Variables that explain variation in prenatal care in turkey; social class, education and ethnicity re-visited

The extent and quality of prenatal care are important for the health of women and their babies. Recent studies suggest that women lack adequate prenatal care in contemporary Turkey. This paper uses regression models to examine the major factors impacting on the access of women to prenatal care through the 1993 Turkish Demographic and Health Survey. The findings suggest that after controlling for class, ethnicity does not explain the likelihood of a woman's access to prenatal care, partly because the predominant patriarchal ideology in Turkey determines women's access to education, which in turn determines their access to prenatal care. It can be argued that unless women's socioeconomic status in the family improves, their access to health care in general and prenatal care in particular will not increase significantly

Space, Agency and Withdrawal: Birth Control Choices of Women in Turkey

Cataloged from PDF version of article.Withdrawal (WD) is not a reliable method for preventing unwanted pregnancies, yet it is still a very popular form of birth control in many societies, including Turkey. We look at the relationship between women's agency and physical space in relation to birth control choices of women in Turkey. Agency in our context refers to a woman's ability to resist domination and subordination to the patriarchal beliefs valuing her reproductivity over her pleasure. Our analysis of the Turkish Demographic Health Survey (TDHS) suggests that (a) the available space in the household for possible private encounters between husband and wife, and (b) the women's capacity to insert her agency into her life choices are closely correlated with WD choices. Women with better social and physical resources prefer WD less

Determinants of choosing withdrawal over modern contraceptive methods in Turkey

Objectives The determinants of the use of withdrawal in Turkey are examined using a multinomial logistic model. Methods Data were drawn from a nation-wide population-based cross-sectional study, the Turkish Demographic Health Surveys that took place in 1998 and 2003. Detailed interviews were conducted with 8576 women aged 15-49 and analysed using SPSS. Results Contextual, cultural and demographic characteristics define women's choice of withdrawal over modern methods. Socio-economic status, education, employment status, and past fertility behaviour are among key determinants. First-ever used contraception method has a very strong impact on later choices. Urban women, the more educated, those with better socioeconomic status, and those living in less crowded households resort less to withdrawal. Experience and empowerment positively linked to modern contraceptive use among women in Turkey. Conclusions The use of contraceptive methods in Turkey differs greatly. Empowerment of women in terms of better socioeconomic status, better education, modern and liberal attitudes towards women and family planning seem to reduce withdrawal use as the main method of contraception. The results suggest the need for education (particularly targeting young women and couples), information and provision of modern contraceptive services particularly for disadvantaged groups

Inter-regional migration and intermarriage among Kurds in Turkey

This study examines interregional migration and intermarriage of internal migrant Kurds in Turkey using the latest available census data. Unlike many other studies, birth region is used as a proxy of ethnicity due to the apparent language shift among the Kurds in Turkey. To ensure comparability, only regions where both Turkish and Kurdish populations co-exist are selected for analysis of intermarriage. Analysis of language shift is based on the 2003 Turkish Demographic Health Survey data to ensure temporal comparability with the 2000 Census. Variables used for tabulation are sex, age group, region of residence and educational attainment. As prevalence of intermarriage remains rather constant within each education category, the increase in intermarriage of Kurds to non-Kurds at the aggregate level appears to be a product of rising education. Also the gender gap in favour of males appears to be a construct of differences in educational attainment levels, since Kurdish women out-marry more than their male co- ethnics once they have completed primary education or studied further. A similar picture is also observed among Turks, as the majority, intermarrying to Kurds in Turkey. The findings are in line with the modernization theory as opposed to the exchange theory

Barriers for highly qualified A8 immigrants in the UK labour market

The number of migrants arriving in the UK from the EU accession countries has been higher than projected. The evidence indicates that they have been over-represented in low-paid and low-skilled jobs. This is arguably transitory and there should be good prospects of upward mobility. Over-qualification among A8 migrants, measured using the Annual Population Survey data, is examined in this article. The findings show that A8 migrants have been subject to migration penalties at the high end of the UK labour market. There are persistent labour market disadvantages for A8 migrants in the UK and their over-qualification may be a long-term concern

The ethnic question in an environment of insecurity: The Kurds in Turkey

This article examines the effect that a poor structural context, what we term an 'environment of insecurity', has on the Kurdish ethnic nationalist mobilization in Turkey. The empirical evidence for this analysis is based on data from the 1993 Turkish Demographic and Health Survey [TDHS]. The data provide, to the best of our knowledge, the first reliable and representative figures on the situation of Kurds in Turkey. Our key claim is that the Kurdish population in Turkey is relatively much worse off than the Turkish population in the country. This claim is strongly supported by the data. Many other factors also account for the ethnic nationalist mobilization, but we argue that the Turkish Kurds' environment of insecurity, materially and non-materially, stands out as a key package of both causal and intermediate variables behind the ethnic revival

Effects on heavy menstrual bleeding and pregnancy of uterine artery embolization (UAE) or myomectomy for women with uterine fibroids wishing to avoid hysterectomy: The FEMME randomized controlled trial.

