Chapter 4. Restricted physical integrity

This chapter presents an overview of discrimination against women’s physical integrity in Eurasia. It examines discriminatory social institutions – formal and informal laws, social norms and practices – that increase women’s vulnerability to a range of forms of violence and that limit women’s control over their bodies. It covers areas such as violence against women, female genital mutilation, missing women and reproductive autonomy. The chapter also seeks to provide policy makers with the necessary tools and evidence to design effective gender-responsive policies in order to protect women’s physical integrity.

Box 4.1. Measuring women’s restricted physical integrity

The restricted physical integrity (RPI) sub-index captures social institutions that increase women’s and girls’ vulnerability to a range of forms of violence and that limit women’s control over their bodies. This includes formal and informal laws, norms and practices that fail to respect women’s physical integrity, or that serve to normalise and justify practices that impinge upon their reproductive autonomy.

The restricted physical integrity sub-index is composed of four indicators.

1. “Violence against women” (VAW) captures the level of social acceptance and prevalence of domestic violence, as well as its legal acceptance: whether the legal framework protects women from violence, including intimate-partner violence, rape and sexual harassment, taking into account non-statutory (societal) discrimination against women in traditional, religious and customary laws and practices.
2. “Female genital mutilation” captures the level of social acceptance and prevalence of female genital mutilation (FGM) as well as its legal acceptance: whether the legal framework criminalises FGM and includes penalties for practitioners, taking into account non-statutory (societal) discrimination against women in traditional, religious and customary laws and practices.
3. “Missing women” captures the statistical shortfall in the number of girls in the age range 0-4 years, relative to the expected number, in the absence of sex-selective abortions, female infanticide or preferential treatment of sons over daughters, correcting for natural biological and physiological differences.
4. “Reproductive autonomy” captures the prevalence of women of reproductive age who have an unmet need for family planning and contraception, as well as legal discrimination against women with respect to their reproductive autonomy rights in case of non-desired pregnancy.

Figure 4.1. Level of discrimination regarding women’s physical integrity

Women’s physical integrity is unevenly protected across the region, with an average level of discrimination of 20%. The restricted physical integrity score is the best among the four sub-indices of the SIGI, but the overall score hides regional disparities. Discrimination is more pervasive in the Caucasus (32%) than in Central Asia (15%) and Eastern Europe (14%) (Figure 4.1). The ten countries ranked in this sub-index1 span very low to medium levels of discrimination. Mongolia is the best performer, with a level of discrimination of 8%. Seven countries follow with a low level of discrimination (from 13% in Moldova to 20% in Tajikistan), while Armenia (35%) and Azerbaijan (43%) have higher levels.

Figure 4.2. SIGI results in the “restricted physical integrity” indicators

Discrimination is especially high regarding violence against women. With a regional level of discrimination of 38%, VAW is the most pervasive and acute form of discrimination against women’s physical integrity. It is not adequately addressed in the law, and it is pervasive and commonly tolerated. While female genital mutilation is not commonly practised and women’s reproductive autonomy is fairly protected (the region scores respectively 0% and 7%), missing women is a serious issue in the Caucasus, and the regional level of discrimination is 22% in this indicator.

The missing women indicator is high in the Caucasus. Sub-regional scores are similar in three of the four indicators of the restricted physical integrity sub-index (Figure 4.2). Discrimination against women’s reproductive autonomy ranges from 4% in Eastern Europe to 8% in Central Asia, the VAW indicator ranges from 34% in Eastern Europe to 41% in Central Asia, and the FGM indicator is equal to 0% in the three sub-regions. However, with a pronounced preference for sons specific to the Caucasus, discrimination in the missing women indicator for this sub-region, at 68%, is far higher than in the other sub-regions (6% in Central Asia and 13% in Eastern Europe).

Mongolia is the best regional performer, with a discrimination level of 8%, and it is the only country with a very low level of discrimination against women’s physical integrity. The law accurately protects women from all forms of VAW, including domestic violence and sexual harassment; no evidence suggests the practice of FGM (although it is not criminalised); sex ratios are balanced; and abortion is legal on demand. However, domestic violence remains widespread in Mongolia (affecting 31% of women) and accepted (10% of women condone it), and the prevalence of unmet needs for family planning, at 16%, is the second highest in the region.

