Türkiye’s Birthrate Crisis Does Not Own Women’s Bodies -By Fransiscus Nanga Roka

A government concerned with declining enrollment does not have the authority to control where children are born. Türkiye has good cause to limit the number of unnecessary Cesarean sections performed. However, using basic surgical statistics to punish physicians for providing too many Cesarean sections could result in replacing patient care with population management.

The AFP news agency reported on July 11, 2026, using information from the Turkish newspaper BirGün, that over 100 obstetrician-gynecologists were fined, suspended and ordered to take mandatory training for performing too many C-section (Cesarean) deliveries. According to medical associations, disciplinary proceedings were initiated based on high numbers of C-sections being performed by the doctors involved. However, these are reported administrative actions and not evidence that each doctor punished was guilty of performing an unnecessary C-section.

The crackdown was implemented in response to a April 19, 2025 regulatory change that prohibited scheduled cesarean sections from taking place within private healthcare organizations, as well as providing regulations regarding where mothers can give birth. While the regulations apply to a specific type of organization, they should not be portrayed as a complete prohibition on cesarean sections in all Turkish hospitals. This regulation was established as part of President Recep Tayyip Erdoğan’s efforts to increase the number of vaginal births and combat declining birth rates.

The numbers for Turkey should be analyzed. OECD data cited in the report indicate that the rate of cesarean delivery was about 615 per 1,000 live births in 2023. However, a single country’s statistics cannot prove malpractice in an operating room.

Two distinctions must anchor this debate.

First, “elective” refers to a planned procedure, however, this does not imply that the procedure is not medically necessary. For example, a planned cesarean delivery may prevent or resolve a potentially life threatening condition prior to becoming an emergency. To allow women’s health to decline to the point where surgery is required for treatment of their conditions would reverse the concept of preventative care. Additionally, the Royal College of Obstetricians and Gynaecologists recognizes that there are situations which require a planned cesarean birth.

In addition, the 10-15 percent benchmark used by WHO has been clearly identified as not being a universal quota for hospitals. In fact, WHO’s position is based upon providing health care services based upon individual needs and not meeting a certain percentage. To take evidence from a population level and turn it into a disciplinary threshold is simply the government using bad statistics.

As with delays in surgery, unnecessary surgeries carry risk. In addition to potential for delay in treatment, a clinician may choose to avoid treating patients who present complex medical histories (e.g., prior cesarean sections) or who have had complications during their pregnancy if there is an incentive to lower the rate of unnecessary surgeries. This type of reaction is a foreseeable policy risk, but it has yet to be demonstrated as an actual outcome of the current “crackdown.”

Because policymakers do not like the statistics about how many people are having babies, this does not mean that reproductive autonomy will cease to exist. A good example of what could be used as a model for reproductive autonomy is Britain’s NICE guidelines. The guidelines for NICE allow for a woman to request a cesarean birth, the options for other methods of birth should be discussed with the woman, and if she needs psychological support, then it should be provided. Ultimately, the woman is allowed to make her own informed decision after receiving information. This is not binding upon Turkey, but it shows a viable way to avoid coercion.

Ankara should change course.

First, provide the basis for your legal authority to impose sanctions and the reason why you chose to sanction based upon that information. Provide independent expert review, proportionate penalties, and effective appeals. When there is a percentage of patients affected by a physician’s practices, this should be used as a trigger for further investigation and not as a replacement for providing proof of wrongdoing.

The second step is to audit similar patient groups with the World Health Organization’s Robson Classification. Publish maternal complications, neonatal outcomes, emergency response performance and the rate of surgery. Safer births should be rewarded, not prettier spreadsheets.

Third, provide funding for midwives, continuous support during labor, access to analgesia, and emergency operating facilities. Review the payment incentives and working conditions that could potentially lead to a higher use of surgery. Government cannot require a patient-centered approach to labor when it is funding assembly-line style care.

Fourthly, safeguard recorded joint decisions and timely, appropriately based on clinical judgment, surgical interventions. Also, pursue as seriously commercial pressures to have unnecessary operations.

Finally, address the concerns about demographic decline by providing affordable housing, childcare, parental leave, and job stability. The goal of birth policies is to provide parents with a greater degree of sustainability.

Women have dual roles as both patients and citizens. The female body is not meant to be used as a means of achieving a certain number of people in a given area. When it comes to developing a successful maternity policy, the goal should be to provide a safer environment for mothers, healthier conditions for babies, and more informed decision making—rather than creating an environment where doctors are scared to treat women, or where women are being controlled by politics.

Fransiscus Nanga Roka

Faculty of Law University 17 August 1945 Surabaya and Managing Partner Law Firm Victorious Indonesia