The right to reproductive health_2012_Dushanbe_Tajikistan (1)

1
Public Foundation “Nota Bene”
THE RIGHT TO REPRODUCTIVE
HEALTH: ANALYSIS OF THE RIGHT
BASED APPROACH TO THE
FORMULATION OF THE STATE POLICY
Dushanbe 2012

2
ББК 67.91
Н19
Authors: Favziya Nazarova, Gulchehra Rahmonova, Nodira
Abdulloeva, Larisa Aleksandrova, Subhiya Mastonshoeva
Editor: Nigina Bakhrieva
The present analysis was conducted with the financial support of the
Ministry of Foreign Affairs of the Netherlands. Opinions reflected in
the analysis do not necessarily represent the views of the Ministry of
Foreign Affairs of the Netherlands.

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Content
Abbreviations 4
Introduction 5
1. Applying HRBA in formulating National Policies 8
2. Brief summary of the situation with the right to
reproductive health in the Republic of Tajikistan
12
3. International standards in the field of reproductive
human rights
15
4. National policy in the sphere of reproductive health 22
5. National legislation of the Republic of Tajikistan in
the field of reproductive rights
26
6. Gaps and inconsistencies in the National Policy
and realization of the Strategic Plan
29
7. Realization of the right to reproductive health for
some vulnerable groups in the Republic of
Tajikistan
48
8. Main outcomes and recommendations 54
Recommendations for action 57

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ABBREVIATIONS
RT – Republic of Tajikistan
RRS – Regions of Republican Subordination
FC RT – Family Code of the Republic Tajikistan
RR – Reproductive rights
SPRH – Strategic Plan for Reproductive Health
AIDS / HIV - Human Immunodeficiency Virus / Acquired
Immune Deficiency Syndrome
LGBT - Lesbian, gay, bisexual and transgender
STD - Sexually transmitted infections
UN - United Nations
UDHR - Universal Declaration of Human Rights
ICCPR - International Covenant on Civil and Political Rights
ICESCR - International Covenant on Economic, Social and
Cultural Rights
CEDAW - Convention on the Elimination of Discrimination
against Women
CRC - Convention on the Rights of the Child
ICERD - International Convention on the Elimination of All
Forms of Racial Discrimination.
CPRMWMF - Convention for the protection of the rights of
migrant workers and members of their families
HRC - Human Rights Committee
CEDAW - Committee on the Elimination of Discrimination
against Women
SR - Special Rapporteur
UNICEF - Children's Fund, United Nations
UNFPA - United Nations Population Fund
WHO - World Health Organization
UNGASS - United Nations General Assembly Special Session

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Introduction
“Systematic discrimination based on
gender impedes women’s access to
health and hampers their ability to
respond to the consequences of ill health
for themselves and their family” The
Special Rapporteur on Health Paul Hunt1
.
The recent years proved that health and economic
development are closely interdependent Women and
newborns health should be in the central focus of the society
development and the fact that thousands women around the
world continue to die from preventable pregnancy-related
causes is human rights violation, including the right of
everyone to the enjoyment of the highest attainable standard
of physical and mental health. Improving maternal health is
one of the important areas of public health, and it is closely
linked to the state of the family, its level of financial security,
living conditions, relations within the family etc.
The concept of “reproductive rights” was first enshrined in the
Program of Action adopted at the International Conference on
Population and Development (Cairo, 19942
) and was further
developed in the Report of the Fourth World Conference on
Women3
and the Platform for Action adopted by the
Conference.
According to these documents, reproductive rights embrace
human rights recognized in national and international legal
instruments and other human rights documents including:
 All couples and individuals have the basic right to
decide freely and responsibly the number and spacing
1
E/CN.4/2003/58 Report of the Special Rapporteur, Paul Hunt, submitted in
accordance with Commission resolution 2002/31, 2003
2
The Program of Action of the International Conference on Population and
Development (Cairo, September 1994) - Principe 8, 7.3.
3
The Declaration and the Platform for Action of the Fourth World Conference on
Women (Beijing, September 1995) - Platform, pp.95, 97, 216, 223 (cited in 107).

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of their children and to have the information, education
and means to do so;
 the right to attain the highest standard of sexual and
reproductive health;
 The right to make decisions concerning reproduction
free of discrimination, coercion and violence.
The present analysis was conducted from June to October
2012 and includes the analysis of international human rights
treaties and national legislation of the Republic of Tajikistan in
the field of the right to reproductive health.
The main objective of the analysis is to determine if the
Government applies the rights-based approach in the
development of public policy in accordance with international
human rights standards to identify and address the legal,
policy and regulatory barriers to women's access to quality
health care. The analysis is based on a review of public
policies and legal instruments in the field of reproductive
health rights in accordance with international obligations
assumed by the Republic of Tajikistan.
The concept of “reproductive rights” is used in the analysis as
an analytical tool to determine compliance between the current
legislation of the Republic of Tajikistan on access and the
protection of reproductive health of the citizens, international
standards and international obligations assumed by the State.
In the course of the analysis the main focus was given to the
following three key principles: participation, non-discriminatory
approach to program development or implementation of
policies, accountability mechanisms.
Considering the reproductive rights within the context of the
right to the highest attainable standard of physical and mental
health, the analysis considered the following interrelated items:

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- Availability and accessibility of a sufficient number of
functioning health facilities, goods and services, and programs
to realize the right in this sphere.
- Access to information, which includes the right to seek,
receive and impart information on sexual and reproductive
health. At the same time, the availability of information should
not violate the right to privacy of personal health information
and access to qualified medical care.
- Protection from discrimination: facilities, goods and
services in the sphere of health care should be available
without discrimination to all, especially the most vulnerable
and marginalized groups, teens and young people: women
victims of violence and abuse, women working in the sex
industry, out of school youth, people living with HIV, LGBT,
refugees and etc.
The monitoring group expresses its deep appreciation to the
Executive Director of the Alliance of Tajik family planning, Ms.
Mohsharif Nasrulloyev, Deputy Director of the National Center
for Reproductive Health, Ms. Gulnora Akhmedjanova, Director
of the NGO “Nasl” Ms. Orzu Ganieva, Executive Director of the
NGO “Chashmai hayot” Ms. Rafoat Boboeva, lawyer of the
Isfara branch of the Human Rights Center Ms. Nargis Burieva,
the employees of the Netherlands Helsinki Committee, Mr.
Henk Hulshof, Mr. Jan de Vries, Ms. Kirsten Hawlitschek, and
Ms. Kamala Laghate for the providing information and
assistance in preparing the analysis. Also we express our
gratitude to the Ministry of Health of the Republic of Tajikistan
and the Ministry of Finance of the Republic of Tajikistan for
submitting written responses on the inquiries of the monitoring
group.

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1. APPLYING HRBA IN FORMULATING NATIONAL
POLICIES
An approach based on human rights marked a new approach
to development. Consideration of the development as a set of
human rights that must be implemented, suggests the
following principal characteristics of human rights4
.
Universality
Human rights belong to everyone, everywhere and at all times,
regardless of state borders. “All human beings are born free
and equal in dignity and rights” 5
. The universality of human
rights differs from other acquired rights such as citizenship. In
this sense, human rights are “inalienable - can not be taken
away or voluntarily given”.
Non-discrimination and equality
“All persons are entitled to all human rights and fundamental
freedoms, ... despite such differences as race, color, sex,
language, religion, political or other opinion, national or social
origin, property, birth or other status”. It is important to note
that in the search for equality, the state should have the
programs that prove the implication of these rights, in order to
bring the equality in traditionally marginalized or vulnerable
groups. Equity in development sometimes requires to take
affirmative action in order to diminish or eliminate conditions
that perpetuate discrimination.
Indivisibility
Rights are indivisible and must be considered holistically.
Some rights cannot be classified as being more important than
others. For example, we cannot negotiate with a group to
acquire some rights while forgetting about the others. The
4
United Nations Philippines. Rights-Based Approach to Development Programming:
Training Manual. July 2002, p. 31
5
Universal Human Rights Decloration.

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holistic idea of the rights - is that they should be provided. In
other words, there is an obligation to provide these rights to
their holders. Using a rights-based approach to development,
we can set priorities for the implementation of human rights.
Interdependence and interrelatedness
Human rights are so inextricably intertwined that the absence
of one affects the presence of others. The right to education
affects the right to work and the right to the highest attainable
standard of health, and vice versa. This principle helps us to
relate the deep causes of the problems with the symptoms of
the problem.
Participation
Participation is a very important principle stated in the first
article of the UN Declaration on the Right to Development.
This means that everyone has the right freely to fully
contribute to, participate in and enjoy the political, economic,
social and cultural development of their communities6
. The
right to participate must be protected and guaranteed by the
state.
Rule of law
Rights should be protected by strong legislative base and
independent judiciary to ensure the validity of the law and its
equal application to all people.
Accountability
All people have rights and are called rights holders. People
or entities which are required to provide and ensure these
rights are called duty bearers. The main duty bearers are the
states that are responsible for the protection of human rights
and to ensure access to these rights. For its activities in
6
Ljungman, Cecilia M.,COWI. Applying a Rights-Based Approach to Development:
Concepts and Principles, Conference Paper: The Winners and Losers from Rights-
Based Approaches to Development. P. 15.November 2004

