON’T KNOW.………….…. 1 2 8 YES.….……………………….……. NO.………………………………. 457 DON’T KNOW.………….…. 1 2 8 456 When …… had ilness with cough, did he/she breathe faster than usual with short, rapid breathe or did he/she have problems in breathing? YES.….……………………….……. NO.………………………………. DON’T KNOW.…………….…. 1 2 8 YES.….……………………….……. NO.………………………………. DON’T KNOW.…………….…. 1 2 8 457 CHECK 454 AND 455 HAD FEVER OR COUGH? HAD ONE OR BOTH NO HAD ONE OR BOTH NO SKIP TO 464 SKIP TO 464 458 Did you seek advice or treatment for fever/cough? YES….……………….……….……. NO…….………………………. 460 DON’T KNOW.…………….…. 1 2 8 YES….……………….……….……. NO…….………………………. 460 DON’T KNOW.…………….…. 1 2 8 459 PUBLIC SECTOR PUBLIC SECTOR GOVT./SAMPLE HOSP . A GOVT./SAMPLE HOSP . A MATERNITY HOUSE . B MATERNITY HOUSE . B MCHFP CENTER . C MCHFP CENTER . C HEALTH CENTER .D HEALTH CENTER .D HEALTH HOUSE .E HEALTH HOUSE . E SSK HOSP/DISPANSERY .F SSK HOSP/DISPANSERY . F OTHER ___________________________ G OTHER ___________________________ G (SPECIFY) (SPECIFY) PRIVATE SECTOR PRIVATE SECTOR PRIVATE HOSP . H PRIVATE HOSP . H PRIVATE CLINIC . I PRIVATE CLINIC . I PRIVATE DOCTOR ………. J PRIVATE DOCTOR ………. J PRIVATE NURSE/MIDWIFE . K PRIVATE NURSE/MIDWIFE . K PHARMACY/MEDICAL STORE .L PHARMACY/MEDICAL STORE .L OTHER ___________________________ M OTHER ___________________________ M (SPECIFY) (SPECIFY) ÜNİVERSITY HOSPITAL .N ÜNİVERSITY HOSPITAL . N VOLUNTEER ORGANIZATION/ ASSOC./FOUNDATIONS . O VOLUNTEER ORGANIZATION/ ASSOC./FOUNDATIONS . O MARKET/SHOP.P MARKET/SHOP. P RELATIVE/FRIENDS/NEIGHBOUR . R RELATIVE/FRIENDS/NEIGHBOUR . R TRAD. MIDWIFE/MIDWIFEGRAN.S TRAD. MIDWIFE/MIDWIFEGRAN.S Where did you sek advice/treatment? Else? RECORD ALL MENTİONED. OTHER ____________________________ U OTHER ____________________________ U (SPECIFY) (SPECIFY) LAST BIRTH NAME___________________________ LAST BIRTH NAME___________________________ 460 Did you give anything to . for the treatment of cough/fever? YES….……………….………….……. NO……………………………………. 464 DON’T KNOW………………….…. 1 2 8 YES….……………….………….……. NO……………………………………. 464 DON’T KNOW………………….…. 1 2 8 461 INJECTABLES . A INJECTABLES . A ANTIBIOTICS (PILLS/SYRUP) . B ANTIBIOTICS (PILLS/SYRUP) . B FEVER KILLER FEVER KILLER (ASPRİN, PARACETAMOL, VS.). C (ASPRİN, PARACETAMOL, VS.). C COUGH SYRUP . D COUGH SYRUP . D OTHER PILL OR SYRUP . E OTHER PILL OR SYRUP . E HOME-MADE TRADITIONAL DRINKS AND MEDICINE (SUCH AS TEA OR AYRAN) . F G HOME-MADE TRADITIONAL DRINKS AND MEDICINE (SUCH AS TEA OR AYRAN) . F G OTHER ____________________________H OTHER ____________________________H What did you give? Else? RECORD ALL MENTIONED. (SPECIFY) (SPECIFY) 464 IF THERE IS OTHER LIVE BIRTHS RETURN 442 IN NEXT COLUMN IF THERE IS OTHER LIVE BIRTHS SKIP TO 442 IN THE SECOND COLUMN OF ADITIONAL QUESTIONNAIRE 465S RECORD TIME HOUR – MINUTE. SECTION 6. FERTILITY PREFERENCES 601 CHECK COVER PAGE CLUSTER NO EVEN, AND HH NO. ODD OR CLUSTER NO ODD, AND HH NO. EVEN CLUSTER NO EVEN CLUSTER NO ODD 701 AND HH NO. EVEN AND HH NO. ODD 601A CHECK 250: CURRENTLY CURRENTLY MARRIED NOT MARRIED 612 601A CHECK 314 AND 314A: WOMAN HAD TUBAL WOMAN NOT HAD LIGATION OR TUBAL LIGATION HUSBAND 612 OR HUSBAND STERILIZED NOT STERILIZED 602 CHECK 227: NOT PREGNANT OR UNSURE CURRENTLY PREGNANT Now I have some questions Now I have some questions HAVE (A/ANOTHER) CHILD.1 about the future. about the future. NO MORE/NONE .2 Would you like to have(a/another) After the child you are expecting SAYS SHE CAN'T GET child or would you prefer not to would you like to have another child PREGNANT . 3 612 have any (more) children? or would you prefer not to UNDECIDED/DON’T KNOW. 8 have any more children? 