Indicators of Target 5

13. Under-Five Mortality Rate

14. Infant Mortality Rate

15. Ratio of One-Year-Old Children Fully Immunized Against Measles

Status and Trends

Indicators related to child mortality are commonly used for all international development measures. Within the scope of the Millennium Development Goals, three indicators were chosen to monitor child mortality and child health: the mortality rate in under-fives, the infant mortality rate and the proportion of one-year-old children immunized against measles.

Target 5: Reduce by Two-Thirds, Between 1990 and 2015, the Mortality Rate of Children Under Five Years of Age

Indicator 13: The Under-Five Mortality Rate per 1,000 Live Births

Indicator 14: Infant Mortality Rate

Based on the results of the 2003 Turkey Demographic and Health Survey (TDHS), infant and child mortality rates in Turkey were determined as 29 and 37 per 1,000, respectively. These rates reflect the continuity of the improvements since the 1990s in the child mortality trend in Turkey. When compared to the results of the 1998 Turkey Demographic and Health Survey, an improvement of 33% has been observed in infant mortalities and 29% in under-fives.

Table 12: Infant and Under-Five Mortality Rates

Source: HUIPS, TDHS 2003

The mortality rates in both infants and the under fives are high, although a significant decrease was has been observed within the last 13 years. This decline suggests that both the birth and living conditions of children have been improving in Turkey.

Indicator 15: Proportion of One-Year-Old Children Immunized Against Measles

The World Health Organization recommends the immunization of 9- to 12-month-old children in developing countries with one dose of the measles vaccine. In Turkey, significant achievements have been made in combating measles. However, since measles or other preventable diseases are fought through routine vaccination services and vaccination campaigns, the rates of vaccination display fluctuations.

Table 13: Proportion of One-Year-Old Children Immunized Against Measles

Source: HIPS, TDHS.

Combating preventable diseases has an important place among the determinants of the prevalence and variety of child mortalities. These kinds of diseases can be prevented to a great extent usually by means of low-cost vaccination campaigns and vaccination programs.

Relevant Policies

The Health-21 Program has been developed for Turkey in accordance with the World Health Organisation's Health for Europe-21 Program. The program aims at increasing life expectancy, improving the quality of life and reducing disparities among different regions and socio-economic groups by improving health status indicators. The following actions implemented under the program are expected to be completed soon:

•  restructuring of the Ministry of Health

•  consolidation of all public hospitals, namely hospitals affiliated to the Ministry of Health and other public institutions, into a single framework

•  ensuring the autonomy of hospitals in terms of their financial and administrative structures

•  expanding family practitioners' practice

•  putting special emphasis on maternal and child health services

•  encouraging the private sector to invest in the field of health

•  expanding preventive health care services

The Health Transition Project (HTP), developed in cooperation with the World Bank in conformity with EU norms and launched in 2004, aims at improving accessibility to health care services, developing financial protection, improving primary health care services and the quality of health services, establishing a referral system and reinforcing the administrative capacity of the institutions in the health sector. It should also be mentioned that the project will support the implementation of Universal Health Insurance (UHI). The support of the EU to maternal and child care is worth mentioning under this heading. It is also important to clarify that the Conditional Cash Transfers (CCT) now also covers pregnant women, plus a bonus for giving birth in a health facility, and health services for children of 0-6 years up to the age of six. The CCT now covers candidate mothers and as well as families with children aged 0-6 who cannot pay regular visits to health clinics.

The Country Program of Cooperation between Turkey and UNICEF (2001-2005) focuses on the family, and targets empowering 3 million parents with knowledge on better care practices for their children; ensuring their survival, development and protection; and stimulating a nationwide initiative for the promotion of good child care practices by incorporating different aspects of early child care, such as exclusive breastfeeding, nutrition, immunisation, stimulation and education.

Vaccination Campaigns: An important development in the fight against measles is the inititation of an extensive campaign by the Ministry of Health at the end of 2003 with the aim of eliminating measles in Turkey. Between 2003-2005, 18 million children were vaccinat.ed

Conditional Cash Transfer Program: Health support is provided to children in the 0-6 age group of the poorest 6% of the population under the Conditional Cash Transfer Program, executed by the General Directorate of Social Assistance and Solidarity (SYDGM) with the support of the World Bank. Health support provides for the attendance of children to the health clinics for regular check-ups within the periods specified in the follow-up tables determined by the Ministry of Health. As of 23 May, 2005 the amount of Health Support has amounted to 17 YTL ($13)/month and the number of beneficiaries is has reached 562,426. 44,044,177.40 YTL has been transferred since the beginning of the program. Moreover, SYDGM has the capability to carry on the program after the end of the World Bank support, and new resources are planned to be allocated.

Benchmarks and Monitoring Capabilities

Targets and Indicators

Monitoring Capability

Challenges

Turkey's infant and under-five mortality rates are still very high compared to other OECD countries. The still-high infant mortality rates in Turkey can be divided into three main health concerns: prenatal causes (stillbirth, premature birth, fetal congenital malformation, prenatal asphyxia), pneumonia and diarrhea.

The infant mortality rate indicator varies significantly on an east-west axis. This was particularly true for 1990. Based on the 2003 Turkey Demographic and Health Survey, the infant mortality rate was found to be 39 per 1,000, and the under-five mortality rate is 50 per 1,000 in rural areas. For urban areas, the rates are 23 per 1,000 and 30 per 1,000 respectively.

Significant variations are also observed based on the mother's level of education, whether the mother received prenatal care and the type of settlement. Approximately 6 million mothers between the ages of 14 and 44 are illiterate. In cases where the mother is uneducated, the under-five mortality rate can vary between 61 and 73 per 1,000. In cases where prenatal care is not received, this rate is determined to be 95 per 1,000.

Some discrepancies are observed between urban and rural settlements with respect to the ratio of immunizations for measles. While 84% of the 12- to 23-month-old children in urban settlements were found to be immunized against measles in the 2003 TDHS, the rate for rural settlements was 69%.

Measles is one of the most contagious and probably the deadliest of all childhood diseases. Like measles; diphtheria, pertussis, tetanus, tuberculosis, hepatitis B and polio are all vaccine-preventable diseases that can easily kill or disable children. Routine immunisation practice for these diseases also needs to be strengthened to reach at least 90%. Some 30% of children below the age of one are not fully immunized against preventable fatal diseases.

Many new mothers are encouraged by elders, or are forced by work commitments, to wean their newborn at the earliest opportunity. The misconception that formula foods are just as good as breast milk is common. Rates of exclusive breast feeding are increasing all over Turkey. Many activities have been operated by the MoH to improve the rate of exclusive breastfeeding. As a result, the rate of exclusive breastfeeding for all newborns increased from 5.4 % in 1998 to 20.8 % in 2003. Pneumonia, the risk of which can be reduced by breastfeeding, is the second biggest cause of under-five mortalities. In Turkey, 12.2% of under five-year-olds are malnourished.

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