1. 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.

2. 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: million (2015, UNDESA Population Projections)
Women of reproductive age (15-49): million (2015, UNDESA Population Projections)
Number of young people (15-24): million (2015, UNDESA Population Projections

3. 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 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Thank you!