We also interviewed the husband. He confirms the narrative by saying nothing about birth control in those early days -- it was his wife's initiative and done without his knowledge. With the complete narratives in our hands, we may try to imagine the negotiations of those sixteen or so years of marriage. The wife had decided that she wanted no more than two children many years before the husband. The reasons she tells are her own -- lack of money, a drunken husband, and her dislike for many children. In time, her husband improved his ways and stopped drinking. She knew from the very beginning that it was the normal thing in Istanbul for men to take responsibility in birth control. Thus, she came to the marriage with her own ideas, just as he came with his ideas of doing nothing about reproduction. Quietly and in time, the more socially- supported ideas, which were also his wife's ideas about a family, became his ideas. This is a kind of negotiation which eventuated in his adopting withdrawal and becoming a proper Istanbul man.

The time was the 1950s and the place was Beykoz in Istanbul. Medical female contraceptive methods were not yet legal in Turkey, though they became available later while she continued with the method she understood. (footnote: The term "modern methods" is not used here because it carries an implication of being superior in some sense or of being recent in origin, either or both of which may be misleading.)

This narrative can be interpreted as an explanation for the continuation of low, controlled fertility in Istanbul, maintained in this instance by a couple of migrant background.

The second woman, Hanife, had her two children around 1990 at the beginning of her marriage. She and her husband are Kurdish migrants from Eastern Turkey, and she came to Istanbul to find a husband and be married -- at age 19. Now she is 26 and tells her story of life in Karanfiltepe. She refers to the village people of the East as she sees them, and to her own mother who grew up and bore her family in that village.

Those who lived in the village were ignorant. . . For example, they didn't know that there were pills or IUDs (20 years ago). That is, urban people didn't inform them in the village. Due to ignorance. Now my mother says that if she lived today, she would not give so many births. She would never give nine births. If somebody tells her, Hanife is giving birth to her third child -- my name is Hanife -- my mother would raise hell. She says what will I do with many children during my whole life. .... If one has one child one can look after it. But if one has two or three children it becomes really difficult. When my child was an only child, he was crying to have a sibling. His (the child's) uncle had a child. He was saying that they had a baby, but we did not have one. He was jealous of them. For this reason, I said let another one come. I got this (second) child only for my first child. My husband did not want it. I wanted the second child, but since my husband did not agree, I was also thinking about my own special situation. I did not want to have a new delivery. Of course, cesarian is difficult to think about. (She had already had one.) However, if one has a normal delivery, one can do everything the day after the delivery. When one has cesarian one does not have the capacity to do anything for one week. One has a real operation. This is a very difficult and risky operation. For instance, they put stitches in the place where the child was. They stitch inside the belly. And they stitch outside the belly. They stitch three times during cesarian.

Hanife holds ignorance and the failure of the mainly urban family planning program to reach villages in the East for her mother's high fertility. Factually, she is correct that the new methods -- pill and IUD -- came to the whole country slowly in the late 1960s and 1970s, but there were other methods to use. So we interpret Hanife's narrative as her way of assigning "blame" for many children, while she, with her mother's support, is "doing the right thing" in Istanbul today. One might say that Hanife rationalizes the flow of her own conduct, even against her husband who did not want to have the second child, by claiming goodness in responding to the first child's desire for a sibling.

We also interviewed the husband who said that he used withdrawal to avoid a second child until they decided to go ahead and he stopped. She also explains why she should be cautious for health reasons. Hanife's sister died during a third birth while having a cesarian. Though her husband expresses worries about worsening economic conditions, he was also concerned about her health.

Another situation seen in these communities is recently married couples who do not have a child immediately. One of these is Mehmet, a young man of 30 who was raised in the WHC and now works as an accountant in a commercial firm. He only had a high school education and never would have obtained such a job except that there was a man in the community who rose very high in the business world who kept his neighborhood relationships and would recruit new employees for one of the large holding companies. Mehmet was able to make a career at this level and moved to another commercial company at a similar level. He worked among mostly middle class university graduates who never accepted him as one of them, while he retained his working class relationships. He married a woman 8 years younger from a similar class background whom he met at the company and brought her to the WHC to live. He talks about the value of having children, but then expresses his worries about facing the costs and discomforts too soon in his marriage.

