Feature Story

Tackling family planning from every angle in Albania

30 January 2014

TIRANA, Albania – Anxhela Muhaxhi and her husband Erion married when she was just 12 years old. Early marriage and childbearing are common in her Roma community in Fushë-Krujë, 25 kilometres from the Albanian capital city of Tirana, and many girls there don’t even bother attending school as a result.

The young couple now have a 6-month-old baby girl they struggle to feed. Erion, 18, managed to get a summer job this year, but has had difficulty finding work in the winter. “Some days he works, some days he doesn’t have anything to do,” says Anxhela, 13.

The average age at which Roma men marry, 18.2 years, is nine years earlier than the national average of 27.2 years. Roma women marry at the youngest average age (15.5 years) of all ethnic groups in Albania, according to 2005 data. Anxhela, for one, regrets marrying so young. “I was a child, I should have waited a few more years,” she says. “I want my daughter to marry when she is older, not suffer like me now.”

UNFPA and its partners in Albania are working to improve access to family planning information and services among Roma and other marginalised groups through a Total Market Approach (TMA) for Family Planning/Reproductive Health Commodity Security that engages the public sector, commercial suppliers, and nongovernmental organisations to ensure that reproductive health supplies are reliably available at prices everyone can afford. Currently, just 25 percent of Roma in Albania have enough money to buy medicines, including contraceptives, and many are being left even more vulnerable as healthcare services decrease in rural areas.

Difficult life for Albania’s Roma

Members of Albania’s Roma community are subject to longstanding social exclusion and prejudice, leading to unemployment and illiteracy rates four times higher than average. Most lack civil registration and don’t speak the official language, making attaining an education difficult and restricting job opportunities. Access to health services and housing programmes is also limited among Roma.

Mimoza Rakipi and her two daughters are from the same Roma community as Anxhela and her family. They live in a house with no running water, plumbing, or roof after Mimoza’s father-in-law lost their previous home due to gambling, a growing problem among unemployed men in the area. Because of her lack of education, Mimoza says she is already “lost”, but she hopes for a better future for her girls.

Like many Roma, Mimoza speaks little Albanian, and barely knows how to read or write. But at a community centre serving Fushë-Krujë’s Roma, a UNFPA-trained volunteer mediator offers Mimoza advice on enrolling in vocational training as a tailor and enhancing her language skills.

That mediator, Fatmira Dajlani, has had her own struggle to get into the workforce. “My husband and my in-laws did not want me to study or work, so it was very difficult for me,” she says. “I am insisting that my daughter gets educated, even though my husband does not agree.”

Increasing access to contraceptives

UNFPA has been active in Albania for 24 years, with a particular focus on family planning. The agency helped the Albanian government develop its National Contraceptive Security Strategy, which aims to increase access to family planning resources in remote and marginalised communities. The state spends 80,000 USD annually distributing free male condoms, birth-control pills, IUDs, and injectable birth control at 431 public-health centres across the country. The strategy’s goal is to increase the usage rate of modern contraceptives by 30 percent. That rate was just 11 percent in 2008, when the last demographic and health survey was conducted.

“Every couple, every woman, and every man can have the opportunity to choose the most appropriate method [of contraception] and find it for free in the public sector,” says Dr Miranda Hajdini, the national coordinator of the state-owned Logistic Management Information System (LMIS), which is responsible for coordinating the nationwide distribution of contraceptives.

Work to increase access to contraceptives through a total market approach also includes social-marketing and private-market components such as partnerships with pharmacies like the one in Tirana where Naime has now been working for 35 years. She helps advise clients on family planning and make sure they have access to a range of contraceptives at various prices.

“The social marketing network helps ensure people can get the method and brand [of contraception] they want in order to plan their families and protect themselves,” Naime says.

Youth educating their peers

The number of young people using contraceptives in Albania is on the rise, according to UNFPA, which has launched a new initiative with young activists and peer educators who offer friendly, high-quality counselling in youth centres and high school health clubs.
 
