Basic Health and Welfare of Children
 
 

(extracts from the UNITED NATIONS CONVENTION ON THE RIGHTS OF THE CHILD INITIAL STATE REPORT TURKEY 1999 - ANKARA)
 
 

Living Standards (Article 27, paragraphs 1-3)
 
 

The informative programs are conducted together with health care efforts for offering an adequate living standard to ensure the physical, mental and social development of children. They also aim to educate the handicapped and to reduce the risks of becoming handicapped. The General Directorate of Social Services and Child Protection Agency is rather active in this field through its provincial directorates all over Turkey.
 
 

The Constitutional provisions on living standards are as follows:
 
 

Article 17(1): "Everybody has the right to life and the right to protect and develop his material and spiritual entity."
 
 

Article 41(2): "The State shall take necessary measures and establish the necessary organization to ensure the peace and welfare of the family, especially the protection of the mother and children, and for family planning education and application."
 
 

Article 49(2): "The State shall take necessary measures to raise the standard of living of workers, to protect them in order to improve the general conditions of labour, to promote labour, and to create suitable economic conditions for prevention of unemployment."
 
 

Article 59(1): The State shall take measures to develop the physical and mental health of Turkish citizens of all ages…."
 
 

In the fight against poverty, with its Regulation on Cash and in Kind Social Assistance, the General Directorate of Social Services and Child Protection Agency provides financial aid to people who cannot acquire their basic needs. Social workers conduct the necessary research to find those in need. Those living in poverty are given material (food, clothing, medicine, medical instruments, fuel etc.) and financial aid. Financial aid is distributed to these people monthly for 6 months, 1 year or 2 years. The monthly amount of social aid, according to the afore-mentioned regulation will be 20 percent of the salary, including the bonus payment, of the highest official.
 
 

Survival and Development (Article 6, paragraph 2)
 
 

The age group of the child has special importance within the general health system since children represent a sizeable part of the population.
 
 

According to the results of 1993 census and health survey in Turkey, the average age for the first marriage for females is 18. Only 62.8 percent of women use a birth control method. The total fertility rate is 2.7 and the birth rate is 0.23 percent. (The entire population is considered in the total fertility rate and the 15 to 49 age group of the population is taken into account in the birth rate).
 
 

According to research findings, the infant mortality rate in the rural areas where children die in greatest numbers before reaching one year of age is approximately one third higher than in the urban areas. A quarter of children living in rural areas have a greater chance of contracting respiratory tract infections than children in urban areas.
 
 

Annually, of approximately 1,358,000 live births, only 59.6 percent occur in health institutions.
 
 

Although the studies tend to show a rapid decrease in the infant mortality rate, the desired level is yet to be achieved. According to the result of the 1993 study mentioned above, the average infant mortality rate is 52.6 per thousand live births, which rises to 60 per thousand in some regions. 29.2 per thousand infant deaths occur generally during the first four weeks after the birth and 60.9 per thousand occur in the first five years. It should be remembered that 86 percent of these deaths occur before the completion of the first year of life. About 60 percent of the infant mortality cases are ascribed to preventable diseases. Despite the intensity of special-purpose health programs conducted to keep the children alive and to protect their health, the insufficiency of the system and infrastructure and the problems arising from the personnel turnover prevent the attainment of the desired results. Presently, 64.7 percent of all children in the 12 to 23 month-age group have received full inoculation within the scope of the expanded immunization program, though this rate falls down to 40.6 percent in the eastern part of the country. These figures show us that an excessive number of infants still cannot be protected from preventable diseases. Acute respiratory tract infections and diarrhea constitute the other two important causes of infant deaths.
 
 

In 1995, the share of health investments within the total public sector fixed investments was 3.3 percent.
 
 

Disabled Children (Article 23)
 
 

According to article 8/III of the Basic Law of National Education, the duty of providing education and training to the children with special educational needs has been given to the Ministry of National Education with the statement that “Special measures will be taken to train the children who need special education and protection."
 
 

The functions of the Special Education, Guidance and Counselling Services described by the Law No. 3797 Concerning the Organization and the Duties of the Ministry of National Education are as follows:
 
 

  1. To carry out all duties and services regarding educational methods used in special educational schools and classes, guidance and research centers, occupational schools, vocational education centers, other schools and educational institutions;
  2. To prepare the educational and instructional programs, textbooks and other educational materials used by the schools and educational institutions.

