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The Fight Hidden in Plain Sight

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The Fight Hidden in Plain Sight THE FIGHT HIDDEN IN PLAIN SIGHT SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS IN CENTRAL AND EASTERN EUROPE AND CENTRAL ASIA Table of contents: Introduction 5 Albania 6 Armenia 14 Belarus 22 Bosnia and Herzegovina 32 Bulgaria 38 Croatia 44 Georgia 52 Kazakhstan 60 Attribution-NonCommercial-NoDerivatives 4.0 International Latvia 64 Introduction: Antonina Lewandowska North Macedonia 68 Proof reading: Joel Henderson Cover and layout design: Julia Karwan-Jastrzębska, Joanna Meuś Moldova 76 ISBN 978-83-88-568-67-1 Published by: ASTRA Network Secretariat Poland 82 Nowolipie 13/15, 00-150, Warsaw, Poland Warsaw, Poland, 2020 Romania 92 Publication of this report was possible due to financial support of International Women’s Health Coalition. Russia 100 Introduction The year 2019 marked ASTRA Network’s 20th international attention, just like Polish Black anniversary of existence. For two decades, we Protest or Slovak Nebudeme Ticho to name have been monitoring the situation of sexual the latest ones, have had the power to stop and reproductive health and rights in Central draconian laws and keep the legislature intact. and Eastern Europe and Central Asia. Our However, Poland and Slovakia are not the only work focuses on supporting grassroot organ- ones that can mobilize the people – similar isations in the region and providing them initiatives, often organized or coordinated with opportunities to forward their work by ASTRA Network member organisations, even further – including the international were attended by tens of thousands in differ- arena. Our members are amazing actors in ent countries of the region as well. Activists their home countries, who do game-chang- defending human rights are fighting relent- ing grassroot work on community organizing, lessly to not let the far-right and religious providing healthcare and education, mobiliz- fundamentalists alter the system. Despite that ing the general public and reacting to current fight, the situation remains a dynamic one. political and social events. It is honouring and Today, at the beginning of a new decade, we humbling to be able to bring together such are presenting you with the newest and most initiatives. We are more than proud to say that comprehensive publication about sexual and today ASTRA Network consists of 42 organisa- reproductive health and rights in Central and tions based in 21 countries. Eastern Europe and Central Asia. The report The past 20 years were extremely exciting you are holding right now is a coherent over- and eventful. Starting from repetitive attempts view of 14 countries’ situations regarding Note: As ASTRA Network we recognize everyone’s of fundamentalist movements to limit access abortion, contraception, pre- and antenatal gender identity and the fact that not only women get to abortion and contraception, attacks aimed care, sexuality education, LGBTQI+ rights and pregnant and need access to reproductive services. at women’s and sexual and reproductive rights gender-based violence – all written from the The term “woman” used in the publication is a activists, numerous attempts to alter the law in perspective of local activists. In the spirit of simplification made for the sake of clarity of the text. several countries of the region so that women providing a platform for regional initiatives, would struggle to actively exercise their basic all the inputs were provided by our member Moreover, countries of the region lack specific data human rights to decide about themselves and organisations and their national associates. on access to SRHR for transgender men, non-bi- their bodies… And this is just the tip of the Central and Eastern Europe, and Central nary and genderqueer persons and it would be iceberg – all of the above, and so much more, Asia tend to be left out of the conversation risky and most likely inaccurate to apply data is the norm for women living in Central and when it comes to building civil societies and gathered on cisgender women to representatives Eastern Europe, and Central Asia. protecting human rights. Hopefully, this of the queer community. Authors aimed to tackle However, the fact that women of the region report will change the way you think about our the topic of LGBTQI+ rights in each country in a do fight back cannot go unseen – and they have region – which is an unnoticed bastion of fight dedicated chapter. been doing so for years. Protests that gained for basic human rights. 