It will take more than special awards to encourage families to have more children.
By IWPR staff in Central Asia (RCA No. 538, 21-Mar-08)
Alarmed at falling birth rates, officials in Turkmenistan are putting new measures to encourage people to have more children. Analysts say the government needs to focus on basic healthcare and welfare provision if it is to stem the population decline.
On March 5, President Gurbanguly Berdymuhammedov launched a new award called “Ene Mahri” or “Mother’s Tenderness”, to be awarded to women who give birth to and raise eight or more children.
The award is reminiscent of similar titles conferred on mothers with many children in the Soviet era, and comes with similar fringe benefits – free utilities and public transport, for example.
The authorities simultaneously announced they were drafting a new law to offer greater benefits to mothers in general. It is not, however, clear what these will consist of.
One senior government official, speaking on condition of anonymity, said action was being taken to reverse demographic trends that were “catastrophic”.
“In recent years, there’s been a significant drop in the birthrate, and that’s plain even to the casual observer,” said the official.
Accurate recent statistics on birthrates are hard to come by in this secretive and authoritarian state. In 2003, the national statistics agency reported that the population had reached 6.2 million, an increase of 5.2 per cent on the previous year.
But independent observers have cast doubt on those figures. Research published in 2006 on the opposition website tm-iskra.org suggested that the country was undergoing depopulation, in that more people were dying than being born.
The study attributed this to the low level of state welfare provision for mothers and children, and problems in accessing healthcare services.
Interviews suggest that the fees and bribes that have to be paid to get medical treatment do seem to be a disincentive to young families raising children.
One young woman from Dashoguz in northern Turkmenistan said she had been forced to pay the equivalent of 300 US dollars to get a qualified doctor to assist her in childbirth. She was sent home from hospital the very next day and received no postnatal treatment.
“I am not going to have any more children,” she concluded.
Health ministry officials, speaking off the record, admit that corruption is rampant.
One official told IWPR that many obstetricians tried to persuade pregnant women to have caesarian sections, simply because the operation is expensive and they earn more money that way.
“The price of services in maternity hospitals will continue to grow, since life is expensive and doctors want to earn money,” she said.
Another health official told IWPR the government could usefully restore the old network of rural midwives, who used to provide services free of charge. The midwife centres were closed in 2003 on the orders of Berdymuhammedov’s predecessor as president, the authoritarian Saparmurat Niazov.
Since then, many women in rural areas have delivered babies at home, increasing the risk to both mother and child.
Even prior to the abolition of midwives, World Health Organisation data for 2002 indicated that 55 out of 1,000 children in Turkmenistan dies before the age of five. This is one of the worst rates in the entire Asia-Pacific region, exceeded only by Burma, Cambodia and Afghanistan.
Annagul, who lives in the capital Ashgabat and has several children, says the government needs to ensure medical services for women in childbirth are free in practice as well as in theory. It should also, she says, increase benefits for pregnant mothers and grant them a monthly allowance for the period when their children are young.
She feels unrewarded for “staying at home and raising future citizens of the state”.
“We eat poorly - soup in the day, while in the evening we have bread with jam from the apples growing near our house,” she said.
In Annagul’s opinion, if the authorities want the next generation to be healthy, they need to take drastic measures to increase the birth rate and stop talking about benefits that do not exist in reality.
Under the current legal code on welfare dating from July 2007, mothers are entitled to a monthly allowance of 250,000 manats (48 dollars at the official exchange rate) until children reach adulthood and a one-off payment of 500,000 manats after the birth of their first and second child. A third child merits a one-off payment of one million mantas, with two million for the fourth.
Several women who had received these benefits said they did not cover much beyond the basic expenses incurred by having children, and did not compensate for the loss of their wages while they were off work.
Moreover, most of those interviewed said they had not even received the maternity benefits due them, and had not heard that they were entitled to a monthly allowance until their children were adults.
It is not just mothers, of course, who complain of the expense of maintaining a family.
One 32-year-old unemployed man from Tejen, a small town in southeastern Turkmenistan, said it was too costly to have children these days.
“How can you have children now?” he asked. “Schools, books, all of it costs a lot. Every day we have the problem of how to feed them.”
Tajigul Begmedova, chair of the Bulgaria-based Turkmen Helsinki Fund for Human Rights, said turning around the demographics would be difficult given the lack of reliable statistics.
Even government officials do not have sensible information about the price of an average consumer basket, living standards and inflation.
“Sources in the Ministry of Social Security told us that when the new law [on maternity support] was being drafted, they ran into difficulties because they were unable to calculate the scale and scope of the various benefits that are going to be offered,” said Begmedova.
Annadurdy Khajiev, an independent economic analyst in the diaspora, said the authorities needed to develop a wide-ranging programme to boost the birth rate.
First, he said, the government should conduct an accurate census, drafting in foreign specialists to help, and then it would be in a position to assess the scale of emigration and of mortality and birth rates.
Mothers and children needed to be guaranteed priority access to health care benefits, and the government needed to unveil a package to help the mothers of large families and also single mothers, including free meals for schoolchildren.
These and other benefits would cost a fair amount, but Khajiev insisted that “they are well within reach for a country that is one of the world’s leading [natural gas] exporters”.