SRH Needs of Young Women in Central Asia INTERNATIONAL SESSION of EBCOG / TSOG / UNFPA: SRH ISSUES AND WOMEN'S RIGHTS 25th European Congress of Obstetrics and Gynaecology Antalya, 2017 Tamar Khomasuridze, MD, PhD SRH Regional Adviser, UNFPA EECARO Setting the Stage: Family Planning in the context of new 2030 agenda: achievements, challenges and opportunities

Lifetime Risk of Maternal Death: EECA Countries Maternal Health in Central Asia: Significant progress, but need for improvements Highest Risk of Maternal Deaths: 1 in 390 - 1 in 1500 Higher then EECA average risk Closer to average of developing countries

SRH of Young Women in CA Countries Reproductive behavior Younger age of marriage Higher birth rate among young women Higher fertility rate Shorter interval between births limited decision making power on number and spacing of children Inequalities (rural/urban areas and social status) High impact of stereotypes and community pressure

SRH of Young Women in CA Countries Only 13% of women aged 15–19 years report the use of modern contraception in Central Asia. The adolescent birth rate is very high; ranges between 31.3 per 1,000 girls aged 15-19 in Kazakhstan and 65 in Kyrgyzstan.  Access to SRH information and services is limited due to availability of services, age of consent or stigma (EECA) Absence or inadequate quality of youth-friendly services and standards (EECA)

Adolescent birth rate per 1,000 women, ages 15-19 The proportion of adolescent birth rates in the EECA region has decreased in the last several decades but remains a matter of concern. Eastern Europe and the Caucasus are the sub-regions with the highest adolescent birth rates, with the highest rate in Georgia. The South Eastern European countries with the highest rates of adolescent pregnancies are Bulgaria and Romania (which also have high adolescent abortion rates).

Abortion rate among women below 20 years old, 2006-2011, per country Adolescents have more difficulties than adults obtaining family planning services and therefore are more at risk for unsafe abortions. Pregnancies among adolescents appear more likely to end in abortion in Eastern Europe than in Central Asia: e.g. one in every three pregnancies among adolescents in Moldova ends in abortion, compared with less than one in every 20 in Tajikistan, at the other extreme (Figure 11)

Gender issues 1 in 3 women in Central Asia (versus 1 in 4 in EECA region) experienced physical or sexual violence from a current or former partner (31.4% physical and 6.2% - sexual violence). Bride kidnapping Forced marriages Consent to access SRH services

Addressing the needs of Young Women: Uzbekistan Access to sexual  and reproductive health as an essential  human right and contributing factor to sustainable  development; Equitable  access to  quality health services for  all. Need for further  empowerment of  women, adolescent girls, so that  they  can make  free and  informed  choices about  their  sexual  and reproductive health.   

Addressing the needs of Young Women: Kazakhstan Access to high quality youth friendly SRH services and free contraceptives for young people in order to decrease rates of adolescents pregnancies in Kazakhstan.  Access to comprehensive sexuality education for all young people in Kazakhstan will lead to the safe sexual behaviour and better SRH outcomes.

Addressing the needs of Young Women: Kyrgyzstan Need for comprehensive sexuality education and improved awareness of healthy SRH behavior, to address vulnerabilities, teenage pregnancies, HIV and other STIs.   Improving access to integrated quality reproductive/ maternal health services for disadvantaged vulnerable  young women such as rural residents, migrants, women with disabilities, most-at-risk youth. Focus on effective antenatal, perinatal and emergency obstetric care,  particularly, in remote and rural areas.

Addressing the needs of Young Women: Turkmenistan Access to contraceptives including condoms and access to family planning services without parents consent, as there are no legal limitations in access to FP based on age or marital status. Access of young women to SRH information and comprehensive sexuality education

Addressing the needs of Young Women: Tajikistan Increased priority on adolescents, especially on very young adolescent girls, in national development policies and programmes; Availability of comprehensive sexuality education and sexual and reproductive health services; Increased availability and use of integrated sexual and reproductive health services (including family planning, maternal health and HIV) that are gender-responsive and meet human rights standards for quality of care and equity in access

Effective approaches to policies and programmes Human rights based approaches Life course approach to SRH Gender and culture sensitives Addressing inequalities Addressing the determinant of SRH Promoting health and safe SRH behavior Addressing SRH needs in a wider perspective of empowerment and development Multifaceted approaches

Development/strengthening legal frameworks Multisectoral strategies/policies addressing the needs of young women Stronger institutional capacities to introduce/advance health sector response to SRH needs and GBV Need for comprehensive sexuality education and integrated client oriented SRH services at the PHC level (including GBV prevention and management, FP, MCH) Development/updating the guidelines and protocols for client oriented and youth friendly SRH services. Networking and knowledge exchange with European institutions and professional networks.

Thank you!