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protection and enforcement of human rights, State is
accountable not only to its citizens but also to the international
community.
In this regard the Special Rapporteur on the right of everyone
to the enjoyment of the highest attainable standard of physical
and mental health, Paul Hunt had developed certain indicators
for using the rights based approach to health care , which
includes the following factors:
- A national strategy and plan of action that includes the
right to health. Because the right to health demands
that a State has a strategy and plan of action that
encompasses the right to health, including universal
access, indicators are needed to measure this
essential feature;
- The participation of individuals and groups, especially
the most vulnerable and disadvantaged, in relation to
the formulation of health policies and programs.
Because participation is an essential feature of the
right to health, indicators are needed to measure the
degree to which health policies and programs,
including the quality control of services, are
participatory;
- Access to health information, as well as confidentiality
of personal health data. Because access to health
information is an essential feature of the right to health,
indicators are needed to measure the degree to which
health information is available and accessible to all.
Health information enables people to, inter alia,
promote their own health and claim quality services
from the State and others. Clearly, other essential
features of the right to health, such as meaningful
participation, depend upon the accessibility of reliable
information on health issues. Additionally, because of
the requirements of confidentiality regarding personal

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health data, indicators are also needed to measure the
degree to which such confidentiality is respected;
- International assistance and cooperation of donors in
relation to the enjoyment of the right to health in
developing countries. The right to health places an
obligation on developed States to take measures that
help developing countries realize the right to health.
Thus, indicators are needed to measure the degree to
which donors are fulfilling this responsibility;
- Accessible and effective monitoring and accountability
mechanisms. Because the right to health requires that
all those holding right to health duties are held to
account for their conduct, indicators are needed to
measure the degree to which accessible and effective
monitoring and accountability mechanisms are
available.7
Thus, human rights-based approach helps to resolve the root
causes of poverty through equitable distribution of resources
among the population, including vulnerable groups. The right
based approach requires paying special attention to the most
disadvantaged people and communities; it requires active and
well-versed participation of individuals and communities in
decisions that affect their communities, and the adoption of
effective, transparent and accessible monitoring and
accountability mechanisms. The cumulative effect of these and
other aspects of the right based approach is to create
favorable living conditions for all segments of the population.
7
E/CN.4/2006/48 Report of the SR on the right of everyone to the highest attainable
standard of physical and mental health, Paul Hunt, 3 March 2006

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2. BRIEF SUMMARY OF THE SITUATION WITH THE
RIGHT TO REPRODUCTIVE HEALTH IN THE
REPUBLIC OF TAJIKISTAN
The Republic of Tajikistan in cooperation with external donors
has developed and implemented the National Strategy for
Poverty Reduction, which includes the implementation of
incremental health and social as well as economic measures
to improve the health of the population.
While during the Soviet Union time, Tajikistan in terms of
health conditions was referred to a number of countries with
the average indicators, for the past several years of
independence, the situation has changed. Although the
maternal and infant mortality had been declined in recent
years the numbers remain fairly high. According to the Ministry
of Health of the Republic of Tajikistan infant mortality rate in
2009 made 17.7 per 1,000 live births. Most alarming is the
state of maternal health. Diseases complicating pregnancy,
are observed in 68% of cases (including anemia, urinary tract
infections, the pathology of the endocrine system, the veins,
the circulatory system, etc.). According to the Ministry of
Health in 2011, the maternal mortality rate was reduced from
46.5 in 2009 to 37.0 per 100 000 live births8
.
One of the main reasons for the high rate of maternal mortality
is the inadequate quality of services in the field of reproductive
health, lack of a functioning referral system, transportation,
especially in rural areas, lack of education and skills of health
workers, as well as the low level of awareness among women.
Insufficient attention from the government and society to these
issues is the result of the fact that all the measures taken to
reduce maternal and infant mortality are scattered and do not
8
А.Зуев: Заботясь о здоровье женщины, мы заботимся о будущих поколениях,
НИАТ Ховар, 13.07.2012 http://www.khovar.tj/rus/society/33729-azuev-zabotyas-o-
zdorove-zhenschiny-my-zabotimsya-o-buduschih-pokoleniyah.html

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take into account the socio-economic and cultural factors that
influence the growth of such indicators.
Greater concern is the weak preventive measures, including
education and awareness raising on issues of mother and
child health care, lack of criteria for referral of pregnant women
from the primary to the secondary and tertiary levels, low
quality of emergency care and its failure to provide aid, weak
approach to family planning in rural areas, which in its turn
may lead to further growth of these parameters.
The most significant risk is an acute shortage of qualified
medical personnel as a result of labor migration and the low
level of knowledge among the existing medical personnel.
Deteriorating state of the infrastructure, old buildings,
communication, equipment in hospitals and other medical
facilities.
A recent study conducted by UNICEF in 2012, in Sughd and
Regions of Republican Subordination revealed that 43.5% of
all neonatal deaths were the result of poor prenatal care,
despite the fact that 77% of mothers of diseased children
received some prenatal care during the pregnancy. The
indicators of factors related to poor prenatal care at Dushanbe
and Khatlon region made 32% of neonatal deaths9
.
This study revealed a negative impact of the poor care during
pregnancy and childbirth at home by untrained personnel on
the infant mortality rate. It was also clear, however, that
although majority of parents would seek outside help for their
child, they were impeded by unsatisfactory level of medical
institutions, as well as financial and transportation problems.
9
Infant Mortality in Tajikistan: Two studies on the analysis of risk factors. UNICEF -
Tajikistan Digest Research number of children 4, 2012
http://www.unicef.org/tajikistan/Article_4_RUS.pdf

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The UN Special Rapporteur on the Right to Health, Anand
Grover, following his visit to the country from 24 to 31 May
2012 called on the Tajik government to increase spending on
health care in order to ensure universal access to health care
for all. He noted main problems in the Tajik health care system
like: poor financing of the sector, pocket and informal
payments, low salaries of physicians, the outflow of highly
skilled professionals, and a lack of legal mechanisms to
protect the rights, including compensation for incorrect
diagnosis and medical errors. “The Tajik authorities have
made efforts to increase the costs of health care: from 2007 to
2012, government funding has been increased by more than
400% - from 178 million Somoni (37.3 million dollars) to 716
million Somoni (152.3 million U.S.). Despite this, the current
financing is too low, for example, in 2010, it was below the
average in the former Soviet republics (5.9%)”- ,mentioned the
Special Rapporteur, adding that during that period the average
for developing countries in Europe and Central Asia was
around 10%.10
10
Спецдокладчик ООН призвал Таджикистан увеличить расходы на медицинское
обслуживание, Азия Плюс 31/05/2012 http://news.tj/ru/news/spetsdokladchik-oon-
prizval-tadzhikistan-uvelichit-raskhody-na-meditsinskoe-obsluzhivanie

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3. INTERNATIONAL STANDARDS IN THE FIELD OF
REPRODUCTIVE HUMAN RIGHTS
Right to reproductive health was reflected in the following
international documents:
1. The Universal Declaration of Human rights states that:
“Everyone has the right to a standard of living adequate for the
health and well-being of himself and of his family ….”11
.
2. The International Covenant on Economic Social and
Cultural Rights recognizes “the right of everyone to the
enjoyment of the highest attainable standard of physical and
mental health”, the state parties are committed to take
appropriate steps “for the reduction of the stillbirth-rate and of
infant mortality and for the healthy development of the child”
and “creation of conditions which would assure to all medical
service and medical attention in the event of sickness”12
3. The Convention on the Elimination of Discrimination against
Women (CEDAW) called “to eliminate discrimination against
women in the field of health care in order to ensure, on a basis
of equality of men and women, access to health care services,
including those related to family planning”13
. The CEDAW
Committee further called the member state to remove “all
barriers to women's access to health services, education and
information, including in the area of sexual and reproductive
health”14
.
4.Child Rights Convention “States Parties recognize the right
of a child who has been placed by the competent authorities
for the purposes of care, protection or treatment of his or her
physical or mental health, to a periodic review of the treatment
provided to the child and all other circumstances relevant to
11
Art. 25 (1) UDHR
12
Art 12 ICESCR
13
Art. 12 (1) CEDAW
14. Women and health : . 05.02.1999.CEDAW General recom. 24. (General
Comments

16
his or her placement”15
, as well as to ensure “access to
information and material from a diversity of national and
international sources, especially those aimed at the promotion
of his or her social, spiritual and moral well-being and physical
and mental health”16
.
The International Convention on the Protection of
the Rights of All Migrant Workers and Members of
Their Families ensures the right for “equal access
to social and health services, provided that the
requirements for participation in the respective
schemes are met”17
.
The right to reproductive health is in the focus of attention of
the UN Special Rapporteur on the right of everyone to the
enjoyment of the highest attainable standard of physical and
mental health. As it was mentioned in the SD report on the
right of everyone to the enjoyment of the highest attainable
standard of physical and mental health“ Underpinned by the
right to health, an effective health system is a core social
institution, no less than a court system or political
system”.18
In addition to the treaty bodies documents there is also a large
number of international declarations and other instruments of
soft law, that also recognize the right to reproductive health.
These include:
- The Vienna Declaration and Program of Action
adopted by the World Conference on Human Rights in
1993, which recognizes the importance of ensuring
“the highest attainable standard of physical and mental
health throughout their lives” for women.
15
Art. 24 CRC
16
Art 17 CRC
17
Art 44 ICPRMWMF
18
E/CN.4/2006/48 Report of the Special Rapporteur on the right of everyone to the
enjoyment of the highest attainable standard of physical and mental health, Paul Hunt*
3 March 2006