As a result of the increase in the need for special educational and guidance services nationwide, the Law No. 2926 on Children with Special Educational Needs was enacted in 1983 in order to provide these services more effectively and widely.
 
 

After the evaluation of 13 years of implementation of this Law, it was found that structural modifications are needed in the area of special education.
 
 

For the purpose of overcoming the problems encountered by individuals with special educational needs, their families and their educators, a new legislation has been prepared by considering the existing status of education for individuals with special educational needs and the recent developments and successful practices in this area. Being potentially a guide for public and private investments and practices, the Decree Equivalent to Law No. 573 Concerning Private Education was enacted on 6 June 1997. Immediately after its enactment, the old Law No. 2926 has become ineffective.
 
 

The new Decree Equivalent to Law Concerning Private Education has facilitated to overcome the problems encountered in the existing practices and to use the available resources more rationally.
 
 

Special Classes
 
 

In addition to the public institutions and organizations, real persons and legal entities may establish special education schools and classes for children with special needs under the Law No. 625 on Private Education Institutions. Through the activities carried out by federations, associations and special educational centers, the delivery of educational services for such individuals is diversified. A study for determining the exact number of such individuals by the State Institute of Statistics is underway.
 
 

The content of the main articles concerning special classes of Law No. 625 on Private Education Institutions are listed below:
 
 

Article 71 - Special classes like:
 
 

a) Classes for blind and visually handicapped students

b) Classes for deaf students and students with hearing problems

c) Semi-special classes

d) Upper special classes

e) Classes for child prodigies
 
 

can be established for children who are in need of special training, who cannot sufficiently benefit from the program of the school at the public and private primary and secondary schools and at special training institutions, by making use of programs that are prepared by taking into consideration their abilities, fields of interest, disabilities and capabilities.
 
 

Partially blind and deaf children will be admitted to special education and other schools and those who are blind or deaf and who are superior in their studies can be placed at classes in normal schools.

Establishment of Special Classes
 
 

Article 72 – At least 10 students with the same handicap will be required for the establishment of a special class. Where the number of students is less than 10, these students will be exempted from some of the subjects in the curricula depending on their situations and constraints.
 
 

Additional Classes
 
 

Article 74 - Where there are students of different handicapped groups needing special education in public and private primary, secondary and senior high schools and special schools, additional classes may not be established and these students will be admitted to normal classes and sent to additional classes to support their education.
 
 

Ambulant Instructing
 
 

Article 75 - Ambulant-instructing systems will be instituted in areas where there is a limited number of handicapped students for whom special classes may not be established.
 
 

Tutors who are trained to instruct students from one or more handicapped groups can be employed in special classes, auxiliary classrooms and mobile training programs.
 
 

The Primary Education and Training Law article 12 includes a provision stating "It is provided that children, who are in the age of compulsory primary education, but who are mentally, physically, psychologically or socially disabled, get special education and training."
 
 

According to article 39 of the Apprenticeship and Vocational Training Law No. 3308, "The Ministry (of National Education) holds special vocational courses, to prepare people needing special training to professions in business life. The fields of interest, needs and abilities of these people are taken into consideration in the preparation and execution of these courses. Those attending these courses benefit from the rights given by this Law to apprentices and students."
 
 

The Law on Social Services and Child Protection Agency introduces the following provisions on handicapped people:
 
 

Article 3/c - "While executing social service programs, priority is to be given to children in need of protection, to the disabled in need and elderly people in need.”
 
 

Article 4/1 - "Every kind of measure is to be taken in order to provide that people in need, disabled people and the elderly people continue their lives in health, tranquility and security; that care and rehabilitation is provided to the handicapped in need, to ensure that they become self-sufficient people in the society; and that permanent care is provided to those who cannot be cured."
 
 

Article 9 – "Family Advisory and Rehabilitation Center defined as daily social service institutions provide services to families and disabled children for promoting harmony in families, preparing disabled children for school training and making disabled children self-capable and self-adequate."
 
 

Article 9/b – “The duty of the foundation is "First to determine children, disabled and elderly people, who are in need of protection, care or help, to give necessary services in order to provide these people with protection, care, development and rehabilitation, and to establish and operate social service institutions, defined in article 3, within the principles mentioned in article 4."
 
 

Article 25 - "The education and training of school-age children who are in need of protection is completed in schools of the Ministry of National Education and other state institutions.”
 
