Frederic C. Shorter
This paper is concerned with the cultural construction of gender, health perceptions, and contraceptive choice. It focusses on the end-point of the fertility decline in Turkey using a combination of anthropological and demographic approaches. The ethnographies show how reproduction is negotiated by males and females in a working-class population of Istanbul. One important conclusion is that the physical characteristics (male or female) of methods of contraception do not directly reveal whose power dominates negotiations. Male participation in the negotiations appears to work as much in favor of controlled fertility as does women's participation. Thus, the working-class motivations to control fertility were effective without very much empowerment of women. The proposition that women's status, in terms of education and economic activity, must increase to bring about a fertility decline is questioned by the Turkish experience.
Frederic C. Shorter, Professor of Demography, Ataturk Institute (ATA), Bogazici
(Bosphorus) University, 80815 Istanbul.
Zeynep Angin, Graduate Teaching Assistant, Department of Sociology, Colorado State University, Fort Collins, CO 80523, USA. E-mail: email@example.com
Publication source: The Population Council, West Asia and North Africa Region, PO Box 115, Dokki, Cairo, A.R.Egypt. Regional Papers No. 42. Adapted for the Internet. Footnotes that give the complete original narratives in Turkish were deleted. Reproduced with permission. Copyright (c) 1996 Frederic C. Shorter.
- Negotiating Reproduction, Gender, and Love during the Fertility Decline in Turkey
- Organization of the ethnographic work
- Ethnographies of reproduction
Starting from around 1950, the level of total fertility, nationally, declined from 6.7 children to a near-replacement level of fertility by the early 1990s; in some places it did not fall so far yet, but in some others it even went below replacement (State Institute of Statistics, 1995:3-33). (footnote: A replacement level of fertility is the number of children that women must have in order to replace themselves with a next generation of parents. The required average is more than two children in order to cover losses of children by death before they can bear a next generation.)
Thus, Turkey became the first large national population in the geographically-defined Middle East (West Asia and North Africa excepting Israel) to reach such a low level of fertility. Istanbul was always a singular culture in matters of family, households, and reproduction. Since early in the century, fertility was controlled and declined over time, and some other cities had similar histories. (footnote: See Duben and Behar's historical study of Istanbul households from 1880 to 1940 (1991:161-176). Prior to the onset of the generalized national decline, comparative statistics for urban and rural Turkey (the earliest available are 1945) showed total fertility rates for Istanbul and Izmir of 2.4 children, an average of 4.4 for all other urban settlements (greater than 10,000 population), and 7.0 for rural settlements (places under 10,000) (Shorter and Macura, 1982:51).)
When Istanbul (and some other cities) began absorbing massive numbers of migrants from 1950 onwards, the new families they bore and the ones their children created as second-generation migrants set the pace of fertility decline in Turkey. In this paper we pay particular attention to these migrant lines of descent from their origins in Anatolia and the Balkans to the present time.
The macro-demography of the fertility decline and its control thereafter owes its existence to a web of relationships among people that creates numbers as statistical facts, and it is these relationships that we shall investigate in this paper. (footnote: In this, we align ourselves with the spirit of Bourdieu. For him, "the collection and analysis of statistical data is simply the starting point, the sociological constitution of the thing to be explained." (As characterized by Jenkins, 1992: pp 59-62, referencing Distinction, pp 503-518, and Homo Academicus, pp 69-72).)
We shall look at some of the ways in which reproduction, gender, and love, the framework within which two adults pursue their family lives, are constructed by the daily acts and perceptions of individuals. There is a continuous flow of life and practice as they construct and reconstruct, through negotiation, the meanings attached to these things. For example, two people, man and woman, are separately and jointly enmeshed in the conduct of their everyday lives as they come together before marriage, after marriage, and as they produce, nurture, and rear children of the next generation.
Negotiation is a process of using one's own power and knowledge to modify or create meanings for oneself and to influence the meanings that significant others hold. Negotiation as a relationship of power is not limited to speaking and discussing between two people. As Foucault says (1982: p.220), "It is a total structure of actions brought to bear upon possible actions; it incites, it induces, it seduces, it makes easier or more difficult; in the extreme it constrains or forbids absolutely; it is nevertheless always a way of acting upon an acting subject or acting subjects by virtue of their being or being capable of action." Thus, negotiation is the medium through which individuals exercise their will and power. They continuously modify the salient structures within which their own meanings and those of significant others exist. The process of constructing meanings takes place among individuals, couples, older and younger generations of the family, and friends. The meanings interact on each other, since they are not wholly private, but are revealed to others through actions and practices.
Our approach will be recognized by many readers as a form of practice theory. When it
is brought together with the demographic facts, a more culturally attuned interpretation
of fertility -- we prefer to say reproduction -- is reached. (footnote: The theory goal is to
give human agency its central place within, not outside of, the structures of culture.
These structures themselves are subject to additional "insider" molding by such forces as
politics and economics. Classic treatments of the theoretical problem at a high level of
generality may be found in Giddens (1984: pp 1-40), Bourdieu (1990:pp 25-111), and
Unstructured depth interviews are the principal means we use to learn about the flows of conduct and the construction of meanings that are central to our study. The word "conduct" is chosen deliberately to indicate both the leading of others and the choosing of "a way of behaving within a more or less open field of possibilities (Foucault, 1982: pp 220-221)." This double meaning, which exists both in French and English, is more indicative of negotiation than such words as "behavior" or "actions."
In order to show clearly how the conduct of everyday life is monitored selectively and reflexively by individuals and are subject to revision as life is lived and contexts change, we use the device of listening to individuals through quite lengthy segments of their life histories. Ethnographies are used to focus on the daily stream of individual negotiations subject by subject. Birth control is a central subject, because of what it reveals about reproduction, gender, and love. They are all refracted in one way or another through the meanings given to birth control and the actions that individuals take in that domain.
From the perspective of the state, rather than individuals, the way to raise fertility in the early years of the Republic -- which was the policy -- was to withhold contraceptive methods. After the 1960s the policy was to reduce the birth rate and the state attempted to implement this policy by providing medical female methods of contraception. (footnote: The designation of methods as "medical" means that they are obtained from the health system at clinics or pharmacies.)
However, it was individuals not the state that chose what to do. Surveys show that contraception increased from 28 per cent of married women of reproductive age in 1963 (first survey ever held) to 63 per cent in 1993. However, withdrawal was the main method at both the beginning and end (see appendix table for details). This method clearly could not be withheld or provided by the state. Reliable comparative abortion statistics do not exist, though it is believed to have also been important both at the beginning and end of the decline in fertility. (footnote: Dr. Pakize Tarzi, the famous Turkish gynecologist, writes about her visits to villages in the early years of the Republic (1920s and 1930s) where she found self-induced abortions to be widespread (Tarzi, 1992: 38). In our ethnographic work, which included genealogies, we also heard many reports of induced abortions dated before the 1950s. In 1993, 18 percent of reported pregnancies were being aborted according to self-reports of women in a national survey (Hacettepe, 1994: 52-53).)
The principal modification of birth control over this 30-year period is that female contraceptive methods have become more medicalized (IUDs and pills instead of vaginal potions, douches, and blockages). As the medical establishment, including pharmacies, became better equipped to offer methods, there was some uptake. The individuals using these female methods in 1993 are from a different cohort than the individuals who used the now-discarded female methods of 1963. While the passage of time sees a change in female contraception, the new male cohorts are not behaving very differently from their predecessors, as they too rely predominantly on withdrawal.
The main limitation of the state's attempt to manage the fertility decline as a bio- demographic problem was that it focussed only on the expansion of female methods of birth control. It did not understand the ways in which birth control were already culturally situated within the society and individual actions to contracept was motivated.
