ELİF AKGÜL

News Center- The increase in the exchange rate and increasing inflation rate in Turkey have affected all people, as well as women and reproductive health services. Access to products such as condoms, birth control pills, intrauterine devices, contraceptive injections has become more difficult in this period when more women cannot access free birth control methods. Gynecologist Irmak Saraç answered our questions and said that the difficulty in accessing birth control services causes unwanted pregnancies, which may increase the maternal mortality rate.

“Access to the medicines used by women the most has become difficult”

The pharmaceutical industry is among the industries affected by the exchange rate crisis. Many medicines for reproductive health are not covered by the SGK (Turkish Social Security Institution) and the price of medicines increases every day. How are women affected by this situation?

The unstable exchange rate has actually affected the examination fees of private hospitals. Normally, the price of medicines used to be raised once a year; however, the prices are raised every day today. Now, the number of medicine boxes are less, probably because of the fall in the profit margin of the pharmaceutical companies. For instance, ten thousand boxes of medicines were delivered to pharmacies; however, the number of medicine boxes is not five thousands. The pharmacists have difficulty in getting medicines and patients have to visit many pharmacists to find their medicines. Access to medicines used by women the most such as birth control pills, menstrual regulators, hormone therapy medicines has become difficult now.

How does this situation affect patients?

When patients do not find their medicines, they cannot be treated. Not being able to access the birth control pills can lead to the use of birth control. Sometimes, women use birth control pills to regulate their menstrual cycles; however, they cannot access them. Then, they suffer from irregular periods. In other words, women are deprived of their right to health.

“Health transformation program make women to have difficult in accessing contraceptive services”

After the price hikes for sanitary pads, a campaign was launched and it was a partially successful campaign. What about access to sexual health products such as condoms, birth control pills, vaccines preventing pregnancy, morning-after pills? Who can access these products?

We have been experiencing transformation in reproductive health, sexual health and reproductive health policies for a long time. This transformation has become visible when more women cannot access to abortion services. The health transformation program has a very serious impact on this situation. You know, before the healthy transformation program, there were health centers, Mother-Child Health and Family Planning Centers in hospitals and clinics. Some of these centers were closed down while some of them were turned into Children, Adolescent, Women and Reproductive Health Centers, known as ÇEKÜS. Before these centers were closed down, they served three million and two million people every year; however, the Children, Adolescent, Women and Reproductive Health Centers serve only 200,000 and 300,000 people every year now because it is difficult to find these centers.

 “Materials preventing pregnancy are not provided”

One of the problems is that the material is not supplied. In other words, birth control pills, monthly injections and condoms are not regularly provided by family physicians because family physicians have not received birth control pills, monthly injections or condoms. For instance, doctors want to insert the IUD but they do not have this device.  I mean, there is a serious medical material shortage. In other words, we face serious difficulties in accessing methods to prevent pregnancy.

According to the 2018 Turkey Demographic and Health Survey (TNSA) conducted among married women aged 15- 49 by the Hacettepe University Institute of Population Studies every five years, the use of modern methods of preventing pregnancy decreased. The most commonly used method was the withdrawal (20%), followed by male condom (19%), the IUD (14%), and the sterilization (10%). The decline was mainly due to decreases in use of the withdrawal (from 26% to 20%) and the IUD (from 17% to 14%). The rate of those receiving these services from the state decreased from 60% to 55%. The rate of those buying these materials from shops increased from 7% to 12%.

“Maternal mortality rate may increase due to unwanted pregnancies”

Therefore, people can no longer receive these services from the state. You can apply to the Healthy Life Centers, state hospitals to get an IUD but you are told, “We can insert it but we do not have these devices”. So what will be the result? The rate of unwanted pregnancies will increase. Poor people, who will not be able to access the free health services, will not buy medicines preventing pregnancy from pharmacies because they do not have money. So they will apply illegal methods. As a result, maternal mortality rate may increase due to unwanted pregnancies.

“Young people cannot access health and counseling services”

Do women have to be married in order to benefit from health services of state hospitals and family health centers such as getting an IUD or contraceptive injections?

Women do not have to be married in order to benefit from any family planning method. Normally, women can go and ask for such services. Married and single women can demand such services. However, young people cannot access counseling services on methods preventing pregnancy or sexually transmitted infections. If there is an unwanted pregnancy, they cannot access the methods because they do not have money. They face social and family pressure. Therefore, there is a serious problem for them as well.

“The ideal number of children has increased from 2 to 3”

What kind of health policy should be followed regarding sexual and reproductive health?

We can say that 2012 was a milestone (in Turkey). The state has a pro-natalist policy. When you enter a family health center, you can see many posters about pregnancy but not methods of preventing pregnancy. According to the TNSA, the pregnancy rate has not increased, the ideal number of children has increased from two to three.

“Healthcare services must be legal and accessible”

A health policy is the right to health. In other words, women have the right to end and prevent pregnancy. Healthcare services must be legal, accessible and free so that everyone can access them equally. When healthcare services are not legal, accessible and free, people face many health problems