The Politics of the Female Body in Contemporary Turkey

Reproduction, Maternity, Sexuality

Hilal Alkan, Ayse Dayi, Sezin Topçu, Betül Yarar, Hilal Alkan, Ayse Dayi, Sezin Topçu, Betül Yarar

• Publisher: I.B. Tauris
• Year: 2021
• Print ISBN: 9780755642748
• eBook ISBN: 9780755617418
• Edition: 1
• Topic: Política y relaciones internacionales
• Subtopic: Políticas de Oriente Medio

In Turkey, the Justice and Development Party government has introduced new regulations about reproductive rights, and shifted family and gender policies. Women's central role in reproductive and domestic work was swiftly reaffirmed, and abortion and IVF were newly debated. Taking Turkey as the case study, this is the first book to examine the various ways neoliberal modes of governing women's bodies interact with conservative and authoritarian measures. The contributions focus on reproduction, maternity and sexuality, to explore the three main areas of governmental interventions into the female body. Topics for discussion include: the expansion of IVF and egg markets, the privatization of gynaecological and obstetrical care, differential treatment of poor and ethnic minority women's fertility/sexuality, and women's multiple responses to these shifts. While focusing on Turkey, the book presents analytical tools applicable under rising authoritarianisms and conservatisms worldwide.

Part One

Governing the reproductive body: Emerging markets and contested moralities

1

Neoliberal Health Restructuring, Rising Conservatism and Reproductive Rights in Turkey: Continuities and Changes in Rights Violations

Ayşe Dayı and Eylem Karakaya

Neoliberal health restructuring in Turkey

In the latest stage of neoliberalism, termed the debt economy by Maurice Lazzarato (2012), finance dominates every sector of the economy and society, from housing, education and health, to public services. Through mechanisms such as privatization and the imposition by banks and rating and investment agencies of interest rates, and of ‘appropriate rates’ for unemployment wages, pensions, public services and the rates of public debt for governments and municipalities, the public sector (including the welfare state) is completely dismantled, privatized, public debt is created and the role of the state is turned into a regulator of services that is itself bound to credit and debt mechanisms.

Lazzarato (2012: 10) writes that ‘the neoliberal power bloc cannot and does not want to “regulate” the excesses of finance but seeks to follow through on a program it has been fantasizing since the 1970s: reduce wages to a minimum, cut social services so that the Welfare State is made to serve its new “beneficiaries” – business and the rich – and privatize everything’. Assaults on welfare systems include the restructuring of healthcare. This is seen in the latest case of Greece (Europe Solidarity Declaration 2013) as well as in the global emergence of a ‘health reform epidemic’ (Klein 1993), or, in World Bank discourse, of Health Sector Reforms (HSRs). These are reforms undertaken in the late 1980s to early 1990s in ‘developing’ countries such as Brazil, Mexico, South Korea and Taiwan, always under the rationale of a ‘healthcare crisis’ and framed in terms of efficiency and cost while the public sector is denigrated as corrupt and inefficient, and markets are seen as a panacea to many problems (Ağartan 2012). The AKP’s ‘Health Transformation Program’, launched in Turkey in 2003, also outlined an agenda to ‘improve governance, efficiency, user and provider satisfaction, and the long-term fiscal sustainability of the healthcare system’, and is part of this global neoliberal trend. As in these other geographies, the latest Turkish health reform also originated in the late 1980s and took shape within the Ministry of Health as a result of reports prepared by public health academics from Harvard and Johns Hopkins and in consultation with World Bank advisers (Keyder 2007).

Turkish health reform shares many of the characteristics of neoliberal global health reforms such as financial reform, managerial reform, changes in service provision, decentralization and the quantification of services over quality of care in the name of ‘cost reduction’ and ‘efficiency’. Changes in healthcare provision and financing, which specifically relate to sexual and reproductive health, include the closing down of the AÇSAP (Mother-Child Health and Family Planning) Directory that had specialized in reproductive health provision in primary care, the introduction of the ‘family physicians system’ the implementation of a performance system for healthcare that comprises abortion, prenatal follow-ups, births and the digitalization of health data.

In the new system, former ‘health centres’ (sağlık ocağı) and AÇSAP centres were replaced with family health centres (FHC) and ‘community health centres’ (toplum sağlık merkezi) at the primary level. Family physicians, the intended ‘gatekeepers’ of the system, would provide preventative care and refer patients to a secondary level for specialized care. Different from the previous system, the family physician system brought on a form of semi-privatized care, which added to the ongoing privatization of care. The family physicians work as contract workers who contract midwives and nurses for a period of two years, with their wages based on the capitation set by the socio-economic development of their region. The salaries of physicians, midwives and nurses are subject to performance criteria and can be cut by up to 20 per cent when they fail to reach their targets. Instead of serving a geographic area (as previously done), FHCs serve the population who register under them. Physicians compete with one another to keep their clientele and to keep patients that have less chronic problems.

