The reproductive health of women - where are we and what are the costs for it?
On March 30, 2005 Gender Education, Research and Technologies foundation (GERT) held a round table discussion on the issue of the costs of women’s reproductive health in Bulgaria.
Jivka Marinova, GERT executive director welcomed the participants - representatives of NGOs and State institutions working in the field of reproductive health and explained that the meeting was part of a larger international campaign in CEE of the ASTRA network for sexual and reproductive health and rights of women. The presence only of women in the room was due to the fact that most of the positions in this sphere were held by women, but the feminization of any professional field was an alrming sign, noted Mrs. Marinova.
Bulgaria has been classified in the category of country with reduced risks for the reproductive health, together with some other countries from the region, but in its group it is the country with the lowest birth rate. According to the organizers of the round table the discussion should stress on the social interpretation of the data and on the question, how market oriented should be the health economy.
After the short presentation of the participants doctor Tzveta Timcheva, expert in the Ministry of Health presented the trends of the reproductive behavior of Bulgarian women during the last decade. She gave the definition of the reproductive health and pointed out that it depends on different factors, including social, psychological and bioligical, and the state policy, which should ensure the right to education, gender equality and women’s rights, as well as the access to health and family planning services. Bulgaria has not only low birth rate, but relatively high child mortality, aging population and relatively low maternal mortality, but in the same time increasing morbidity and increasing number of cases of cervical, uterus and breast cancer. The high rate of teenage births and abortions is alarming as well as the decreasing age of first sexual intercourse, when the sexually active behavior goes ahead of the intellectual development of adolescents.
Marta Diavolova from UNFPA spoke about the role of the sexual health education for cultivating the culture of reproductive health. She stressed on the health prevention and promotion and noted that the number of organizations providing such services is insufficient.
Mrs Diavolova underlined the important interdependence between the health and education. In the country still there are bigger groups of population, which are undereducated or totally illiterate. 28% of Roma population was illiterate and additional 23% have attended only the initial school. This is a prerequisite for their low health status and the lack of sexual culture and fertility control. The State should ensure such education, which not only gives information but also aims at changing the negative attitudes and perceptions. The strategy for change should be the motivation of people to change the risky behavior with unrisky one.
The health programs should be compatible with the age of adolescents and with the dominating perceptions and values of the community. The main directions of the change in health education should be:
demedicalization of the interventions
rethinking the influence on the health of some factors
understanding the need of holistic health policy
And why the reproductive health education should be provided in schools:
because most of adolescents attend school
because it is possible to implement complex programs for health education
the health education is most effective as a prevention measure (often we talk about reproductive health after the adolescents became sexually active and started their sexual life)
The media also are playing substantial role in shaping the models of behavior.
Marta Diavolova ended her presentation with the questions:
What is the price of the health promotion?
What is the price of health?
Doctor Emilia Tasheva from the Ministry of Health answered with the comment that whatever the Ministry does the health status of the population is getting worse. The Ministry could not cope alone with this issue. The health is merely a question of self awareness and prophylaxis.
In the discussion the State representatives remarked that NGOs never acknowledge the achievements of the Ministry.
During the debate Pavlina Filipova from the Women’s Alliance for Development (WAD) stated that the good thing in this meeting was the starting of a dialogue, but additionally the participants should try more constructive approaches. The expectation was to discuss examples of joint approaches of the State institutions and civil society. She noted as well that there is a need of gender disaggregated information, because women are 1,5 times seeker than men are and this is the result of their additional overload. It is necessary to think about special prophylaxis for women as well as to raise the awareness on gender inequalities in the society.
The discussion calmed down with the statement of Christina Haralanova from the Internet Rights Bulgaria Foundation (IRBF). She noted that young people in the country feel already the advancements, but they still need the experience of the previous decades of women’s activists gathered in the room.
Doctor Radosveta Stamenkova and Dessislava Georgieva from the Bulgarian Family Planning Association (BFPA)presented the services of their organization for young people in the field of sexual and reproductive health. In working with young people from disadvantaged and marginalized groups the Association was led by the principle that the building of selfesteem is an integral part of the health services. During the year 2004 BFPA provided services to 19 800 persons, out of them 65% under 25 years old and more than 80% - women.
Julia Panayotova from the Women’s Initiative for Health Foundation presented the results of a research of the scientific centre "Psychology and health in Bulgaria" under the title "Oncological screening of the cervicus in Bulgaria and Romania: psychosocial aspacts and status of the health system".
According to the study the mortality rate of cervical cancer is 0.64 per 100 000 women, but in both states this ratio is being incresing when it could be prevented with an easy prophylaxis.
Magdanela Delinesheva from the Center for Women’s Studies and Policies presented more information on the study of the status of reproductive tract cancer of women in Bulgaria.
The meeting of so many professionals with diverse experience in the field of reproductive health and rights made possible the interesting exchange of good practices and views and ended with the conclusion that people working in a specific field should meet more frequently and cooperate for better efficiency of the campaigns.