Child, Early and Forced Marriage in Turkey (PDF)

Child, Early and Forced Marriage in Turkey Data Analysis of Turkey Demographic and Health Surveys  Child, Early and Forced Marriage in Turkey Data Analysis of Turkey Demographic and Health Surveys 1993 - 2018  The United Nations Joint Program for the Prevention of Child, Early, and Forc...

Child, Early and Forced Marriage in Turkey Data Analysis of Turkey Demographic and Health Surveys  Child, Early and Forced Marriage in Turkey Data Analysis of Turkey Demographic and Health Surveys 1993 - 2018  The United Nations Joint Program for the Prevention of Child, Early, and Forced Marriage in Turkey, implemented by the United Nations Children’s Fund (UNICEF), International Organization for Migration (IOM), United Nations Population Fund (UNFPA), United Nations Entity for Gender Equality and the Empowerment of Women (UN Women) and United Nations High Commissioner for Refugees (UNHCR) with the financial assistance of Swedish International Development Cooperation Agency (SIDA) takes a multi-sectoral and holistic approach for conducting both prevention and intervention activities to strengthen national mechanisms for protection of women and children, and to promote positive social norms aiming to prevent child, early and forced marriages. With the primary objective of supporting the development of local institutional capacity for preventing child, early and forced marriage within the scope of the program, UNFPA has been conducting activities in the fields of promoting mother and child health, improving reproductive health and rights, supporting gender equality, combating violence against women and humanitarian aid in Turkey since 1971. UNFPA works for a more equal and safer world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. The analyses and interpretations of 1993-2018 Turkey Demographic and Health Surveys expressed in this publication are those of the authors, academic staff of Hacettepe University Institute of Population Studies. The views and information expressed in the report do not necessarily reflect the views of the beneficiary and supporting organizations and institutions of the surveys. Further information on Turkey Demographic and Health survey can be found at www.hips.hacettepe.edu.tr Research conducted and report Prepared to publishing by Contributed by prepared by (in alphabetical order): (UNFPA-in alphabetical order): (in alphabetical order): A. Banu Ergöçmen* Cansu Oba Erdoğan Meltem Ağduk Ahmet Sinan Türkyılmaz* Faruk Keskin** Emine Kuzutürk Savaş Tuna Çakmur Akya Akarsu**** İlknur Yüksel-Kaptanoğlu*** Gökhan Yıldırımkaya Zeynep Başarankut Kan Alanur Çavlin*** December 2020 @United Nations Population Fund (UNFPA) All rights of this publication belong to United Nations Population Fund (UNFPA). It may not be copied, reproduced or published in part or whole without obtaining written permit of the United Nations Population Fund. It can be quoted on the condition that the relevant source is cited. UNFPA, United Nations Population Fund Turan Güneş Bulvarı No:180 Park Oran Ofis E Blok Kat:12 No: 37-38-39 Oran-Çankaya/Ankara – Turkey https://turkey.unfpa.org/en Cover & Layout Design: Burak Elmas Printing: Emsal Matbaa, 46753 This material/production has been financed by the Swedish International Development Cooperation Agency, Sida. Responsibility for the content rests entirely with the creator. Sida does not necessarily share the expressed views and interpretations. * Prof. Dr. Hacettepe University Institute of Population Studies *** Assoc. Prof. Dr. Hacettepe University Institute of Population Studies ** Res. Assist. Hacettepe University Institute of Population Studies **** 2018-TDHS Scholar, Hacettepe University Institute of Population Studies 2  CONTENTS Abbreviations 4 Tables 4 Figures 5 Foreword 7 Acknowledgement 8 Introduction 10 I. Background of Child, Early and Forced Marriage (CEFM) 12 Child, Early and Forced Marriage 13 Global Prevalence of CEFM 16 Age at First Marriage and CEFM in Turkey 16 II. Selected Studies on CEFM in Turkey 18 III. Data Sources and Method 22 Data Sources 24 Method 25 IV. Child, Early and Forced Marriage 26 CEFM Prevalence in Turkey 27 Reproductive Health and Rights 30 Termination of Pregnancies 33 Fertility Preferences 34 Fertility 34 Antenatal Care, Delivery and Postnatal Care 36 Child Health 38 Social and Cultural Factors 40 Characteristics before Marriage 40 Formation of Marriage 42 Characteristics of Women 45 Women’s Relationship with Spouses 47 Attitudes of Women 49 V. Highlights of TDHS Analyses 52 Annex Tables 56 References 72 3  ABBREVIATIONS ANC Antenatal Care QRE Questionnaire CEDAW The Convention on the Elimination of all Forms of Discrimination Against Women TCC Turkish Civil Code CEFM Child, Early and Forced Marriage TDHS Turkey Demographic and Health Survey DHS Demographic and Health Survey TURKSTAT Turkish Statistical Institute HH Household UN WOMEN The United Nations Entity for Gender Equality HUIPS Hacettepe University Institute of Population Studies and the Empowerment of Women IOM International Organization for Migration UNFPA United Nations Population Fund IUD Intrauterine device UNHCR United Nations High Commissioner for Refugees MoFLSS Ministry of Family, Labor and Social Services UNICEF United Nations Children’s Fund NUTS Nomenclature of Territorial Units for Statistics WHO World Health Organization TABLES Page Table 1 TDHS Information, 1993-2018 24 Table 2 Terminated Pregnancies 33 Table 3 Mean Number of Live Births and Number of Living Children 35 Annex Table 1 CEFM and Place of Residence, Region and Wealth Index 57 Annex Table 2 CEFM and Contraceptive Use 58 Annex Table 3 CEFM and Terminated Pregnancies 59 Annex Table 4 CEFM and Fertility Preferences 60 Annex Table 5 CEFM and Fertility 61 Annex Table 6 CEFM and Antenatal Care, Deliveries and Postnatal Care Services 62-63 Annex Table 7 CEFM and Child Health 64-65 Annex Table 8 CEFM and Premarital Characteristics 66 Annex Table 9 CEFM and Formation of First Marriage 67 Annex Table 10 CEFM and Basic Characteristics of Women 68 Annex Table 11 CEFM and Spousal Relationship of Women 69 Annex Table 12 CEFM and Attitudes of Women 70-71 4 FIGURES Figure No Page Figure No Page 1 Proportion of 16-19 Age Group in First Marriage 17 24 Timing of Postnatal Care 37 2 Prevalence of Marriage Before Age 15 27 25 Birthweight < 2,5 kg 38 3 Prevalence of Marriage Before Age 18 27 26 Breastfeeding within the First 1 Hour 38 4 CEFM Prevalence by Place of Residence 28 27 Age-appropriate Breastfeeding 0-23 Months 39 5 CEFM Prevalence by 5 Regions 28 28 Childhood Place of Residence 40 6 CEFM Prevalence by 12 Regions 29 29 Mother's Educational Level 41 7 CEFM Prevalence by Wealth Index 29 30 Father's Educational Level 41 8 Accurate Knowledge of the Fertile Period 30 31 Consanguineous Marriage of Women's Parents 42 9 Use of any Contraceptive Method 30 32 Marriage Decision 42 10 First Contraceptive Method Use 31 33 Ceremony Type and Order 43 11 Currently Used Contraceptive Method 31 34 Consanguineous marriage 44 12 Knowledge of Source of Supply for Contraceptive Methods 32 35 Bride Price 45 13 Need for Family Planning 32 36 Mean Years of Education 45 14 Terminated Pregnancy 33 37 Employment of Women 46 15 Approval of Induced Abortion 33 38 Reasons for Not Working 46 16 Ideal Number of Children 34 39 Ownership of Income and Goods 47 17 Women's Desire for More Children 34 40 Age Difference Between Partners 47 18 Age at First Birth 35 41 Educational Differences between Spouses 48 19 ANC within the first trimester of pregnancy 36 42 Limiting Behaviors 49 20 ANC from Skilled Healthcare Provider 36 43 Age at Marriage Preference of Women 49 21 Place of Delivery 36 44 Attitudes