602A CHECK 227: NOT PREGNANT/ OR UNSURE CURRENTLY PREGNANT NUMBER . How many more children would How many more children would you like to have in the future? you like to have in the future OTHER ANSWERS _____________________ 96 not counting the one you (SPECIFY) are currently pregnant with? 603 CHECK 227: NOT PREGNANT/ OR UNSURE CURRENTLY PREGNANT MONTHS .1 YEARS .2 How long would you like to After the child you are SOON/NOW. 993 wait from now before the expecting now, how long SAYS SHE CAN'T GET birth of (a/another) child? would you like to wait before PREGNANT.994 612 the birth of another child? OTHER______________________________ 996 (SPECIFY) DON’T KNOW .998 612 CHECK 216: HAS LIVING CHILDREN NO LIVING CHILDREN NUMBER . If you could go back to the time you If you could choose exactly did not have any children and could the number of children to have in OTHER________________________________ 96 701 choose exactly the number of your whole life, how many (SPECIFY) children to have in youR whole life, would that be? how many would that be? 613 How many of these children would you like to be boys, how many would BOYS you like to be girls and for how many would it not matter? NUMBER . OTHER________________________________ 96 (SPECIFY) GIRLS NUMBER . OTHER ________________________________96 (SPECIFY) EITHER NUMBER . OTHER________________________________ 96 (SPECIFY) SECTION 7A. HUSBAND’S BACKGROUND 701 CHECK 250: CURRENTLY CURRENTLY MARRIED NOT MARRIED 703 702 How old is your husband? COMPLETED AGE . 703 Did your (last) husband ever attend school? YES .1 NO . 2 DON’T KNOW.8 706A 704 PRIMARY SCHOOL.1 SECONDARY SCHOOL.2 PRIMARY EDUCATION.3 HIGH SCHOOL. 4 UNIVERSITY . 5 GRADUATE . 6 What was the highest level of school he atended? DON’T KNOW. 8 706A 705 GRADE . What is the highest grade he completed at that level? DON’T KNOW. 96 705A Did he graduate from that school (Did he recieved YES .1 diploma)? NO .2 DON’T KNOW.8 706A CHECK 250: CURRENTLY CURRENTLY MARRIED NOT MARRIED 706R 706B CHECK COVER PAGE: HUSBAND HUSBAND WAS NOT IN RECORDED IN HH LIST HH LIST 706R 706C YES .1 706G Did your husband work in a job in last week whether paid or unpaid? NO . 2 706D YES .1 706G As you know, some people do temporary jobs, they work in family farm or business paid or unpaid. Did your husband work in such job? NO . 2 706E Does he have a job that he usually work? YES .1 NO …….2 706N 706F Why did not your husband work in last week? HOLIDAY/ON VACATION.01 SICK/UNABLE TO WORK. 03 BUSINESS TRAVEL/IN CHARGE/ EDUCATION/TRAINING. 04 UNPAID VOCATION. 05 IT IS NOT WORKING SEASON.06 WORKPLACE IS CLOSED/INACTIVE.07 OTHER ____________________________________________.96 (SPECIFY) DON’T KNOW .98 706G What is your husband’s occupation? RECORD TYPE OF WORK, PLACE OF WORK AND POSITION AT WORK OPENLY. _______________________________________ ____________________________________________________ 706H GOING TO BE RECODED BY SUPERVISOR/FIELD EDITOR 706I RECORD POSITION AT WORK. EMPLOYER (10+ EMPLOYEES) . 01 EMPLOYER (1-9 EMPLOYEES) . 02 WAGED, WORKER (REGULAR) .03 SALARIED, GOVERNMENT OFFICAL (REGULAR) . 04 DAILY WAGED (SEASONAL/TEMPORAL) .05 FOR HIS/HER OWN (REGULAR) .06 FOR HIS/HER OWN (IRREGULAR) .……………….07 UNPAID FAMILY WORKER .08 OTHER ___________________________________________ 96 (SPECIFY) DON’T KNOW .98 706J GOVERNMENT. 01 VOLUNTEER ORGANIZATIN . 02 PRIVATE . 03 OTHER ___________________________________________ 96 (SPECIFY) RECORD TYPE OF WORK. DON’T KNOW . 98 706K FIELD/GARDEN. 01 HOUSE (OWN).02 HOUSE (SOMEONE ELSE) . 03 REGULAR WORK PLACE .04 MOBILE .05 UNFIXED WORKPLACE .06 MARKETPLACE .07 OTHER ___________________________________________ 96 (SPECIFY) RECORD PLACE OF WORK. DON’T KNOW . 98 706L NO . 00 SSK .01 EMEKLİ SANDIĞI .02 BAĞ-KUR .03 PRIVATE . 