Thursday, November 13, 2014

In Armenia, Abortion Rates are High and Access to Contraception is Limited

By OBOS | February 6, 2013

Taleen K. Moughamian, a women’s health nurse practitioner in Philadelphia, traveled to Armenia in the fall of 2012. Working with the Children of Armenia Fund, she conducted health exams, including breast and cervical cancer screenings, and provided contraceptive counseling. The following account is based on her work and conversations with Armenian women.

by Taleen K. Moughamian

The differences between Armenia’s capital, Yerevan, and the rest of the country are vast. While Yerevan has most of the modern-day conveniences you could ask for, the villages I visited in the Armavir region have populations between 300 and 1,000, mostly comprised of women.

Their husbands have gone –- off to neighboring countries, especially Russia, to find work. They usually stay away for 10 months out of the year. Some men have even started new families in their work countries.

It was not uncommon to meet women who needed to be treated for sexually transmitted infections (STIs) because their husbands are having extra marital affairs while abroad. They are upfront about this, though it surprised me how openly they talked about it.

I heard so many of them say, “They are men. They have needs. What can we do?”

This has created a huge problem and is one of the reasons why STIs, including HIV, are on the rise in Armenia.

There is limited access to effective contraception, so the rate of abortion, which is legal up to 12 weeks, is high. Most of the women who seek an abortion are married, already have two or three children, and do not feel they can provide for a larger family.

Sex-Selective Abortions

For some women, this means having three or four or even 15 abortions over the course of their lives as they struggle to create a family they can support. The median number of abortions for women over 40 is eight, according to a 1995 study conducted at a Yerevan abortion clinic.

Sex-selection has also become a huge issue. Since women leave their homes and join their husband’s family after marriage, a son provides a source of security for his parents. I met so many women who have had multiple abortions because the sex of the child was not what they had wished; for more data, see this UNFPA report on sex selection in Armenia and this story in The Armenian Weekly.

If you look at recent family planning data, it appears the number of abortions is going down, but from what I observed, that is not necessarily the case. Rather, more abortions are going unreported.

Rise in Unsupervised Abortions

Women are using an over-the-counter medication called Cytotec (the brand name for misoprostol) to induce abortions at home without the supervision of a trained medical professional. Cytotec’s indication is to treat ulcers, but it also acts as an abortifacient. Fifty cents worth of Cytotec can induce an abortion, whereas a surgical abortion usually costs about $35-$50.

When used properly, Cytotec is very safe, even without clinical supervision. But it is most effective when used in combination with a second drug, mifepristone (see more on this below).

Women in the villages I visited were not familiar with the World Health Organization guidelines now used by women all over the world. (Note: Women on Waves offers guidance, based on the WHO research, on how to do an abortion with pills.)

Many Armenian women are therefore in a dangerous situation, as they are using Cytotec without the relevant information about its efficacy or side effects, which can range from an incomplete abortion to bleeding to death.

In Russian we call an evidence like this: one of grandmas said

Statistical analysis of abortions in Georgia between 2000 and 2013

by Alexander Chavchidze, Gulnara Shelia Tsereteli State University, Kutaisi, Georgia -
Objective : To show the number and the structure of women who had decided to interrupt the unwanted pregnancy in Georgia during the period 2000 to 2013.
Method : Results are based on statistical analysis of National Centre for Diseases Control and Public Health (NCDC) .
Results : Despite decreases in the rate of abortions at the present time, Georgia continues to have one of the highest recorded rates of induced abortion in the region (3.7 abortions per woman in 2000 , 3.1- in 2005 and 1.6 - in 2012). Most abortions (86 – 87.1 %) were performed in the legally sanctioned gestation range of up to 10 weeks. The average age of women was 30 years (range 14 – 45 years). Induced abortion was most commonly performed in women ranging from 25 – 34 years old 52.3 % (2000) and 56.4 % (2012). Closely followed by women ranging from age 35 – 39 (25.3 % and 26.5 % accordingly - in 2000 and 2012). Women under 20 were represented with 4.1 % (2000) and 4.2% (2012). 62.7% (2000) and 41.4 % (2012) of the women had undergone their first abortion, for 26.7 % (2000) and 33.5% (2012) it was the second. The abortions were performed : in hospital (55.8%) , in a clinic (42.2 %) and outside of a health care institution (1.9 %).
Conclusions: The falling number of abortions in Georgia (in spite of the still large number) reflects the more adequate family planning and usage of contemporary contraceptive methods. In Georgia family planning has not achieved its goal yet and induced abortion is still the most common method of fertility regulation. This underlines the need for fully implementing the organizational measures aimed at improving these indices.