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Chapter 10. Groups with special needs. Socially vulnerable groups. Minorities
Chapter 10. Groups with special needs. Socially vulnerable groups. Minorities
Findings
As it has already been mentioned in the chapter “Access”, the women from the socially vulnerable groups are extremely affected by the social and economic crisis of the transition period in the Republic of Moldova.
The MHSP regulations, the single Program of the compulsory insurance, the republican fund regulation and the local funds for population’s support, represent only some of the acts , meant to guarantee the access to the reproductive health for these groups.
The political parties’ representatives of the Moldovan Government, interviewed during the evaluation, consider that for these categories of people the reproductive health services must be free of charge and declared themselves available to support the measures of improving the current situation.
It is worth mentioning that the access of these groups to family planning services and safe abortions is quite limited. Summing up the field work performed by the team members, we can assert that this situation was caused by:
- the insufficiently and inefficiently defined mechanism of contraception distribution among these groups and limited access to the free of charge abortion services
- the unawareness of the providers and the members of the community about these mechanisms;
- the lack of the definition and criteria that establish the belonging to these groups and the mechanisms of their proof.
- the barriers imposed by exaggerated and useless bureaucratic requirement, the request for referential acts, the presence of a special commission to issue the permits etc.;
- confidentiality violation at all the levels of the health care system;
- the low level of population informing and education concerning the reproductive health
- the insufficiently active involvement of the NHIC staff in the educational and informing task of the providers and the population;
- the lack or insufficient involvement of social assistants in the cases of women from the socially underprivileged groups or teenagers, thus keeping the social context that generates unwanted pregnancies.
In Moldova there is no limit to the access to contraceptive services or abortion because of any ethnic minority belonging, but it is especially defined by the level of poverty. During the evaluation we interviewed some Roma patients, who proved a good level of reproductive and sexual knowledge and did not mention any barrier in accessing these services.
Recommendations
See the chapter Access
10.1 Youths
Findings
The young people constitute a category of the population, who even through their essence represent a group of risk through risky behavior, unwanted pregnancies, resort to risky abortions, teenagers’ delivery etc.
The lack of knowledge in the field of reproductive and sexual health, the fear and anxiety, the hostile attitude of adults towards the early start of the sexual life and the lack of financial sources very often contribute to the intensification of the isolation and exclusion of the young people from the society.
Although the state bodies, the international organizations, and NGOs are trying hard to improve this situation, the members of the assessment team noticed that the teenagers and young people, as well as for underprivileged groups, have a limited access to the reproductive health services, contraception and safe abortion.
For the young people there are no contraceptive or abortion services that would be related to their needs. The young people especially mention the violation of the confidentiality when accessing these services, what forces them to avoid the use of the contraception or seek clandestine services for the pregnancy termination.
The dissatisfaction on the side of the school teenagers was expressed towards the practice of gynecologic examination in the presence of more girls in the same room discussing the problems detected in the presence of others.
Because of the confidentiality violation, when they need abortion, they prefer going to another rayon or to Chisinau.
Addressing the doctors from the respective divisions, the teenagers remarked in the interviews the disrespectful and blaming attitude on the side of the staff.
The boys- respondents declared that they prefer buying the condoms at the bars and discos because they are embarrassed to buy them at the chemist’s, because of the pharmacists’ attitudes and because „tomorrow the mother is sure to find out about this”
They also mentioned the sexual abuse, which takes place more often after alcohol consumption.
During multiple meetings with young people, they brought examples of pregnancies among school girls, who delivered, because abortion is considered to be something extremely bad for their health, and after that dropped out of the school, without the right to continue their studies, because „it is a shame” for the school. A pregnant teenager is blamed by her colleagues and teachers, very often she does not know where to address, but if she addresses, the case is immediately known by the whole community, so it has the same consequences.
They told a case when the school director made public the pregnancy of a girl aged 15 during the general meeting with school pupils in order to teach them all a lesson.
The students of a medical college declared that 2% of the students have abortions annually.
The sexual education in schools is practically missing or it is only formal. The mentioned remarked that the education is often reduced to “scaring” and not “informing”. The abortion is presented only in terms of risks, the presented information being very biased.
In the opinion of the community members, a big part of the teenagers start their sexual life at the age of 14-15, not having any knowledge in this field, or having very derisive knowledge.
Abstinence is the essential method of preventing the unwanted pregnancies, promoted and supported by the religion representatives. But teenagers have a negative attitude towards this method, most of whom declared that they „are not going to wait till marriage.”
The young people know and welcome the introduction of the “Life skills” course, they want to know more in this respect, regard it as useful for teachers and parents. The practice of training the volunteers in schools who will then educate their mates is welcomed.
The opinion of the providers and community towards the problem whether it is necessary for the teenagers to get the consent from the parents to have an abortion is contradictory.
The providers mention that they often do the abortions without asking for the parents’ consent, the former being away or they consider the young woman to be adult enough to take independently a decision. They believe that this represents an additional barrier for teenagers, that may contribute to the delay of the abortion and to the resort to illegal abortions.
Other providers declared that they do not want to have problems and refuse them, not caring what the further fate of those girls is going to be.
The community respondents consider the parents consent for the minors’ abortions to be compulsory, because the former are supported by them and cover all the expenses connected with health care and support.
The teenagers declared that in fact this generates an extortion of money, and if „you can pay no one asks you how old you are or about the parents.”
The teenagers believe that the final decision to have an abortion must belong to them.
At the same time, they accept that the parents must be asked, because in case they keep the child, the parents “might turn them out of home, or they must take the responsibility for his/her bringing up.”
Another opinion was expressed as an insistence to the parents’ consent and the spread opinion that it is better to deliver, leads to a double abandon: the young woman delivers, then she is turned out from home, and now there are already two children on the streets-the babe and she.
Multiple members of the community consider that the teenagers aged more than 16, must decide themselves the problem of abortion and that the teenagers have the same rights and liberties.
During the evaluation the opinion of the decision-makers of the Ministry of Justice was examined, who declared that there is a legal background to ask for the parents’ consent only from those under the age of 16.
The stipulation nr. 411 ZPM411/1995 on Health Care passed on March 28, 1995, in the article nr. 23 „The consent for the medical care service” stipulates:
„...Only the people under the age of 16 need consent to be offered medical help...”
Recommendations
- To develop of youth-friendly contraceptive and abortion services:
- To train providers in providing youth-friendly services and cooperate with the educational, psychological and social assistance system.
- To extend and consolidate of the youth-friendly centers’ network
- To make the IEC work in schools more efficient:
- To include the modules about abortion and contraception in the curricula of teachers training;
- To support the introduction of the “Life skills” course in the school compulsory curricula, including information on the concept of safe abortions;
- To select and train in a systematic and organized way trainers in the sexual and reproductive health education;
- to reduce the age of the abortions for which the parents consent is required to 16.
- In some special cases, when a young woman under the age of 16 requests an abortion, the decision of pregnancy termination to be made in accordance with the decision of three medical workers, including the specialist who is performing the abortion.