I want (to have a child), but one year later. Why I want to have a child is that a child is the cheer of a home. . . . For in my opinion life without a child in marriage looks like a tree without fruit. I believe that God will bless our home. God gives subsistence to all living creatures. . . . I believe that it brings families together. Children are a factor that can bring spouses into good relationships. . . . .(What is special about one year later?) We have not yet adapted ourselves completely to have a child. I wait for time to pass. If I have a child now, I will become financially discouraged. Can I explain this to you? In the past we had two salaries, but now we have only one salary. As you know, a child creates many additional expenses. In addition, in our company there is some talk and manipulations. What will happen to me is not very predictable. . . . I want to make sure of my salary and career at work. . . .In fact having a child means having troubles. When you have a child, as I said before, it is the happiness, honey, and cream of a home; however, there are some negative sides of it. For example, sometimes you can not sleep in the morning due to its crying. You will go to work like a zombie. We talk with our friends who have complaints about buying baby food, diapers, and so on. In addition, when it becomes ill, you should pay the doctor. You should be strong enough to take care of these things. First you should feel like this, and then you should say okay for having a child. . . . My friends also do not have children. The friends whom I like very much and who got married when I did are doing the same thing.

Mehmet's explanations are in the language of a generation that graduated from high school, some of whom reached universities and others not, but all of whom give similar reasons for being cautious about having children too soon. They find themselves ambivalent, located between being working-class and middle-class.

The belief that one should "Take a break" when using any female device or medical method such as the pill was found in other informant's accounts as well. It was reinforced, in some instances, by advice from physicians. Yelda, however, did all these things without ever going to a physician. Most of the time, in these working-class communities, women (and men) choose their methods of birth control without consulting a specialist. They trust the knowledge of their husbands who are usually more experienced, (footnote: Men have more social acceptance and opportunities to have sexual experiences before marriage in these communities. This was confirmed by a number of interviews.) and the knowledge of people in their close networks, seeking help from physicians seldom or not at all. After she bore Burak, Yelda tells about her first visit to a gynecologist. She visited a mother-and-child health (MCH) center for a baby checkup. While there she asked about contraceptives and reports,

I asked a doctor. He did not give contraceptive pills to me. He said that I was breast feeding and they are dangerous. He said that I could only use condoms. I went to the clinic in Kanlica. After nine months I was still afraid of examinations, so I did not have an IUD inserted. . . During the delivery (of a child) you have to go to a doctor. They "scratch" inside of you (she means that while doing something necessary, they create additional problems as well as pain). I do not want to go there for any other reason (except deliveries). I am really afraid.

Yelda perceives her body as vulnerable and thinks that any small mistake by a doctor can harm her body. Therefore she wants to keep her body in its natural harmony by staying away from doctors.

A thirty-one-year-old woman, Fatma, who migrated to Istanbul from southeastern Anatolia talks about the doctors in Zeynep Kamil, which is a large state hospital for women in Istanbul. She has five children, born before she moved to the WHC, and her eldest daughter is already engaged:

No, no, for the love of God, who at that place is concerned with patients? Answer the question, are they concerned with patients? For example, even though we go to hospitals and pay money, since we do not have any social security rights, they are not concerned about us. Doctors do not permit us even to tell them our illnesses. We cannot be examined, even after paying money.

Feeling devalued and fearful in the presence of physicians is a frequent theme, which we interpret as due in part to the different class origins of the patients, the unsatisfactory state of the public health services, and a culture of attitudes towards patients that doctors seem to have acquired during their training and subsequent practice. While patients may exaggerate the negative points, corroboration comes from a study of family planning clinics of Istanbul carried out by a team of physicians and social scientists which shows that these shortcomings are by no means exceptional (Bulut and Turan, 1995: pp 95-96).

Another woman, Selma, 30 years of age, who lives in the WHC, talks about the same questions in a different situation.