“I am happy I can share information with other young people, so they don’t have to resort to the Internet or rely on rumours,” says Blerta Shehu, 23, a member of the Youth Peer Education Network (Y-PEER). She volunteers at a youth centre in Tirana that provides sexual and reproductive health services and counselling for those up to 24 years old.
 
UNFPA-trained Y-PEERs like Blerta work to promote healthier lifestyles and empower young people so they can make responsible decisions. Though discussion of sexuality-related issues is more open than it once was, many youth – even those from wealthier, more educated families – still confide only in friends and avoid seeking medical advice, leaving them more vulnerable to unintended pregnancies and sexually transmitted infections (STIs).
 
“A friend of mine, the 16-year-old daughter of physicians, got pregnant. It was very difficult for us to talk to her parents about this, but the centre doctor helped us,” says Marxhino Starova, a Y-PEER who volunteers at a youth centre in Vlora. “We wish she’d had the information before she got pregnant.”
 

TIRANA, Albania – Anxhela Muhaxhi and her husband Erion married when she was just 12 years old. Early marriage and childbearing are common in her Roma community in Fushë-Krujë, 25 kilometres from the Albanian capital city of Tirana, and many girls there don’t even bother attending school as a result.

Health clubs are another component of the effort to increase outreach to youth. These volunteer-run high school groups are established by school doctors and students, and encouraged by government health agencies. They carry out awareness-raising activities on reproductive-health issues in collaboration with the youth centres, supported by UNFPA and the Albanian Centre for Population and Development (ACPD), an NGO affiliated with the International Planned Parenthood Federation (IPPF).
 
Bela, 18, and her friends volunteer at a high school health club in Tirana. Those who are sexually active say the dual-protection concept – preventing both pregnancy and STIs – has made their lives better and safer. “The discussions I had with the school doctor removed barriers [and] the fear of doing something wrong. I use dual protection: condoms and pills. I know this is the best choice for me,” Bela says.
 
Diego Sala, also 18, has been one of the most active students in the health club since joining two years ago. “I felt more grown-up and responsible in my relationship after we talked to the school doctor about sex,” he says. “We have chosen to use condoms and both feel comfortable with the choice.”
 
Choosing when to have children
 
The total market approach in Albania also supports couples who want to get pregnant, like Afrim and Kimete, whose premature twins have been under constant medical supervision at a maternity hospital in Tirana for the month since their birth.
 
“A child is a life we celebrate,” says Dr Lindita Myzyri, who has worked in a health centre in the Albanian capital for more than 15 years. Dozens of women and girls line up outside her office every day to get counselling and contraceptives. “I have 400 regular clients; 60 percent of them come from poor, uneducated families,” she says.
 
One of her patients, Luljeta Mustafa, is 32 and expecting her third child, a girl. That’s a big family for Albania, where the fertility rate has dropped to 1.6, below the replacement rate, according to 2009 data.
 
Luljeta decided to start using the pill after receiving counselling at the health centre. “I am very happy I was able to choose, together with my husband, not only the number of children we wanted, but also when we wanted them,” she says.
 
Photos: UNFPA/Besfort Kryeziu
Work to increase access to contraceptives through a total market approach also includes social-marketing and private-market components such as partnerships with pharmacies like the one in Tirana where Naime has now been working for 35 years. She helps advise clients on family planning and make sure they have access to a range of contraceptives at various prices. - See more at: http://eeca.unfpa.org/public/pid/16300#sthash.kQfYraIC.dpuf
Work to increase access to contraceptives through a total market approach also includes social-marketing and private-market components such as partnerships with pharmacies like the one in Tirana where Naime has now been working for 35 years. She helps advise clients on family planning and make sure they have access to a range of contraceptives at various prices. - See more at: http://eeca.unfpa.org/public/pid/16300#sthash.kQfYraIC.dpuf