Say Yes, Autumn 2005: Educated Mothers … Healthier Families

Infant and maternal mortality rates, targeted by the fourth and fifth MDGs respectively, are high in Turkey compared to other middle-income countries and they are among the highest in Europe. Although a great deal has been done to reduce child mortality rates during the past decade there is still room for improvement -- not least in the provision of prenatal and early childhood health care services targeted to low-income women and their families.

Following the intensive Measles Elimination drive that began in 2003, the Ministry of Health (MOH) announced a 95% coverage rate for immunisation of all children against measles in June. The UNICEF supported campaign is a crucial step towards achieving the fourth MDG. Turkey has also been polio-free since 2002.

However, The Turkey Demographic and Health Survey (TDHS) for 2003 reveals that infant and under-five mortality rates (IMR and U5MR) are still high -- 40% above the national average in the north and eastern regions, compared to the urbanised west where the rate is significantly below the national average. Levels of malnutrition also follow the pattern of urban/rural inequality: the stunted growth rate for under-five-year-olds is recorded as 9% in urban areas; 18% in rural areas; 6% in the West and 22% in the East. Overall rates of incomplete immunisation are high and 52% of children under one year old are not immunised against the major diseases. The TDHS underlines the “strong link between the survival chances of children and the level of education of their mothers” by pointing out that the IMR for children of mothers who have never completed primary education or who have had no education at all is 51‰ whereas it is only 18‰ for children of mothers who have had secondary or tertiary level education.

The high concentration of health care facilities and professionals in the west in comparison to the east and southeast where health centres are severely understaffed also contributes significantly to urban/rural variations in child and maternal health outcomes.

The MOH, with the support of UNICEF and WHO, has promoted several important preventive health care measures in recent years. The TDHS shows that rates of exclusive breastfeeding during the first six months increased from 5% in 1998 to 21% in 2003. Pneumonia, the risk of which is reduced by exclusive breastfeeding, is the second biggest cause of under-five mortalities. Compulsory iodisation of table salt is expected to lead to 90% of Turkish consumers using iodised salt by the end of 2005, significantly reducing the incidence of iodine deficiency disorders (IDD) which can be particularly detrimental to the health of both mother and child during pregnancy.

Maternal mortality, that is death from pregnancy related complications, often occurs suddenly and unpredictably. Problems with the classification of the cause of death mean that accurate maternal mortality rates (MMR) are difficult to obtain. Estimating the MMR for Turkey is especially difficult due to the inconsistency of methods used to assess MMRs over the past three decades.

UNICEF stresses that the best solution to maternal and infant mortality is to reach adolescent girls before they become actively reproductive -- another factor underlining the fundamental importance of girls’ education. Roughly 6 million Turkish mothers between the ages of fourteen and forty-four are illiterate.

The government is planning to expand the Family and Child Training programme (FACT) with UNICEF support, targeting parents with knowledge of early childhood development and care practices such as exclusive breastfeeding, immunisation and nutrition.

Forthcoming reforms in line with the WHO Health for Europe programme will address the geographic and income disparities in health service provision. The most important changes will involve a complete restructuring of the MOH; vigorous promotion of preventive health care measures; improvements to the family practitioners system and a stronger emphasis on maternal and child health.

The Government is preparing to expand the Green Card scheme of universal health care coverage for the entire population by 2011 with the support of the World Bank under the Health Transition Project. The latest HBS shows that 37% of the population does not have health care insurance which rises to 50% in rural areas: 79% of the wealthiest 20% have health insurance whereas only 42% of the poorest 20% are covered.

Health outcomes for low income families are severely affected when they avoid or cannot afford out-of-pocket expenditures for hospitalisation, treatment, check-ups and medication.

The message is hopeful: mother and child health in Turkey should be vastly improved if plans to eliminate economic barriers, improve access and raise levels of education are realised.

Goal 4: Reduce child mortality

Indicators	Base Year value (1990)	Current (2003)	Target value (2015)
Target: Reduce by two thirds, between 1990 and 2015, the mortality rate of children under five years of age
Indicator 13: Under-five mortality rate per 1,000 live births	52.1‰	37‰	20.7‰
Indicator 14: Infant mortality rate	43‰	29‰	17.5‰
Indicator 15: Proportion of one year-old children immunised against measles	77.9%	79.4%	100%

Find out more about the FACT programme.

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