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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 3  |  Page : 145-154

Socio demographic characteristics of women who leave their babies to social services after giving birth in Turkey


1 Division of Midwifery, Faculty of Health Sciences, İzmir Tınaztepe University, İzmir, Turkey
2 Tepecik Education and Research Hospital, Health Sciences University, İzmir, Turkey
3 Division of Midwifery, Faculty of Health Sciences, Adnan Menderes University, Aydın, Turkey

Date of Submission28-Aug-2020
Date of Acceptance24-May-2021
Date of Web Publication19-Jul-2021

Correspondence Address:
Dr. Aysegul Donmez
Division of Midwifery, Faculty of Health Sciences, İzmir Tinaztepe University, Aydoğdu Mah, 1267/1, Street, No. 4, 35400 Buca, İzmir
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNMS.JNMS_110_20

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  Abstract 


Context: It has been known that parents leave their newborn babies under government protection due to various social, cultural, and economic reasons, unwanted pregnancies being one of the most important reasons.
Aims: The aim of the study was to examine the sociodemographic and life characteristics of mothers who had to leave their newborn babies to social services after giving birth.
Settings and Design: Using a qualitative research approach, this research was conducted in the qualitative document analysis design.
Materials and Methods: The data were obtained from the social review reports (electronic) of 66 mothers who gave birth and left their newborn babies to social services between 2010 and 2019 in a hospital in the city center of Izmir, Turkey.
Statistical Analysis Used: The electronic data (number: 1–66) in these reports were analyzed by descriptive and content analysis methods.
Results: Most of the mothers were had 2 years of education (n = 17), were not officially married (n = 31), and worked in an environment open to abuse (n = 6). Six themes were obtained from the data analysis including family status and living with the spouse/partner, pre- and post-pregnancy residence, the process of abandoning the infant, pregnancy process and health problems, sharing pregnancy news and safety, and the conception of pregnancy and the legal process.
Conclusions: This study revealed that mothers who leave their infant to social services have several high-risk sociodemographic and life characteristics, predominantly related to lifestyle, residence, pregnancy experience, and sexual violence. Midwives and other healthcare professionals can help improve mother/infant health by considering these risk groups, while providing the prepregnancy, pregnancy, delivery, and postpartum care services and by providing support to mothers who want to leave their infant to social services.

Keywords: Care, High risk, Infant, Lifestyle, Midwifery, Social protection, Women's health


How to cite this article:
Donmez A, Gencay SK, Karaçam Z. Socio demographic characteristics of women who leave their babies to social services after giving birth in Turkey. J Nurs Midwifery Sci 2021;8:145-54

How to cite this URL:
Donmez A, Gencay SK, Karaçam Z. Socio demographic characteristics of women who leave their babies to social services after giving birth in Turkey. J Nurs Midwifery Sci [serial online] 2021 [cited 2021 Aug 1];8:145-54. Available from: https://www.jnmsjournal.org/text.asp?2021/8/3/145/321723




  Introduction Top


Some of the babies born out of unwanted pregnancies or those who cannot be cared for by their parents are abandoned in the early or late postnatal stages to social institutions or in unsafe environments. This increases the mortality, disease rates, and abuse of babies. In addition, being under institutional care has been shown to affect the growth and development of infants.[1],[2],[3] There are legislations regarding the protection of unwanted babies in Turkey.[4],[5] According to these regulations, parents who are unable or unwilling to take care of their babies are allowed to leave the infant to care units or hospitals affiliated with the Social Services and Child Protection Agency. In addition to preventing unwanted pregnancies, midwives have important responsibilities in protecting unwanted babies and reducing infant illnesses and deaths due to abandonment. In this context, identifying the characteristics of mothers who may need to put their infant under social protection after birth is an important issue that should be investigated as it will create an opportunity to take protective measures.

It has been known that parents leave their babies under government protection due to various social, cultural, and economic reasons, unwanted pregnancies being one of the most important reasons. According to the most comprehensive population and health research conducted in Turkey (2018), unwanted pregnancies constitute 15% of births.[6] Some of these infants are left in the hospital by their parents to be placed under social protection. It has also been reported that 14,214 children are currently cared by institutions affiliated with the General Directorate of Child Services of the Ministry of Family and Labor in Turkey and that 0.06% of children aged 0–18 grow up without parents (as orphans).[7]

