Fertility rate and child health indicators in Turkey

The fertility rate in Turkey has been steadily declining in recent years. According to TUIK data, the fertility rate, which was 2.38 in 2001, fell to 1.51 in 2023.

These rates, which President Recep Tayyip Erdoğan finds “alarming,” are an indication that his call to have 3 children has not found much resonance in society. Moreover, these rates become even more striking when considering that family planning efforts are not being carried out as they should be. So much so that this decline in the fertility rate, which poses a threat to Turkey's population balance, has been discussed for months as creating a danger of the population being equalized by immigrants and refugees. Recent statistics support this concern. The birth rate among Syrian immigrants in our country is nearly 4 times higher. Even worse, 15 out of every 100 pregnant women are children. 

THEY ARE BORN AND GROWING, BUT HOW?

With the fertility rate at this level, it is essential to look at the data presented regarding the health status, living conditions, and future of the babies born. Ensuring that babies who are brought into the world healthy can survive their first five years remains one of the most important problems in our country. 

This is precisely why pediatricians, as well as obstetricians and gynecologists, take every opportunity to point out: “One of the most important indicators determining the level of development of a country is the maternal-infant mortality rate!” 

We need to forget the commonly used saying “they are born and grow up” and instead ask, “How many of the children born get the chance to grow up healthy?” and “How many of them can survive the first 5 years of life?” 

WE ARE NOT AT THE DESIRED LEVEL IN INDICATORS

The “Status of Child Health in Turkey 2024” Report by the Public Health Specialists Association (HASUDER) covers all data from the last few years regarding being a child in Turkey. 

The report, prepared by volunteer members of the association's Child-Adolescent-School Health Working Group, serves as a “situation assessment” in many areas, from the nutritional, livelihood, and housing problems of children in Turkey to the criminal incidents they are involved in. Experts evaluating the presented data report the current situation in many parameters as “below the desired level or far below the desired level.” 

According to the “Status of Child Health in Turkey 2024” Report, prepared between January and April 2024, the crude birth rate was determined to be 12.9 in 2021 and 12.2 in 2022. The total fertility rate, which was 2.38 in 2001, also showed a decrease over the years, falling to 1.62 in 2022. 

Prof. Dr. Ferdane Oğuzöncül, a faculty member at Arel University Faculty of Medicine, Department of Public Health, and the manager of the group that prepared the report, summarizes the situation reflected in the reports on childhood in Turkey as follows: 

“The number of infant deaths, which was 10 thousand 89 in 2021, was 9 thousand 522 in 2022. The infant mortality rate, which is one of the most important child health indicators and is expressed as infant deaths per thousand live births, fell from 13.9 per thousand in 2009 to 9.2 in 2022. The goal of reducing infant and child mortality, which are the most important indicators of child health and are also included in the United Nations Sustainable Development Goals, has been included in all development plans, and efforts have been made to achieve it. However, despite the decrease, the desired level has not been reached.” 

WE ARE 122ND IN UNDER-5 MORTALITY RATE

The report states that the under-five mortality rate was calculated as 11.2 in 2022, compared to 17.7 per thousand in 2009. Stating that we are not yet at the desired level in the under-5 mortality rate, Prof. Dr. Ferdane Oğuzöncül shares the information: “According to 2020 data, Turkey ranks 122nd out of 188 countries in the under-five mortality rate ranking. This rate is approximately 5 times the data of the country in first place.” 

Emphasizing that the adolescent fertility rate is one of the most important indicators of child health in the context of children's rights, it is stated that “the adolescent fertility rate, defined as the average number of live-born children per thousand women in the 15-19 age group, was 12 per thousand in 2022.” It is added that the infant mortality rate, which is one of the most important child health indicators and is expressed as infant deaths per thousand live births, was determined to be 9.2 in 2022. 

INJURIES AND POISONINGS ARE THE LEADING CAUSES OF DEATH

When death cause statistics are examined, it is reported that the leading cause of death among children aged 1-17 in 2021 was external injuries and poisonings, followed by deaths due to diseases of the nervous system and sensory organs, deaths due to benign and malignant tumors, and deaths due to diseases of the circulatory system. 

NUMBER OF CHILD LABORERS INCREASED BY 101 THOUSAND IN 1 YEAR

Another issue that draws attention in the report is the increase observed in the number of working children. It is stated that 79.7 percent of working children are in the 15-17 age group, 15.9 percent are in the 12-14 age group, and 4.4 percent are in the 5-11 age group. 

According to 2022 statistics, the poverty rate in Turkey is 32.6 percent. However, most importantly, children are reported as the largest poor group, accounting for 42.7 percent of this rate.  

In the Ministry of Labor and Social Security's 2022 activity report, it is reported that the number of children working between the ages of 15-17 reached 620 thousand in 2022, an increase of 101 thousand compared to 2021, meaning the number of working children increased by approximately 20 percent annually. Although those under 18 are considered children in the Convention on the Rights of the Child, according to the Labor Law in Turkey, children who have completed the age of 15 but have not completed the age of 18 are considered “young workers.” According to TUIK's 2022 data, the labor force participation rate of children only in the 15-17 age group was 18.7 percent. While 520 thousand children were working in 2021, this number rose to 619 thousand in 2022. 

Prof. Dr. Ferdane Oğuzöncül points to the importance of the issue by saying, “The fact that the number of children working only between the ages of 15-17 increased by 101 thousand in one year shows that many children have entered working life to provide economic assistance to their families as poverty deepens. Earthquakes, the pandemic, and inflation have negatively affected Turkey's efforts to end child labor.”  

TECHNOLOGY USE INCREASES THE RISK OF ADDICTION

Pointing to the increases in mobile phone / smartphone usage rates, the report states, “While this rate was 24.3 percent in 2013, it increased to 64.4 percent in 2021. It has been observed that this rate also increased in the 6-10 age group and the 11-15 age group. It is clear that this increase in internet, computer, and mobile phone usage will also lead to an increase in behavioral addictions. However, there is no study or database system for the detection and monitoring of behavioral addictions on a national scale.” 

NUMBER OF CHILDREN DRAGGED INTO CRIME INCREASED 2 FOLD

The HASUDER report emphasizes that although there has been no significant change in the 0-17 age population between 2013-2022, the number of children who came or were brought to security units has increased 2.2 times. It is reported that the number of children among these who were dragged into crime has increased 1.8 times, and the number of children accused of using or purchasing drugs or stimulants has also shown an upward trend in the last 2 years.

The report also points out that the data in our country regarding substance use does not reflect the social situation, nor can it track the current situation.