Among academic economists and sociologists, a broader interpretation of the fertility decline prevailed, saying that Turkey was passing through a classical demographic transition. The prominent demographer and economist, Cem Behar gives his account by setting out a demand-supply model for fertility control. (footnote: We use Behar's writings, because they are the most recent and best articulated examples of demographic theorizing in Turkey.)
Behar summarizes the balance of independent causal variables as follows: "Factors of
demand played a more important role in fertility reduction than those of supply. In other
words, the purely societal and structural factors -- which enhanced women's status,
improved children's health and education, and began to eradicate poverty -- appear to
have created a demand for fertility control (Behar, 1995
On a different level of theorizing, Behar has a very interesting discussion of the role of men (not women) in bringing birth rates down. He says, "The exceptionally high male initiative, responsibility and participation is perhaps the most salient feature of the fertility decision-making and implementation process in Turkey. In 1988, over one-half of contracepting couples with a wife between fifteen and forty-nine years old were using male methods. These were either family planning methods relying exclusively on direct male initiative (withdrawal, condoms), or they were methods requiring male knowledge and/or participation (periodic abstinence, other traditional methods)." (footnote: Behar, 1995: pp 50. Also see Goldberg and Toros (1994).)
Since social-structural reasoning needs decision makers who respond to social changes and act to control fertility, writers such as Behar end up allocating decision powers to different actors. He concludes (p.53), "Turkish husbands seem to expect to take charge of contraception, just as they usually expect to initiate sexual activity," (footnote: Earlier, Santow (1993: pp 782) had reached the same conclusion, referring to populations using coitus interruptus in the Ottoman region, inclusive of Turkey.) One puzzle left by this kind of reasoning is that there is no role here for women -- only a very "traditional" male-dominated family system in the matter of birth control. We accept Behar's work as one way of posing the problematic (how low fertility came to be accepted, in whose interests, and by what means of action), not answering it.
When we first understood that the study of reproduction in Turkey needed an ethnographic approach, where and how to do it became the question. We thought that unstructured in-depth interviews would be a good way to listen to how people perceived their reproduction and to learn what they were doing as actors. We recognized that it might not be possible nor even desirable to claim objectivity or distance when interpreting the results. Nevertheless, we thought that this approach would open our eyes to connections between the wider economic and political structure and the actions of the individuals being interviewed. The process of developing both the data base of interviews and our interpretations would be iterative. We could protect ourselves from mechanistic claims that social change has universal (even within one country) form, timing, or quality. Furthermore, diversity would not be hidden from view when this approach is used.
The ethnographic materials in this paper come from two communities of Istanbul which are distinctively working class. There were 30 life-history types of interviews (some with multiple visits) and approximately 3,000 pages of transcripts which we believe captured rather well the variety of experience and characteristics of working class individuals. The interviewers (one female and one male) each lived in one of the communities as permanent residents. The two research workers interviewed both in their own community and in the community of the other worker in order to obtain a good balance of male and female interviews, some of them referring to both husband and wife. Thus, we chose to do the research not as outsiders, but as research students who are accepted by the local people and can engage in conversation as one of them, though able at the same time to listen, record, and observe with a trained mind. (footnote: Doing anthropology as a native raises questions, but as Clifford (1986: pp 9-10) says, "Insiders studying their own cultures offer new angles of vision and depths of understanding. Their accounts are empowered and restricted in unique ways." We try to achieve the advantages that this suggests. See also, Altorki and El-Solh (1989); Fahim (1982); Ohnuki-Tierney (1984); Nakhleh (1979).)
The two communities characterize different faces of the working class in Istanbul, though they have similarities as well. (footnote: By working class we generally mean low education, usually primary and never more than high school, and occupations that normally earn a very modest living.) Both have high proportions of residents who came to Istanbul as migrants. Household heads are 66 per cent migrants in one community and 97 per cent in the other. In Istanbul as a whole they are 83 per cent. (footnote: Computed from a public use sample of the 1990 census data. For 1970, another sample gives similar results for Istanbul, and for earlier dates other less precise indicators make clear that this has been a long-standing condition of the city.)
There is nothing unique about these high proportions since this has been the character of Istanbul for a long time. Istanbul has been a city with close to, or less than, replacement fertility during this century, so that growth has always had to depend upon migrants. It grows by virtue of migrants who arrive with children not yet born and add whole families (the new generation) to the city. Without this process, Istanbul could not have grown from less than one million in 1950 to nearly eight million by 1985 (Shorter, 1995: 19-20). (footnote: This is not to say that migrants have particularly high fertility. In the late 1980s, it was only one-third higher than the below-replacement "native" fertility of Istanbul (SIS, 1995: p58). Statistically, the children of migrants become part of the "native" group of parents when they marry and start their childbearing.)
The first community was founded in the late 1950s and early 1960s by families who had migrated earlier to Istanbul. By now, a whole new generation of native-born offspring has been added living together with the older inhabitants. The community was based on the model that the state held out for housing new population in the cities as it pursued a policy of industrialization based largely on the vehicle of state economic enterprises. According to state policy of the time, housing should be built according to plan with small gardens, infrastructure, and public facilities such as schools. Such communities could receive financial support (mortgage loans) as worker cooperatives. (footnote: Many such communities were established in Beykoz and elsewhere nationally, most of them for workers, but some were for middle class cadres of the state enterprises and the bureaucracy.)
The Workers' Housing Community, (footnote: Some of the place names, and all personal names, are fictitious replacements made in order to guard against personal identification of individuals.) established by one of the State Economic Enterprises (factories) in Beykoz, thus reflected the policies and aspirations of its time. Its original inhabitants had come to Istanbul as migrants in the 1930s and 1940s attracted by jobs in the state enterprises. They mostly lived in poor housing or dormitories, but set a high value on saving and obtaining decent housing in time. They contracted for the cooperative housing with alacrity, and moved in as early as possible, though not without difficulties, because the state could not keep all of its promises. In the post-world-war-II era, this community symbolized the dream of a modern, industrial labor-force living in urban areas, working in formal factory jobs, and having small houses, properly built, for their nuclear families with two children.
Though the vision was state-led industrialization and planning, the speed and scale of urbanization quickly outran the capacity of the state to organize and finance such orderly development for the working class population. Most of the migrants who came to Istanbul after the 1950s had to fend for themselves, giving rise to vast expanses of illegal housing -- the gecekondus of Istanbul. The second community, Karanfiltepe, was founded in the 1980s during this later period. By this time economic policy no longer attempted to achieve planned and state-led industrialization, but encouraged the free market and tolerated rapid growth of the informal sectors of production. The new habitations were also built the informal way.
Between the time of its founding and today, the Workers' Housing Community doubled in size simply by adding a second story to most of the houses, informally, and without permits in most instances. This accommodated a second generation of population and served, mostly through rentals, to bring the community within the circulation of population of similar class backgrounds from elsewhere in Istanbul. The community has climbed higher in terms of education and diversification of employment along with the general trend over time in Istanbul. Yet it remains a basically working class community.
The generation which is now retired or has passed on, consisted of men more educated than women, but even they seldom had more than primary school. Today, men and women have about equal education. About half of the youth have gone on to high school, and a few to university. Though the residents of this community nowadays identify themselves as Istanbulites, their origins were mainly the Black Sea provinces, and some other places in inner Anatolia, Marmara, or the Balkans.
Karanfiltepe differs by having a population more than half of which is from Eastern Turkey, many of them Kurdish. Nowadays, people in the East are in closer communication, well informed, and can come to Istanbul hoping to improve their position. However, the Black Sea and Central Anatolia are also represented. Ninety-six percent of heads of households are from these three regions. The basic educational standard for residents who are in the working ages is only primary school. Their economic activities are in both the formal and informal sectors. The community is growing rapidly with new land being taken under construction and additional floors being added to existing houses, all of which is reflected in rising real estate values as is typical of all of Istanbul..
