NGO Helps Relieve Distress of
Women's Reproductive Health in Karakalpakstan
by Oral Ataniyazova
I began my career as a gynecologist in Karakalpakstan's Leninabad region
that is adjacent to the city of Muinak, the epicenter of the Aral Sea catastrophe.
As early as 1980 there was evidence among women of pregnancy complications
and high rates of illness. At the time I assumed that in order to best help
women I should become a qualified medical practitioner. So I passed my medical
internship in Leningrad and then defended my candidate of science dissertation
in Moscow. When I returned to Karakalpakstan I realized that all that work
wasn't nearly enough.
The environmental and health crisis produced by the mindless, almost
criminal, treatment of water and land resources in the Aral Sea region created
far more serious consequences than anyone could have imagined, and conditions
continue to worsen to this day. The situation is particularly problematic
in Karakalpakstan where almost the entire territory has been polluted by
excessive use of pesticides and herbicides in agriculture.
The effects of polluted soil, produce, drinking water and air are felt
in daily life. Since the number of digestive illnesses has risen, families
are now extremely cautious about feeding their children fresh fruits and
vegetables, which may have been contaminated by chemical treatment.
When I am in Karakalpakstan I can see the white salt covering the ground
and can feel it on my skin and between my teeth. Those most vulnerable to
the increased salinization of water and soil are pregnant women and children.
Karakalpakstan has the highest levels of maternal and infant mortality in
all of Uzbekistan. General illness levels are also high among the same group
and many children are born with birth defects. Anemia is by far the most
common illness and almost all women suffer from it.
The collapse of the Soviet Union has aggravated the situation immensely.
In general, the broader population still suffers from the "expectancy
syndrome" - the belief that someone from another country will arrive
with help. This belief was justifiable under Soviet times when the construction
of good health facilities and hospitals and the training of local scientific
and health workers in outlying regions was not considered a priority since
seriously ill patients could be sent for treatment to Moscow or Tashkent.
And that's actually how things worked: patients were sent to central hospitals,
air medics could easily be called and special medical teams arrived each
summer to help the women in the Aral Sea region.
The Soviet Union no longer exists and we are left to fend for ourselves
without good hospitals, without the vast Aral Sea once teeming with fish
and with a frightful ecological situation. Our hospitals lack elementary
medicines such that when pregnant women go to the birthhouse for labor,
they must bring the necessary drugs with them.
No less important are the attitudes of Karakalpak women toward their
own health and that of their children. A survey of more than 1,000 women
pregnant for the first time revealed that a majority do not have the skills
needed to raise a child, do not know about the nutritional aspects of pregnancy,
and are unaware of the complications that can accompany pregnancy. In short,
there is a general lack of knowledge of reproductive issues. Approximately
50-60 percent of women in this region become pregnant before they turn 20.
For this reason, work on consciousness-raising among young women and adolescents
is particularly crucial.
Central Asian women traditionally bear several children. Many health
problems are related to the high average number of births per woman; in
response to these problems, the state health care system has devised a massive
birth control program that has provided IUDs for 40-50 percent of Karakalpak
women - the same level as in Europe. Even though births have fallen, maternal
and infant mortality remains high and no indicators suggest a reverse trend.
Although this family planning effort is a step in the right direction, it
is being implemented as an order from the state; women automatically receive
an IUD at checkups (sometimes without being informed) and receive no further
consultation or explanation about the impacts and aspects of family planning.
Karakalpak women need to understand the necessity of playing an active
role in terms of their own health, the environment and issues affecting
global population. Unfortunately, Karakalpakstan lacks the financial means
to publish the most basic educational brochures for pregnant women on issues
such as nutrition and hygiene. Of particular importance are educational
materials on the effects of pollution on human health.
With few signs that the government is raising the necessary funds to
address these needs, my colleagues and I decided to start our own nongovernmental
organization, Perzent. In the Karakalpak language, it literally means progeny,
but in our culture, it also implies passing along the best to one's children.
To do this, we aim to conduct independent scientific research on the effect
of environmental factors on reproduction and offer educational programs
for women and children on health, hygiene, ecology and reproduction through
brochures, television shows, summer camps for teenagers, etc. We also provide
qualified medical assistance in the areas of family planning, other reproductive
rights issues and much more.
The center was established at the end of 1992. We've accomplished quite
a bit despite the republic's terrible communications capabilities, the lack
of available funding for nongovernmental organizations (NGOs) compared to
Russia and the government's unsympathetic attitude towards NGOs. We have
conducted research on the impacts of negative environmental factors on the
health of women in Karakalpakstan. In an effort to attract international
interest and possible sources of financial and technical support, we have
made valuable contacts with several international scientists and NGOs. Attending
the International Conference on Population and Development in Cairo, as
an NGO representative, I was able to take part in the global debate surrounding
family planning. I also acquired mounds of printed and video material that
will be incorporated into local educational programs. Internationally, we
have been recognized, supported and given a voice as an NGO force. Hopefully,
in time, our efforts in Karakalpakstan will gain us the same at home.
About the Author
Oral Ataniyazova spent several years working as a gynecologist in a rural
hospital in Karakalpakstan, an autonomous republic within Uzbekistan. Her
experience with local women revealed the serious lack of education in maternal
and child health among all strata of society. Women knew little about their
bodies and rarely sought medical attention until it was too late.
A woman of impressive vitality, passion and perseverance, Oral decided
the best way to help her people would be to gain further education and enrolled
in a doctoral program in Moscow at the Russian Scientific Research Center
of Obstetrics, Gynecology and Perinatology. As part of her research, she
distributed 1,000 questionnaires to Karakalpak women aged 13-20 through
medical institutions, schools and clubs. She also offered materials on contraception
and health that have been welcomed by local women and men alike.
The breakup of the Soviet empire has created problems for Oral. Although
Western assistance now reaches the former Soviet Union, much of it specifically
excludes Uzbekistan and virtually none is dedicated to Karakalpakstan. Although
Oral has written or co-authored many articles, the Russian-language journals
in which she previously published now reject her papers in favor of works
by Russian scientists and to date no analogous publications exist in Karakalpakstan.
However, Oral recently received a fellowship to work with the National
Institute of Environmental Health Sciences (NIEHS) and Family Health International
(FHI), in Chapel Hill, North Carolina. At NIEHS she will work on analyzing
her health survey data and at FHI she will develop family planning materials
to use in her homeland.
-Rachel Schucker, ISAR-Moscow Staff |
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