Birth and biopolitics: The C-section debate in Turkey
ANKARA — “At least three children.” “A woman who rejects motherhood is incomplete.” “Abortion is murder.” These are some of the statements Turkish Pres. Recep Tayyip Erdoğan has made about family planning over his 22-year tenure.
The rhetoric, at times, has also touched on methods of birth. In 2012, Erdoğan advocated for natural births, stating that cesarean deliveries (C-sections) were “a step towards freezing the country's population”. In 2013, he claimed citizens were being “sterilized” by C-sections.
Though pro-natalist discourse did not become a central focus of government policy until this year. In January, Erdoğan declared 2025 the “Year of the Family”, unveiling financial incentives and programs intended to reverse the nation’s falling birth rate.
Along with efforts to encourage families to have more children, the Turkish government last month introduced restrictions on C-sections after Erdoğan linked the procedure to the nation’s decline in births.
This prompted backlash, but also put a spotlight on Turkey’s world-leading rate of C-section deliveries, which rose from 21 percent of live births in 2001 to 61.5 percent in 2023, according to health ministry statistics.
The same data indicates C-section rates are higher in private medical centers, nearing 80 percent in 2023. As a result, the new regulations banned elective C-sections at private clinics without dedicated birth units in a move intended to promote natural births.
Yet, as the Turkish government campaigns for more natural births, some leading health advocates claim the spike in C-section births was largely caused by decades of medical sector privatization overseen by Erdoğan's Justice and Development Party (AKP).
“The health policies of the AKP government, which privatized healthcare and turned it into a commercial commodity, are the reason for this increase in cesarean birth rates,” said Zeliha Aksaz Şahbaz, a deputy chair of the main opposition Republican People’s Party (CHP).
The Ministry of Health did not respond to interview requests for this report.
The Health Transformation Program
Şahbaz, who is also a gynecologist overseeing CHP’s health ministry policies, said natural births require robust infrastructure in medical facilities, such as experienced midwives and gynecologists on staff to provide 24-hour emergency obstetric services.
Through medical sector reforms initiated in 2003 known as the Health Transformation Program (HTP), Şahbaz said the government closed down several public maternity and children’s hospitals. Obstetrics and gynecology clinics were also removed from many public hospitals.
“Public healthcare services for childbirth have become inaccessible,” Şahbaz told Turkey recap.
“Private hospitals, with their commercial profit expectations, insufficient staff and inexperienced midwives are not capable of monitoring vaginal births for long hours,” she continued. “So, instead, a cesarean operation is performed in a short time, like half an hour.”
Dr. Ayşe Gültekingil, a member of the Turkish Medical Association's Women Physicians' Branch, also commented on the HTP, which she said gradually weakened preventive healthcare services over the last 20 years, particularly putting pregnant women at risk.
Gültekingil said a healthy birth process requires regular appointments with doctors or midwives before the delivery date. She then noted government policies and HTP reforms have reduced staff capacity at public hospitals, leaving one-third of pregnancies in Turkey without adequate prenatal care and monitoring appointments.
This lack of guidance before birth, Gültekingil argued, is one of the main factors leading women to choose C-section deliveries.
“Women often arrive at the moment of birth without being physically prepared for it, without sufficient information about the … birth process, and without knowing whether they and their babies will face any risks,” Gültekingil told Turkey recap.
In this context, delivering mothers understand they will not receive adequate medical and psychological support during labor, so they tend to choose C-sections, which they see as less risky, Gültekingil said.
“Obstetricians also prefer to perform cesarean to avoid risking the health of the mother and child, both due to the increasing number of malpractice lawsuits and the increase in risky births due to the lack of [prenatal] follow-ups,” she added.
Biopolitics
As a result of such dynamics, Turkey now leads OECD nations in C-section births, which have risen globally from about 7 percent in 1990 to 21 percent in 2021, according to the World Health Organization, which projects cesarean birth rates to keep rising.
Yet, the global trend toward C-sections has not dissuaded the Turkish government from attempting to reverse it. Recent efforts include a football team taking the field with a banner reading "Natural birth is normal birth” in April.
This was followed by a pro-natalist statement by Turkey’s Health Min. Kemal Memişoğlu, who said: “If you don't have children, you can't be a family.”
Such rhetoric is often associated with the term ‘biopolitics’, a concept created by French philosopher Michel Foucault in which states manage and control populations by regulating citizens' bodies and biological processes.
Gültekingil also used the term ‘biopolitics’ while linking the ‘Year of The Family’ program to Turkey’s broader economic troubles.
“The government wants to decide whether women will give birth or not, how many children they will have and by which method they will give birth because they are attempting to resolve the current economic crisis by increasing the young population and confining women to caregiving labor,” Gültekingil said.
“Cesarean policies are a part of this pattern, just like abortion policies … and the year of the family,” she continued. “We know that women who have vaginal births return to social and working life more quickly and can have more children, and these reasons are an important part of the main goal.”
CHP deputy chair Aylin Nazlıaka, who leads the party’s family and social services policies, said the recent regulations are direct infringements on women’s rights and freedom of choice.
“The imposition of a birth method is also a form of violence. This is called political violence,” Nazlıaka told Turkey recap. “You cannot interfere with the decisions that women will make together with their doctors. Take your hands off women's bodies. Get out of the people's bedrooms.”
In the face of such pushback from the opposition and women’s rights groups, the government has emphasized its campaigns are intended to benefit the health of both mothers and children. Leading rights advocates in Turkey, however, have rejected such messages.
“The state's duty is not to dictate how people should live, but to guarantee the right to life by respecting their decisions,” Canan Güllü, president of the Federation of Turkish Women's Associations, told Turkey recap.
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