Servet Ozgur ( Department of Public Health, Faculty of Medicine, Cumhuriyet University, Sivas 58140, Turkey. )
Fertility rates in married women, aged 15 - 44 years, in Yildizeli, were high. Only 86% of the pregnancies resulted in normal delivery, with 50% neonatal mortality, thus reducing the population increase in the area. Similarfindings are seen all over rural areas of Turkey. The mean fertility rates in women, aged 40 - 44 years were similar to those of eastern regions of Turkey. The abortion ratios for 1979-1981 were also identical. Poor socioeconomic conditions and unsatisfactory public health services in the region are the probable cause (JPMA 39 :72, 1989).
Population growth is a major economic problem in Turkey. A U.N. population study published by WHO has included Turkey in regions of high rate of population increase1. Fertility control is the known method of preventing undesired escalation of population. Although pursuing an antinatalist policy since 1965, the fertility rates in Turkey have not been reduced to the described level.
Table I shows the data obtained from a population survey in Turkey in 1983 comparing the total pregnancies with the total live births. The present pilot study was undertaken to establish the fertility rates of all married women aged 15 — 44 years, with the aim to determine the population probims and find their solution.
PATIENTS AND METHODS
A cross sectional survey *as carried out from December 1981 to January 1982 by the Department of Public Health of Curnhuriyet University, to obtain data relating to fertility rates. For economic reasons, the District of Yildizeli, located 20 — 100 km in the west of Sivas, and its 129 villages and 15 areas of settlement were surveyed on a sampling basis. The population of the district in 1980 was 73,235 with 84.8% living in the rural areas. Six hundred households were selected for sampling. Questionnaires were then directed to all the married women aged 15 - 44 to collect the necessary data on the fertility rates and family planning. The data obtained were evaluated and written out on the data coding sheets for computer processing. The preliminary computer outputs obtained were then re-evaluated for statistical analysis.
Only 584 of the 600 households could be interviewed. There were 450 fertile married women (12.2%) in the age group 15 - 44 years with 64.4% illiterate women. Ten infertile women were excluded, Of the total, 445 were recently married, with 19% under 15 years, 69.1% between 15 — 19 years, 10.4% between 20 — 24 years and 1.1% between 25 — 29 years. Thirty three women had no issues, 8 were currently pregnant, 5 had abortions and stillbirths and 3 lived separate from their husbands. Four percent of the 450 women, 4% had their first deliveries during the first year, 52.4% during the second year, 15.1% during the third year, 10.2% during the fourth year and 8.9% during the fifth year.
Table II shows the mean values relating to the fertility rates per age group. It was observed that in all the age groups of the total population, 85% of the pregnancies resulted in live births of which 70% survived. Sixty percent of the pregnancy outcome below the age of 39 and 53% of those in the 40 — 44 age group survived, whereas the others were recorded as abortions, stillbirths and deaths.
Table III presents some demographic rates obtained from six-year pregnancy histories of married women aged 15 — 44. In contrast to a high rate of general fertility, the crude bbth rate was, contrary to expectations, low and the child mortality rate high. In addition, according to the significance test of difference between the two percentages, the total rate of abortions between 1976 and 1977 and 1978 and 1979 and that of spontaneous abortions between 1978 and 1979 showed a statistically significant increase. As for the criminal abortions, the increase was statistically significant between 1976 and 1977 but a significant decrease was noted between 1980 and 1981. (Degree of freedom = 898 and t = 2.220, p<0.05; t=2.663, p<0.002; t=3.054, p<0.01; t = 2308, p <0.05; t = 3.438, p <0.01, respectively).
In the 15 - 44 age group the mean number of pregnancies in Yildizeli was lower than that of Ulas and eastern Turkey and higher than that of Turkey in general but similar to that of rural regions. The live birth mean in Yildizeli was similar to that of Ulas and rural regions of Turkey, higher than that of Turkey in general but lower than that of eastern Turkey. As for the number of children surviving in Yildizeli, this was lower than that of Ulas, rural regions and eastern provinces of Turkey but similar to that of Turkey in general2,3. On completion of the study a comparison was done between the number of pregnancies, livebirths and surviving children in Yildizeli, Ulas, eastern Turkey and entire Turkey. In the 40 — 44 age group, the pregnancy outcome in Yildizeli were higher than those of Ulas, rural regions and Turkey in general but lower than those of eastern Anatolia. In evaluating the number of live births in the pilot region, the Ulas Research Center was divided into two subgroups as the Kayadibi-Koyuncu and Ulas Stations. It was consequently observed that live births in Yildizeli corresponded to those of the Kayadibi.KOyuflcu Subgroup and eastern Anatolia whereas exceeded those of Ulas Subgroup, rural regions and Turkey in genera!. The number of children surviving was similar to that of Ulas and rural regions, higher than that of Turkey in general but lower than that of eastern Anatolia2,3. The statistics of abortions per year were obtained from histories dating back to three years. No information could be obtained except of criminal abortions for the last year of the research. As for other abortions, no statistically significant difference was found. The data on the total number of abortions, induced and spontaneous, were in conformity with those of rural Turkey, developing provinces and the eastern Anatolian region1,4,5. The high rate of infant mortality established seemed to result from the women’s consideration of all children as infants dying in the first year. It was concluded that married women in the pilot region had a low educational level and lived in poor socioeconomic conditions. They generally experienced ten pregnancies by 40 - 44 years suffering 4 . 5 losses. This clearly indicates the prevalence of a serious maternal and child health problem in the region. It also suggests that a solution contributing towards the survival of infants should be found if a lasting family planning or an effective reduced fertility rate is desired to be realized.
I am indebted to the WHO Collaborating Center, Etimesgut, Ankara, Turkey for financing this preliminary pilot survey, Prof. Dr. Nushet H. Fisek for his guidance and Mr. S. Torel, M. A. for his help in the preparation of the English text of this manuscript.
1. WHO. World demographic trends. The Impact of Demographic Trends on Health, World Health Stat. Q., 1987; 40r6.
2. Hacettepe University Institute of Population Studies: 1983 Turkish Population and Health Survey. Ankara, Turkey, 1987; 66:43, 45, 51,107, 110.
3. Ozgur, S. Ulas alaninda A.P. durumu septama arastirmsi. Doga Tu Tip ye Ecz. D., Ankara, 1987; lh383.
4. Ozgur, S. and Kocoglu, F. Ulas Egitim Arastirma Bolgesi Calisma Raporu (1985-1986). Cu Tip Fakultesi Hulk Sagligi Anabilim Dali, Sivas, Turkey, 1987 :p. 3.
5. Bulut, A. Qubuk Merkez Saglik Ocagi Bolgesinde Dusukler in Incelenmesi, Uzmanlik Tezi, Ankara, 1979.