OFFICE OF THE UN POPULATION FUND WAS FOUNDED IN YEREVAN IN 1995. THE
FUND RENDERS ASSISTANCE TO DEVELOPING COUNTRIES SUCH AS ARMENIA TO
COMBAT THE PROBLEMS OF REPRODUCTIVE HEALTH IN SOCIETY, AIDS CONTROL,
MEDICAL SERVICES, DATABASE DEVELOPMENT.

Oksana Musaelyan
ARMINFO, 14 September, 2004

Anne-Birgitte Albrectsen, new assigned country director for Armenia,
Azerbaijan and Georgia, representative for Turkey, who is on her first
fact-finding visit to Armenia, answered Arminfo’s questions

Q: What new projects and programs is UNFPA planning to implement in
Armenia, and the target groups that will be covered by them?

A: UNFPA in Armenia of course has been focusing on saving the lives of
women, particularly in situation when women are pregnant and have been
dying on pregnancy relating causes, problems of delivery etc. In the
past work we have found that the best way to deal with it through what
we call “emergency obstetric care”, combined with access to antenatal
care and family planning services, UNFPA in Armenia has funded a
special mobile unit of doctors who go out through all the corners of
the country. It has also supported “travelling doctors” in some
regions of Armenia, as well as helped improve access to family
planning services across the country. As a result, over the past
decade we have managed to help bring down the number of mortalities
relating to pregnancies from about 45 every year to 5- 6 a year. In
terms of maternal mortality ratio (MMR) which is an internationally
accepted indicator for the maternal mortality, it has decreased from
40 per 100,000 live births in 1999 to as low as 16.4 in 2003. So, it
has almost been eliminated, and we can say Armenia in this sense is
almost at the same level as developed countries. But we still think
that more work is needed in this area to ensure sustainable and
durable results. Thus, this mobile unit has been working from Yerevan,
so in the new program we are suggesting that we also provide some
equipment and training for doctors to do the same work in some other
regions of the country. Exactly where that will be has not been
decided yet, but we just feel that we need to get closer to some of
the remote districts.

Q: How can you evaluate the problems facing Armenia, what should be
done to improve the situation, and the assistance of UNFPA to
alleviate and solve the existing problems?

A: There is another area where women are affected by fatal disease –
cervical cancer, basically, because women do not go to regular
oncological check-ups. In the new program we will start doing a
survey of the entire country both on cervical cancer and STIs
(sexually transmitted infections) through testing women of
reproductive age on the voluntarily basis to see how prevalent these
diseases are. Cervical cancer is one of the types of cancer that is
eminently preventable, simply by going to regular check-ups, you will
catch that there is a very small procedure, and you can go on with
your life without any problems. So of course, we are not in here to
see that when something is so preventable, people are still dying of
it. This is something that we would like to help do something about.

The other fatal disease is HIV/AIDS, so we will continue a lot of
advocacy work that we have been doing with community groups, young
people. We want to try in the new program to reach a lot more men. In
the past program we have found that our community meetings, round
tables are mostly attended by women. Men don’t really come to the
meetings. So as a new thing we will be trying to target men through
the social and institutional structures where there are a lot of men,
such as the army, may be the police, any uniform services. We will be
thinking also of sport clubs and other things where we see men
coming. Then, we will of course continue our work on the reproductive
health and family planning, which has been quite successfully in the
past program. We believe that together with the governments we have
been able to help considerably reduce abortions.

Q: What other means could be in help to reduce the number of abortion
in Armenia?

A: Surely, we still feel that the current level of abortions is quite
high, so through other, modern contraceptive means we can bring this
down even more. Why do we think it’s high? Because abortion sometimes
leads to complications, infections resulting in infertility, which for
a country with low fertility like Armenia, is a serious problem. So we
feel that we still need to bring the rate of abortion down and to
increase the general use of contraceptives. So we will continue this
program, working through the primary health care structures, NGOs,
community groups, training, medical staff trainings, journalists’
trainings, training of local officials, elected officials,
parliamentarians and so on. We really want to increase the knowledge
both on the family planning and also sexually transmitted infections,
including HIV/AIDS. A new emphasis of the already ongoing programs
will be targeting men’s involvement, and will also focus on the young
people and youth friendly services, making sure that young people feel
well going into the health center and not feel intimidated to talk
about their problems with the doctors, nurses and that they receive
proper confidential services. In terms of the new initiatives, as I
mentioned earlier, it will be in the area of cervical cancer; so these
are some things that we will be looking at.

Q: What commitments or provisions have been reached in the course of
your meetings with the Armenian ministries?