Karanfiltepe is a working class community of the free market "Ozal" period. Young women often travel outside this community to work in menial jobs, which is common in Istanbul during the period when families are building and financing housing. Women work less often in the Workers' Housing Community.
In a transition theory perspective, the worker housing model should produce lower fertility in comparison with other less formal economic settings. In fact, the micro demography for Beykoz and WHC shows somewhat lower fertility than the Istanbul average and a relatively lower average child mortality as well. (footnote: The micro demography is based on individual-level data from the 1990 census. In Karanfiltepe, where employment in family enterprises and the informal sector is common, fertility and child mortality are higher than in Beykoz, though the statistical result appears to be associated mainly with women who began or completed their childbearing before coming to Istanbul.)
As part of the factory town of Beykoz, dominated by the state's economic enterprises, there is social insurance and the people have free medical care. Though these facts might suggest causal relations to demographers, they are tenuous and we do not want to depend on such a transition interpretation by itself, as it is barren of human detail.
Having chosen to collect material by unstructured interviews, informants arrange the sequences of topics, repetitions, and intertwining of multiple topics as they wish. To be sure, some guidance is exerted by the interviewer to focus on parts of the life history most likely to provide us with relevant material or to ask for more to be said about a topic. When quoting from the narratives, ellipses are used to cut repetitions and diversions, but we deliberately try to retain passages which show the many events, considerations, and recollections that seem to be part of the negotiations relating to reproduction and birth control.
The narratives should not be interpreted as recollections of mental calculation, of
balancing and calculus, but should be accepted as verbalized recall of "activity in
setting." Though intra-mental rational calculus might be present at times, it is more
likely that the informant is exhibiting his/her knowledge as it is socially organized and
indivisible. That is, "...everyday practice is distributed -- stretched over, not divided
among -- mind, body, activity and culturally organized settings (which include other
actors)." (footnote: We are quoting from Carter (1995:
The quotations given below are a small part of the ethnographic material. While we try to keep the voices of the informants intact, and the excerpts long enough to bring the informant's own ways of narrating their histories to the fore, it is unavoidable that our own interpretations influence what is selected. To save space, we present factual background information and then, following the quotations, try to place them in the context of the research questions.
We begin by listening to three working-class people who talk about their decisions to have or not to have children. The first, Cemile, is a woman whose childbearing took place around 1950. Her family came from Romania, with her as a nine-year old child, around 1940. She was married at age sixteen to a man chosen by her parents, and lived with her house-painter husband in Beykoz. Only later, in 1979, did they move to the Workers' Housing Community. (WHC) where they rented one of the original worker houses at a reasonable, low, rent that continues to the present time. The narrative picks up her story after two children have been born early in her marriage.
Well, I protected myself. I had a landlady (from Bulgaria), she taught me about a medicine. Not pills; it was sodium bicarbonate. She told me that I should protect myself by sodium bicarbonate ... I did not want to have a child. We didn't even have a house. My husband didn't have a regular job. What would I do with many children? In fact, I don't like children. Because if one has many children, one can buy for one, but cannot buy for the other one. First, my milk protected me. Then I protected myself. I didn't have any other children. (What did your husband say about this?) He didn't say anything. In fact he wanted to have many children, but I didn't want. .....In fact there are many different methods. In those times there were no pills as we have them nowadays. There was nothing. For protection it was better for a man to protect himself. There were some men who did not protect themselves. In addition, he was occasionally getting drunk. She (my landlady) said I had better use this method (sodium bicarbonate). ... It was not something to be afraid of. She said that it would be comfortable during the intercourse. ... Now look, one buys sodium bicarbonate from a pharmacy. You put it in a clean piece of cloth. You wash your hands carefully. Then by your finger you take some sodium bicarbonate and you put it into your vagina...... the seamen turns sour when it meets the sodium bicarbonate. (footnote: The original Turkish for these narratives is available in a working paper of the Population Council, Regional Paper No. 42, Cairo: Regional Office for West Asia and North Africa, PO Box 115, Dokki, Cairo, A.R.Egypt.)
We also interviewed the husband. He confirms the narrative by saying nothing about birth control in those early days -- it was his wife's initiative and done without his knowledge. With the complete narratives in our hands, we may try to imagine the negotiations of those sixteen or so years of marriage. The wife had decided that she wanted no more than two children many years before the husband. The reasons she tells are her own -- lack of money, a drunken husband, and her dislike for many children. In time, her husband improved his ways and stopped drinking. She knew from the very beginning that it was the normal thing in Istanbul for men to take responsibility in birth control. Thus, she came to the marriage with her own ideas, just as he came with his ideas of doing nothing about reproduction. Quietly and in time, the more socially- supported ideas, which were also his wife's ideas about a family, became his ideas. This is a kind of negotiation which eventuated in his adopting withdrawal and becoming a proper Istanbul man.
The time was the 1950s and the place was Beykoz in Istanbul. Medical female contraceptive methods were not yet legal in Turkey, though they became available later while she continued with the method she understood. (footnote: The term "modern methods" is not used here because it carries an implication of being superior in some sense or of being recent in origin, either or both of which may be misleading.)
This narrative can be interpreted as an explanation for the continuation of low, controlled fertility in Istanbul, maintained in this instance by a couple of migrant background.
The second woman, Hanife, had her two children around 1990 at the beginning of her marriage. She and her husband are Kurdish migrants from Eastern Turkey, and she came to Istanbul to find a husband and be married -- at age 19. Now she is 26 and tells her story of life in Karanfiltepe. She refers to the village people of the East as she sees them, and to her own mother who grew up and bore her family in that village.
Those who lived in the village were ignorant. ... For example, they didn't know that there were pills or IUDs (20 years ago). That is, urban people didn't inform them in the village. Due to ignorance. Now my mother says that if she lived today, she would not give so many births. She would never give nine births. If somebody tells her, Hanife is giving birth to her third child -- my name is Hanife -- my mother would raise hell. She says what will I do with many children during my whole life. .... If one has one child one can look after it. But if one has two or three children it becomes really difficult. When my child was an only child, he was crying to have a sibling. His (the child's) uncle had a child. He was saying that they had a baby, but we did not have one. He was jealous of them. For this reason, I said let another one come. I got this (second) child only for my first child. My husband did not want it. I wanted the second child, but since my husband did not agree, I was also thinking about my own special situation. I did not want to have a new delivery. Of course, cesarian is difficult to think about. (She had already had one.) However, if one has a normal delivery, one can do everything the day after the delivery. When one has cesarian one does not have the capacity to do anything for one week. One has a real operation. This is a very difficult and risky operation. For instance, they put stitches in the place where the child was. They stitch inside the belly. And they stitch outside the belly. They stitch three times during cesarian.
Hanife holds ignorance and the failure of the mainly urban family planning program to reach villages in the East for her mother's high fertility. Factually, she is correct that the new methods -- pill and IUD -- came to the whole country slowly in the late 1960s and 1970s, but there were other methods to use. So we interpret Hanife's narrative as her way of assigning "blame" for many children, while she, with her mother's support, is "doing the right thing" in Istanbul today. One might say that Hanife rationalizes the flow of her own conduct, even against her husband who did not want to have the second child, by claiming goodness in responding to the first child's desire for a sibling.
We also interviewed the husband who said that he used withdrawal to avoid a second child until they decided to go ahead and he stopped. She also explains why she should be cautious for health reasons. Hanife's sister died during a third birth while having a cesarian. Though her husband expresses worries about worsening economic conditions, he was also concerned about her health.
