Zofia, 15, is Bulgarian. She plans to finish her studies before looking for a job. She’s in a steady relationship and wants to avoid getting pregnant. Her family doctor told her that hormonal contraceptives were dangerous and threatened to tell her parents that she had a boyfriend. She could probably buy condoms in a nearby town, but knows that people would talk. In any case, her boyfriend gets angry if she talks about contraception, and insists that as long as he withdraws when they have sex, there’s no risk.

By Lene Stavngaard, IPPF EN Regional President and Vice Chair of IPPF's Danish Member Association, Sex og Samfund

In Eastern Europe and Central Asia, the use of modern contraceptives is alarmingly low. The “art” of withdrawal is seen as a sign of virility and as the man’s responsibility. A study by UNFPA in 2012 showed that in several middle-income countries in the region, usage was below 28%, which is the average in the world’s poorest countries. One of the reasons for this is that social norms make it difficult, if not impossible, for girls to find out about, and get hold of, reliable contraception. Macho culture means that men will often refuse to use condoms and prohibit their partners from using other modern contraceptives, so that a ‘good’ method is one that can be used without a man’s knowledge. For young people in particular, a lack of confidential, youth-friendly services is a true obstacle to accessing modern contraceptives.

In 2012, research led by IPPF EN in Armenia, Bosnia and Herzegovina, Bulgaria, TFYR of Macedonia, Serbia, Kazahkstan and Azerbaijan confirmed that social norms contribute to the very low use of modern contraception, even when this is available and relatively affordable. Conservatism makes it impossible to talk about anything related to sex or sexuality, and prescribed gender roles and tradition also limit contraceptive use. For example, in Armenia a young bride is expected to be a virgin and to become pregnant soon after marriage. If she does not have a child within a reasonable time period, her husband may seek a divorce.

There are many reasons why people don’t use modern contraception, including misinformation that is often based on myths about hormones, as well as poor counselling, high costs and lack of choice. But social norms are pervasive and play a key role in influencing contraceptive choices that increase the vulnerability of women and girls.

How then can Eastern European and Central Asian countries overcome these obstacles and empower women and girls? IPPF EN believes decision-makers need to make sure that health systems use evidence-based argumentation to calm fears about hormonal contraceptives, and that all young people receive comprehensive sexuality education that covers gender, rights and sexuality. Promoting condoms as a family planning method would help tackle the social norms defining men’s role in avoiding pregnancy, as well as protecting against sexually transmitted infections, including HIV. It is essential that men are included in these efforts with due respect for their needs. It is only through education, access and male involvement that we can enable girls and women to enjoy good sexual and reproductive health and make their own life decisions. 

Photo: IPPF EN/Layla Aerts