Turkey

OVERVIEW

In Turkey, there are a wealth of health care resources available. But it can also be complex, often confusing, environment for women's health care. While birth control pills are available in many pharmacies ("eczane" is pharmacy in Turkish) in the city center, and abortion is legal, it can be difficult to find reliable and responsive treatment. This is due to the conflicting messages surrounding women's sexual and reproductive freedom in the country.

On the one hand, Turkey is constitutionally secular and certain cities, such as Izmir or parts of Istanbul, are famously progressive. Furthermore, Turkey is full of internationally accredited hospitals, making it a hotspot for medical tourism. On the other hand, it is typically considered taboo to discuss many aspects of sexuality, and unmarried women are often expected to remain virgins. This creates a discrepancy between the legal options and the social realities of the city. For this reason, it is especially important to do one's research in advance when looking for a gynecologist or STD test.

Contraception (Birth Control)

Laws & Social Stigmas

In Turkey, you do not need a prescription to purchase birth control pills or condoms at pharmacies. While President Erdogan made headlines by advising Muslim families to avoid birth control in May 2016, birth control is still available in Turkey. Furthermore, the rate of contraceptive use has increased in the past few decades. According to a 2015 United Nations report, it is estimated that 74.2% of Turkish women (who are of reproductive age and married or in unions) use some form of contraception. Meanwhile, 6.1% of Turkish women have unmet family planning needs. However, it should be emphasized that a great portion of Turkish women use traditional contraceptive methods. In fact, the most common form of contraception used by women is the withdrawal or "pull-out" method (25.8%). Following this method, the most common methods are IUDs (16.9%), condoms (15.9%), female sterilization (9.5%) and birth control pills (4.6%). Meanwhile, there is extremely low usage of contraceptive injectables (0.6%) and essentially none for contraceptive implants (0.0%). In total, this means that the vast majority of women in Turkey today depend on withdrawal, IUDs or condoms for their contraceptive methods.

Despite increasingly religious government policies, Turkey has also seen an increase in contraceptive use over the past two decades. In a 1998 study, 63.9% of women practiced some form of birth control, with 4.4% on the pill, 19.8% with IUD and 24.4% practicing the pull-out method. This is compared to the 74.2% of Turkish women who used birth control in 2015.

What to Get & Where to Get It

In Istanbul, birth control pills are available in many pharmacies ("eczanes" in Turkish). While pharmacies don't have tons of options, they do carry a few brands, including Yasmin and some generic brands. NuvaRing is also available in Istanbul. Most pharmacies do not carry the Nuvaring but the bigger ones (i.e. In shopping malls) have it, without prescription for max 30tl per 1-month pack. There are no limitations as for how many packages you can buy.

There are no DivaCup sellers in Turkey so it should be purchased online. There is only one registered mooncup seller in Turkey (in Canakkale) so it should also be purchased online.

Costs

Birth control pills should cost between 15-30 lira, depending on the brand. As of 2016, Yasmin is 25 TL. If you want the pills that are better than breastfeeding moms, they're 42 TL. Mirena and the Copper IUD can be purchased for about 700 TL.

Emergency Contraception (Morning After Pill)

Important Note: The earlier you take emergency contraception, the more effectively it will work. After you have unprotected sex, take it as soon as possible.

Laws & Social Stigmas

In Turkey, you do not need a prescription to purchase emergency contraception, and there is no age restriction. It is generally easy to purchase in pharmacies. However, according to a 2008 study, only 29.1% of Turkish women of reproductive age were aware of emergency contraception and only 2.3% had practiced it.

What to Get & Where to Get It

Most pharmacies should have emergency contraception. For progestin only, they typically sell NorLevo .75 mg (take 2 pills within 120 hours). As another option, some people take Lo/Ovral, Lo-Femenal pr Microgynon 21 according to the following instructions: 4 pills within 120 hours after unprotected sex and take 4 more pills 12 hours later. Another option is Miranova according to the instructions: Take 5 pills within 120 hours after unprotected sex and take 5 more pills 12 hours later.