Another situation seen in these communities is recently married couples who do not have a child immediately. One of these is Mehmet, a young man of 30 who was raised in the WHC and now works as an accountant in a commercial firm. He only had a high school education and never would have obtained such a job except that there was a man in the community who rose very high in the business world who kept his neighborhood relationships and would recruit new employees for one of the large holding companies. Mehmet was able to make a career at this level and moved to another commercial company at a similar level. He worked among mostly middle class university graduates who never accepted him as one of them, while he retained his working class relationships. He married a woman 8 years younger from a similar class background whom he met at the company and brought her to the WHC to live. He talks about the value of having children, but then expresses his worries about facing the costs and discomforts too soon in his marriage.
I want (to have a child), but one year later. Why I want to have a child is that a child is the cheer of a home. ... For in my opinion life without a child in marriage looks like a tree without fruit. I believe that God will bless our home. God gives subsistence to all living creatures. ... I believe that it brings families together. Children are a factor that can bring spouses into good relationships. ... (What is special about one year later?) We have not yet adapted ourselves completely to have a child. I wait for time to pass. If I have a child now, I will become financially discouraged. Can I explain this to you? In the past we had two salaries, but now we have only one salary. As you know, a child creates many additional expenses. In addition, in our company there is some talk and manipulations. What will happen to me is not very predictable. ... I want to make sure of my salary and career at work. ... In fact having a child means having troubles. When you have a child, as I said before, it is the happiness, honey, and cream of a home; however, there are some negative sides of it. For example, sometimes you can not sleep in the morning due to its crying. You will go to work like a zombie. We talk with our friends who have complaints about buying baby food, diapers, and so on. In addition, when it becomes ill, you should pay the doctor. You should be strong enough to take care of these things. First you should feel like this, and then you should say okay for having a child. ... My friends also do not have children. The friends whom I like very much and who got married when I did are doing the same thing.
Mehmet's explanations are in the language of a generation that graduated from high school, some of whom reached universities and others not, but all of whom give similar reasons for being cautious about having children too soon. They find themselves ambivalent, located between being working-class and middle-class.
When people want to control their fertility, the question arises of what method to use to avoid pregnancies. In the narratives that follow, we shall see how the choices are negotiated and how relationships to the health system are involved. We see how people understand the effects of contraceptives and health care interventions on their bodies (cf. in another context, Patel, 1994). We begin with reports from several women, and follow thereafter with reports from men.
As soon as Yelda was married, she became pregnant. She is 23-years old and lives in the WHC like her aunt and grandmother. She met her husband, a taxi driver, while working in an art gallery as a semi-skilled manual worker. She has now been married for five years. She bore a son after nine months, but the baby died in its fourth month. She talks about her first, then second child, and about her body. She shows us her understanding of contraception.
During the first week I suckled my baby. Then my milk did not come. After that since my milk did not come, I used contraceptive pills. ... We did not go to a gynecologist to get information about this subject. I had the pills purchased from a pharmacy. I had Hasan (my husband) read the information inside carefully. Then you begin by taking the pills on the first day of menstruation. You stop taking those pills in the fifth day of menstruation. After a few days' break, you begin to take the pills again. What could I use? I had never used the other methods. I did not have an IUD insertion. I am afraid of it. My sister-in-law had the IUD inserted. She had so much pain. For this reason I did not have it inserted. I said that the best was contraceptive pills. I used contraceptive pills for one year. I stopped taking them after one year. After that I gave a small break for six months (thinking the protection would continue for some time). ... I got pregnant with Burak, which was two years after (my first child). After that I suckled Burak. For my first baby I did not have milk, but for my second baby, I had it. I did not have bleeding (return of menstruation) for nine months. When you do not have bleeding you are not supposed to use an IUD. You should go to a doctor the last day of your period when you have less blood (to have it inserted).
The belief that one should "Take a break" when using any female device or medical method such as the pill was found in other informant's accounts as well. It was reinforced, in some instances, by advice from physicians. Yelda, however, did all these things without ever going to a physician. Most of the time, in these working-class communities, women (and men) choose their methods of birth control without consulting a specialist. They trust the knowledge of their husbands who are usually more experienced, (footnote: Men have more social acceptance and opportunities to have sexual experiences before marriage in these communities. This was confirmed by a number of interviews.) and the knowledge of people in their close networks, seeking help from physicians seldom or not at all. After she bore Burak, Yelda tells about her first visit to a gynecologist. She visited a mother-and-child health (MCH) center for a baby checkup. While there she asked about contraceptives and reports,
I asked a doctor. He did not give contraceptive pills to me. He said that I was breast feeding and they are dangerous. He said that I could only use condoms. I went to the clinic in Kanlica. After nine months I was still afraid of examinations, so I did not have an IUD inserted. ... During the delivery (of a child) you have to go to a doctor. They "scratch" inside of you (she means that while doing something necessary, they create additional problems as well as pain). I do not want to go there for any other reason (except deliveries). I am really afraid.
Yelda perceives her body as vulnerable and thinks that any small mistake by a doctor can harm her body. Therefore she wants to keep her body in its natural harmony by staying away from doctors.
A thirty-one-year-old woman, Fatma, who migrated to Istanbul from southeastern Anatolia talks about the doctors in Zeynep Kamil, which is a large state hospital for women in Istanbul. She has five children, born before she moved to the WHC, and her eldest daughter is already engaged:
No, no, for the love of God, who at that place is concerned with patients? Answer the question, are they concerned with patients? For example, even though we go to hospitals and pay money, since we do not have any social security rights, they are not concerned about us. Doctors do not permit us even to tell them our illnesses. We cannot be examined, even after paying money.
Feeling devalued and fearful in the presence of physicians is a frequent theme, which we interpret as due in part to the different class origins of the patients, the unsatisfactory state of the public health services, and a culture of attitudes towards patients that doctors seem to have acquired during their training and subsequent practice. While patients may exaggerate the negative points, corroboration comes from a study of family planning clinics of Istanbul carried out by a team of physicians and social scientists which shows that these shortcomings are by no means exceptional (Bulut and Turan, 1995: pp 95-96).
Another woman, Selma, 30 years of age, who lives in the WHC, talks about the same questions in a different situation.
We went to a private doctor in Kadiköy. He was from Zeynep Kamil Hospital. We went to his private office. For medicine, we are retired (at an age below 40 under the rules). So we received it free through the social security arrangement. The doctor wrote the prescription in Zeynep Kamil Hospital for this. They are more considerate in their private clinics. (Whereas in hospital clinics) the doctors push you around and they swear at patients. One cannot find any sympathy in normal hospitals. For example, I went to this private doctor. He addressed me as "dear elder sister Sükran". Of course they charge money but they make you comfortable. For instance, by talking to us ... he overcame my fears.
....In other places, for example, Tepe Üstü Hospital, they don't show any respect to people. ..., recently I went to the department for ear, nose, and throat. They don't let people speak. You can not ask them anything. However, when you go to their private offices, there is a kind of welcome. When they behave in a welcoming way, you do not think about one million TL (about US$25).
A completely different set of considerations comes into play when a single person deals with the issues of birth control: choice of method, relationships to the health system, and the surrounding social views of their use of contraception. A young woman, Ezgi, in her 20s from a working-class family speaks as follows:
I had decided to use pills but did not go to a gynecologist. There is the risk of discovery of the relationship by other people. As a single person this is very dangerous. ... I know, since my mother searches everything that belongs to me. If you live in such an environment. ... Really it is not very easy for a single woman When you go to public hospitals or clinics, and if you are an unmarried woman, you should be very cautious when getting a medical service. Nobody in your close community should know this. Everything should be done in a very secret way. For a man, it is very easy to go to a pharmacy and buy condoms.
