Background The 1983 Turkish Population Planning Act aimed at improving reproductive health outcomes. We examined the effects of the Act and of modernisation in a small, underdeveloped city and province, Kars.

Methods Between June 2009 and January 2010, 576 parous women at a hospital in Kars participated in a study of reproductive histories and living standards. Results were compared by decade during which the birth took place of the first child who survived its first year, and urban/rural residence. Correlation and multi-way analyses of variance (ANOVA), ?2 and t tests were used as appropriate. We also examined women's education and living standards and use of hospital and family planning (FP) facilities.

Result From 1970 through 2009 maternal age at first live birth increased by 4.9 years (p <?0.05) from a baseline of 18.9 years. The number of pregnancies fell from a mean of 8.1 per woman in the 1970s to 5.6 in the 1980s (p <?0.05), with strong indications of continued decreases through the 2000–2009 decade. FP sites in Kars province increased in number and services, as did antenatal hospital visits and the proportions of women giving birth in a hospital. Concomitantly, delivery by caesarean section augmented markedly over the decades. Education levels of both urban and rural women rose from two years of schooling in the 1970s to ten years in the last decade.

Conclusion Modernisation, including increasing urbanisation, education, and new governmental policies that translated into maternal-child health and FP services were likely the backbone for improved reproductive health and lower fertility rates of women in Kars over the 40 year-period we studied.