FAMILY PLANNING
The governments committed to:
- help couples and individuals meet their reproductive goals;
- prevent unwanted pregnancies;
- improve the quality of family-planning advice, information, education, communication, counseling and services;
- ensure that women and men have information and access to the widest possible range of safe and effective family-planning methods;
- provide accessible, complete and accurate information about various family planning methods;
- make services safer, affordable, more convenient and accessible.1
Prevention of unwanted pregnancies must always be given the highest priority and every attempt should be made to eliminate the need for abortion.2
Contraception prevalence in the CEE countries is low and there is a high reliance on low-effective natural family planning methods, such as withdrawal or calendar method (periodic abstinence). Prevalence of modern methods of contraception is on average as low as 35% in Eastern Europe as compared to 71-76 % in Northern and Western Europe. Recent surveys show that while the popularity of traditional methods decreased in Western Europe, it did not decrease in Eastern Europe.3 The unmet need for contraception results in high rates of abortion. Abortion continues to be used as a method of birth control. The use of such methods as sterilisation – both male and female - is very low. The reasons for such situation are diverse. First of all, family planning services do not receive adequate proportion of government health spending and are not sufficiently integrated into primary public health-care programmes. Furthermore, the number of clinics specifically designed to provide family planning services and counselling is insufficient, in particular in rural areas. In addition to that, health care providers often have unsatisfactory knowledge on family planning methods. They frequently have misconceptions or prejudice about effectiveness, safety, risks and benefits of hormonal contraception, IUDs and other modern methods. Providers are commonly reluctant to perform contraceptive counselling as well as to encourage the use of modern contraceptives. Counselling is often limited to offering one method rather than discussing the wide range of contraceptive methods, from which a woman could choose. Reluctance to counsel on contraceptive option is sometimes associated with providers’ own religious views. Yet another barrier is high costs of modern contraceptive methods, in particular hormonal contraception, making them inaccessible for the majority of population. Governments generally do not subsidize contraceptives.
In Ukraine, in 1999, the unmet need for contraception was estimated
at 37 %.4
In Georgia, only 15% of women, who have had an abortion
received counselling about contraception following the abortion procedure and only 3 %
were given a method or prescription (1%) for a contraceptive method.5
In Poland, contraceptive sterilisation is considered
illegal. According to the dominant interpretation of provisions of the Polish Criminal
Code, sterilisation is a criminal offence carrying a penalty of 1 to 10 years of
imprisonment.6 Contraceptive sterilisation is also considered illegal in
Lithuania.7 In other CEE countries, where sterilisation is legal, its
prevalence is very low. Usually less than 1% of the users of contraception apply
sterilisation.8
In Armenia, the most widespread contraceptive method is
coitus interruptus (withdrawal), a method used by 53% of those declaring using
contraception.9 Withdrawal in general is the main method still used in
Eastern and Southern Europe, where its general prevalence reaches 18%.10
The lack of the government’s commitment to support access
to the wide range of contraceptive option is very apparent in Poland, where the Ministry
of Health in 1998 withdrew subsidies for five out of eight previously subsidised oral
contraceptives, leaving three of the same composition.11
Prices of oral contraceptives are very high as relative to
an average income. In Bulgaria, the price of pills for one month varies from 5 to 12 levs
(€ 3-6), which can be as much as 12% of the minimum salary.12
EXAMPLE OF GOOD PRACTICE
In Romania, after the fall of Caucescu’s regime in 1989 and the liberalisation of its highly restrictive abortion law and pro-natalist policies, a rapid increase in the number of abortions took place. This trend was reversed owing to effective state policies supported by international agencies and donors to develop network of reproductive health clinics, to distribute contraceptives and to disseminate information on contraceptive methods. The government made commitments to fund contraceptive consultations from public health insurance system, to procure contraceptives using government funding, and to give certain categories of disadvantaged women access to free contraceptives.13
REFERENCES:
1 “Cairo Programme of Action”, supra note 1, par. 7.14 – 7.26.
2 “Cairo Plus Five”, supra note 13, par. 63(i).
3 UN Economic and Social Council “Concise report on world population monitoring, 2002: reproductive rights and reproductive health with special reference to human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS)” E/CN.9/2002/2, p. 26-27.
4 Centers for Disease Control and Prevention (CDC) et al., “1999 Ukraine Reproductive Health Survey, September 2001”, p. 6.
5 CDC, “Reproductive Health Survey Georgia”, supra note 15, p. 166.
6 M. Rutkiewicz, “Towards a Human Rights – based Contraceptive Policy; a Critique of Anti-sterilisation Law in Poland”, in: European Journal of Health Law 8: 225 – 242, 2001.
7 CRLP, “Women of the World”, supra note 10, p. 88.
8 CDC, “Ukraine Reproductive Health Survey”, supra note 27, p. 87.
9 “Women Status Report Armenia”, supra note 23, p. 47.
10 UN ESC “Concise report on world population monitoring”, supra note 26, p.29.
11 FWFP, “The Anti-abortion Law in Poland”, supra note 20, p. 26.
12 J. Marinova, Bulgarian Gender Research Foundation, “Reproductive Rights and Health of Women: Perspectives from New Democracies of Europe and Asia”, paper presented at the Expert Meeting in Bratislava, 2001.
13 CRLP, “Women of the World”, supra note 10, p. 133 – 136.