Violence against women

Key messages

Countries have been increasingly committed to eliminating VAW. Revised legislation entered into force in Moldova and Mongolia in 2017, making both countries regional leaders in terms of legal response to VAW. Ukraine also took a positive step in 2018 by introducing criminal liability for domestic violence. Rape is criminalised in all 12 countries, no country allows rape perpetrators to escape prosecution if they marry the victim after the crime and there is no evidence of provisions that reduce penalties in case of so-called honour crimes.
But no country protects women from all forms of violence. The main legal loopholes reside in the non-criminalisation of sexual harassment (in ten countries2 across the three sub-regions) and domestic violence (in five countries3). In addition, the legal definition of rape does not include marital rape in eight countries.4
Domestic violence against women is pervasive and rates decrease slowly. Despite countries’ commitments, 17% of women in the region have suffered intimate-partner violence at least once in their lifetime, and 10% in the past year, down from 11% in 2014. Women in Central Asia are particularly exposed to VAW (20% have suffered domestic violence at least once, and 10% in the past year), as well as women in Eastern Europe (17% and 10%), while women in the Caucasus are the least vulnerable (11% and 7%).
Condonement and under-reporting remain high. The social acceptability of domestic violence, including by women themselves, and the stigmatisation of victims prevents the majority of survivors from reporting the crime. Some 21% of women declare that spousal violence is acceptable under certain circumstances (from 4% of women in Eastern Europe to 34% in Central Asia). While the overall proportion decreased from 27% in 2014, condonement and under-reporting remain high and explain why reducing the high prevalence rate of VAW is an ongoing struggle. Across six countries, 67% of women who suffered violence from their partner never told someone about it or sought help of any sort.
Mongolia is the regional best performer despite its relatively poor ranking at the world level (21^st), with a discrimination level of 22% in the VAW indicator. A 2017 revision to the Law on Combating Domestic Violence criminalised most forms of VAW (with the exception of gender-based online harassment). The government implemented a National Programme on the Control and Prevention of Domestic Violence, established shelter homes, a help hotline and service centres. However, social norms remain highly discriminatory since 31% of women have suffered violence from a partner and 10% think it can be tolerated.

Key policy recommendations

Provide all women with legal protection from all forms of gender-based violence, including criminalisation of intimate-partner violence, rape and sexual harassment, without any legal exceptions and in a comprehensive approach, in line with international standards (Box 4.2). Guarantee that all women can claim their rights and obtain legal redress by suing perpetrators. When a woman files for divorce on the grounds of spousal violence, abrogate mandatory reconciliation periods (see Chapter 3).
Address discrimination that normalises VAW and prevents women from reporting the crime in order to ensure that women can seek legal redress under the formal law enforcement and justice systems (Box 4.3). For example, the law in Azerbaijan foresees informative actions raising awareness of the negative legal, medical and social consequences of domestic violence and including other public education activities related to prevention of domestic violence.5
Guarantee that protection and support services are available for survivors of gender-based violence. In Belarus, for example, the government operates 109 temporary shelters throughout the country for survivors of domestic violence.
Provide rehabilitation for perpetrators of gender-based violence. In Kazakhstan, for example, assistance organisations are tasked with providing psychological assistance to perpetrators; health authorities are mandated to carry out measures to reduce alcoholism, drug addiction and substance abuse; and violent persons can receive counselling.6
Train judicial, police, medical and educational personnel on gender-based violence and the protection of women’s human rights. In Georgia, for instance, training on how to deal with domestic violence cases is now included as part of basic police training.
Adopt a multisectoral approach to ending VAW in policies and interventions. For example, supporting women’s access to economic empowerment opportunities can enhance their status within the household or increase their ability to leave abusive relationships.

Box 4.2. International standards on violence against women

The due diligence standard, derived from international human rights law, requires States to take positive actions to prevent, investigate, punish and provide remedies for human rights violations, including those committed by private actors.

