Fertility management Fertility management options for women in options for women in

AzerbaijanAzerbaijan November 2006 November 2006 Boston, MABoston, MAAnnual APHA ConferenceAnnual APHA Conference

Nabat Mursagulova, M.D.Nabat Mursagulova, M.D.Monitoring & Evaluation AdvisorMonitoring & Evaluation AdvisorEngender Health/ACQUIRE Engender Health/ACQUIRE Project Azerbaijan Project Azerbaijan

Republic of Azerbaijan

CDC, Reproductive Health Survey: Azerbaijan, 2001.

Area Area 86,600 km286,600 km2Population Population 8.3 million8.3 million

Population growth rate 0.52% (2004 est.)Total fertility rate 1.8WRA 2.76 millionMarried women of RA 1.474 million (53% of WRA)Number of refugees and IDPs 1 million

Data source: Population Reference Bureau,

2004 World Population Data Sheet; CIA World

RUSSIA

IRAN

Caspian Sea

; UN/ESA World Contraceptive Use, 2003;

Azerbaijan: Current situationAzerbaijan: Current situation Part of former Soviet UnionPart of former Soviet Union

Oil boomOil boom – –Contract of the Century “Baku-Tbilisi-Ceyhan” (Signed in 1994):(Signed in 1994): Fast growing National EconomyFast growing National Economy Potential for increased investment inPotential for increased investment in health and social sectorshealth and social sectors

Conflict with ArmeniaConflict with Armenia (1989): (1989): 20% of Azerbaijani lands 20% of Azerbaijani lands

(Nagorny Karabakh and around) (Nagorny Karabakh and around) are under occupationare under occupation

1 million refugees 1 million refugees (80 % are IDPs)(80 % are IDPs)

BASELINE SURVEY, 2005 BASELINE SURVEY, 2005

WHERE? WHERE? 5 Central districts, total 5 Central districts, total population almost 426,600:population almost 426,600:Urban -28% (5 main district centers) Urban -28% (5 main district centers) Rural – 72% (257 villages)Rural – 72% (257 villages)

•HOW? HOW? Health Facility (79), Health Facility (79), Pharmacy (61)Pharmacy (61) and Community (1011) Surveysand Community (1011) Surveys

WHY?WHY? To identify barriers to FP service utilization and To identify barriers to FP service utilization and prepare for project implementationprepare for project implementation

Of funded by Of funded by

Reproductive Intentions Reproductive Intentions (married women)(married women)

• 70.2% know but never used •18.8% used but discontinued •2% never heard of FP methods

ACQUIRE/Azerbaijan Baseline Report, 2005

• Average family size is 2.18

9%

73%

Don’t want more children

Use modern FP methods

YET

Azerbaijan: Abortion Azerbaijan: Abortion Abortion is the primary method of fertility regulationAbortion is the primary method of fertility regulation Abortion rate: estimated 116/1000 women aged 15-44 (3.2 Abortion rate: estimated 116/1000 women aged 15-44 (3.2

per woman)per woman) Abortion to live-birth ratio: 3:1 Abortion to live-birth ratio: 3:1 Women achieve desired family size at young age, then Women achieve desired family size at young age, then

many use abortion to terminate unintended pregnanciesmany use abortion to terminate unintended pregnancies

CDC, Reproductive Health Survey: Azerbaijan, 2001.

Abortion Rate Reporting: Surveys vs. Official Statistics

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Independent Surveys

Offical Statistics

Abortion ExperiencesAbortion Experiences 52% of women had an abortion 52% of women had an abortion

(35% in last 2 years), of whom: (35% in last 2 years), of whom: 1-2 abortions - 48% 1-2 abortions - 48% 3-5 abortions – 32%3-5 abortions – 32%6-10 abortions -14%6-10 abortions -14%>10 abortions – 6%>10 abortions – 6%

Reasons: limiting, spacing, birth Reasons: limiting, spacing, birth defectsdefects

Most were using traditional or no Most were using traditional or no method at the timemethod at the time

82% of women were aware abortion 82% of women were aware abortion is harmful, but said they had no is harmful, but said they had no other choiceother choice

