PROMOTING SAFE MOTHERHOOD IN THE NAKHCHIVAN AUTONOMOUS REPUBLIC - ADRA'S EXPERIENCE
By Jenny Sequeria -Nakhchivan Health Development Program manager
When Lamia first came to the rural village health point in her community, she
thought she was experiencing complications from the abortion she had recently
undergone. The gynecologist, who was part of the ADRA mobile health unit team,
was surprised by her findings. "She was still pregnant. Maybe the doctor
only took her money and didn't perform the procedure, or maybe she was very
unskilled." Regardless, Lamia was pregnant and she was devastated by the
news. The Kerambayli nurse and the gynecologist provided reproductive health
counseling to Lamia, who decided to keep the baby rather than having another
The day we
spoke to Lamia, she was holding her 5 month-old boy. "I think that God
really wanted my son to be born," Lamia said quietly. Lamia is happy to
have a healthy son, but does not want any more children in the future."
According to the nurse, Lamia's situation is shared by many women in Kerambayli.
"As a mother, I understand the importance of family planning," the
nurse told us. "When I received information about safe motherhood, I immediately
began to share this with the women in my village." Several women that ADRA
spoke to in the village also stated that accessibility to contraceptives is
a common problem.
Similar to other villages in Nakhchivan, agriculture and animal husbandry are
the primary sources of income in Kerambayli, with a small proportion of individuals
earning income from government positions (e.g. teachers, nurses), wage labor,
or small enterprises (e.g. pharmacies, grocers). Agriculture and animal husbandry
are seasonal, creating surplus income for only a few months of the year. The
women interviewed reported an average monthly income of 60,000 manats, while
the nurse estimated an average monthly income of 100,000 manats for village
The need for accessible reproductive health services in Nakhchivan is apparent-especially
interventions addressing common problems associated with early age marriages
and with pelvic inflammatory diseases exacerbated by high abortion rates. ADRA
is working with the Ministry of Health in Nakhchivan towards developing a broad-based
sustainable safe motherhood pre-paid fee-for service system (PPFFS), offering
accessible reproductive health care to rural communities.
According to results of a recent ADRA/CDC survey of reproductive health in
Azerbaijan, many women (87%) have heard of at least one modern contraceptive
method1. However, rates of modern contraceptive usage remain low (see Table
1), while abortion is a common means of fertility regulation. In fact, as in
most Newly Independent States, induced abortion remains the single most important
factor for controlling fertility in Azerbaijan. Several issues are believed
to contribute to this heavy reliance on abortion including limited availability
of high-quality modern contraceptive methods, fears about side effects from
using contraceptive methods, and easy access to abortions. (Source: Adventist
Development and Relief Agency (ADRA) and Centers for Disease Control and Prevention
(CDC). Atlanta, 2002. Reproductive Health Survey, Azerbaijan, 2001. Final Report
Table 1: Current Use of Contraception Among All Women (in Percent)
Reproductive Health Survey: Azerbaijan, 2001
|Use Of Contraception Percent
|Currently Using Any Method
|Periodic abstinence (rhythm)
|Not Currently Using Any Method
Note: ADRA/CDC survey does not include data from Nakhchivan
Immi, a nurse from Kerambayli, was enrolled in the safe motherhood PPFFS for
only one month at the time of the interview, but she already believes that the
investment in her health has been a wise one. For the past five years, Immi
has suffered from serious complications from the eleven abortions she has had.
Due to the extreme scarring in her uterus, intercourse has become a painful
event for Immi and she regularly suffers from pain in her lower abdomen. When
interviewing Immi, we asked why she had relied on abortions as a method of birth
control, presuming that she, as a nurse, would have had adequate information
regarding reproductive health care. Immi replied, "I had training in nursing,
but I had little information about reproductive health or contraceptives. I
only knew about withdrawal. It was when I attended an ADRA reproductive health
training several years ago that I first learned about contraceptives."
Immi was able to apply the information she received at the training in her own
life. Today, after 3 children and 11 abortions, Immi is preventing unwanted
pregnancies by taking birth control pills. Immi also does her best to educate
the women in her community about reproductive health and contraceptive choices.
"Most of my neighbors need this information. Contraceptives are better
for the health of women than abortion, and it will save them money."
The PPFFS program also aims to promote the health of children through the education
of mothers. "Health education is an important part of improving the health
of children in Nakhchivan." The nurse explained, " In order to improve
the health of children, mothers need information about spacing births, about
exclusive breastfeeding, nutrition, growth monitoring, immunization, and diarrhea.
When you educate mothers about these things, you can help them keep their children
|MALE INVOLVEMENT IN REPRODUCTIVE HEALTH
In order to maximize the reproductive health of a population, attention
must be paid to the role of men in reproductive health including their decision-making
role in fertility regulation and sexually transmitted infections (STIs).
The PPFFS program is encouraging the involvement of couples in family planning
in Nakhchivan. Additionally, PPFFS promotes condom use as a method to protect
Our conversations with Immi and other women in the villages of Nakhchivan also
highlighted the significant influence men have over the selection of contraceptive
methods in most households. Many women we spoke to believe that the man should
be responsible for choosing the contraceptive method for the family. Concurrently,
nurses asserted that men tend to have very low levels of knowledge regarding
modern contraceptive methods and are unable to make informed decisions about
family planning. The traditional method of withdrawal has remained the most
widely used method among currently married women although there are effective
contraceptive methods available. Other reproductive health issues discussed
that are particularly linked to men revolve around migration and sexually transmitted
infections.ADRA's health activities in Nakhchivan are funded by USAID.
Temporary work migration to Turkey, Iran, Russia, and other countries has become
a common reality for the residents of Nakhchivan, arising out of the dissolution
of the Soviet Union and the blockade that has separated Nakhchivan from the
rest of Azerbaijan since early 1990.
motherhood PPFFS program works towards addressing some of these reproductive
health issues, including educating women and men about sexual and reproductive
health, increasing access to modern contraceptives, providing accessible and
affordable gynecological care for women, and improving the health of children.
In doing this, ADRA and its partners aim to not only promote the health of mothers,
but to also work towards building healthier families and communities throughout
the Nakhchivan Autonomous Republic. ADRA's activities in Nakhchivan are part
of the Azerbaijan Humanitaraian Assistance Program (AHAP) funded by USAID and
managed by Mercy Corps.