POPULATION OUTLOOK Kazakhstan and Countries of Central Asia European Population Forum

Socio-Economic Development KAZAKHSTAN - Achievements Fastest Growing Economy among CAR – GDP growth 9.5% in 2002, 10.2% in first half 2003 – Inflation decreased to 7-8% – Budget deficit decreased (1.4% surplus in 2003) – Increase in social sector programmes

Socio-Economic Development (cont.) KAZAKHSTAN - Issues Poverty and Social Stratification –richest 10% receive 26% of national wealth vs. poorest receive only 2% –Rural poverty is almost twice as much as urban (38% vs. 20.4%) –Most vulnerable least protected (women and youth, especially in rural areas)

Socio-Economic Development (cont.) KAZAKHSTAN - Issues Population decline - since 1991 population reduced by 1.7 million due to: –emigration –reduced fertility –increased mortality (particularly among men) Turkmenistan is also concerned with population decline Uzbekistan - high fertility in rural areas

Socio-Economic Development (cont.) KAZAKHSTAN - Issues Decreasing health status of population –Unhealthy behavior practices –Lack of life skills and knowledge of healthy lifestyles –Poor attitudes to own health –Poor ecology

National Population and Development Policies KAZAKHSTAN National development strategies 2030 and 2010 Poverty reduction programme Demographic and migration programme Rural development programme National Plan on environment for sustainable development

National Population and Development Policies (cont.) Kyrgyz Republic – population issues addressed in various documents, but no integrated policy or strategy exists Turkmenistan – social protection of vulnerable, environmental and internal migration policies Uzbekistan – population issues integrated into development policies and reforms Tajikistan –PRSP, environmental policies, internal migration policies

Gender Equality, Equity and Women Empowerment Kazakhstan and republics of Central Asia are the signatories of the ICPD PoA and Beijing Platform of Actions Legislation and relevant institution established Kazakhstan – National Commission on Family and Women Affairs under the President of RK Uzbekistan – Bureau on Gender and Development Similar establishments and/or enabling legislation on gender exist in Kyrgyz Republic, Tajikistan and Turkmenistan

Gender Equality, Equity and Women Empowerment (cont.) Gender Violence and Discrimination Kazakhstan Gender differentials in key socio-economic indicators Gender Stereotyping Lower carrier perspectives Reported domestic violence Similar situation in other CA countries

Gender Equality, Equity and Women Empowerment (cont.) Gender Violence and Discrimination Kazakhstan Units combating abuse against women formed in 1999 in the Ministry of Internal Affairs Network of crisis centers established Planned adopting of the Law Concerning Domestic Violence and the Law on Introducing Additions to the Criminal Code of the Republic of Kazakhstan Regarding the Issues of Illegal Trafficking and Migration for Purposes of Sexual or any other Exploitation

Reproductive Rights and Reproductive Health Kazakhstan MMR is highest among CA countries – 50.5 per 100,000 livebirths High rate of pregnancy and delivery complications – 60% Causes of maternal deaths –Insufficient management of obstetric emergencies (hemorrhages, infections, eclampsia, etc) –Abortions –Poor health & nutritional status –Poor quality of antenatal care

Reproductive Rights and Reproductive Health (cont.) Kazakhstan Contraceptive prevalence rate on rise – 50.7 (MoH, 2002) Unmet need for family planning – 8.7% (DHS, 1999) Access and quality of reproductive health services poor, particularly in rural areas

Abortion Trends in Kazakhstan During 10 years the absolute amount of abortions in RK decreased by 2.3 times. All indicators defining abortions have improved: 1 abortion accounts for each 2 childbirths Number of abortions per 1000 females in reproductive age decreased by 2.2 times Number of abortions per 100 births decreased almost twice But discrepancies between official and independent sources on abortion and its complications limits analysis of abortion related maternal deaths