Violence against women is widely recognised as a fundamental human rights violation. The rights to equality, security, liberty, integrity and dignity of all human beings are enshrined in several international instruments.

The Universal Declaration of Human Rights (1948) guarantees to every individual “the right to life, liberty and security of person” (Art. 3).
The Declaration on the Elimination of Violence against Women (1993) calls on States to “pursue by all appropriate means and without delay a policy of eliminating violence against women” (Art. 4).
The Beijing Declaration and Platform for Action (1995) reaffirms that “violence against women is an obstacle to the achievement of the objectives of equality, development and peace” (Art. 112).
SDG Target 5.2 explicitly calls on States to “eliminate all forms of violence against all women and girls”.
All six regional members of the Council of Europe reiterated their commitment to end VAW by signing or ratifying the Istanbul Convention (2011), with the exception of Azerbaijan.

In-depth analysis of violence against women

Countries are increasingly committed to eliminating VAW. Mongolia and Moldova established new legislation in 2017 to criminalise intimate-partner violence (Mongolia) and to better protect survivors (Moldova), making them the best regional performers in terms of legal response to VAW. Ukraine also made progress with a new law criminalising domestic violence in 2018. No country allows rape perpetrators to escape prosecution if they marry the victim after the crime, and there is no evidence of provisions that reduce penalties in cases of so-called honour crimes. In addition, rape is a criminal offense in all countries. Finally, seven countries7 have implemented a national action plan to eliminate domestic violence, and the law in six countries8 compels governments to provide a budget or to allocate funding for the implementation of relevant programmes or activities on VAW.

But comprehensive legal protection from all forms of violence is lacking. To date, no country in any sub-region has yet enacted laws to protect women from all forms of violence, without exceptions and in a comprehensive manner:

No country has criminalised all forms of sexual harassment. In Mongolia and Moldova, sexual harassment is a criminal offense but the law does not cover cyber harassment (Mongolia and Moldova) or harassment in educational and sporting establishments and public places (Moldova). In Armenia, Azerbaijan, Georgia, Kyrgyzstan and Ukraine, there is legal protection from sexual harassment, but it is not a criminal offense. In Belarus, Kazakhstan, Tajikistan, Turkmenistan and Uzbekistan, the law does not provide legal protection from sexual harassment.
The legal definition of rape does not include marital rape in eight countries,9 even though a wife can file a complaint in all. In Uzbekistan, for example, the Criminal Code foresees imprisonment of three to seven years for anyone who commits a rape, without explicitly including marital rape. However, perpetrating rape on a close relative is considered an aggravating circumstance and punishable by imprisonment of seven to ten years.10
The legislation on domestic violence protects women in only six countries.11 In Azerbaijan, Georgia, Kyrgyzstan, Moldova, Mongolia and Ukraine, domestic violence is a criminal offense, and this includes physical, sexual, psychological or economic violence from a former partner or a family member. In Tajikistan, the law does not include abuse from former partners. In Armenia, Belarus, Kazakhstan, Turkmenistan and Uzbekistan, domestic violence is not a criminal offense.

Domestic violence is a serious issue across the region. Some 17% of women have suffered physical and/or sexual violence from an intimate partner at least once in their lifetime. Although this is lower than the world level (31%), it varies across the region, ranging from 6% of women in Georgia to 46% of women in Moldova. Lifetime prevalence of VAW is more pervasive in Central Asia (20%) and Eastern Europe (18%) than in the Caucasus (11%). The same patterns are observed regarding recent episodes of intimate-partner violence: 10% of Eurasian women suffered violence from a partner in the past year, from 1% in Georgia to 17% in Kyrgyzstan, compared to 14% of the world’s women. Recent episodes of intimate-partner violence are more frequent in Central Asia and Eastern Europe (10%) than in the Caucasus (7%). Domestic violence has far-reaching consequences on the health, economic and social status of survivors, and some women do not survive: one in two women killed in the region are murdered by an intimate partner or family member (UNFPA, 2016[1]). VAW also represents a cost for societies and economies. In Ukraine, for example, VAW is estimated to cost USD 208 million per year, or 0.23% of the annual GDP (UNFPA, 2017[2]) (see Chapter 2).

