From Abortion to Contraception

July 20, 2012, 7:07 AM

By HALEY SWEETLAND EDWARDS

TBILISI — Eka, a short brunette with brown eyes highlighted by green eyeliner, is by several measures the average Georgian woman. She has a high-school degree, a job, a husband, two children, and at age 30, has had, over the course of her eight years of married life, four abortions.

“It’s a reality in Georgia,” Eka told me over coffee on Wednesday. She said that “almost everyone” she knows has had at least two abortions.

Indeed, a 2005 survey on reproductive health in Georgia [pdf.] found that women here had on average 3.1 abortions in their lifetimes — a number that at the time earned Georgia the dubious honor of having the highest documented abortion rate in the world. (The rate in the United States today is .02.) The situation since then has improved considerably. According to a 2010 survey, Georgian women were having on average only 1.6 abortions in their lifetimes — a 48 percent decline over five years earlier.

Why the remarkable drop? The simple answer is that women in Georgia finally got the pill. That’s largely thanks to a campaign funded by U.S.A.I.D. and the United Nations Population Fund (U.N.F.P.A.) that educates doctors and nurses here, markets birth control on television and subsidizes the cost of condoms, pills and I.U.D.s.

This is a development success story that underscores a simple truth: more contraception equals fewer abortions.


But too often, still, myopic politics continue to stand in the way of that equation, endangering women in the process. Georgia’s current fertility rate — which is below replacement, despite a recent climb to two children per woman — is a hot political issue. Consequently, the government refuses to cover contraception in the state-funded healthcare program for the poor.

Denying poor women safe contraception won’t solve the problem of population decline, though; it will only encourage them to use abortion as a primary means of birth control, as they have done for decades. Right now, roughly 40 percent of Georgian women in rural areas wouldn’t be able to afford birth control ($9-12 per cycle) without the subsidies provided by the U.S.A.I.D.-U.N.F.P.A. program.

Denying poor women safe contraception won’t solve the problem of population decline, it will only encourage them to use abortion as birth control.

The issue is further complicated by the Orthodox Church, which wields enormous political power in Georgia. Family planning clinics, public health providers and international NGOs must walk a delicate line, and so they tend to promote contraception, which the Church condemns, as a means to reduce rates of abortion, which the Church condemns even more.

What’s more, modern methods of birth control are only slowly becoming culturally acceptable. Many Georgian women remain distrustful of them, said Dr. Tamar Sirbiladze, an adviser at the U.S.A.I.D. Office of Health and Social Development. Some fear that the hormones in birth-control pills will make them sterile, give them cancer or make them fat. Others believe the pills don’t really work, which is partly because for many years Georgian women were not instructed on how to use them correctly.

Eka went without the pill for the first seven years of her marriage, weathering four abortions as a result. Why? “I don’t know,” she said, looking genuinely perplexed. She said that when she was breast-feeding she didn’t take it for health reasons but that afterward, it just didn’t occur to her. “It wasn’t something I thought about,” she said. “My mother didn’t take it. My friends didn’t take it.”

Then last year, Eka began taking a basic oral contraceptive for the first time in her life. With only 36 percent of Georgian women using any modern birth control, according to Sirbiladze, by this measure, Eka is ahead of the curve.

Haley Sweetland Edwards is a freelance writer living in Tbilisi, Georgia.

Source: http://latitude.blogs.nytimes.com/2012/07/20/from-abortion-to-contraception-in-georgia/

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