Needed: Reproductive, Sexual Health Supplies

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:

• 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.