Thus, people who are alienated from health services construct their own knowledge about contraceptive methods, different from the medical knowledge. As with other kinds of knowledge, the knowledge of reproduction and birth control is uncertain, unstable, constructed and imposed through relations of power (see, e.g., Foucault, 1976). Cultural beliefs about the methods of birth control and their degrees of pleasure, efficiency, healthiness and protection against infection circulate in the same way as "natural truths" do throughout the society. As Kleinman (1988: 10) puts it, "... what is natural depends on shared understandings in particular cultures and not infrequently diverges among social groups. The meanings ... are standardized "truths" in a local cultural system inasmuch as the groups' categories are projected onto the world, then called natural because they are found there." (footnote: In an ethnographic study of epilepsy in Turkey, the narratives showed that patients had a variety of interpretations of cause and outcome of their illnesses, different from those of the medical personnel (Good and Good, 1994).)
As a result, spouses often go to a health institution or pharmacy to obtain a method of contraception after having made their own evaluation of all the alternatives in the light of these culturally constructed categories. Or they may rely on their own methods such as withdrawal or rhythm. Some of them claim that withdrawal is a temiz method (literally translated as clean, but means uncomplicated as in a "clean deal"). Some of the females in our study also say that condoms are clean, since the husband takes all the responsibility. For single partners, the male methods have a particular appeal as natural, secure, solutions which do not involve other people.
Canan, for example, who thinks of herself as a middle class person, says,
Firstly, I used pills. Then I used the IUD which is normal, and that everyone of us uses. ... The doctor advised me to use it after the birth; it was not my decision. In fact, I did not think of anything else to do. It is the most natural way, because the pills have side effects.
Negotiation is part of the process of choosing a method, bringing to bear the knowledge and power of man, woman, and sometimes other persons. In this instance the woman involved used her own power in concert with that of a doctor. These negotiations produce apparently settled positions, but they are in fact re-negotiated again and again. Our next quotation shows exactly such a renegotiation taking place, as Yelda speaks in the first person about why, following her second delivery, she continues to prefer condoms to the IUD unlike her husband:
Still I use condoms. In fact, my husband does not want to use them. He wants me to have an IUD inserted. In a way, I would like to use it. Using it is easier than other methods. I heard that it is not useful for everybody. It can move to the stomach. My skin is very sensitive. When I have a lesion, it takes two years to heal. Due to my skin, I am very afraid of using it. It might have some side effects. Then I should go to a doctor to have it removed. We will continue using condoms as long as he will use them -- as long as I can "deceive" him. In fact they are temiz in a way. That is, they are temiz for women. You do not need to be concerned about anything. You do not intervene in any way. That is, it is good.
What appears for a time to be a consensus about birth control may be re-opened and renegotiated. Foucault tells us how to interpret this (1982: pp 219-220): Power may be "integrated into a disparate field of possibilities brought to bear upon permanent structures. This also means that power is not a function of consent. In itself it is not a renunciation of freedom, a transference of rights, the power of each and all delegated to a few (which does not prevent the possibility that consent may be a condition for the existence or the maintenance of power); the relationship of power can be the result of a prior or permanent consent, but it is not by nature the manifestation of a consensus."
From these narratives we can understand that methods of birth control do not always become a subject of discussion as soon as intercourse is initiated. After a woman gains some experience, her relations with her partner become different from those at the beginning of her sexual life. It becomes normal to discuss these things also with the people around them and to use such knowledge in the negotiation of a method.
For single women, the gathering of knowledge is far more inhibited than for males, due to having no social permission to have experience, so their power may be less in the relationship. Here is what another single woman, Yeliz, from one of our study communities says,
In my last relationship we began with condoms. Eventually, it turned to withdrawal. And then I was planning to use pills, but I didn't. ... Until now I have never known a young single woman who uses a medical female method ... also I think that men want to make the choice. Really they feel more comfortable, because in my opinion, men think that the only aim of women is to get married to someone. They think that women can do everything to catch the man. They see this as a big risk. Therefore, they are very afraid if they do not have control.
The next group of narratives is from men. When the choice of methods is explained by men, they evaluate methods, but seldom speak of the preferences of their partners. The male perceptions, or at least their statements, are that they make the evaluation and the decision. We might have believed that men in this society have the final and absolute decision in family affairs if we had not interviewed women and, in particular, some who were wives of the men to whom we listened. Thus, we shall see in some of the men's statements that they try to claim, and may in fact gain, some extra power in society by the authoritative discourse they use.
Some of our married men think of IUDs as the best female method because of its support for pleasure. It has the additional attraction of being very similar to withdrawal, not mechanically, but because it is not necessary to acquire or place contraceptives prior to each intercourse. Some males also feel secure with an IUD, the same as with withdrawal, because a pregnancy will not occur by some "hidden" initiative of his spouse -- forgetting to take the pill for example. (footnote: In the Turkish data on contraceptive failure rates, pills appear to have high failure rates. This is usually interpreted as showing that women are not capable of following the daily regime. The narratives suggest that another interpretation might be relevant.) A 29-year-old male, Cemal, from the Black Sea region says,
Well, for example, say it is a condom. If I and my wife used it, I would suffer. There are some men who use male methods of birth control. I heard about it. I think it gives pain to the man himself and to the woman. ... If you and the woman both cannot get any pleasure, making love does not make any sense. There is no pleasure in that it is something we are not used to using, and the risk of them bursting open is high. A condom is not a healthy thing either. Further, some men use withdrawal as a method of birth control. At the most pleasant moment you have to withdraw. It makes one get weaker and older. It makes you get older quickly. I mean it is harmful in terms of health. It is the sweetest moment for a human being. It is the sweetest moment of marriage. When one withdraws, he is destroyed, ruined.
When withdrawal is rejected by a man, a female method of birth control becomes desirable. We noted a repeated pattern of preference by working-class men for IUDs as compared with contraceptive pills, as explained by this same male:
The best is an IUD. Others are harmful for one's health. In birth control, what fits my mind is an IUD. (Q-Do men have methods of birth control?) Yes, but theirs don't fit my mind the least bit. It is like a cover, not to be trusted. ... On this issue, I educated myself in my circle of friends and neighborhood. I am in general a bit of a talkative man. On some issues one must think logically. Pills are harmful for a woman's health. Those pills cause some women to gain weight. She has to take them regularly on time. It is highly risky. The best is an IUD. It is guaranteed with respect to the others. %1500. ... The ideal one is an IUD. It is women who use it. ... IUDs are very good for some women. It is a matter of getting used to it. It is a device like a colander. You have it placed in the woman. She needs only a few days to become used to it. It may cause an allergy. It may cause injury. It may cause nothing. If you see there is something wrong with your wife, it means you cannot use it. You have to have it taken out. It may even cause cancer. Of course, it does if there is a problem with the adaptation, but if it is okay. ... Anyway when we had it inserted, the doctor said: "you will come to me for a check-up one week later." When you go for the check-up after one week or fifteen days, if you feel OK, the IUD is the best. Those pills and others are a tale. I mean they are a bit of a primitive method. There is a problem if you do not take them on time.
As this man makes the case for the IUD, we notice that it has several facets, one of which is male control. He has this control as long as he monitors his wife's access to medical institutions where she would have to go to have it removed, and this is easily accomplished by him in a community where women seldom can move outside alone. Furthermore, the method is in place for a very long duration.
On the other hand, we found males in the communities who clearly preferred what they perceived to be a known, effective, and widely used method, withdrawal. Here a male, Adnan, who is the husband of the woman who talked about how she convinced her husband to have the second child, tells us why he prefers withdrawal.
