Women’s Health Problems in  Belarus

Women’s Health Problems in Belarus

 Reported, January 12, 2012

After adoption of the National Programme of Demographic Security for the period 2007-2010, there were numerous articles and appearances on radio and TV about the attention paid to health care of a mother and a child and health care of pregnant women in Belarus. The State attention to women’s reproductive health was mainly caused by the acuteness of demographic problem in the country. And indeed, one can speak about some successes in solving of problems of maternal and children’s mortality. According to data of the Ministry of Healthcare, Belarus took the lead over the CIS countries and a number of Eastern European countries by decline of maternal mortality level (5.8 cases per 100 000 born alive – 2007) and up to five-year-old children’s mortality (6.7 cases per 1000 newborns). At the same time, it does not mean stability of this indicator and absence of other problems in the sphere of women’s reproductive health.

However, data of a sociological survey and estimations of the expert community (specialists in medicine, NGOs activists) show that not only many health problems of women in Belarus were not solved, but even grew worse during the last period. According to results of the nation-wide independent survey conducted in June 2009, three fourth (75 per cent) of women aged 18 and older have health problems. This figure is significantly higher in the elderly age groups. Among causes of diseases, women-respondents make a special emphasis on problems with early diagnostics,inaccessibility of specific medical services at the place of living, low quality of services provided by state-owned healthcare system and high price of private medical services, unfavourable ecological environment, constant nervous exhaustion, and stresses. It is significant that low quality of medical
service and inaccessibility to a number of services are mentioned by all women’s groups irrespective
for their age and region of living.

In accordance with the Law of the Republic of Belarus “On Healthcare”, medical services should be provided to women by state-owned medical institutions free-of-charge. But due to the deficit in the market of medical services and desperate shortage of narrow profile specialists, women often have to be examined and treated for a fee at private clinics. At the present time, Belarusian healthcare system lacks the medical profession, including obstetrician-gynaecologists, children’s gynaecologists, mammologists, oncologist and other specialists. Rural areas are highly understaffed due to closure of many first-aid stations; great shortage of specialists is also noticed in areas that suffered from the Chernobyl explosion. All above-mentioned facts reduce the level of accessibility of the population to highly qualified medical assistance.

Constant negative changes of the Belarusian women’s health are mainly caused by radiation pollution of the environment, in spite of the fact that the government does not consider this problem as serious one. Independent expertise proved that there is an internal chronic radiation exposure of the population with small doses of radiation on the whole territory of Belarus. Thus, radioactive caesium was discovered in 100 per cent of tissues taken during the examination of scrapes of endometrium after abortion from women-patients of Grodno region that was recognized by the authorities as a region “clear from radiation”, and nearly 20 per cent of the analysis samples were highly radioactive.
However, statistical data concerning health condition of the population of the Republic of Belarus,including women’s population, often appears to be inaccessible for researchers and the public.The pathology of thyroid gland has dramatically increased in Belarus since Chernobyl catastrophe and remains until present at the extremely high level; though women suffer from this problem four times more often than men do. Nowadays, 23 years after the accident, the pathology of thyroid gland,including cancer, starts to be revealed in children whose parents were exposed to radiation in the early childhood (at that time they belonged to the youngest and the most vulnerable risk group). The pathology of thyroid gland directly influences on reproductive function of both men and women. Still, this is one of many problems connected with radiation. Experts of focus-groups (healthcare employees) mentioned growth of complications during pregnancy and labor, and inflammatory processes in women’s urogenital system. On the whole, percentage of healthy newborns has
significantly reduced over the last years in Belarus, and a number of malformations has increased.Particular hazardous for women’s health are malignant tumors of female genital organs and breast cancer. In the structure of common oncological disease incidence and mortality in Belarus, they made up 17 per cent in 2008. The number of breast cancer cases at the average increases annually in Belarus by 3500 people. Breast cancer in our country takes the first place in the structure of common disease incidence and mortality among malignant tumor in women in our country. According to data of the Oncology and Radiation Medicine Research Institution, the number of breast cancer cases has increased more than twice during the last ten years. Breast cancer is not only spreading more and more on women, but also is “becoming younger”. If previously average age of women suffering from breast cancer was 56-60 years old, now it is 42-46 years old. In the opinion of specialists, one can predict significant increase of breast cancer level of girls that were born in 1986 and received intrauterine irradiation and irradiation at a very young age.