17
- The Millennium Declaration, adopted at the Millennium
Summit in 2000, which includes the provision for
reduction of maternal mortality and achieving universal
access to reproductive health care system.
In 2001, the World Health Organization adopted its Strategy
which declared the right to health as a fundamental human
right. In line with the strategy of "everyone has the right to the
best attainable state of physical and mental health. Member
States shall take all necessary measures to ensure - on the
basis of equality of men and women - universal access to
health care services, including reproductive health, as well as
family planning and sexual health”.
The significant impact of the development of reproductive
rights had the documents of the international conferences on
population and development (Bucharest, 1974, Mexico City,
1984, Cairo, 1994), materials of the World Conference on
Human Rights (Vienna, 1993), as well as the materials of the
World Conference on Women (Beijing, 1995). In particular, the
invaluable contribution in the field of reproductive health and
family planning has made a UN International Conference on
Population and Development (Cairo, 1994), where for the first
time the States recognized the need for legislative formulation
of the principles of reproductive health at the level of the
national legislation of the Member States. States parties have
committed to provide universal access to information and
services on reproductive health by 2015. 19
Rights related to reproductive health include (among others):
the right to life, right to development, right to the highest
attainable standard of health, right to education and
19
Annual UNFPA report for 2004
http://unfpa.org/webdav/site/global/shared/documents/publications/2005/annual_report
04ru.pdf

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information, as well as the right to protection from
discrimination.
The Republic of Tajikistan is a member of almost all universal
international human rights treaties, including the Convention
on the Elimination of All Forms of Discrimination against
Women (CEDAW), the Convention on the Rights of the Child,
the International Covenant on Economic, Social and Cultural
Rights, the International Covenant on Civil and Political Rights
and the international Convention on the Elimination of All
Forms of racial Discrimination.
Thus, the Government should ensure that the national
legislation, policies and practices are consistent with their
obligations under international law and that the State respects,
protects and fulfills the right to health and other human rights.
This includes the adoption of appropriate legislative and other
measures, as well as modifying or abolishing existing laws,
regulations, customs and practices which constitute
discrimination against women.
According to its international obligations, the Government of
Tajikistan had submitted reports to the UN treaty bodies, and
received the following recommendations:
Committee on Economic, Social and Cultural Rights
November 26, 2006 20
35. The Committee is concerned that the annual Government
expenditure on public health has been in sharp decline in
recent years, from 6 per cent in 1992 to 1 per cent in 2006,
despite the rise in GNP. The Committee is in particular
concerned that the lack and the poor quality of public health
facilities may impact negatively on low-income groups and the
20
Concluding observations of the CESCR Tajikistan,. E/C.12/TJK/CO/1, 24/11/2006

19
rural population.
36. The Committee is deeply concerned about the high
mortality rate of children and mothers, which is the highest
among OSCE countries, and the decrease in life expectancy.
68. The Committee urges the State party to take all effective
measures to combat the high mortality rate of children and
mothers and improve child and maternal health, inter alia
through measures aimed at introducing sexual and
reproductive health related education and information,
including family planning. The Committee also recommends
the State party to take steps to improve access to sexual and
reproductive health services, including hygienic conditions in
hospitals, pre- and post-natal care, and emergency obstetric
services.
Committee on the Elimination of All Forms of
Discrimination against Women (CEDAW), 200721
31. While noting the various efforts made by the State party
to improve reproductive health care for women, including
through the National Reproductive Health Strategic Plan
(2005-2014) and other plans, the training of birth assistants in
the rural areas through the establishment of new networks for
family planning and reproductive health services and the 2006
Law on breastfeeding, the Committee is seriously concerned
about the limited access to adequate health-care services for
women, especially women in rural areas. It is concerned about
the high maternal and infant mortality rates, the low
contraceptive prevalence rate and the reported lack of
knowledge of young girls about HIV/AIDS
32. The Committee recommends that the State party
continue, with the assistance of international agencies if
necessary, to take measures to improve women's access to
general health care, and reproductive health care, services in
particular. It calls on the State party to increase its efforts to
21
Concluding observations of the CEDAW Committee: Tajikistan,
CEDAW/C/TJK/CO/3, 2/02/ 2007

20
improve the availability of sexual and reproductive health
services, including family planning, to mobilize resources for
that purpose and to monitor the actual access to those
services by women. It further recommends that family planning
and reproductive health education be widely promoted and
targeted at girls and boys, with special attention to the
prevention of early pregnancies of girls in underage marriages
and the control of sexually transmitted diseases and
HIV/AIDS.
The Committee requests the State party to include in its next
report further information, especially trends over time and
covering the life cycle of women, on: women's general and
reproductive health, including the rates and causes of
morbidity and mortality of women in comparison with men, in
particular maternal mortality; contraceptive prevalence rates;
spacing of children; diseases affecting women and girls, in
particular various forms of cancer; and updated information on
the efforts of the State party to improve women's access to
health-care services, including family planning and services
directed towards cancer prevention and treatment. It also
requests the State party to include information about
monitoring and evaluation mechanisms in place for health-
related strategies.
Committee on Child’s Rights, 201022
Adolescent health
54. The Committee notes that the State party is planning
to expand the youth-friendly health services. The
Committee also notes the information provided by the
delegation during the dialogue that under current
legislation adolescents below the age of 16 cannot seek
confidential information and services for sexual and
reproductive health. The Committee regrets that there is
no comprehensive study conducted about the barriers to
access sexual and reproductive health information.
22
Concluding observations of the CRC. Tajikistan CRC/C/TJK/CO/2, 5.02.2010

21
Furthermore, the Committee is concerned at the
increasing use of alcohol and drugs among adolescents
and the limited efforts made to provide them with
adequate treatment and rehabilitation.
55. The Committee recommends that the State party:
a) Adopt legislation to allow adolescents to seek
information and services for sexual and
reproductive health;
b) Provide sustainable funding to youth friendly
health services and adopt a comprehensive
strategy for the implementation and monitoring of
these services;
c) Take appropriate measures to address effectively
the situation of adolescents using alcohol and
drugs and to provide them with adequate medical
and psychosocial services;
d) Seek cooperation with, inter alia, UNICEF, WHO,
and others.

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4. NATIONAL POLICY IN THE SPHERE OF
REPRODUCTIVE HEALTH
The Government of the Republic of Tajikistan has made
significant efforts to promote women's reproductive rights
through the adoption of programs and policies designed to
respect and protect the internationally agreed human rights
standards, including:
- Strategic Plan for Reproductive Health of the
population until 2014
- Strategic Plan for Safe Motherhood
- Strategy of the Ministry of Health of Tajikistan for safe
abortion
- State Program “Basic directions of state policy to
ensure equal rights and opportunities for men and
women in the Republic of Tajikistan for 2001-2010”
- The concept of state demographic policy of the
Republic of Tajikistan for 2003-2015.
- National Strategy for enhancing the role of women in
the Republic of Tajikistan for 2011 - 2020
- National Development Strategy of the Republic of
Tajikistan until 2015
- Program on HIV / AIDS in the Republic of Tajikistan for
2011-2015
- The National Strategy for the development of child and
adolescent health for the period up to 2015
- The national program of a healthy lifestyle in the RT-
2020 in 2011
- National program for the prevention, diagnosis and
treatment of malignant tumors in the RT 2010-2015
- The program of state guarantees to ensure the health
of the population by the pilot areas of the Republic for
Tajikistan for 2010-2011.;

23
In the framework of the Millennium Development Goals the
Government of Tajikistan has set the following objectives:
1. Reduce by two thirds the mortality rate among children
under the age of 5 years (reduced by 2/3do 2015)
2. Reduce by three quarters the maternal mortality rate
(70 per 100 000 live births in 2015)
In order to achieve these objectives, the Government has
developed certain policies, strategies, plans, and programs to
reduce maternal mortality, including better access to
professional care during childbirth, family planning, reducing
early marriage, etc. In 2004, the Strategic Plan was adopted
by the Republic of Tajikistan on reproductive health for the
period up to 2014
Strategic plan for reproductive health for the years 2005-
2014 (SPRH) was adopted under the Governmental Decree #
384 from 31 August 2004. The document identified the
following priorities for improving maternal health for the period
2005-2014:
 Improve the quality of and access to essential health
care services (including family planning, provision of
contraceptives, antenatal and post-natal care);
 Improving access to antenatal care and safe delivery
services;
 Reduce morbidity and mortality during pregnancy and
improving perinatal outcomes.
The document proposes a number of measures to strengthen
health care systems and improve the delivery of services:
 Improve the quality of and access to essential services
(including family planning, contraception, prenatal and
delivery care);
 Integration of reproductive health services into primary
health care;
 Development of adequate human resources;

24
 Improved information and communication and
educational activities.
These efforts have contributed to the approval of the National
Plan of Action for Safe Motherhood until 2014 in the Republic
of Tajikistan. The main objective of this plan is to reduce
maternal and neonatal mortality by improving access to safe
services and emergency obstetric care, which includes:
 The development of normative legal documents on
safe motherhood and neonatal care;
 To build capacity for the sound management of
maternity services, including emergency obstetric care;
 To improve the infrastructure of health facilities
(reconstruction, basic medicines and equipment);
 To strengthen social mobilization for improving access
to high quality health services for women and children;
 Develop a monitoring and evaluation system.
.
In the frame of the Concept of the health care reform for
improving and optimizing health care services for the
population, including adolescents and young people, the
Ministry of Health of the Republic of Tajikistan issued a decree
“On improvement of services in the field of reproductive health,
the Republic of Tajikistan” (# 643 from 5.12.2005).
At the same time, the mechanism for the implementation of
these standards was fully developed, and not enough attention
was paid to the financing of the intended goals.
Successful implementation of the Strategic Plan for
Reproductive Health largely depends on the cooperation
between responsible agencies with other related governmental
policies and programs in this area. Lack of linkages and
coordination between individual programs negatively affect the
implementation of governmental policies in the area of access
to reproductive rights. The analysis of the adopted programs

25
showed that many of these programs have no interaction with
SPRH. While developing new program, the Government does
not take into the issues that are already affected by the
Strategic Plan for Reproductive Health, and which have
already been implemented in practice.
For example, the State Program to combat HIV / AIDS in
Tajikistan for 2011-2015 contains issues concerning
reproductive health however there are no references to
interact with Strategic Plan for Reproductive Health. This is the
same for other programs such as the “Concept of the state
population policy in the Republic of Tajikistan for 2003-2015”,
despite the fact that according to the Strategic Plan for
Reproductive Health this program should be supplemented
and revised; the “National Program for Healthy Lifestyles in
Tajikistan in 2011-2020”, “The program of state guarantees to
ensure the public health care for the pilot districts of RT for
2010-2011”, "The state safeguards to ensure public health
care for the pilot districts of Tajikistan for 2008-2010” and
“Poverty Reduction Strategy RT 2007-2009, and 2010-2012”.
The only exception is the National program for prevention,
diagnosis and treatment of malignant tumors in the RT for
2010-2015, which addresses issues of interrelation with other
programs, which also includes the study document (Strategic
Plan for Reproductive Health).
Thus, most of the strategic documents developed by the
Government of Tajikistan in the field of reproductive health are
not consistent, thus affecting the efficiency of the measures
taken under those policies.

