On World Population Day, Dr. Tamar Khomasuridze, UNFPA Regional Sexual and Reproductive Health Adviser, speaks about the reasons the Eastern Europe and Central Asia region is lagging behind in terms of access to family planning, the case for family planning in countries with low fertility, and what UNFPA is doing to assist countries in making progress towards the goal of reducing unmet demand for modern methods to zero.
Family planning is the theme of this year’s World Population Day. Are you satisfied with the status of family planning in our region? Where do you see the main challenges?
The theme of this year’s World Population Day is very relevant and timely, also considering that universal access to sexual and reproductive health, including family planning, is one of the key targets under the global Agenda 2030. We have seen significant progress in the Eastern Europe and Central Asia region over the past decades. More women are using modern contraceptives and there is better awareness of the different methods available. Access to services and information has improved. And medical professionals are better trained to deliver family planning services.
But we still have some way to go to reach the ultimate goal of reducing unmet demand for modern contraceptives to zero. There are large disparities among countries in the region – and within countries – when it comes to modern contraceptive use. In total, some 17 million women have an unmet need for modern contraceptives, many of them from poorer households or living in rural areas. In several countries in Southeastern Europe and the South Caucasus, the percentage of women using modern contraceptives is lower than the average for the world’s least developed countries. As a result of limited access to modern methods in the region, we have higher rates of adolescent pregnancy and unsafe abortions compared to Western Europe, higher risks of maternal deaths and delivery complications, growing incidence of STIs and infertility, and the number of HIV infections is rising rapidly as sexual transmission has become the predominant mode of transmission in the region.
What is the reason the region is still lagging behind?
There are several factors to explain this situation. On the demand side, for example, too many women still believe the myth that modern methods are harmful, and social pressure can get in the way of people asking for advice and supplies. This is a particular problem for young people. On the supply side, not all medical personnel are trained to provide quality advice and services, and not always is a wide range of contraceptives available reliably and at costs that people can afford.
It didn’t help that during last decade donor funding for family planning has decreased by more than 50 per cent per woman in the region. More and more governments in Eastern Europe and Central Asia are taking over responsibility and provide state funding for contraceptives for marginalized and at-risk populations, but this process needs to be stepped up and the funds available need to match the needs.
We also see a certain resistance towards family planning in parts of region, based often on the false assumption that more access to family planning means fewer children.
What is the case for family planning in a region characterized by concerns related to low fertility?
First of all, access to family planning is a human right. Every woman has the right to decide when to have children and how many. And all people have the right to obtain the information and services they need, including family planning, to maintain their health.
Ensuring this right has massive positive consequences. Girls can avoid becoming pregnant and stay in school. Women can complete their education, find a job, stay healthy, and plan their pregnancies. This makes it more likely, not less, that they will have the number of children they actually want. Evidence from our region supports this: in Georgia for example, the use of modern contraceptives has been going up steadily – and so has the fertility rate.
And it doesn’t end there. Family planning empowers more women to contribute to the economy and public life more broadly. This strengthens families, boosts the economy and helps societies strive. Investing in family planning truly is an investment in the future.
What is UNFPA doing to ensure that everyone with an unmet need for modern contraceptives is able to have access?
In a region composed of middle-income countries with significant resources at their disposal, we – and our country offices in the region – primarily work with national partners to make sure marginalized and otherwise under-served people have access to quality reproductive health and family planning services. We help ensure that regional and national policies and strategies are developed based on best evidence and in line with human rights standards. Bridging European experiences with the needs of the countries in the region, we support knowledge management and institutional capacity-building, and assist countries with the adaptation and roll-out of international quality-of-care standards and guidelines at national level. For example, we developed different online platforms such as the Virtual Contraceptive Consultation, which is aimed at strengthening the capacities of family-planning providers at all levels, as well as residents and medical students. This contributes to building institutional capacities to provide quality advice and services.
Where do you see the biggest success stories so far?
I believe we are making real progress. We now have a solid policy framework in place at the regional level, with the adoption last year by member states of the first-ever regional action plan on sexual and reproductive health. Under our joint programme with WHO, we played an important role in developing this ground-breaking framework and mobilizing state support for it in our region. We are now working with national partners to develop national strategies to help implementation at country level.
And we have made a wide range of tools available that are being actively used by governments and civil society in the region. For example, the new regional commodity security strategy, developed by UNFPA together with national governments and adopted last year, has prompted an innovative region-wide exercise identifying and address procurement gaps and barriers.
Perhaps most importantly, we are seeing growing commitment by governments in the region to make sexual and reproductive health and family planning a priority. I’m not only talking about the policy level: that’s very important, but not enough. More and more governments in the region are assuming responsibility for integrated family planning programmes and have actually started to allocate resources. Among the 17 countries and territories in the region where we have country offices, seven already have dedicated budget lines for contraceptives. This is a very encouraging trend that we will continue to support through our work at the regional and country level.
All of these achievements have had a real impact on the lives of millions of people in the region. They mean that a woman or girl in our region today is more likely to get quality advice, to have access to the contraceptive method that is best for her, to plan when to have children, and, ultimately, to realize her full potential.