Toward Gender Equality 50 22 Deliveries by Healthcare Providers 37 45 Attitudes Toward Physical Violence 51 23 Deliveries by C-section 37 5 6 FOREWORD Child marriage is a violation of human rights and a significant obstacle to the empowerment of women and girls. Every year, 12 million girls are married off during their childhood and therefore deprived of their many fundamental rights, especially their rights to education and health. Child marriage is an obstacle, especially for girls, to living an equal, healthy, non-violent, and quality life with a bright future. To overcome this obstacle, civil society organizations, United Nations agencies, scientists, independent networks, and, in particular, the signatory states to the Convention on the Rights of the Child and the Convention on the Elimination of All Forms of Discrimination Against Women need to continue to exert effort without slowing down. The United Nations Population Fund (UNFPA) works to end child marriage and to achieve the Sustainable Development Goals in Turkey and around the world. Within this framework, ‘The United Nations Joint Program for the Prevention of Child, Early, and Forced Marriage in Turkey’ has been carried out since 2018 by the United Nations Children’s Fund (UNICEF), the International Organization for Migration (IOM), the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women), the United Nations High Commissioner for Refugees (UNHCR) and UNFPA. Within the scope of this joint programme, UNFPA Turkey has conducted capacity-building activities for service providers and community-based activities across the country and has pioneered data-driven, qualitative and quantitative studies on the health consequences of child marriages. The quantitative, data-driven “Child, Early and Forced Marriage in Turkey: Data Analysis of Turkey Demographic and Health Surveys 1993 - 2018” report, which was collaboratively developed by UNFPA and the Hacettepe University Institute of Population Studies, analyses the current situation of child marriage in Turkey. This study is underlaid by the descriptive analysis of the last 25-years of data from the Turkey Demographic and Health Survey series, which is conducted by the Hacettepe University Institute of Population Studies and is the most comprehensive, long-running and comparative demographic data source in this field. The report focuses on the prevalence of child, early and forced marriages, reproductive health, reproductive rights, and socio-cultural factors. Within the framework of reproductive health rights, the use of contraceptive methods, fertility preferences, age at first birth, type of birth, and pre- and post- natal care are covered. There are also analyses of child nutrition and health. Under the subject of socio-cultural factors, the basic characteristics of women who have been exposed to child marriage, their pre-marital characteristics, the way their first marriage was established, their relations with their spouses, their attitudes towards gender equality, and physical violence were evaluated. I hope this report will build fundamental grounds for the studies and programmes focusing on the prevention of child marriage, and for this, I would like to register my gratitude to researchers at Hacettepe University Institute for Population Studies, to my colleagues at the UNFPA Turkey Country Office, and to the Swedish International Development Cooperation Agency (SIDA). Hassan Mohtashami UNFPA Representative, Ankara, Turkey 7  ACKNOWLEDGEMENT Child, early, and forced marriages continue to exist Child, early, and forced marriages depriving women of their as a global problem in varying acceptance levels within right to education, leaving them without an education, and different communities through a perspective that contradicts thus in a weak state socially and economically, are an issue the advancement of the times we live in. Being an adult that Turkey also must address substantially. While the age is a prerequisite to marry, and the marrying age has been at first marriage in Turkey increases over time, and despite established by the law. However, in cases where social marriages below the age of 15 being rare, the fact that the acceptance overshadows the law, childhood ends abruptly percentage of those married before the age of 18 in the for some. The fact that an individual is married off during 20-24 age group is 15% indicates that the matter is still a time when they face a number of social and economic worthy of being addressed. limitations because they are not of age yet, where they have not yet completed their physiological and social The study Child, Early and Forced Marriage in Turkey: development, and should in fact be taking part in the Data Analysis of Turkey Demographic and Health Surveys education system, is a paradox. In such a case, which is 1993-2018 has been conducted using the data from the a violation of human rights, one of the two genders sharing research of the last twenty-five years. Thanks to the dataset social life, namely women, is affected more due to the fact prepared every five years since the foundation of the Institute, that their rights and liberties are limited and even deprived covering a period of over half a century retrospectively, the in most cases because of such a marriage, and thus are Turkey Demographic and Health Survey (TDHS) has made reduced to a disadvantageous level in the community, the calculation of possible marriage-related indicators and carrying with them the adverse repercussions the study of causality connections. Unlike the official statistics, of marriage for life. which are limited to legal marriages only, TDHSs allow studies to be carried out on the basis of age and marriage based on individual statements. What underlies the development, implementation, and evaluation of policies and programs is data. Accordingly, with its samples representative of the Turkish demographics, TDHS constitutes a data source that is rich, reliable, and that allows both national and international comparisons for marriages carried out before childhood is complete. 8 The twenty-first century is an era where the objective It is the Turkey Demographic and Health Surveys that is to provide a global dimension to human rights and to have made this study possible; I would like to thank all the determine the goals required to be attained as per the academics of the Institute of Population Studies who have Sustainable Development Goals and the 2019 Nairobi carried out these surveys for their valuable contributions. Summit (ICPD+25), and where the priority is to eliminate I would also like to thank Assoc. Prof. İlknur Yüksel-Kaptanoğlu, discrimination with a future perspective. Within this scope, Faruk Keskin, and Akya Akarsu, who have, with their dedicated I am confident that this study, which has been conducted work, completed Child, Early and Forced Marriage in Turkey: taking into account the Turkey Demographic and Health Data Analysis of Turkey Demographic and Health Surveys Surveys will contribute to the efforts to prevent child, early, 1993-2018. and forced marriages, which have an adverse effect on the physical and mental development of girl children, and which bring about maternal deaths and the risk of various health Prof. Dr. A. Banu Ergöçmen problems due to pregnancies/births taking place before Director the physical development of the body is complete. Child, Early and Forced Marriage in Turkey: Data Analysis of Turkey Demographic and Health Surveys 1993-2018 was carried out in cooperation with the United Nations Population Fund Turkey Office and the financial support of Swedish International Development Agency (SIDA). I would like to thank all the experts in this project, on behalf of the representative of the United Nations Population Fund Turkey Office, for their contributions and support for the study. 