According to data of the US Institute of Cancer, radiation was declared as the only external factor that influences occurrence of breast cancer. The Belarusian specialists of the Institution of Radiation Medicine (Gomel) also confirmed this pattern. They revealed unusually high rates of breast cancer growth in Gomel region and in areas contaminated after the explosion at Chernobyl Atomic Electro Station. However, the Ministry of Healthcare of the Republic of Belarus does not officially recognize connection between growth of oncological diseases and radiation.
According to data of the Ministry of Healthcare, more than a half cases of breast cancer are diagnosed at the second stage. There is high index of detection of neglected cases of metastatic cancer (22.5 per cent), at the same time five-year survival rate makes up less than 60 per cent: it means that the majority of patients die within less than five years of life. Such a situation makes breast cancer in Belarus a mortally dangerous disease with low survivability.
According to official data, early detection of oncological localizations in female reproductive system during preventive examinations in 2008 made up less then 20 per cent. It confirms low efficiency of preventive work aimed at oncology detection. The reason of this depends largely on absence of mammographic screening in our country. With the high incidence rate, main attention should be paid to early detection based on mammographic screening. Deficit of mammographs, especially in small towns and rural areas, is still greatly perceptible in Belarus. Total lack of mobile mammographs for the rural population actually means that there is no opportunity for women to be examined for both preventive and diagnostic purposes in time. According to independent experts, the Ministry of Healthcare has not yet adopted a single statutory act that would provide for development and introduction of mammographic screening of female population of the country.
Within the bounds of the sociological research, experts were of a low opinion of efficiency of both the government programme of overcoming the aftermath of the Chernobyl disaster and the programme in
the field of women’s reproductive health (prevention, diagnostics, and treatment).
Lack of specialists and equipment explains low quality of regular medical check-up of a “labor reserve” group, established by the Ministry of Healthcare among female population for the purpose of increase of natality and improvement of reproductive health. However, the mark-out of the “labor reserve” group does not lead to the significant improvement of reproductive health and reproductive rights. On the one hand, medical supervision of this group often appears to be of a formal character,laboratory examination on hormonal status are not adequately carried out, there are also problems of getting to subspecialty consultations. On the other hand, creation of the “labor reserve” group significantly abridges freedom of reproductive choice of women of fertile age. District doctors at polyclinics often refuse to make a referral for abortion to women of the “labor reserve” group.
Therefore, many young women have to go to private clinics for abortion, where this procedure is much
more expensive then if provided by governmental medical institutions.
Teenage pregnancy, artificial interruption of pregnancy, and teen childbearing are serious problems of
reproductive health of young women. According to official data, the number of abortions in the Republic of Belarus decreased practically in 2.3 times (89 000 cases in 2002, in 2007 – 38 000 cases). However, induced abortion is still widely used as a primary method of birth control. According to data of the Ministry of Healthcare of the Republic of Belarus, hormonal contraception is used only by 17.4 per cent of women. In compliance with the legislation, abortion can be conducted up to the twentysecond week of pregnancy; it can be either therapeutic abortion or abortion by social indications (low income, other children, housing problem, etc.), it ruins women’s health and harms the society, on the whole. Surgical and medicamentous contraception of men is not even discussed in Belarus. High abortion level is caused not only by change of moral standards of society, but also by lack of system of sexual education of the youth, poor popularization of healthy lifestyle and low quality of family planning services. As a rule, competent counselling on the matters of reproductive health and family planning can only be provided in large towns. As a result, quite a number of women give birth to their children within less than two-years of interval between pregnancies, which brings irreparable harm to their health. Introduction of screening programmes aimed at prevention and early detection of reproductive system diseases is often of a formal character, as there is lack of personnel and low accessibility to laboratory examination (laboratories that use polymerase chain reaction (PCR), hormonal, bacteriological laboratories and others).
According to data of the Ministry of Healthcare, reduction of the spread of sexually transmitted diseases was noted during the reporting period (in 2004 such diagnosis was made in 636 cases per 100 thousand people, in 2007 – in 541 cases per 100 thousand people). However, it should be mentioned that the population has access only to diagnostics of syphilis and gonorrhea.
Experts taking part in the research defined a problem of low awareness level on prevention and diagnostics of diseases, modern methods of contraception and family planning. The majority of women do not know about their right to qualified medical care and social security, it often leads to serious consequences. All participants of the research: specialists, experts, women-respondents, and women who had participated in discussions – emphasized the necessity of awareness-raising campaigns on women’s health problems through modern information technologies, including advertising campaigns, promo-actions, the Internet.

Credits:Ludmila Petina – co-chairwoman, Public Association “Women’s Independent Democratic Movement” (PA “WIDM”)
Elena Tonkachva – chairwoman, Enlightenment Institution “Centre of Legal Transformation”
Olga Smolyanko – director, Enlightenment Institution “Centre of Legal Transformation”
Tamara Serzhan – doctor, national coordinator, International Organization “Europa Donna”
Nadezha Efimova – leading sociologist, “NOVAK” Laboratory
Elena Eskova – national lawyer, “Belarusian Confederation of Democratic Trade Unions”

More Information:
http://www2.ohchr.org/english/bodies/cedaw/docs/
ngo/PAWIDM_Belarus48.pdf