LATVIA

In the first place, one of the most significant problems in Latvia regarding these issues is the lack of sufficient, reliable, available and accessible gender-disaggregated data on health. For this reason this is a very difficult question to answer. However: there are extremely high rates of STDs amongst both women and men, although they are significantly higher in men. Women comprise approximately 1/3 of cumulative registered incidence of HIV. Maternal mortality is higher than in EU countries (Latvia: 41 per 100000 live births in 1999), although it has slightly increased in absolute numbers in the last 5 years, which may be cause for concern. Another area of concern is the unsatisfactorily high number of children born with syphilis, as well as 8 documented instances of HIV+ women giving birth (as of December 1999), of which vertically transmitted HIV has been diagnosed in one case. There is concern that these women are not receiving adequate care and psychosocial support as women – as opposed to mere “vessels” of infection.

Numbers of abortions are very high (30 per 1000 women aged 15-44 in 1999), primarily stemming from lack of knowledge about and access to reliable forms of modern contraceptives. This lack of awareness also in some instances applies to medical professionals themselves, although extensive education and information activities have been carried out over the past 5 years.

There is a complete lack of reliable statistical information on the incidence of violence against women, although anecdotal and informal sources certainly report a very high incidence. Main problems here are lack of information, awareness and sources of support.

Despite the formulation of various policy documents and strategies concerning health care and health promotion, only in rare cases are activities specifically targeted towards gendered audiences. For example, although cardio-vascular disease as a cause of death among women is much higher, this is not taken into consideration in strategic intervention plans. In a new HIV/AIDS strategy and work plan, women are not identified as a target audience.

Similarly, reproductive health strategic documents do not consider the role of men, despite the obvious need for this.

A new Law on Reproductive Health is currently being proposed in Parliament (November 2000). While there are concerns about the draft law regarding the full protection of women’s reproductive and sexual rights, there are positive signs that these concerns may yet be addressed.

Recent studies on poverty in Latvia have shown that single women with children face a much higher risk for poverty than any other group. These same studies highlight the extremely negative consequences of this on women’s health.

Although there are some high quality, affordable health services available to women, there are several problems concerning access:

1. There is a lack of understanding among women themselves (older women, particularly) concerning their rights as clients. This means they are not always aware that they can demand high quality services.
2. There is a lack of information about where to find such high quality services (e.g. physician’s reference service or other formal referral channels).
3. Because of widespread poverty, even state-subsidised services are financially inaccessible to some women. Drugs and other medicaments or aids are even more so out of reach.

Women in rural areas are particularly vulnerable. They face not only a lack of information, but also a lack of confidentiality, as well as high costs incurred to travel to points of service.

Quality greatly varies. Widespread problems include a lack of confidentiality and respect for one’s private life

Young girls are particularly vulnerable in terms of finding confidential, quality services, particularly concerning reproductive health.

Not all schools provide health education including sex education to students.

Peer educators report anecdotal evidence of unwanted sexual experiences, particularly amongst girls.

Other problems facing young women include eating disorders (about which there is little or no public discussion or information).

This relates to another, more general issue: social stress and changing gender roles caused by the transition and other factors. This has left many young people confused and lacking appropriate role models.

Most distressing, in a recent survey of young people, while less than 8% of boys reported that “they don’t expect to accomplish that much in the future” or that “they expect to face great problems in the future”, these same answers were given by 15% of girls. On the flip side, 37% of boys “are convinced of their future success” or “think they will be able to succeed”, while only 28% of girls feel the same way.