Abortions in Kazakhstan

Adolescents and Youth Kazakhstan STIs on the rise Drug abuse: 40,000 officially registered; estimated 250,000 Smoking: 10% of adolescents under 14 years, 20% under 16 years, and 70% under 24 years. Alсohol: 6% of adolescents under 16 years, up to 80% of under 24s Reproductive Health: only 20% adolescents under 17 are healthy abortions among girls under 17 of which secundigravidae - 53,8% (NHLS, 2003) 24 HIV positive among adolescents under HIV positive among adolescents years

HIV/AIDS in Kazakhstan Spread of HIV/AIDS in Kazakhstan at a fastest pace among countries of Former Soviet Union –3788 HIV positive in September 2003 –205 HIV positive pregnant women –80% IDUs among HIV positive –17% of men and 33% of women ages 15 to 19 are not aware of HIV prevention measures Enacted the Concept Paper and National Programme on Counteracting of HIV/AIDS Epidemic in the Republic of Kazakhstan for

Partnerships UNFPA and other UN organizations, development agencies and donors Government Civil Society

Best Practices Kazakhstan Focus on quality of care enabled developing and introducing evidence-based clinical protocols on a variety of reproductive health issues A continuing series of training for health professionals on modern contraceptive technology, management of STIs and RH counseling by national experts and NGOs Alliance of the Government with international community and civil society organisations paved the way for introducing population dimensions into development strategies Community-based distribution of information and services demonstrated its high value as a tool for social mobilization

Best Practices Kyrgyz Republic – establishment of a community-based Social Patronage System enabled minimizing cases of infant and maternal mortality Turkmenistan – advocacy efforts led to introduction of gender issues into sectoral plans Uzbekistan – running of a social communication campaign covering a broad spectrum of reproductive health issues Tajikistan –participatory approach involving Government agencies, technical expertise and civil society resulted in adoption of Poverty Reduction Strategy Paper

Emerging Issues Kazakhstan Low understanding of reproductive rights among decision-makers may jeopardize development agenda of the country pursuing pro-natalist policy Lack of national expertise in demography and social statistics exacerbated by data problems Growing danger of HIV/AIDS well recognised but very little action in place. Actual level of the disease is likely times exceeds official figures. Low capacity to detect STIs. Real dimensions unknown. High incidence of STIs may have serious impact on reproductive health of entire population.

Health Legislation in Kazakhstan The Constitution of the Republic of Kazakhstan as of according to which the citizens have right to health care Citizens have right to get free guaranteed package of health care

Legislation in the Area of Reproductive Health The Law of the Republic of Kazakhstan on Healthcare of the citizen of RK asof according to which: a woman has right to decide herself the issue on maternity with a view of healthcare a woman has right to use the modern methods of contraception maternity in RK is preserved and encouraged maternity care is ensured by organizing of the wide network of specialized medical organisations, benefit payments on account of child’s birth, efficient employment of pregnant women, ensuring maternity leave with benefit payments to child-care.

Legislation on health protection of children and pregnant women The Law of the Republic of Kazakhstan on Health Protection of the Citizens of RK dated according to which: the Government protects the rights and interests of children who are to be under medical examination and constant and dispensary observation Adults must care about children’s health, their physical, intellectual and moral development, to bring up children to the healthy life style Pregnant women must get registered in maternity healthcare centers Parents should follow regulations promoting the birth of healthy children

Legislation (continued) The Law of RK on Marriage and Family as of A person under 18 years old is recognized as a child. Every child has right to live and be brought up in a family, to know her/his parents. Parents should provide care to their children Health legislation has been implemented through the State Programme Health of the Nation. Priorities identified in the programme include protection of maternal health, family planning, and building of health lifestyles

Priorities of Reproductive Health in Kazakhstan Improvement of reproductive health of population, formulation and training of skills for responsible attitude of people towards their own health

Non-Governmental Organizations (NGOs) At the present time in Kazakhstan exist more than 150 women’s NGOs Republican movement “Women of Kazakhstan”, Coalition of women’s NGOs in operation.