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Family Planning and Reproductive Health in Central and Eastern Europe and the Newly Independent States

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Family Planning and Reproductive Health in Central and Eastern Europe and the Newly Independent States Third edition 2000 (first edition1995, second edition 1997) From abortion to contraception Family Planning and Reproductive Health in Central and Eastern Europe and the Newly Independent States UNFPA Division for Arab States and Europe WHO Regional Office for Europe Women’s and Reproductive Health Programme Abstract The profound and rapid changes that have taken place in recent years in the countries of central and eastern Europe (CCEE) and the the newly independent states (NIS) has revealed a particularly disadvantaged group in these countries: women. The growing health problems and particularly the widening gap between women’s health in western and eastern Europe require the rethinking of social and health policies. With limited resources available, reproductive health services are increasingly being viewed as one appropriate mechanism for improving women’s health. Although most countries in the CEE and NIS report a growing interest in contraceptives, limited availability and cost remove them as viable options for many people. The level of reproductive health services to be provided should be determined on a case-by-case basis, taking into account the client and community needs and programme capabilities. As a minimum, reproductive health programmes should provide a broad range of family planning choices, STI prevention, safe abortion, safe perinatal, postnatal and antenatal care. This document is the third update of reproductive health data for the region since 1995. Targets for HEALTH21 Target 1: Solidarity for Health in the European region Target 2: Equity in Health Target 3: Healthy Start in Life Target 7: Reducing Communicable Diseases Target 8: Reducing Noncommunicable Diseases Target 15: An Integrated Health Sector Target 16: Managing for Quality of Care Keywords FAMILY PLANNING REPRODUCTIVE HEALTH ABORTION CONTRACEPTION MATERNAL MORTALITY INFANT MORTALITY WOMEN’S HEALTH BIRTH RATE FERTILITY RATE HUMAN DEVELOPMENT INDEX Family Planning and Reproductive Health in CEE and the NIS All rights in this document are reserved by the WHO Regional Office for Europe and the UNFPA Division for Arab States and Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The WHO Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. World Health Organization Regional Office for Europe Women’s and Reproductive Health 8, Scherfigsvej DK-2100 Copenhagen Denmark Telephone: +45 39 17 14 26 Telefax: +45 39 17 18 50 Electronic mail: [email protected] Family Planning and Reproductive Health in CEE and the NIS This working document was funded by UNFPA Division for Arab States and Europe and was prepared by Dorte Jepsen, consultant; Dr Nese Savas, consultant; Nadia Redman, assistant; Ken Legins, Technical Adviser, Health Information and Communications; and Dr Assia Brandrup-Lukanow, Regional Adviser for Women’s and Reproductive Health, WHO Regional Office for Europe. Acknowledgements are hereby extended to all the Ministries of Health and their collaborative partners in the countries included in this working document, different United Nations agencies, including the statistical unit of the World Health Organization Regional Office for Europe and consultants who have given their time and efforts to make this working document as complete as possible with the available data. Family Planning and Reproductive Health in CEE and the NIS Contents Introduction 1 Reproductive health 1 Women’s health 1 Family Planning and Reproductive Health 4 The abortion issue 5 Child Health 6 The implications of the International Conference on Population & Development (ICPD) 8 Expert Meeting, Copenhagen, September, 1998 9 Beijing Declaration of the UN Women’s Summit 14 WHO Health Strategy for Europe 15 Donor assistance to CCEE and NIS 17 Notes on data collection and analysis 19 Morbidity and mortality 19 Data validity and comparability 19 The Baltic States 23 The region 23 Estonia 26 Latvia 31 Lithuania 35 Caucasian Countries 41 The region 41 Armenia 44 Azerbaijan 48 Georgia 51 Central and Eastern Europe (CEE) 55 The region 55 Albania 59 Bosnia and Herzegovina 63 Bulgaria 66 Croatia 71 Czech Republic 74 Hungary 78 Poland 82 Romania 86 Slovakia 90 Slovenia 95 The Former Yugoslav Republic of Macedonia (FYROM) 99 Family Planning and Reproductive Health in CEE and the NIS Central Asian Republics and Kazakhstan (CARK) 103 The region 103 Kazakhstan 106 Kyrgyzstan 109 Tajikistan 113 Turkmenistan 117 Uzbekistan 121 Belarus, Republic of Modova, the Russian Federation and Ukraine 125 The region 125 Belarus 129 Republic of Moldova 133 The Russian Federation 138 Ukraine 143 References 149 Annexes 153 Questionnaire 155 Databox 162 Total fertility rate by regions Total fertility rate by ranking Maternal mortality ratio by regions Maternal mortality ratio by ranking Infant mortality rate by regions Infant mortality rate by ranking Abortion rate by regions Abortion rate by ranking Family Planning and Reproductive Health in CEE and NIS Introduction Reproductive health In September 1994, at the International Conference on Population and Development in Cairo, 185 participating countries endorsed the Programme of Action which states that reproductive rights rest on “the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health”. Also included is “their right to make decisions concerning reproduction free of discrimination, coercion and violence, as expressed in human rights documents”. At the conference it was also decided that to provide a full picture, which takes reproductive rights into account, research and data are needed on such topics as: • The extent of unmet demand for safe and effective methods of fertility regulation; • The extent of unmet need for the information necessary to make free and informed choices about childbearing; • Levels of reproductive morbidity in women of all ages, including conditions such as reproductive tract infections, uterine prolapse and cancer; • Quality of care in the provision of family planning and reproductive health services; • Legal and ethical standards relating to reproductive rights and the extent to which those standards are observed in practice; • The extent to which individuals are aware of their reproductive rights and the means of redress available if rights are violated. Initiatives have begun to collect better information on these topics, but much more work is needed to develop methods for measuring more directly the implementation of reproductive rights. Women’s health Profound and rapid changes are underway in the countries of central and eastern Europe (CCEE) and the newly independent states (NIS), of the former USSR. These changes have led to social and economic hardship and, in some cases, to war. The result is a widening gap in health indicators between the eastern and western halves of the WHO European Region: a serious inequity. The leading causes of death in the CCEE and NIS are the same as in most other European countries: cardiovascular diseases, malignant neoplasms and external causes. A closer look at the CEE and CIS reveals a particularly disadvantaged group in these countries: women. While women bear more of the burdens imposed by change, they also comprise an invaluable, largely untapped resource for the response to change. Studies by the United Nations and the World Bank have shown that __________________________________________________________________________________________________________________________________________________ 1 Family Planning and Reproductive Health in CEE and NIS investments in women yield high returns in the form of faster growth, higher efficiency, greater savings, and reduced poverty. Healthy mothers have an increased chance of having healthy new-borns and children, while a woman's ill health or death affects not only her own opportunities and potential, but those of her children. Women’s health is, therefore, an issue that crosses borders, political systems and cultural differences and it is an excellent investment as it guarantees an improvement in the health of the next generation. The World Health Organization (WHO), as well as UNFPA and UNAIDS, fully support the charter on sexual and reproductive rights by the International Planned Parenthood Federation (IPPF). WHO will cooperate with the Member States on all the principles contained in the charter, particularly in the implementation of the activities concerning sexual and reproductive health, and encourages Ministries of Health to: • Recognize the importance of protecting reproductive health and placing it high on the list of priorities of public health. Many countries in the eastern part of the European Region are now in the process of finalizing national policies on reproductive health; • Respect sexual and reproductive rights and to revise, if necessary, the respective legislation particularly regarding abortion and homosexuality; • Apply an
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