FAMILY PLANNING

Azerbaijan is one of the few countries not to have a law on reproductive health, even though the issue is closely linked to ensuring national security. Recent discussions of a draft law on reproductive health in the Milli Maclis and subsequent comments and definitions have revealed a real lack of public awareness and information about the subject. As a result, the adoption of this important decision is focussing on secondary issues. At the same time, the law includes other important components that protect the reproductive health of the nation and form accurate public opinion on health and sex education and psychological development. The current discussion of the bill includes grains of both irrationality and rationality and these two are now fighting it out. Since 1993 in Azerbaijan action has been taken at the Republican Centre for Family Planning to improve general reproductive health, including services for families suffering from infertility (in vitro fertilization or IVF). This is a great help to families that have wanted children for many years but been unable to have them. It's not the fact that discussion is taking place that is surprising but the subject of the most heated debate - you get the impression that people in Azerbaijan are hearing about IVF and surrogate motherhood for the first time and the desire to have children is considered a sin. Today Azerbaijan has every opportunity to help the infertile and this is rational. What would be irrational in this regard is not to pass a law which includes several key provisions for the nation's reproductive health.

The draft law "On reproductive health" has been referred for further work by the Milli Maclis so that it might be discussed again at the spring session of parliament. This gives the media the opportunity to bring to public attention more material about reproductive health, family planning, sex education for teenagers, female and male infertility etc. There remains a public lack of understanding about family planning which is directly related to protecting reproductive health. This situation is typical not only in Azerbaijan. Throughout the world people do not always have a correct understanding of the aims of family planning, why we talk about it and why it is essential. But many countries are taking action to involve society in improving public information in this area. In post-Soviet countries this remains mostly the preserve of doctors, as we are used to medical professionals taking the decisions for us which is a way of transferring responsibility to them. 

But it should not be like this. Every member of the family and of society should think about this and know how to take the relevant decisions. The expression "family planning" is better understood in the sense of planning a healthy pregnancy. This is essential in order to bring a healthy child and one that is always wanted into the world.

Only wanted children 

The published results of research into public health and demography, carried out on the initiative of the Ministry of Health with the support of international organizations in Azerbaijan, have clearly revealed a problem: a large percentage of women deliberately choose to terminate a pregnancy for a variety of reasons. Meanwhile, the demand for family planning varies at different times in a person's life and reproductive health. A new family has certain requirements for family planning - couples want a healthy child. A family that already has children, for example, four or five or however many they want, has different requirements. That is, at every different stage of family life, the requirements change and a family needs information in order to make their choice. In this regard, the question arises: what does a family want? What does it think? How should the birth of children be planned and how much time should be set aside for it? Two years? Five years? Contraception helps families avoid unwanted pregnancy and, therefore, avoid something that nobody needs: abortion. Comments can often be heard - "We weren't planning anything yet," "I didn't want to now and then all of a sudden…" - and the result is abortion. Our country has an extremely high number of abortions. A depressing statistic: a woman in Azerbaijan has more abortions than she has children. And this damages not only her health but the health of her family too. It should not be forgotten, either, that from the religious and ethical point of view terminating a pregnancy is considered to be murder. Nevertheless, women and men do nothing to avoid this happening again. Unfortunately, the reason is often hidden in a lack of awareness.

Healthy family 

Different countries have different aims for their family planning programmes. In some countries contraceptives are used to improve the demographic situation; in others there is still a need to prevent the spread of sexually transmitted diseases. Azerbaijan has a clear need to use contraceptives to improve public health and reduce the number of abortions. At the same time, the interval between births for women in Azerbaijan is not bad at all. The research into public health and demographics in Azerbaijan revealed that in our country women have an interval between childbirth, giving themselves time to recover. But how this is done is a big question. I would like to point out again that family planning means having as many children as you want and when the family wants to. You have to think about the health of the child which you plan to bring up and about your own health. 

Free access to contraceptives is a problem in protecting reproductive health in Azerbaijan. In our country they are available only in pharmacies. We do not have state provision via medical establishments. And this is one of the barriers to free access to contraceptives referred to in the National Strategy on Reproduc-tive Health for 2008-15. The strategy says that contraceptives should be included in the main list of medicines available free of charge. Of course, everyone cannot be provided with free contraceptives, but they are essential for the more vulnerable groups in society.

According to the law 

It's positive that the new bill on reproductive health is being discussed. It would be worse if the bill were not discussed at all. This would have meant a lack of interest. The lively discussion of the bill means that the public and parliamentarians are involved and reacting to it. This means that the law is needed and affects people. It means that the law concerns me and I want to take part in the discussion about it. It's another question why one article or one part of the law is discussed. Other parts of the law have remained in the shadows. Only artificial insemination and assistance to families to treat infertility are discussed, while the law itself encompasses reproductive health, family planning, safe pregnancies, infertility and related issues and reproductive health for adolescents. Does this mean that we agree with all the other points in the law? By the way, male and female infertility is a big problem. And if we look at where it has come from, then it emerges that a family did not know at the time how to protect themselves from abortion and how to protect themselves from sexually transmitted diseases. The problem of infertility grows from here. And medicine can tackle the problem. But this requires the creation of juridical safety, ensured by law. So it is not worth completely excluding these points. Perhaps, they can be reduced somehow and not be written out so broadly. After the law has been passed, there will be some provisions, decrees, legal acts. The media can determine public opinion on all points of the law equally. And when we discuss the law properly and in full, we will see that it has been passed by more than 140 countries and that it has a very specific, medical basis, scientifically proven by other countries. 

Azerbaijan has every opportunity to provide IVF services. Of course, this is high technology, designed for families that need this service. And these families need help. Azerbaijan can offer this help, it has specialists and protocols. There is a need. There are people who want children and no-one should deny them this right. Sometimes we look at these things globally, including from the point of view of demographic problems. But all this time people are waiting for IVF and want a child. The technology allows it, medicine is developing and the potential is there. But at a certain stage doctors need a legal base. The time has come. If for some reasons the relevant points of the law are not passed, this will mean no rights for families who want children but cannot have them, mothers and fathers, women and men. Without understanding the discussions, we have all piled into one corner where we talk about women who bear a child for someone else and at the same time we include women who can carry a child but cannot conceive. IVF fertilizes an egg in a test tube but then returns the egg to the mother's body. This method can be considered equivalent to a doctor prescribing medicine to conceive. And after IVF a woman carries HER OWN and her husband's child. Surrogate motherhood is not a large percentage and people turn to this as a last resort, i.e., when all other methods have been tried.

The law guarantees the right to have children. The law on reproductive health should be considered more widely, as ensuring reproductive rights. It would be a shame if by going off into discussions of part of this draft law, a decision on the issue was left hanging in abeyance, especially as the country already has a bad example of this - for several years debates have been under way in Azerbaijan on the law "On education" but its adoption slips from agenda to agenda at every session of the Milli Maclis.

I would like to stress in particular that all the conditions to realize people's rights to have children should be in place in Azerbaijan. And although the National Strategy on Reproduc-tive Health does not have points on treating infertility via IVF, all aspects are taken into account in the draft law. And this is cause for optimism.