Previous studies have investigated different aspects of infants abandoned or taken under protection. In one study, 5.7% of the children under social protection in Turkey were reported to have been abandoned by their parents.[2] Two studies have reported, based on newspaper reports in Turkey, that 87 infants were abandoned in 2013 and 2017; a significant portion of these infants (38 infants) were found dead.[8],[9] In a study of infant deaths in China, deaths due to abandonment (traumatic brain injury) (4.8%) were also included among the causes of neonatal death.[10] Another study reported the neglect or abuse of the infant among the causes of late neonatal death (0.1%).[11] A study of the children left to social care in institutions affiliated to a provincial directorate in Turkey in 2013 reported that the number of girls was higher, the majority of children had fragmented families, families had low socioeconomic and educational levels, and the majority of children did not continue their secondary or high school education. In the same study, sexual and physical abuse in or outside the family, the desire to live away from the family, the desire to be free, the disapproval of the social environment they live in, and the desire for better living conditions were reported among the reasons to leave children to social care.[12]

A study conducted in Malaysia reported that 472 infants were abandoned between 2000 and 2010, and 258 of these infants were found dead.[13] It was reported that approximately 100,000 newborns are abandoned in China every year due to congenital anomalies.[14] A study based on infant autopsy results in China reported abandoned infants to constitute 2.3% of infant deaths.[10] A study in South Africa reported that more than 3500 infants were abandoned in 2010, 65% of these were newborns, and 70% were abandoned in unsafe environments.[15]

Taking infants who are not cared for by their parents in the early postpartum period into social protection is an essential practice that can prevent these infants from being left in inappropriate environments and from serious negligence and abuse in the later life stages. There are related legislative and administrative procedures in Turkey regarding the protection of unwanted babies in the early postnatal period and are implemented successfully.[5] On the other hand, it is well known that there are significant problems in the growth and development of children under protection. In this context, it is important to carry out studies to prevent infants from going through this process. There are a limited number of studies on issues related to various aspects of children under the protection and their families. A previous study in Turkey reported that women wanted to leave their babies in the hospital due to social reasons such as hiding pregnancies from family members (78%).[16] A study of Razali et al. reported that, in Malaysia, infants were abandoned in unsafe areas such as dumps (8.9%), places of worship (7.5%), by a river, pond, or beach (7.0%), or roadside (9.1%).[17] In a study conducted in England, it was reported that 77.4% of the abandoned infants were newborns and 78.1% of these infants were abandoned to unsafe outer areas.[18] Identifying the individual and sociocultural characteristics of the mothers who put their infant under social protection would be the first and an important step in taking preventive measures. It was decided to do research with document analysis design of the qualitative research approaches for deeply understanding the issue.

Aim and the research questions

This study was conducted to examine the sociodemographic and life characteristics of mothers who had to put their infants under social protection after birth. The study questions were as follows:

  1. What were the sociodemographic characteristics of these mothers, how were their pregnancy processes and health status?
  2. How were their relationship with their spouse/partners, family union, and residence characteristics?
  3. How was the process of leaving their newborn babies?
  4. What were the experiences of the mothers about legal processes and sexual life?



  Materials and Methods Top


The study design

This research was conducted in the qualitative document analysis design, a qualitative research approach. In qualitative research, the existing events or cases are evaluated in their natural environment without any intervention with a realistic and holistic approach using the data collection techniques such as observation, interview, and document analysis. Document analysis is done through the examination of printed and electronic documents.[19] Qualitative research through document analysis involves five stages: (1) accessing the documents, (2) checking the authenticity of the documents, (3) understanding the documents, (4) analyzing the data, and (5) using the data.[19]

The data source, accessing the documents, and checking their authenticity

The data were obtained from the files of a hospital in Izmir metropolitan area. The study electronic documents were constituted by the social review reports (SRRs) of 66 mothers who gave birth and left their newborn babies to social services between 2010 and 2019 in the hospital. These documents were obtained with official permission from the hospital administration. The documents used in the study were original and created by a social work specialist who carries out related studies at the hospital.

Understanding the documents and the analysis and use of data

The documents were examined to understand the variety and content of the data. These documents alone constituted the entire data set of this research. Descriptive and content analysis methods were used to analyze the data. With descriptive analysis, the findings were summarized and presented along the lines of the research questions.[19] In content analysis, inductive analysis approach was used to analyze data. With this approach, it was aimed to reveal the underlying concepts and the relationships between these concepts by coding of the data.[19] Content analysis was made according to the study purpose and questions, and the preliminary codes, subcategories, and themes were created based on the data obtained from the SRRs and were associated and combined with each other.

Ethical aspects of the study (using the data)

In order to conduct the research and use the related documents as a data source, official permission has been obtained from the hospital administration. In addition, the research protocol was approved by the local ethics committee at the hospital (meeting no: 2, decision no: 16). In the study, the consent of the mothers whose documents were examined could not be obtained. However, special care was taken not to include any expressions that allow the identification of mothers in this report.