Rise of neoconservatism and sexual-reproductive rights

Alongside neoliberal policies, there has also been a rise in neoconservatism under the AKP regime. Initially calling itself a moderate Islamic regime, the social policies of the AKP can be best described as ‘an amalgam of neoliberalism with social conservatism’ (Buğra and Keyder 2006: 3) and have at their centre, anti-women, and at times misogynist discourses, policies and implementations that reposition women in familial roles thereby overturning decades of gain by feminist movements in Turkey towards the recognition of women as individuals and citizens in their own right (Acar and Altunok 2013). In the realm of sexual and reproductive health, these anti-women discourses and policies include the reigniting of the abortion debate with signals to change the existing law on abortion, and the promotion of a pronatalist policy.

During the March 8 celebrations in 2008, then–Prime Minister Erdoğan announced the government’s plans to introduce financial incentives for births, which, from 2009 onwards, quickly turned into a formulation of three children per family (i.e. per women). The initial sign of this shift of policy – from the anti-natalist stance upheld since the 1960s, to a pronatalist one – can be found in the government's attempt in 2003 to re-draft the Law on the Rights of the Disabled, to bring restrictions to abortions conducted after ten weeks, that had been previously allowed for the medical reason of foetal disability (Acar and Altunok 2013). Due to objections by women’s organizations, medical associations and media, the proposed article was removed from the draft. Yet in May 2012, Erdoğan made a statement during the closing session of the Parliamentarians’ Conference of the UNFPA in Istanbul, saying that abortion was mass murder (referencing the killing of thirty-four Kurdish citizens in Uludere for which his government had been critiqued). He later included caesarean section procedures as murders, declaring both to be ‘secret plots designed to stall Turkey’s economic growth and a conspiracy to wipe the Turkish nation from the world stage’ (Hürriyet Daily News 2012).

Erdoğan’s remarks on abortion were met with criticism from opposition parties and his own Minister of Family and Social Policy, and elicited a strong reaction from the feminist movement in Turkey who under the slogan ‘abortion is a right and a woman’s decision’, organized protests in multiple cities. The ‘Abortion Is a Right and a Woman’s Decision Platform’ was formed and the status of abortion care began to be monitored via research done by Mor Çatı-Purple Roof Women’s Shelter (2015) and Kadir Has University (2016). All of these efforts were successful in preventing a change in the abortion law. However, as seen in this chapter too, the neoconservative discourse and pressure from state officials, combined with the neoliberal mechanisms of assigning low performance points for abortion procedures, led to a serious decline in abortion services in Turkey.

In previous articles (Dayı and Karakaya 2018; Dayı 2019), we discussed in detail the effects of neoliberal health restructuring and conservatism on women’s sexual and reproductive care and rights from the perspective of FHC workers. We showed how neoliberal mechanisms (i.e. the dismantling of the public through market and bureaucratic mechanisms) and conservative pressure on providers led to: (1) the indebtedness of women through out-of-pocket payments for private contraceptive and abortion care; (2) the indebtedness of physicians, nurses and midwives to the state through salary cuts from missed performance targets (and the use of fraud to avoid missed targets); (3) a reduction in the quality of existing reproductive care (such as prenatal follow-ups) and (4) a reduction in access to reproductive care itself (namely contraception, sexual and reproductive counselling, and abortion). Dayi (2019) discusses how neoliberal mechanisms used in tandem with conservative discourse can erode, as in Turkey, the right to abortion and contraception without changing the abortion law or official policies on contraception themselves.

In this chapter, using women’s own narratives, we investigate sexual and reproductive rights violations in contemporary Turkey, in the areas of abortion, birth control, birth and routine gynaecological care. We specifically focus on: (a) the continuities in rights violations (prior to health restructuring), (b) the augmentation of certain rights violations that accompanied this neoliberal health restructuring that is coupled with conservative discourse and policies (including the new pronatalist policy) and (c) the new rights violations that came into being as a result of neoliberal policies and conservative pressure. In doing so, we aim to contribute to existing literature on feminist political economy, especially in terms of the research and activism that transnationally connect neoliberal health restructuring and women’s sexual and reproductive care and rights. We aim to make visible the direct and indirect effects of neoliberal reforms that are used in conjunction with conservative pressures on these rights and on women’s bodies, the topic of this edited collection. Even though lesbian women’s invisibility in gynaecological care emerged as a topic as brought up by one self-identified lesbian participant and by the Family Health Center staff, our sample is predominantly composed of heterosexual ciswomen. Thus, the paper is on the rights violations of mainly heterosexual ciswomen, with implications for lesbian, bisexual and trans individuals who utilize gynaecological care, sexual counselling, birth control and abortion as needed. While reproductive politics is a sexual-gender-class-race-ethnicity based issue and has been analysed as such in the feminist literature, a newer trend added to the analysis is that of queering reproduction. This is seen in the attempts to queer bioethics (Richie 2016) and to queer abortion, the latter of which emerges directly from the movement side, in working of LGBTI+ and feminist movements as in the United States (Thomsen and Tacchera Morrison 2020) and Argentina (Sutton and Borland 2018) for example, to widen the definition of abortion – which is seen typically as a heterosexual and feminist and not LGBTI+ movement issue – to include lesbian and bisexual women and trans men as possible users of abortion care alongside heterosexual women and to bring LGBTI+ and feminist movements together in reproductive rights struggles. These, we believe are hopeful emergences. Future work on neoliberalism and women’s sexual and reproductive rights in Turkey could take up heterosexual and LGBTI+ people’s access to services and rights together, engage with queer theory and present a more holistic picture then does our present study at the moment. Before discussing our methodology and findings, a brief section on sexual and reproductive health rights in Turkey will help to better contextualize the findings.

