Towards Better Reproductive Health in Eastern Europe: Concern, Commitment, and Change 9789633865064

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Towards Better Reproductive Health in Eastern Europe

Towards Better Reproductive Health in Eastern Europe Concern, Commitment, and Change Edited by

G. LINDMARK, M. HORGA, A. CAMPANA, andJ. KASONDE WHO Scientific Working Group on Reproductive Health Research

..

.'.

.. CEU PRESS

••• Central European University Press

World Health Organization

Published by Central European University Press Okt6ber 6. utca 12 H-1051 Budapest Hungary 400 West 59th Street New York, NY 10019 USA

© 1999 by WHO, Geneva Distributed by Plymbridge Distributors Ltd., Estover Road, Plymouth PL6 7PZ, United Kingdom All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the permission of the Publisher. ISBN 963-9116-30-0 ISBN 9789633865064 ebook

Graphic artwork on cover by Tamas Karacsony and Tamas Maros Library of Congress Cataloging in Publication Data A CIP catalog record for this book is available upon request Printed in Hungary by Akademiai Nyomda Kft.

Contents

List of tables .

Vll

List of figures

lX

List of contributors

Xl

Foreword by J.E.Asvall

Xlll

Reproductive health in Eastern Europe: an overview and the challenges ahead HELENA HONKANEN

and GIUSEPPE BENAGIANO

. . . . . . . . .

Can a process of quality assurance improve pregnancy outcome? GUNILLA LINDMARK . . . . . . . . . . . . . . . . . . . . . . . .

The challenge of rising trends in the incidence of sexually transmitted diseases in Eastern Europe A. GROMYKO

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Obstacles and opportunities in the development of adolescent reproductive health care GUNTA LAZDANE

and ILONA AUZINA

. . V

19

47

65

Contraception: current use and future perspectives LASZL6 KovAcs . . . . . . . . . . . . . . . . . . . . . . . .

85

How can the rates of induced abortion be reduced? MIHAI HORGA

and FRANK LDDICKE . . . . . . . . . . . . . .

99

Infertility in Eastern Europe: a survey of the current status in nine countries FRANK LDDICKE, ASSIA BRANDRUP-LUKANOW, MIHAi HORGA and ALDO CAMPANA . . . . . . . . . . . . . . . . . . . . . . . . . .

129

Towards better reproductive health in Eastern Europe ASSIA BRANDRUP-LUKANOW . . . . . . . . . . . . . . . . . . .

Vl

143

List of tables

2.1 American College of Obstetricians and Gynecologists Ob­ stetric Clinical Indicators -p. 35 2.2 Key common European quality development indicators in perinatal care (O BSQUID project) -p. 3 6 2.3 Perinatal mortality in the year 1995, Tallinn, Tartu, and Estonia, using different birthweight cutoff points -p. 37 2.4 Common Nordic-Baltic perinatal death classification -p. 3 7 2.5 Perinatal deaths by categories of the Nordic-Baltic perinatal death classification in Lithuania 1993-94 and Denmark and Sweden 1991-p. 38 5.1 Contraceptive use in several countries -p. 94 5.2 Survey on human sterilization in Eastern Europe -p. 95 5.3 Contraceptive prevalence and reproductive health indicators -p. 95 6.1 Fertility, birth, abortion, and contraception prevalence rates in countries of Eastern Europe -p. 12 6 7.1 Existence of referral centers and national organizations deal­ ing with infertility; specific legislation on donor insemination or adoption in selected countries of EE/NIS -p. 140 7.2 Investigation of infertility as performed by the centers in nine countries of EE/NIS -p. 140. vn

7.3 Possible treatments offered by the centers in nine countries of EE/NIS -p. 141 7.4 Age distribution and type of infertility -p. 141 7.5 Self-reported history, female partner-p. 14 1 7.6 General categories of infertility -p. 14 2 7.7 Distribution of specific diagnoses of infertility -p. 14 2

Vlll

List offigures

1.1 Contraceptive prevalence rate (effective methods) for 100 married women -p. 1 3 1.2 Abortion rate per 1000 women aged 1 5--49 years -p. 1 4 1.3 Abortion to birth ratio per 100 births -p. 1 5 1.4 Maternal mortality rate per 100 000 live births -p. 1 6 1.5 Infant mortality rate per 1000 live births -p. 17 2.1 Maternal mortality rate per 100 000 live births -p. 3 9 2.2 Infant mortality rate per 1000 live births -p. 40 2.3 Health care system: process of quality assurance and im­ provement -p. 41 2.4 Eclampsia prevalence per 100 000 deliveries (national data) -p. 42 2.5 Blood transfusion national averages and local data, percent of deliveries -p. 43 2.6 Intrapartum deaths per 1000 deliveries -p. 44 2.7 Cesarean sections (national data), percent of deliveries -p. 45 3.1 Incidence of syphilis cases in the Baltic states during the last 1 5 years -p. 56 3.2 Annual incidence of syphilis in the Russian Federation, Be­ larus, Republic of Moldova, and Ukraine -p. 57 3.3 Annual incidence of syphilis in Kyrgyzstan, 1 98 6-95-p. 58 lX

3.4 Annual incidence of syphilis in the Republic of Kazakhstan, 198 6-95 -p. 59 3.5 Incidence of syphilis cases in the Russian Federation, 199096 -p. 60 3.6 Annual incidence of syphilis cases in Ukraine, 1991-95 -p. 6 1 3.7 Annual incidence of syphilis cases in the Republic of Moldova, 1980-95 -p. 62 3.8 Imported cases of gonorrhea in Helsinki -p. 6 3 3.9 Annual incidence of syphilis cases in Finland, 1980-95-p. 6 4 4.1 Prisoners-juveniles in Latvia -p. 77 4.2 Children who have acquired a basic education in Latvia-p. 78 4.3 Births in Latvia outside marriage -p. 79 4.4 Induced abortions in Latvia in the age group