We went to a private doctor in Kadiköy. He was from Zeynep Kamil Hospital. We went to his private office. For medicine, we are retired (at an age below 40 under the rules). So we received it free through the social security arrangement. The doctor wrote the prescription in Zeynep Kamil Hospital for this. They are more considerate in their private clinics. (Whereas in hospital clinics) the doctors push you around and they swear at patients. One cannot find any sympathy in normal hospitals. For example, I went to this private doctor. He addressed me as "dear elder sister Sükran". Of course they charge money but they make you comfortable. For instance, by talking to us ... he overcame my fears.

....In other places, for example, Tepe Üstü Hospital, they don't show any respect to people. ..., recently I went to the department for ear, nose, and throat. They don't let people speak. You can not ask them anything. However, when you go to their private offices, there is a kind of welcome. When they behave in a welcoming way, you do not think about one million TL (about US$25).

A completely different set of considerations comes into play when a single person deals with the issues of birth control: choice of method, relationships to the health system, and the surrounding social views of their use of contraception. A young woman, Ezgi, in her 20s from a working-class family speaks as follows: I had decided to use pills but did not go to a gynecologist. There is the risk of discovery of the relationship by other people. As a single person this is very dangerous.. . . I know, since my mother searches everything that belongs to me. If you live in such an environment.. . . Really it is not very easy for a single woman When you go to public hospitals or clinics, and if you are an unmarried woman, you should be very cautious when getting a medical service. Nobody in your close community should know this. Everything should be done in a very secret way. For a man, it is very easy to go to a pharmacy and buy condoms. Thus, people who are alienated from health services construct their own knowledge about contraceptive methods, different from the medical knowledge. As with other kinds of knowledge, the knowledge of reproduction and birth control is uncertain, unstable, constructed and imposed through relations of power (see, e.g., Foucault, 1976). Cultural beliefs about the methods of birth control and their degrees of pleasure, efficiency, healthiness and protection against infection circulate in the same way as "natural truths" do throughout the society. As Kleinman (1988: 10) puts it, " . . . what is natural depends on shared understandings in particular cultures and not infrequently diverges among social groups. The meanings . . . are standardized "truths" in a local cultural system inasmuch as the groups' categories are projected onto the world, then called natural because they are found there." (footnote: In an ethnographic study of epilepsy in Turkey, the narratives showed that patients had a variety of interpretations of cause and outcome of their illnesses, different from those of the medical personnel (Good and Good, 1994).)

As a result, spouses often go to a health institution or pharmacy to obtain a method of contraception after having made their own evaluation of all the alternatives in the light of these culturally constructed categories. Or they may rely on their own methods such as withdrawal or rhythm. Some of them claim that withdrawal is a temiz method (literally translated as clean, but means uncomplicated as in a "clean deal"). Some of the females in our study also say that condoms are clean, since the husband takes all the responsibility. For single partners, the male methods have a particular appeal as natural, secure, solutions which do not involve other people.

Canan, for example, who thinks of herself as a middle class person, says, Firstly, I used pills. Then I used the IUD which is normal, and that everyone of us uses. . . The doctor advised me to use it after the birth; it was not my decision. In fact, I did not think of anything else to do. It is the most natural way, because the pills have side effects. Negotiation is part of the process of choosing a method, bringing to bear the knowledge and power of man, woman, and sometimes other persons. In this instance the woman involved used her own power in concert with that of a doctor. These negotiations produce apparently settled positions, but they are in fact re-negotiated again and again. Our next quotation shows exactly such a renegotiation taking place, as Yelda speaks in the first person about why, following her second delivery, she continues to prefer condoms to the IUD unlike her husband: Still I use condoms. In fact, my husband does not want to use them. He wants me to have an IUD inserted. In a way, I would like to use it. Using it is easier than other methods. I heard that it is not useful for everybody. It can move to the stomach. My skin is very sensitive. When I have a lesion, it takes two years to heal. Due to my skin, I am very afraid of using it. It might have some side effects. Then I should go to a doctor to have it removed. We will continue using condoms as long as he will use them -- as long as I can "deceive" him. In fact they are temiz in a way. That is, they are temiz for women. You do not need to be concerned about anything. You do not intervene in any way. That is, it is good. What appears for a time to be a consensus about birth control may be re-opened and renegotiated. Foucault tells us how to interpret this (1982: pp 219-220): Power may be "integrated into a disparate field of possibilities brought to bear upon permanent structures. This also means that power is not a function of consent. In itself it is not a renunciation of freedom, a transference of rights, the power of each and all delegated to a few (which does not prevent the possibility that consent may be a condition for the existence or the maintenance of power); the relationship of power can be the result of a prior or permanent consent, but it is not by nature the manifestation of a consensus."