 

Children, who cannot attend school due to various reasons are employed in the workplaces of the state or private persons and receive pay and training. Some of the salary of children employed in this way which is determined by the administration is paid as pocket money. The rest of the salary is credited to an account at a national bank under the name of that child, in the first 10 days of the next month. The starting date and the amount of the salary are determined between the administration and the employer, according to the local standards and existing values. The principles on this subject are outlined by a regulation.
 
 

The education and training of blind, deaf, mute or physically handicapped as well as mentally or psychologically disordered children or those who are in a similar situation and who need special training and protection, is to be completed in schools, established by the Ministry of National Education.
 
 

The Regulation on Locating, Examining, Care and Rehabilitation of the General Directorate of Social Services and Child Protection Agency has the following provisions:
 
 

Article 1 - The purpose of this Regulation is to introduce rules for the location, examination, institutional care, assistance at home and rehabilitation of persons who are not able to cope with the routine daily activities as a result of their handicaps, to identify the nature of services to be provided and the duties and responsibilities of the personnel.
 
 

Article 4 - Services of rehabilitation centers such as recreation and counselling will be provided as home support facilities for the visually handicapped, spastics, orthopedically and audially handicapped and mentally retarded.

Article 5 - The responsibility for locating, assisting, caring and training the handicapped persons is vested with the provincial directorates.
 
 

Local administrative officials, health institutions, village headmen and general and municipal police forces are responsible for reporting such persons.
 
 

Other public bodies and agencies, citizens and relatives of the handicapped may also report them.
 
 

The Essential Law for Medical Services has commissioned the Ministry of Health to give protective health services. In a circular sent to hospitals, it is required that modifications should be made in hospitals to ensure that disabled people can also use these facilities. With an amendment to the Regulation on Private Hospitals, building ramps became also an obligation for private hospitals. A new regulation has been prepared to give priority to disabled people at the hospitals and clinics and studies on preparing identification cards for these people are also underway.
 
 

The preparation of a regulation on the standardization of Health Council Reports, which will be of special interest to the handicapped people, is at its final stages.
 
 

The preparation of a questionnaire for building a profile of handicapped people, in order to determine their demographic, social, educational and cultural standings which will be performed by the State Institute of Statistics, continues with the contributions of the General Directorate of Medical Services.
 
 

The Ministry of Health, through cooperating with an association, opened the “Early Intervention Center" in order to determine whether the children of 0-6 years of age (starting from birth) are handicapped or not, to treat and rehabilitate disabled children and to give guidance training to their families. According to the results, this activity will be spread all over the country.
 
 

It becomes evident from a perusal of the legislation in force in Turkey that laws, regulations, instructions and circulars constitute bases for the protection of the rights of individuals with special care needs.
 
 

Reports of education councils and committees indicate, however, that the services offered are not systematic and sufficient. In fact, while an overregulation appears in some areas, there exist no provisions in some others such as the elimination of discrimination, meeting the needs of families having handicapped members, family and informal education and supervision.
 
 

The number of children, who need special care and training, is not exactly known, but estimates based on world rates exist. While the spread of schools over the country is not balanced, the rate of boarding schools is high.
 
 

Most of the disabled children in Turkey are trained in boarding schools. This training system isolates the disabled children from the society and hinders them from developing communicative and social skills.
 
 

With respect to children who are in need of special care and training, the current regulations are insufficient in terms of early recognition and educational diagnosis, prevention, placement, educational environment, educational methods, personnel, technology.
 
 

Article 39 of the Law No. 3308 on Apprenticeship and Vocational Training introduces provisions on holding vocational courses, which are necessary in business life and which take into consideration the fields of interest, the needs and abilities of the individual with special needs. Various courses are held according to this law and vocational counseling is applied in schools.
 
 

Some material aid is provided to children of state employees or workers in the "Ba?-Kur" (Pension Fund for the Self-Employed) who need special training. Nevertheless, workers who are not a part of these two social security systems cannot benefit from these rights.
 
 

Children who are in need of special care and training are provided with care and training at specialized centers under the Ministry of National Education and the General Directorate of Social Services and Child Protection Agency. They are medically treated at centers affiliated to the Ministry of Health.
 
 

Special training schools and institutions are spread over Turkey with the following rates: 24 percent in the Middle Anatolian Region, 22 percent in the Marmara Region, 16 percent in the Black Sea Region, 14 percent in the Aegean Region, 9 percent in the East Anatolian Region, 8 percent in the Mediterranean Region and 5 percent in the South-East Anatolian Region.
 