5 stereotypes are one of the main contributors ADHS (2017–2018) reports indicate that the to abortion-related stigma. Women still face total fertility rate is 1.8 children per woman; barriers in accessing safe and legal abortion the use of modern contraception among Albania care due to the state’s failure to ensure that currently married women decreased from 11% women can still access abortion services in in 2008–09 to 4% in 2017–18; 15% of currently practice when medical professionals refuse married women and 11% of all women have care on grounds of conscience or religion. an unmet need for family planning. The Additionally, ACPD has revealed that stigma total demand for family planning among has caused some women to carry their preg- currently married women decreased from nancies to term and assume a disproportionate 82% in 2008–09 to 61% in 2017–18. There are economic burden for care; it has led women to many reasons associated with the decrease in seek unsafe abortions clandestinely to avoid numbers and lack of information due to stigma judgment by society, or contribute to women and difficulties in accessing and correctly avoiding or delaying safe post-abortion care. understanding is one of those reasons.2 Although a number of initiatives have been Contraception is offered in Albania in the undertaken by the Ministry of Health and three levels of healthcare – primary, second- Abortion and post- There is no full access to abortion care Social Protection to strengthen law enforce- ary and tertiary (family planning centres, abortion care throughout the country and abortion still is ment, the 2013 study conducted by UNFPA1 maternity hospitals, healthcare centres, etc.). stigmatized among community members, shows that a preference for sons is a distinctive Contraception is provided for free, and you Abortion in Albania was fully legalized through health care providers, men and some political feature of Albania’s population structure, with can access it without prescription. Although by Law no. 8045/1995 on the Interruption parties’ representatives. fertility behaviours clearly shaped by strong when accessed in the healthcare sector, family of Pregnancy. Abortion can be performed As there are no national studies on abor- gender considerations, leading to gender planning is always preceded by medical consul- on demand until the twelfth week of preg- tion stigma, ACPD refers to its work with the biased sex selection. tation on the best method to take. Contracep- nancy. According to the law, an abortion is not community and service providers, and a few Medical abortions are included in the tion is provided in three forms – for the most allowed to be performed without the parental studies, such as the study conducted in 2013 national guidelines for abortion, but there are part, it is provided for free (in 426 healthcare consent of girls under the age of 16. The law was (funded by the Packard Foundation through not clear mechanisms in place as to how to centres) at prices subsidized by social market- amended by Law no. 57/2013, but it still does IPPF) to analyse abortion stigma. Interviews provide and monitor them. ing programs, and at market prices in the not foresee free health care, such as carrying conducted with women who had undergone a for-profit private sector. Oral contraception is out a pre-abortion analysis, abortion proce- legal induced abortion, service providers and the one of the most used contraception meth- dures or post-abortion visits. community members and/or supporters in Contraception ods in Albania. Also, emergency contraception In 2018, the National Institute of Statistics Tirana and Vlora, found a high level of stigma is accessible without medical prescription. estimated 191 abortions per 1,000 live births associated with abortion revealing that gender The Albanian government has constantly given Despite the fact that contraceptive methods showing a slight increase over 2017 (171 abor- high priority and attention to Family Planning are provided, there are still some difficulties tions per 1,000 live births). Unofficial sources and Contraceptive Security. Access to family in accessing them due to social norms and indicate a higher number of abortions than planning was legalized by a Government Order extra-social factors that hamper the protec- those published that are performed illegally in May 1992. Family Planning is integrated tion and provision of RH rights, especially of in un-registered private clinics. To address There is no full access to abortion into the Primary Health Care system. The those underserved communities. Partial data under-reporting and illegal abortions, the care throughout the country and Albanian Ministry of Health is in the process suggest that infant and child mortality rates Ministry of Health released an order based abortion still is stigmatized among of developing strategies and policy docu- among Roma are higher than among the rest of on which as of January 2013, private-sector community members, health care ments: The National Strategy of Reproductive the population. Nineteen percent of the Roma health care clinics no longer have permis- providers, men and some political Health 2016–2020; National Strategy of Health population declared they have lost a child after sion to perform abortions; only public-and parties’ representatives. Promotion 2016–2020; and the Guideline and birth. Early marriage and childbirth adversely private-sector hospitals are be allowed to do so. protocol for the provision of FP services.
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