Many countries of the CEE region have not met these requirements. Few countries introduced specific policies, which should be the consequence of commitments made in Cairo and Beijing. This results in the poor accessibility and quality of reproductive health services as well as the low level of awareness of sexual and reproductive health issues in the society.

In Georgia 28% of sexually experienced women reported never having had a routine gynaecological exam and 19% reported they had their last exam more than three years before. Only 40% had ever had a pap smear and 1/3 of women never heard of cervical cancer screening.⁴

The incidence of breast cancer and cervical cancers appear to have increased in most countries of the region. In Latvia, the incidence of breast cancer rose from 44 cases per 100,000 individuals in 1989 to 64 in 1996.⁵ In Poland, the incidence of breast cancer in 1999 was 50,5 cases per 100,000 women.⁶ The rates for cervical cancer in the countries of Central and Eastern Europe are three times as high as the EU average. This is largely due to the lack of screening services and cervical cancer prevention / early detection programmes.⁷

There is a general tendency that physicians do not pay adequate attention to prophylactics. Gynaecologists do not conduct breast examination routinely. In a survey conducted in Poland only 21,9 % of women reported having had regular breasts check by a physician. However, this figure is still overstated, since women surveyed were better educated and had better knowledge on reproductive health than the general public.⁸

Demographic situation in the CEE countries often has impact on the state policies (or the lack of them or low priority given to them) which concern reproductive and sexual health and rights. The majority of CEE countries goes through similar demographic changes as can be observed in Western Europe – birth rate is low and still falling, with exception of Albania, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. Thus, the majority of CEE countries has a declining population. These demographic trends; instead of prompting the development of good social policies (giving priority to such measures as positive social and economic incentives, e.g. development of better child-care support system); have sometimes fuelled restrictive pro-natalist policies. Such policies, directed at limiting voluntary reproductive choice, contravene the international human rights commitments.

In Poland, the pro-natalist ideology gives support to measures that limit access to effective fertility control, such as: restrictive abortion law, lack of policies that promote and subsidize family planning, retention of the illegality of contraceptive sterilisation, and the lack of sexual education in schools.⁹ The characteristic element of such ideologies is perceiving women mainly as mothers and treating them as means to population and demographic goals.

In Croatia in 1992 a special Division for Demographic Renewal was established by the Ministry of Reconstruction and Development. The first head of this unit was a Catholic priest, who was best known for his extreme nationalistic and conservative views, especially as regards the role of women and the view on family.¹⁰

In Russia, the quality of the gynaecologists’ work is evaluated on the number of pregnant women, who register and carry the pregnancy to term under their care. It is an incentive for physicians to put pressure on women to not undergo abortion.¹¹