International Session at the 25th European Congress Big Challenges of Sexual and Reproductive Health in Central Asia and Eastern Europe ADVANCING WOMEN’S HEALTH IN EASTERN EUROPE AND CENTRAL ASIA  International Session at the 25th European Congress Turkey, May 17-21 Dr. Tamar Khomasuridze, SRH Regional Adviser, UNFPA EECARO Ladies and gentlemen, distinguished professors Dear Colleagues It is my honour to welcome you to this important session, aiming the ADVANCEMENT of WOMEN’S HEALTH IN EASTERN EUROPE AND CENTRAL ASIA. We believe, this session will contribute to strengthened cooperation between professional networks of the EU and EECA countries for addressing the challenged by joint actions in wider perspective of health care, not limited to the clinical interventions. Expressing the Gratitude to EBCOG and personally to Dr, Taheer Mahmood for support and cooperation During the cooperation years since 2014 several important outcomes have been delivered, addressing top priorities in women's health in EECA Gratitude to the experts from EECA countries, we hope that the 25th congress will be the useful in terms of cooperation and new networks.

The population: 409 million (2015, UNDESA Population Projections) Women of reproductive age (15-49): 103 million Young people (15-24): 55 million Operating since 1969, our organisation, the United Nations Population Fund works in 155 countries and territories through a network of 123 country offices, liaison offices, regional and subregional offices to accomplish its mission: to deliver a world where every pregnancy is wanted, every birth is safe and every young person’s potential is fulfilled. Our Regional Office in Istanbul assists the countries of the Eastern Europe and Central Asia with: The population: 409 million (2015, UNDESA Population Projections) Women of reproductive age (15-49): 103 million (2015, UNDESA Population Projections) Number of young people (15-24): 55 million (2015, UNDESA Population Projections  

Universal access to SRH services, information and education SRH: From Cairo to SDGs Reproductive Health: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” ICPD PoA, 1994 Sexual and reproductive health encompasses key areas of UNFPA’s vision and support, guided by the International Conference on Population and Development (ICPD) held in Cairo in 1994 , which defined reproductive health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Addressing SRH challenges under Cairo agenda since 1994 and the MDGs since 2000, our region achieved significant progress, although our mission is not accomplished: the challenges in the area of SRH are still significant and manifested in high rates of unintended pregnancies, growing incidence of STIs and HIV, growing numbers of deaths caused by cervical cancer, child marriage… and many other challenges! These challenges, addressed by new development agenda, and particularly, SDGs 3 and 5, are clearly reflected in the targets to be achieved by 2030. Now, the progress in the countries depends on new approaches and effective programmes, and the progress is not responsibility of the health sector only… Universal access to SRH services, information and education

ICPD related targets in 2030 agenda (SRH/FP) Goal 3: Good Health and Well-Being Target 3.1: Maternal Mortality reduction to less than 70/1000 Target 3.3: End epidemics and other communicable diseases Target 3.7: Universal access to SRH, including FP, education and information and integration in national strategies and programmes Target 3.8: Universal health coverage and access to quality services, medicines and vaccines Goal 5: Gender equality Target 5.6: Universal access to SRH in line with ICPD and Beijing Platforms of Action Analyzing the targets and indicators, it is clear that the achievement of 3.1, 3.2, 3,3 is not possible if the targets 3.7, 3.8 and 5.6 (red) are not achieved.

