Reproductive Health Providers Disincentivised in Turkey’s Hostile Climate for Women’s Rights

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100 victims of domestic rape are estimated to have been refused abortion in Turkey this year. Barney Cullum reports from Istanbul.

Women are increasingly being denied abortions from state hospitals in Turkey to appease the country’s authoritarian leader, national women’s shelter Purple Roof has told Conatus News. Abortions up until the tenth week of pregnancy remain free and legal on paper, but women are being “humiliated” when contacting doctors, it has been claimed.

Patriarchal contributions made by the Turkish President to policies concerning women’s reproductive rights during his fifteen years leading the country are notorious. “Abortion is murder,” Recep Tyyip Erdogan told a women’s conference in 2012. “One or two children mean bankruptcy,” he insisted a year later, warning Turkey’s economy was at risk of an ageing population. “Three children mean we are not improving but not receding either. So, I repeat, at least three children are necessary in each family.”

How did women respond? “We asked him, ‘Who is going to look after these children, are you going to do it?’” recalls Gulsan Kanat-Dinc, a social worker who works for the Purple Roof women’s shelter in Istanbul, Turkey’s largest city. Childcare provision for under-3s does not exist here. To no one’s great surprise, families did not immediately take it upon themselves to create larger families in order to bolster an already booming economy.

The Turkish economy has now faltered, however. Inflation reached 25 percent in October and the Turkish Lira slumped in value against both the Euro and the dollar following US trade sanctions. Erdogan has not yet repeated his crude ideas for growing the domestic workforce, nor has he followed through on a threat to change the legal limit for abortions from 10 weeks to four weeks. But he hasn’t had to, such is the culture of fear and submission he has instilled in abortion doctors and others through a crackdown on independent thought seen since public protests in 2013.

It started with ‘Gezi’, an environmental protest at Gezi Park in central Istanbul that morphed into a huge civil rights display that saw eight people die following clashes with the police. Then there was an attempted coup in 2016, followed by a change to the constitution last year permitting Erdogan to rule by decree and to potentially stay in post until 2034. Over 160,000 people have faced jail time for thought crimes including ‘Insulting Turkishness’ and other perceived shows of dissent, according to the United Nations.

Hospital responses to abortion requests have radically shifted in order to meet Erdogan’s public advocacy and expectations. “This year we are seeing more victims of domestic rape contact us than ever before, saying they are unable to find a hospital that will provide them a free abortion,” says Kanat-Dinc. Purple Roof says it has received as many as 100 such calls in 2018. “I think the state hospitals want to show that they are with him [Erdogan]. In Istanbul there are still a few hospitals that provide free abortions, but in some other cities there are none.”

The organisation supports women to find the few remaining state hospitals who still perform abortions no-questions asked. 2013 research from Kadir Has University in Istanbul found that just eight percent of state hospitals provide abortion services no-questions-asked, which is permitted by the current law, while 78 percent provide abortions only when there is a medical necessity for it. This is despite an awareness than 14 percent of Turks will pursue an abortion at least once at some point in their lives.

“We do public opinion surveys annually and what we’ve seen is public support for women’s right to abortion is eroding,” says Professor Mary Lou O’Neil, Director of the Gender and Women’s Studies Research Centre at Kadir Has. “When we ask people whether they agree with the statement ‘do you think abortion is a sin’ or ‘do you think it’s the sacrifice of an innocent life’, those figures have gone up every year since we started collecting the data five years ago.”

The pattern correlates both with Erdogan making his first outspoken abortion polemics and the show of force he orchestrated following Gezi. All public institutions have faced purges, including hospitals. The period of oppression has seen doctors even face six-figure fines for treating patients injured as activists. A two year state-of-emergency granting the government special powers to bypass human rights law has now been lifted. However, a constitutional referendum that took place during that period granted Erdogan ongoing powers to govern by decree and to appoint a greater number of judges and prosecutors.

“The vast majority of doctors and patients are at public hospitals and you have an entire computer system which tracks these things,” explains O’Neil. “All procedures are recorded in a system centralised in the health ministry. [This system] can potentially be exploited for bad ends. It’s also a system of incentive and disincentive: it’s how doctors are evaluated. Each procedure has a certain amount of points. Things related to reproductive health have a very low amount of points. So there’s not a lot of incentive to build points, earn promotion or earn extra pay in the system.”

“It’s just not worth doing abortions. If you operate in an environment where you sense that it will be frowned upon, whether it is or not, you’ll regulate yourself. ‘I’ll put more of my energy or emphasis in this area or that area because then I won’t get into trouble.’

“It’s the kind of thing that doesn’t usually get into the paper but stories come to me about people who are treated badly while seeking an abortion. They’ve been humiliated, not treated very kindly.”

A system of institutional discrimination has built up, without any changes to abortion law itself. Women who have not found a sympathetic hospital, or who have not yet been reached by Purple Roof, face private clinic fees of between 1,200 and 4,500 Turkish Lira (£200 – £700). These fees have spiked amid the sudden, soaring inflation. The price of the morning-after pill and imported contraception has also increased.

Kanat-Dinc says she is feeling the pinch of inflation herself. “I don’t want to live in an economy like Venezuela’s,” she says. The social worker is proud of her daughter, currently studying in London. A life of economic independence potentially awaits. The same is not true for most Turkish women, with just 37 percent in employment and long waiting lists for scant childcare options. The cost of a private abortion is more than a month’s salary for those on minimum wage.

O’Neil reflects on how abortion rights in Turkey contrast with her native US. “On one hand, it’s amazing in this country that abortion’s legal, not an election issue and potentially free. Yet it’s horrible you cannot attain your rights just because you might not have the money. The ideal environment is when women can make these choices for themselves, when it’s not the social environment, or the political environment or the economic environment making the choice for them.”

With local elections on the horizon, the government has offered no plans to encourage doctors to allow women to exercise their reproductive rights. Instead, it is supporting a motion put forward by men to end ongoing divorce support payments (alimony), after some argued that it leaves them with a lifelong commitment that is challenging to meet.

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About Author

Barney Cullum is a freelance journalist. His reporting features in New Internationalist and Open Democracy.

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