Turkmenistan Women Health Information

Turkmenistan Women Health Information

Reported, January 10, 2012

Turkmenistan has seen the resurgence of traditional gender stereotypes since gaining independence in 1991.The economic and social upheaval that followed the breakup of the Soviet Union forced people in Turkmenistan and elsewhere to restructure social and familial roles. For example, whereas many parents encouraged their daughters to pursue higher education degrees and professional opportunities during the Soviet period, when education was free, most parents in Turkmenistan today cannot afford to pay the bribes required for admission to universities. The country’s poor economic conditions force parents to make difficult choices about whom to send to school, and they generally give preference to sons over daughters.

Reproductive health education is essentially lacking in primary and secondary schools and is addressed only ad hoc if at all. Little health material is available in the Turkmen language. For girls, the lack of general and reproductive health education has resulted in a low level of knowledge of basic health information and the perpetuation of myths about women’s health. Many girls and young women know little about women’s health. Information about contraception and sexually transmitted diseases is not taught in school, and access to information for young women about these subjects elsewhere is limited. As a result, young women are ill-prepared to make informed decisions regarding their personal health or family life.

Official health data and statistics are often either nonexistent or unreliable. However, outside sources, including NGO publications and news articles, report clear signs of a health crisis in Turkmenistan.Compared regionally, data show that women’s health in Turkmenistan, and particularly that of rural women, is considered to be the worst of all the former Soviet Republic.

While the health system has been in decline since the mid-1990s, progress has been made in some areas, including greater access to a variety of contraceptive technologies. Health policies are based on ad hoc presidential decrees, which can gain or lose favor without warning. Thus, the key features of the Turkmen health system are instability and insecurity.

Autonomy in Health Care Decision Making

Many women in Turkmenistan lack the fundamental right to make their own health care decisions. Demographic Health Survey (DHS) data from 2000 note that fewer than half of married women (40%) decide issues of health care on their own. Among the remainder of married women, 41% of health care decisions are made jointly with their husbands, 3% are made jointly with another, 9% are made by their husband alone, and 7% are made by someone else alone. The circumstances of unmarried women illustrate even less autonomy in health care decision making: only 32% make their own decisions, 21% make decisions jointly with others, and for 47% of unmarried women, health care decisions are made entirely by another.

Contraception

The United Nations Population Fund (UNFPA), in coordination with the Turkmen government and the World Health Organization (WHO), has made progress in both increasing access to contraceptives and providing a wider variety of contraceptive options. The UNFPA provides contraceptives to recently established reproductive health centers and trains medical personnel.Although laudable progress has been made, technical and logistical concerns have been raised.

Although the IUD (intrauterine device) is the most common form of contraception and is used by 20% of women of reproductive age,midwives and family physicians are not trained in IUD insertion. Such training was also not a considered priority of the Ministry of Health.Access to IUDs in rural areas is further hindered by lack of access.IUDs must be inserted by a specialist, who visits rural areas only once every two weeks, which may not coincide with the point of a woman’s cycle at which it must be inserted. The alternative is for women to travel to a hospital for insertion, which may not be possible due to women’s responsibilities in the home and availability of transport.

The alternative of hospital-based IUD insertion may no longer be available as President Niyazov in February 2005 ordered the closure of all hospitals outside of the capital.Niyazov declared the policy to be a way to assure quality care due to a shortage of good doctors. Although it is unclear whether and how this presidential order will be executed, its implementation would further limit access of the millions of women in Turkmenistan to reproductive health and curative care.

Although the UNFPA program has increased women’s access to contraception, overall knowledge of reproductive health remains low in the population, especially among young people in certain parts of the country.

Contraception is generally framed as a woman’s issue. Focus on female-centered fertility technology absolves men from responsibility and forces women to bear any possible costs and all physical consequences of all contraceptive options. Condoms, the only fertility technology designed for men, are reportedly only available through commercial stores and not from free health clinics. Additionally, the effectiveness of the condoms for sale is questionable since some were found to have been kept in direct sunlight or were past their expiration date. More attention must to be given to the role of men in contraceptive use and family planning.

Pregnancy and Birth

The government asserts in its report that improvement and preservation of motherhood and childhood have a central place in the state health program. To this end, the report notes that state-of-the-art Centers for Reproductive Health have been opened throughout the country, including remote areas. The report states several times that these Centers are stocked with “the latest medical equipment” and “expensive modern equipment … to provide effective treatment of premature babies,” and even include laparoscopes.Yet a recent news report now documents women’s fear of giving birth in hospitals because of the unsanitary conditions in buildings that have not had major repairs since their construction during the Soviet era. Infants born in state maternity hospitals also frequently become infected by meningitis, hepatitis B and C, and salmonella. Doctors and nurses are forced to purchase supplies like gloves, gauze, and disinfectant at their own expense. Some women are choosing to give birth at home due to a lack of specialized physicians.