Reliability and validity of the study

Validity and reliability should be demonstrated to confirm the credibility or quality of the results obtained in qualitative research.[19] To improve reliability in this study, the five stages reported by Yıldırım and Şimşek were followed.[19] To ensure the internal reliability of the study, the coding of the data was done by AD and ZK, providing for consistency among the authors. In order to ensure the external validity of the research, where and how the data were obtained, the analysis process, and how the conclusions were reached were explained in detail.


  Results Top


The average age was 23.94 ± 7.45 years (range: 12–40) for the mothers included in the study; 22.72% were in the range of 12–17, and 25.75% were in the range of 20–25. In terms of education, 11 dropped out of school, 17 primary school graduate, five were high school graduates, one had a college degree, and eight student (high school/university/graduate student). Most of the mothers did not have an official marriage license (n = 31) and some were divorced (n = 13). Mothers were found to have worked in various environments open to abuse including selling vegetables and fruits in open bazaars (n = 1), selling corn as a street vendor (n = 1), working at taverns, discos, or bars (n = 3), working in jobs not approved by her family (n = 1), and having sex in exchange for money (n = 1) [Table 1]. Three were found to quit their jobs once their pregnancy was noticeable.

Six themes were identified through the analysis of the data from the SRRs. The first theme was “family status and living with the spouse/partner” and included two categories: “living with the spouse/partner” and “information about family status.” The subcategories and preliminary codes for these categories were given in [Table 2]. The second theme was “pre- and post-pregnancy residence” and included two categories: “history of prepregnancy residence” and “history of postpregnancy residence.” These categories consisted of a total of ten subcategories [Table 3]. The third theme was “the process of abandoning the infant” and included three subcategories: “the reason for abandoning,” “the possibility of taking the child back,” and “the final decision to abandon[Table 4]. The fourth theme was “pregnancy process and health problems” and included three categories: “finding out about the pregnancy,” “demand for health care,” and “health problems.” The subcategories and preliminary codes for this theme were given in [Table 5]. The fifth theme was “sharing pregnancy news and safety” and included two categories: “sharing” and “safety” with three subcategories each [Table 6]. The sixth theme was the “conception of pregnancy and the legal process” and included two categories. The “conception of pregnancy” category included the subcategories of “rape/coercion,” “biological father is known,” “biological father is not known,” and “result of incest.” The “communication with security forces” category included the subcategories of “complaints due to rape,” “protection,” and “complaints about the father[Table 7].
Table 1: Sociodemographic characteristics of mothers

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Table 2: Family status and life style of mothers with spouses/partners

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Table 3: Pre- and post-pregnancy residence of mothers

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Table 4: Status of mothers regarding the process of abandoning their infant

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Table 5: Pregnancy process and health problems of mothers

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Table 6: Sharing pregnancy news and safety situations of mothers

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Table 7: Mother's experiences about pregnancy conception and legal process

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  Discussion Top


This study was carried out to examine the sociodemographic and life characteristics of mothers who had to place their infant under social protection after birth by examining the SRRs of 66 mothers in a document analysis design, a qualitative research approach. In the study, important information was gathered about these mother's sociodemographic characteristics, residence characteristics, lifestyles, pregnancy process, family and health status, the process of abandoning their infants, legal procedures, and sexual life. These data were valuable in reflecting on our cultural characteristics and facilitating the improvement of social and health services that can be offered to mothers who need to place their infants under social protection.

In the “family status and living with the spouse/partner” theme, it was found that most of the mothers did not have a happy marriage and lived separately from their parents. Previous studies similarly reported that children who were abandoned or left to social care institutions were members of fragmented families.[2],[20],[21] Accordingly, it can be said that it is important to consider the children who are growing up without their parents and the individuals and families with problematic marriages as high-risk groups and to support these groups.

In the “pre- and post-pregnancy residence” theme, it was found that some of the mothers had stayed at foster care as a child, fled from home due to violence, or lived in unsafe places (i.e., streets). It has been reported that girls, adolescent girls, and homeless people are at the highest risk for sexual violence.[22] Basar and Demirci reported that some women flee from home in the face of violence.[23] In the National Research on Domestic Violence Against Women in Turkey, it was reported that women had little knowledge about and various prejudices against the charities serving violence victims.[24] Avşar reported that women did not have sufficient information about how to reach women's shelter and exercise their rights when faced with violence.[25] These results indicate that it is important to provide a safe living environment for women.

In the “process of abandoning the infant” theme, the most emphasized code was ”unwillingness to take the infant and not having the means to take the infant” as the reason for the infant's abandonment. In a previous study examining the sociodemographic characteristics of the mothers who left their newborn infants in the hospital in Ankara, Turkey, it was found that 62.7% did not work.[16] In another study in Isparta, Turkey, it was reported that the primary reason for families to place their children under social protection was economic concerns.[2] In a study conducted in Malaysia, the parents of the abandoned infants were reported to be under the age of 18, student, and unemployed.[17] According to these results, it can be said that the abandonment of the infant after birth is a more common phenomenon, especially among individuals with a low socioeconomic background. Providing these individuals with safe environments that allow protection for their infants is critical in terms of protecting neonatal health and preventing infant abuse and death.