04 OTHER ___________________________________________ 96 (SPECIFY) Does he pay social security when doing this job? (IF YES) According to which schedule? DON’T KNOW . 98 706M SKIP TO 706R. 706N WILL START NEW JOB.……. 01 STUDENT .02 RETIRED . 04 INCOME RECIPIENT .05 FAMILY WORKER .06 HANDICAPPED/SICK.……….07 LOOKS AFTER ELDERLY .08 LOOKS AFTER CHILD .09 WILL BE CONSCRIPTED/IN MILITARY SERVICE. 11 LOOKS FOR JOB/UNEMPLOYED. 12 JUST GRADUATED. 14 JUST MIGRATED.………….16 NO NEED TO WORK. 17 OTHER ___________________________________________ 96 (SPECIFY) What is the reason of your husband for not working? (What is your husband’s occupation? Why doesn’t he work?) DON’T KNOW . 98 706O Is your husband looking for a job nowadays? YES .1 706R NO .2 DON’T KNOW .8 706P When was your husband‘s last attempt to find job? NEVER. 0 IN LAST MONTH. 1 BEFORE 2-3 MONTHS.2 BEFORE 4-6 MONTHS.3 MORE THAN 7 MONTHS.4 DON’T KNOW.8 706R NO .……….0 SSK .1 EMEKLİ SANDIĞI .2 BAĞ-KUR .3 PRIVATE .……………………. 4 YEŞİL KART .5 OTHER ___________________________________________ 7 (SPECIFY) Is/was your (last) husband covered by a health insurance? Does/did he have a health insurance? (IF YES) According to which schedule? DON’T KNOW . 8 708A TURKISH.01 KURDISH.02 ARABIC. 03 GREEK, ARMANIAN, HEBREW (LADINO)……………….04 CIRCASSIAN, GEORGIAN, LAZ LANGUAGE.05 RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN.06 ENGLISH, GERMAN, FRENCH…… .07 OTHER ___________________________________________ 96 (SPECIFY) DON’T KNOW . 98 What is/was your (last) husband’s mother tongue? RECORD ONLY ONE RESPONSE. 708B TURKISH.A KURDISH.B ARABIC.C GREEK, ARMANIAN, HEBREW (LADINO)……………….D CIRCASSIAN, GEORGIAN, LAZ LANGUAGE.E RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN.F ENGLISH, GERMAN, FRENCH…… .G OTHER ___________________________________________ U (SPECIFY) In addition to his mother tongue, which language(s) can/could your (last) husband speak? RECORD ALL MENTIONED. KNOWS NO OTHER LANGUAGE . Y 708C What is/was your (last) husband’s mother’s and father’s mother tongues? USE CODES IN 708A. HUSBAND’S MOTHER . HUSBAND’S FATHER. 708D TURKISH.A KURDISH.B ARABIC.C GREEK, ARMANIAN, HEBREW (LADINO)……………….D CIRCASSIAN, GEORGIAN, LAZ LANGUAGE.E RUSSIAN, BULGARIAN, RUMANIAN, SERBIAN.F ENGLISH, GERMAN, FRENCH…….G OTHER ___________________________________________ U Which language do/did you usually use when talking with your (last) husband? RECORD ALL MENTIONED. (SPECIFY) SECTION 7B. WOMAN'S WORK AND STATUS 709 YES . 1 712 Now I would like to ask you questions about working. Aside from your own housework, did you work in a job whether paid or unpaid in last one week? NO .…….2 710 YES ….1 712 As you know some women sell small things, sell goods at the market place, work on the family farm or business, look after children, work as housemaids etc. Are you doing any of these at the present or any other work of similar nature? NO .……….2 710A YES .1 You told that you did not work last week. Do you have a job that you usually work? NO .2 711 710B HOLIDAY/ON VOCATION . 01 PREGNANCY/BIRTH VOCATION. 02 SICK/UNABLE TO WORK. 03 BUSINESS TRAVEL/IN CHARGE/ EDUCATION/TRAINING. 04 UNPAID VOCATION. 05 IT IS NOT WORKING SEASON.06 WORKPLACE IS CLOSED/INACTIVE. 07 OTHER ___________________________________________ .96 (SPECIFY) Why did not you work last week? 711 Have you worked in any job in the last 12 months? YES .1 NO ……….2 740 712 _______________________________________ ______________________________________________________ What type of work are/were you doing? What kind of job are/were you in? 713 GOING TO BE RECODED BY SUPERVISOR/FIELD EDITOR 713A EMPLOYER (10+ EMPLOYEES) . 01 EMPLOYER (1-9 EMPLOYEES) . 02 WAGED, WORKER (REGULAR) .03 SALARIED, GOVERNMENT OFFICAL (REGULAR) . 