On the application of modern methods of contraception in Uzbekistan

Дата публикации: Apr 17, 2012 10:58:33 AM

The Government of the Republic of Uzbekistan implements a number of large-scale State programs aimed at strengthening women's health, the birth and raising a healthy generation, increasing the medical culture in the family. During 20 years of Independence of our country the child and maternal mortality rates fell three and two times respectively, while the life expectancy for women climbed up to 75 from 67 years.

Ensuring safe maternity is one of the priorities of state policy in Uzbekistan. Recognizing the fundamental rights of women and couples to make decisions freely and responsibly about the child's birth, the government provides them with services required for the formation of healthy family, in accordance to which all types of modern contraceptives are being provided free of charge.

Prior to 1990 the main method of preventing unwanted pregnancies in Uzbekistan was abortion. Each year more than 6% of women of fertile age used to get rid of an unwanted pregnancy. During the period from 1991 to 2011 the overall abortion rate in the republic declined by more than 5 times and over the past few years cases of illegal abortions have not been recorded.

Taking into account that the issue of abortion in many countries, including in the post-Soviet area, has an extremely negative impact on the psychophysiological conditions of the women and society, there is a reasonable question, what activities helped to achieve such results in Uzbekistan.

The main areas of protection of the reproductive health are reflected in the Decree of the President of the Republic of Uzbekistan dated April 13, 2009, № PP-1096 “On additional measures on protection of the health of mother and child, formation of a healthy generation” and “Programme of measures for 2009-2013 to further strengthen and improve the efficiency of the work carried out to improve reproductive health of the population, the birth of a healthy child, the formation of physically and spiritually mature generation”, approved by the Decree № PP-1144 in 2009. The implementation of activities under these programs has allowed in three years to increase the coverage and availability of various methods of contraception among the women in most remote regions of the country.

At the present stage the population of the country is familiarized with the effects of different methods of contraception: intrauterine devices (IUDs), both oral and injectable hormonal contraceptives and methods when couples consciously decide to voluntary surgical contraception (VSC). The main requirements for modern contraceptives are high efficiency, minimum side effects affecting a woman's body, simplicity, accessibility.

According to researches conducted in the country by international organizations (WHO, UNICEF, UNFPA), 90.9% of all women of reproductive age are familiar with the modern methods of contraception. The most well-known methods are IUDs, oral pills, injections. If in 1991 only 13% of women of fertile age regularly used certain types of contraceptives, by the end of 2011 their number reached more than 67%. The prevalence of contraceptive use is almost the same in rural (69%) and urban (66%) areas. Especially important to note the increase in use of contraceptives among 20-30 years-old women with highest birth rate. In 2011, the most common method of preventing of unwanted pregnancy became a IUDs, which are used by up to 65.5% of women of fertile age. 27.2% of women use hormonal contraceptives (oral tablets and injectable contraceptives) and 7.2% - voluntary surgical contraception.

VSC is a common method of contraception in the world. For example, the number of women, using this method, reaches 25% in Asian countries, 30% - in Latin America and the Caribbean. Meantime, in the number of developed countries of Europe this figure varies from 6 to 14%.

In Uzbekistan in recent years, thanks to application of high-tech equipment (laparoscopic method), the use of local anaesthesia with small sedative effect, improvement of surgical techniques and training of medical personnel, the use of VSC increased from 3.3% in 2000 to 7.2% in 2011.

Application in the country of the VSC method is not dominant among all other methods of contraception and is carried out on a voluntary basis after consultation with a specialist with the written consent of both spouses and completing the form of informed consent.

The production of caesarean operations in Uzbekistan in 2011 averaged at a very low level of 6.8% with regard to all births. Created system of provision of highly skilled obstetric care in the Republican and regional perinatal centres of the country increased the percentage of caesarean operations by identifying and assisting under severe obstetric pathology, but this figure does not exceed 26% even at the Republican Perinatal Centre, in which concentrated pregnant women and mothers with complicated pregnancy and delivery from across the country.

The garbled information on the methods of contraception in Uzbekistan, and particularly, the allegations about "forced sterilisation of women”, which appear in some media, have nothing to do with the real situation in the country and can be considered as purposeful slander against our nation.

Numerous studies conducted by representatives of many international organisations, such as WHO, UNICEF and UNFPA, have confirmed the transparency of the policy pursued by the Government of Uzbekistan in respect of human rights on protection of reproductive health and healthy family.

The Tashkent International Symposium, which was held in November 2011 with the participation of the WHO Director General Mrs Margaret Chan, leadership of UNICEF, UNFPA and many other international organisations, with the adoption of the Resolution of the Symposium, once again showed that the National model of protection of maternity and childhood in Uzbekistan can serve as a model for many countries, not only the region, but around the world.

The healthcare system of Uzbekistan was also highly assessed by Save the Children, international organization on protection of children's rights. On 6 September 2011, this organisation published a report titled “Health Workers Reach Index”, in which the situation in the children's health systems in 161 countries was analysed on three indicators:

1) a measure of health worker density;

2) the percentage of children receiving three doses of the vaccine for diphtheria, whooping cough and tetanus;

3) skilled birth attendance rate.

Uzbekistan in this index is placed at 9th position (Germany - 10, Russia - 11, France - 12, UK – 14, USA - 15, Latvia – 41). Among the top ten countries with the best performance are seven European countries (Switzerland (1), Finland (2), Ireland (3), Norway (4), Belarus (5), Denmark (6), Sweden (7) as well as Cuba (8).

Full report of Save the Children is here:

http://www.savethechildren.org.uk/sites/default/files/docs/HealthWorkerIndexmain.pdf