9  Introduction 10  Child, early and forced marriage (CEFM) is among the most important global social problems. This issue, which is a clear violation of children’s rights, is among the particular violations of human rights. Furthermore, this issue leads to adverse effects, especially, on women’s lives. CEFM reinforces gender inequalities which hinder women’s many rights, such as the right to education and employment, reproductive health rights and the right to life without violence. As a multidimensional issue, CEFM is defined as a form of discrimination and a public health issue and an impediment to the sustainable development goals, as well as a criminal offence at the international level, and one of the forms of gender-based violence. This study aims to contribute to efforts for the prevention of CEFM in Turkey through a data-based analysis with a special emphasis on reproductive rights. The data of the Turkey Demographic and Health Survey (TDHS) was used in the analysis. The TDHSs are important data sources that collect comprehensive and detailed information on the reproductive health, socio-economic characteristics, marriages, work life and attitudes of women in the 15-49 age group. In this report, which aims to steer the efforts towards preventing CEFM, information on the current status was gathered using 2018-TDHS data. Furthermore, snapshot of Turkey over the past 25 years is presented through analysis of the TDHSs conducted in 1993, 1998, 2003, 2008 and 2013. In this report: This section, which is allocated to the background information on CEFM, includes concepts I. and global statistics as well as the legal regulations in Turkey and the current statistics. II. The second section is allocated to selected studies on CEFM in Turkey. This section, where the data sources and method of the study are presented, III. includes information on the data of six TDHSs conducted since 1993. This section presents the analyses on 1993-2018 TDHSs and focuses on the changes IV. that have occurred over the time related to CEFM. The findings of the analyses are presented under the following titles: CEFM prevalence, reproductive health and rights, child health and social and cultural factors. The last section is allocated to a brief evaluation of the changes observed V. in the last 25 years based on descriptive analyses. 11  I. Background of Child, Early and Forced Marriage (CEFM)  middle-income countries, it also occurs in high-income Child, Early and Forced Marriage countries. The available data provides information mainly on the countries where standard research is conducted. While the concepts of child marriage, early marriage and In sub-Saharan Africa, 38% of women aged 20-24 were forced marriage are used interchangeably, all of these married before the age of 18. On a global scale, Niger has concepts highlight diverse dimensions of the issue. the highest proportion of marriages before the age of 18 (76%) (UNICEF, 2019b). In high-income countries, the Child marriage forced marriage aspect of the issue comes to the forefront. Religious or civil marriages where at least one of the parties is under the age of 18. CEFM is a matter of education. Child marriage leads to Early marriage interrupted education. It causes premature participation Marriages that at least one of the parties is under the in the labor force among boys and causes girls to shoulder age of 18 or marriages where parties are not equipped responsibilities of motherhood and domestic work in to give consent due their physical, emotional, sexual a period when they are not ready to take on such and psychological level of development and their lack responsibilities. It is estimated that 2.5 million children of knowledge on individuals’ life choices, despite worldwide do not continue their education. being over the age of 18. Forced marriage CEFM is a poverty and economic issue. As a mechanism Marriages in which one and/or both parties have for coping with economic problems and poverty, families not personally expressed their full and free consent opt for marrying off their children and asking for a bride to the union. price to marry off their daughters. Even though having one less person from the household and their daughters living CEFM combines these interrelated concepts. These in a more comfortable home are among the motivations, marriages occurring, during childhood, before the age the stated economic-related reasons are supported of 18, are defined as early marriages as it is unacceptable by social and cultural norms. for children to be ready and give consent in many respects. Furthermore, these marriages, which are largely decided by Due to limited educational opportunities, CEFM families, are treated as one of the forms of forced marriage, negatively affects children's participation in the labor since it is not possible for children to enter marriage with force at later ages. It reduces the adult participation of the full and free will which is essential for marriages. girls in the labor force, due to low levels of education. CEFM is violations of children's fundamental rights. CEFM hinders child development and participation Child and forced marriage hinder children's education, in social life. It causes the best interests and special limit their social, psychological, physical and cultural protection of the child to be overlooked. This issue, development, and restrict their freedom. which has been addressed in many international conventions, especially the UN Convention on the Rights CEFM is a global problem that is not limited to a of the Child, emphasizes that childhood is the most particular region and is experienced in all corners of auspicious, and thus important, period, for physical, the world. While it is more common in low-and mental, psychological, and social development. 13  CEFM is a form of discrimination against girls. These give full and informed consent" (United Nations Joint marriages, to which women and men are subjected, Programme for the Prevention of Child, Early and Forced signal gender inequality. Childhood pregnancy and Marriages, 2018). motherhood further restrict girls’ lives. Worldwide, 21% of young women aged 20-24 were married before the age CEFM is an obstacle to sustainable development. of 18. This percentage indicates that 650 million women The importance of the issue has been evaluated on were married as children, and 12 million girls enter a global scale, and the relevant criteria have been included marriage every year (UNICEF, 2019a). Even though CEFM in the 2015 to 2030 Sustainable Development Goals. The is usually addressed in terms of girls, this issue also creates prevalence of marriages occurring before the ages of 18 problems for boys. UNICEF states that 115 million men and 15 is also among the indicators related to the goals were married as children, and 23 million of them were of gender equality and the empowerment of women married before age 15 (UNICEF, 2019b). and girls. CEFM is a sexual and reproductive health problem. CEFM has been defined as a problem in international CEFM has serious adverse consequences, especially conventions and documents. This practice is contrary in terms of the sexual and reproductive health of girls. to many international conventions, starting with the Since the International Conference on Population and Universal Declaration of Human Rights, the Convention Development held in Cairo in 1994, this issue has been on the Rights of the Child, the Convention on the addressed on the basis of sexual health and reproductive