1. Promoting hormonal methods in Ferghana Oblast, Uzbekistan Implemented by ZdravPlus/ Quality Primary Health Care project (Abt Associates) October, 2002 Mary E. Skarie, USAID/CAR

3. Map of Uzbekistan

4. Ferghana and Uzbekistan data Uzbekistan Data199920002001 Birth Rate22.421.420.4 Abortion Rate* 9.4 9.0 8.4 % Contraceptive Users58% 59%42.7% % IUD Users46,7% 45%38.2% % OCP Users 6,5%5,7% 2.1% % Indictable Users2,2%2,5% 1.6% Ferghana Oblast Data199920002001 Birth Rate21.120.018.7 Abortion Rate* 6.7 5.0 5.1 % Contraceptive Users71.1%66.5%60.4% % IUD Users52.8%55.4%54.9% % OCP Users12.5% 6.5% 2.0% % Indictable Users 5.8% 4.6% 3.5% * Abortion is under-reported in official data as mini-abortions (menstrual extractions) performed before 6 weeks are not reported as abortions and private clinics do not report abortions.

5. Program components  refresher training at rural PHC level for GPs and midwives  training for ob-gyns to improve their knowledge of hormonal methods and management of side effects  reference materials in Uzbek  contraceptive/procurement  logistics system design and implementation

6. Initial results and next steps Issue: Post training monitoring showed improved clinical skills but need to develop counseling skills Planned Intervention: Interpersonal counseling skills training Issue: Focus groups with women and men indicate cost, inconvenience and fear of side effects are main concerns about hormonal methods Planned Intervention: Reproductive health campaign including soap opera, clinic-based health education, NGO activities and print materials

7. Impact to date: Three Pilot Rayons in Ferghana 1999 2000 2001 Women using contraceptives 613.8 446.1 723.0 (any) (per 1000 women) Women using IUD (percent of users 89,1% 93,3% 47.5% among all contraceptive users) Women using hormonal pill 10,3% 4,3% 22.9% (percent of users among all contraceptive users) Women using injectables 0,6% 3,0% 21.7% (percent of users among all contraceptive users)