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Reproductive health shows signs of improvement

[Turkmenistan] A patient receives counselling at the Balkanabat health centre. IRIN
Health care system is deteriorating in Turkmenistan and many patients cannot afford treatment
Reproductive health services are improving in Turkmenistan, home to some 6.5 million people, with more women utilising modern methods of contraception, officials say. Bahar, 21, a resident of the western Turkmen city of Balkanabat, the capital of Balkan province, is waiting her turn to see the doctor at the reproductive health (RH) centre. Four-months pregnant, as this is her first pregnancy, she wants to be sure that everything is going right. "I was told that there is a good doctor at this centre. That's why I came here," she told IRIN. "We have a lot of patients, women of different age groups. Our aim is to ensure that they have good reproductive health (RH) services through regular monitoring, counselling and if necessary treatment," an official at the Balkanabat city RH centre told IRIN. In an effort to improve RH services and to deal with maternal and infant mortality the Turkmen government issued a decree in 1998 on establishing RH units in all of the five Turkmen provinces. For example, during the Soviet times the family planning component was heavily based on intrauterine devices (IUDs) called 'spirals' among the population. But now the doctors evaluate each case separately and try to choose the best contraception method to suit the patient. "We have a government policy on promoting birth rates and thus population growth, so our task is to make sure that we explain to women how to have healthy children. Therefore, we prescribe each patient either contraceptive pills or an injection or IUD or condoms so that they have intervals between the births and maintain their health," a doctor at the RH centre explained. Under a cooperation framework between the government and the United Nations Population Fund (UNFPA), the UN agency provides contraceptives for these centres, while conducting training of family doctors and other medical personnel. "We have contraceptives provided by the UNFPA, which we give to our patients free of charge," the officials said. Along with routine checks and examinations the centre's medical staff also pay attention to the regular counselling of women in raising their awareness. And women's mindset on the issue seems to be changing. Asked whether she planned on having another baby after her first delivery, Bahar said: "Oh no, we are not planning to have another child for at least three years. Life is not easy and I will have to raise my first child first," she said. "Young people are now more aware and smart. First of all, they want to live for themselves for a while and then have children," another official explained. Back in the capital, Ashgabat, Guzel Hojayeva, a reproductive health project coordinator for the UNFPA mission, told IRIN that things were moving forward. "The situation with regard to reproductive health in the country has remarkably stabilised. There is a sustainable tendency for a decrease in maternal and infant mortality. Birth intervals are longer and the fertility rate among older women (40-45 years old), who are a high risk group in terms of complicated pregnancy and births, is going down," Hojayeva said. Maternal mortality in the largely desert, but energy-rich country had decreased between 1994 and 2002 by 2.8 times, the UNFPA official said. According to the Turkmen health ministry, there were 98.8 maternal deaths per 100,000 live births in 1994, while in 2002 that figure stood at some 36. Maternal deaths in the country were mainly caused by haemorrhage and toxaemia, according to the United Nations Children's Fund (UNICEF), while infections, abortions and extra-genital pathologies were other causes of maternal deaths. Echoing that view, Ezizgeldy Hellenov, a UNFPA national programme officer, told IRIN that things on the ground were improving. "We should say that there have been positive changes in Turkmenistan since 1997 after adopting an action plan with regard to the Cairo International Conference on Population and Development (ICPD). First of all, it is full adoption of reproductive health rights of citizens and the government's responsibility to ensure these rights," he said. "Secondly, a national strategy on reproductive health until 2010 was adopted, which is more comprehensive than only family planning, with the creation of reproductive health bodies for males and adolescents with their further integration." Another positive thing is a higher awareness level amongst the population, Hojayeva noted. "More than 99 percent of married women know about contraception methods and where they can be obtained. Also, more than 60 percent of married women are using contraception methods, of which over 80 percent are utilising modern methods (IUDs, pills and injections, barrier methods and etc.)," she said. But not everyone maintained that optimism. A former NGO activist who didn't want to be identified, claimed that there had been a lack of awareness among youth in some parts of the country, a worrying development in terms of their reproductive health. "We did a little survey and discerned that the level of knowledge of young people [ secondary school and university students] about STDs [Sexually Transmitted Diseases], family planning and contraception methods was very low. Moreover, that level among students of schools with Turkmen as the language of instruction was even lower compared to the pupils studying at Russian classes," she said. Meanwhile, another former health official told IRIN that condoms, one of the most important methods of contraception and prevention of STDs, were not even available at government-run pharmacies. "Condoms are only available at commercial shops [private shops selling beverages, cigarettes and other staff] where they are not properly kept. They are exposed to direct sunlight without proper temperature and God knows about their quality," the former health official said.
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