Crossroads Asia

Kyrgyzstan’s Persistent Urban-Rural Divide in Reproductive Health

Awareness about reproductive health and access to contraceptives are unevenly distributed across Kyrgyzstan.

Colleen Wood
Kyrgyzstan’s Persistent Urban-Rural Divide in Reproductive Health
Credit: Pixabay

In addition to shedding light on obstacles to family planning and reproductive health in Kyrgyzstan, a quiz recently published by Kloop News reveals the severity of gaps in common knowledge about contraceptives access. Only 29 percent of respondents correctly answered a question about insurance-provided discounts on birth control pills, for example.

The challenge of educating Kyrgyz about reproductive and sexual health is complex, with bureaucratic budgets, traditional values, and international donors pushing and pulling policy in different directions. Disparities are not evenly distributed across the country, and rural communities tend to struggle more with access and awareness.

Part of the awareness problem is related to path dependence of international aid programs and the country’s healthcare bureaucracy.

For nearly two decades, the United Nations Population Fund fully subsidized birth control pills in Kyrgyzstan. UNFPA ended funding for contraceptives in 2015, and supplies slowly dwindled by 2017. Osmonbek Artykbaev, the head of the National Committee of Kyrgyzstan’s Parliamentarians for Population and Development, said that Kyrgyzstan’s government was not planning to take over UNFPA’s initiative to fund contraceptives; instead, they instituted a measure to provide a 50 percent discount for birth control pills for insurance holders. Artykbaev explained to RFE/RL in June 2017 that this policy is not enough, however, given that it fails to reach thousands of women in rural areas.

For women in rural communities, limited access to reproductive health services also poses a serious problem.

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Although there are well over 800 pharmacies in Bishkek alone, Naryn and Talas oblasts each have fewer than 100. Partially as a result of transportation costs and as a function of supply and demand mechanisms, women in rural areas also must pay more for contraceptives. Kloop reporters found that oral contraceptives are anywhere from 20 to 220 Kyrgyzstani som ($0.29 to $3.15) more expensive outside Bishkek. This puts undue pressure on women in areas where average incomes are half that of the capital. In the city of Bishkek, average monthly wage in 2017 was around 19,336 som but in Osh region that sum amounted to 10,180 som (and only slightly more, 13,274 som, in Osh city).

Even in areas where women enjoy regular, affordable access to contraception, education about sexual health in Kyrgyzstan is generally lacking. Sex education in Kyrgyzstan’s schools has historically been a contentious topic. In 2005, a letter-writing campaign prompted the withdrawal of a sex education textbook from school libraries across the country. Efforts to pass a law that further institutionalize sex education in schools and require proper training for educators teaching the subject are subject to scorn and politicization from more conservative factions in the country.

Even with the law and the development of a sex ed curriculum in Kyrgyzstan, some activists worry these measures are not enough to overcome shame and disinformation. “There is no concept of standards for sex ed,” Activist Aikanysh Eralieva told Azattyk in May 2017. “It is not a required subject, and there are no standards.”

Indeed, sex education is not offered as a formal stand-alone subject. Only 10 hours a year are set aside for students grade six through 11 to attend lectures about “healthy living” broadly. These lectures are not solely about sex education, and also cover information about nutrition and the consequences of drug and alcohol use.

Given the dearth of formalized education about sexual and reproductive health, some young people are taking the matter into their own hands. They have creatively used independent media platforms to spread information about sexual and reproductive health.

Boktukorgon — a feminist online magazine made by and for teenagers from Central Asia, Russia, Ukraine, and the Caucasus — is one such platform where informal, peer-to-peer education is happening. Young women are publishing articles about consent, contraception, healthy relationships, and menstruation for Boktukorgon; these essays offer readers careful and simple explanations that they might not get from embarrassed teachers or parents.

To be sure, the team behind Boktukorgon has created a meaningful channel for expression and peer-to-peer education. However, the platform and others like it are not a panacea, especially for rural communities.

Boktukorgon functions primarily on social media, privileging those in areas with regular internet access. Moreover, Boktukorgon publishes primarily Russian-language content, which makes sense, given the transnational community they’re trying to forge. Russian is spoken widely in Kyrgyzstan’s capital and other urban areas, but less so in rural communities. The relative lack of content in Kyrgyz or Uzbek means women who are already less likely to have access to information and resources are left out of this network too.

More creative solutions — from the government and civil society alike — are needed to overcome the rural-urban divide in Kyrgyzstan that disproportionately disadvantages rural women trying to take control of their reproductive health.