CONTRACEPTIVE SECURITYCONTRACEPTIVE SECURITY Issues for Central Asian RepublicsIssues for Central Asian Republics

USAID SOTA Course October, 2002 Washington DC

Mary Skarie, USAID/CAR

U.S. Agency for International Development U.S. Agency for International Development Central Asia Regional MissionCentral Asia Regional Mission

Population *Life expectancy *Per capita income *Religion

Kazakhstan - 14,9 mln. 57.8 - male $1,421 47%Muslim

68.9 - female

Kyrgyzstan - 4,7 mln. 59.2 - male $322 75%Muslim

67.9 - female

Tajikistan - 6,5 mln. 61.0 - male $286 80%Muslim 67.4 - female

Turkmenistan - 4,6 mln. 57.4 - male $652 89%Muslim

64.7 - female

Uzbekistan - 25 mln. 60.2 - male $488 88%Muslim

67.5 - female

2.89

2.05

3.37 3.34

0

1

2

3

4

5To

tal F

ertil

ity R

ates

TU-2000 KZ-1999 KY-1997 UZ-1996

DEMOGRAPHIC DATA - RECENT DHSDEMOGRAPHIC DATA - RECENT DHS FERTILITY

61.866.1

59.555.6

0

20

40

60

80

Con

trac

eptiv

e pr

eval

ence

rate

TU-2000 KZ-1999 KY-1997 UZ-1996

DEMOGRAPHIC DATA - RECENT DHSDEMOGRAPHIC DATA - RECENT DHS CONTRACEPTIVE USE

Use of Contraception by Currently Married Use of Contraception by Currently Married Women in Turkmenistan (DHS/2000)Women in Turkmenistan (DHS/2000)

Pills1%

IUD39%

Other modern methods

5%

Lactational amenorrhea

8%

Traditional methods

9%

Don't use38%

10.18.7

11.6

13.7

0

3

6

9

12

15

18

Per

cent

cur

rent

ly m

arrie

d w

omen

with

an

unm

et d

eman

d fo

r fam

ily p

lann

ing

TU-2000 KZ-1999 KY-1997 UZ-1996

DEMOGRAPHIC DATA - RECENT DHSDEMOGRAPHIC DATA - RECENT DHS CONTRACEPTION: UNMET NEED

0.85

1.4

1.55

0.67

0

0.3

0.6

0.9

1.2

1.5

1.8

Tota

l abo

rtio

n ra

tes

TU-2000 KZ-1999 KY-1997 UZ-1996

DEMOGRAPHIC DATA - RECENT DHSDEMOGRAPHIC DATA - RECENT DHS ABORTION

Lifetime Abortion in KazakhstanLifetime Abortion in KazakhstanBackground % of women who had Among women who have had an Mean numberCharacteristic an induced abortion induced abortion, % who have had of abortions Specific numbers of abortions 1 2-3 4-5 6+ TotalAGE <20 1.6 84.2 15.8 0.0 0.0 100.0 1.220-24 15.5 54.6 41.8 3.5 0.0 100.0 1.625-34 43.2 46.5 39.9 9.9 3.6 100.0 2.135+ 62.7 29.3 44.1 16.3 10.3 100.0 3.0

No.of live births 0 4.9 60.3 37.8 1.9 0.0 100.0 1.51 44.7 43.9 40.4 10.9 4.8 100.0 2.42-3 61.4 31.8 43.9 14.7 9.6 100.0 2.94-5 47.9 37.2 41.1 16.9 4.9 100.0 2.56+ 32.3 41.6 41.2 10.8 6.4 100.0 2.3

Ethnicity Kazakh 27.1 44.9 42.8 8.9 3.4 100.0 2.1Russian 55.4 31.4 41.0 16.8 10.8 100.0 3.0Other 51.9 30.6 45.3 15.2 8.9 100.0 2.8

TOTAL 39.6 36.2 42.6 13.5 7.7 100.0 2.7

Reference: DHS/Kazakhstan, 1999

Contraceptive Supply in Uzbekistan (1993-2002Contraceptive Supply in Uzbekistan (1993-2002))

Contributions in US dollars

1993 1994 1995 1997 1998 2000 2001 2002 2003

UNFPA: 828,000 728,000 249,000 421,600 208,560 1,135,000 119,000

KfW: 2, 000,000

USAID: 200,000 105,000

Government: 3, 000,000

TOTAL: 828,000 728,000 3,200.000 249,000 421,600 208,560 1,240,000 121,002

0

2000000

4000000

6000000

8000000

10000000

12000000

14000000

16000000

18000000

Pieces/Cycles/Vials

1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

Years

Contributions in quantities of contraceptives contributed versus national need

QuantitiesNeeded

QuantitiesSupplied

Main Donors of Contraceptives

UNFPAKfWUSAIDGovernment

UNFPA-40,7%Government-18,6%

USAID-1,7%

KfW-39%UNFPA: 1993 - 2002KfW: 2003USAID: 1995, 2001Government: 1995

Reproductive HealthReproductive HealthSalient Issues:Salient Issues:

• High reliance on abortion (legal)

• Very limited range of contraceptives; heavy reliance on IUDs

• Severe constraints on government spending and non-convertible currencies

• Tepid donor commitment

• Dysfunctional/failing systems, including logistics

USAID ResponseUSAID Response

• Limited contraceptive donations to pilot areas in Uzbekistan

• Launch of Social Marketing Program

• New regional program on MCH/RH

•Planned contraceptive donations in selected areas

USAID ResponseUSAID Response

Policy dialogue with MOHs - partially successful collaboration with other donors: • DfID condom donation to Kyrgyzstan• KfW donations in Uzbekistan• Uzbek tender to procure 10% of national need