Elimination of all Forms of Discrimination Against Women health rights. Adolescent pregnancies and motherhood (CEDAW), the International Conference on Population in childhood in particular carry crucial risks for maternal and Development held in Cairo, the Beijing Fourth World mortality and the health of the infants of child mothers. Conference on Women, and the Istanbul Convention. CEFM is forms of gender-based violence. The marriage/ CEFM continues to exist through traditions ingrained marrying off of women as children results in sexual in societies. Despite the Convention on the Rights of the intercourse before reaching physiological and physical Child, which is the most widely ratified convention and maturity, unwanted pregnancies, and psychological, which draws attention to the prevention of CEFM, along physical and sexual violence. In such marriages, girls with CEDAW, CEFM is still an ongoing practice feeding face a higher risk of violence perpetrated by their on societal norms. spouse's family. Every child, early and forced marriage is caused by different CEFM is an issue of human/women trafficking. Marrying reason(s).These reasons are often intertwined and typically off girls for money is an especially important form of reinforce each other. forced marriage. As stated in the initial report of the United Nations Joint Programme on the Elimination of Child, Early and Forced Marriage, forms of forced marriage include "trafficking, traditional arranged marriages, kidnapping of girls, marriages for the purpose of obtaining citizenship, and marriages in which the victim lacks the capacity to 14  The common reasons for CEFM suggested by the literature are: Poverty and economic conditions Lack of education Gender inequality Cultural norms and, traditions Gender-based violence Conflict and crisis settings (Plan International UK, 2020) CEFM is multi-dimensional issue. Therefore, combating CEFM requires a multi- and inter-disciplinary approach that includes various disciplines such as education, health, economy, sociology and law. As mutual grounds for all related disciplines, gender equality should also be taken into consideration. 15  Global Prevalence of CEFM Age at First Marriage and CEFM in Turkey The indicator used to measure the prevalence of CEFM Marriage in Turkey is regulated according to the Turkish at the global level centers on the age criteria of such Civil Code (TCC) and the Regulation on Marriage Procedures. marriages. This indicator, accepted by UNICEF and other Since the amendment to the TCC in 2002, the legal age of international organizations, is the proportion of marriages marriage has been set as 17 for both men and women. occurring before the ages of 18 and 15 among women in the 20-24 age group. The same indicator is also used in TCC Article 124 the indicators of UNICEF, the United Nations 52 Minimum Set of Gender Indicators and the Sustainable Development “A man or a woman cannot get married until they Goals to demonstrate the prevalence of CEFM (UNICEF, reach the age of 17 years. However, a judge, in exceptional circumstances and for some very important reasons, 2005; UN, 2015; UNSD, 2019). may allow the marriage of a man or woman who has completed 16 years of age”. Sustainable Development Goal 5 Target 5.3. Following the amendments to the Regulation on Marriage “Eliminate all harmful practices, such as child, Procedures in 2003, the criteria for marriage were early and forced marriage and female genital redefined: mutilation” Indicator 5.3.1. Regulation on Marriage Procedures Article 14 “The proportion of women aged 20-24 years who were Men and women who have reached the age of eighteen married or in a union before the age of 18 or 15”. and are not put under guardianship by the court marry without the consent or permission of another: Worldwide, the proportion of marriages before the a) Men and women who have reached the age of age of 18 is slowly decreasing. In 2000, while one-third seventeen can marry with parental consent, or if there of women in the 20-24 age group entered marriage before is a guardian, with the consent of the guardian the age of 18, in 2017 this proportion declined to one in or the guardianship, five women. As a result of efforts to prevent child marriages b) Men and women who have reached the age of sixteen in the last 10 years, child marriage of 25 million girls has can marry with the approval of a judge. been prevented. This decrease occurred in South Asia, where child marriage was the most common. Within ten years, the proportion of women who were married before In Turkey, where marriage is common, a small increase in the age of 18 decreased from 49% to 30%. Today, Child the age at first marriage and a decrease in marriage under marriages are most common in sub-Saharan Africa, at 37%, the age of 18 have been observed throughout the years. according to data released by UNICEF. UNICEF states that The mean age at first marriage in the country increases if measures are not expedited, by 2030 more than 120 slowly over time. According to official statistics, which million girls are at risk of getting married before only include civil marriages, the mean age at first marriage reaching the age of 18 (UNICEF, 2019b). increased from 23.7 for women in 2010 to 24.8 in 2019. 16 Over the same period, the mean age at first marriage for Since official statistics do not cover all marriages, research men increased from 27.0 to 27.8 (TURKSTAT; 2020). results are often used for more detailed information on this topic. The Turkey Family Structure Survey and the TDHS are According to official statistics comprised only of civil the most commonly used surveys included in the Official marriages, the total proportion of women aged 16-19 in Statistics Programme. marriages declined from 26.3% to 15.9% between 2010 and 2019. In the same period, the marriages in the 16-19 age group among men declined from 3% to 1.9% (Figure 1). Figure 1. Proportion of 16-19 Age Group in First Marriage Proportion of women and men aged 16-19 in total marriages (%) TURKSTAT Source: Gender Statistics, 2019, TURKSTAT Female 26,3 Male 25,3 24,7 23,7 22,5 21,0 19,9 18,6 17,8 15,9 2,9 2,8 2,8 2,6 2,5 2,3 2,2 2,0 2,0 1,9 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 17  II. Selected Studies on CEFM in Turkey  Child, early and forced marriage, which plays a crucial role history, film and music studies have also contributed in shaping the lives of, women and girls in particular has on this issue. Even though disciplinary perspectives are gained increasing international interest in the last decade. dominant in these studies, they include information, Along with studies focusing on the causes and outcomes evaluations and interpretations of the reasons, of this issue, research by United Nations entities such as consequences, and legal dimension of this issue. the United Nations Population Fund (UNFPA), The United Nations Entity for Gender Equality and the Empowerment The often-intertwined reasons that reinforce CEFM include of Women (UN WOMEN), the International Organization for poverty, low levels of education, lack of legal regulations, Migration (IOM), the United Nations High Commissioner for violence and abuse, cultural practices and, customs and Refugees (UNHCR), the World Health Organization (WHO) traditions, along with gender inequalities and migration and, especially, the United Nations Children’s Fund (UNICEF) (Gök, 2016; Anık & Barlin, 2017; Kahraman & Şenateş, employ up-to-date data. In Turkey, public institutions, 2018). Many studies mention the choice of marrying off international organizations, universities, non-governmental girls at earlier ages as a means of coping with financial organizations and