Research Article

Social independence and reproductive health inequalities among married women in Türkiye

Number: 1 July 7, 2026

Social independence and reproductive health inequalities among married women in Türkiye

Abstract

Objective: Women's empowerment is a key determinant of reproductive health outcomes. In Türkiye, persistent gender gaps in education, labor force participation, and decision-making autonomy may shape reproductive behaviors and outcomes. This study examines the association between women’s social independence and reproductive health outcomes using nationally representative data. 
Methods: We conducted a secondary analysis of 5,156 married women aged 15-49 from the 2018 Türkiye Demographic and Health Survey. Women’s social independence was assessed using a modified version of the SWPER Global Index, adapted to the Turkish context by excluding items not locally applicable. Eight reproductive outcomes were examined: total births, ideal number of children, having more children than the desired number, unplanned births, demand for family planning satisfied with modern methods, contraceptive use (female-only vs. couple methods), induced abortion, and miscarriage. Robust Poisson regression models, adjusted for demographic and socioeconomic factors, estimated prevalence ratios. 
Results: Higher social independence was consistently linked to more favorable reproductive outcomes. Women in the lowest quintile had a higher prevalence of four or more births (16-fold), desiring four or more children (1.9-fold), having more children than the desired number (5.7-fold), unplanned births (2.3-fold), induced abortions (1.9-fold), and miscarriages (1.7-fold) compared with the highest quintile. Lower social independence was also associated with greater use of female-only contraceptive methods. 
Conclusion: Social independence strongly influences reproductive health in Türkiye. Integrating gender empowerment into reproductive health policies-through improved education, enhanced mobility, and support for decision-making autonomy-is crucial to reduce inequalities and advance progress toward Sustainable Development Goal 5.

Keywords

Demographic Health Survey, Reproductive Health, Social Independence, Türkiye, Women’s Empowerment

Supporting Institution

None

Project Number

None

Ethical Statement

This study is based on publicly available, anonymized data from the 2018 TDHS, conducted by Hacettepe University Institute of Population Studies with approval from the Hacettepe University Ethics Committee. As this is a secondary data analysis using publicly available data, no additional ethical approval was required.

Thanks

We gratefully acknowledge Prof. Aluisio J. D. Barros for his invaluable feedback and for his contributions to modifying the social independence domain of the SWPER Global Index. We also thank the Hacettepe University Institute of Population Studies for granting access to the TDHS-2018 dataset. Finally, our deepest gratitude goes to all participating women, whose contributions made this research possible.

References

  1. 1. World Health Organization. Reproductive health: reproductive health in the South-East Asia Region. Geneva: WHO; 2024. Available from: https://www.who.int/westernpacific/health-topics/reproductive-health. Accessed Aug 22, 2024.
  2. 2. Heise L, Greene ME, Opper N, et al. Gender inequality and restrictive gender norms: framing the challenges to health. Lancet 2019;393(10189):2440-54.
  3. 3. United Nations. Sustainable Development Goals. New York: UN; 2024. Available from: https://sdgs.un.org/goals. Accessed Aug 22, 2024.
  4. 4. Upadhyay UD, Gipson JD, Withers M, et al. Women's empowerment and fertility: a review of the literature. Soc Sci Med 2014;115:111-20.
  5. 5. Haque R, Alam K, Rahman SM, Keramat SA, Al-Hanawi MK. Women’s empowerment and fertility decision-making in 53 low and middle resource countries: a pooled analysis of demographic and health surveys. BMJ Open 2021;11:e045952.
  6. 6. Atake EH, Gnakou Ali P. Women’s empowerment and fertility preferences in high fertility countries in Sub-Saharan Africa. BMC Womens Health 2019;19:54.
  7. 7. Rahman M, Mostofa G, Hoque A. Women's household decision-making autonomy and contraceptive behavior among Bangladeshi women. Sex Reprod Healthc 2014;5(1):9-15.
  8. 8. Ahmed S, Creanga AA, Gillespie DG, Tsui AO. Economic status, education and empowerment: implications for maternal health service utilization in developing countries. PLoS One 2010;5(6):e11190.
  9. 9. Corroon M, Speizer IS, Fotso JC, et al. The role of gender empowerment on reproductive health outcomes in urban Nigeria. Matern Child Health J 2014;18(1):307-15.
  10. 10. Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries. Reprod Health 2018;15:214.
APA
Ozdemir, R., & Dinç, G. (2026). Social independence and reproductive health inequalities among married women in Türkiye. Turkish Journal of Public Health, 1. https://doi.org/10.20518/tjph.1822410
AMA
1.Ozdemir R, Dinç G. Social independence and reproductive health inequalities among married women in Türkiye. TJPH. 2026;(1). doi:10.20518/tjph.1822410
Chicago
Ozdemir, Raziye, and Gönül Dinç. 2026. “Social Independence and Reproductive Health Inequalities Among Married Women in Türkiye”. Turkish Journal of Public Health, no. 1. https://doi.org/10.20518/tjph.1822410.
EndNote
Ozdemir R, Dinç G (July 1, 2026) Social independence and reproductive health inequalities among married women in Türkiye. Turkish Journal of Public Health 1
IEEE
[1]R. Ozdemir and G. Dinç, “Social independence and reproductive health inequalities among married women in Türkiye”, TJPH, no. 1, July 2026, doi: 10.20518/tjph.1822410.
ISNAD
Ozdemir, Raziye - Dinç, Gönül. “Social Independence and Reproductive Health Inequalities Among Married Women in Türkiye”. Turkish Journal of Public Health. 1 (July 1, 2026). https://doi.org/10.20518/tjph.1822410.
JAMA
1.Ozdemir R, Dinç G. Social independence and reproductive health inequalities among married women in Türkiye. TJPH. 2026. doi:10.20518/tjph.1822410.
MLA
Ozdemir, Raziye, and Gönül Dinç. “Social Independence and Reproductive Health Inequalities Among Married Women in Türkiye”. Turkish Journal of Public Health, no. 1, July 2026, doi:10.20518/tjph.1822410.
Vancouver
1.Raziye Ozdemir, Gönül Dinç. Social independence and reproductive health inequalities among married women in Türkiye. TJPH. 2026 Jul. 1;(1). doi:10.20518/tjph.1822410