By Ene Tuyliyeva, with reporting by Parviz Boboev

ASHGABAT/DUSHANBE – Aygul, 23, nearly lost her life when she developed complications during labour due to a heart condition. Fortunately, she was rushed from her home in rural Turkmenistan to the capital Ashgabat, where, under the care of a cardiologist, she successfully gave birth to a baby girl.

“I’ve had heart problems since I was a teenager,” Aygul explained. “When I got married, I didn’t realize it could become a threat. Plus, my husband’s family expected we would start having children immediately.”

Following her close call, Aygul began receiving free contraceptives, which will enable her to prevent another pregnancy until she has fully recovered and received treatment for her condition.

Like many other countries in Eastern Europe and Central Asia, Turkmenistan is playing an increasing role in helping at-risk women access modern contraceptives, part of efforts to improve overall maternal health.

Working together to improve access

Family planning saves lives. When women are empowered to choose the number, spacing and timing of their children, they face fewer complications during pregnancy and childbirth, and their children are healthier.

Yet in many places in the Eastern Europe and Central Asia region, women have difficulty obtaining modern contraceptives. Some face stigma, others lack affordable options, and some simply lack access – particularly those from marginalized or vulnerable groups, such as members of the Roma community, young people or women in rural areas.

UNFPA is addressing these issues by promoting a ‘total market approach’ to family planning. This means working with multiple sectors – including the public sector, commercial suppliers and nongovernmental organizations – to ensure that all people can choose, obtain and use quality contraceptives whenever they need them.

In May, UNFPA organized a workshop in Antalya, Turkey, advocating the total market approach. Participants at the workshop, including members of governments, civil society and the private sector, came together to discuss how to work together to improve women’s access to reproductive health services, including contraceptives.

Dr. Rano Kulobieva, a leading specialist on maternal and child health in Tajikistan’s Ministry of Health and Social Protection, attended the workshop.

“I’m so excited by the positive experiences of other experts and specialists from the region and the opportunity to work jointly,” she said, adding that she felt better equipped to improve rural women’s access to family planning services. She said the experience will also help her advocate for making contraceptives available to the most-at-risk people in her country.

Committing to women’s health

Similar workshops held last year helped boost the total market approach in eight countries in the region, including in countries where it had previously been challenging to put family planning on the government’s agenda.

Moldova has made a commitment to implement a total market approach national action plan, and Tajikistan has committed to begin state procurement of contraceptives next year.

Armenia’s Ministry of Health has announced plans to replicate the experience of Turkmenistan, which earlier this year signed an agreement with UNFPA to cover the cost of modern contraceptives and other reproductive health commodities from its state budget by 2017. That agreement will be the basis of a national plan to ensure all people, particularly at-risk women, have access to voluntary family planning services and supplies.

The plan will help doctors identify the most-at-risk women and then direct them to local reproductive health centres like the one that saved Aygul’s life.

“Risk factors of most-at-risk women contribute to a significant percentage of the maternal mortality rate,” said Bahar Agayeva, head of the Medical Statistics Department at Turkmenistan’s Ministry of Health and Medical Industry. “Addressing the family planning needs of these women will help us significantly decrease maternal mortality and improve maternal and child health.”