Current estimates of domestic violence rates understate the reality. In all 12 countries, the stigmatisation of survivors, fear of retaliation, mistrust in the police and justice systems, and social norms that consider domestic violence as a private matter prevent women from reporting crimes.12 Across the six countries with available data,13 67% of survivors never reported the violence or sought help of any sort. Among women who sought help, 53% turned to their family, while only 22% appealed to medical personnel and 3% to the police (DHS, n.d.[3]). The low reliance on the police is in part explained by the fear of institutional discrimination and the predominance of men among police staff: in Georgia and Kazakhstan, 90% of police officers are men (UNFPA, 2015[4]; UNECE, n.d.[5]).

Discriminatory social norms feed domestic violence. Across the region, 21% of women and girls consider that a husband can be justified in hitting or beating his wife under certain circumstances (if she burns the food, argues with him, goes out without telling him, neglects the children or refuses to engage in sexual intercourse with him). Women in Central Asia are particularly likely to condone domestic violence (34%), followed by women in the Caucasus (21%). In Eastern Europe, only 4% of women hold discriminatory attitudes. Discriminatory norms reinforce gender roles in the society and support visions of “toxic” masculinities, whereby a man is entitled to engage in aggressive behaviours towards a woman.

Box 4.3. Mobilising men to fight VAW in Tajikistan

In Tajikistan, where 20% of women have suffered domestic violence in their lifetimes, a “Strong Men Respect Women” campaign was launched to engage men in raising awareness on the causes and consequences of VAW. The campaign is supported by a network of male martial artists who have been trained as advocates in the battle against gender-based violence.

The network was initiated by the National Taekwondo and Kickboxing Federation of Tajikistan, in partnership with the United Nations. The campaign, led by the world Taekwondo champion, Daler Tyuryaev, has trained more than 500 athletes on gender equality and violence prevention to speak out against VAW in martial arts lessons, competitions and public gatherings. The athletes appeal to wider audiences through public videos and major media campaigns on national TV channels, and these appeals have reached approximately 70% of the Tajik population.

Sources: UNFPA (2015), “Martial artists fight gender discrimination, violence in Tajikistan”, https://eeca.unfpa.org/news/martial-artists-fight-gender-discrimination-violence-tajikistan (accessed on 7 March 2019); UNFPA (2015), Combatting violence against women and girls in Eastern Europe and Central Asia, https://eeca.unfpa.org/sites/default/files/pub-pdf/21770%20Brief_web.pdf (accessed on 7 March 2019).

Figure 4.3. Acceptance of domestic violence among women in Eurasia

Domestic violence is less prevalent and less tolerated than previously. In 2012, 19% of Eurasian women had suffered assault from their partner at least once, compared to 18% in 2014 and 17% by 2018. This trend parallels a reduced acceptance of domestic violence. In 2012, 33% of women believed that a husband could be justified in beating his wife under certain circumstances, compared to 27% in 2014 and 21% in 2018 (Figure 4.3). Progress in this regard has been particularly significant in Central Asia, where the tolerance of domestic violence decreased from 49% in 2012 to 34% in 2018.

Female genital mutilation

Key messages

FGM is virtually not a concern in the region. As no customary practice of FGM has been reported, it has not been on the legislative agendas of Eurasian countries. With the exception of Georgia, no country has criminalised FGM.
Data collection is nonetheless needed. As no country in the region has collected representative survey data on the prevalence of FGM, one cannot assume for certain that it is not a concern. Data collection is needed to reach out to every girl and woman at risk. Georgia’s response to the uncovering of FGM cases among a minority community illustrates the importance of data collection.

Key policy recommendations

Include FGM modules in national surveys systematically in order to monitor its use or appearance.
Criminalise the practice of FGM when cases are unveiled, in compliance with international and regional conventions and treaties (Box 4.4). Mobilise public opinion against the practice through tailored awareness-raising interventions within local communities on the short- and long-term negative consequences of FGM on women’s and girls’ physical and mental well-being.

