The move toward market economies in the countries of the Former Soviet Union has had a negative impact on women’s health. Many countries have experimented with major health sector reforms, decentralizing and privatizing health care, increasing user fees and adding further economic barriers to access. Rural and indigenous populations face both paucity in health care infrastructure and ethnic discrimination.
The high incidence of trafficking and the increasing prevalence of HIV/AIDS among injecting drug users (IDUs), commercial sex workers, and labour migrants further threaten women's health and rights and create new challenges for bringing health services to vulnerable populations. The low level of modern contraceptive use is a legacy from Communist times when abortion was seen as the method of family planning. Abortion still is legal today, in most ex-Soviet countries, but not always safe – and modern hormonal contraceptives are met with a high level of suspicion.
In 2008, IPPF successfully applied to conduct a five-year initiative entitled “Joining Forces for Voice and Accountability” funded by the UKaid Governance and Transparency Fund. The project has been implemented simultaneously in two regions of IPPF: the Western Hemisphere region with Member Associations in Latin America and the European Network with its Member Associations from: Albania, Bosnia & Herzegovina, Kazakhstan, Kyrgyzstan, Moldova and Tajikistan. The project aimed to strengthen Civil Society Organizations as key players in democracy building and to develop strategic collaboration between Governments and Civil Society to meet national commitments to universal access to reproductive health and gender equality.
Albania: ACPD successfully advocated the Ministry of Health and got approval for the first and only policy on Sexuality Education Models for young people in the country (8 June 2012). This policy has been disseminated among key national and local decision makers to guide action in the field. Benefitting more than 500,000 young people (aged 10-19), the policy will inform programmes on sexuality education for youth. Plans to implement the models at the local level have started in four districts and as a result of the work, the youth strategy, developed by the regional authorities of Elbasan (the second biggest area after Tirana), now includes young people’s sexual and reproductive health and rights and sexuality education (approved on 28 March 2013).
Bosnia & Herzegovina: In 2010, the Association XY successfully advocated for a national sexual and reproductive health and rights strategy in the Federation of Bosnia & Herzegovina and it was adopted on 21 September 2010. At the same time XY advocated for a similar document to be adopted in the Republica Srpska and this happened on 16 August 2012. The total number of beneficiaries in both parts of the country is more than 4 million.
Kazakhstan: The Roadmap for Strengthening Reproductive Health of Kazakhstan’s Citizens for 2011-2015 was adopted by the Ministry of Health as a result of the long-term advocacy efforts of the Member Association KMPA. . When on December 25, 2012 the Ministry of Health signed Decree No. 1113, the execution of the Roadmap became possible throughout the country’s regional health departments. The Roadmap is an implementing document for the National Programme for Healthcare System “Salamatty Kazakhstan 2011-2015” which contains a step-by-step Plan of Action to provide sexual and reproductive health care for all citizens. All of this was developed with the technical support of KMPA. A National/Republic budget is allocated, as well as budgets at local authority level, to implement the Roadmap. As a result, by 2015, potentially more than 4.5 million women (30% of the population)of reproductive age will improve their sexual and reproductive health by 2015.
Kyrgyzstan: through direct advocacy with key decision makers, RHAK in Kyrgyzstan worked with the Ministry of Health to develop and approve the Plan of Implementation of the National Reproductive Health Strategy in which adolescents’ reproductive health, including youth friendly services and sexual education, is a priority. The Plan is a practical document that identifies the responsibilities and roles of Ministries and civil society organisations. It includes inter-agency and inter-sectoral cooperation, and has a budget allocated. According to the Plan, the public health care system could establish, develop and maintain youth friendly services. As a result, 1,684,500 young people (approximately 31% of the population) will benefit from improved access to information, education and services.
Moldova: Long term advocacy by SPFM in Moldova led to the formation of the National Coordinating Council on the National Strategy on Reproductive Health (NRHSApproved by the Ministry of Health on 29 April 2010, the NRHS is a monitoring and evaluation body. Its goal is to improve the reproductive health of the population. The NRHS is interested in sexual and reproductive rights encouraging Moldova's citizens to healthy sexual development and safe, risk-free sexual behaviour. Its plans will affect the whole population of Moldova (3.5 million people) – particularly the 620, 000 young people. The NRHS also addresses a plan for the desired number of children under safe and healthy conditions without SRH related illnesses and, in the event of SRH dysfunctions, accessing quality services. It is also concerned with suffering from violence and other SRH related abuse.
Tajikistan: a legal framework for safe abortion was adopted on 19 March 2011 following the long-term advocacy of TFPA. This framework includes new national standards for safe abortion and post abortion care, as well as tools for monitoring and evaluation plus a training module which was included in the curriculum of the Obstetrics and Gynaecology Department of the Tajik Institute of postgraduate training for medical professionals – 246 hours will be covered by government funding). This is new methodology, which includes medical abortion. It allows all Tajikistan’s 1,839,135 women of reproductive age access to safe abortion.