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Regional and Interregional Overview |
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| EUROPE | |
| Introduction
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European countries with economies in transition. The year 1998 was especially challenging for European countries with economies in transition. While some countries in Central Europe and the Baltic region experienced impressive economic growth, others saw a serious deterioration of their economies. Gains that had been made in living standards are now receding, and the overall well-being of the population is declining in many parts of the region. The year provided several opportunities to review progress made in the area of population and development. An expert group meeting on "Reproductive Health: Implementing the ICPD Programme of Action in Central and Eastern Europe: Lessons Learnt Post-Cairo", was held in Copenhagen, Denmark, in September, and a regional population meeting was held in Budapest, Hungary, in December. Both meetings provided an opportunity to analyse current trends in the area of population and development and to make recommendations on future actions. On the demographic front, many countries in the region are experiencing unprecedented demographic change and are in the midst of a health and mortality crisis. Issues such as low fertility and population ageing are perceived as having a profound impact on the economy. In the Commonwealth of Independent States and the Baltic countries, the health status of the population and mortality levels, particularly of men, are deteriorating. The reproductive health situation in the region remains diverse. The contraceptive prevalence rate is showing a slow but positive trend, and the abortion ratio has decreased. However, there remains a major discrepancy between the low contraceptive prevalence rate and low total fertility rate, suggesting that abortion remains the main method of regulating fertility. Maternal mortality ratios in the region, although improving, are still five to ten times higher than in the rest of Europe. Furthermore, secondary infertility as a consequence of abortion is assessed to be quite high. The integration of reproductive health services into primary health care is the region's most pressing operational issue. One of the region's major problems is the prevalence of sexually transmitted diseases, including HIV/AIDS. The reported number of syphilis cases has increased 30 to 40 times over the past few years, posing a significant threat of an immediate STD epidemic in the region. In addition, a cumulative rise of new HIV cases has occurred in many parts of the region, particularly in Belarus, the Russian Federation and Ukraine. Adolescent reproductive health has become a critical issue, particularly in light of deteriorating economic conditions that have left young people exposed to various forms of high-risk behaviour. Teenage fertility rates in the region were roughly three times as high as the average in Western Europe, and there has been an increase in the rate of teenage abortion in the past few years (every 10th abortion in the region was among girls below the age of 19); however, there are signs of stabilization. Although it is clear that reproductive and sexual education in schools plays an important role in preventing unwanted pregnancies and STDs, several countries in the region have been half-hearted in integrating such subjects into curricula, due to strong political opposition. To address such trends, the Fund initiated numerous activities in 1998. In Albania, for example, a UNFPA country programme was launched. Approved in 1997, the programme focuses entirely on reproductive health. Also in 1998, UNFPA for the first time approved a project to support the development of comprehensive reproductive health information and services in Bosnia and Herzegovina. To respond to the needs in regions hardest hit by the Russian economic crisis, UNFPA approved a six-month project to provide reproductive health services at the district level in the Russian Federation's Republic of Sakha (Yakutia). Continuing to help strengthen national capacity in data collection and analysis, the Fund supported the 1998 publication of the Republic of Moldova's first reproductive health survey. UNFPA also continued to assist comprehensive reproductive health programmes in Armenia, Georgia, Romania and Ukraine. All these programmes aim to improve the reproductive health status of women and men through training medical professionals and by carrying out IEC activities. UNFPA supported a number of country-specific activities related to adolescent reproductive health. In Romania and Armenia, UNFPA provided funds for surveys to better understand adolescent behaviour. Also in Romania, the Fund helped the Youth for Youth Foundation, a youth NGO, carry out an information and awareness-creation programme to reduce the incidence of unwanted pregnancies and STDs. In the Russian Federation, UNFPA is supporting the Russian Family Planning Association's development of a peer-education programme for teenagers. Eastern European countries continued to host large numbers of refugees and internally displaced persons, in particular in Armenia, Bosnia and Herzegovina, Croatia, Georgia and the Russian Federation. Many of the refugees and internally displaced persons have not been able to return to their countries or homes and face an uncertain future in refugee camps or collective centres throughout the region. The reproductive health situation in these centres and camps is often very difficult, with cervical cancers and other cancers of the reproductive system being on the increase due to lack of proper screening and other preventive measures. In December 1998, UNFPA fielded a needs assessment mission to the Kosovo province of Yugoslavia. A proposal for providing emergency reproductive health assistance to displaced Kosovars was developed. It was superseded in early 1999 by activities in support of Kosovar refugees in Albania and Macedonia. Turkey.
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