04 DAILY WAGED (SEASONAL/TEMPORAL) .05 FOR HIS/HER OWN (REGULAR) .06 FOR HIS/HER OWN (IRREGULAR) .……………….07 UNPAID FAMILY WORKER.08 PAID HOUSEHOLD WORKER . 09 OTHER ___________________________________________ 96 (SPECIFY) RECORD POSITION AT WORK. 714 GOVERNMENT. 01 VOLUNTEER ORGANIZATION .02 PRIVATE . 03 OTHER ___________________________________________ 96 (SPECIFY) RECORD THE TYPE OF WORK. 714A FIELD/GARDEN. 01 HOUSE (OWN).02 HOUSE (SOMEONE ELSE) . 03 REGULAR WORKPLACE .04 MOBILE .05 UNFIXED WORKPLACE .06 MARKETPLACE .07 OTHER ___________________________________________ 96 (SPECIFY) RECORD THE PLACE OF WORK. 715 NO …………….00 SSK .01 EMEKLİ SANDIĞI .02 BAĞ-KUR .03 PRIVATE …………. 04 OTHER __________________________________________ 96 (SPECIFY) Do/did you pay social security when doing this job? (IF YES) According to which schedule? 716 THROUGHOUT THE YEAR.1 SEASONALLY/PART OF THE YEAR.…….2 In this job, do/did you usually work throughout the year, or do you work seasonally, or only once in a while? ONCE IN A WHILE. 3 720 YES .…….1 Do/did you earn cash for your work? PROBE: Do/did you make money for your work? NO .……….2 724 721 THE WHOLE.1 MORE THAN THE HALF. 2 THE HALF.3 LESS THAN THE HALF.4 NO CONTRIBUTION.……….5 (In the times that you work) Generally what amount of the family expenses is met by your earnings? The whole, more than the half, the half, less than the half, or does your earning have no contribution to the family expenses? DON'T KNOW .8 722 CHECK 250: HERSELF DECIDES.1 HUSBAND DECIDES.2 JOINTLY WITH HUSBAND.3 SOMEONE ELSE DECIDES.4 CURRENTLY MARRIED: Who mainly decides how the money you earn will be used: you, your husband, you and your husband jointly, or someone else? CURRENTLY NOT MARRIED: Who mainly decides how the money you earn will be used: you, someone else, or you and someone else jointly? JOINTLY WITH SOMEONE ELSE.5 724 CHECK 217 AND 218: HAS A CHILD LIVING WITH HER DOES NOT HAVE A CHILD WHOSE AGE IS LIVING WITH HER 5 OR LESS WHOSE AGE IS 740 5 OR LESS 725 WOMAN . 01 HUSBAND .02 FEMALE CHILD .03 WOMAN’S MOTHER.05 HUSBAND’S MOTHER .06 MALE CHILD .07 OTHER RELATIVES .08 SERVANTS/HIRED HELP. 09 INSTITUTIONAL CHILDCARE.10 HAS NOT WORKED SINCE LAST BIRTH.95 OTHER ___________________________________________ 96 Who usually takes care of …… (NAME OF THE YOUNGEST CHILD AT HOME) while you are working? (SPECIFY) 740 CHECK 709, 710 AND 710A: CURRENTLY CURRENTLY NOT WORKING WORKING 742 741 WILL START NEW JOB.……. 01 STUDENT .02 HOUSEWIFE . 03 RETIRED . 04 INCOME RECIPIENT .05 FAMILY WORKER .06 HANDICAPPED/SICK.……….07 LOOKS AFTER ELDERLY .08 LOOKS AFTER CHILD .09 WILL MARRY .……….10 LOOKS FOR JOB/UNEMPLOYED. 12 YOUNG TO WORK ……. 13 JUST GRADUATED.…. 14 HUSBAND/FAMILY DOESN’T ALLOW .15 JUST MIGRATED.………….16 NO NEED TO WORK. 17 OTHER ___________________________________________ 96 (SPECIFY) You told that currently you are not working. What is the main reason that you are not working? 741A Are you looking for a job nowadays? YES .1 741C NO ….2 741B When was your last attempt to find job? NEVER. 0 IN LAST MONTH. 1 BEFORE 2-3 MONTHS.2 BEFORE 4-6 MOTHS.3 MORE THAN 7 MONTHS.4 741C CHECK 711: WORKED DURING DID NOT WORKED LAST 12 MONTHS DURING LAST 746 12 MONTHS 742 How long have/had you been working in your current/last job? IF IT IS LESS THAN A YEAR RECORD AS MONTHS. MONTHS .1 YEARS .2 746 YES .1 Have you ever worked before your (first) marriage? NO …….2 757 747 What was the last job you worked before your (first) marriage? CURRENT JOB .……….000 751 What type of work were you doing? _______________________________________ ______________________________________________________ 748 GOING TO BE RECORDED BY SUPERVISOR/FIELD EDITOR 748A EMPLOYER (10+ EMPLOYEES) . 