research companies generate information issues, especially among poor families. The studies also on this issue. A literature review¹ for 2000 to 2019 showed focus on the relationship between this issue and social that the number of publications on the topic increased in and cultural factors (Anık & Barlin, 2017; Boran et al., 2013; the last two years. Due to the multi-dimensional nature of Mıhçıokur et al., 2010). For instance, according to the the issue, the studies on CEFM require a multi-disciplined findings of a qualitative study conducted by Anık & Barlin approach. (2017), the issue of seeing girls as a means for economic gain is decisive in marriages decided and forced by families, Among public institutions, various directorates of the especially by the fathers. Similarly, bride price can also be T.R. Ministry of Family, Labor and Social Services (MoFLSS) traditionally important for families (Kara, 2015). While these carried out and/or supported nationwide studies that also marriages are seen as a way to mitigate the economic include information on the prevalence of CEFM. The Turkey burden, it is also mentioned that through these marriages, Family Structure Survey² conducted in 2006 and 2011, and the Study on Domestic Violence against Women³ the liability and responsibility of “honor” was transferred to conducted in 2008 and 2014 are among these studies. the other family along with the economic burden (Burcu et (MoFP, 2006; MoFP, 2011; HUIPS, 2009b; 2015). al., 2015; Kıran, 2017). Related to programmes aimed at the elimination of CEFM reinforced by the product of financial The academic studies, which increased in 2013 and are circumstances and cultural practices, some studies assert largely based on field studies, draw attention to the multi- that preventions falls short without programmes aimed dimensional nature of CEFM. The necessity of using at ending poverty (Çakmak, 2009). On the other a multidisciplined approach for this issue is one of the hand, it is mentioned that consanguinity played an common grounds for these academic studies (TÜBAKKOM, important role in child marriages and that consanguineous 2015; Gök, 2016; Anık & Barlin, 2017). While the majority marriages were very prevalent due to both economic of the studies on CEFM were carried out in the fields reasons and cultural codes (Altuntek, 2001; 2006; of sociology, health and law, other disciplines such Yüksel-Kaptanoğlu & Ergöçmen, 2012; Baykara-Krumme, as psychology, social work, economy, communication, 2016; Kahraman & Şenateş, 2018; Kayi et al., 2018). 1 In the literature review, the concepts of child marriage, early marriage and forced marriage and their combinations were used as key words. The sources were categorised according to the aim, methodology (target group, methods etc.) of the study, publication type (article, report) and academic discipline. 2 Conducted by the General Directorate of Family and Community Services affiliated with the MoFLSS, and TURKSTAT. 3 Studies conducted by Hacettepe University Institute of Population Studies with the support of the General Directorate on the Status of Women affiliated with the MoFLSS. 19  CEFM occur more prevalently among families with lower music and film bring to the forefront, justification of child levels of education and, consequently, is a hinderance to marriage by society (Çaycı, 2014; Ünal 2017). girls’ right to education, which points out that the level of education plays an important role in terms of both causes Health-related studies address this issue with a reproductive and consequences of early marriage. (Malatyalı, 2014; health rights perspective and largely focus on adolescent Yüksel & Yüksel, 2014; Edirne et al., 2010; Yüksel-Kaptanoğlu pregnancies, access of adolescent mothers to reproductive & Ergöçmen, 2012; Yavuz, 2012; Yağbasan & Tekdemir, 2017; health services, and the perspectives of healthcare personnel Boran et al., 2013; Aktepe & Atay, 2017; Ertem et al., 2008). on this issue. There are certain studies that focus on In their study focusing on the impact of families’ level of women’s mental health and the trauma caused by these education, especially fathers’ low levels of education, on marriages. The majority of studies related to the causes CEFM Yüksel-Kaptanoğlu and Ergöçmen stated that girls of adolescent pregnancies, mention the economic, social should have a minimum of secondary education for the and cultural factors that instigate adolescent pregnancies. prevention of CEFM. Supporting the rights of girls to For instance, Nasıroğlu and Semerci (2017), state that the education is one of the common recommendations issues of unemployment, not having social security and mentioned by most studies for the prevention of child living in crowded households are among the risk factors marriages and adolescent pregnancies (Edirne et al., 2010; affecting adolescent pregnancies. Furthermore, studies Yavuz, 2012; Yüksel-Kaptanoğlu & Ergöçmen, 2012; Boran also mention the social pressures created by traditional et al., 2013; Aktepe & Atay, 2017; Mıhçıokur et al, 2010; structures that force women to have children right after Kıran, 2017). marriage (Ertem et al., 2008). Family structure, a history of violence in the family or having older siblings who also had Violence and abuse, both create an environment for adolescent pregnancies are among the important factors the formation of CEFM and increase the risk of violence affecting adolescent pregnancies (Gökçe et al., 2007). as a result of these marriages (Kardam & Yüksel, 2009; It is mentioned that the age difference between spouses Güler & Küçüker, 2010; Anık & Barlin, 2017). Studies show is also an important factor affecting adolescent that women who have experienced child, early and/or pregnancies (Yavuz, 2012). forced marriage were subjected to more oppression and violence (Şen & Kavlak, 2011; HUIPS, 2015; Adalı, 2020). Studies on the relationship between adolescent pregnancies Since child marriage also brings with it the act of sexual and healthcare services, focus on the attitudes, knowledge intercourse with a child, it is an act of child abuse and and responsibilities of healthcare personnel on this issue sexual violence against children (Yüksel & Yüksel, 2014). (Yakıt & Coşkun, 2014; Aydın & Akay, 2017; Kavlak et al., Due to this abuse, violence and social exclusion faced 2018). For instance, adolescent pregnancies are linked with at very young ages, children who are married suffer from premature birth and low birth weight, and it is noted that depression, risky behavior, and suicidal tendencies the reason for these issues might be insufficient antenatal (Eyüboğlu & Eyüboğlu, 2018). birth services (Edirne et al., 2010). Şen & Kavlak (2011) highlight the importance of nursing care for adolescent Studies on CEFM highlight that customs and traditions, pregnancies and touch upon the importance of cultural practices and imposed gender roles influence CEFM improvements in adolescent mothers’ levels of knowledge and violate children’s fundamental rights (Gök, 2016; Kıran, about pregnancy and infant care, along with the 2017; Anık & Barlin, 2017; Kahraman & Şenateş, 2018). improvements in the quality of services provided before, Although in limited numbers, certain studies in literature, during and after births. Child mothers’ lack of information 20 both on reproductive health and childcare creates a negative a specific region (Yüksel-Kaptanoğlu & Ergöçmen, 2012; impact on infants in cases of adolescent pregnancy. The risk Köse, 2014; Anık & Barlin, 2017; Wringe et al., 2019). of mortality for women and children increases in pregnancies before the age of 18 (Edirne et al., 2010; Şen & Kavlak, 2011; The fact that CEFM is