From these narratives we can understand that methods of birth control do not always become a subject of discussion as soon as intercourse is initiated. After a woman gains some experience, her relations with her partner become different from those at the beginning of her sexual life. It becomes normal to discuss these things also with the people around them and to use such knowledge in the negotiation of a method.

For single women, the gathering of knowledge is far more inhibited than for males, due to having no social permission to have experience, so their power may be less in the relationship. Here is what another single woman, Yeliz, from one of our study communities says, In my last relationship we began with condoms. Eventually, it turned to withdrawal. And then I was planning to use pills, but I didn't . . . . Until now I have never known a young single woman who uses a medical female method. . . . also I think that men want to make the choice. Really they feel more comfortable, because in my opinion, men think that the only aim of women is to get married to someone. They think that women can do everything to catch the man. They see this as a big risk. Therefore, they are very afraid if they do not have control. The next group of narratives is from men. When the choice of methods is explained by men, they evaluate methods, but seldom speak of the preferences of their partners. The male perceptions, or at least their statements, are that they make the evaluation and the decision. We might have believed that men in this society have the final and absolute decision in family affairs if we had not interviewed women and, in particular, some who were wives of the men to whom we listened. Thus, we shall see in some of the men's statements that they try to claim, and may in fact gain, some extra power in society by the authoritative discourse they use.

Some of our married men think of IUDs as the best female method because of its support for pleasure. It has the additional attraction of being very similar to withdrawal, not mechanically, but because it is not necessary to acquire or place contraceptives prior to each intercourse. Some males also feel secure with an IUD, the same as with withdrawal, because a pregnancy will not occur by some "hidden" initiative of his spouse -- forgetting to take the pill for example. (footnote: In the Turkish data on contraceptive failure rates, pills appear to have high failure rates. This is usually interpreted as showing that women are not capable of following the daily regime. The narratives suggest that another interpretation might be relevant.) A 29-year-old male, Cemal, from the Black Sea region says, Well, for example, say it is a condom. If I and my wife used it, I would suffer. There are some men who use male methods of birth control. I heard about it. I think it gives pain to the man himself and to the woman. . . If you and the woman both cannot get any pleasure, making love does not make any sense. There is no pleasure in that it is something we are not used to using, and the risk of them bursting open is high. A condom is not a healthy thing either. Further, some men use withdrawal as a method of birth control. At the most pleasant moment you have to withdraw. It makes one get weaker and older. It makes you get older quickly. I mean it is harmful in terms of health. It is the sweetest moment for a human being. It is the sweetest moment of marriage. When one withdraws, he is destroyed, ruined. When withdrawal is rejected by a man, a female method of birth control becomes desirable. We noted a repeated pattern of preference by working-class men for IUDs as compared with contraceptive pills, as explained by this same male:

The best is an IUD. Others are harmful for one's health. In birth control, what fits my mind is an IUD. (Q-Do men have methods of birth control?) Yes, but theirs don't fit my mind the least bit. It is like a cover, not to be trusted. . . On this issue, I educated myself in my circle of friends and neighborhood. I am in general a bit of a talkative man. On some issues one must think logically. Pills are harmful for a woman's health. Those pills cause some women to gain weight. She has to take them regularly on time. It is highly risky. The best is an IUD. It is guaranteed with respect to the others. %1500. . . The ideal one is an IUD. It is women who use it.. . . .IUDs are very good for some women. It is a matter of getting used to it. It is a device like a colander. You have it placed in the woman. She needs only a few days to become used to it. It may cause an allergy. It may cause injury. It may cause nothing. If you see there is something wrong with your wife, it means you cannot use it. You have to have it taken out. It may even cause cancer. Of course, it does if there is a problem with the adaptation, but if it is okay. . . Anyway when we had it inserted, the doctor said: "you will come to me for a check-up one week later." When you go for the check-up after one week or fifteen days, if you feel OK, the IUD is the best. Those pills and others are a tale. I mean they are a bit of a primitive method. There is a problem if you do not take them on time.

As this man makes the case for the IUD, we notice that it has several facets, one of which is male control. He has this control as long as he monitors his wife's access to medical institutions where she would have to go to have it removed, and this is easily accomplished by him in a community where women seldom can move outside alone. Furthermore, the method is in place for a very long duration.

On the other hand, we found males in the communities who clearly preferred what they perceived to be a known, effective, and widely used method, withdrawal. Here a male, Adnan, who is the husband of the woman who talked about how she convinced her husband to have the second child, tells us why he prefers withdrawal.

We did not go to hospital for it (for a method of birth control). You know something is being placed inside a woman. No, absolutely no. It has been five years since the birth of my first child. During these five years, we used neither a pill nor an IUD. We used our own methods. It has been this way for five years. If I had wanted, she could have become pregnant immediately after her first birth. This is something (to be decided) between the man and his wife. The doctor said: "You must not have a child for five years." My wife's elder sister gave three births one after another. In the end, she died at the last birth. I would have made her pregnant if I had wanted. I could have. She said: "I shall use spiral." I said: "Absolutely no." (Q- Why did you not allow her to use an IUD?) Medical problems. People say: "It will be OK if I use it (contraceptive pills or IUDs). "However, one may become pregnant even though she uses it. There is also something like a rubber. Con . . . Even though you wear three or four of them, she may become pregnant. I mean their (men's) efficiency rates are high. Of people like me, big and strong. Those thin men who are very fond of sex are also like that. . . When I have sexual relationship with my wife, . . . when the liquid is about to come, I withdraw. Women have menstruation. If she does not have it after one month, it means she is pregnant. My wife has informed me every month. If she had it. . . Why? We tested ourselves. We have been successful. My brothers cannot take this precaution like us. I mean when they come to the thing (peak) of pleasure, they think that they will be devoid of pleasure if they withdraw. In fact, they will not. It is the same whether the liquid comes inside or outside. There is no difference. It is the same. . . You have sex with your wife. You do not allow her to take pills, right? Why? They all cause illness. This is the important issue. Now being overweight, women's illnesses are all due to these (contraceptive pills and IUDs).

We see in these narratives that some men and women are cautious about using medical interventions that they think might be harmful to the female body. However, the aversion to medical contraception, is more complex and nuanced than that. Some female methods would place more responsibility and control over births in the hands of women. For some males this is a problem, because they want to retain a monopoly of the knowledge and power to make choices about restricting births and the choice of method. This arrangement of considerations is not very different when we listen to single male. Kenan is from a working-class background, but has achieved through the educational system a place in a professional school and is in his last year. He has been together with a girlfriend from a university for four years, without the knowledge of the parents on either side, as far as they know. Concerning choice of method, Kenan says,

I say that condoms are the most guaranteed (to protect against pregnancy). However, from a man's point of view, after the first or the second time, they spoil sex. ...... Withdrawal might be another method. Because if I were not afraid of getting a child, I might use withdrawal for a while. But if I want the most guaranteed method, ...... suggestions from a doctor are very important. It is necessary to go to a doctor both for men and women. Even though men's problems are not very complicated, women's are. In other words, after marriage, one should go to a gynecologist. Having a checkup for both cancer and fungus and ovulation is a good thing, and might bring a beautiful sexual life. (Do you use a method when you are with your girlfriend?) Condoms. The most logical one. It is the most straightforward and healthiest one. It is the best method as far as I'm concerned for this particular time. That's all. There is nothing else. (What are the methods that your male friends use?) They use condoms as well. That is, in general, in our society since women find it shameful to go to a doctor's office, men do these kinds of things. They use condoms as well. Or as I said, withdrawal. In general, these kinds of things are not put on the shoulders of women.