01 EMPLOYER (1-9 EMPLOYEES) . 02 WAGED, WORKER (REGULAR) .03 SALARIED, GOVERNMENT OFFICAL (REGULAR) . 04 DAILY WAGED (SEASONAL/TEMPORAL) .05 FOR HER OWN (REGULAR) . 06 FOR HER OWN (IRREGULAR) .………………. 07 UNPAID FAMILY WORKER.08 OTHER ___________________________________________ 96 (SPECIFY) RECORD THE POSITION AT WORK. 749 GOVERNMENT. 01 VOLUNTEER ORGANIZATION .02 PRIVATE . 03 OTHER ___________________________________________ 96 (SPECIFY) RECORD THE TYPE OF WORK. 749A FIELD/GARDEN. 01 HOUSE (OWN).02 HOUSE (SOMEONE ELSE) . 03 REGULAR WORKPLACE .04 MOBILE .05 UNFIXED WORKPLACE .06 MARKETPLACE .07 OTHER ___________________________________________ 96 (SPECIFY) RECORD THE PLACE OF WORK. 750 NO.……………. 00 SSK .01 EMEKLİ SANDIĞI .02 BAĞ-KUR .03 PRIVATE ………. 04 OTHER ___________________________________________ 96 (BELİRTİN) Do/did you pay social security when doing this job? (IF YES) According to which schedule? 751 YES .1 Were you working just before your (first) marriage? NO ……….2 757 752 YES, THE SAME JOB.1 YES, DIFFERENT JOB.2 757 After your (first) marriage, did you continue to work in the same job, or start to work in another job, or did you stop working? STOPPED WORKING….3 753 GOT PREGNANT/CHILD CARE.01 HOUSEWORK.02 SICK/HANDICAPPED……….03 COULDN'T FIND JOB.04 MOVED/MIGRATED. 05 HUSBAND/ELDERS DIDN'T WANT .06 NO NEED FOR WORKING.07 DIDN'T WANT TO WORK.08 WORKED UNPAID.09 What was the main reason that you stop working? DISCHARGED……….10 ELDERLY/SICK CARE IN FAMILY.11 WORKPLACE CLOSED .12 OTHER ___________________________________________ 96 (SPECIFY) 757 HUSBAND'S EARNINGS. 01 HER AND HER HUSBAND'S JOINTLY…. 02 HER EARNINGS…………. 03 HUSBAND'S FAMILY'S INCOME. 04 HER FAMILY'S INCOME…….05 ALIMONY/SUPPORT FOR CHILD.06 HER PENSION………….07 HUSBAND'S PENSION……….08 OTHER ___________________________________________ 96 What is the main source of income providing your and your family's subsistence? (SPECIFY) 758 NO .0 SSK . 1 EMEKLİ SANDIĞI .2 BAĞ-KUR . 3 PRIVATE .……….4 YEŞİL KART . 5 OTHER ___________________________________________ 7 (SPECIFY) Are you covered by any health insurance? (IF YES) According to which schedule? 759 Now I will ask some questions about housework. Who do/does the jobs that I will list now? CODE AT MOST THREE CHOICES ACCORDING TO THE ORDER IN WOMAN’S ANSWER. HER OWN . HUSBAND . FEMALE CHILDREN . MALE CHILDREN. MOTHER/MOTHER-IN-LAW . FATHER/FATHER-IN-LAW . OTHER FEMALES IN HOUSEHOLD . OTHER MALES IN HOUSEHOLD . PAID SERVANT/MAID . NOBODY DOES THE JOB . OTHER . A B C D E F G H I T U 1 2 3 Cooking? . . . Setting and cleaning the dining table? . . . Cleaning like wiping and sweeping? . . . Washing the dishes/putting the dishes in dishwasher? . . . Washing the clothes? . . . Ironing? . . . Shopping for the kitchen? . . . Preparing the household budget, accounting? . . . Jobs in the governmental offices, paying the bills? . . . 766 Would you please tell me if a husband is justified in beating his wife for each of the following situations? If she burns the food? If she neglects the children? If she answers him back? If she wastes money? If she refuses to have sexual intercourse? YES 1 1 1 1 1 NO 2 2 2 2 2 DON’T KNOW 8 8 8 8 8 767 Now I will read you a few sentences. I would like to get your opinion on these sentences. Tell me if you agree or disagree with each sentence? The important decisions in the family should be made by the men of the family. Men are usually wiser than women. If a woman disagrees with her husband, she should not argue with him, keep quite. It is always better for the male child to have education than the female child. AGREE 1 1 1 1 DISAGREE 2 2 2 2 DK/HAS NO IDEA 8 8 8 8 768 YES . 