We did not go to hospital for it (for a method of birth control). You know something is being placed inside a woman. No, absolutely no. It has been five years since the birth of my first child. During these five years, we used neither a pill nor an IUD. We used our own methods. It has been this way for five years. If I had wanted, she could have become pregnant immediately after her first birth. This is something (to be decided) between the man and his wife. The doctor said: "You must not have a child for five years." My wife's elder sister gave three births one after another. In the end, she died at the last birth. I would have made her pregnant if I had wanted. I could have. She said: "I shall use spiral." I said: "Absolutely no." (Q- Why did you not allow her to use an IUD?) Medical problems. People say: "It will be OK if I use it (contraceptive pills or IUDs). "However, one may become pregnant even though she uses it. There is also something like a rubber. Con ... Even though you wear three or four of them, she may become pregnant. I mean their (men's) efficiency rates are high. Of people like me, big and strong. Those thin men who are very fond of sex are also like that. ... When I have sexual relationship with my wife, ... when the liquid is about to come, I withdraw. Women have menstruation. If she does not have it after one month, it means she is pregnant. My wife has informed me every month. If she had it. ... Why? We tested ourselves. We have been successful. My brothers cannot take this precaution like us. I mean when they come to the thing (peak) of pleasure, they think that they will be devoid of pleasure if they withdraw. In fact, they will not. It is the same whether the liquid comes inside or outside. There is no difference. It is the same. ... You have sex with your wife. You do not allow her to take pills, right? Why? They all cause illness. This is the important issue. Now being overweight, women's illnesses are all due to these (contraceptive pills and IUDs).
We see in these narratives that some men and women are cautious about using medical interventions that they think might be harmful to the female body. However, the aversion to medical contraception, is more complex and nuanced than that. Some female methods would place more responsibility and control over births in the hands of women. For some males this is a problem, because they want to retain a monopoly of the knowledge and power to make choices about restricting births and the choice of method. This arrangement of considerations is not very different when we listen to single male. Kenan is from a working-class background, but has achieved through the educational system a place in a professional school and is in his last year. He has been together with a girlfriend from a university for four years, without the knowledge of the parents on either side, as far as they know. Concerning choice of method, Kenan says,
I say that condoms are the most guaranteed (to protect against pregnancy). However, from a man's point of view, after the first or the second time, they spoil sex. ...... Withdrawal might be another method. Because if I were not afraid of getting a child, I might use withdrawal for a while. But if I want the most guaranteed method, ...... suggestions from a doctor are very important. It is necessary to go to a doctor both for men and women. Even though men's problems are not very complicated, women's are. In other words, after marriage, one should go to a gynecologist. Having a checkup for both cancer and fungus and ovulation is a good thing, and might bring a beautiful sexual life. (Do you use a method when you are with your girlfriend?) Condoms. The most logical one. It is the most straightforward and healthiest one. It is the best method as far as I'm concerned for this particular time. That's all. There is nothing else. (What are the methods that your male friends use?) They use condoms as well. That is, in general, in our society since women find it shameful to go to a doctor's office, men do these kinds of things. They use condoms as well. Or as I said, withdrawal. In general, these kinds of things are not put on the shoulders of women.
When this man balances pleasure against risk, he chooses to use condoms after all. In the event of marriage, he says that the circumstances would then allow consultation and other choices to be made.
So far, we have been discussing only contraceptive methods of birth control. In Turkey, abortion has existed for a long time as a socially acceptable, though traumatic method of birth control (Duben and Behar, 1991). The demographic data show that 24 per cent of pregnancies in Istanbul today are terminated by induced abortions. (footnote: Special tabulation for Istanbul from the 1993 Turkish Demographic and Health Survey courtesy of Hacettepe Institute of Population Studies and Macro International.)
When abortion is an option and there is a contraceptive failure, women can be asked by their husbands, or they may themselves decide, to avoid a birth by abortion. This may happen even though they might see abortion as unethical or as a sin. For example, one of our informants, Yelda, tells how she feels about this issue:
I do not want to have another child, but I do not know what will happen after (my son) grows up. However if I have a failure, I do not want to have a medical abortion. Instead of having that sin, I would prefer to give birth to that child. I am very much against abortions. You should think about it before the pregnancy. If there is bread in this world to eat, why should I sin? Even if I would get pregnant now, I would bear the baby.
Another woman, Safiye, also evaluates the question from her own personal religious standpoint, and then tells how she faced the situation of an unwanted pregnancy when it happened:
In our religion, abortion is certainly prohibited. There is no difference whether I kill the baby before or after the birth. These two situations are the same. After twenty days, its heart palpitates in the womb of its mother. It is alive. You cannot kill a newborn infant bird, then how can you kill a baby. It is murder. However, I had an abortion but I do not know how I did it and furthermore I do not want to remember, because I may become crazy, I may become unhappy. I behave as if I never experienced such an event. I wonder how I will be able to give the report of this event to God on doomsday.
The next woman, Emel, talks about abortion not in relation to ethics but in relation to her husband's wish not to have more children. As she tells the story, other persons interfered on her behalf and she did not have an abortion after all. Then, later, when she became pregnant again, she came to the Capa University Hospital to have an abortion, which is where we met her and arranged an interview. She said:
My husband brought me to the hospital for an abortion. He wanted an abortion for the previous (fourth) child, too, but I did not want to have an abortion. Maybe, if we (were not thinking of moving soon) to the Eastern part of Turkey, I would not have come to this center for an abortion, but looking after five children is a very difficult thing (while moving).
At the time of her fourth pregnancy, she had even received some unsolicited support from her landlord, who is a very conservative Muslim. He declared that abortion was a great sin and, in the event, the woman was able to continue her pregnancy. However, she thinks that her present abortion is not sinful since the pregnancy was very new. She did not tell her family that she would have the abortion. She said only that she would go to the hospital to have X-rays for her stomach. She did tell a few neighbors, however, that she would have the abortion.
This last story shows that the woman was able, for one of her pregnancies, to resist the husband's requests that she terminate it. In these narratives we see that there are negotiations about whether to have a child or not. In all the cases where we heard about abortions, the negotiation from the man's side was in favor of the abortion, while women sometimes wished to have the additional child. Reasons given were usually stated in the language of religion or ethics, but we are not sure whether another child might have also been welcomed by the woman as a way of enlarging the space occupied by the mother in the family. Motherhood is a basis for claiming power in family negotiations, and some of the women were keenly aware of this.
Most abortions are done by private physicians, even though they are free at state hospitals, because the procedure is seen as more accessible -- less number of visits, less waiting, and more certain service -- and as a better screen against public scrutiny (also see, Bulut and Toubia, 1994). Some women go so far as to obtain from pharmacies high doses of hormones to "bleed out" an early pregnancy. The women in our study made it clear that they continue to bear the burden of health risks, the pain of invasive procedures, and the ignominious experience of sometimes having to listen to derogatory or censorious comments by physicians at the time of service. "Blame" when apportioned has many faces -- inattention to contraceptive procedures, husband's or partner's fault, not thinking ahead, the fault of a medical method or device, and ethical or religious approbation.
Controlling family size, protecting one's health, regulating one's reproduction, and engaging in sexual activity, emerge as questions that can be studied by an ethnographic approach. Purely bio-demographic basis, or the transition-theory dichotomies of modern in opposition to traditional, provide an incomplete picture even though they may offer some information and clues as to what questions should be asked. We find, through the ethnographies, that people make their own evaluations of what the goals should be, what signifies good and bad behavior, how men and women should relate and negotiate with each other, and how they should understand the having or not having of children.
Birth control practices are found in the lives of all of the working-class people who took part in our study. In Istanbul in these times, when they explain why they limit their births, they say that they worry about their economic conditions, the cost of each additional child, the future for those children, and their own comfort as parents. They give their own particular reasons. They see their choices as their own and do not talk about the "role models" of other families around them. By their individual actions they create a culture of reproduction in the community which belongs to their own times and different from past time. (footnote: "Instead of accounting for practices in terms of fixed cultural rules, researchers see the practices themselves as having a developmental structure that works itself out over time. ... time is not merely lived, but is 'constructed' in the living." (Bourdieu as paraphrased by Greenhalgh, 1995: p.22).)
