Overview: Eastern Europe & Central Asia

The countries of Central and Eastern Europe and Central Asia may be grouped on the basis of geography, common needs, cultural cohesion and the adequacy of their health support systems.

Some largely developed countries in the region (Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovenia and the Slovak Republic) are looking forward to joining the European Union as early as 2004. Another group of countries, including Albania, Armenia, Georgia, Romania, the Russian Federation, Turkey and Ukraine, continue to need selective assistance from the international community in such areas as HIV/AIDS prevention, affordable reproductive health commodities, advocacy of reproductive rights, the reproductive health needs of young people, reproductive health education and gender issues.

A third group, the countries of Central Asia, including Azerbaijan and Kazakhstan, face the most daunting population and development challenges in the region. This is due to myriad problems — including generally worsening economies, increasing numbers of people falling below the poverty line, the AIDS pandemic, and crumbling health infrastructures. These countries will require larger levels of assistance from the international community if they are to make real progress towards meeting the ICPD and Millennium Development Goals and targets by 2015.

Among the important population and reproductive health issues and trends in the region that need to be more forcefully addressed are:

• The rapid rise in rates of HIV/AIDS and sexually transmitted infections — the rate of increase during 2002 was among the fastest ever experienced anywhere — especially among young people, and in the eastern parts of the region;
• Inadequate access to quality services for counselling, diagnosis and treatment of STIs is increasingly recognized as a constraint on the whole region;
• The need to address the reproductive health needs of young people, ensuring access to information and services to help them adopt healthy behaviours;
• The continuing incidence of recourse to abortion;
• The large discrepancy between the life expectancy of males and females in numerous countries;
• Negative population growth rates in many countries;
• The ageing of the population throughout the region;
• The rise in trafficking of women and girls;
• High maternal mortality rates.

There have been some positive developments. A growing number of national and community NGOs are active in addressing HIV/AIDS and in reproductive health concerns including family planning, and there are a growing number of well-structured regional and subregional initiatives on AIDS, reproductive health and other population issues.

While abortion rates in the region have been coming down, due in large part to greater access to modern contraception, they are still far too high. In many countries, ensuring access to modern contraceptive supplies at affordable prices remains a critical challenge.

While some countries are making progress in reducing maternal mortality, it is increasing in the Caucasus subregion and in some countries in Central Asia.

There is growing awareness of the need for capacity building to enable analytical assessment of the social situation and to provide a basis for effective policies. The United Nations system, including the Bretton Woods institutions, continues to be active in assisting countries, at their request, to prepare Common Country Assessments (CCAs), United Nations Development Assistance Frameworks (UNDAFs), Poverty Reduction Strategy Papers (PRSPs) and other instruments designed to focus and improve the impact of domestic and internationally assisted social and economic development efforts of each country. To this end, an international initiative led by the World Bank (with 24 countries and three other organizations also taking part) was launched in 2002 to promote poverty reduction, growth and debt sustainability in seven low-income Commonwealth of Independent States (CIS) countries — Armenia, Azerbaijan, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan and Uzbekistan.

Among the many additional challenges requiring greater attention and the commitment of domestic and international human and financial resources in almost every country in the region are poverty reduction, environmental degradation, migration, institutional capacity building, gender mainstreaming, and fostering reproductive health commodity security.

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