Helping to improve Reproductive Health in Georgia

What's the situation?

Reproductive Health in Georgia like many of the country's social and healthcare sectors suffered during Georgia's long and sometimes turbulent transition to independence from the former Soviet Union in the early 90s.

As it established independence, Georgia struggled with new poverty, economic, social disparities and political difficulties. These were further compounded by civil war and armed conflicts which resulted in the displacement of around 300,000 people.

With only very low national budget allotments available for the health sector (0.3 to 0.6 per cent of GDP expenditures in 1997-2003) the healthcare system deteriorated and public access to services were reduced.

The results of this deterioration can be seen in key health indicators:

The maternal mortality ratio (MMR) in Georgia rose from 40.9 per 100,000 live births in 1990, to 70.0 in 1997 and then dropped again to 49.8 in 2003. The infant mortality rate (IMR), which was 19.7 per 1,000 live births in 1990 increased to 24.8 in 2003.

Now that family planning services and supplies are more readily available, the number of abortions has decreased by 70 per cent. But the abortion rate 4.4 per cent in remote districts compared with 3.7 in the capital still remains high.

Sexually transmitted infections (STIs) are increasing in Georgia, as is infertility to the extent that the growth rates here are among the highest in the former Soviet Union countries.

Although Georgia in 2004 had only 597 officially registered cases of HIV/AIDS , the risk of increasing prevalence is high for a number of reasons: As well as having a general low level of public awareness about HIV/AIDS, Georgia shares borders with high-prevalence countries such as Russia and many people also migrate seasonally from Georgia to look for work.

A project supported by the Global Fund which is a public-private partnership established to attract, manage and disburse new resources to fight AIDS, TB and malaria has been initiated, but growing numbers of sexual and mother to child transmissions in Georgia will need extra support.

Georgia's young people and adolescents are of particular concern. Despite general awareness about family planning, young peoples' awareness of sexual and reproductive health and rights is still limited. This is partly due to cultural stigmas and partly due to a lack of supportive policies and healthy life education practices.

More needs to be done to involve men of all ages in Reproductive Health, with better access to RH information and services.

Since the "Rose Revolution" of November 2003, the Georgian government has been striving to reinforce reforms and implement national development strategies. Reform of the healthcare system started in 1995, but because state allocations for health are still low, international assistance remains crucial for improving health and healthcare in Georgia.

UNFPA supported Georgia's first nationwide reproductive health survey in 1999, along with USAID and UNHCR. This showed that when it comes to public access and use of RH services, there is a big difference between the capital, Tbilisi and more remote districts.

For example, awareness of family planning methods in Tbilisi is much higher at 97.8 per cent than in rural areas 84.6 per cent. Actual use of family planning methods in the capital is also higher : 44.9 per cent, compared with 37.2 per cent in rural areas.

One of the major concerns of the Government of Georgia is to improve the access of population in such remote districts to quality RH information and services. It is also keen to improve the efficiency of the health statistics system. so as to have better data for development and policy planning.

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