CHP's Şahbaz: 'Childbirth is a medical condition; the decision on how to give birth belongs to the woman and her doctor'

CHP Deputy Chair responsible for the Ministry of Health, Zeliha Aksaz Şahbaz, issued a written statement regarding the recent, highly controversial debate over cesarean sections, which gained prominence following a banner displayed at a football match.

Şahbaz stated the following:

"Trying to create social awareness by handing football players a banner that reads 'The Natural Way is Normal Birth' in a stadium filled with thousands of men is exactly the kind of act one would expect from the AKP government. This practice is an expression of an archaic, patriarchal mentality that seeks to exert control over women's bodies, where men decide what women wear, how many children they have, and how they give birth.

We invite the Ministry of Health to carefully examine the change in cesarean and normal vaginal birth rates. When we look at the changes over the years, we see that while the cesarean section rate was 21% in 2001, it rose to 43% in 2010 and 61.5% in 2023 with the Health Transformation Program. Meanwhile, the cesarean section rate in private hospitals in 2023 was 78.1%.

Cesarean section rates are very high in our country, but a solution cannot be found by questioning the reasons without addressing them, by labeling women as 'failed mothers' simply because they had a cesarean section, by handing banners reading 'The Natural Way is Normal Birth' to male football players in stadiums filled with thousands of men to exert social pressure, or by punishing doctors.

Let us look at the point reached in women's health under AKP's health policies over the years; as a first act, Family Planning centers, which are extremely important for women's health, were closed. Birth control pills, condoms, and intrauterine device applications, which were distributed free of charge in these centers and health clinics, have become inaccessible.

With the Health Transformation Program, midwives were removed from primary healthcare services. The number of midwives who used to work in almost every health clinic, taught birth control methods, inserted IUDs, followed up on pregnant women, and managed blood pressure and vaccination programs has dwindled to almost nothing.

There are no midwife positions in Family Health Centers. First and foremost, pregnant women are now deprived of the follow-up, psychological, and medical support of midwives before birth. Almost all prenatal follow-ups are carried out in hospitals to the extent that they can be accessed. This causes pregnant women to enter the process without overcoming their fears, without receiving the necessary medical information and psychological support—that is, without being prepared for birth—which leads to an increase in cesarean section rates.

Normal vaginal birth requires clinics and hospitals with strong infrastructure that provide 24-hour emergency birth services with experienced midwives and obstetricians. The equivalent of this is the Maternity and Children's Hospitals, which have a hundred-year history, are found in almost every province in our country, and have strong staff with experienced midwives and specialist doctors. These hospitals were closed with the Health Transformation Program. For example, the Bakırköy Maternity and Children's Diseases Training and Research Hospital in the center of Bakırköy was closed and replaced by a shopping mall. In Ankara, Zekai Tahir Burak, Etlik Zübeyde Hanım, Telsizler, Ulucanlar, and in İzmir, Bursa, Kocaeli, Adana, Mersin, Isparta, Eskişehir, Antalya, Manisa, Elazığ, and many other provinces whose names I cannot list, Maternity and Children's Hospitals were closed, and their staff were moved to city hospitals located kilometers away from the city center.

In most hospitals, Obstetrics and Gynecology clinics have been hollowed out and rendered unable to provide birth services. Public health services for childbirth have become inaccessible. The public has been forced to go to private hospitals located in city centers.

Private hospitals are not suitable for monitoring vaginal births for long hours due to their commercial profit expectations, insufficient staff, and inexperienced midwives. Instead of monitoring a birth for hours, the delivery is performed via cesarean section in as little as half an hour.

In both the private and public sectors, doctors prefer cesarean sections because they cannot spare enough time for patients under the pressure of performance targets and heavy workloads.

Meanwhile, patients who are not properly informed and not prepared for birth also prefer cesarean surgery with the understanding of a painless and risk-free birth, wanting to avoid pain and expecting a healthy baby in a short time.

Our obstetricians are the group of physicians most frequently faced with malpractice lawsuits. Due to the pressure of malpractice and compensation claims in the event of even the slightest complication, and the long and exhausting judicial processes, doctors prefer cesarean sections over normal vaginal births. They defend themselves by saying, 'I did everything I could, I performed a cesarean section, but a complication still developed; there was nothing else I could do,' and try to avoid malpractice and compensation penalties.

The health policies of the AKP government, which privatizes health and turns it into a commercial commodity, are the cause, and this increase in cesarean section rates is the result.

The Ministry of Health, which closed maternity homes and maternity hospitals in the country, accuses women of not having normal births. It shares media posts that label women who have cesarean sections as failures. It is not right, nor is it a solution, to try to reduce cesarean section rates by only imposing sanctions on doctors or applying social pressure on women by labeling them as failed mothers without questioning all these reasons and fixing the system.

Childbirth is a medical condition, and a woman and her doctor and midwife will decide together how she will give birth.

We would also like to list our solution proposals:

? Fear of childbirth should be overcome, and the patient should be prepared for birth by providing education, medical, and psychological support through close follow-up by midwives who will work in primary Family Health Centers before birth.

? Maternity and Children's Hospitals, with strong expert staff consisting of experienced midwives and obstetricians who will perform long-hour birth monitoring and delivery, should be reopened in easily accessible locations. In these hospitals, the hours-long labor process should be able to take place safely with strong infrastructure and experienced, strong staff.

? A legal and economic infrastructure should be created to protect obstetricians against malpractice and multi-million lira compensation lawsuits in the face of complications experienced during the birth process."