Overview: Eastern Europe and Central Asia

The Eastern Europe and Central Asia region has enjoyed robust economic growth over the last few years. Eight countries (the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia and Slovenia) joined the European Union in 2004. Two more (Bulgaria and Romania) are scheduled to enter the EU in 2007, while Croatia and Turkey are currently in negotiations for eventual entry. The upturn of the economy has not been accompanied by comparable social progress, however, and in many cases has increased disparities between and within countries.

The transition countries in Central Asia, the Caucasus, the Western Balkans and the Commonwealth of Independent States (CIS) that were part of the former Soviet Union are still struggling with social disruptions that accompanied the moving away from centrally planned economies. These countries have continued to be characterized by high poverty rates, income inequality, long-term unemployment and declining access to public services. In many Central Asian and Caucasian countries, illiteracy rates are still increasing while school enrolment rates are declining. The number of refugees in the region has also grown rapidly in the past decade, creating significant social challenges.

In spite of good overall economic growth in the last few years, progress toward the Millennium Development Goals (MDGs) has been mixed, and poverty has increased in many countries. The transition and CIS countries of Central and Eastern Europe tend to receive insufficient attention from international efforts to achieve the MDGs, largely due to the failure to appreciate internal diversity and gaps under decades of communism and the impact of the market transition on the state-sponsored services, according to the UN Millennium Project report, Investing in Development (2005). Progress toward the MDGs and the ICPD goals has been hampered in several countries by corruption, weak public institutions, deteriorating service delivery systems and inequitable internal distribution of resources. The report highlights the need to reinforce health service delivery systems as an urgent priority, as well as reversing HIV transmission trends, with a focus on effective prevention strategies.

Although the Russian Federation reported sharp declines in absolute poverty during 2000-2004, few other transitional countries have registered similar progress. Most countries experienced massive deterioration in living standards over the past decade. Poverty has spread from affecting only a small proportion of the population (about 3 per cent in 1987) to about half of the population in several countries.

Demographic trends continue to be causes of deep concern. Populations throughout most of the region are ageing and shrinking, and fertility rates are dropping. In some countries mortality rates are rising (particularly for men), and human trafficking is a major concern.

The current average regional total fertility rate is well below replacement level in the region except in Albania, Turkey and Central Asia. Five countries in the world are expected to lose a substantial proportion of their population by 2050 and all of them are in the EECA region. Migration has exacerbated depopulation. In some countries, the decline in fertility has led to discussion of pronatalist policies that could threaten reproductive rights.

Lower fertility has also resulted in ageing populations. In all of the transition economies, the overhauling of social services has left the elderly as one of the poorest and most vulnerable groups. In many countries, high mortality for men has left a large proportion of widows living alone with limited access to care and social services.

Maternal mortality and morbidity remain a great concern throughout the region. In many countries, this is associated with poor quality of institutional maternal health care, and in several countries, with declining levels of hospital deliveries. There also continues to be a high level of unmet need for contraception throughout the region, except in south-east Europe and the Caucasus. In several countries of Central and Eastern Europe, abortion rates declined rapidly over the last decade with the establishment of family planning information and service programmes, wider availability of contraceptive supplies and the advocacy by civil society. Ensuring access to modern contraceptive supplies at affordable prices remains a challenge in many countries.

Gender inequities have risen in the last decade. Women's participation in economic and political life has decreased, income disparities have increased and girls' school enrolment has slowly fallen. Gender-based violence in the region, including the rise in human trafficking, which primarily affects women and girls, constitutes a severe human rights and public health problem. It is estimated that more than a quarter of all women and girls who fall victim to trafficking are from Central and Eastern Europe.

One of the world's fastest-growing epidemics of HIV continues in the region. The number of people living with HIV reached an estimated 1.4 million at the end of 2004, according to the latest UNAIDS estimates. This is an increase of more than nine-fold in less than ten years. Women account for about a third of those with the infection, but they make up an increasing share of newly diagnosed cases. The Baltic States, the Russian Federation and Ukraine are the worst affected countries, but HIV continues to spread, particularly in Belarus, Kazakhstan and Moldova. The driving force behind the epidemic in the region is injecting drug use allied with unsafe sex.

The vast majority of people living with HIV are young adults, which highlights the need for a more vigorous and comprehensive response. If the present trend is not rapidly reversed, the region will become one of the world's AIDS epicentres. Denial, stigma, and the institutional challenges of providing services to marginalized and vulnerable sub-populations jeopardize progress to preventing the further spread of HIV in this region.

UNFPA, as a member of the Subcommittee on Peer Education of the UN Interagency Group on Young People's Health Development and Protection, is addressing HIV prevention in part through support to an innovative programme called the Y-PEER network. Y-PEER coordinates and strengthens the efforts of nearly 200 peer education projects in 27 countries of Eastern Europe and Central Asia using web-based communications to share information, strategies, resources and lessons learned.

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