26
5. NATIONAL LEGISLATION OF THE REPUBLIC OF
TAJIKISTAN IN THE FIELD OF REPRODUCTIVE
RIGHTS
Over the last decade, the Government of the Republic of
Tajikistan has taken a series of effective steps to bring national
legislation in line with international standards of human rights,
including in the area of reproductive rights.
The Constitution guarantees the rights and freedoms of every
person, regardless of nationality, race, sex, language, religion,
political beliefs, education, social status, wealth, equality of
men and women and the right to free health care for all
citizens in public institutions. The Law of the Republic of
Tajikistan “On protection of public health” provides that
“motherhood is under the special protection of the state.
Women are provided with special conditions that allow
combining work and motherhood, including legal protection,
material and moral support of motherhood. Every woman in a
period of pregnancy, during and after childbirth is provided by
medical assistance in the institutions of public health system.
Woman during pregnancy and the birth of a child is eligible for
benefits and paid leave. Woman is given the right to decide
individually the question of motherhood. In order to protect the
health of a woman at her request she may be recommended
modern contraceptive (birth control), the means and methods
for prevention of unwanted pregnancy. The procedure of
contraceptive provision is determined by the Ministry of Health
of the Republic of Tajikistan. Abortion, including for social or
medical reasons, carried out at the request of a woman within
the terms stated by the Ministry of Health of the Republic of
Tajikistan in coordination with the Ministry of Justice of the
Republic of Tajikistan23
23
art. 33 of the Law “On protection of the health of the population”

27
In 2002, the Government adopted the Law of the Republic of
Tajikistan “On Reproductive Health and Reproductive Rights”,
which sets a framework and procedures for the regulation of
relations in the field of reproductive health and reproductive
rights. The law recognizes the right of men and women to be
informed and to have access to safe, effective and acceptable
methods of family planning and fertility, prevention of sexually
transmitted diseases. Another important aspect to the
advancement of social and economic rights of women in
Tajikistan was the adoption of the Law “On State Guarantees
of Equal Rights for Men and Women and Equal Opportunities
for their realization” in 2005.
Besides, reproductive rights are also regulated by the Family
Code of the Republic of Tajikistan, which is an institutional
document which regulates and protects the rights of citizens in
family relationships. In accordance with the provisions of the
Family Code the issues of parenthood, upbringing and
education of children and other family matters are resolved
jointly by the spouses on the basis of the principle of equality
of spouses (art.32 FC RT), for securing healthy population for
future generations of Tajikistan it is prohibits the entry into
marriage with close relatives (art. 14 FC RT), it provides for
the opportunity to undergo a medical examination of persons
entering into a marriage, as well as consultations on health
matters and genetic improvement of the family, which are
provided by the public health agencies for free, and only with
the consent of the parties getting into the marriage. The
survey’s results are confidential and can be communicated to
others party only upon receiving the consent of the person that
has passed the examination. Also, these norms provide for the
right to legal protection in the event of failure to provide
information about the presence of venereal disease or
Acquired Immune Deficiency Syndrome (AIDS) in one of the
spouse (art.15 FC of RT).

28
Equally important for the protection of the rights of women and
the provision of social guarantees is the Labor Code of RT and
the Law “On protection of labor”. These regulations include
measures for the protection of pregnant and nursing mothers;
extended time for maternity leave (total - 140, and in
complicated births – 156 days, at the birth of two or more
children - 180 calendar days); paid national insurance,
provision of paid leave to care for a child up to the age of 1.5
years and an additional, unpaid leave to care for a child up to
the age of 3 years, etc. (Chapter 12 LC RT “Additional
safeguards for women and those with family responsibilities”)

29
6. GAPS AND INCONSISTENCIES IN THE NATIONAL
POLICY AND REALIZATION OF THE STRATEGIC
PLAN
The Strategic Plan for Reproductive Health separately and
sufficiently considers the interests of women and children. The
Strategic Plan for Reproductive Health recognized that gender
inequality affects the health of women, limits their abilities to
achieve best attainable state of physical and mental health,
and that “gave rise to the development of country-specific
Strategic Plan of the Republic of Tajikistan on reproductive
health”.
In line with the Strategic Plan for Reproductive Health, policies
and national legislation in the field of reproductive health are
based on the following international instruments:
 Convention on the Rights of the Child.
 The Vienna Declaration and Program of Action on
Human Rights.
 Recommendations of the International Conference on
Population and Development
 Platform for Action of the Fourth World Conference on
Women.
Although there is a link to “other documents” in the SPRH,
there is no clear listing of other documents in the field of
human rights, including such important documents as the
International Covenant on Civil and Political Rights and the
International Covenant on Economic, Social and Cultural
Rights.
Availability and accessibility of adequate number of
functioning health care facilities, goods and services, as well
as programs for realization of this right. In its concluding
observations, the UN Committee on Human Rights
recommended that the Republic of Tajikistan “to take steps to

30
improve access to sexual and reproductive health services,
including hygienic conditions in hospitals, pre- and post-natal
care, and emergency obstetric services” 24
and “to take
measures to improve women's access to general health care,
and reproductive health care, services in particular”25
.
In the development of the Strategic Plan the Government of
the Republic of Tajikistan relied on the norms of international
instruments signed and ratified by the country. Thus, in line
with the strategic plan objectives the main goal of the plan is to
improve the reproductive health of the population based on the
recognition of reproductive rights for men and women to be
informed and to have access to safe, effective, affordable and
acceptable methods of family planning and reproduction, as
well as prevention of sexually transmitted diseases26
.
In the area of access to reproductive health the Strategic Plan
for Reproductive Health main objectives are to ensure the
provision of comprehensive information and a wide range of
affordable, efficient, affordable, acceptable services in the field
of reproductive health and family planning, taking into account
the characteristics of vulnerable groups.
Access to reproductive health care services (clinics, antenatal
clinics, maternity homes, medical supplies, availability of
qualified staff) for all segments of the population.
The strategy does not sufficiently disclose the concept of
vulnerable groups. This is especially relevant today, as the
category of vulnerable populations supplemented by
increasing migration rate among the population and of various
social trends (for example, labor migration is the cause for
24
Concluding observations of the CESCR Tajikistan,. E/C.12/TJK/CO/1, 24/11/2006
25
Concluding observations of the CEDAW Committee: Tajikistan,
CEDAW/C/TJK/CO/3, 2/02/ 2007
26
Chapter 4 of the SPRH

31
emerging of such groups as households dependent on
remittances from migrant workers, abandoned or left behind
wives of migrants, polygamous marriages lead to the
appearance of the second, third and subsequent wives and so
on.). Also, the Strategic Plan does not take into account the
differential approach to rural and urban populations and their
access to services. This in turn adversely affect the safe
access to services for women living in remote areas, women
that are living in different from their registration areas, internal
migrants who are not staying at their residence, women living
in rural areas and who were forced to go to the city for medical
services, women who do not have identification documents,
and children without a birth certificate. According to paragraph
3 of Order of delivering health care services to the citizens of
Tajikistan “the basic condition for the provision of free health
care to the population of the Republic of Tajikistan is the
presence of the family doctors, local therapist, pediatrician,
obstetrician gynecologist, territorial health care facilities, and
conclusion of medical control Commission”. However all
mentioned documents are issued according to residential
registration of the citizen. According to the Program of State
guarantees for public primary health care for 2012-2013
“Citizens who do not have a referral from family physicians,
primary care physicians, pediatricians and obstetrician -
gynecologists should cover the cost of specialized care,
including laboratory and diagnostic studies according to a
price list approved by the Ministry of Health of the Republic of
Tajikistan and the Antimonopoly Service of the Government of
the Republic of Tajikistan in accordance with established
procedure. (§ 1/4). All of the above suggests that even if the
citizens are entitled to preferential treatment in accordance to
their social status, without the registration and without
documents, they do not get it. This dramatically reduces the
access of the population, especially women and children to
quality health care. Further, even in the place of residence it is
not always possible to obtain the necessary medical

