Inequalities in Reproductive, Maternal, Newborn, and Child Health in Turkey: An Analysis of the Demographic and Health Survey Series
Abstract
Objective: This study aimed to examine trends in health inequalities by place of residence and household welfare using data from the Turkey Demographic and Health Survey.
Methods: Absolute and relative inequalities were calculated using the methods recommended in the WHO Health Inequality Monitoring Handbook, which focuses on low- and middle-income countries. Absolute inequality is the difference between the two subgroups and relative inequality is the ratio between the two subgroups. Inequalities in the field of child, reproductive, and women's health were measured using simple measurement methods recommended in the WHO Health Inequality Monitoring Handbook. To examine changes in health inequalities across household welfare levels and rural-urban residence, we used data from the 2008, 2013, and 2018 Turkey Demographic and Health Surveys.
Results: Living in rural and low-income areas has been found to be predominantly disadvantaged. Increased inequality in child vaccination and the use of modern contraceptive methods has been seen by wealth level. Increases in inequality were found in indicators such as adolescent pregnancy, violence against women, years of education for women, and low birth weight, both by wealth level and by residence. However, inequalities in prenatal and postnatal care and the percentage of children receiving all basic vaccinations by residence have decreased, and rural areas have even become more advantaged.
Conclusion: Policies targeting rural areas and low levels of welfare are needed to reduce health inequalities. While addressing disadvantaged groups to reduce inequalities is necessary, urban areas are at higher risk for childhood obesity and exclusive breastfeeding. Interestingly, these groups have higher wealth levels and should be selected as the target group for intervention. The findings suggest that the programs implemented in our country are effective in reducing inequalities in some indicators.
Keywords
health inequality absolute inequality relative inequality maternal health newborn health child health
Ethical Statement
Permission was received from Uludağ University Faculty of Medicine Clinical Research Ethics Committee with the board decision dated 18.09.2019 and numbered 2019-15/20
References
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- 17. Hacettepe University Institute of Population Studies (2014), “2013 Turkey Demographic and Health Survey”. Hacettepe University Institute of Population Studies, T.R. Ministry of Development And TÜBİTAK, Ankara, Turkey.
- 18. Hacettepe University Institute of Population Studies (2019). 2018 Turkey Demographic and Health Survey. Hacettepe University Institute of Population Studies, T.R. Presidency of Turkey Directorate of Strategy and Budget and TÜBİTAK, Ankara, Turkey. Hacettepe University Institute of Population Studies, Presidency of Turkey Directorate of Strategy and Budget. 2019.
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- 21. Hosseinpoor AR, Bergen N, Schlotheuber A. WHO | State of Inequality: Reproductive, Maternal, Newborn and Child Health. WHO, 2015.
- 22. WHO | State of health inequality: Indonesia. 2017, Geneva, Switzerland, World Health Organization, p.176.
- 23. Murray CJ, Gakidou EE, Frenk J. Health inequalities and social group differences: what should we measure? Bull World Health Organ. 1999;77(7):537-543.
- 24. Pearce A, Dundas R, Whitehead M, Taylor-Robinson D. Pathways to inequalities in child health. Arch Dis Child. 2019;104(10):998-1003. doi:10.1136/archdischild-2018- 314808
- 25. Voronezhskyi K, Ostapenko I, Gushcha D, Sergiienko L, Holobutska N. Health and society: disparities in access to healthcare services. Sal Cienc Tec. 2025; 5:1188. doi:10.56294/saludcyt20251188
Türkiye'de Üreme, Anne, Yenidoğan ve Çocuk Sağlığı Alanında Eşitsizlikler: Türkiye Nüfus ve Sağlık Araştırması Serisinin Bir Analizi
Abstract
Amaç: Çalışmamızın amacı, Türkiye Nüfus ve Sağlık Araştırması (TNSA) verilerini kullanarak yerleşim yeri ve refah düzeyine göre sağlık alanında eşitsizliklerin varlığı ve değişimini incelemektir. Yöntem: Mutlak eşitsizlik ve göreceli eşitsizlik, özellikle düşük ve orta gelirli ülkelere odaklanan “WHO health inequality monitoring book” kullanılarak hesaplandı. Mutlak eşitsizlik iki alt grup arasındaki fark, göreli eşitsizlik ise iki alt grup arasındaki oran formülü kullanılarak hesaplandı. Çocuk, üreme ve kadın sağlığı alanındaki eşitsizlikler, “WHO Health Inequality Monitoring Book” ta önerilen basit ölçüm yöntemleri kullanılarak ölçüldü. Çalışmamızın amacı hanehalki refah düzeyi ve kırsal-kentsel farklılıklara göre sağlık eşitsizliklerinin değişimini incelemek olduğundan, bu verileri sağlayan 2008, 2013 ve 2018 TNSA verileri kullanıldı.
