Azerbaijan: Abortion Used for Family Planning

Since marrying at the age of 16, Natavan has had 11 abortions. Now 28-years-old and a mother of two, she still doesn’t use contraception and suffers from ill health as a result of the frequent terminations.

“I ... got pregnant after the first night, from my first man. We never used any protection. To begin with we simply didn’t know anything, and then my husband did not want to use condoms,” said Natavan.

Natavan’ story is a familiar one in Azerbaijan where just 12 per cent of women use modern methods of contraception, according to the international NGO Engenderhealth.

The group reports that abortions are the main way of regulating the birth rate in Azerbaijan. It blames the situation on a limited supply of contraceptives and the poor quality of medical care with some doctors profiting from terminations – which are often the main source of their income.

Mekhriban Mamedova, deputy manager of the Reproductive Health and Family Planning project at Save the Children, believes the rash of unwanted pregnancies are also the result of a general lack of knowledge about contraception, coupled with a reluctance to discuss the issue in order to find out more.

“Many people simply do not know how to protect themselves, because this has always been considered a closed subject in Azerbaijan. People are embarrassed to talk about it not just with outsiders, but among themselves,” said Mamedova.

Gynaecologist Tarana Hasanova said many Azeri women are influenced by popular misconceptions about birth control, including one that they risk becoming excessively hairy or overweight by taking birth control pills, or that intra-uterine devices, known as IUDs or coils, cause cancerous growths. She also tells the story of one young couple from the countryside who categorically refused an IUD because they feared the women might be electrocuted.

As a result, at the hospital where Hasanova works, just two or three of the ten daily abortions are done for medical reasons. Most are “mini abortions”, said Hasanova, performed when the foetus is less than six weeks old.

The director of the Women’s Crisis Centre in Baku, Matanat Azizova, is critical of the doctors who perform these operations, saying many clinics do not observe even elementary rules of hygiene, and do not even make the preliminary medical checks which need to be carried out before an abortion.

“A 16-year-old HIV-infected prostitute came to us who served seven to eight clients a day, without even thinking about any form of contraception, and every two months she had an abortion, hiding her disease from doctors,” said Azizova.

The lack of proper contraception has led to the problem of venereal disease among women, many of whom are infected by their own husbands who are unwilling to use condoms. Many men are reluctant to admit they even carry the infection.

“In these cases usually only the women are treated, but when the first results are achieved they stop, risking having their diseases take on a chronic form with more serious consequences,” said Hasanova.

Pakiza caught a venereal disease from her husband who works as a truck driver. “I used protection against unwanted pregnancy, but I didn’t think that I could catch this disease from my husband, so I never used condoms,” she said.

One problem is the common misconception among Azeris that contraceptives are expensive and difficult to obtain.

“We never have enough money for contraceptives, but I am scared of getting pregnant again, because I had to borrow money for this abortion anyway,” said Sevinj, a 25-year-old unemployed mother whose husband works as a waiter at a restaurant in Baku.

Mamedova, however, insists the idea that contraceptives affect the family budget is false.

“An abortion costs around 80-100,000 manats (20-30 US dollars), while the most expensive oral contraceptives designed for a month vary from 4-35,000 manats (one to eight dollars). IUDs cost around 20-50,000 and work for three to five years, and condoms are sold in every chemist in Azerbaijan, at acceptable prices,” said Mamedova.

Some measures have been taken in Azerbaijan to inform the population about reproductive health.

In 2003, Save the Children and the National Department for Family Planning began a two-year programme in several regions including Baku to inform people about birth control.

Programme representatives who spoke directly with people at first encountered incomprehension, but found that attitudes did change over time.

“We counted on changes in people’s mentality, but as a result the people did not just gain information, they began to buy and use contraceptives,” said Mamedova.

However, much work is still needed as Azeris remain reluctant to discuss the issue with the younger generation.

“After our programme, many women complained that they did not have this information earlier, but when they were advised to share this information with their children, they refused,” said Mamedova.

Sabina Kiryashova is an IWPR contributor in Baku.