Thus, we may understand why a young married woman, Hanife, with two children in Karanfiltepe cannot understand the life experience of her mother, who had nine children in a village in East Anatolia, as a reflection of culture in those times, but sees it as due to "ignorance."
We also found single persons using birth control in our working-class communities. For these people, especially women, having a child outside marriage is culturally not an option. These individuals, in cooperation with their friends and partners, find the ways to avoid births, unless of course, a decision to marry is made. In the category of single persons, we do not include individuals who have been married solely by a religious ceremony (no legal civil ceremony), since the community sees them as married persons in an Islamic tradition. (footnote: Marriages based solely on a religious ceremony are not common. However, we found women in the communities who had been married in that way to already-married men in order to bear children as second wives. The man can give legal legitimacy to the children by registering them as the children of his first (civil-marriage) wife. Otherwise, the children would have no legal rights (single women cannot acknowledge maternity and thereby accord legal rights to their children). The woman who enters such a marriage has no rights in any event, but her reproductive activity would be seen in the community as part of a marriage.)
As people seek to control their fertility, they choose methods of protection against pregnancy and they use abortion as well. Individuals in the study give many narratives about how they control fertility in their own lives. The narratives warn us against thinking that the association of methods of birth control with the male or female body signify who decided when to control fertility and how to do so. Such associations are not able to explain the relative power positions and gender responsibilities for the choice of method.
Recall Hanife's narrative (page 14), confirmed by her husband, that withdrawal was the method that avoided a second child, but was stopped after negotiation when Hanife wanted the second child, even though the husband was reluctant. Recall Cemal (page 25), a male who was interested in having the power to decide whether a pregnancy will occur, but who thought withdrawal was not a pleasurable method. He insisted on the IUD, viewing it as a method that was secure, like withdrawal, because his wife could not become pregnant by some initiative of her own such as forgetting to take the pill. With an IUD he would know about it if she went to a clinic for removal.
By observation of the method alone, we would not know how it came to be selected. Thus, we can not say that the use of male methods engenders absolute power in male hands for the management of fertility and birth control, even though in particular cases where the man does have absolute power in matters of reproduction he chooses to use that method. Neither does the use of an IUD engender absolute power in female hands or reflect such power; it is sometimes a male choice and a means of monitoring the situation. Thus, we must look more deeply into the culturally constructed knowledge about the body and the practice of birth control. We must also look into the power relations among the parties who negotiate the choices. In this way, we may be able to understand how and for whom birth avoidance is the objective. We may also answer the puzzle of how such results are achieved without very much recourse to medical technology.
In bio-demographic calculations, and in one strand of feminist discourse, female methods are separated from male, and recommended over male ones (condoms excepted). There is a built-in, but not usually articulated, policy objective to empower women by substituting female methods for male methods of control. Withdrawal is classified as "traditional" and, therefore, not acceptable as a "modern" solution to the birth control problem. Furthermore, from some of the feminist perspectives, men are not to be trusted with taking responsibility for birth control. The narratives of our working- class people seem to say something different, namely, that women often wish to hold husbands responsible, to have their participation, and to avoid some of the health problems that they see in female contraception. This brings us to the point, also recognized in some of the feminist discourse, that women's bodies and their health are considerations in choosing methods of birth control (Ginsburg and Rapp, 1991).
In these two Istanbul communities, both women and men talk about their bodies in relation to birth control and about the ways in which the different contraceptive options affect them. They have an extensive repertoire of concepts and references to specific events and examples. As mentioned earlier, they build upon this knowledge "natural truths" which may not always accord well with current medical understanding, but are the basis on which these people make choices, act, and decide whether or not to add to their knowledge by consultations with health services.
Canan says that IUDs are the "most natural way" of female contraception, while male methods are to some others considered to be the most "natural" procedures. Choice of methods, and decisions whether or not to undertake abortions if that alternative arises, almost always involve considerations of health according to the narratives. This is one way, for example, to understand why some men may use withdrawal even while complaining about reduced pleasure and how this would be accepted by their wives as well (though others say they have full pleasure). The choice is "reasonable" if the man and/or the woman are concerned at the same time about the health and beauty of the wife who they think would be adversely affected by one of the "modern" contraceptives.
In another place, Sicily, at another time, withdrawal was constructed as a sacrifice of pleasure that is at the same time a virtuous act which gives the couple "respectability" for controlling fertility and the passions of sex in the "right" way (Schneider and Schneider, 1991). In our communities, dissatisfaction with a male method would call for complaint and would be continued only if there were good reasons, such as health, male supervision, or secrecy.
Although the choice of a method often includes health considerations that are dealt with by their own knowledge and constructions of what the health problems are, they do not see the question of establishing a routine in the sexual relationship as a medical problem. We notice that they consult infrequently with the health services as they make their decisions. The health services come into the picture most often as professionals to implement decisions already made, such as obtaining an IUD, or because there is a problem of infertility. Though many health services have been established in Istanbul whose mandates include family planning services and mother and child care, the objectives reflect the bio-demographic view of what should be done, namely, to increase the use of contraception and, in more recent times, to provide legal abortion services. From the perspective of the people with whom we talked, however, these services do not seem to coordinate well with their definitions of their needs and problems. The same might be less true among upper and upper middle class clienteles who use different public and private services; but they were not the subject of this study.
Finally, we return to the other theoretical question in which we are also interested. Transition theory attributes fertility decline to a number of "modernization" factors which include increases in autonomy and status for women. Our narratives put a serious question mark, however, on the idea that the empowerment of women is an important, even necessary, societal change to bring about reductions in fertility. Such reasoning seems to say that this is the way more decision power is given to women and that women, more so than men, want to limit their pregnancies, and that is not borne out either by our narratives.
Among working class people, where gains by "modernization" are limited --schooling, jobs, social status, mobility, privacy for women --, powerful constraints on reproduction exist nevertheless, such that low fertility is now the norm. There is no woman among all those interviewed, except one, who has a job, and all of them, except two, have at most a primary school education. In addition, all the men, except one university student, had at most a high school education. Thus, we would have to conclude that the culture of low fertility that we see in these communities is not based on the complete "modernization" of their lives that the theory postulates.
As we have seen throughout the paper, while discussing different constructions of engendered relationships among individuals with regard to sexuality, birth control, and reproduction, men usually behave as if they enter the negotiations with a privileged position. However, as we found in this study, there is no absolute male control of the events. Women, too, have resources, and the negotiated results early in their relationship, and even more so later in the marriage, show the participation of both parties.
We conclude that both men and women have the potential to manipulate and to revise as well as to subordinate the structures and relationships around them. Some individuals are more successful at negotiating solutions to the kinds of issues we have been discussing, and at creating solutions for themselves but others less so. "Every relationship of power puts into operation differentiations which are at the same time its conditions and its results (Foucault, 1982: 223)." So it seems that the culture has space for individuals to choose many different ways to express and live by their own ways. This shows that no single characterization of individuals or their family systems is acceptable for the Turkish discourse. For example, a young working-class woman can have sex without marriage, and she can want her partner to protect himself against her pregnancy. Another woman, as early as the 1950s can limit the number of her children by using sodium bicarbonate without the knowledge of her husband. And so on, the variety seems limitless.
Methods of protection used by married couples in Turkey at an early year of the fertility decline (1963) and thirty years later (1993), and methods used in Istanbul by migrant and non-migrant married couples in 1993. Per cent of all users.
|Methods||Turkey||Istanbul 1993 [a]|
|Douche, potion, blockages||37||2|
|All couples using a method||100||100||100||100|
|Per cent using a method of protection||28||63||69||74|
|Sample size, N||2555||6519||419||204|
Contraceptive prevalence is measured by the reports of married women under age 50 (1993) or under age 45 (1963).