OBJECTIVE: To determine treatment options (myomectomy vs. uterine artery embolization (UAE)) for women wishing to avoid hysterectomy. METHODS: A multicenter randomized controlled trial was conducted on 254 women and data were collected on fibroid-specific quality of life (UFS-QOL), loss of menstrual blood, and pregnancy. RESULTS: At 4 years, the mean difference in the UFS-QOL was 5.0 points (95% confidence interval (CI) -1.4 to 11.5; P = 0.13) in favor of myomectomy. This was not statistically significant as it was at 2 years. There were no differences in bleeding scores, rates of amenorrhea, or heavy bleeding. Of those who were still menstruating, the majority reported regular or fairly regular periods: 36 of 48 (75%) in the UAE group and 30 of 39 (77%) in the myomectomy group. Twelve women after UAE and six women after myomectomy became pregnant (4 years) with seven and five live births, respectively (hazard ratio 0.48, 95% CI 0.18-1.28). There was no difference between the levels of hormones associated with the uterine reserve in each group. CONCLUSION: Leiomyoma are common in reproductive-aged women, causing heavy menses and subfertility. Among women with uterine fibroids, myomectomy resulted in better fibroid-related quality of life at 4 years, compared with UAE but the treatments decreased menstrual bleeding equally. There was also no significant difference in the impact of treatment on ovarian reserve

Uterine artery embolisation versus myomectomy for premenopausal women with uterine fibroids wishing to avoid hysterectomy: the FEMME RCT.

BACKGROUND: Uterine fibroids are the most common tumour in women of reproductive age and are associated with heavy menstrual bleeding, abdominal discomfort, subfertility and reduced quality of life. For women wishing to retain their uterus and who do not respond to medical treatment, myomectomy and uterine artery embolisation are therapeutic options. OBJECTIVES: We examined the clinical effectiveness and cost-effectiveness of uterine artery embolisation compared with myomectomy in the treatment of symptomatic fibroids. DESIGN: A multicentre, open, randomised trial with a parallel economic evaluation. SETTING: Twenty-nine UK hospitals. PARTICIPANTS: Premenopausal women who had symptomatic uterine fibroids amenable to myomectomy or uterine artery embolisation were recruited. Women were excluded if they had significant adenomyosis, any malignancy or pelvic inflammatory disease or if they had already had a previous open myomectomy or uterine artery embolisation. INTERVENTIONS: Participants were randomised to myomectomy or embolisation in a 1 : 1 ratio using a minimisation algorithm. Myomectomy could be open abdominal, laparoscopic or hysteroscopic. Embolisation of the uterine arteries was performed under fluoroscopic guidance. MAIN OUTCOME MEASURES: The primary outcome was the Uterine Fibroid Symptom Quality of Life questionnaire (with scores ranging from 0 to 100 and a higher score indicating better quality of life) at 2 years, adjusted for baseline score. The economic evaluation estimated quality-adjusted life-years (derived from EuroQol-5 Dimensions, three-level version, and costs from the NHS perspective). RESULTS: A total of 254 women were randomised - 127 to myomectomy (105 underwent myomectomy) and 127 to uterine artery embolisation (98 underwent embolisation). Information on the primary outcome at 2 years was available for 81% (n = 206) of women. Primary outcome scores at 2 years were 84.6 (standard deviation 21.5) in the myomectomy group and 80.0 (standard deviation 22.0) in the uterine artery embolisation group (intention-to-treat complete-case analysis mean adjusted difference 8.0, 95% confidence interval 1.8 to 14.1, p = 0.01; mean adjusted difference using multiple imputation for missing responses 6.5, 95% confidence interval 1.1 to 11.9). The mean difference in the primary outcome at the 4-year follow-up time point was 5.0 (95% CI -1.4 to 11.5; p = 0.13) in favour of myomectomy. Perioperative and postoperative complications from all initial procedures occurred in similar percentages of women in both groups (29% in the myomectomy group vs. 24% in the UAE group). Twelve women in the uterine embolisation group and six women in the myomectomy group reported pregnancies over 4 years, resulting in seven and five live births, respectively (hazard ratio 0.48, 95% confidence interval 0.18 to 1.28). Over a 2-year time horizon, uterine artery embolisation was associated with higher costs than myomectomy (mean cost £7958, 95% confidence interval £6304 to £9612, vs. mean cost £7314, 95% confidence interval £5854 to £8773), but with fewer quality-adjusted life-years gained (0.74, 95% confidence interval 0.70 to 0.78, vs. 0.83, 95% confidence interval 0.79 to 0.87). The differences in costs (difference £645, 95% confidence interval -£1381 to £2580) and quality-adjusted life-years (difference -0.09, 95% confidence interval -0.11 to -0.04) were small. Similar results were observed over the 4-year time horizon. At a threshold of willingness to pay for a gain of 1 QALY of £20,000, the probability of myomectomy being cost-effective is 98% at 2 years and 96% at 4 years. LIMITATIONS: There were a substantial number of women who were not recruited because of their preference for a particular treatment option. CONCLUSIONS: Among women with symptomatic uterine fibroids, myomectomy resulted in greater improvement in quality of life than did uterine artery embolisation. The differences in costs and quality-adjusted life-years are very small. Future research should involve women who are desiring pregnancy. TRIAL REGISTRATION: This trial is registered as ISRCTN70772394. FUNDING: This study was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme, and will be published in full in Health Technology Assessment; Vol. 26, No. 22. See the NIHR Journals Library website for further project information