Big Challenges in sexual and reproductive health EECA region Complications of pregnancy and delivery Adolescent pregnancies HIV/STIs Unintended pregnancies and unsafe abortions Cervical Cancer UNIVERSAL ACCESS TO SRH SERVICES, INFORMAITON AND EDUCAITON Analysing, Assessing and Addressing the causes Despite significant progress the EECA countries achieved during implementation of the ICPD PoA and MDGs, the remaining challenges in the areas continue to be the main causes of mortality and morbidity of women of reproductive age. I would like to bring several facts: The life time risk of maternal death in several countries of the region is 5-6 times higher than is EU countries; the unmet need for modern contraception is 17 mln in EECA, in seven countries of the regional is as high as in least developed countries; Adolescent pregnancies continue to be a challenge the mortality and morbidity, caused by cervical cancer are 10 times higher in EECA countries, than in EU. EECA is the only region in the world with growing number of the new cases of HIV. These challenges are more significant in the context of emergencies and humanitarian crisis, the region faces. How can we address those challenges? Wider outlook on causes and solution; Joint actions beyond clinical interventions Focus on causes UNIVERSAL ACCESS TO SRH can be ACHIEVED if Availability, Accessibility, Affordability and Acceptability of population to integrated SRH services is ensured and the main causes of morbidity and mortality serve as a strategies pillars for prioritization and integration of the services at the primary heath care level At the regional level, UNFPA prioritizes programmes focused on reduction of maternal mortality and morbidity, caused by Complications of pregnancy and delivery, Unintended pregnancies and unsafe abortions, Unmet need for contraception, Cervical Cancer, STIs and HIV. These are particular areas, where the inequities are significant between the countries of the EU and our region. To support countries in the focus areas, UNFPA supports capacity development of national partners and institutions, assists in building evidence for better programming and decision making, brings technical expertise in country and supports South-South cooperation between countries. UNFPA is committed to reducing the vast inequalities in access and utilization of sexual and reproductive health services throughout the region. UNFPA acts as catalyst for actions at regional and country levels to achieve universal access to comprehensive sexual and reproductive health. Health systems Population

Universal Access to SRH: Key Causes Health systems Clients, Communities, Society Leadership and governance Service delivery Health system financing Health workforce Medical products/technologies Health information systems Knowledge Attitudes Behavior Demand Stigma/discrimination Culture and traditions Opposition to SRHR The causes of SRH challenges are diverse and today, I would like to talk about two groups of causes affecting universal access: these are health systems related cause and the factors from population side. Both groups are addressed by different actors, although we believe, experts, academia, professional associations are the catalyzers of progress in both areas; hence, our objective is to support and strengthen the role of professional associations in addressing these challenges. Professional associations – the catalysers of progress

Key challenges to be addressed in EECA: health systems Leadership and governance Evidence based policies and programmes Institutional capacities for implementation Sustainability of results Service delivery Inequities Availability, Accessibility, Affordability, Acceptability of SRH services Integrated services at the primary health care level Health system financing Inadequate financing for SRH programmes sustainability What are key challenges to be addressed at the level of the causes? Key interventions: Evidences Advocacy Participation and strong voice in policy dialogue

Key challenges to be addressed in EECA: health systems Health workforce Human resources structure (Doctors/Midwives/Nurses) Pre- and post diploma education programmes Licensing and accreditation Knowledge, attitudes and behavior Medical products/technologies Adequate supply of commodities and equipment Capacity gaps in supply chain management Cooperation between private and public sectors Health information systems Availability and quality Databases/Records Computer literacy

Key factors, affecting universal access to SRH Knowledge, Attitudes and Behavior Social determinants of SRH Lack of CSE and SRH information for all groups of population Misconceptions, Lack of trust to SRH services, Personal experiences Demand on: Realisation of human rights and RRs in particular Information Services Health seeking behavior From Population perspective the KAB and demand of services are critical determinants of SRH, to be addressed

Key factors, affecting universal access to SRH Stigma/discrimination Marginalised groups and key populations Youth Ethnic minorities Culture, traditions Child marriage and adolescent pregnancies Family consent to access services Growing opposition to SRHR New networks and movements (global, regional, national) New restrictive policies

Addressing Challenges in SRH in EECA Region Health systems Clients, Communities, Society Bridging Science with Policies Knowledge Transfer from West to East Participation in policy dialogue Evidences for improved policies and funding Developing QoC tools and mechanisms Building institutional Capacities and knowledge base Networking and partnerships Advancing technologies Analyzing and addressing KAB Influencing environment as opinion leaders Partnering with civil society Cooperation with media Collaboration with development partners

Thank you!