A: It was just a fact-finding mission, but I would highlight specific
commitment made by the Ministry of Education, to include a healthy
lifestyle curriculum into the national curriculum starting by 2006 in
schools of 8, 9, 10 grades and higher education institutions. It will
be a comprehensive program, which will include all aspects of health,
including reproductive health (RH) education. In the past programs we
were already helping the MOES develop the national curriculum for
schools in terms of education on reproductive health, health in
general and healthy lifestyle. Generally, our collaboration with our
Armenian counterparts in the ministries is very open, transparent;
both side clearly understand that UNFPA can help raise some of the
issues, to build the technical skills, and help improve access to RH
information and services. I find the relationship to be incredibly
fruitful. By the end of this year all the ministries, NGOs,
parliamentarians that we work with will have developed the activities
under the UNFPA Country Program Action Plan (CPAP) for 2005-2009, and
it is envisaged that at the end of the year the Armenian government
and UNFPA will sign the CPAP.

Q: How much is the annual budget of UNFPA Armenian office?

A: UNFPA is not rich, it has $500.000 annually for the projects in
Armenia that is not really much taking into account the mentioned
problems facing Armenia today. That’s why the budget is used in a very
targeted way. For example, with the “emergency obstetric care” we are
able to save 40-50 lives every year for less than $10,000, which was a
UNFPA contribution to the establishment of the emergency obstetric
care mobile service. This of course does not reflect the operational
costs of the service, which is covered from the health budget. So
it’s very cost effective.

Q: How can you generally estimate the situation in the region? What do
you think on problem of gender disparity in Armenia?

A: In terms of general demographic trends that we have to look at, we
see, for example, large migration out of the country, quite high level
of infertility, low fertility rate in general when families have few
children, a great number of older people outside of reproductive
age. The policy-makers, of course, are well aware of if. But a lot of
the planning that goes at the local, district and the national level
demonstrate that these issues aren’t really taken into account. What
we would like to do is really engage in a broader dialog about what
does it mean for a country when you have people migrating, low
fertility and an aging population. What does it mean in terms of
social services when you have to provide for women in reproductive
age, senior citizens and young people. Obviously, in terms of the
general problems, for example the part of the poverty reduction
strategy of Armenia shows real commitment of the government as well as
the NGOs to improve the quality and the access to health care. If we
look at this year, we will see the commitment to increase the health
budget by 38%, which is a quite good indicator especially in
comparison with the other countries in the region. Of course, it is on
the very low level, Armenia needs a lot of investments in health care,
but the commitments to invest in the area is very good. But general
health care, the quality and the accessibility of health care are the
problem that we have to look at. It is not necessarily something that
UNFPA should interfere with, but we see it as a part of enabling
environment for us to do our job better. In terms of advocacy and
awareness raising, we still face the fact that the culture of
awareness of general health issues as well as reproductive health
issues is still quite low. UNFPA and other organizations have managed
to help the governments increase this awareness. Another thing to
praise is the adoption of the law on reproductive health and
reproductive rights, and it is incredibly impressive achievement that
took a long time for some cultural change to happen, but this was a
very important step. Now it needs to be implemented: doctors, local
officials, media — everybody need to be trained, and understand what
this law means, what are the rights for the individual in term of this
particular law. So there is a strong need for more advocacy,
information, general campaigning on health problems that are
threatening lives and general well-being of the population, as well as
on broader issues of the population dynamics, social-economic
development and poverty reduction. Armenia has a desperate poverty
with high rates of social, economic, and political inequality. This
issue has to be addressed through decentralization processes, through
fiscal decentralization, and through real commitment to invest in
social sector of the country to deal with some of these issues. In
terms of gender, for example, I see a lot of general equality on the
surface, but there are a lot of issues relating to wage inequalities
of men and women, which need to be addressed. I think probably, one of
the issues which I have found is most disturbing but is very hard to
document is a high level of domestic violence against women, and, in a
sense, existence of some cultural, family values that make this
acceptable. Demographic and health survey that was done in 2000 had a
module on the attitudes of men and women of all age groups to the
question “Do you feel that beating of a wife by a man is justifiable?”
Across the country the majority said “YES”, and not only men but also
women. When you look at the age distribution of the answers, young
people answer the same as their grandparents. There is really no
difference in terms of acceptability now. If you look at all the
International Conventions on the human rights, any violence against
woman that takes away a woman’s dignity is not acceptable, so this is
of course something to look at. While there are a lot of reasons why
it is difficult to address this issue, initially UNFPA has been trying
to see what we can do to inform people about this, make people aware,
bring discussions out, because a lot of the problems are kept inside a
family. We have been also trying to generally advocate women’s rights
issues, make sure that also young children understand the value of the
human rights.

Q: How much do the conflicts affect the wealthfare of the population,
what are the most vulnerable groups or spheres suffering the
conflicts? Does UNFPA have its model on conflict resolution within the
framework of its activities?

A: We try to focus our activity on the most vulnerable group: young
people, women, old people and among them there is a very large
population of internally displaced people. Conflicts affect women and
children disproportionately. A lot of the issues that we see in the
three Caucasian countries are similar in terms of a need of more
awareness raising, the need to address issues relating to the rights
of women, the need to address general accessibility to family planning
and to reproductive health services. There are slight differences in
emphasis of the programs in this region, but UNFPA, regardless of the
political situation in the region, is always trying to address exactly
these issues, and therefore there are many similarities in the
programs of Armenia, Azerbaijan and Georgia.