Bulgular: Kırsal alanlarda ve düşük refah düzeylerinde yaşamanın çoğunlukla dezavantajlı olduğu görülmüştür. Refah düzeyine göre, çocukların aşılanması ve modern doğum kontrol yöntemlerinin kullanımında eşitsizlikte artış tespit edilmiştir. Adölesan gebelik, kadına yönelik şiddet, kadınların eğitim süresi ve düşük doğum ağırlığı gibi göstergelerde hem refah düzeyine hem de yerleşim yerine göre eşitsizlikte artışlar tespit edilmiştir. Bununla birlikte, doğum öncesi ve sonrası bakım ve tüm temel aşıları olan çocukların yüzdesinde yerleşim yerine göre eşitsizlikler azalmış, hatta kırsal alan daha avantajlı duruma geçmiştir..
Sonuç: Sağlık eşitsizliklerini azaltmak için kırsal kesimleri ve düşük refah seviyelerini hedefleyen politikalara ihtiyaç vardır. Eşitsizlikleri azaltmak için dezavantajlı gruplara yönelmek gerekse de, çocuklarda obezite ve sadece anne sütüyle beslenme açısından riskli gruplar kentte yaşamaktadır. İlginçtir ki, bu grupların refah düzeyleri yüksektir. Müdahale için hedef grup olarak seçilmelidir. Ülkemizde uygulanan programların bazı göstergelerdeki eşitsizlikleri azaltmada etkili olduğu söylenebilir.
Keywords
sağlıkta eşitsizlik mutlak eşitsizlik göreceli eşitsizlik anne sağlığı yenidoğan sağlığı çocuk sağlığı
Ethical Statement
Uludağ Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu'nun 18.09.2019 tarih ve 2019-15/20 sayılı kararıyla izin alınmıştır.
References
- 1.Wyatt R, Laderman M, Botwinick L, Mate K, Whittington J. Achieving Health Equity: A Guide for Health Care Organizations. (Roessner J, Weber V, eds.). Cambridge, Massachusetts: Institute for Healthcare Improvement; 2016.
- 2. World Health Organization. Constitution of the World Health Organization. 1946. Bull World Health Organ. 2002;80(12):983-984.
- 3. International Conference on Primary Health Care. Declaration of Alma-Ata. WHO Chron. 1978;32(11):428- 430.
- 4. WHO. Declaration of Astana. In: Declaration of Astana. From Alma-Ata towards universal health coverage and the Sustainable Development Goals. Astana; 2018.
- 5. Rosa W, ed. Transforming our world: the 2030 agenda for sustainable development. In: A New Era in Global Health. Springer Publishing Company; 2017. doi:10.1891/9780826190123.ap02 Paslıoğlu and Özdemir/ CMJ.2025;47(4):3-12. 12
- 6. Hosseinpoor AR, Bergen N, Lee JH, et al. Handbook on Health Inequality Monitoring: With a Special Focus on Low- and Middle-Income Countries. WHO, 2013.
- 7. Hosseinpoor AR, Nambiar D, Schlotheuber A. Monitoring health inequality in Indonesia. Glob Health Action. 2018;11(sup1):3-6. doi:10.1080/16549716.2018.1475041
- 8. Explorations of Inequality: Childhood Immunization, World Health Organization; 2018.