Note [a]: For the present study of working-class people, the migrant column is the most relevant. The non-migrants include some second- generation working-class, but are more often individuals from middle and upper class.
Sources: 1963 Survey (Ozbay and Shorter, 1970:5). 1993 Survey (Hacettepe Institute of Population Studies, 1994: 38). Istanbul, 1993 was tabulated from the Istanbul clusters of a representative sample collected by the 1993 Turkish Demographic and Health Survey, kindness of Hacettepe Institute of Population Studies and Jeanne Cushing of Macro International.
The authors wish to thank Leyla Neyzi, Henry Rutz, Seteney Shami, Homa Hoodfar, and anonymous reviewers for their valuable comments. The authors also thank Arif Kütük, who served as research assistant and made the male interviews. An earlier draft of the ideas in this paper was presented at the Conference on Population, Family, and Gender in Muslim Central Asia and the Middle East, Bogazici University, Istanbul, May 31-June 4, 1995, sponsored by the Social Science Research Council (USA) and the Cairo Regional Office of the Population Council (MEAwards).
Altorki, Soraya, and Camillia Fawzi El-Solh (eds.). 1989. Arab Women in the Field: Studying Your Own Society. Cairo: American University in Cairo Press.
Behar, Cem. 1995. "The fertility transition in Turkey: reforms, policies and household
structure," in Carla Mahklouf Obermeyer (ed.). Family, Gender, and Population in
the Middle East: Policies and Context. Cairo: American University in Cairo Press.
Behar, Cem. 1980. Türkiye'de Nüfus Planlamasi Politikasinin Nüfussal Etkinligi (1965-1980): Bir Uygulama Denemesi (The demographic effectiveness of population planning policy: a policy trial). Docent's dissertation. Istanbul: Faculty of Administrative Sciences, Bogazici University.
Bledsoe, Caroline H., Allan G. Hill, Umberto D'Alessandro; and Patricia Langerock.
1994. "Constructing Natural Fertility: The Use of Western Contraceptive Technologies
in Rural Gambia." Population and Development Review.
Bourdieu, P. 1984. Distinction: A Social Critique of the Judgement of Taste. London: Routledge and Kegan Paul (original French 1979).
Bourdieu, P. 1989. Homo Academicus. Cambridge: Polity Press (original French, 1984).
Bourdieu, P. 1990. The Logic of Practice. Stanford: Stanford University Press (original in French, 1980).
Bulut, Ayşen and Turan, Janet Molzan. 1995. "Postpartum Family Planning, and Health
Needs of Women of Low Income in Istanbul, Studies in Family Planning, 26(2)
Bulut, Ayşen, and Nahid Toubia. 1994. Hastanelerde Gebelik Sonlandìrma Hizmetlerinin İslerligi ve Etkinligi (Efficiency and Functioning of Services for Hospital Termination of Pregnancy), Istanbul: Istanbul Üniversitesi Cocuk Sagligi Enstitüsü.
Carter, Anthony. 1995. Agency and Fertility: For an Ethnography of Practice. In
Susan Greenhalgh (eds.). "Situating Fertility: anthropology and Demographic Inquiry."
Cambridge and New York: Cambridge University Press.
Clifford, James. 1986. "Introduction: Partial truths," in Writing Culture: The Poetics
and Politics of Ethnography by James Clifford and George E. Markus (eds.).
Berkeley: University of California Press.
Duben, Alan, and Cem Behar. 1991. Istanbul Households: Marriage, Family and Fertility, 1880-1940, Cambridge: Cambridge University Press.
Fahim, Hussein. 1982. Indigenous Anthropology in Non-Western Countries. Durham, N.C.: Carolina Academic Press.
Foucault, Michel. 1976. "Two Lectures: Lecture One:
Foucault, Michel. 1982. "The Subject and Power," in Michel Foucault: Beyond
Structuralism and Hermeneutics: with an Afterword by Michel Foucault by Hubert
L. Dreyfus and Paul Rabinow. Brighton, Sussex, Great Britain: The Harvester Press.
Geertz, Clifford. 1973. The Interpretation of Culture. Chapter 1, "Thick
Description: Toward an Interpretive Theory of Culture,"
Giddens, A. 1984. The Constitution of Society. Cambridge: Polity Press.
Ginsburg, F. and R. Rapp. 1991. "Politics of Reproduction," Annual Review of
Goldberg, H. I., and Aykut Toros. 1994. "The Use of Traditional Methods among
Turkish Couples." Studies in Family Planning. 25(2)
Good, Byron J. and Mary-Jo Del Vecchio Good. 1994. "In the Subjunctive Mode:
Epilepsy Narratives in Turkey." Social Science and Medicine
Greenhalgh, Susan. 1995. "Anthropological Contributions to Fertility Theory," in S.
Greenhalgh (ed.) Situating Fertility: Anthropology and Demographic Inquiry.
Cambridge: Cambridge University Press.
Hacettepe Institute of Population Studies. 1994. Turkish Demographic and Health Survey, 1993. Joint authors are: Ministry of Health: General Directorate of Mother and Child Health and Family Planning; Hacettepe University: Institute of Population Studies; and Macro International, Inc.: Demographic and Health Surveys. Final Report. Ankara: Ministry of Health.
Hammel, E. A..1990. "A theory of Culture for Demography," Population and
Hodgson, Dennis. 1983. "Demography as social science and policy science," Population and Development Review, 9(1): pp. 1-34.
Jenkins, Richard. 1992. Key Sociologist: Pierre Bourdieu. USA: Routledge
Kleinman, Arthur. 1988. The Illness Narratives. New York: Basic Books.
Lave, Jean. 1988. Arithmetic Practices and Cognitive Theory: An Ethnographic Inquiry. Cambridge: Cambridge University Press.
Lieberman, Samuel S. 1976. An Economic Approach to Differential Demographic Behavior in Turkey. Outstanding dissertations in economics (series). Cambridge, Massachusetts: Harvard University.
McNicoll, Geoffrey. 1980. "Institutional determinants of fertility change," Population
and Development Review
McNicoll, Geoffrey. 1994. "Institutional Analysis of Fertility," Working Papers:
Nakhleh, Khalil. 1979. "On Being a Native Anthropologist." in The Politics of Anthropology ed G. Huizer and B. Mannheim. Den Haag/Paris: Mouton.
Patel, Tulsi. 1994. Fertility Behavior: Population and Society in a Rajasthan Village. Delhi: Oxford University Press.
Ohnuki-Tierney, Emiko. 1984. "`Native' Anthropologist," American Ethnologist.
Ozbay, Ferhunde and Shorter, Frederic C. 1970. "Turkey: Changes in Birth Control
Practice, 1963 to 1968," Studies in Family Planning,
Santow, Gigi. 1993. "Coitus Interruptus in the Twentieth Century," Population and
Development Review, 19(4):
Schneider, Jane, and Peter Schneider. 1991. "Sex and Respectability in an Age of
Fertility Decline: A Sicilian Case Study," Social Science and Medicine
Shorter, Frederic C., and Miroslav Macura. 1982. Trends in Fertility and Mortality in Turkey 1935-1975, Washington: Committee on Population and Demography, U.S National Academy of Sciences, National Academy Press.
Shorter, Frederic C. 1995. "The Crisis of Population Knowledge in Turkey," New
Perspectives on Turkey,
State Institute of Statistics (SIS), Prime Ministry, Turkey. 1995. The Population of
Tarzi, Pakize I. 1992. Anilarlar (Memoirs), Istanbul: Dizgi Baski.