common among girls and women Boran et al, 2013; Ertem et al., 2008). A study conducted that arrived in Turkey from Syria after 2011 has increased among Kurdish-speaking women in the Southeastern the number of studies in this area that focus on the migrants. Anatolia Region highlight the importance of the healthcare These studies suggest that families regarded marrying off professionals raising awareness on the negative effects of their daughters as a source of income; the girls can be CEFM (Ertem & Koçtürk, 2008). Yavuz (2012) stress the married off as second wives through religious marriage significance of establishing reproductive-health related and are forced to be sex workers. Moreover, access to health programmes aimed at spouses. services, as well as children’s and women’s rights are also covered along with the prevalence of CEFM and reproductive It is also mentioned that the lack of information, especially health services (TTB, 2014; Süt, 2017; Şenol & Dinç, 2017; in terms of reproductive health, family planning and use of Ördek, 2017; Şimşek et al., 2018, Yücel et al., 2018; Çelik & contraceptive methods, poses a risk for sexually transmitted Vural, 2018; Wringe et al., 2019; MAZLUMDER, 2014; infections (Yavuz, 2012; Özcebe et al., 2013; Uslu, 2018). In Badael Foundation, 2019). addition to the risk factors for reproductive health, sexual intercourse at very early ages result in psychological Studies by non-governmental organizations, on the other problems for girls whose mental and physical development hand, cover the issue from the perspective of the violation is not yet complete (Soylu et al., 2014; Koçtürk & Bilginer, of children’s, women’s and human rights (Flying Broom, 2019). Child marriages render children vulnerable to all 2010; UNICEF, 2011; Göç Vakfı, 2012; Göç Vakfı, 2013, kinds of abuse and lay a great deal of responsibility on Demirdirek & Şener, 2014; Güney et al., 2014; Göç ve İnsani the shoulders of children and adolescents (Aktepe & Atay, Yardım Vakfı, 2015; KAMER Foundation, 2016; Çocuk Vakfı, 2017; Anık & Barlin, 2017). Therefore, some studies aim to 2016; Rittersberger-Tılıç & Çelik, 2016; Damarlı & Kuyucu, identify psychological problems caused by early marriage 2017; Arkadaş-Thibert et al., 2017; Sakallı et al., 2017; and adolescent pregnancies, as well as to offer solutions to UNICEF, 2018). these problems. For instance, Yağbasan and Tekdemir (2017) focus on the mother-child relationship among women who The nationally representative TDHSs conducted with have experienced child marriage and adolescent pregnancies five-year intervals are among the studies that produce and mention the problems and difficulties caused by the data on this issue (HUIPS; 1994, 1999, 2004, 2009a, 2014, responsibility of becoming mothers as children. 2019a). This study includes analyses that are based on TDHS data. CEFM, which increases with low levels of education and poverty, vary according to regions and rural areas. Many studies showed that CEFM is more common in the Eastern and Southeastern regions of Turkey (Orçan & Kar, 2008; Dağdelen, 2011; KAMER Foundation, 2016; Yağbasan & Tekdemir, 2017; Altay, 2017; Subaşı-Kırıkçı, 2018; Boğucu, 2018; Kahraman & Şenateş, 2018). However, there are also studies which illustrate that this issue is not limited to 21  III. Data Sources and Method In this study, the current status of CEFM in Turkey and These internationally comparable cross-sectional changes over the years are presented through analyses surveys demonstrate trends over time. With these of TDHS data. Since 1968, Hacettepe University’s Institute household-based surveys, information is collected of Population Studies (HUIPS) carried out 11 nationally through face-to-face interviews from women of representative demographic surveys with five-year reproductive age (15-49 years) on fertility, infant and intervals. The TDHSs conducted since 1993, are in line child mortality, contraceptive methods, immunization with the standards of the Demographic and Health and, antenatal and postnatal care, as well as women’s Survey (DHS⁴) Programme. Since 1984, the DHS socio-demographic characteristics and marriage. Programme has provided technical support to more than 400 surveys in over 90 countries for advancing the global The TDHSs are rich data sources for CEFM through understanding of health and population-related changes modules with country-specific expansions, such as in developing countries. The technical assistance of the marriage history and work history. Since in TDHS, the DHS Programme consists of data quality control and definition of marriage also includes religious marriage contribution to analyses. The DHS Programme has a and people who live together without a formal union, worldwide reputation for collecting and disseminating along with civil marriage, comprehensive information nationally representative, accurate data on fertility, family is collected on marital issues. planning, maternal and child health, gender, HIV/AIDS, malaria, and nutrition. 4 The DHS Program, https://dhsprogram.com/Who-We-Are/About-Us.cfm 23  (QRE) were used for women in the 15-49 age group. Data Sources The husband questionnaire was used for the women’s husbands only in the 1998 survey. The woman QRE was This study used data from surveys conducted by HUIPS comprised of modules on women’s basic characteristics, between 1993 and 2018 with five-year intervals , namely migration history, pregnancy, birth history and fertility 1993-TDHS, 1998-TDHS, 2003-TDHS, 2008-TDHS, preferences, antenatal and postnatal care, breast feeding 2013-TDHS and 2018-TDHS. Information on the sample and nutrition, immunization, marriage history, husband’s size, design, estimation domains and questionnaires background, women’s status, and anthropometric data are presented in Table 1 (HUIPS, 1994; 1999; 2004; of women and children. As part of 2018-TDHS, a separate 2009a; 2014; 2019a). field study was conducted for Syrian migrant women In these household-based surveys, a household (HH) using the same questionnaires, and a report was questionnaire, and an individual (woman) questionnaire prepared (HUIPS; 2019b). Table 1. TDHS Information, 1993-2018 1993-TDHS 1998-TDHS 2003-TDHS 2008-TDHS 2013-TDHS 2018-TDHS 8,619 HH 8,059 HH 10,836 HH 10,525 HH, 11,794 HH 11,056 HH Sample 6,519 women 8,576 women 8,075 women 7,405 women 9,746 women 7,346 women Size 1,971 men (husbands) Weighted, Weighted, Weighted, Weighted, Weighted, Weighted, Sample multi-stage multi-stage multi-stage multi-stage multi-stage multi-stage Design stratified, stratified, stratified, stratified, stratified, stratified, cluster cluster cluster cluster cluster cluster sampling sampling sampling sampling sampling sampling Turkey, Turkey, Turkey, Turkey, Turkey, Turkey, Estimation Urban/rural Urban/rural Urban/rural Urban/rural Urban/rural Urban/rural **** Domains Five Five regions* Five regions* Five regions* Five regions* 5 regions * regions* NUTS 1 NUTS 1 Regions** NUTS 1 Regions* NUTS 1 ** Regions** 7 largest * 7 largest metropolitan metropolitan cities*** cities*** HH QRE, HH QRE, HH QRE, HH QRE HH QRE, HH QRE, Questionnaires Individual Individual Individual Individual Individual Woman’s QRE QRE (ever-married QRE (ever-married QRE (ever-married QRE (ever-married QRE (ever-and (all ever-married women of 15-49 women, never-married women of 15-49 women of 15-49 never-married and never-married age) women of 15-49 age) age) age) women of 15-49 in 15-49 age Male QRE (husbands) age) group) * West, South, Central, North, and East regions, ** The 12 Nomenclature of Territorial Units for Statistics. Estimations were presented for selected indicators with a sufficient number of observations. *** Metropolitan cities with population above one million: Istanbul, Ankara, Izmir, Bursa, Adana, Konya, and Gaziantep **** Due to administrative naming changes, the urban/rural division was defined as a survey variable considering the former administrative status and population size of each cluster. 