Costs

Emergency contraception should cost 20 TL (this is based on one stat from Bursa, so we'll need to collect more info).

Ella, a single 30mg tablet, costs 51.50 TL and is available over the counter in Istanbul.

Medications

Laws & Social Stigmas

You can access most medications in Turkish cities for reproductive health and STDs. But this is not the case for everything. The European Centre for Disease Prevention and Control (ECDC) has recommended that all European teenagers receive the HPV vaccine, but Turkey has no program in place. Regarding HIV, PreP is not available in Turkey, and not all antiretroviral drugs are available either. But the HIV drugs that are available can be found in pharmacies.

What to Get & Where to Get It

You can get medications for yeast infection at Turkish pharmacies. The word of "yeast infection" in Turkish is "mantar enfeksiyonu." You typically need a prescription for a urinary tract infection ("idrar yolu enfeksiyonu" in Turkish) since it's an antibiotic. However, you can often get drugs like Monural without a prescription. The word for "chlamydia" is the same and it seems that the word for "gonorrhea" is "belsoğukluğu." HIV and HPV are the same, and "Hepatitis" is " Hepatit."

Menstruation

Laws & Social Stigmas

While tampons are technically available in Turkey, there seems to be less comfort or familiarity with them. Tampons are less commonly sold in stores and most Turkish women do not use them. This has lead to some travelers mistakingly thinking that there are absolutely no tampons in Istanbul. To clarify: There are tampons, but you need to look in special places.

What to Get & Where to Get It

Pads and panty-liners are easy to find in Istanbul. However, tampons are much more difficult to find. They are sold in select pharmacies. It's been reported that in expat areas, like Cihangir or Moda, you may be more likely to find them in grocery stores or stores like Gratis as well. If you do find tampons, they're almost always OB (so no applicator).

There are no known sellers of DivaCup in Turkey so it should be purchased online. The only known seller of Mooncup in Turkey is in Canakkale (Dedetepe Eco Farm) so it's probably easiest to purchase it online as well.

Costs

One box of 32 tampons should cost you around 11 TL.

Gynecological Exams

Laws & Social Stigmas

While cervical screenings are common in Turkey, a July 2016 Hurriyet article claimed that "cervical screening remains taboo in Turkey."

There are a many hospitals and clinics in Istanbul, not only because it's a massive city, but also because it's a medical tourism destination. For this reason, it's recommended that you carefully consider the full range of options before making your choice. As a starting point, you should first know the three main types of hospitals to choose from. There are three main types:

• First, there are the state hospitals, or "Devlet Hastanesi" in Turkish. These public hospitals can be found all over Istanbul (for example, Uskudar Devlet Hastanesi, Beşiktaş Sait Çiftçi Devlet Hastanesi, etc). This map can give some sense of the distribution of the state hospitals in the city (though, be aware, that it probably doesn't show all state hospitals). If you're a Turkish citizen or have Turkish health care coverage, this is your cheapest option, and services will often be free. If you don't have Turkish health care coverage, the prices will be cheaper than a private hospital but they will not necessarily be "cheap." You can expect to pay quite a bit more than someone with Turkish health coverage. Meanwhile, for all patients at these hospitals, it's typical to deal with long wait times and bureaucracy. Health care practitioners will have varying levels of skill and sensitivity. The majority of the staff will not speak English, so it's recommended that you either know Turkish yourself or bring along someone who does.
• Second, there are the Medical Centers, also known as "Tip Merkezi" in Turkish. You'll see many of these medical centers in Turkey, which always have "Tıp Merkezi" or "Medical Center" in the name. They function like private hospitals in many ways, in the sense that they're more independently run and can have higher-quality care. Unlike private hospitals, they work harder to keep down the costs and they only accept Turkish Social Security (SGK).
• Finally, there are the private hospitals. Generally speaking, you'll find the most efficient, responsive and highest-quality care at these facilities. However, the costs will be much higher. You can check out this list of private hospitals in Istanbul. For private hospitals with English-speaking staff, you can check out this list from the American Consulate General.