 

Besides state institutions and foundations, real and legal entities can also establish special schools or classes for the training of children who are in need of special care and training, according to the principles of the Law No. 625 on Special Training Institutions.
 
 

Education of the Visually Disabled Children
 
 

For the totally blind or low vision individuals, there are 11 special primary schools and 5 special educational classes. Such individuals may also attend the inclusive schools. The number of children with visual impairment attending all kinds of educational institutions is 1427.
 
 

The Ministry of National Education organizes literacy and vocational courses for those who cannot attend formal educational institutions. All kinds of printed publications and educational materials are produced in the Braille Printing House and Evening Art School, established for the visually impaired. In addition to this, secondary school textbooks have been recorded to audiotapes, duplicated and delivered to the visually impaired students. Educational materials required by the visually impaired students in mathematics and social science courses are produced and delivered by the Production Center for Educational Materials.
 
 

Education of Audially Disabled Children
 
 

For students who are deaf or who have hearing problems, there are 47 special primary education schools and 61 special education classes. The number of students with hearing impairment attending both special and inclusive education is 7630.
 
 

For the adults with hearing impairment, literacy and vocational courses are organized by the Ministry of National Education. A sign-language guidebook, aimed at eliminating the local differences in the use of sign language has been prepared.
 
 

In order to improve the quality of existing inclusive practices, high schools with Mullet-programs for the hearing impaired have been established in eight provinces. The students attending these schools take the cultural courses in their schools and vocational courses in the Vocational High Schools in the neighborhood. Courses concerning the use of wireless hearing aids are organized for teachers.
 
 

A study is being carried out for the purpose of evaluating the effectiveness of the natural-oral-audio method.
 
 

Education of Mentally Disabled Children
 
 

For the moderately and severely mentally handicapped students, there are seven special primary education schools, 40 Vocational Education Centres, 55 Education and Practice Schools and three Independent Occupational Training Centres . In addition to these, there are 630 special educational classes. The mentally handicapped students also attend inclusive schools. The total number of students with mental handicap attending these institutions is 20 thousand.
 
 

The adults with mental handicap, regardless of whether or not they received formal education, may attend occupational training centers.
 
 

Education of Physically Disabled Children
 
 

There are 600 students with orthopedic handicap attending four special primary education schools, four vocational high schools and inclusive schools. Studies concerning the architectural modifications are in progress for the purpose of facilitating accessibility to the school buildings and public facilities for the orthopeadically handicapped.
 
 

Education of Chronically Ill and Hospitalized Children
 
 

For children who need special education because of a chronic illness, 26 primary schools have been established within hospitals.
 
 

Education of Children with Speech Difficulties
 
 

Children with language and speech difficulties attend inclusive schools after the necessary measures are taken for their special education. The ones who cannot attend regular schools are provided therapeutic and supportive educational services in the guidance and research centers. The number of students with language and speech difficulties attending inclusive schools is 8300.
 
 

Education of Children with Adaptation Problems
 
 

Research is being carried out to provide educational services to children who have difficulty in forming and maintaining healthy social relations and who experience adjustment problems due to various reasons.
 
 

Family Education
 
 

The family education, an inseparable part of the special education services, is pursued through school guidance facilities, as well as the guidance and counselling centers, despite the absence of legal arrangements governing these activities.
 
 

Guidance Work
 
 

There are 96 guidance and research centers at 80 provinces in Turkey where 540 guiding teachers work.
 
 

Making the decision on the location, selection, diagnosis of children needing special education, determining the facilities to which they will be sent, managing special therapeutic activities to improve the situation of children failing to adapt themselves to their environments for spiritual, sentimental and social reasons, planning guidance support at the primary and secondary education institutions and examining cases reported by the schools are among the duties of the guidance and research centers under the Law No. 2916 on Children Needing Special Education.
 
 

Several activities are performed for the handicapped by the Ministry of Health and a department was established on 17 May 1997 within the General Directorate of Therapeutic Services for the coordination of work oriented to the handicapped and the provision of health services of higher calibre.
 
 

Activities intended for the handicapped may be divided into preventive, rehabilitation and therapeutical categories. Some of these activities are listed below:
 
 

Vocational Rehabilitation and Employment Services
 
 

The Constitution, Law No. 573, Decree which is equivalent to Rule on Private Education, Law No. 3308 on Apprenticeship and Vocational Training, Labor Law No. 1475, Regulations on the Employment of the Handicapped and Law No. 2828 on the Social Services and Child Protection Agency contain a number of clauses about the rehabilitation and employment of handicapped persons.
 
