Interview with Lela Bakradze, Assistant Representative, UNFPA Georgia Country Office  

Gender-based violence (GBV), child/early marriages, the harmful practices of son preference and gender biased sex selection and female genital mutilation, life-threatening complications during pregnancies and childbirth – these are the problems that girls and women face in various regions of the world with various degrees of seriousness.  Therefore, UNFPA - the United Nations Reproductive Health and Rights Agency aims to ensure reproductive rights for all and secure reproductive healthcare for women and young people in more than 150 countries throughout the world. The organization provides life-saving help for pregnant women, especially the one million women facing life-threatening complications each month; ensures reliable access to modern contraceptives for more than 20 million women; fights to end gender-based violence, which affects 1 in 3 women, campaigns for the 70 million girls who face marriage before 18 years of age in the next five years and advocates for eradication of the harmful practice of female genital mutilation (every year about 3 million girls become the victims of this practice globally).

The UNFPA Country Office in Georgia opened in 1999 and immediately began to work to improve the sexual and reproductive health of the population – especially that of young people and women.

Indigo Magazine interviewed Lela Bakradze, Assistant Representative, UNFPA Georgia Country Office about the organization’s goals, activities and the importance of its work.

What was the main goal of UNFPA’s activities in Georgia during the first years of its work?

Lela Bakradze: As a member state of the United Nations, Georgia has certain commitments in terms of human rights and the sustainable development of the country. The main goal of the UNFPA is to help the state in meeting these commitments. Guided by the 1994 Programme of Action of the International Conference on Population and Development (ICPD), UNFPA aims to support realization of reproductive rights for all and access to a wide range of sexual and reproductive health services – including voluntary family planning, maternal health care and awareness and education on reproductive health and rights issues for women and youth. We started to work on improving the access to quality sexual and reproductive health services for the population from the very first day, as well as the provision of information on family planning and other issues related to sexual and reproductive health. In addition, we work to help in the retraining of reproductive health professionals, by enhancing their knowledge and skills. Generally speaking, improving the standards and quality of such services were the main activities we carried out.

This goal remains unchanged to this very day. However, starting from 2006, our agency launched 5-year Country Programmes, planned in consultation with government authorities and the civil society partners. Our goal was to identify the main needs and priorities of the country, address those priorities and overcome the challenges through those programs.

What does UNFPA concentrate its efforts on these days? What are the main challenges and needs of the country in that regard?

Lela Bakradze: In 2016 the Third Country Program for Georgia was approved. We identified three main directions of support – sexual and reproductive health and improving the situation with reproductive rights; achieving gender equality and empowering girls and women; improving availability of high-quality statistical data and their analysis with a view to using them in policy-making and planning activities. All three of these directions are interconnected – they complement each other. Therefore, working in all three directions is equally important.

We’re working on understanding the reasons behind maternal mortality, we need to do our best to prevent such cases. Integration of family planning services in the primary healthcare system is very important – everyone should be able to visit doctors that will individually assess the patient’s health, counsel and offer them the most appropriate modern methods of family planning.

Together with the Public Defender’s Office, UNFPA conducted the research last year that was in essence an assessment of the situation we have in terms of sexual and reproductive health and well-being of the population. This is the first step in discussing and monitoring sexual and reproductive health and rights in the context of human rights.

Other aspects that are vitally essential for planning the correct policies, are the assessment of population dynamics, the generation of quality data and their in-depth analysis.

Looking at the existing data, what main problems do we have in Georgia?

Lela Bakradze: UNFPA has been actively assisting the government in elaboration of the National Maternal & Newborn Health Strategy for 2017-2030, as well as the three-year Action Plan for its implementation. That’s when we realized and identified the main problems. These are the first national strategy and the action plan that include Family Planning and Youth Sexual and Reproductive Health among priorities.

The maternal mortality rate in Georgia is significantly higher than the average rates in Europe. The second important problem is access to family planning services in the healthcare system. A very big portion of the population has no access to modern contraceptives. Induced abortions are still actively used in order to end unwanted pregnancies, which is a heritage that comes from the former Soviet Union. Such practice, especially, the complications of unsafe abortions caused high rates of secondary infertility in countries of our region. Therefore, it’s recommended that this method of avoiding unwanted pregnancies is replaced with voluntary family planning using modern contraceptives.

Some people incorrectly believe the use of contraceptives will reduce the country’s overall birth rate. The evidence paints the opposite picture: According to a Georgia Reproductive Health Survey, birth rates have actually grown with the more frequent use of modern contraceptives. The survey analyzed data spanning 1999 – 2010 and shows that the increased use of contraceptives reduced the number of induced abortion rates. At the same time, the total fertility rate is increasing. The less unsafe abortions are performed the better the women’s reproductive health becomes. This in turn, reduces maternal mortality, morbidity and secondary infertility rates.