ACQUIRE/Azerbaijan Baseline Report, 2005

73%

6%11% 8%

limiting spacing birth defects can't afford

Current method useCurrent method use

ACQUIRE/Azerbaijan Baseline Report, 2005

37% of men and 33%of women reported using 37% of men and 33%of women reported using withdrawal and perceived it to be a reliable methodwithdrawal and perceived it to be a reliable method

43.3% of women reported practicing abortion as a 43.3% of women reported practicing abortion as a

method of family planningmethod of family planning

11% of 11% of marriedmarried respondents are currently using respondents are currently using modern FP methods (9% of women and 14% of men):modern FP methods (9% of women and 14% of men):

49%

36%

10% 5%

IUD

Condoms

Pills

Spermicides

Influencing factors: FP ServicesInfluencing factors: FP Services

ACQUIRE/Azerbaijan Baseline Report, 2005

Women are expected to seek FP services from Ob/Gyns Women are expected to seek FP services from Ob/Gyns Ob/Gyns:Ob/Gyns:

little motivation to provide FP services as abortions are their little motivation to provide FP services as abortions are their main source of incomemain source of incomelack correct knowledge about methodslack correct knowledge about methodshave negative attitudes to modern methodshave negative attitudes to modern methodssometimes openly discourage women from using methodssometimes openly discourage women from using methods

OB/gyns are mainly situated in district centre hospitals only OB/gyns are mainly situated in district centre hospitals only - lack of access in rural areas- lack of access in rural areas

Vertical health care systemVertical health care system

There is no governmental procurement of FP methodsThere is no governmental procurement of FP methods

Influencing factors: PharmaciesInfluencing factors: Pharmacies

Staff seriously lack knowledge about modern methods (only Staff seriously lack knowledge about modern methods (only 1/61 had received training in FP)1/61 had received training in FP)

Staff often have no education in pharmaceutical scienceStaff often have no education in pharmaceutical science Few pharmacies in rural areas - only 5 (out of all 61) are Few pharmacies in rural areas - only 5 (out of all 61) are

outside district centeroutside district center Little interest to promote contraceptives’ because no demandLittle interest to promote contraceptives’ because no demand Cost of abortion vs. oral contraceptivesCost of abortion vs. oral contraceptives

62% of Pharmacists said that they are asked about pregnancy 62% of Pharmacists said that they are asked about pregnancy termination by clientstermination by clients

- 82% reporting selling Oxytocin without any prescription82% reporting selling Oxytocin without any prescription

ACQUIRE/Azerbaijan Baseline Report, 2005

• Pharmacies are the only source of FP commodities in AzerbaijanPharmacies are the only source of FP commodities in Azerbaijan

Influencing factors: Influencing factors: Community knowledgeCommunity knowledge

Almost all (98% women; 89% of men) can name a way to prevent Almost all (98% women; 89% of men) can name a way to prevent pregnancy:pregnancy:

Most-mentioned method among women: IUD (79%), condoms (44%) Most-mentioned method among women: IUD (79%), condoms (44%) and OCs (41%). and OCs (41%). BUT!BUT! Very few know how to use these methods. Very few know how to use these methods.

Women also mentioned withdrawal (62%) and abortion (79%)Women also mentioned withdrawal (62%) and abortion (79%)

Some women (27%) and men (7%) also mentioned traditional Some women (27%) and men (7%) also mentioned traditional methods (e.g. herbal drinks)methods (e.g. herbal drinks)

• 64.5% of men and women have never used any modern FP method:64.5% of men and women have never used any modern FP method:• Don’t need FP methodDon’t need FP method• DON’T KNOWDON’T KNOW about methods and/or don’t trust them about methods and/or don’t trust them• Prefer natural methodsPrefer natural methods

ACQUIRE/Azerbaijan Baseline Report, 2005

ResponseResponseTo increase community demandTo increase community demand

•Peer education

•Mobilize key influential people

•Health festivals

Strengthen access and quality of services and productsStrengthen access and quality of services and products

•Upgrade counseling and technical skills of providers

•Involve and improve knowledge of pharmacists

•Social marketing of quality products

THANKS!THANKS!