Obstetricians/Gynecologists

The enactment of the State Health Program of the President in July 1995 created a shift from specialized and hospital-based medicine to prevention and primary care practices instituted by generalist family physicians.A UNFPA report published in 2000 notes resistance to this shift among specialized obstetrician/gynecologists in Turkmenistan. According to the report, these specialists, as well as the family doctors, are concerned about the policy because family physicians are not trained in gynecological examination and in general lack experience in this field. The report notes that most family doctors were pediatricians and therapists with “little knowledge even of the physiology of the menstrual cycle.” There is specific concern about rural family doctors who have had limited exposure to additional training since their graduation from medical school.

The recommendation of a WHO advisor on reproductive health includes additional reproductive health training for Ob/Gyn specialists, family doctors, and midwives. However, he notes several barriers to providing the necessary training, including the elaborate and time-consuming process to obtain the Ministerial approval for training courses. Additionally, Ministry officials fear staffing shortages when professionals attend trainings, although the 1995 decision to cut thousands of medical worker jobs (see below) is based on the claim that too many doctors and other medical workers were burdening the health care system.

HIV

Only two official cases of HIV exist in Turkmenistan, and the government denies there have been any additional infections in recent years. Although UNAIDS continues to estimate the number of HIV cases to be low (below 200 people),HIV incidence is rising faster in Eastern Europe and Central Asia than in most other regions of the world. An anonymous Ministry of Health source contradicted official numbers and stated that there were more than 300 confirmed cases of HIV in Ashgabat alone, with the actual number of cases potentially being much higher.Unemployment, intravenous drug use, and reported increases in sex work all raise the risk of a major HIV epidemic within Turkmenistan’s borders. Poverty and the largely unguarded border with Afghanistan, a major source of heroine, contribute to the growing population of intravenous drug users. One official estimated about 64,000 intravenous drug users in the country. Also driven by harsh economic conditions, there are reports that sex work is increasing among women and that it is leaving a “sexual health crisis” in its wake.

Women are at risk for HIV through sex work and intravenous drug use, but also as wives and partners of men who use sex workers or use injected drugs. Another factor that increases women’s risk is their lack of knowledge of HIV/AIDS. Although 73% of women of reproductive age had heard of HIV, only half believed they could cut risk through behavior change. Additionally, only 31% of women knew that condoms can also reduce risk of infection.A WHO advisor noted the need for HIV prevention and education services.

Sexually transmitted diseases (STDs) are a known risk factor for and facilitator of HIV.Since Turkmenistan’s independence, STDs have increased at an alarming rate. These various risk factors combined threaten a major HIV epidemic in Turkmenistan.

Other Infectious Diseases

The Turkmenistan Helsinki Foundation has reported that the Ministry of Health and Medical Industry placed an unofficial ban on diagnosing certain infectious diseases in 2004. Secret instructions were issued to prevent the mention of such widely prevalent diseases as tuberculosis, measles, dysentery, cholera, and hepatitis.Such a ban would serve to further endanger health as the most recent mortality statistics reported to WHO in 1998 list infectious disease to be one of the major causes of death in Turkmenistan.If the report of the ban is true, obtaining care for sick patients would be close to impossible. As family caregivers, women would likely take on the additional responsibility of caring for the “undiagnosed” sick and at the same time face an elevated risk of infection.

According to 2003 World Health Organization figures, the life expectancy for women in Turkmenistan was the lowest in the WHO-defined European region at 65 years.The life expectancy of women living in rural areas was reported to be 10 years lower than that of their counterparts in Ashgabat. This difference has been interpreted as being due in part to lower survival rate of female infants in rural areas

Rural women’s access to health care is more limited than in urban areas. Although most collective farms have at least one small health clinic, the clinics do not have emergency equipment, modern technology, or sufficient quantities of medicine. Essential supplies, such as syringes, antiseptics, first aid equipment and proper vaccine storage containers, are often absent from rural health clinics. Many clinics do not even have running water or toilets. Distances to better-equipped health care facilities are sometimes great, and rural women are may not be able to afford the cost of transportation to regional health centers, medical care, or a stay in a hospital or diagnostic center. In some areas, hospitalized patients’ families have to buy supplies such as syringes and some medicines to bring to the hospital for use. These may be harder to find in rural areas.

When a woman does see a doctor in a rural clinic, she may have to travel to a nearby city to fill a prescription. Rural families sometimes do not allow women to travel alone, even to seek medical assistance, which can prevent women from seeking treatment in a timely fashion. When rural women do travel to areas with improved health facilities, it is often too late for obtaining good treatment results.
Women in rural areas have limited access to information about reproductive health, and they have fewer options for contraception. Because reproductive health centers may be inaccessible for rural women, some give birth at home without the assistance of trained medical personnel. In rural areas, the rate of infant mortality was 79.9 per 1000 live births for 1990–2000, compared to 60.1 per 1000 live births in urban areas

Credits:IWRAW Director Marsha A. Freeman with the assistance of Cram-Dalton Scholar Natalie Hoover.The International Women’s Rights Action Watch (IWRAW)

More Information at:
http://www1.umn.edu/humanrts/iwraw/publications/
countries/turkmenistan.htm