When this man balances pleasure against risk, he chooses to use condoms after all. In the event of marriage, he says that the circumstances would then allow consultation and other choices to be made.

Another woman, Safiye, also evaluates the question from her own personal religious standpoint, and then tells how she faced the situation of an unwanted pregnancy when it happened:

In our religion, abortion is certainly prohibited. There is no difference whether I kill the baby before or after the birth. These two situations are the same. After twenty days, its heart palpitates in the womb of its mother. It is alive. You cannot kill a newborn infant bird, then how can you kill a baby. It is murder. However, I had an abortion but I do not know how I did it and furthermore I do not want to remember, because I may become crazy, I may become unhappy. I behave as if I never experienced such an event. I wonder how I will be able to give the report of this event to God on doomsday.

The next woman, Emel, talks about abortion not in relation to ethics but in relation to her husband's wish not to have more children. As she tells the story, other persons interfered on her behalf and she did not have an abortion after all. Then, later, when she became pregnant again, she came to the Capa University Hospital to have an abortion, which is where we met her and arranged an interview. She said:

My husband brought me to the hospital for an abortion. He wanted an abortion for the previous (fourth) child, too, but I did not want to have an abortion. Maybe, if we (were not thinking of moving soon) to the Eastern part of Turkey, I would not have come to this center for an abortion, but looking after five children is a very difficult thing (while moving).

At the time of her fourth pregnancy, she had even received some unsolicited support from her landlord, who is a very conservative Muslim. He declared that abortion was a great sin and, in the event, the woman was able to continue her pregnancy. However, she thinks that her present abortion is not sinful since the pregnancy was very new. She did not tell her family that she would have the abortion. She said only that she would go to the hospital to have X-rays for her stomach. She did tell a few neighbors, however, that she would have the abortion.

This last story shows that the woman was able, for one of her pregnancies, to resist the husband's requests that she terminate it. In these narratives we see that there are negotiations about whether to have a child or not. In all the cases where we heard about abortions, the negotiation from the man's side was in favor of the abortion, while women sometimes wished to have the additional child. Reasons given were usually stated in the language of religion or ethics, but we are not sure whether another child might have also been welcomed by the woman as a way of enlarging the space occupied by the mother in the family. Motherhood is a basis for claiming power in family negotiations, and some of the women were keenly aware of this.

Most abortions are done by private physicians, even though they are free at state hospitals, because the procedure is seen as more accessible -- less number of visits, less waiting, and more certain service -- and as a better screen against public scrutiny (also see, Bulut and Toubia, 1994). Some women go so far as to obtain from pharmacies high doses of hormones to "bleed out" an early pregnancy. The women in our study made it clear that they continue to bear the burden of health risks, the pain of invasive procedures, and the ignominious experience of sometimes having to listen to derogatory or censorious comments by physicians at the time of service. "Blame" when apportioned has many faces -- inattention to contraceptive procedures, husband's or partner's fault, not thinking ahead, the fault of a medical method or device, and ethical or religious approbation.

Contraceptive prevalence is measured by the reports of married women under age 50 (1993) or under age 45 (1963).

Note [a]: For the present study of working-class people, the migrant column is the most relevant. The non-migrants include some second- generation working-class, but are more often individuals from middle and upper class.

Sources: 1963 Survey (Ozbay and Shorter, 1970:5). 1993 Survey (Hacettepe Institute of Population Studies, 1994: 38). Istanbul, 1993 was tabulated from the Istanbul clusters of a representative sample collected by the 1993 Turkish Demographic and Health Survey, kindness of Hacettepe Institute of Population Studies and Jeanne Cushing of Macro International.