Here are some useful terminology for hospital visits: Vagina = vajina. Labia = labia. Biopsy of the endometrium (= endometrium in Turkish) is called probe curetaj. Curettage = curetaj. Myoma= myom. Fibroid = fibrom . Cervix = serviks. Uterus = uterus. Cyst= kist. Polyp= polip. Breast = meme. Nipple = Mamelon.

What to Get & Where to Get It

Some useful terminology: Vagina = vajina. Labia = labia. Biopsy of the endometrium (= endometrium in Turkish) is called probe curetaj. Curettage = curetaj. Myoma= myom. Fibroid = fibrom . Cervix = serviks. Uterus = uterus. Cyst= kist. Polyp= polip. Breast = meme. Nipple = Mamelon.

For recommendations of local clinics, please visit the city pages.

Sexually Transmitted Infection (STI) Testing & Support

What to Get & Where to Get It

To say "STD Test" in Turkish, simply say "STD Test" (it's the same as English). It seems that many hospitals can give tests for HIV, Hep B, Hep C and syphilis. However, it is much more difficult to also get tested for gonorrhea, chlamydia, etc. One way to get a free HIV, Hep B, Hep C and syphilis test is to donate blood to Kizilay (https://www.kizilay.org.tr/) because they test the blood and then get back to you. In July 2016, Şişli municipality launched a free and anonymous health service for the LGBT community, focusing on the prevention of STDs. Every 3 months, patients can receive a free STD test and examination. Patients can register with a nickname if they wish.

Testimonial: "For all STD, after morning pills and infections, I believe the Austrian Hospital http://www.sjh.com.tr rocks! I am not sure about the abortion since it is not legal here. The prices are affordable (max 90-100 tl for a check up and you have a second one within 10 days, free of charge, called 'control visit'). Moreover, it is half shared cost with SGK (national insurance) if you have it."

Here's a list of some clinics that do STD testing in Turkey: http://www.whatclinic.com/doctors/turkey/sexually-transmitted-diseases-testing

Costs

Tests for Turkish citizens are supposed to be free (can we confirm this?) at public hospitals. As for foreigners, this may greatly vary, depending on whether you go to a public or private hospital, as well as how many tests you order.

Pregnancy

What to Get & Where to Get It

Testimonial: Dr. Hakan is my gyno. He also delivered my son. He works in Maltepe Delta hospital. He is very friendly, speaks English -- not perfect but I had no problem understanding him. Very helpful.

Abortion

Laws & Social Stigmas

Since 1983, abortion has been fully legal in Turkey. In 2012, a law was proposed that would allow doctors to refuse performing abortions. In response, protesters took the streets. The law did not pass, but many doctors (especially in public hospitals) have reportedly acted like the law passed, and they have decided to stop performing abortions. This means that, currently, you get an abortion in Turkey -- but not only at select hospitals/clinics.

In Turkey, you can get an abortion for up to 10 weeks of pregnancy. After 10 weeks, the abortion can only be performed if the woman's life is endangered or in cases of fetal impairment. Overall, legal reasons for abortion include: to save the life of the woman, to preserve physical health, to preserve mental health, rape or incest, fetal impairment, economic or social reasons, and availability on request. According to Law No. 2827 of 24 May 1983, Population Planning Law, married women need spousal consent, and minors or mentally disabled patients need approval from their parents, guardians or the magistrate's court. If there is endangerment to life or vital organs, no approval is required from spouses or parents/guardians. If there is a risk to the woman's life or risk of fetal malformation, two specialists (one ob/gyn and one specialist in a related field) must write their objective findings in a confirmation letter.

There are cases of some gynecologists who may also secretly/illegally perform abortions after 10 weeks. One anonymous testimonial: "My private doctor would have done it much, much later than 10 weeks. Not sure about the legality, but she said it would happen if necessary. I had amnio during both pregnancies to check for genetic abnormalities at around 20 weeks, and she told me that if there was a problem, then she would do an abortion, if we wanted to."

