Public health experts have told Inside Turkey that a combination of economic and political factors is making it increasingly difficult for women in Turkey to access contraceptives, posing long-term health risks.
The rising cost of medication, due to the country’s economic crisis, is making one of the most widely-used treatments – the morning after pill – unaffordable for many. The cost of the medication, 90 liras at the start of 2023, had risen to 416 liras by August. The birth control pill, meanwhile, rose from 34 to 270 liras over the same period.
Turkey’s health ministry, which sets prices for medication based on the value of the euro, is struggling to keep up as the Turkish lira decreases in value. It has raised prices on five separate occasions this year already.
Pharmacies at five different locations in the western Turkish city of Izmir told Inside Turkey that sales of the morning after pill had dropped by around 80 per cent in recent months. One outlet, in the low-income neighborhood of Gümüşpala, said they had only sold five doses of the pill in July, compared to 28 last December.
Problems have been exacerbated by a change in policy by the UN Population Fund (UNFPA), which funds birth control measures in low and middle-income countries. Until 2019, thanks to UNFPA funding, family doctors offered a range of contraceptives – including condoms, pills, contraceptive injections and IUDs – to women for free. When birth rates in Turkey started to fall, the UNFPA cut off funding, redirecting the money to countries in Africa with rising birth rates.
Mübeccel Ilhan, a board member of the Izmir Medical Association, told Inside Turkey that Turkey’s government “failed to take initiative” when the funding stopped.
“They did nothing, it was like they were ignoring the situation,” she said. As a result, the free provision of contraceptives has now ended.
Ilhan believes this is part of a deliberate strategy, in line with the AKP-led government’s socially conservative platform. She pointed to restrictions on abortion as another example of “policies that use women’s bodies as vessels”.
The government has not commented on birth rates since the UNFPA cut its funding in 2019, although President Recep Tayyip Erdogan has long encouraged Turks to have large families and is fond of telling couples they should have at least three children.
Socially conservative attitudes can also discourage young women from seeking advice. Büşra Muratdağı, a 20 year-old Izmir resident, told Inside Turkey that she was aggressively questioned when she asked her local family health centre for contraceptives. Staff told Muratdağı that the only available contraceptive method was a monthly injection that could only be administered with proof of marriage.
“I live in this neighbourhood with my family, so of course I have some reluctance about going to the family health centre for something like this,” Muratdağı said. “They might talk about me to my mum or dad later on.”
According to Z, a member of the Izmir Medical Association’s women’s health commission who asked to remain anonymous, sexuality is increasingly treated in Turkey as a “shameful” matter that “shouldn’t be discussed”.
Z also blamed market-driven reforms to Turkey’s health system, introduced by the AKP during its first period of government in 2002, for the lack of access to contraception. Under the AKP’s Programme for Transformation in Health, a network of specialist family planning centres were closed down and their duties transferred to family doctors.
Z believes this “degraded the culture of raising awareness [about women’s health] in frontline health organisations”. Under the previous system, she said, young people could receive consultation or access information about sexual health when they visited a medical facility.
What’s more, with family doctors paid on a per-patient basis, practitioners tend to be overloaded and are often unable to see patients on demand, Z continued. As a result, over-the-counter treatments at pharmacies are the preferred options for many young women – if they can afford them.
The pharmacists in Izmir who spoken to Inside Turkey all said that young women usually buy these products without seeing a doctor first. However, there were wide variations in the frequency of these requests depending on how well-off the local neighbourhood was.
A pharmacist in the low-income neighbourhood of Gümüşpala, for instance, said that women would often change their minds about buying contraceptives when they found out the price. Less than half a kilometre away, in affluent Karşıyaka, a pharmacist said that customers asked for contraceptives by brand name and bought them without even checking the cost.
For Z, this illustrated how women were bearing the brunt of Turkey’s ongoing economic crisis, and that if these problems persist Turkey was likely to see a rise in unwanted pregnancies and complications, including deaths during childbirth.
“Women should be able to get prescriptions for free, taxes should be lifted from female hygiene products and school curricula should involve sexual education,” she concluded.