- 9. Centers for Disease Control and Prevention. CDC Health Disparities and Inequalities Report - United States, 2013. MMWR Suppl. 2013;62(3):3-5.
- 10. Public Health England. Health Equity Report, Focus on Ethnicity. PHE publications; 2017.
- 11. Arno CA. Health Equity Report: District of Columbia 2018. Government of the District of Columbia; 2018.
- 12. World Health Organization & World Bank. (2023). Tracking Universal Health Coverage: 2023 Global Monitoring Report. https://iris.who.int/server/api/core/bitstreams/3d4572d 2-30a5-4cf0-bf73-0062d677bbf0/content
- 13. Brumana L, Carvajal-Vélez L, González M, Hauck G, López AA, Terán V. Maternal, Newborn, Child, and Adolescent Health Inequities in Latin America and the Caribbean to Inform Policy Making. United Nations Children’s Fund, UNICEF; 2016.
- 14. Mackenbach JP. Health inequalities in Europe. How does Norway compare? Scand J Public Health. 2019;47(6):666- 671. doi:10.1177/1403494819857036
- 15. Karakuzu B, Sengül S. Türkiye’de Sağlık Eşitsizliğinin Sosyoekonomik Belirleyicileri. Third Sector Social Economic Review. 59(4), 3222-3243.
- 16. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü (2009) Türkiye Nüfus ve Sağlık Araştırması, 2008. Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü, Sağlık Bakanlığı Ana Çocuk Sağlığı ve Aile Planlaması Genel Müdürlüğü, Başbakanlık Devlet Planlama Teşkilatı Müsteşarlığı ve TÜBİTAK, Ankara, Türkiye.
- 17. Hacettepe University Institute of Population Studies (2014), “2013 Turkey Demographic and Health Survey”. Hacettepe University Institute of Population Studies, T.R. Ministry of Development And TÜBİTAK, Ankara, Turkey.
- 18. Hacettepe University Institute of Population Studies (2019). 2018 Turkey Demographic and Health Survey. Hacettepe University Institute of Population Studies, T.R. Presidency of Turkey Directorate of Strategy and Budget and TÜBİTAK, Ankara, Turkey. Hacettepe University Institute of Population Studies, Presidency of Turkey Directorate of Strategy and Budget. 2019.
- 19. WHO | Global Reference List of 100 Core Health Indicators, 2015: Metadata. Accessed June 7, 2020. https://www.who.int/healthinfo/indicators/2015/metad ata/en/
- 20. WHO (2013). Handbook on Health Inequality Monitoring: with a focus on low- and middle-income countries. https://www.who.int/docs/default-source/ghodocuments/health-equity/handbook-on-healthinequality-monitoring/handbook-on-health-inequalitymonitoring.pdf
- 21. Hosseinpoor AR, Bergen N, Schlotheuber A. WHO | State of Inequality: Reproductive, Maternal, Newborn and Child Health. WHO, 2015.
- 22. WHO | State of health inequality: Indonesia. 2017, Geneva, Switzerland, World Health Organization, p.176.
- 23. Murray CJ, Gakidou EE, Frenk J. Health inequalities and social group differences: what should we measure? Bull World Health Organ. 1999;77(7):537-543.
- 24. Pearce A, Dundas R, Whitehead M, Taylor-Robinson D. Pathways to inequalities in child health. Arch Dis Child. 2019;104(10):998-1003. doi:10.1136/archdischild-2018- 314808
- 25. Voronezhskyi K, Ostapenko I, Gushcha D, Sergiienko L, Holobutska N. Health and society: disparities in access to healthcare services. Sal Cienc Tec. 2025; 5:1188. doi:10.56294/saludcyt20251188
Details
| Primary Language | English |
|---|---|
| Subjects | Health and Community Services |
| Journal Section | Research Article |
| Authors | |
| Submission Date | September 19, 2025 |
| Acceptance Date | November 7, 2025 |
| Publication Date | December 31, 2025 |
| Published in Issue | Year 2025 Volume: 47 Issue: 4 |