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Progress in reproductive health

The Republic of Moldova has a national reproductive health strategy (2005–2015) and aims to make further progress with its implementation. This country has done much work in recent years on reproductive health. Services are provided not only by family doctors and specialized out-patient health facilities, but also, with the support of partners, 47 offices of reproductive health, 3 centres for women’s health and 12 youth-friendly health clinics.

Since 1993 the United Nations Population Fund (UNFPA) has provided free contraceptives for vulnerable groups, and the abortion rate has decreased consistently from 1200 per 1000 live births in 1993 to 400 per 1000 in 2008. The quality of abortion services was improved using the methods suggested by WHO, and 35% of obstetricians and gynaecologists have received extra training. The standard of youth-friendly health services has been raised, and services were evaluated in 2009. Many seminars and training workshops have been held on subjects such as domestic violence, male sexual and reproductive health, and cervical cancer screening.

Challenges

The financial crisis in the country will reduce the services included in the package covered by national insurance, and programmes lack coordination, partly because of a lack of experience. Information on sexual and reproductive health is lacking in rural areas, especially for vulnerable groups; service providers lack counselling skills and data and research results on sexual and reproductive health are lacking. Men can only access sexual and reproductive services by going to a specialist such as a urologist, not family doctors.

WHO’s “Using human rights to advance SRH: a tool for examining laws, regulations and policies” is being pilot-tested in the Republic of Moldova and a draft report is planned to be presented in 2010 to a broad range of stakeholders to discuss legal barriers to further improvement of sexual and reproductive health and access to services. The document is being prepared by researchers and national team members led by health ministry representatives.

In November 2009, WHO/Europe and other partner organizations, such as the United Nations Population Fund (UNFPA), the United Nations Development Fund for Women (UNIFEM) and nongovernmental organizations, discussed and evaluated a paper on the gender-responsiveness of sexual and reproductive health policies that is in line with development of the national programme to ensure gender equity.

Recommendations

• WHO/Europe should assist in developing monitoring of the national reproductive health strategy.
• The role of reproductive health offices and their integration with family doctors at primary care level should be examined, taking evidence and cost–effectiveness into account.
• Health system capacity should be strengthened to implement the national strategy, with particular emphasis on ensuring equitable access to high-quality maternal, newborn and other reproductive health services.
• Health system capacity should also be improved in relation to access, and existing national laws, regulations or policies should be recognized.