 

The Constitution indicates that the State will protect the handicapped persons, both in their social and vocational activities.
 
 

Several other laws foresee the employment of handicapped persons commensurably with the resources at hand.
 
 

The regulation issued under the Labor Law No. 1475 indicates that the functions of employment consultancy, vocational orientation and rehabilitation may be performed by the Labor and Employment Administration. Fines given to employers who disregard this decision, are accumulated in a fund at the Employment Agency and are used for the professional rehabilitation of disabled children.
 
 

It is suggested that the vocational rehabilitation services provided by several ministries should be consolidated to enable them to better perform the tasks of evaluating the situation of the handicapped and to provide an efficient consultancy service to those needing it.
 
 

Amendments have been made in the relevant laws to enable the State to furnish the handicapped children who are not covered by the Public Servants Law and Labor Law with hearing aids and other devices.
 
 

Legal Basis of Health Services (Article 24)
 
 

Article 56 of the Constitution states the following:
 
 

"Everyone has the right to live in a healthy, balanced environment.
 
 

It is the duty of the State and citizens to improve the natural environment, and to prevent environmental pollution.
 
 

To ensure that everyone leads their lives in conditions of physical and mental health and to secure cooperation in terms of human and material resources through economy and increased productivity, the State shall regulate central planning and functioning of the health services."
 
 

Article 41(2) of the Constitution says that "The State shall take the necessary measures and establish the necessary organization to ensure the peace and welfare of the family, especially the protection of the mother and children, and for family planning education and application."
 
 

According to article 3, paragraph (j) of the Law on Essential Health Services, "Training the citizens on protection from diseases, healthy environment, nutrition, mother-child health and family planning and others is performed with the cooperation of professional institutions accepted as state institutions and private and voluntary institutions."
 
 

According to article 13 of the above-mentioned Law, the main duties of the General Directorate of Mother-Child Health and Family Planning are as follows:
 
 

  1. To determine the aims of the Mother-Child Health and Family Planning services, to prepare plans and programs of action according to these aims and to execute these plans,

  2.  

     

  3. To provide service in protecting the physical and psychological health of the mother and of the child.

The Subregulation No. 154, prepared in accordance with the Regulation on Providing Health Services in Regions, covers the subjects of mother and childcare and family planning. The relevant provisions of this Subregulation are as follows:
 
 

"Necessary information is to be given to pregnant women, women who gave birth and breast feeding women about child-care and the protection of their own health.
 
 

Measures are taken to provide the most suitable means for pregnant women to deliver their children.
 
 

Mothers and children are monitored and examined after birth.
 
 

Necessary measures are taken, in order to ensure healthy physical and psychological development of children.
 
 

Pregnant women enjoy healthcare for prenatal and postnatal periods. Follow-up controls ensure that the new born grows up, physically and psychologically healthy."
 
 

The Law on the General Protection of Health article 1 states that "To improve the health conditions in the country, to fight diseases and all other harmful factors endangering the health of the society, to ensure a healthy next generation and to provide medical and social assistance to citizens constitute the general State services." Article 3 states that "The Ministry of Health directly performs services like protecting the health of mothers after birth, taking measures to protect the health of children and young people and providing all other services related to the protection of the children." Article 151 states that "The Ministry of Health establishes and directs institutions necessary for the protection of children and for decreasing the death rate of children and takes measures to help people learn the benefits of protecting the health of children."
 
 

The Turkish legislation on health services complies with the requirements of the CRC.
 
 

It is stressed in article 56 of the Constitution that everybody has the right to live in a healthy and balanced environment. In 1984, the activities for extending health services covered all cities. In the Fifth Five-Year Development Plan, it is accepted as a basic principle that service has to be provided to everybody in an equal, continuous and effective way in order to improve the general health level. State expenditures related to health constitute about 3.75 percent of the GNP.
 
 

The rate of pregnant women who undergo medical examination before birth has been increasing. The rate of those who use effective birth control methods is lower in the eastern and northern Anatolian regions than those in the western regions. It has been determined that there is a strong correlation between the educational level of the women and the use of a health institutions or birth control methods.
 