Sexual and reproductive rights in Turkey

Sexual and reproductive rights in Turkey, especially those that relate to gynaecological, contraception and abortion care, and sexual-reproductive counselling, which are the main focus of this chapter, are protected through the laws on contraception and abortion (law on population planning and related laws and regulations), the constitutional right to healthcare, through regulations on patient rights and through international aggrements, such as the International Conference on Population and Development (ICPD) Programme of Action, UN Sustainable Development Goals: SDGs, and the Convention on the Elimination of All Forms of Discrimination against Women: CEDAW, to all of which Turkey is a signatory.

The history of reproductive law in Turkey follows a trajectory that parallels global trends, dating back to the late nineteenth century, the period of modernization in the Ottoman Empire, when abortion moved from the religious to legal domain and became codified in law under the 1858 Criminal Law. As in Europe and in the United States, pronatalist laws and policies were prioritized in the aftermath of wars and during the formation of the nation-state (late Ottoman period to early years of the Turkish Republic). This was followed by the legalization of contraception and therapeutic abortions in 1965, which was parallel to the international shift in population policies whereby population growth was seen as a hindrance to economic development. As a result of the global feminist debates on abortion that reached Turkey, the lobbying efforts of the Turkish Medical Association, the Turkish Family Planning Association and the Turkish Gynaecological Association, and the publicizing of public health studies that revealed the effects of unsafe abortions on women (including maternal mortality), abortion on demand (up to ten weeks of pregnancy) was legalized in 1983 with the revision of the 1965 ‘Law on Population Planning’. The law requires the written consent of the husband of a married woman seeking an abortion, and parental consent from minors. According to the regulations in place, in addition to obstetrician-gynaecologists (ob-gyns), the general practitioners who receive training can also perform abortions under the supervision of an ob-gyn. In the case of rape, women can obtain abortions up to twenty weeks.

As discussed in a previous article by Dayı (2019), and more in depth in Erkaya Balsoy’s (2015) and Akşit’s (2010) works, reproductive law in Turkey has been introduced and framed in the context of a population planning approach which instrumentalizes women’s bodies and sexuality. The actual name of the law legalizing both contraception and abortion is the ‘Law on Population Planning’, where, while the individual right to determine the number and spacing of children is recognized, the state is defined as the agent responsible of taking necessary steps to ‘provide education and the implementation of population planning’. While this population control agenda continued as the governing legal framework, the years 1965–2009 saw more of a family planning approach, which evolved in the 1990s (at least in reproductive policies) to include a ‘women’s rights’ approach. This was due to Turkey’s support for the international documents that emphasized women’s sexual and reproductive rights as human rights, which included the International Conference on Population and Development (ICPD) Programme of Action, UN Sustainable Development Goals (SDGs) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), that Turkey ratified in 1985. For each of these agreements there is a monitoring and reporting procedure that the Turkish state needs to complete periodically, and each is monitored by independent women’s organizations and platforms in Turkey that produce shadow reports.

Under the ICPD Programme of Action, states are expected to take all necessary measures to secure access to healthcare, including sexual and reproductive healthcare, and to take into consideration gender equality and women’s autonomy in decision making in sexual and reproductive health matters when developing reproductive health programs and population-related programs. The UN Sustainable Development Goal on gender equality (Goal 5.6) also includes stipulations for the granting of universal access to sexual and reproductive care, including abortion access, stating that governments should not limit access to abortion on cultural or religious grounds. Additionally, CEDAW requires governments to attain gender equality in healthcare, including in family planning services (art. 12) and to secure adequate access for rural women on family planning counselling and methods (art. 14(b)). In CEDAW General Recommendation no. 35, the denial or delay of safe abortions and the forced continuation of pregnancy are considered gender-based violence (Item 18).

In terms of constitutional protections, sexual and reproductive rights are protected under the right to health, which includes the right to access healthcare and the...

Table of contents

• Cover
• Halftitle Page
• Title Page
• Dedication Page
• Contents 
• Illustrations
• Contributors and Editors
• Acknowledgements
• Introduction: Changing Regimes of Governing Women’s Bodies in Contemporary Turkey
• Part 1: Governing the reproductive body: Emerging markets and contested moralities
• Part 2: Governing the maternal body: Between biomedical power and neoliberal healthcare
• Part 3: Governing the sexualized body: Neoconservatism, authoritarianism and counter strategies
• Index
• Imprint