Georgia is one of the countries in the region where teenage pregnancies are frequent. This may pose significant threats to the health of teenage girls, because their organisms are not ready for pregnancy and childbirth. Therefore, the barriers must be removed and young people, as well as the most vulnerable groups should be provided with family planning services free-of-charge. The environment where people receive consultations should be friendly, especially in the case of young people. They shouldn’t feel reproachful attitudes from healthcare providers and their confidentiality and safety must be protected.

Young people’s knowledge of sexual and reproductive health is still scarce. However, with UNFPA’s technical assistance, issues concerning reproductive health and a healthy lifestyle are being introduced in the National Curriculum. At the same time, through peer education projects, we try to deliver the correct information concerning their health and development issues to as many young people as possible.

These problems should be eradicated step-by-step. On the one hand, it’s important to decide which groups require assistance most of all so that we can remove barriers that impede their access to family planning services. On the other hand, we need to work on improving the quality of sexual and reproductive healthcare services. In order to do that, we need to adapt modern international guidelines and protocols on clinical practices to our country’s context and introduce them in practice. The clinics and service providers need to follow these guidelines and protocols and have internal audit mechanism in place so they can analyze critical cases of maternal mortality and morbidity, identify gaps in their services, as well as critical errors and strive for continuous improvement of the quality of their services.

The provision of family planning services and the eradication of all of the above-mentioned problems is an investment for the state and the benefits of such investments are huge. This will reduce the number of unwanted pregnancies, eradicate preventable maternal deaths, as well as morbidity caused by complicated pregnancies and childbirths. It will also empower women and girls and advance gender equality. This is a type of investment that is beneficial for the country both in terms of the positive impact on the sustainable development and its cost-effectiveness.

When speaking about reproductive health and gender equality we can’t avoid the topic of the harmful practice of early/child marriages, which, unfortunately, is still a challenge in Georgia. We always try to explain to the public how harmful early marriages may be for the teenagers, especially for girls. Married teenage girls are mostly unable to complete their education. Not to mention that pregnancy at the adolescent age jeopardizes their health and their child’s health. Most importantly, they are often excluded from social and economic life, which results in the loss of human capital for our country.

How important is the change in public attitude in this process?

Lela Bakradze: We have a very stereotypical attitude toward the role of parents, child upbringing and family care in Georgia, as well as other countries in the region. Therefore, a change of attitudes and social behaviors, as well as rethinking the stereotyped roles of men and women is necessary.

One of our social campaigns called #mencare is directed towards that goal. We want to demonstrate through that campaign that fathers should have the desire and possibility to participate equally in child-rearing and family care. The campaign supports changing the attitudes towards men’s role in this, by strengthening their role as caring, non-violent fathers and partners. This is very important for both a woman’s career and economic participation and for raising children in harmonious environments. It is also important for the men’s well-being as well. Such healthy relationships and egalitarian families represent the basis of progressive societies and states.

Changing attitudes is also important in the eradication of the harmful practice of selecting the gender of future children, when parents prefer to have sons. Aside from being the most radical form of gender discrimination, it is also accompanied by negative demographic changes. For example, statistical estimates show that 33,000 girls were not born from 1990s till 2014, which will further reduce the Georgia’s population in the future. Our campaign and photo project A Girl is Born by documentary photographer Dina Oganova is aimed at challenging the attitude of son preference and triggering change. The photo project demonstrates the families that have only daughters and the photos are accompanied with the father’s opinions on the importance of equality and an equal attitude towards children.

According to the last census, the disproportion in the number of boys and girls born since 90s has decreased and the Sex Ratio at Birth approached its normal rate in 2016. However, this ratio is still significantly skewed in Kakheti, Kvemo Kartli and Samtskhe-Javakheti regions, due to more boys being born. Last year, we started an awareness raising campaign in Kvemo Kartli and Kakheti and we’re going to actively implement it over the course of the next two years. The campaign slogan is Do Not Discriminate – Both a Daughter and a Son are your Future.

We now see positive dynamics in terms of women’s empowerment - more women achieve success in their business and carriers. The stereotypical differences between daughters and sons that existed under the archaic public norms are gradually being erased, because for families and parents, both daughters and sons are equal sources of hope and pride. Continuing support in that process is necessary, because moving towards real gender equality is an important precondition for the eradication of that harmful practice.