Helping to improve Reproductive Health in Azerbaijan

What's the situation?

The health sector in Azerbaijan has suffered from a lack of resources, largely because of the country's struggle with economic crisis and political instability in the years which followed Independence. Although the national economy is now in much better shape, Azerbaijan still needs assistance to improve its services for reproductive health and to ensure people can access them.

Until 1991, Azerbaijan was part of the former Soviet Union. The disruption of the old system of central planning allowed many new freedoms, but also led to economic decline and institutional instability in the early 90s. The situation was exacerbated by the Nogorno-Karabakh conflict and by the displacement of 800,000 people. Currently, internally displaced persons still account for 10 per cent of Azerbaijan's population.

Under-resourced, outdated services

Thanks to a series of macroeconomic stabilization programmes and the recovery of the oil sector, Azerbaijan's economy has grown and social tensions have eased. However it is estimated that half of Azerbaijan's population of 8.25 million still lives in poverty. The Government has also had to divert resources to meet the needs of displaced persons.

As a result, the health sector as a whole currently receives less than 1 per cent of Azerbaijan's Gross Domestic Product. When it comes to reproductive health , years of under-financing have meant that the physical infrastructure for services has become run down, especially in rural areas. E xisting legislation relating to maternal health reflect the principles and social attitudes of the former Soviet system. Training programmes are needed to bring the knowledge and skills of doctors, midwives and other service providers up to date.

Inconsistent data

It is hard to get a clear picture of Reproductive Health in Azerbaijan because of a lack of accurate data on population and development and discrepancies among key indicators.

One reason for these disparities is that different definitions and methodologies have been used to collect reproductive health data.

For example, data collected in a m ultiple indicator cluster survey conducted by UNICEF in 2000 puts maternal mortality rates notably higher (at 79 deaths per 100,000 live births in 1988) than those reported by official statistics (23.8 deaths).

Similar inconsistencies can be seen in data about infant mortality, the use and availability of contraception, rates of abortion and adolescent fertility.

From what is known about reproductive health in Azerbaijan, it is clear that there has been a rapid change to smaller families over the past few decades, resulting in a sharp decline in fertility.

There are large disparities between the access to prenatal care and safe delivery services in towns and cities and what is available in rural areas. As a consequence there is a clear contrast between the levels of infant, child and maternal mortality in urban areas and those in rural areas.

Contraception : traditional versus modern methods

When it comes to family planning , natural methods of contraception, especially withdrawal, are still the most popular in Azerbaijan. But modern methods of contraception are becoming more widely used, with prevalence rates increasing from 0.2 to 13.3 per cent in less than a decade. In some regions, where pilot health programmes are underway, the contraceptive prevalence rate is as high as 20 per cent.

Although the number of abortions in Azerbaijan is declining, there are still an estimated 300 abortions per 1,000 live births among women aged 25-29. Moreover, abortion is still commonly used as birth control in Azerbaijan and in contrast to a number of neighboring countries this practice seems to be increasing. The abortions often lead to serious complications, including infertility and reproductive tract infections.

Increase in sexually transmitted infections low awareness

The incidence of sexually transmitted infections (STIs) and HIV/AIDS is on the rise. Many of Azerbaijan's migrant labor force work in countries such as Russia, which has a very high rate of STI infection and those who have unprotected sex while they are away risk spreading these infections on their return home.

Research by Baku municipality in 1999 revealed that nearly one quarter of prostitutes detained in 1999 have STIs. Despite the growing risk of infection, there is little awareness of STIs among Azerbaijani women and many do not take the issue seriously. The fact that education on sexual and reproductive health is practically non-existent in the schools adds to the problem. In time, this could fuel an HIV/AIDS epidemic. At present, i ntravenous drug use is the most common method of HIV transmission, followed by sexual contact and transmission from mother-to-child.

Another major health concern is the increase in cervical cancer, particularly in women over 40 as both awareness of cervical cancer and of the availability of screening is very low.

Young people at risk

UNFPA recognizes the particular need to safeguard the reproductive health and rights of youth and adolescents in Azerbaijan.

Young people in Azerbaijan today enjoy more personal and social freedoms than in communist times. But the early onset of sexual activity, the growth in the commercial sex industry and the trafficking of women and young girls are all causes for concern.

Reliable information and services for young people about reproductive and sexual health and rights are scarce and in many areas there is still a social stigma about these issues.

In some communities Azerbaijan's recent economic and social upheavals have led to a re-emergence of patriarchal traditions. These attitudes and/or financial pressures on family resources can lead to young women being pressured into early marriage . This can result in a number of problems: health issues associated with early pregnancy, the loss of educational opportunities and a lack of legal protection in case of marital problems.

The practice of marriage between blood relatives is still widespread in Azerbaijan. There are worrying health implications for children conceived in such marriages, with a high incidence of birth defects.

Currently, Azerbaijan still needs international support to address the needs of young people regarding reproductive and sexual health, including such issues as unintended pregnancies among adolescents, the use of modern methods of contraception, or the prevention of sexually transmitted infections. There is also a need to involve men in reproductive health matters and to improve the understanding of these issues among Azerbaijan's armed services.

For more details about the issues affecting young people in Azerbaijan, click here.

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