According to a UN report, "Despite the liberal nature of abortion laws in Turkey, the number of legal abortions performed in the country has been sharply restricted by the requirement that the procedure be carried out only by or under the supervision of gynaecologists. This factor is especially critical in rural Turkey, where medical specialists of any type are scarce or non-existent" (Abortion Policy - Turkey).

Misoprostol (the abortion pill) is no longer available.

Note that pre- and post-abortion counseling is not common in Turkey.

What to Get & Where to Get It

It is advised to try to book an appointment at a private hospital. In March 2016, the Turkish Society of Obstetrics and Gynecology declared that public hospitals have effectively banned abortion. There is also reported discrimination against single woman, and it has been found that some hospitals ask for marriage certificates from patients. In 2013, Ayse Arman wrote about the condescending, judgmental and unprofessional treatment she received upon receiving an abortion at an Istanbul public hospital.

For local recommendations, please visit city pages, like the Istanbul page.

Costs

Turkey has a nationalized health care system so prices are lower for Turkish citizens. For foreigners, expect to pay between 700 TL-1000 TL, depending on the clinic.

Advocacy & Counseling

What to Get & Where to Get It

• Morçatı Kadın Sığınağı Vakfı (Purple Roof Women’s Shelter and Foundation) - Provides legal and practical aid to women who are victims of domestic violence Phone: Email: 0090 212 292 52 31-32. Katip Mustafa Celebi Mah. Anadolu Sok. No:23 D:7-8, Beyoglu-Istanbul, Turkey morcati@ttnet.net.tr. (http://www.morcati.org.tr/tr/)

List of Additional Resources

• Istanbul Hollaback - "Hollaback! is an international movement to end harassment. We believe that everyone has the right to feel safe and confident in public spaces." (http://istanbul-en.ihollaback.org/)
• Kirmiza Semsiye/Red Umbrella Sexual Health and Human Rights Association - "Red Umbrella Sexual Health and Human Rights Association aims to raise awareness and visibility regarding human rights violations experienced by male, female and transgender sex workers in Turkey." Based in Ankara. Phone: +90312.419.2991. Email: kirmizisemsiye@kirmizisemsiye.org. Website: http://kirmizisemsiye.org/
• Morçatı Kadın Sığınağı Vakfı (Purple Roof Women’s Shelter and Foundation) - Anti-domestic violence organization (http://www.morcati.org.tr/tr/)
• Lamda Istanbul - LGBT organization; reports human rights violations (http://www.lambdaistanbul.org/s/)
• Kadın Eserleri Kütüphanesi ve Bilgi Merkezi Vakfı (Women’s Library and Information Centre Foundation - First and only women's library and education center in Turkey. Fener Mahallesi, 34220 Istanbul, Turkey, Phone: 0090 212 534 9550, Fax: 0090 212 523 7408, E-Mail: kadineserli@gmail.com, Website: http://www.kadineserleri.org
• Pazartesi - Feminist magazine of Turkey. Abdullah Sok. No: 9, Beyoglu-Istanbul, Turkey. Phone: 0090 212 292 0739. E-Mail: pazartesidergi@superonline.com. Website: http://www.pazartesidergisi.com
• Sosyalist Feminist Kolektif/Socialist Feminist Collective - Address: Katip Çelebi Mah. Tel sok. No: 20/3, Beyoğlu-İstanbul, Turkey, Phone 0090 212 243 4993, E-Mail: sosyalistfeministkolektif@gmail.com, Website: http://sosyalistfeministkolektif.org
• Kadının İnsan Hakları Projesi (Women for Women’s Human Rights) - "an independent women’s non-governmental organization (NGO) that aims to promote women’s human rights, equality and non-discrimination in Turkey and on the international level." Address: Inonu Cad. Saadet Apt. No: 37/6, Gumussuyu 80090, Istanbul, Turkey, Phone: 0090 212 251 00 29, Fax: 0090 212 251 00 65, E-mail: wwhrist@superonline.com, Website: http://www.wwhr.org