Georgia: NGOs promote family planning awareness

Molly Corso 5/09/07

More than four decades after birth control pills were first approved for use in the United States, women in the South Caucasus country of Georgia are being taught how to use them.

Pills – and other birth-control methods – have long been available in Georgia, where premarital sex is still largely taboo, and, traditionally, women are expected to give birth during the first year of married life. Yet, according to a 2004 report on abortion and contraception in Georgia, less than 50 percent of Georgian women know how to use birth control pills, and only a slightly higher percent are familiar with other forms of contraception.

Six months ago, a USAID-sponsored program, called "Contraception – the Modern Choice," began airing public service announcements on the three major Georgian television stations. The short ads – featuring young, professional women working and studying – extolled the virtues of contraception as a woman's choice and an instrument to help her plan her own future.

The public service announcements started running in November of 2006. According to Dr. Kartlos Kankadze, deputy chief of party at the USAID-sponsored Healthy Women in Georgia Program (HWIGP), whose program helped develop the ads, the response has been huge: 300 phone calls a day during the peak of the campaign's first cycle.

Although the data from the first round of commercials has not been fully processed, in December of 2006 HWIGP surveyed the number of abortions and the level of birth control usage in two villages where family-planning programs had been operating for the past two years. According to Kankadze, the level of birth control use was up – but the birth rate was the same, which crushed one of the largest myths against birth control use in Georgia. "We saw a good deal of improvement. Contraception use went up, the abortion rate down," he said. "We wanted to show that it [contraceptives] does not affect the birthrate. [And] we showed this."

According to Nina Tsuleiskiri – the executive director of Hera XXI, an NGO that promotes reproductive rights and family planning – there are several widely prevalent misconceptions in Georgia that presently hamper the use of contraception. For example, when some internally displaced persons were first offered pills through one of Hera XXI's health programs, many women refused to take them for fear that it would make them fat. "[Part of the problem is] there still exists a mistrust toward birth control pills not only among the population but also among doctors," Tsuleiskiri said.

Currently many Georgian women are using abortion as their primary form of birth control. According to the Centers for Disease Control and Prevention, Georgia has one of the highest abortion rates in the world. A 2005 survey on reproductive health in Georgia showed that average Georgian woman has 3.1 abortions during her lifetime – a number, when considered collectively, amounts to roughly two-thirds of the total pregnancies in the country.

While the latest Georgian figure is slightly lower than what the original survey found in 1999, it is still one of the highest rates in the region: women in Russia average between two and three abortions in a lifetime, while the number goes up slightly in Azerbaijan to 3.2.

According to the CDC's original survey in 1999, nearly 90 percent of all Georgian women support a woman's right to choose. However, Tsuleiskiri noted that until recently many women were not aware of what choices they had. Most who have abortions in Georgia do not receive counseling either before or after the procedure to educate them on family planning options, Tsuleiskiri said.

"Our goal should be to reduce the number of abortions because our society should understand that abortion is the most dangerous procedure for a woman," she said. "Therefore, if we provide good information ... if doctors give good information and women believe him, then I believe we can reduce the number of abortions by half."

The Georgian Ministry of Labor, Health, and Social Affairs is also aware of the issue, according to Vera Baziani, the reproductive health advisor at the ministry. During a telephone interview with EurasiaNet, she acknowledged that abortion is a "serious problem," but it is not an urgent issue for the ministry, which is more concerned right now with decreasing the death rates of both mothers and infants. Baziani added that the ministry "does not have a set strategy" to deal with issues of contraception or abortion, but it does support the non-government programs that exist.

Kankadze suggests that economic pressures are contributing to the high number of abortions. "I don't want to say anything about my colleagues, but abortion is a business," Kankadze said. "Why should they [doctors] promote contraception when they making money on abortion?"

Deeply ingrained cultural attitudes also exert considerable influence over choices. "[W]e still have the problem of selective abortion, which is directly linked to macho culture in this society," said Nina Tsihistavi, co-founder of the Caucasus Women's Research & Consulting Network. "Many men in society are not allowing partners to use medicine."

Despite Georgia's reputation as a traditional, male driven culture largely influenced by the orthodox faith, both Kankadze and Tsuleiskiri said women and men have been very receptive to the trainings and education programs. According to Kankadze, in the villages women are bringing their husbands with them to family planning classes and making them pick up their birth control pill prescriptions. "I thought that there would be some backlash but [there is] nothing special," he said. "So this culture of contraceptives has started to my surprise; I would not expect that people would be open to this."

Tsuleiskiri noted that attitudes still can vary significantly. Women in Tbilisi and other urban areas are "more independent," Tsuleiskiri asserted. "Change is not as noticeable in rural areas, where women are more dependent on traditions, on their family, on the opinion of their mother-in-law," she added.

Editor's Note: Molly Corso is a freelance reporter and photojournalist based in Tbilisi.

Posted May 9, 2007 © Eurasianet