Uterine-Artery Embolization or Myomectomy for Uterine Fibroids.

BACKGROUND: Uterine fibroids, the most common type of tumor among women of reproductive age, are associated with heavy menstrual bleeding, abdominal discomfort, subfertility, and a reduced quality of life. For women who wish to preserve their uterus and who have not had a response to medical treatment, myomectomy and uterine-artery embolization are therapeutic options. METHODS: We conducted a multicenter, randomized, open-label trial to evaluate myomectomy, as compared with uterine-artery embolization, in women who had symptomatic uterine fibroids and did not want to undergo hysterectomy. Procedural options included open abdominal, laparoscopic, or hysteroscopic myomectomy. The primary outcome was fibroid-related quality of life, as assessed by the score on the health-related quality-of-life domain of the Uterine Fibroid Symptom and Quality of Life (UFS-QOL) questionnaire (scores range from 0 to 100, with higher scores indicating a better quality of life) at 2 years; adjustment was made for the baseline score. RESULTS: A total of 254 women, recruited at 29 hospitals in the United Kingdom, were randomly assigned: 127 to the myomectomy group (of whom 105 underwent myomectomy) and 127 to the uterine-artery embolization group (of whom 98 underwent embolization). Data on the primary outcome were available for 206 women (81%). In the intention-to-treat analysis, the mean (±SD) score on the health-related quality-of-life domain of the UFS-QOL questionnaire at 2 years was 84.6±21.5 in the myomectomy group and 80.0±22.0 in the uterine-artery embolization group (mean adjusted difference with complete case analysis, 8.0 points; 95% confidence interval [CI], 1.8 to 14.1; P = 0.01; mean adjusted difference with missing responses imputed, 6.5 points; 95% CI, 1.1 to 11.9). Perioperative and postoperative complications from all initial procedures, irrespective of adherence to the assigned procedure, occurred in 29% of the women in the myomectomy group and in 24% of the women in the uterine-artery embolization group. CONCLUSIONS: Among women with symptomatic uterine fibroids, those who underwent myomectomy had a better fibroid-related quality of life at 2 years than those who underwent uterine-artery embolization. (Funded by the National Institute for Health Research Health Technology Assessment program; FEMME Current Controlled Trials number, ISRCTN70772394.)

Imagination, Hope and the Migrant Journey : Iraqi Asylum Seekers Looking for a Future in Europe

Europe received an unprecedented number of asylum seekers in 2015. This article examines Iraqi asylum seekers who journeyed through Europe in search of an idealized version of Finland, which they had imagined based on word-of-mouth and social media information. Through cognitive migration, the act of pre-experiencing futures in different locations, Finland was seen to offer both subjective hope of personal growth and advancement and objective hope of safety and physical security. This hope motivated them to embark on a journey of 6,000 kilometers to the European North. Based on interview data and relevant studies, the article concludes that hope of a better, imagined future abroad acts as a powerful magnet for persons with poor prospects in their countries of origin. Hope is a kind of critical emotion strongly shaped by beliefs and real-time opportunities; and as such, beliefs are notoriously difficult to change. Imagination, therefore, should not be overlooked when planning and implementing migration policies.Europe received an unprecedented number of asylum seekers in 2015. This article examines Iraqi asylum seekers who journeyed through Europe in search of an idealized version of Finland, which they had imagined based on word-of-mouth and social media information. Through cognitive migration, the act of pre-experiencing futures in different locations, Finland was seen to offer both subjective hope of personal growth and advancement and objective hope of safety and physical security. This hope motivated them to embark on a journey of 6,000 kilometers to the European North. Based on interview data and relevant studies, the article concludes that hope of a better, imagined future abroad acts as a powerful magnet for persons with poor prospects in their countries of origin. Hope is a kind of critical emotion strongly shaped by beliefs and real-time opportunities; and as such, beliefs are notoriously difficult to change. Imagination, therefore, should not be overlooked when planning and implementing migration policies.Peer reviewe