1 Have you ever gone to the cinema? NO …….2 770 769 When did you last go to a cinema? IN 1 WEEK …………….1 IN 1 MONTH .…….2 IN THIS YEAR .……. 3 IN LAST 5 YEARS .4 BEFORE 5 YEARS .5 770 YES .1 Have you ever gone to a theatre? NO .2 772 771 When did you last go to the theatre? IN 1 WEEK …………….1 IN 1 MONTH .…….2 IN THIS YEAR .……. 3 IN LAST 5 YEARS .4 BEFORE 5 YEARS .5 772 Now I want to ask some questions about your daily life. YES NO Do you make a branch of sports regularly? 1 2 Do you participate the activities of any society/club/association regularly? 1 2 Do you go to holiday other than your homeland/town? 1 2 Do you go outside for meal with your family? 1 2 Do you go to picnic? 1 2 Do you put on make up? 1 2 Do you wear head scarf when you go outside the street? 1 2 SECTION 8. SEXUALLY TRANSMITTED DISEAES AND AIDS 801 CHECK COVER PAGE: CLUSTER NO. IS EVEN, HH. NO IS ODD OR CLUSTER NO. IS ODD, HH. NO IS EVEN CLUSTER NO. IS EVEN CLUSTER NO. IS ODD 812S AND HH. NO. EVEN AND HH. NO. IS ODD 801A Now I would like to talk you about sexually transmitted diseases. Have you ever heard of sexually transmitted diseases? YES .1 NO .2 801L 801B Which diseases have you heard? SYPHILIS .A GONORE . B AIDS . C WART/SORE IN GENITAL ORGANS .D RECORD ALL MENTIONED. FUNGUS .E OTHER _______________________________ U (SPECIFY) OTHER _______________________________ V (SPECIFY) DOESN'T KNOW THE NAMES .X 801K CHECK 801B: NOT MENTIONED MENTIONED 802A AIDS AIDS 801L Have you ever heard of an illness called AIDS? YES . 1 NO .2 812S 802A From which sources of information have you learned most about AIDS? RADIO . A TV . B Any other sources? NEWSPAPERS/MAGAZINES .C PAMPHLETS/POSTERS .D HEALTH WORKERS .E MOSQUES .F RECORD ALL MENTIONED. SCHOOLS/TEACHERS .G FRIENDS/RELATIVES .I HUSBAND . J WORKPLACE .K OTHER _______________________________ U (SPECIFY) 802B Through what ways a person is transmitted AIDS? SEXUAL RELATION .A SEXUAL RELATION WITH MORE THAN ONE PARTNER . B SEXUAL RELATION WITH A PROSTITUTE . C NOT USING CONDOM .D Any other ways? HOMOSEXUAL RELATION .E BLOOD TRANSFUSION . F RECORD ALL MENTIONED. INJECTION .G KISSING .H OTHER _______________________________ U (SPECIFY) OTHER _______________________________ V (SPECIFY) DON’T KNOW .X 803 Is there anything a person can do to avoid getting AIDS YES .1 or the virus that causes AIDS? NO . 2 DON’T KNOW .8 807 804 What can a person do? USE CONDOMS.A HAVE ONLY ONE SEX PARTNER .B Any other ways? AVOID SEX WITH PROSTITUTES .C AVOID SEX WITH HOMOSEXUALS .D RECORD ALL MENTIONED. AVOID BLOOD TRANSFUSIONS .E CONTROL BEFORE BLOOD TRANSFUSIONS . F USING STERILIZED INJECTIONS .G AVOID KISSING . H AVOID MOSQUITO BITES .I SEEK PROTECTION FROM TRADITIONAL HEALER . J USING STERILIZED TOOLS .K OTHER _______________________________ U (SPECIFY) OTHER _______________________________ V (SPECIFY) DON’T KNOW .X 807 Is it possible for a healthy-looking person YES .1 to have the AIDS virus? NO . 2 DON’T KNOW .8 808C Can the virus that causes AIDS be transmitted from a mother to a child: YES NO DON’T KNOW During pregnancy? 1 2 8 During delivery? 1 2 8 By breastfeeding? 1 2 8 812S RECORD THE TIME. HOUR . MINUTES . 813 PRESENCE OF OTHERS DURING THE INTERVIEW. NO ONE .A CHILDREN UNDER 10 .B CIRCLE ALL APPROPRIATE ALTERNATIVES. MOTHER IN LAW .D HER MOTHER .E OTHER MEN . F OTHER WOMEN .G 814 WAS THE INTERVIEW INTERRUPTED? NO .000 IF YES, FOR HOW MANY MINUTES APPROXIMATELY? MINUTES .1 815 IN YOUR OPINION, WHAT IS THE RELIABILITY POOR . 1 OF THE RESPONSES? FAIR .2 GOOD .3 VERY GOOD .4 816 WHAT LANGUAGE WAS USED DURING THE INTERVIEW? TURKISH . 1 921 KURDISH .2 ARABIC .3 OTHER _______________________________ 7 (SPECIFY) 817 WAS AN INTERPRETER USED DURING THE INTERVIEW? YES .1 NO . 