32
assistance specialist. Thus, “in the absence of needed health
specialist in the health facilities of a specified areas and the
conditions for certain types of laboratory and diagnostic
studies, these type of consultations and examinations can be
conducted in other health care settings, with settlements
between the health care agencies on the basis of contracts” (
§ 1/4 Programs of State guarantees for public primary health
care for 2012-2013.). Any distance, especially in remote rural
areas are associated with the problem of transport and its high
cost to the poor, which also affects the accessibility to health
services.
While talking about alternative scientific methods of family
planning, the art. 19 of the Law “On Reproductive Health and
Reproductive Rights” provides that the list of professional and
medical evidence on which the government guarantees the
free provision of services for the storage of gametes,
established by the Government of the Republic of Tajikistan.
However, there is no information about the implementation of
these provisions of the law
The procedure and conditions of donation, vitro fertilization
and embryo transfer are established by the Ministry of Health
of the Republic of Tajikistan (Article 38 of the Law "On
protection of public health"). Despite the fact that Tajikistan
has the experience of artificial insemination, there is no
information about relevant regulations governing these issues.
Access to the acceptable methods of family planning. One of
the activities scheduled within the Strategic Plan, is to “ensure
contraceptive resources to provide services in the field of
reproductive health” and “the development of regulations on
preferential and free supplies of methods and means of
contraception”. These obligations are also enshrined in the
Law of RT "On Reproductive Health and Reproductive Rights",
in accordance with Article 3 it provides for “accessibility to the

33
public of safe contraceptive methods and reduced-price or free
provision of contraceptive methods in accordance with
established procedures. However, public access is limited yet
on the stage of development and adoption of legal acts. The
Ministry of Health regulation27
does not contains the
responsibility for discounted or free supply of contraceptives.
Furthermore the Program of the State guarantees to provide
the population health care in the pilot areas of Tajikistan for
2012-201328
states that "the primary health care is the main
type of health care and is free of charge in the following types
and amounts: a) prevention: in the field of reproductive health
and family planning (one of the types of care)."
There is no list of assistance types in the field of reproductive
health, for example, it is not clear whether this is related to
distribution of contraceptives or no. The law of the country
lacks the provisions on the types of prevention in the field of
reproductive health and family planning. Health care on
preferential terms is valid only in the pilot areas. However, in
the Decree of the Government did not list the pilot areas,
which also limits access to full and accurate information. The
list of medicines freely distributed to the population, means of
contraceptives are not included, the order (distribution of
drugs) is not legally established. Thus, the Law “On
Reproductive Health and Reproductive Rights” there is no
concrete responsible state agency, it does not provide
preferential and free provision of contraception and the order
granting it.
The analytical group sent a written request to the Government
of the RT to provide the text of the “Regulations on preferential
and free provision of contraception methods and tools”,
planned in the frame of the SPRH. The request was also
forwards to the Ministry of Health, which provided the following
27
Adopted of the Government Resolution from 28.12.2006, #603
28
Adopted of the Government Resolution from 03.12.2011 # 2579 .

34
information: “At the present time, all contraception in the form
of humanitarian aid provided by the United Nations Population
Fund and reproductive health centers of the country. In all of
the centers contraceptives are free”. Based on the response
from the Ministry of Health it can be concluded that the
absence of a normative document regulating mechanism for
systematically providing concessional and free of charge
contraceptives, and no allocation of funds from the state
budget for these activities.
According to information provided by the Ministry of Finance,
the State Budget for 2012 to provide reproductive health care
facilities provided 3,734. 4 TJS (for republican institutions -
277.6 TJS and local institutions - 3,456.8 TJS), an 87%
increase in compared with 2011. At the same time, this
amount is not sufficient to implement all the measures
provided in the Strategic Plan for Reproductive Health.
Economic access. In accordance with the objectives of the
Strategic Plan for Reproductive Health services in the area of
reproductive rights should be available to all segments of the
population. At the same time, there are problems when
pregnant women unable to address the antenatal care service
due to lack of money. Financial problems in the family leads to
the fact that one in three women gave birth to children at
home29
.
Inadequate funding for the health sector, the outflow of
qualified personnel have limited access to quality health
services at all levels of pregnancy and childbirth and had
resulted on maternal mortality.
There is a significant deterioration of women's rights observed
in the provision of state guarantees in the field of reproductive
health. Thus, the right to reproductive health is linked including
29
Human Development Report 2000, UNDP http://www.tajik-
gateway.org/index.phtml?id=1504&lang=ru

35
the size of government support, which is not acceptable in its
quantitative terms with the realities of today’s life. This applies
to changes in welfare benefits. Social payments do not meet
the minimum subsistence level, in addition, it has also been
reduced by half after the Law “On the State Budget” was
amended the formulation “indicator for expenditures” which is
a violation of international obligations in the field of socio-
economic rights.
The minimum subsistence level is set by the special Law of RT
“On the minimum cost of living” and includes the cost of living
and the amount of required payments. The consumer basket
consists of a set of food; set of non-food products, a range of
services. The law states that the approximation of minimum
social and labor guarantees in the Republic of Tajikistan to the
subsistence minimum is achieved in stages, taking into
account the economic situation of the Republic of Tajikistan.
At the moment, article 14 of the Law “On State Social
Guarantees” indicates that the one-off payment for the birth of
a child is assigned to the extent: at the birth of the first child -
three indicators for the calculations, while before these
amendments it was: “One time allowance for the birth of a
child is assigned to the extent of the birth of the first child -
three times the minimum wage”. The indicator for the
calculations is twice lower the minimum wage and is currently
40 Somoni, and the minimum wage - 80 Somoni. Article 2 of
the ICESCR provides that “Each State Party to the present
Covenant undertakes to take steps, individually and through
international assistance and co-operation, especially economic
and technical, to the maximum of its available resources, with
a view to achieving progressively the full realization of the
rights recognized in the present Covenant by all appropriate
means, including particularly the adoption of legislative
measures” This means that the state should gradually
increase the guaranteed social benefits, but not reduce them.

36
The article 5 of the Law “On Protection breastfeeding”
provides for the State guarantees for nursing mothers,
including protection of their rights, freedoms and interests of
nursing mothers and their, children ensured by the state
structures. In particular, the law provides for such benefits like
free access to health care services, stores and public
catering, regardless of ownership and departmental affiliation,
free use of a mother and child rooms, related to railway
stations, airports and road transport terminals; free
transportation of infants and young children by air, water, rail,
and public passenger transport. However the law does not
provide free infant feeding for women who find themselves in a
difficult situation that violates the norms of Part 2 of article 12
of the CEDAW, according to which “States Parties shall
ensure to women appropriate services in connection with
pregnancy, confinement and the post-natal period, granting
when necessary, free services, as well as adequate nutrition
during pregnancy and lactation”.
Access to information. Health information allows individuals
and communities to improve their own health, to be active
participants in the health care system, to demand quality
services, to monitor the progress of their rights, to expose
corruption, to call those responsible to account, and so on.
The UN Committee on Human Rights, in its concluding
observations, recommended to the State “to take all effective
measures to combat the high mortality rate of children and
mothers and improve child and maternal health, inter alia
through measures aimed at introducing sexual and
reproductive health related education and information,
including family planning”30
as well as to “adopt legislation to
allow adolescents to seek information and services for
sexual and reproductive health”31
.
30
Concluding observations of the CESCR Tajikistan, E/C.12/TJK/CO/1, 24/11/2006
31
Concluding observations CRC: Tajikistan CRC/C/TJK/CO/2, 5.02.2010

37
In order to ensure access to information the SPRH foreseen
the following tasks:
- Awareness raising among the population on issues
related to pregnancy and childbirth, as well as in the
fight against STIs / HIV / AIDS.
- Increase awareness and educate young people on all
aspects of sexual and reproductive health, and help
them to develop the life skills required for satisfactory
and responsible to address these issues.
- Raising awareness of their rights to independent and
informed choices about the number and timing of
children, effectively promote responsible behavior and
well-being of the family.
In developing the above-mentioned problems the SPRH does
not consider the following aspects:
- Accessibility of information: a) about the programs and
strategies, and b) about free services, and c) about
sexually transmitted diseases, and d) about forced
sexual abuse by spouse.
- Language of the information for the linguistic minority
groups
- Means of communication, according to the level of
education of women
One of the main reasons for the deterioration of reproductive
health of adolescents is their low level of awareness.
Adolescents and young adults account for nearly one-third
(29.9%) of the population in Tajikistan32
. They are an
extremely important group of the population, as they will
largely determine the nature of the country's development in
the coming decades, and this applies equally to the field of
reproductive health. Many young people aged 18 are already
32
Доступ к услугам по охране репродуктивного здоровья (РЗ)
http://lib.ohchr.org/HRBodies/UPR/Documents/session12/TJ/UNFPA-rus.pdf

38
married, and, early marriages are more prevalent among the
poor and less educated populations33
.
The State should ensure and enhance the level of awareness
and education among the population, including young people
on all aspects of sexual and reproductive health, and help
them to develop the life skills required for satisfactory and
responsible addressing of these issues. According to the
document of Cairo Conference sex education should be
conducted in accordance with national traditions and culture of
each country34
.
Article 3 of the Law “On Reproductive Health and
Reproductive Rights”, defines the basic tasks for the public
authorities in the field of reproductive health and reproductive
rights, however it does not name specific body which would be
responsible for the fulfillment of these tasks. In accordance
with art.4 of the Law, the Ministry of Health of the Republic of
Tajikistan leads the services in the sphere of reproductive
healthcare, activities of the republican institutions, public
research and educational institutions involved in the
development of strategies for reproductive health and together
with the executive power is exercised by the control and
coordination of the institutions of the state system of
reproductive health, for the provision of quality health care,
contraceptive assistance in the field of reproductive health
departmental agencies, institutions, private health care system
and is responsible for the condition and development of the
reproductive health service.
33
Ш.Хабибова: Девушкам необходимо до замужества проходить медицинское
обследование, НИАТ Ховар 23.07.2012 http://khovar.tj/rus/society/33848-
shhabibova-devushkam-neobhodimo-do-zamuzhestva-prohodit-medicinskoe-
oыbsledovanie.html
34
Report of the International Conference on Population Development.
A/CONF.171/13/Rev
http://www.unfpa.org/webdav/site/global/shared/documents/publications/2004/icpd_ru
s.pdf

