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 Report - Promoting Safe Motherhood in the Nakhchivan Autonomous Republic-ADRA?s Experience (MC)

 Report date: 29.04.2003


By Jenny Sequeria -Nakhchivan Health Development Program manager

When Lamia first came to the rural village health point in her community, she thought she was experiencing complications from the abortion she had recently undergone. The gynecologist, who was part of the ADRA mobile health unit team, was surprised by her findings. "She was still pregnant. Maybe the doctor only took her money and didn't perform the procedure, or maybe she was very unskilled." Regardless, Lamia was pregnant and she was devastated by the news. The Kerambayli nurse and the gynecologist provided reproductive health counseling to Lamia, who decided to keep the baby rather than having another unsafe abortion.

The day we spoke to Lamia, she was holding her 5 month-old boy. "I think that God really wanted my son to be born," Lamia said quietly. Lamia is happy to have a healthy son, but does not want any more children in the future." According to the nurse, Lamia's situation is shared by many women in Kerambayli. "As a mother, I understand the importance of family planning," the nurse told us. "When I received information about safe motherhood, I immediately began to share this with the women in my village." Several women that ADRA spoke to in the village also stated that accessibility to contraceptives is a common problem.

Similar to other villages in Nakhchivan, agriculture and animal husbandry are the primary sources of income in Kerambayli, with a small proportion of individuals earning income from government positions (e.g. teachers, nurses), wage labor, or small enterprises (e.g. pharmacies, grocers). Agriculture and animal husbandry are seasonal, creating surplus income for only a few months of the year. The women interviewed reported an average monthly income of 60,000 manats, while the nurse estimated an average monthly income of 100,000 manats for village households.

The need for accessible reproductive health services in Nakhchivan is apparent-especially interventions addressing common problems associated with early age marriages and with pelvic inflammatory diseases exacerbated by high abortion rates. ADRA is working with the Ministry of Health in Nakhchivan towards developing a broad-based sustainable safe motherhood pre-paid fee-for service system (PPFFS), offering accessible reproductive health care to rural communities.

According to results of a recent ADRA/CDC survey of reproductive health in Azerbaijan, many women (87%) have heard of at least one modern contraceptive method1. However, rates of modern contraceptive usage remain low (see Table 1), while abortion is a common means of fertility regulation. In fact, as in most Newly Independent States, induced abortion remains the single most important factor for controlling fertility in Azerbaijan. Several issues are believed to contribute to this heavy reliance on abortion including limited availability of high-quality modern contraceptive methods, fears about side effects from using contraceptive methods, and easy access to abortions. (Source: Adventist Development and Relief Agency (ADRA) and Centers for Disease Control and Prevention (CDC). Atlanta, 2002. Reproductive Health Survey, Azerbaijan, 2001. Final Report Draft.)

Table 1: Current Use of Contraception Among All Women (in Percent)
Reproductive Health Survey: Azerbaijan, 2001

Use Of Contraception Percent  
Currently Using Any Method 32.4
Modern Methods 7.0
IUD 3.6
Condom 1.9
Tubal ligation .07
Pill 0.6
Spermicides 0.2
Traditional Methods 25.4
Withdrawal 23.7
Periodic abstinence (rhythm) 1.7
Not Currently Using Any Method 67.6
Total 100.0

Note: ADRA/CDC survey does not include data from Nakhchivan

Immi, a nurse from Kerambayli, was enrolled in the safe motherhood PPFFS for only one month at the time of the interview, but she already believes that the investment in her health has been a wise one. For the past five years, Immi has suffered from serious complications from the eleven abortions she has had. Due to the extreme scarring in her uterus, intercourse has become a painful event for Immi and she regularly suffers from pain in her lower abdomen. When interviewing Immi, we asked why she had relied on abortions as a method of birth control, presuming that she, as a nurse, would have had adequate information regarding reproductive health care. Immi replied, "I had training in nursing, but I had little information about reproductive health or contraceptives. I only knew about withdrawal. It was when I attended an ADRA reproductive health training several years ago that I first learned about contraceptives."

Fortunately, Immi was able to apply the information she received at the training in her own life. Today, after 3 children and 11 abortions, Immi is preventing unwanted pregnancies by taking birth control pills. Immi also does her best to educate the women in her community about reproductive health and contraceptive choices. "Most of my neighbors need this information. Contraceptives are better for the health of women than abortion, and it will save them money."

The PPFFS program also aims to promote the health of children through the education of mothers. "Health education is an important part of improving the health of children in Nakhchivan." The nurse explained, " In order to improve the health of children, mothers need information about spacing births, about exclusive breastfeeding, nutrition, growth monitoring, immunization, and diarrhea. When you educate mothers about these things, you can help them keep their children healthy.


In order to maximize the reproductive health of a population, attention must be paid to the role of men in reproductive health including their decision-making role in fertility regulation and sexually transmitted infections (STIs). The PPFFS program is encouraging the involvement of couples in family planning in Nakhchivan. Additionally, PPFFS promotes condom use as a method to protect from STIs.

Our conversations with Immi and other women in the villages of Nakhchivan also highlighted the significant influence men have over the selection of contraceptive methods in most households. Many women we spoke to believe that the man should be responsible for choosing the contraceptive method for the family. Concurrently, nurses asserted that men tend to have very low levels of knowledge regarding modern contraceptive methods and are unable to make informed decisions about family planning. The traditional method of withdrawal has remained the most widely used method among currently married women although there are effective contraceptive methods available. Other reproductive health issues discussed that are particularly linked to men revolve around migration and sexually transmitted infections.ADRA's health activities in Nakhchivan are funded by USAID.

Temporary work migration to Turkey, Iran, Russia, and other countries has become a common reality for the residents of Nakhchivan, arising out of the dissolution of the Soviet Union and the blockade that has separated Nakhchivan from the rest of Azerbaijan since early 1990.

The safe motherhood PPFFS program works towards addressing some of these reproductive health issues, including educating women and men about sexual and reproductive health, increasing access to modern contraceptives, providing accessible and affordable gynecological care for women, and improving the health of children. In doing this, ADRA and its partners aim to not only promote the health of mothers, but to also work towards building healthier families and communities throughout the Nakhchivan Autonomous Republic. ADRA's activities in Nakhchivan are part of the Azerbaijan Humanitaraian Assistance Program (AHAP) funded by USAID and managed by Mercy Corps.

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