2 SECTION 9. HEIGHT AND WEIGHT 921 • RECORD THE NAME OF THE WOMAN AND IF ANY, THE NAME(S) OF THE CHILDREN THAT WAS BORN AFTER JANUARY 1998 AND STILL ALIVE IN 922 BY BEGINNING FROM THE YOUNGEST CHILD. RECORD THE LINE NO. OF CHILDREN IN 923. IF THERE IS MORE THAN 2 LIVING CHILDREN THAT WAS BORN AFTER JANUARY 1998, USE ADDTIONAL QUESTIONNAIRE. • MEAUSURE THE WEIGHT AND HEIGHT OF WOMAN'S LIVING CHILDREN THAT WAS BORN AFTER JANUARY 1998 AND RECORD IN THE CONCERNED QUESTION. WOMAN YOUNGEST LIVING CHILD NEXT-TO-YOUNGEST LIVING CHILD 922 NAME CHECK 212 FOR CHILDREN. (NAME) ________________________ (NAME) ________________________ (NAME) ________________________ 923 LINE NO. IN 212. LINE NO . LINE NO . 924A DATE OF BIRTH CHECK 105 FOR WOMAN, CHECK 215 FOR CHILDREN AND RECORD . MONTH . YEAR . MONTH . YEAR . MONTH . YEAR . 924B ASK IF WOMAN AND YES, SEEN .1 YES, SEEN .1 YES, SEEN .1 CHILDREN HAVE IDENTITY YES, NOT SEEN .2 YES, NOT SEEN .2 YES, NOT SEEN .2 CERTIFICATES. 926 926 926 IF YES, THEN SAY YOU’D NO .3 NO .3 NO .3 LIKE TO SEE IT DON’T KNOW.8 DON’T KNOW.8 DON’T KNOW.8 924C RECORD THE PROVINCE AND DISTRICT INFORMATION THAT REGISTER BELONGS TO IN IDENTITY CERTIFICATE. PROVINCE . DISTRICT ______________ PROVINCE . DISTRICT ______________ PROVINCE . DISTRICT ______________ 924D RECORD THE DATE OF BIRTH IN THE IDENTITY CERIFICATE. MONTH . YEAR . MONTH . YEAR . MONTH . YEAR . 924E CHECK105 FOR WOMAN AND SAME .1 SAME .1 SAME .1 215 FOR CHILDREN AND 926 926 926 COMPARE IT WITH DATE OF DIFFERENT .2 DIFFERENT .2 DIFFERENT . 2 BIRTH IN 924C. 924F DETERMINE THE TRUE ANSWER IN 105 .1 ANSWER IN 215 .1 ANSWER IN 215 .1 INFORMATION FOR DATE OF BIRTH AND DO NOT ID CERTIFICATE .2 ID CERTIFICATE .2 ID CERTIFICATE .2 MAKE ANY CORRECTION. 21 3 WOMAN YOUNGEST LIVING CHILD NEXT-TO-YOUNGEST LIVING CHILD 926 HEIGHT (cm) . . . 927 WAS THE HEIGHT/LENGTH LYING.1 LYING. 1 OF CHILD MEASURED BY LYING DOWN OR STANDING.2 STANDING. 2 STANDING UP? 928 WEIGHT (Kilogram) . . . 929 DATE WEIGHTED AND MEASURED. DAY . MONTH . DAY . MONTH . DAY . MONTH . 930 RESULT MEASURED. .1 MEASURED.1 MEASURED. 1 NOT PRESENT. .3 NOT PRESENT.3 NOT PRESENT. 3 REFUSED . .4 REFUSED . .4 REFUSED . 4 OTHER ____________ _ 7 OTHER ____________ _ 7 OTHER ____________ 7 (SPECIFY) (SPECIFY) (SPECIFY) 931 NAME OF MEASURER _____________________________ 21 3 INTERVIEWER’S OBSERVATIONS To be filled after completing interview COMMENTS ABOUT WOMAN COMMENTS ON SPECIFIC QUESTIONS ANY OTHER COMMENTS SUPERVISOR’S OBSERVATIONS NAME OF THE SUPERVISOR: DATE: EDITOR’S OBSERVATIONS NAME OF THE EDITOR: DATE: 1 2 3 06 JUNE 01 01 JUNE 06 05 MAY 02 02 MAY 05 04 APR 03 03 APR 04 03 MAR 04 04 MAR 03 02 FEB 05 05 FEB 02 01 JAN 06 06 JAN 01 12 DEC 07 07 DEC 12 11 NOV 08 08 NOV 11 10 OCT 09 09 OCT 10 09 SEP 10 10 SEP 09 08 AUG 11 11 AUG 08 07 JULY 12 12 JULY 07 06 JUNE 13 13 JUNE 06 05 MAY 14 14 MAY 05 04 APR 15 15 APR 04 03 MAR 16 16 MAR 03 02 FEB 17 17 FEB 02 01 JAN 18 18 JAN 01 12 DEC 19 19 DEC 12 11 NOV 20 20 NOV 11 10 OCT 21 21 OCT 10 09 SEP 22 22 SEP 09 08 AUG 23 23 AUG 08 07 JULY 24 24 JULY 07 06 JUNE 25 25 JUNE 06 05 MAY 26 26 MAY 05 04 APR 27 27 APR 04 03 MAR 28 28 MAR 03 02 FEB 29 29 FEB 02 01 JAN 30 30 JAN 01 12 DEC 31 31 DEC 12 11 NOV 32 32 NOV 11 10 OCT 33 33 OCT 10 09 SEP 34 34 SEP 09 08 AUG 35 35 AUG 08 07 JULY 36 36 JULY 07 06 JUNE 37 37 JUNE 06 05 MAY 38 38 MAY 05 04 APR 39 39 APR 04 03 MAR 40 40 MAR 03 02 FEB 41 41 FEB 02 01 JAN 42 42 JAN 01 12 DEC 43 43 DEC 12 11 NOV 44 44 NOV 11 10 OCT 45 45 OCT 10 09 SEP 46 46 SEP 09 08 AUG 47 47 AUG 08 07 JULY 48 48 JULY 07 06 JUNE 49 49 JUNE 06 05 MAY 50 50 MAY 05 04 APR 51 51 APR 04 03 MAR 52 52 MAR 03 02 FEB 53 53 FEB 02 01 JAN 54 54 JAN 01 12 DEC 55 55 DEC 12 11 NOV 56 56 NOV 11 