Publication: Fertility Regulation in Kazakhstan : The Role of Providers and the Public Financial Cost
Date
2006-11
ISSN
Published
2006-11
Author(s)
Rani, Manju
Chao, Shiyan
Arystanova, Gulzada
Rakhimova, Meruert
Abstract
This study examines fertility regulation
in Kazakhstan, with dual emphases on providers'
attitudes toward abortion and the public financial costs of
abortion provision. Though abortion incidence declined
sharply in the 1990s in Eastern European countries and in
the former Soviet republics, it stagnated at relatively high
levels in the early 2000s, accounting for a substantial
proportion of gynecological morbidity and maternal
mortality. Limited literature is available on the role of
health service providers' attitudes that may encourage
or discourage abortion culture. Additionally, most studies
examine abortion incidence from the perspective of its
impact on women's health, while the issue of the public
financial burden imposed by the provision of services for
"avoidable" abortions remains unexplored. This
study sheds lights on these two areas by conducting a
two-part field survey in Kazakhstan. Three-stage stratified
sampling was used to select 126 providers from 52 health
facilities from four oblasts and two major cities (Almaty
and Astana) at different administrative levels to assess
providers' attitudes and perceptions; and to analyze
the public costs of providing abortion and family planning
services. Findings from the provider survey suggest that
providers' biases towards certain contraceptive
methods-partly attributable to their lack of training in
alternative methods-lead them to limit the choice of
contraceptive methods on offer, thereby reducing the quality
of family planning services and potentially contributing to
stagnating abortion rates. Findings from the costing survey
suggest that in terms of cost per birth averted,
contraceptives are almost 3.2 times more cost-effective than
abortion services. In 2004, abortion services accounted for
almost one percent of total public health spending. The
study suggests that by expanding family planning services,
including increasing contraceptive choices, the reliance on
abortion for fertility control may be reduced. Savings may
be redirected to improved family planning services or other
public health interventions.
Citation
“Rani, Manju; Chao, Shiyan; Arystanova, Gulzada; Rakhimova, Meruert. 2006. Fertility Regulation in Kazakhstan : The Role of Providers and the Public Financial Cost. HNP discussion paper series;. © World Bank, Washington, DC. http://openknowledge.worldbank.org/entities/publication/70d8f576-ed75-51ed-b27c-5c552d75df1f License: CC BY 3.0 IGO.”