39
Does this mean that only the Ministry of Health is responsible
for carrying out the tasks set out in the art. 3 of the Law? At
the same time, it should be noted that many of the tasks
specified in the Law, for example, development of access to
information of citizens, improving the level of education of
children and adolescents in the area of reproductive health, is
not related to the function of the Ministry of Health, they are
more relevant to the functions of the Ministry of Education. But
the law does not specify the responsibilities of the individual
authorities in the field of reproductive health.
In 2005 the Ministry of Education with the support of UNICEF
developed and adopted the program of “Healthy lifestyle” for 1
- 11 grade schoolchildren of secondary schools. The program
reflects a variety of questions that teachers can cover during
extracurricular activities - hygiene and sanitation, ethics,
infectious diseases, reproductive health, addictions, substance
abuse, communication within the family, at school, among
peers, animals, etc. Since 6th grade, the program includes
issues related to reproductive health.
In 2008, with technical and financial support from UNICEF and
the Global Fund to Fight AIDS, Tuberculosis and Malaria,
according to the National Program on “Healthy lifestyle” were
developed textbooks for students and teachers guide for 7, 8,
9 grades. At the moment the program has been implemented
in 586 schools nationwide (trained teachers and teaching
materials are provided). These activities included not only
teachers, but also non-governmental youth organizations that
provide training for teachers on interactive techniques,
monitored the course and quality of teaching. In 2011, with
technical and financial support of the German Society for
International Cooperation (GIZ) in Tajikistan, were developed
training manuals and handouts for teachers of 5 - 6 grades.
Also, since 2012, with technical and financial support from the

40
United Nations Population Fund was initiated the process of
development of teaching materials on healthy living program
for 10 - 11 grades.35
However, this is not enough, and knowledge about
reproductive health remains poor with a very limited
understanding of how can be prevented sexually transmitted
infections (STIs). Often young people are getting this
knowledge out of educational institutions, which contains
negative, information and is associated with guilt, fear and
disease. Providing young people with quality information and
training regarding sex, equips them with the necessary skills
for the perception of contradictory information. Knowledge
about sex at school - a very important and effective way to
improve young people's knowledge, their attitude and
behavior.
Protection from discrimination. The right to protection from
discrimination suggests that reproductive health services must
be accessible to all population groups (women and men),
including adolescents, unmarried women, minorities, migrants,
refugees and other populations. The Government should
provide protection from discrimination, respect for diversity and
the unique needs of women, men and adolescents in health
care. This means that services must be available to meet the
special needs of both men and women. For example, women
have specific health needs related to their sexual and
reproductive functions. Female reproductive health problems
can arise even before its functioning (girls) and after the
termination of reproductive function (for older women). In
addition, women are susceptible to diseases of other systems
of the body, which can affect and men. However, the progress
of a disease in women is often different due to their unique
35
В Таджикистане создаётся Ресурсный центр по ЗОЖ, НИАТ Ховар
http://khovar.tj/rus/education/32494-v-tadzhikistane-sozdaetsya-resursnyy-centr-po-
sozh.html

41
genetic constitution, the effects of hormones and gender roles.
Thus, the policy of the country should take into account the
characteristics of different groups in order to prevent
discrimination in the exercise of the right to reproductive
health.
Protection from gender discrimination. Gender roles make
women more vulnerable to certain conditions influencing
health, such as for example domestic violence. In this respect,
the freedom to dispose of one’s body is an important part of
women's health. It also points out that the strengthening of
women's rights to health requires a reduction of gender
inequality. In this regard, despite of many years of work by the
Government of the Republic of Tajikistan and the civil society
in promoting equal opportunities for women, discrimination
against women remains widespread. The UN Special
Rapporteur on violence against women, Yakin Erturk noted
that: “About one-third of women in Tajikistan are systematically
subjected to violence in the family”. According to the NGO
Coalition “From equality de juro to equality de facto” in 2010
their 10 crisis centers have addressed by 4415 people,
including 3,946 women. In 599 cases it was necessary to
provide medical care, in 260 cases there was physical
violence, 134 cases of sexual violence, 576 cases of multiple
types of violence. As a result of the violence, in 88 cases was
termination of pregnancy in 44 cases the victims received
middle, and 19 cases severe harm to their health. The existing
legislation does not bring the desired results in the elimination
of violence against women, especially domestic violence,
which is becoming a more common type of offenses against
the life, health and dignity of women, children and other family
members. Unfortunately, in the country there are no special
state institutions dealing with the issues of violence in the
family and that are capable to provide effective protection and
support for victims of domestic violence. The problem of
violence against women is better handled by the non-

42
governmental organizations. For providing assistance for the
victims of violence in Tajikistan are 11 crisis centers (CC),
created by the NGOs and one under the Committee for
Women and Family Affairs, with the support of international
organizations. On the uptake of women in CC in the first place
there are cases of psychological violence. Then follow the
cases of physical and economic violence36
.
Protection against discrimination also includes the right to
freedom of choice in marriage, building and family planning.
This is especially true of minor girls married under pressure
from their parents and relatives. Despite the fact that the laws
of the Republic of Tajikistan is fixed age of marriage from 18
years in practice underage girls to marry against their will.
An equally important factor is the freedom of citizens to
choose whether and when to have children and planning
issues are based on equality, freedom and mutual
responsibility and respect. Forcing a woman to pregnancy or
abortion is prohibited. At the same time, women are often
subjected to various kinds of pressure, which often takes the
form of psychological violence, especially by the husband, in-
laws, parents and other relatives. While for forcing a woman to
have an abortion is criminalized, 37
women often do not have
the right to have an abortion, so devoid of free choice.
Another violation is a compulsion to fulfill marital duties - a
common phenomenon in Tajikistan. According to the “Amnesty
International” report for 2009, 11.1 percent of men admitted
that their wives were forced to commit sexual acts against their
36
Alternative report of non-governmental organizations of Tajikistan to implement the
Convention on the Elimination of All Forms of Discrimination against Women (2012)
37
art. 124 CC RT

43
will, and 42.5 percent of women were told that they had been
abused by their husbands38
Vulnerable groups of the society. The analysis of the Strategic
Plan for Reproductive Health revealed that the policies
developed by the Republic of Tajikistan in the area of
reproductive health do not adequately address the issues of
non-discrimination, in particular against vulnerable groups of
the population. Although there are some provisions in the
Strategic Plan for Reproductive Health to prevent
discrimination against certain vulnerable groups, such as
youth, refugees, migrants39
, however, these tasks do not
include specific measures for their implementation. Another
negative point is that the Strategic Plan for Reproductive
Health does not have mechanisms that would allow the policy
to be more flexible (because of its long-term), and meet the
challenges that emerged after its adoption. Obviously, the
inflexibility of the policy has led to discrimination against
certain vulnerable groups, which began to emerge recently or
a problem that has become more actively discussed in the last
five years. For example, the Strategic Plan for Reproductive
Health does not take into account the needs of vulnerable
groups such as victims of sexual violence, victims of
trafficking, women working in the sex industry, HIV-positive
women in matters of access to reproductive services. These
categories of women, seeking reproductive services also
require special protection, such as the protection of
information relating to their personal data, however the
Strategic Plan for Reproductive Health does not contain
38
Violence, not just a family. In Tajikistan, women suffer from arbitrariness. Report of
Amnesty International, November 2009.
http://amnesty.org.ru/system/files/SVAW_Tajikistan_Complete_RUS.pdf
39
The SPRH defines youth access to a friendly against them of sexual and
reproductive health, the protection of sexual and reproductive health for refugees,
reducing inequalities in sexual and reproductive health of migrants in relation to
indigenous.

44
provisions that would ensure the confidentiality of information
and or comply with medical ethics in relation to them.
The Strategic Plan for Reproductive Health also does not take
into account the needs of linguistic and ethnic minorities, given
the fact that information is mainly available in the Tajik
language, access to information of ethnic minorities living in
the Republic of Tajikistan, is limited.
Although the Strategic Plan for Reproductive Health had set
targets with regard to vulnerable groups such as victims of
human trafficking, refugees, displaced persons, migrants and
the elderly, there are no measures identified for their
implementation. The lack of specific measures is likely to lead
to a lack of dedicated funding to support the reproductive
health of these vulnerable groups. Also it is not clear on which
basis the Strategic Plan for Reproductive Health set tasks for
these groups while the situation analysis of the document
revealed that there is no data on the state of their reproductive
health. The absence of evidence on the reproductive health of
individual vulnerable groups are likely to lead to development
of the tasks, which not only do not take into account the needs
of these groups, but also authorizing for their implementation
the state bodies that are not competent in that sphere. For
example, in regard of the victims of human trafficking, the
Strategic Plan for Reproductive Health sets tasks such as “to
strengthen measures to prevent the illegal export and
trafficking in women” and “to provide maximum protection for
the victims of smuggling and trafficking”. Since these problems
are directly related to the competence of law enforcement, the
Strategic Plan for Reproductive Health developers and
agencies responsible for its execution, should have establish
the relationship of the Strategic Plan for Reproductive Health
with other sectoral policy in the field of combating human
trafficking. Unfortunately this was not done.