10 OCT 57 57 OCT 10 09 SEP 58 58 SEP 09 08 AUG 59 59 AUG 08 07 JULY 60 60 JULY 07 06 JUNE 61 61 JUNE 06 05 MAY 62 62 MAY 05 04 APR 63 63 APR 04 03 MAR 64 64 MAR 03 02 FEB 65 65 FEB 02 01 JAN 66 66 JAN 01 12 DEC 67 67 DEC 12 11 NOV 68 68 NOV 11 10 OCT 69 69 OCT 10 09 SEP 70 70 SEP 09 08 AUG 71 71 AUG 08 07 JULY 72 72 JULY 07 06 JUNE 73 73 JUNE 06 05 MAY 74 74 MAY 05 04 APR 75 75 APR 04 03 MAR 76 76 MAR 03 02 FEB 77 77 FEB 02 01 JAN 78 78 JAN 01 2 0 0 1 1 9 9 8 1 9 9 9 2 0 0 0 2 0 0 0 1 9 9 9 COLUMN 1: BIRTHS AND PREGNANCIES D BIRTH H PREGNANCY K INDUCED ABORTION F SPONTANEOUS ABORTION J STILLBIRTH CONTRACEPTIVE USE 0 NO METHOD 1 TUBAL LIGATION 2 MALE STERILIZATION 3 PILL 4 IUD 5 INJECTABLES 6 IMPLANT/NORPLANT 7 CONDOM 8 FEMALE CONDOM 9 DIAPHRAM/FOAM/JELLY S LACTATIONAL AMEN. METHOD T RHYTHM G WITHDRAWL U OTHER _____________________________ SPECIFY N MONTHS OF WEDLOCK COLUMN 2: DISCONTINUATION OF CONTRACEPTIVE USE 0 INFREQUENT SEX/HUSBAND AWAY 1 BECAME PREGRANT WHILE USING 2 WANTED TO BECOME PREGNANT 3 HUSBAND DISAPPROVED 4 WANTED MORE EFFECTIVE METHOD 5 HEALTH CONCERNS 6 SIDE EFFECTS 7 LACK OF ACCESS/TOO FAR 8 EXPENSIVE 9 INCONVINENT TO USE Y FATALISTIC M DIFFICULT TO GET PREGNANT/MENOPAUSE B MARITAL DISSOLUTION/SEPERATION/WIDOWHOOD U OTHER _____________________________ (SPECIFY) X DON'T KNOW PLACE OF INDUCED ABORTION C GOVERNMENT/SAMPLE HOSPITAL D MATERNITY HOUSE E MCHFP CENTRE F SSK HOSPITAL/DISPENSARY G OTHER PUBLIC SECTOR H PRIVATE HOSPITAL J PRIVATE POLYCLINIC K PRIVATE DOCTOR L OTHER PRIVATE SECTOR N UNIVERSITY HOSPITAL O VOLUNTEER ORGANIZATION/ ASSOCIATION/FOUNDATION V OTHER COLUMN 3: MARRIAGE X MARRIED O NOT MARRIED CALENDAR 2 0 0 4 2 0 0 3 2 0 0 2 2 0 0 2 2 0 0 3 2 0 0 4 2 0 0 1 1 9 9 8 PROVINCE TRAFFIC CODES 01 ADANA 21 DİYARBAKIR 41 KOCAELİ 61 TRABZON 02 ADIYAMAN 22 EDİRNE 42 KONYA 62 TUNCELİ 03 AFYON 23 ELAZIĞ 43 KÜTAHYA 63 ŞANLIURFA 04 AĞRI 24 ERZİNCAN 44 MALATYA 64 UŞAK 05 AMASYA 25 ERZURUM 45 MANİSA 65 VAN 06 ANKARA 26 ESKİŞEHİR 46 K.MARAŞ 66 YOZGAT 07 ANTALYA 27 GAZİANTEP 47 MARDİN 67 ZONGULDAK 08 ARTVİN 28 GİRESUN 48 MUĞLA 68 AKSARAY 09 AYDIN 29 GÜMÜŞHANE 49 MUŞ 69 BAYBURT 10 BALIKESİR 30 HAKKARİ 50 NEVŞEHİR 70 KARAMAN 11 BİLECİK 31 HATAY 51 NİĞDE 71 KIRIKKALE 12 BİNGÖL 32 ISPARTA 52 ORDU 72 BATMAN 13 BİTLİS 33 İÇEL 53 RİZE 73 ŞIRNAK 14 BOLU 34 İSTANBUL 54 SAKARYA 74 BARTIN 15 BURDUR 35 İZMİR 55 SAMSUN 75 ARDAHAN 16 BURSA 36 KARS 56 SİİRT 76 IĞDIR 17 ÇANAKKALE 37 KASTAMONU 57 SİNOP 77 YALOVA 18 ÇANKIRI 38 KAYSERİ 58 SİVAS 78 KARABÜK 19 ÇORUM 39 KIRKLARELİ 59 TEKİRDAĞ 79 KİLİS 20 DENİZLİ 40 KIRŞEHİR 60 TOKAT 80 OSMANİYE 81 DÜZCE 90 ABROAD CONVERSION OF YEARS OF BIRTH FROM RUMI CALENDAR TO GREGORIAN CALENDAR YEARS: RUMI YEARS + 584 = GREGORIAN YEAR Front Matter Title Page Citation Page Table of Contents List of Tables and Figures Foreword Summary of Findings Map of Turkey - 12 Regions Map of Turkey - 5 Regions Chapter 01 - Introduction Chapter 02 - Household Population and Housing Characteristics Chapter 03 - Women's Characteristics and Status Chapter 04 - Fertility Chapter 05 - Family Planning Chapter 06 - Abortions and Stillbirths Chapter 07 - Other Proximate Determinants of Fertility Chapter 08 - Fertility Preferences Chapter 09 - Infant and Child Mortality Chapter 10 - Antenatal Care and Delivery Assistance Chapter 11 - Vaccination and Child Health Chapter 12 - Infant Feeding Practices and Children's and Women's Nutritional Status Chapter 13 - Knowledge of HIV/AIDS References Appendix A - List of Personnel Appendix B - Survey Design Appendix C - Sampling Errors Appendix D - Quality of the Data Appendix E - Questionnaires Household Questionnaire Ever-Married Women's Questionnaire

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