Kazakhstan’s Success with Family Planning

Expanding Women’s Contraceptive Alternatives and Improving Maternal Health Care

An obstetrics and gynecologist (OBGYN) by training, Dr. Galina Grebennikova, is now the head of the Kazakhstan Association of Sexual and Reproductive Health. Soon after graduating from medical school in 1994, Galina started her rotation in Kazakhstan’s newly formed Family Planning Unit in Almaty.

“It was the first time a government in Central Asia introduced family planning,” says Galina. “I recall my aunt who is also an OBGYN telling me that during the Soviet era, women didn’t have many choices when it came to family planning. Abortion was often the only option for birth control.”

In the mid-1990s, when Kazakhstan introduced family planning, USAID collaborated with national leaders and pioneers in family planning to roll out the program.

Dr. Tamara Dzhusubalieva is one such pioneer, a driving force behind Kazakhstan’s family planning program, and Dr. Galina’s long-time mentor.

USAID and other international donors assisted the Government of Kazakhstan in several areas including raising awareness about family planning and different contraceptive alternatives. Training and outreach efforts targeted healthcare providers from specialists, family physicians to rural midwives, and the general public.

“At that time, there was a significant lack of knowledge about family planning. The informational materials and training provided by USAID was revolutionary for us,” recalls Galina.

Galina remembers what it was like for her to learn about voluntary contraception from international experts from John Hopkins Program for International Education in Gynecology and Obstetrics and Access to Voluntary and Safe Contraception. “I learned a lot myself and then went on to train others across the primary and secondary healthcare system.”

After successful pilot programs in Almaty, the family planning program was expanded across the country in 1997. By 2000, family planning was integrated into primary healthcare facilities across Kazakhstan.

From 1998-2002, Kazakhstan rolled out a hotline, supported by USAID, that provided reliable information on contraception to females of reproductive ages. “It was an excellent way to get information on the use of contraceptives to women and girls confidentially. They could feel comfortable asking questions and understanding their options,” says Galina.

Another important step to normalizing access to family planning was changing the hearts and minds of parliamentarians and policymakers. “We faced significant resistance. They assumed we were trying to curb the country’s population growth. But in fact, we wanted to provide women and girls with access to contraception, reduce reliance on harmful abortions, and give couples the freedom to choose when they have children and how many,” says Galina.

Physicians like Galina, in partnership with USAID and other donors, have educated stakeholders across government, healthcare systems, and the general public on the benefits of providing family planning services. Now, procurement of contraceptives are a budget line item for local governments in Kazakhstan.

USAID also partnered with Kazakhstan’s Ministry of Health to ensure that evidence-based national protocols and policies on modern family planning methods were in place. In the early 1990s, there were 254,943 abortions per year, by 2010, that number declined to 106,074 abortions per year. In 2010, USAID ended its assistance to Kazakhstan’s family planning efforts and redoubled its focus to maternal and child healthcare.

With USAID’s assistance, Kazakhstan introduced the World Health Organization (WHO) recommended Safe Motherhood Initiative in 2002, one of the first countries among the former Soviet Union nations to implement the program. Among its many investments to improve maternal healthcare, Kazakhstan also created a national electronic quality assurance system for maternal and child healthcare, family planning, and reproductive health.

“Today, healthcare workers have forgotten the old Soviet practices and completely adopted the recommendations outlined by the WHO in the Safe Motherhood Initiative. Sometimes I’m amazed when I think about how much history has changed before my eyes. Abortion rates have dropped dramatically because of the availability of contraceptives and maternal mortality rates have declined by three-fold since independence. While we have made tremendous progress, we need to continue to strengthen the capacity of health providers especially in rural communities,” says Galina.

Kazakhstan funds its entire maternal health and family planning services program. The government is also increasing its investment in in vitro fertilization (IVF), a procedure to help with fertility treatment, to help couples in Kazakhstan conceive children.

As Kazakhstan celebrates 30 years of independence in 2021, Galina reflects on the headway the country has made. “We no longer need to explain what family planning is, it’s a common practice that has been widely adopted in the country. Women have access to quality maternal care services nationwide. Knowing that our efforts have borne fruit keeps me excited about our shared efforts,” says a cheerful Galina.

ABOUT THIS STORY:

In 2021, the United States is celebrating 30 years of diplomatic relations with Kazakhstan. The American people, through USAID, have invested more than $700 million in Kazakhstan since 1992. This story highlights USAID’s integral role in enabling Kazakhstan to develop and roll out a robust family planning and maternal and child healthcare program in the country’s formative years after independence. #USKZ30 #KZUS30