 

Within the currently applied health system, mother and childcare services are available to all pregnant women. It has been established that only 63 percent of pregnant women receive pregnancy healthcare.
 
 

The death rate of babies was 81.5 per thousand between 1983-1988, but decreased to 52.6 per thousand in 1993. The great majority of the deaths of babies take place in their first year. The death rate of children below the age of 5 in Turkey is 60.9 per thousand.
 
 

Implementation of Health Services
 
 

The expanded immunization program initiated in 1985 in Turkey was integrated with the health centers, health houses, mother and child care centers and family planning units, in close cooperation with the first-echelon health institutions. The neonatal tetanus eradication program was launched in mid-1994, followed by the polio eradication program in 1995 in which 85 percent of the target population was reached.
 
 

The program for the control of diarrhea was put into action in 1986. The oral rehydration therapy is applied in this program in order to prevent the diarrhea cases and deaths resulting from dehydration. The rate of the use of this treatment was 44 percent in 1988 and 57 percent in 1993. The oral rehydration salt packages are purchased from the manufacturers by the Ministry of Health and distributed free of charge to patients.
 
 

Free distribution of medicines to abate acute respiratory track infections and pneumonia is in full swing at all health institutions under the control of the Ministry of Health.
 
 

Programs exist for the promotion of breast-feeding of the infants and expansion of baby-friendly hospitals along the principles set forth in the joint WHO/UNICEF declaration titled "Ten Steps in Successful Breast-feeding." In an effort to support this activity, a protocol was signed with the baby food manufacturers for prohibiting the free or low-price distribution of baby food in maternity wards so that breast-feeding is not inhibited by such easy-to-reach methods.
 
 

To prevent iodine-deficiency diseases, iodized salt is being produced in Turkey since 1953. A program was launched in 1995 to promote its wider use. The salt manufacturers have signed an agreement with the Ministry of Health and undertook to start manufacturing solely iodized salt by the year 2000.

Phenylkentonuria screening was started in 1987 in cooperation with the Children's Hospital of the Faculty of Medicine at the Hacettepe University with the screening of neonates in 22 provinces. 480.908 neonates were screened for phenylketonuria in 1996.
 
 

The safe motherhood and child care program aims at the identification and follow-up of all pregnancies, the determination of risky pregnancies in order to take the appropriate measures, the education of pregnant mothers on nutrition and immunization, the support of anemic cases with iron foliate preparations, the transfer of pregnant mothers to health care institutions with sterile conditions, the education of mothers and family members about prenatal care and the early diagnosis and treatment of post labor complications (such as sepsis, mastitis, anemia prophylactics, etc.) and about family planning methods. The mothers are also educated on the importance and value of breast-feeding during the first four to six months after the birth of the child.
 
 

With a view to preventing the hereditary handicaps, a program on family health was started in five pilot regions for informing the future parents of the risk factors and for providing genetic consultancy services. The mother and child care and family planning centers integrated into public health programs, which include maternal and infantile health and family planning, encompass additional topics such as the disadvantages of excessive births on the health of the mother and the child and the nutrition of pregnant women and the newborn.
 
 

For abating genetic blood diseases, the Ministry of Health conducts a thalassemia eradication program under the Law No. 3960 in the cities of Antalya, Içel, Mu?la and Hatay where this disease is prevalent. Thalassemia diagnosis and treatment centers have been established in these areas.
 
 

A massive training effort has been initiated to prevent disorders due to the use of narcotic drugs by the youth, mothers and other groups.
 
 

Social Security (Article 26)
 
 

Article 60 of the Constitution confirms that "Everyone has the right to social security. The State shall take the necessary measures and establish the organization for the provision of social security.”
 
 

The ILO Convention No. 102 on the Minimum Standards of Social Security, ratified by Turkey with the Law No. 1451 dated 29 July 1971, requires the signatory States to implement at least four of the social security systems; these are occupational accidents, occupational diseases, maternity, disablement, old-age and death insurance.
 
 

According to articles 1 and 2 of the Law No. 5434 dated 8 June 1949 on the Old-Age Retirement Insurance, the State is in charge of providing coverage to the public servants, retirees, the disabled and orphans through an adequate monthly pay and health services.
 
 

Articles 1 and 2 of the Law No. 506 of 17 July 1964 obliges the Social Insurance Administration to provide coverage for occupational accidents and diseases, maternity, disablement, old-age and death insurance to all persons employed under a labor contract by one or several employers.
 