In the “pregnancy process and health problems” theme, the majority of mothers were in the subcategory of “requesting termination of pregnancy.” Several studies have reported that women who encounter unwanted pregnancies make similar requests.[26],[27],[28],[29] In a study evaluating abortion and family planning services from the point of view of health-care workers in Istanbul, it was reported that these services were not available or limited in public health institutions, and some health workers reported a lower gestational week than the legal limit for abortion (10 weeks).[30],[31] Thus, it can be said that termination of unwanted pregnancies is a significant women's health problem, safe abortion services should be widely available, and training should be provided about the subject, primarily for health-care professionals.

In the “sharing pregnancy news and safety” theme, it was found that some mothers could not share the news about their pregnancy with their families and close circles. In a study in Turkey, the primary reason indicated by women for leaving their infants in the hospital was social reasons (62.7%), among which the most common was to hide the pregnancy from family members (78%).[16] These results are important for suggesting that these infants were born out of extramarital relationships not approved by their social environment. The rate of pregnancies out of wedlock is much lower in Turkey (2%–3%) as well as in Japan and Korea compared with some other countries such as Mexico (67%), Iceland (70%), and Chile (73%).[32] A case report described extramarital pregnancies as a risk factor for suicide due to social pressure on women, since different societies have different perceptions of extramarital relationships.[33] Accordingly, pregnancies that result from extramarital relationships pose a risk for maternal and infant health in some societies.

In the “conception of pregnancy and the legal process” theme, it was found that some mothers filed a legal complaint due to rape and conceived as a result of the rape/incest. Previous studies have also shown that extramarital pregnancies, rape, and incest were cited as common causes of unwanted pregnancies.[16],[22] In previous studies, it was reported that women applied to government institutions or nongovernmental organizations,[24] police stations, courts, health institutions, or municipal governments[34] when they found their situation unbearable. On the other hand, it was also reported that some women, who are constantly subjected to physical violence, do not tell anyone.[24],[35],[36] These results underline the awareness of sexual abuse and violence against women and children and demonstrate the need for radical measures.


  Conclusions Top


By examining the SRRs, the following themes were obtained for mothers who had to place their infant under social protection just after birth: family status and living with the spouse/partner, pre- and post-pregnancy residence, the process of abandoning the infant, pregnancy process and health problems, sharing pregnancy news and safety, and the conception of pregnancy and the legal process. It was found in general that these mothers did not have a happy marriage, were separated from their parents, were sent out of the town due to pregnancy, did not want to keep the infant, and did not want to be put the baby for adoption because of the possibility that the child might be returned to them. In addition, it was found that some were drugged and forced to have sexual intercourse, some knew who the biological father was, some could not understand that they were pregnant, and therefore could not terminate the pregnancy in the advanced stage, some were abandoned by their partners as they learned about the pregnancy, their relatives and neighbors had no knowledge of pregnancy, and they did not share this information with their families out of fear.

The data obtained in this study may contribute to the identification of high-risk individuals and families to abandon their newborns, taking protective measures, and designing and developing services to solve their problems. It is important that the midwives question the medical and family history of pregnant women in detail, make a comprehensive assessment for the possibility of abuse while getting information about their marriage/relationship and pregnancy, and be informed about what to do when faced with high-risk pregnant women. Local government and nongovernmental organizations should provide training to raise social awareness about the social protection for infants. Midwives and midwife instructors may contribute to the development of awareness in the society and among other health-care professionals by including this issue in formal and nonformal educational programs. Health-care administrators and policymakers may create programs that can identify, reduce, or prevent high-risk groups who would put their infant under social protection and advocate for legislative action to provide counseling and support services for them. In addition, more comprehensive quantitative and qualitative studies may also help to guide the processes to improve the delivery of social services.

Conflicts of interest

There are no conflicts of interest.

Authors' contributions

Contributor 1: Concepts, Design, Definition of intellectual content, Literature search, Clinical studies, Data acquisition, Data analysis, Statistical analysis, Manuscript preparation, Manuscript editing, Manuscript review, Guarantor.

Contributor 2: Clinical studies, Data acquisition.

Contributor 3: Concepts, Design, Definition of intellectual content, Literature search, Data analysis, Statistical analysis, Manuscript preparation, Manuscript editing, Manuscript review.

Financial support and sponsorship

Nil.

Acknowledgement:

Acknowledgement: This article was obtained from the Social Examination Reports of women who gave their babies under social protection between 2010 and 2019 in a hospital in the city center of İzmir.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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Abstract
Introduction
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