Top of the C-section charts: how Türkiye climbed from 21% to 61%

There is one ranking where Türkiye sits at the very top, and it is neither tech nor sports: C-sections. Roughly two in three births in the country happen by surgery, with the rate passing 61 percent as of 2024. The World Health Organization recommends a band of 10 to 15 percent. The steeper story is the curve: 21 percent in 2003 nearly tripled within two decades. The episode asks the pointed question: what shifted so dramatically, and are mothers really to blame? The narrator opens with a caveat: no single comprehensive study yet explains the rise in one sentence.

The first stop is the health transformation program launched in 2003. While it expanded access to care, it also moved the address of birth: deliveries migrated to private hospitals. For a private operator, a C-section is predictable business: schedulable hours, full beds, clean billing, and a comfort zone free of labor's uncertainty. In the program's first decade the number of private hospitals doubled, and their share of births roughly tripled.

By 2013, seven in ten births at private hospitals were surgical, double the rate at public ones. Nationwide, the rate jumped from 21 to 48 percent between 2003 and 2013. The pattern is not ours alone: Brazil, with a heavy private share, runs ceiling-high rates, while Norway, with a private share near 14 percent, sits around 17 percent. Yet privatization alone does not explain it; surgical birth spread across every tier, public included, in the same period.

The second cause hides in the family-medicine system adopted in 2005. Midwives once focused on pregnancy follow-up were loaded with chronic-disease tracking and paperwork, and their one-to-one bond with expectant mothers weakened. A 2017 study by the Health Ministry and TUSEB found six in ten public-sector midwives saying they cannot practice properly. With no midwife filling the gap, most mothers prepare for birth largely on their own.

Unsupported preparation feeds fear; fear tenses the body, a tense body feels more pain, and pain turns into a surgery request, which no doctor can overrule. The fear channels are familiar: grim birth stories passed along families, dramatic TV scenes, and real cases of obstetric violence. The episode notes that China, which once paused midwifery training, paid a similar price, and cites the reverse finding: where midwives truly own the birth process, surgical rates fall.

The third cause is obstetricians' fear of lawsuits. Between 2012 and 2022, one in six malpractice suits targeted this specialty; years-long trials and awards that can wipe out a lifetime of savings push doctors toward the safe harbor of surgery. Still, the episode keeps its balance: a timely C-section saves mothers and babies, and countries in Africa with very low rates pay for the gap with lives lost. The organization's formula fits in two sentences: missing a needed surgery harms, and so does performing an unneeded one, while every operation raises the stakes of the next birth through adhesions and injury risk.

From the 2010s onward, Ankara tried both the carrot and the stick, with harsh rhetoric on top. In 2013 the health minister of the day branded needless surgery a cruelty, while the prime minister framed C-sections as an operation to stall population growth. Neither rules nor words bent the curve: the rate marched from 48 to 61 percent, and Türkiye reached the top of the world ranking.

The government's new answer is the Normal Birth Action Plan unveiled on 3 October 2024: mandatory pregnancy schools at every birth facility, mother-friendly hospital standards, clarified midwife authority, dedicated midwife clinics, and a midwife for every mother. The episode objects to the campaign language: a spot where the fetus declares success reduces the message to maternal effort and paints surgery as failure. The experts' two conditions are crisp: replace guesswork with scientific research on doctors, women, and society; and treat coercion as violence too, centering mothers' needs, including concrete working conditions such as genuinely usable prenatal leave.