 

The Organization for Social Insurance of Independent Workers or the Self-Employed enables anyone to be insured regardless of whether he/she is employed or not.
 
 

Under article 20 of the Law on Social Insurance Administration, the banks, insurance and reinsurance companies, chambers of commerce and industry, commodity exchange markets and the retirement funds are entitled to operate like the Social Insurance Administration provided that they offer the same benefits to their members as does the latter. Charters of these funds are subject to approval by the Ministry of Labor and Social Security.
 
 

Consequently, insurance coverage of even one of the parents permits the children to be entitled to the same coverage.
 
 

However, the Turkish social security system has not achieved yet its basic goal of bringing all individuals under a social security umbrella against social security risks, thus, around 20 percent of the population still does not have such a coverage.
 
 

According to article 60(g) of the Social Insurance Law, the period of insurance coverage to be taken into account for the old-age or retirement insurance will begin at the eighteenth year of age irrespective of whether they remit insurance premiums in connection with their employment.
 
 

Child Care Services and Facilities (Article 18, paragraph 3)
 
 

The Republic of Turkey is a social state. The "social state" concept imposes a number of obligations upon the state with regard to care and training of children during the preschool period. Article 41 of the Constitution says that the family is the basis of the Turkish society and that the state will adopt appropriate measures to spread the practice of family planning to protect the child and the mother and to establish the institutions necessary for these.
 
 

Industrialization in Turkey entailed an influx from villages to cities and a transition from extended to nuclear family structure and increased the demand for preschool training. After the 1960s, nurseries and kindergartens were set up by a number of laws and regulations.
 
 

There are various institutions offering training and care services for children in the age group of 0-6 years. Baby care centers and kindergartens of the General Directorate of Social Services and Child Protection Agency, as well as those established by persons and corporate entities and universities, Children’s Homes of the Ministry of National Education, maternal classes established in primary schools, practice classes at secondary schools and kindergartens established by state institutions and foundations.
 
 

Public baby care centers and kindergartens, providing care and education for the age group of 0-6 years, under the General Directorate of Social Services and Child Protection Agency, give services according to the "Regulation on Baby Care Centers and Kindergartens" dated 1983. The establishment, operation and inspection of institutions, to provide services for children of 0-12 years of age by persons or corporate entities according to the "Regulation on the Establishment and Operation Principles of Private Baby Care Center and Kindergartens" and the "Regulation on the Establishment and Operation
 
 

Principles of Private Children’s Clubs" based on the Law No. 2828, are under the responsibility of the General Directorate of Social Services and Child Protection Agency. There are 23 public kindergartens with 2.533 children capacity and 1.070 private kindergartens with 46.848 children capacity.
 
 

Although the General Directorate for Pre-school Education was founded with the Law No. 3797 under the auspices of the Ministry of National Education, pre-school education services are provided by different directorates of the Ministry. Private kindergartens are bound to the General Directorate of Private Education.
 
 

Public bodies and agencies also establish such facilities for the children of their employees under the Regulation of Child Nurseries adopted in 1987. In addition to this, public servants are entitled under article 108 of the Public Servants Law No. 657 to 6 weeks of paid and, upon their request, up to one year of unpaid leave after giving birth.
 
 

Baby care centers and kindergartens can also be established, in the framework of the "Regulation on Working Conditions of Pregnant and Breast-feeding Women and Breast-feeding Rooms and Baby Care Dormitories," which was prepared in accordance with the Labor Law No. 1475. It is an obligation for enterprises where more than 150 women are employed to establish a separate baby care center, near or within the workplace, to look after the children (between the ages of 0-6 years) of their employees and to help mothers breast-feed their babies. According to the same Labor Law, women have the right to 8 weeks of paid leave after giving birth, and breast-feeding hours, if they choose to work during this period.
 
 

Similarly, the local administrations are also charged with a number of obligations by Laws No. 1580 and No. 1593.
 
 

It is necessary to create cooperation and standardization of curriculum, tools, tutors and qualities of other personnel among pre-school education institutions established by the Ministry of National Education, the General Directorate of Social Services and Child Protection Agency and other state institutions and foundations.
 
 

Children’s clubs, where children can stay securely in times out of school and meet their social requirements, are established only by private persons or institutions. Besides these institutions, pre-school and out-of-school care is also given by baby-minders at home. However, in Turkish families which still display some of the features of extended families, a great majority of children of working parents are cared by their relatives voluntarily without any fees.