Focus on family planning

Waiting in the narrow entrance hall of the local reproductive health centre, Mehri Zanjirbekova, a Tajik nearing forty, is clear her child-bearing days are over. "I already have five children and it's increasingly difficult to look after them. I think it is very important to have effective family planning," she told IRIN in Khorog, capital of the Gorno-Badakhshan Province in eastern Tajikistan. Married in 1985, Zanjirbekova, a housewife, is concerned about the welfare of her family. "We don't even have enough to eat and we have to look after the education and health of our children," she said. Working in a local factory, her husband earns US $20 a month, but that income is not regular, as sometimes he is not paid for months. "My message to mothers is that it's better to have fewer children because it's easy to look after them," she said. Family planning practitioners in Khorog hope Zanjirbekova's attitude is typical of new ways of thinking in rural Tajikistan. "There is a growing positive attitude towards family planning," Daulat Mehalieva, head of the reproductive health centre in Khorog, told IRIN. "The population here is 25,000 already. If people do not use contraceptives, we will soon have a population of 50,000, which will further burden the already fragile services," she said. Changing the way Tajiks think about families in this impoverished Central Asian nation is one of the biggest challenges facing the government, as well as the health and planning sectors. During the Soviet period, Tajik women were encouraged to have as many children as possible. In Soviet times, mothers with more than five children were awarded gold medals and showered with lucrative benefits such as tax breaks, telephones, substantial child benefits and fully paid early retirement. Maternity leave could last up to three years, without the risk of losing a job. Some women were even given cars. However, such benefits are a distant dream after the collapse of the centrally-planned Soviet economy. Now the government and aid agencies are backing family planning as a way of improving the health of women and children, and boosting economic stability. With more than 80 percent of its 6.2 million people living below the poverty line - defined as $10 per person per month - experts maintain that unchecked population growth rate would further burden the already fragile resource base of the country. Only seven percent of the mountainous country's total land area of 143,000 sq km is arable. With the large population growth in Soviet times, the average amount of arable land per inhabitant declined from 0.6 hectares to 0.14 hectares. Although thousands of ethnic Russian speakers and other nationalities left Tajikistan in the wake of the five-year-long civil war between 1992 and 1997, the government estimates that the population has increased by 1.5 million - or a third - over the past 14 years. Even though some 50,000 people also died in the civil war, it is estimated that with the current growth rate, the country will have eight million people by 2010. Unlike its neighbours, who have large hydrocarbon resources, Tajikistan has few sources of wealth creation. While there are possibilities for hydro-electric schemes that could generate income, Tajikistan is less well endowed in terms of other resources, and is likely to remain one of the 20 poorest countries in the world. "Considering the small arable land available and taking into account the high levels of infant and maternal mortality, family planning is very important," Zuhra Ahmedova, National Programme Officer of the UN Population Fund (UNFPA), told IRIN in the Tajik capital, Dushanbe. Aid workers estimate that the average family size in Tajikistan is still six to seven persons, with the official fertility rate estimated to be 3.7 children per woman, which is one of the highest among the former Soviet republics. This also results in a younger age structure, with children below the age of 15 making up 44 percent of the population. Tajikistan participated in the 1994 Cairo International Conference on Population and Development and continues to support its goals. The government has set up a commission on population development. The new law on reproductive health adopted late last year grants reproductive rights in line with international standards. However, translating such commitments into action needs resources, which the Tajik government lacks. "The main challenge for us and the government is to improve the access of the population to health care, including family planning," Ahmedova said. The maternal mortality ratio in Tajikistan, according to UNFPA's country population assessment, is 87.7 per 100,000 live births, which is considerably higher than pre-independence levels. Although officially the infant mortality rate was 27.9 per 1,000 live births in 2001, the country still uses a Soviet-era definition, which means that reported levels are much lower. Aid workers believe that if international standards were applied, the figure would increase by 25 to 30 percent. Medical services are widely available, but their condition has deteriorated considerably. Many do not have heating, a regular water supply or proper sanitation. One estimate is that 60 percent of maternity hospitals have no sanitation and 35 percent have no regular water supply. Ahmedova maintained that today, Tajiks were eager to practise family planning methods. But according to the 2002 demographic survey conducted by UNFPA, only 45 percent of all married women in the country had used contraception at some stage, and only 31 percent were regularly using it. Modern methods, such as Intrauterine Contraceptive Device (IUCD), pills and condoms are most common, with only five percent of women useing traditional methods. IUCD remains the most popular contraceptive method. "Clearly there is a lack of access and a lack of knowledge among the population of family planning methods," Saverine Courtiol, head of the NGO, Action Against Hunger in Tajikistan, told IRIN, adding that in many Tajik families, women were pushed to have more children because of the traditional liking for large families. Courtiol said that after realising that more children meant more poverty, people were quite receptive to family planning initiatives. "I am optimistic that with proper education and supply of contraception, family planning can work," she said. Tajik NGOs working on family planning also shared her views. "The situation is changing, which is positive," Viloyat Mirzoeva, head of the Gender and Development NGO, told IRIN. Mirzoeva said that the local government of Baldzhuvon district in the southern Khatlon Province had recently bought contraceptives worth $300. "This is a small step but it is significant and represents the change in thinking," she said.