Needed: Reproductive, Sexual Health Supplies

Anna Wilkowska-Landowska

A European women’s rights group reports that central and eastern European regions experience many obstacles in accessing adequate levels of reproductive health services.

In 2008, ASTRA Central and Eastern European Women’s
Network for Sexual and Reproductive Health and Rights
conducted surveys among ASTRA partner organizations in a number of countries
to obtain information on the accessibility of reproductive health (RH) supplies in Central and
Eastern European (CEE) countries. (Reproductive health supplies include contraceptives, condoms, safe
motherhood supplies, supplies needed for safe abortion care, HIV/AIDS prevention and
treatment supplies, i.e. HIV testing kits, as well
as information regarding family planning, sexuality education and HIV/AIDS
prevention.) ASTRA compiled its results into a Report on Reproductive
Health (RH) Supplies in ASTRA Countries
. Participant countries included: Albania
(Albanian Family Planning for Population and Development/ Tirana); Armenia (Women’s Right Center/Yerevan);
Azerbaijan (Center "Women
and Modern World"/Baku
); Georgia (Women’s Center/
Tbilisi
); Macedonia (Shelter
Centar/Skopje
); Poland (Federation for
Women and Family Planning/Warsaw
); Russia (Novgorod Gender Center) and
Ukraine (Women Health and Family Planning/Kiev). 

Not only do the governments in central
and Eastern Europe neglect to provide sufficient access to RH supplies, the
issue of RH supplies itself is not prioritized in the government policies. The
report finds two main reasons for these
problems.  The first one is related to a strong
influence of religion (cases of Georgia, Macedonia, Poland). The other one is
connected to a prevalence of strong nationalist discourse (again in Poland and
Macedonia).  Such a discourse places
women’s health as secondary (or even worse) to national "health." The nations
under the control of nationalists can become un-developed or
re-patriarchalized, particularly when it comes to women’s reproductive rights;
there is a conservative anti-abortion drive and women’s needs with regard to
their reproductive health are not considered a priority, which results in lack
of access to necessary supplies, including RH supplies.  Albania is the only country studied where
policy to increase the level of contraceptive use exists. 

Non-governmental organizations (NGOs)
very often fill this void that governments leave, primarily with regard to education
and counseling services. NGOs often face barriers in gaining financial support
from their host governments to conduct their RH activities and therefore most of
their programs are covered by foreign funds. 
In countries like Poland, where the Catholic Church has a very strong
influence on the national policy, and most reproductive health programs are
subsidized by foreign funds. Some organizations from the private sector have
subsidized contraceptives in the region. 
The United Nations Population Fund (UNFPA), for example, had a limited
stock of such supplies in Georgia and so only provided the free distribution of
two types of oral contraceptives (Ovidon and Rigevidon) and one type of condom. 

The main problems highlighted in the report include:

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  • Lack
    of information on reproductive health and other related issues

In most countries the report found no
universal or reliable sexuality education programs.  The major exception is Albania, where
sexuality education classes in schools are obligatory, although they do not
provide any information about other contraceptives other than condoms. While
NGOs take a role in providing some education services, they can only do so to
a  limited extent and mostly in big
cities, leaving most areas without sexuality education.  In Poland, for example, the official
educational programs run at schools are very much influenced by the Catholic
ideology and tend to prefer natural methods of family planning.

  • Spreading
    HIV/AIDS epidemic

The HIV
epidemic rate
is rising in Azerbaijan, Georgia, the Russian Federation (66%
of newly reported HIV diagnoses) and Ukraine (21%), which has the highest adult
HIV prevalence in Europe or Central Asia.  The ASTRA member countries claim there is
general access to free HIV VCT (voluntary counseling and testing) in urban
areas. It is more limited in rural areas, especially in Azerbaijan, Albania,
Georgia, and Russia, according to the report. In most countries, pregnant women
in particularly encouraged to take HIV test (Armenia, Georgia, Macedonia, Poland,
Russia, Ukraine).  

  • Low
    level of contraceptive use

The Report states that only 1 percent of
Albanian married women use hormonal contraceptives. Moreover, about 70 percent
of them use withdrawal. Only 5 percent of Macedonian women use hormonal
contraceptives and 24 percent use condoms. About 7 percent of Armenian women decide
to use hormonal contraceptives. In Georgia, only 25 percent of women aged 15-44
are currently using any method. In Poland, about 26.9 per cent of Polish women
are using hormonal contraceptives, while 25.9 per cent still choose natural
methods. In countries like Georgia and Albania women can get contraceptives
without prescription. But in other countries, like Poland and Macedonia, women
not only need prescriptions to legally get hormonal contraceptives, but doctors
in these two countries  have the right to refuse a
prescription on moral grounds. Although condoms are widely available in the
surveyed countries, accessible in pharmacies and other stores, people in these
countries tend to underestimate the effectiveness of condoms as a preventative
for STIs.

  • High
    prices of condoms and contraceptives

The cost of condoms and contraceptives is relatively
high in central and Eastern Europe, and access to subsidized or free contraceptives
is very limited. The Report provides for a few examples: in Albania, where the average
salary is $150 per month, contraceptive pills cost $5-13 and condoms cost
$0.5-2; in Georgia where the average salary starts from $50, contraceptive
pills cost $7 and condoms cost $3; and in Armenia, where the average salary is
$170, contraceptive pills cost $2-22 and condoms cost $1-5.  Armenians face a further challenge: there is
no universal health care, so a lot of Armenians have to pay for all medical
services except obstetrics (motherhood and childhood) which is included in the
special package of services of Ministry of Health. In other countries health insurance
does not cover costs of contraception. Only Poland covers 4 types of
contraceptives

  • High
    abortion rates

In most ASTRA countries, abortion is widely
practiced as a primary birth control method. ASTRA’s  report states that Russia and Ukraine have
higher abortion rates than the rest of the world. In 2004, the estimated
abortion ratio in Russia was about five times higher than the rate in an average
western European country such as Norway: 130 versus 25 abortions per 100 live
births.

  • Lack
    of access to prenatal tests

Because of financial barriers, few women
get prenatal tests. Doctors in public hospitals very rarely suggest such tests
even if there are indications to perform them, due to ideological reasons or
because the cost of the tests is so high. In Poland, doctors fear that prenatal
tests may be the first step towards abortion.

Many of the aforementioned problems are
closely related to the ineffective health systems in these countries. Each country
is at a different stage of implementing its health care system reforms, but
very often even the most widely recognized issues are not discussed, and
therefore not included into the new policy programs.  

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