24  For the examination of CEFM patterns, the categories Method of existing variables were restructured, and new variables were created. All percentages were calculated considering In this study, the data from six TDHSs conducted over the the complex sample design. In the tables, the percentages last 25 years were analyzed descriptively in terms of CEFM. are weighted, whereas the number of observations is Marriages of women in the 20-24 age group before the unweighted. The last two columns of the tables comprised ages of 18 and 15 are usually used in the measurement of the 2018-TDHS include the values for all women of CEFM. The age of 18, which is considered the end of to facilitate the comparison of age groups. childhood, and the age of 15, which is set as the start of the reproductive ages due to increased health risks, are the Despite the multi-dimensional nature of CEFM, the analysis criteria for age at marriage used in these measurements. of these study is limited to the data related to CEFM in Many international organizations, especially UNICEF, focus TDHS. Within this context, for the prevalence of CEFM, the on the marriage of women in the 20-24 age groups which analyses focus on reproductive health and rights and, child provides information on recent marriages to reflect the health, as well as social and cultural factors that include current status of CEFM. Along with recent marriages, the the characteristics of women and their marriage. Under prevalence of CEFM can also be discussed for wider age the social and cultural factors, the relationship between groups to provide information on the previous periods. CEFM and basic characteristics of women, premarital characteristics, formation of first marriage, spousal This study focuses on the descriptive analysis of marriages relationships, gender equality, attitudes towards before the age of 18 in the 20-24 age group using the data marriage and physical violence are analyzed. from the last 6 TDHSs, conducted between 1993 and 2018, which shows change through the years cross-sectionally. The analysis of 2018-TDHS, the latest survey, also includes marriages before the ages of 18 and 15 in the 20-49 age group along with the 20-24 age group. The figures display change over the years cross-sectionally in the characteristics of women who married before the age of 18 in the 20-24 age group, whereas the tables include descriptive analysis both for the 20-24 and 20-49 age groups. The data analysis on women married before the age of 15 is provided solely for the 20-49 age group without the 20-24 age group due to a low number of observations. 25  IV. Child, Early and Forced Marriage  In the last 40 years, there has been a decline in the CEFM Prevalence in Turkey prevalence of marriage before the ages of 15 and 18 in all age groups. However, data from the last two surveys In Turkey, the change in the prevalence of CEFM was did not follow this downward trend. calculated cross-sectionally for the last 40 years using the data from 11 demographic surveys conducted since 1978. In 2018-TDHS, among women aged 20-24 at the time Figures 2 and 3 show the prevalence of marriage before the of the survey who married before the ages of 15 and 18, ages of 15 and 18 among women of reproductive ages. The the prevalence of marriage before age 18 was 14.7%, findings show that, in the 40-year period, the prevalence of and the prevalence of marriage before age 15 was 2.0%. marriage before age 15 among women aged 20-24 As expected, marriage during childhood was more prevalent declined from 10% to 2% (Figure 2). Similarly, while 41% among women in the 20-49 age group. Among women of women aged 20-24 married before age 18 in 1978, in this age group, the prevalence of marriage before 18 this proportion was 15% in 2018 (Figure 3). and 15 was 19.9% and 3.6%, respectively. Figure 2. Prevalence of Marriage Before Age 15 Women at reproductive ages by five-year age groups (%) HUIPS Source: HUIPS Demographic Surveys (HUIPS, 1980; 1987; 1989; 1994; 1994; 2009a; 2014; 2019a) 25 15-19 20-24 20 25-29 15 30-34 35-39 10 40-44 5 45-49 0 1978 1983 1988 1993 1998 2003 2008 2013 2018 Figure 3. Prevalence of Marriage Before Age 18 Women at reproductive ages by five-year age groups (%) HUIPS Source: HUIPS Demographic Surveys (HUIPS, 1980; 1987; 1989; 1994; 1994; 2009a; 2014; 2019a) 70 60 20-24 50 25-29 40 30-34 35-39 30 40-44 20 45-49 10 0 1978 1983 1988 1993 1998 2003 2008 2013 2018 27  Figure 4. CEFM Prevalence by Place of Residence (%) 1993-2018-TDHS Within the scope of 2018-TDHS, a separate field study was Rural Urban carried out with the Syrian Migrant Sample. Accordingly, interviews were conducted with 2,216 Syrian migrant 30 women aged 15-49 in 1,826 Syrian migrant households. 27 In the 2018-TDHS Syrian Migrant Sample carried out with 22 22 the same questionnaire, the prevalence of CEFM calculated 17 21 17 using the marriage-related data on Syrian⁵ migrant women 19 shows that Syrian migrant women are more prevalently 17 13 13 14 subjected to child marriage (HUIPS, 2019b). According to 1993-TDHS 1998-TDHS 2008-TDHS 2013-TDHS 2013-TDHS 2018-TDHS the 2018-TDHS Syrian Migrant Sample, among Syrian migrant women aged 20-24, the proportion of marriage before age 18 was 44.8% and the proportion of marriage fluctuations have been observed, especially in rural areas. before age 15 was 9.2%. It is observed that among women living in rural areas, the proportion of women aged 20-24 who married before age The place of residence (urban/rural), region and wealth 18 is still at high levels (Figure 4). index of women married as a result of CEFM were analyzed. Regional information was provided according to two Regions definitions: Five regions refer to the conventional regions Even though CEFM began to decline starting in 1993, used in TDHSs, 12 regions refer to the Nomenclature of this downward trend did not continue in every region Territorial Units for Statistics (NUTS-1) regions inTURKSTAT’s after 2008. Among five regions, the most consistent decline in the proportion of child marriage among women aged Classification of Statistical Units. Wealth index is an indicator 20-24 was observed in the North, with proportions falling of the economic level calculated based on the durable from 21% in 1993 to 5% in 2018. On the other hand, the goods owned by the households (Annex Table 1). declining trend in the East and the South, which initially Place of Residence had higher CEFM, slowed and, in fact, CEFM proportions are increasing in both of these regions (Figure 5). It is seen that, in the last 25-year period starting in the 1990s, the prevalence of marriage before age 18 in rural For 12 regions, there are also regional differences in terms and urban areas followed a declining trend. Over the years, of CEFM. There has been an increase in West Marmara, Figure 5. CEFM Prevalence by 5 Regions (%) 1993-2018-TDHS 1993-TDHS 1998-TDHS 2003-TDHS 32 33 28 2008-TDHS 25 26 25 20 21 20 20 2013-TDHS 19 19 19 18 16 17 16 16 15 17 17 14 14 2018-TDHS 12 11 12 10 10 6 5 West South Central North East 5 For CEFM analyses carried out using data collected from 2018-TDHS Syrian Migrant Sample see Yüksel-Kaptanoğlu and Dayan, 2020. 