Providing Quality Reproductive Health in Kyrgyzstan

Read more about the project in Kyrgyzstan: Improvement of the Quality of Sexual and Reproductive Health Services

Buried deep in Central Asia, Kyrgystan is home to 5 million people and the world's third highest mountain range. However although 70% of the country is mountainous and largely uninhabited, some of Kyrgystan's valleys are among the most densely populated areas in the world.

In many remote, isolated villages, reproductive health services are non-existent. Where services do exist, the rugged terrain, inadequate roads, or lack of transport have made it nearly impossible for people to reach them. With 80% of the population living in poverty, basic goods and services are hardly affordable.

The total fertility rate, unlike Russia, remains high, averaging 2.4 children per woman. Officially the infant mortality rate is just 22 deaths per 1,000 live births, but WHO estimates the real figure at closer to 50 deaths per 1,000 live births since people living in rural areas do not report infant deaths earlier than 42 days after delivery.

Similarly, the maternal morality rate appears to be increasing slightly - from 42 deaths per 100,000 live births in 1999, to 45 deaths per 100,000 live births in 2000. The main reasons cited for this are too many pregnancies to adolescent girls, multiple births and short intervals between births. To complicate the picture, over half of all pregnant women suffer from alimentary anemia. Many deliveries still take place at home without the presence of a qualified birth attendant or doctor, increasing the risk of both infant and maternal mortality.

One hopeful sign - some 40% of all women of reproductive age are using some form of contraception. But this must be maintained and enhanced if progress is to be made in improving women's reproductive and sexual health.

The project has five main objectives:

  • Increase people's awareness of the recently adopted Law on Reproductive Rights, which puts users into position to have a stronger voice in demanding quality services secured by the law.
  • Identify and document the impact of the health care reform process on the provision and funding of sexual and reproductive health services.
  • Identify ways and means of creating awareness among women of their reproductive health and rights.
  • Establish pilot community-based initiatives aimed at improving the quality of sexual and reproductive health care by empowering clients and developing partnerships with providers.
  • Reallocating core resources from UNFPA, ILO/STEP, UNICEF and WHO during respective programme reviews and mobilizing matching funds from other donors, including bilateral development agencies.

The following activities have been carried out during the planning phase:

  • Identification of information and facilities necessary for project development, including plan of action and timeline for the planning phase.
  • Synthesis and dissemination of existing knowledge through case studies and situational analyses and presentation of results at stakeholder workshops.
  • Design, implementation, monitoring and evaluation of pilot projects in selected regions.
  • Development of funding proposal for full implementation phase.

What's NEW

The UN team in collaboration with other partners have undertaken a number of activities to gather information, including a rapid assessment of the perceptions and needs of communities and health care providers related to reproductive health, rights and services. Interdisciplinary working groups have been formed to analyze these primary elements of the project's scope, including the impact of health sector reforms on reproductive health and community mobilization aimed at better reproductive health services.

At this stage, planning preparations are underway for a baseline study to shape pilot interventions. A community sensitization component, aimed at developing the capacity of communities to communicate and improve relationship skills on reproductive health, is viewed as a crucial step forward. Complementing this initiative will be activities aimed at increasing community awareness of the contents of a recently adopted piece of legislation - the Law on Reproductive Rights. This law puts health care users in a position to demand quality services. There is wide agreement among partners that decisions on the interventions to be pursued will be made by the communities themselves.

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