ARE YOUR FAMILY PLANNING NEEDS ADDRESSED?

The government of Turkmenistan and UNFPA conduct an investment case study on unmet need for family planning.

The Government of Turkmenistan together with UNFPA conducted an investment case to determine the cost of ending an unmet need for family planning by 2030. The study was made public by UNFPA on July 9, 2021.

The unmet need for family planning is defined as the percentage of women of reproductive age, who are sexually active and not using any method of contraception (for a certain reason: economic, health, family, religion, lack of knowledge), but who want to stop or delay childbearing.

Saglyk welcomes the study of the unmet need for family planning that impacts the quality of life of at least 50% of the population which are women in Turkmenistan. We believe that it creates positive language around the issues and draws attention of the public and policymakers to the structural problems in sexual and reproductive public health services in Turkmenistan.

Takeaways:

↪ The goal of the study: to estimate the best possible scenarios for free-of-charge modern contraceptive methods in Turkmenistan to women in need, in order to reduce the unmet need for family planning from 9.7% in 2020 to 3,5% in 2030.

↪ The best-case scenario: The research studies three scenarios and a status quo scenario. Scenario 3 is the most favorable in coverage, method choice and financial terms. It will provide free contraceptives and services for a target group four times larger than the number of women currently included in the program, as well as provide access to a wider choice of contraceptives and create the highest financial gain. Saglyk is hopeful that the government will opt for Scenario 3 for its most advantageous coverage for the public.

↪ Open and accessible data: Although the case study provides quite a significant amount of country specific data with some of it being disclosed for the first time, the references mentioned are not in the public domain. This raises the question of credibility of the case study, as the basis for the assumptions can neither be verified, checked, nor studied.

↪ Men’s absence in decision-making: Because the study is about "family planning" we recommend that UNFPA includes men, their needs and role in the future methodology, planning and implementation of a chosen scenario.

↪ Public communication: The case study does not provide information on the target audience of the study beside the government of Turkmenistan, therefore we suggest UNFPA to elaborate on who potential audience is for the study and disseminate information from the case study to target audiences including the public. At this moment, the research is shared on the UNFPA website only in English and by one post on the UNFPA Instagram in Turkmen. No further public communication has been undertaken.

↪ Needs of the population: Public health literacy is low in the country, resulting in the absence of understanding and having basic knowledge of family planning and contraceptives among the population. Saglyk urges UNFPA to communicate and explain the complex and urgent issues at hand related to family planning in the country to the public in Turkmen and Russian. At the moment Saglyk.org is the only place where a Turkmen speaker can access credible information on contraception and family planning. We receive a lot of questions from the public and see a great need for information and family planning services among the young people in the Turkmen language.

↪ Need for collaboration mindset: We see a huge potential in cooperation among the government of Turkmenistan, UN organizations and civil society working together towards health literacy and ending the unmet need for family planning. No one organization or project can sustainably and efficiently address these complex problems. We recommend UNFPA to include Saglyk and other groups that work on health literacy into the consultations on family planning, sexual and reproductive health in Turkmenistan.

The scenarios scrutinized in the case study:

1. Status quo scenario – keeping the current family planning policy unchanged

2. Scenario 1 – expanding coverage of women involved in the status quo scenario

3. Scenario 2 – expanding contraceptive method choice and free-of-charge family planning services

4. Scenario 3 – a combination of scenario 1 and 2: expanding coverage, method choice and free services

Following is a breakdown of each scenario and their benefits:

Why is the case study necessary?

The case study draws attention to the taboo topic of contraception in Turkmenistan. The authors of the report do not make it clear why the government with pronatalist policies would be interested in providing contraception and improved family planning. Yet, the main focus in the study is the long-term gain to the national budget from the structural family planning and contraception programs and consequential health benefits of such an investment.

Saglyk believes the scenarios provided on family planning investment are of high importance:

↪ to minimize

the adversities of unmet need for family planning and its health complications (such as abortions, including illegal and unsafe abortions, cesarean sections, prematurely born unplanned children), and

financial losses that come along the health adversities;

↪ to provide improved family planning systems, and ability to choose and time childbearing;

↪ to increase

social and economic benefits for women and couples,

opportunities to complete education and participate fully in the workforce, and

productivity in the workplace, that otherwise would be lacking.

What is missing?

Open and Accessible Data:

As mentioned earlier, the case study provides quite a significant amount of country related data with some of it being disclosed for the first time. However, the references mentioned are not publicly accessible (e.g. data on abortions, cesarean sections, prematurely born unplanned children). It is important to underline that to improve support for maternal and child health and to decrease the unmet need for family planning, quality data, reproductive research, and their accessibility are crucial for the healthcare system in Turkmenistan.

Illegal Abortion Estimation:

Illegal and unsafe abortions go underreported. Given this and that the law "On protection of health of citizens" issued on 2015, decreased the gestational time for abortions from 12 weeks to five weeks (Article 19), the number of illegal abortion indicated in the case study seem to be inaccurate and raise questions on sources of data and estimation.

The Ministry of Health’s Distribution Plan:

The case study provides a projection to 2030 for services and access to services (contraceptives) in Primary Health care units (PHC units), Reproductive health consultation rooms (RH Rooms), Hospitals, and HIV centers. Data for 2021 demonstrate contraceptives accessible today.

Table: Estimated projection of the contraceptive mix, UNFPA 2021

The case study mentions 95 reproductive health consultation rooms, where contraceptive methods are offered to the public that provide family planning services throughout Turkmenistan. However, no information on the location of these rooms and services are available publicly neither on the UNFPA website nor on the Ministry of Health website.

Saglyk believes that the public would benefit from knowing where these services are provided and how useful and accessible these services are.

Going forward

Men’s Absence in Decision Making:

It is true that traditionally the burden of family planning (in choosing contraception, prenatal care, pregnancy) lies on women in Turkmenistan. Men are not responsible for contraception and their knowledge of contraception choices is low in the country. Yet, considering the changing cultural, socio-economic realities in the Turkmen society, we believe, men would benefit from being involved in the process as equal partners in family planning and share responsibility for contraceptives. Saglyk believes that a family becomes a happy family because of the active and equal participation of both parents in planning and taking care of children. Men should be invited, addressed, seen, and integrated as active stakeholders in the program in the future.

Rural vs Urban Contraception Use:

Saglyk believes that the differences between rural and urban use of contraception needs to be studied and addressed. According to the MICS 2019 around 55% of women in the urban areas use contraception. For women in rural areas, this number drops to 46%. This gap can be explained by traditionalism and conservatism in rural life. Therefore, women and their partners in rural areas will need additional support and resources in understanding the importance of contraceptives and the issue of the unmet need for family planning.

Turkmen version