28 Figure 6. CEFM Prevalence by 12 Regions (%) 2003-2018-TDHS 23 2003-TDHS 18 18 19 15 15 14 15 16 16 14 16 2008-TDHS 13 12 12 12 12 13 12 10 11 2013-TDHS 9 6 7 2018-TDHS Istanbul West Marmara Aegean East Marmara West Anatolia Mediterranean 28 24 23 20 19 22 20 20 20 21 18 18 16 17 16 16 14 14 11 12 9 6 7 6 Central Anatolia West Black Sea East Black Sea Northeast Anatolia Central East Anatolia Southwest Anatolia Aegean, Mediterranean and Southeast Anatolia, especially Wealth Level after 2008. For instance, the prevalence of CEFM, which There is a negative relationship between CEFM and wealth was 6% in 2013, doubled in 2018. While child marriage level. Women aged 20-24 who married before age 18 live of young women aged 20-24 increased slightly in Istanbul, in the poorest wealth level households. With a fixed it remained stable in Central Anatolia. In other regions, pattern, the prevalence of CEFM decreases with increasing the declining trend continued over the years (Figure 6). wealth level. Thirty-six percent of women living in the poorest households and 7% of women living in the richest According to the 2018-TDHS data, the prevalence of CEFM households married before age 18. As a striking point, is the highest among women in Southeast Anatolia, at 23%. there has been a marked increase in the prevalence of This region is followed by Mediterranean (19%), Central CEFM among women living in the poorest households in Anatolia (18%) and Northeast Anatolia (17%). CEFM is the 2018-TDHS (Figure 7). lowest in the West Black Sea region, at 6% (Figure 7). Figure 7. CEFM Prevalence by Wealth Index (%) 1998-2018-TDHS 39 1998-TDHS 36 30 2003-TDHS 27 25 27 25 2008-TDHS 22 23 22 16 20 19 19 17 17 2013-TDHS 14 10 2018-TDHS 9 7 6 7 7 4 4 Poorest Poorer Middle Richer Richest 29  group who married before age 18 have no knowledge Reproductive Health and Rights about the fertile period. One of the crucial consequences of child marriage is child Talking about Family Planning pregnancies. Regarding reproductive health and rights, the It is understood that, similarly to the knowledge about the knowledge of women who married as children about the fertile period, talking with someone about family planning fertile period, as well as their knowledge and use of is also not common. While 71% of women in the 20-24 age contraceptive methods were examined (Annex Table 2). group stated that they did not talk with someone about family planning, this proportion increaseds to 79% for Accurate Knowledge about the Fertile Period women who married as children (Annex Table 2). Women’s knowledge about the fertile period reflects their level of knowledge about sexuality. While the study Use of Contraceptive Methods findings show that the proportion of women with Regarding fertility regulation, the pattern of contraceptive knowledge about the fertile period increased over the use among women in the 20-24 age group who married years, it is seen that, from 1993 to 2018, only one fourth before age 18 changes over time. For the same age group of women had information on this issue (Figure 8). between the years 1993 and 2008, there was a downward The majority (76%) of the women in the 20-24 age trend for the proportion of women married as children who Figure 8. Accurate Knowledge of the Fertile Period Women aged 20-24 who married before age 18 (%) 1993-2018-TDHS 83 86 82 84 78 76 22 24 Yes 17 14 18 16 No 1993-TDHS 1998-TDHS 2003-TDHS 2008-TDHS 2013-TDHS 2018-TDHS Figure 9. Use of any Contraceptive Method Women aged 20-24 who married before age 18 (%) 1993-2018-TDHS 79 73 65 64 1993-TDHS 56 55 1998-TDHS 27 24 24 2003-TDHS 21 21 10 9 10 17 12 17 15 2008-TDHS 2013-TDHS 2018-TDHS No method Traditional method Modern method 30 never used a contraceptive method, while this situation contraceptive methods reached the level observed in 1993. changed after 2008. According to the findings of 2018- Relatedly, the proportions of both traditional and modern TDHS, one out of five women who suffered CEFM never method use dropped to the 1993 level (Figure 11). used a contraceptive method. Relatedly, the increase in the use of modern contraceptive methods such as female On the other hand, contraceptive method use among sterilization, intrauterine device (IUD),diaphragm/foam/jelly women married before ages 15 and 18 is higher than the contraceptive method use of all women in both of the age slowed after 2008 and decreased to 64% in 2018. A similar groups. For instance, while 39% of women in the 20-49 age pattern can also be observed for traditional methods which group use modern methods, 47% of women in the same consists mainly of withdrawal (Figure 9). age group who married before the age of 18 and 48% of Furthermore, in 2018-TDHS, among women in the 20-24 women married before the age of 15 use modern methods. age group, the proportion of modern method use is 25%, Similarly, while 14% of women in the 20-24 age group use and the proportion of traditional method use is 7%. This modern contraceptive methods, it is 32% among women proportion is 64% and 15%, respectively, among women who married before the age of 18 (Annex Table 2). in the same age group who married before age 18. There In TDHSs, women who use modern or traditional methods is a similar pattern for women in the 20-49 age group are asked whether they prefer another method. While the who married as children (Annex Table 2). proportion of women preferring another method decreased Among women married as children who used any method, in the last 25 years, one fourth of women in the 20-24 age group who married before age 18 stated that they wanted the proportion of those who used modern methods first to change the method. followed a downward trend between 2008 and 2018 (Figure 10). At the time of the survey, the findings on the Knowledge of Source of Supply current use of contraceptive methods demonstrate that for Contraceptive Methods in the last survey the non-use of contraceptive methods In TDHSs women who never used any method or who use increased significantly. For the first time in 25 years, with traditional methods were asked whether they knew any almost half of the women (47%) in the 20-24 age group who supply source for contraceptive methods. The level of married before the age of 18, the proportions of non-use of knowledge about supply sources for any method increased Figure 10. First Contraceptive Method Use Figure 11. Currently Used Contraceptive Method Women aged 20-24 who married before age 18 (%) 1993-2018-TDHS Women aged 20-24 who married before age 18 (%) 1993-2018-TDHS 1993-TDHS 1993-TDHS 1998-TDHS 2003-TDHS 1998-TDHS 2008-TDHS 2013-TDHS 2018-TDHS 2008-TDHS 2013-TDHS 61 62 59 58 54 2018-TDHS 48 44 43 46 47 39 38 41 40 34 33 36 31 31 34 35 36 32 28 21 22 24 21 Modern method Traditional method No method Traditional method Modern method 31  Figure 12. Knowledge of Source of Supply for Contraceptive Methods Women aged 20-24 who married before age 18 (%) 71 87 77 91 84 13 23 16 29 Yes 9 No 1993-TDHS 1998-TDHS 2008-TDHS 2013-TDHS 2018-TDHS between 1993 and 2008 and decreased after 2008 (Figure 12). 20-24 declined from 15% to 6% between 1993-2013, According to 2018-TDHS, one-fourth of women who did not it increased to 12% in 2018-TDHS (HUIPS, 2019a). use modern methods in the 20-24 age group did not have While there is a similar pattern for women aged 20-24 information on this issue. Among women in the 20-24 age who married before age 18, the unmet need for family group who married before age 18, the proportion planning of these women has always been higher than source of supply for any method was 29%. women aged 15-49, except in 2003. Figure 14 shows that, over the years, the unmet need for family planning Unmet Need for Family Planning declined from 21% in 1993 and that between 2003-2013 Unmet need for family planning is defined as the the unmet need for spacing and limiting the childbearing “proportion of women who (1) are not pregnant