45
The acceptability of medical services. Reproductive and
sexual health services should be provided in accordance with
the medical ethics and respect for cultural features. This
principle implies access to health services for girls teenagers,
unmarried women, victims of sexual violence, widows, victims
of trafficking, women working in the sex industry, HIV-infected
women, linguistic and ethnic minorities, taking into account
confidentiality and medical ethics. Also includes access to
contraception, acceptable within the cultural and religious
views of women and their families. The analyzed strategy does
not provide for confidentiality of information on reproductive
and sexual health, and there is no information to provide
services to women living with HIV, victims of violence, victims
of human trafficking, sex workers, and there is no information
about the provision of linguistic and ethnic minorities in
accessible language. With introducing of the relatively recent
technique in the country of in vitro fertilization, is also required
medical ethics, which directly concerns the principle of
admissibility. The Strategic Plan for Reproductive Health does
not contain information on this method, most likely due to the
fact that this method is applied in Tajikistan recently. However,
the development of future strategic documents will need to
take into account the question of the regulation of this method
in Tajikistan, with all the principles, including the question of
the status (or nature) of human embryos. Given the mentality,
traditions and characteristics of the population of Tajikistan
regulation of this method requires a special approach. Due to
the fact that under the legislation of Tajikistan surrogacy is not
provided, the analyzed Plan also does not have information on
this method. However, in practice there are isolated cases of
surrogacy. In this regard, there is a need for legislative
recognition of the issue and raising awareness about
surrogacy.
Participation and accountability. Citizen's participation in all
decision-making processes at the local, national and

46
international levels is an important element of the right to
health. Individuals and groups should be involved in the
process of setting priorities, making decisions, planning,
implementation and evaluation of strategies to achieve better
health. They should also be able to lodge complaints about the
negative impact of laws and policies. The strategy does not
provide information regarding the participation of women,
vulnerable groups, young people and other categories of the
population, which is aimed at the strategy. Also, there is no
information on the participation of non-governmental
organizations working on women's issues in the course of
development of this strategy on the recommendations or
information from non-governmental organizations. In the
process of evaluation and monitoring of the strategy it is also
does not provide for the participation of the public or local
communities. The strategy provides that the assessment of
each priority elements of the Plan will be conducted by local
experts with relevant experience and qualifications. The final
assessment is performed by independent experts - the leading
experts of the field, who know the specifics of the country, with
local experts and key performers. However, during the
analysis, the analytical group was unable to obtain information
on the results of such monitoring and evaluation.
Besides the Strategic Plan does not provide precise
information on the timing and frequency of reports on
implementation of the measures provided for in the strategy,
as well as there is no information on the mechanisms of
reparation or restoration of the rights of the population, such
as grievance procedures, the participation of the Ombudsman
in the recovery process of reproductive rights, the formation of
Association for the Rights of patients.
The responsibility for the coordination of the Strategic Plan is
given to the Commission on Population and Development
under the Government of the Republic of Tajikistan, which

47
shall take a decision on the prioritization of tasks, selection
and correction of basic strategies, identifying key partners, as
well as the amounts and sources of funding for basic
directions.
At the regional level, the coordination of the activity should be
carried out by local coordinating committees that make
decisions about the selection and adjustment of local
strategies depending on local conditions. Local Coordination
Committees and Commissions should provide feedback to the
Commission on Population and Development under the
Government of the Republic of Tajikistan. The responsible
bodies directly ensuring the implementation of the program
shall report to the Commission with a frequency of at least
once every six months.
In the course of the study, it was revealed that the
Commission on Population and Development under the
Government has been abolished. Also, there is no information
whether there is an established local coordinating councils in
the field who have to regulate matters at the local level and
report the said Commission. Based on the foregoing, it was
not possible to assess the reporting procedure for the
implementation of Strategic Plan for Reproductive Health for
the past years.
There are various ministries and agencies as well as Non-
Governmental Organizations and international organizations
indicated in the Strategic Plan for Reproductive Health as
responsible bodies, including the “appropriate authorities,
ministries and departments” which creates difficulty to define a
specific government body responsible for the implementation
of each activity of the strategy. This fragmentation complicates
the process of implementation of the Strategy, as well as
hinders the transparency process.

48
7. REALIZATION OF THE RIGHT TO REPRODUCTIVE
HEALTH FOR SOME VULNERABLE GROUPS IN
THE REPUBLIC OF TAJIKISTAN
The monitoring group did not set a goal of monitoring the
implementation of the Strategic Plan. The following information
is a brief overview of analyzes and reports undertaken by
other organizations in the field of reproductive health, as well
as a brief overview of the implementation of some situational
review of implementation of certain items of the Strategic Plan
conducted by the project experts. For more complete
information it is necessary to conduct additional monitoring.
Teens and young adults. The young people consider being the
most vulnerable group in matters of sexual and reproductive
health in the country. Young girls are more prone to unwanted
pregnancy, early marriage and HIV infection and STDs. This is
consistent with the influence of socio-cultural and economic
factors. In the area of sexual and reproductive health of youth,
the Strategic Plan envisaged ‘to raise awareness and educate
young people on all aspects of sexual and reproductive health,
and help them to develop the life skills required for satisfactory
and responsible addressing of these issues”.
In the frame of the “Concept of health care reform” of the
country in order to improve and optimize the health care
services to the population, including adolescents and young
people, the Ministry of Health of Tajikistan issued a decree
“On improvement of services in the field of reproductive health
of the population of the Republic of Tajikistan” (#643 from
5.12.2005) pursuant to which each of reproductive health
centers, regardless of level, provided the presence of a
adolescent gynecologist and the room for the organization and
provision of services to adolescents and young adults.
However, sexually active adolescents are much less likely to

49
use modern contraceptives than older-age women, which in
turn caused the increase in teenage abortions.
Refugees, migrants and ethnic minorities. The absence of
certain activities in the SPRH in relation to vulnerable
categories of persons as refugees, migrants and ethnic
minorities did not allow to gather information for objective
consideration of the SPRH’s impact on these vulnerable
groups and to determine the presence or absence of
discrimination against them. In this connection is was decided
to conduct a situational overview of selected health facilities in
Dushanbe for compliance with the rights of vulnerable groups
of the population to have access to information related to
reproductive health in reproductive health care centers of
Dushanbe and maternity hospitals of the free, accessible and
understandable information on proving services. Thus it was
revealed that all health centers in Dushanbe and maternity
hospitals have sufficient information on issues related to safe
motherhood, prevention of diseases and infections, sexually
transmitted diseases, breastfeeding, prevention of unwanted
pregnancy. In some institutions were also provided on the
policies and laws in the field of health care and the right to
reproductive health, for example, contained information about
the SPRH, a program of salt iodization, the provisions of the
law on reproductive rights, as well as statistical reports on
various indicators of issues related to reproductive rights.
However, the information provided was mainly in the Tajik
language. Therefore, the information provided may not be
available to certain categories of migrants, refugees and ethnic
minorities. Only a small percentage of information posters
contained information in Russian or themed images on STIs,
which may be available to persons of any nationality.
Migrant workers. According to official data, there were 877,335
Tajik citizens left for migrant work in 2012, according to the
local experts estimations the number of Tajik citizens in labor

50
migration is more than 1 million people. Given the scale of
labor migration from Tajikistan the SPRH should take into
consideration the needs of migrant workers and members of
their families. However, the SPRH does not consider labor
migrants as a separate target group.
Migrant workers make up 0.5% of the group, who are at high
risk of HIV infection. This is a relatively high figure; however,
the results of various studies conducted in Tajikistan indicate
that the migrant workers are more tend to visit sex workers in
destination countries, and thus exposing themselves and their
families at risk of contracting sexually transmitted infections
when they return home. That is why the policy and programs
that are currently adopted in the Republic of Tajikistan in the
sphere of labor migration also considering measures for the
prevention of non-proliferation and HIV and AIDS. There is
also a policy for the prevention of tuberculosis for migrant
workers. Unfortunately no policies, including the SPRH do not
paying attention to other diseases of migrants who can
influence their reproductive health. For example, diseases of
the cardiovascular system, kidneys, liver, brain and spinal cord
tumors, diabetes leave a mark on the reproductive health of
men. The total exhaustion, hormonal background, circulatory
disorders and metabolism lead to violations of potency and
sterility. Unfortunately, these issues have not been studied in
detail in Tajikistan (the impact of labor migration on the
reproductive health of men and women migrant workers).
Another obstacle for the prevention of diseases affecting the
reproductive health of migrant workers may be the lack of
documented status in countries of destination. Migrants who
are residing illegally in the country of destination cannot
access the medical facilities. Failure to address the medical
facilities in time the labor migrants could run the course of the
disease, which subsequently affects the state of their
reproductive health.

51
For the last 4 years, Tajikistan has seen the feminization of
labor migration. The level of female labor migration from the
country increased in 2012 compared to previous years. If in
2011 the proportion of women who went to the migration was
11% in 2012 it reached to 14% of the total number of labor
migrants. According to official statistics, in 2011, for labor
migration had left 81,774 women in 2012, 124 007 women.
The average age of women leaving for labor migration is 24 to
35 years. These data indicate that each year there is an
increase in the number of women migrant workers going to
work at a relatively young age and who are in need of
protection of their reproductive rights. Self-migrating women
may find themselves in situations that make them especially
vulnerable to HIV. Many of them also like men, migrant
workers are employed in relatively unskilled jobs, and quite
often without legal status with sharply limited access or no
access to health care and HIV-related services. In such
situations, they are often vulnerable to exploitation/or physical
and sexual abuse, in some cases, by their employers, and can
also provide sexual services for economic reasons, or in
exchange for physical protection
Women living in rural areas. Another group that exposed to
diseases of reproductive health are women living in rural
areas. In the today’s realities of Tajikistan, these are usually
the left behind migrant workers’ wives. In the frame of the
present analysis the group of experts collected the case
studies and a survey among wives of migrant workers which
were left behind in Tajikistan. The collected data demonstrates
that women living in rural areas often do not raise the issue
before the spouse for medical examination for AIDS and STIs
upon return from labor migration. Women reported that they
are uncomfortable to start a conversation and it is not
accepted in the family, while others said they did not even
think about this. According to interviews with health workers,

