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As Families Shrink, Abortions Grow In Central Asia

Central Asians are having smaller families
Central Asians are having smaller families
Uzbekistan, like other Central Asian countries, dedicates considerable attention and funds to family planning.

Saodat, a maternity ward nurse in the eastern province of Andijon, says that even in the most remote villages local health centers try to educate women on how to safeguard their health and prevent unwanted pregnancies by using safe methods of birth control.

"There are all kinds of promotions and advertisements, even in villages," she says. "There are TV ads about various methods -- tablets, injections, other things. Everybody knows about it. Everybody can choose whatever method they want."

In neighboring Tajikistan, there are over 80 women's health centers, all of which offer free medical advice and checkups, as well as contraceptive pills and condoms provided by international donors.

Fewer Resources, Fewer Children

The government in Dushanbe has put a special emphasis on ensuring access to sex education and birth control options. Doctors and specialists say such efforts are aimed at protecting the well-being of women and their families by urging longer cycles between pregnancies. Family planning, they argue, is not necessarily about having fewer children -- just healthier families.

Many Central Asians in Tajikistan and elsewhere are skeptical, however. They believe that such health-care initiatives are meant precisely to scale down family sizes.

Traditionally, Central Asian families prefer to have at least four children -- and often more. The Soviet authorities used to support large families with generous social-welfare packages, including child benefits, lengthy maternity leaves, and even free housing.

Then, motherhood was glorified. Nowadays, media in Central Asia tend to focus on the other side of the picture -- writing about women suffering from anemia and malnutrition during pregnancy, and about parents struggling to make ends meet amid mounting economic hardship.

The tradition of having big families is changing fast. In Uzbekistan, where having seven to 10 children was long considered the norm, families in rural areas are now having an average of just three children. In cities, most women prefer to have no more than two.

The sudden drive for smaller families, however, has translated into a frequent use of abortions. Health experts say many women of childbearing age have yet to embrace the notion of preventive birth control, and instead choose to terminate unwanted pregnancies after the fact. Abortion is legal in Central Asia, and remains one of the most popular methods of birth control.

Education Needed

According to unofficial figures, in Kazakhstan alone at least 130,000 abortions take place every year. Raigul Rysbai-Qyzy, a medical doctor in Almaty's 1st Clinic, says some of her patients are unmarried girls who know little about pregnancy and how to prevent it:

"Usually, their mothers bring them here," she says. "As you may know, in Kazakh families, mothers do everything to hide things like this from elders in the family -- husbands and other relatives -- because it could evoke very dangerous reactions from them. But abortion itself is very dangerous for a young girl, because [in the future] she has to give birth to children."

Guljahon Tumanova, the head of a women’s health center in Dushanbe, says few young women are properly educated about sexual activity and pregnancy. "Many women still don't know that abortion should not be considered as a method of birth control," she says. "Abortion can have dangerous consequences, such as bleeding or severe infections."

According to Tumanova, family planning projects, which are supported by governments in the region and international organizations such as World Health Organization, have been aimed at raising women's awareness about safe methods of birth control. Both IUDs and contraceptive pills have become increasingly popular.

Tumanova says that specialists who promote family planning projects usually have to speak with the men in the family, who according to Central Asian tradition are the main decision makers. Mullahs and local religious leaders have also been called on to play a role.

"Usually it's up to the men to decide how many children the family should have, or when to have the children," Tumanova says. "So we have a new policy in our health centers that we try to work more closely with men to explain to them the benefits of family planning for the entire family's well-being. We also want them to take part in choosing the birth control method that is most suitable for their wives."

RFE/RL's Kazakh, Turkmen, and Uzbek services contributed to this report
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    Farangis Najibullah

    Farangis Najibullah is a senior correspondent for RFE/RL who has reported on a wide range of topics from Central Asia, including the impact of Russia’s invasion of Ukraine on the region. She has extensively covered efforts by Central Asian states to repatriate and reintegrate their citizens who joined Islamic State in Syria and Iraq.