52
men - migrant workers are not actively being tested for HIV or
AIDS after returning from migration, although medical
professionals offer the returning migrants free HIV tests.
However such appeals are often ignored and a very small
percentage of returned migrants voluntarily come to test upon
their return. Some of the interviewed women pointed to the
fact that when a spouse resides in labor migration the issues
related to their health, including abortion is agreed by the in-
laws. In general, even the question about the treatment in
medical institutions on other reproductive health care needs to
be agreed with the husband, and in his absence with in-laws.
Women noted that the mother in law has a big impact on their
spouses, including on issues related to their reproductive
health.
It is well known that the access to clean drinking water refers
to the determinants of health; clean drinking water also affects
the reproductive health rights. Interviewed women living in
rural areas, stated that they have to purchase the water which
is not always cost cheap. On average, 100 liters of drinking
water is about 4 TJS, but the price can range from water
quality. Those who do not have to finance the acquisition of
purchased water, use water from irrigation ditches and canals.
Interviewed wives of labor migrants also noted that in addition
to housework (washing, cooking, cleaning, child care) they are
engaged in work in the field, drying apricots or raising
livestock. This becomes double burden for women whose
husbands are in labor migration and even during pregnancy
they did not experience a decrease in the level of the load with
respect to the housework.
HIV-positive women. Despite the fact that Tajikistan has
created the conditions for a free and anonymous HIV testing
and treatment, citizens often avoid testing for HIV or seek help
for fear of being ostracized, subjected to mockery and alleged

53
promiscuity. The UNGASS report data for Tajikistan in 2009
shows that women were significantly less likely to get tested
for HIV / AIDS that prevents the achievement of universal and
equitable access to HIV prevention, treatment, care and
support. For example, in the age group 20-24 years the
percentage of women and men who have passed testing for
HIV as of 31 December 2009 amounted to 9.3% of men and
5.5% of women. In the age category of persons from 25 to 49
years, only 11.4% of men were tested, while women made up
only 7.4%.
Social inequality. In the course of the analysis it was revealed
the unequal treatment of working women and unemployed
women. For example, the art. 14 of the Law “On State Social
Insurance” provides for the payment of family allowances at
the birth of children: one-time and monthly. While the
legislation makes is no difference for one-time benefits for the
monthly benefits it states that: “for the period of maternity
leave to take care of a child up to the age of one and a half
years, she is paid a monthly allowance for child care during
this period from the social insurance funds in the amount of
index for calculation”. This means that if a woman worked
before giving birth, she can get a monthly allowance for child
care in the event of her parental leave per child, and the one
that was at home, cannot. Working women due to the fact that
she had formal work accordingly it received government-
guaranteed maternity leave (before birth and postpartum), and
secures the position up to three years. While the unemployed
woman apart from not receiving payments on maternity leave,
also is paid the minimum state support for child care. A
majority of women in Tajikistan because of the mentality are
housewives and are deprived of such an important state
support.

54
8. MAIN OUTCOMES AND RECOMMENDATIONS
Thus, the analysis revealed a number of inconsistencies in the
national policy of the Republic of Tajikistan in the field of
protection of reproductive rights, which do not meet
international standards and commitments made by the
country, which creates some barriers for the citizens’ access to
reproductive health services.
Despite the positive trend in increasing the role of women in
the Republic of Tajikistan, the legislation does not fully
provided the reproductive rights of women.
 The National Policy of the Republic of Tajikistan in the
field of reproductive health does not adequately
address the issues of non-discrimination, in particular
against vulnerable groups of the society. Although
there are some provisions in the Strategic Plan to
prevent discrimination against certain vulnerable
groups (eg. young people, refugees, migrants) 40
,, but
these tasks do not include specific measures for their
implementation.
 While the national policy and legislation provides for
development of sub-legal acts to govern certain issues
related to reproductive health, not all of these
regulations are accepted. For example, terms and
conditions of donation, vitro fertilization and embryo
transfer are established by the Ministry of Health of the
Republic of Tajikistan (Article 38 of the Law “On
protection of public health”). Despite the fact that
Tajikistan has the experience of artificial insemination,
there is no information about the relevant regulations
governing this sphere.
 The Strategic Plan has no mechanisms that would
40
The SPRH defines youth access to a friendly against them of sexual and
reproductive health, the protection of sexual and reproductive health for refugees,
reducing inequalities in sexual and reproductive health of migrants in relation to
indigenous..

55
allow the policy to be more flexible (because of its long-
term), and meet the challenges that emerged after its
adoption. Obviously, the inflexibility of the policy has
led to discrimination against certain vulnerable groups,
which began to appear, or problems that have become
more actively discussed in the last five years. For
example, the strategy does not take into account the
needs of vulnerable groups such as victims of sexual
violence, victims of trafficking, women working in the
sex industry, HIV-positive women and thus does not
provides special conditions to ensure access to
reproductive services for such groups of the society.
 The responsibility for the coordination of the Strategic
Plan is given to the Commission on Population and
Development under the Government of the Republic of
Tajikistan, which shall take a decision on the
prioritization of tasks, selection and correction of basic
strategies, identifying key partners, as well as the
amounts and sources of funding for basic directions. At
the moment the Commission is abolished and its’ the
powers not delegated to other government agencies.
 Lack of coordination between government agencies
affect the quality of services in health and education.
 The other problem is lack of stable and adequate
source of funding from the state budget to cover the
tasks specified in the Strategic Plan.
 The Strategic Plan does not provide precise
information on the timing and frequency of reports on
implementation of the measures provided for in the
plan as there is no information on the mechanisms of
reparation or restoration of the rights of the population,
such as grievance procedures, the participation of the
Ombudsman in the recovery process of reproductive
rights, the formation of associations patients' rights.
 Due to the fact that the Strategic Plan for Reproductive
Health does not provide for the concept of vulnerable

56
groups of the population and specified vulnerable
groups of women (wives of migrants, migrant women,
women with disabilities, women COP and others), they
may not be covered within the activities foreseen in the
Strategic Plan for Reproductive Health.
 The strategy does not take into account the differential
approach to rural and urban populations and their
access to services. This in turn adversely affect the
safe access to services for women living in remote
areas, who are not registered at the places of their
residence, with no identification documents; women
living in rural areas and forced to go to town for
medical services, and children without a birth
certificate.
 There in not officially determined cost of living, which
prevents the allocation of sufficient assistance to
vulnerable groups (mothers with children under the age
of one and a half years of not working pregnant
women, women who are in a difficult situation, women,
migrant workers, orphans, rural women, seniors, etc.).
 The strategy lacks the requirement of confidentiality of
information on reproductive and sexual health.
 The Strategic Plan for Reproductive Health does not
include 1) the availability of information: a) about the
programs and strategies, and b) of free services, and
c) on sexually transmitted diseases, and d) of forced
sexual violence by a husband; 2) the language of
information for the linguistic minorities; 3)
communication tools according to the level of
education of women
 The lack of specific data on issues in the sphere of
reproductive health is also a disadvantage as to
improve the sexual and reproductive health it is
necessary to have accurate and reliable data, without
which the government cannot control the situation, as it
cannot take action to correct problems

57
Recommendations for action
 The National Policy of the Republic of Tajikistan in the
field of reproductive health should include the basic principles
of human rights, including the elimination of discrimination
against all vulnerable groups, privacy, access to information,
etc.
 The Strategic Plan for Reproductive Health should be
include a strategic component - the improvement of the
program in accordance with the changing realities, and
should also provide tools for monitoring, evaluation and
implementation of these changes.
 The approach to the various government programs that
more or less linked to this sphere should be systematic: the
content and the elements shall not be repeated, program
design and evaluation methods must be “compatible” with
each other, and the activities within them should be planned to
strengthen the individual components of each of the programs
within a single goal. This requires no costly and time-
consuming, but comprehensive review of all existing programs
on the subject.
 The Strategic Plan should outline the main coordinating
body of the government, clearly assigned authority and
responsibility for the implementation of specific components of
the Strategic Plan between the relevant national authorities;
provide mechanisms of interaction and coordination between
the public authorities for the implementation of the Strategic
Plan.
 The strategic plan to be equipped by detailed
mechanisms of evaluation and monitoring, the timing and
frequency of reports on implementation of the measures
provided for in the strategy, as well as public access to this
information.
 The strategy to include mechanisms of reparation or
restoration of the rights of the population, such as grievance

58
procedures, the participation of the Ombudsman in the
recovery process of reproductive rights, etc.
 Ensure that the subject of comprehensive reproductive
education acquired mandatory status, in both primary and
secondary schools, with a clear articulation of goals and
minimum standards of teaching.
 Provide real access to reproductive health care
services for girls teenagers, unmarried women, victims of
sexual violence, victims of human trafficking, commercial sex
workers.
 Ensure the development of clear legal framework and
procedures that keep the confidentiality and anonymity of the
services provided
 On the basis of the Human Rights Based Approach to
develop and support programs to improve access for all
populations to reproductive health services and reduce
discrimination in health care system
 The normative legal documents providing social state
guarantees should include rules on the mechanisms of their
implementation
 For a more transparent budget financing of health care
system it is requires that the state budget to be informed of the
extent of funding of each policy
 Adopt a relevant law on the right to artificial
insemination and embryo implantation with a detailed
regulation of the procedure
 Legislatively recognize the surrogacy with the adoption
of an appropriate mechanism for its implementation.

60
For its publications, the Public Fund "NotaBene"
uses paper, the corresponding FSC (a group of
products from responsibly-managed forests).
Signed to print on 03.03.2012 Format 140 × 205.
Typeface Arial. Print operative.
Circulation 50 copies. For free distribution.
Printed by CP Zurbekov B. R.

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