Box 4.4. International and regional standards concerning female genital mutilation

FGM is recognised internationally as a harmful practise and a violation of the human rights of women and girls. Several treaties condemn the practice.

The CEDAW (1979), ratified or accessed by all 12 countries. In particular, CEDAW General Recommendation No. 14 (1990) calls on States Parties to “take appropriate and effective measures with a view to eradicating the practice of female circumcision” (Para. a).
The Convention on the Rights of the Child (1989), ratified or accessed by all 12 countries, requires States Parties to “abolish traditional practices prejudicial to the health of children” (Art. 24).
SDG Target 5.3 explicitly aims to “eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation”.
The Istanbul Convention (2011), signed or ratified by Armenia, Georgia, Moldova and Ukraine, calls on States Parties to take the necessary measures to ensure that inciting, coercing or procuring a girl or a woman to undergo FGM is criminalised (Art. 38).

In-depth analysis of female genital mutilation

Little attention is paid to female genital mutilation in Eurasia. With the exception of Georgia, no country in the region has passed a law to specifically criminalise FGM. However, while no systematic study has been conducted to measure its prevalence, no customary, traditional or religious practices or laws that allow and encourage FGM have been reported. Georgia stands as an exception.

The Georgian example shows that data collection on FGM is crucial for the protection of girls and women at risk. A 2016 study in Georgia uncovered the practice of FGM in some areas of the country. The study revealed that the Avars, a minority group of approximately 2 000 persons living in remote areas of eastern Georgia, customarily cut girls (IWPR, 2016[6]). Prior to this, FGM was believed to be non-existent and therefore was not addressed in the law. The study triggered a political reaction that resulted in the criminalisation of the practice six months later14 (Box 4.5). The case of Georgia highlights the importance of data collection. Reliable and regularly repeated surveys on FGM allow for the identification of girls and women at risk, the reasons behind the practice and its evolution. In order to reach SDG Target 5.3 (“Eliminate all harmful practices, such as child, early and forced marriage and female genital mutilation”), countries need to be able to report on the prevalence of FGM among their population.15

Box 4.5. FGM criminalised in Georgia after practice is discovered

The government of Georgia criminalised FGM less than six months after cases of girls being forced to undergo FGM were uncovered.

In November 2016, an investigation of the Institute for War and Peace Reporting (IWPR) revealed that hundreds of girls from the ethnic Avar community, living in eastern Georgia, were being forced to undergo FGM. Before this revelation, it was assumed due to a lack of data that FGM was not practiced in Georgia, and consequently there was no legislation regulating this practice.

As a response to the investigation, the government convened a meeting with NGOs, UN agencies and the IWPR in December 2016 to confirm the allegations and discuss how to address the issue. Immediately afterwards, the Ministry of Justice prepared legal amendments to the Criminal Code to ensure criminalisation of FGM, in compliance with the Istanbul Convention (that the country had signed in 2014, and later ratified in 2017). The government approved these legal reforms in January 2017 and the Parliament passed the corresponding bill, Law of Georgia No. 763, in early May 2017. The law amended the criminal code by adding Article 133,² which criminalises complete or partial FGM and punishes it by two to seven years of imprisonment.

Sources: Gender Equality Council of the Parliament of Georgia (2017), Implementation of Gender Equality Policy in Georgia, http://www.parliament.ge/en/ajax/downloadFile/72000/Gender_Equality_NAP_report_2016_ENG_Edited_Final_July_2017 (accessed 7 March 2019); IWPR (2016), “FGM Uncovered in Georgia”, https://iwpr.net/global-voices/fgm-uncovered-georgia (accessed 7 March 2019); IWPR (2017), “Georgia: FGM Criminalised Following IWPR Investigation”, https://iwpr.net/global-voices/georgia-fgm-criminalised-following-iwpr (accessed 7 March 2019); Parliament of Georgia (2017), Law 763-IIc Amending the Criminal Code of Georgia, https://matsne.gov.ge/en/document/view/3664456?publication=0 (accessed 7 March 2019).

Missing women

Key messages

Son bias appears high in the Caucasus and low elsewhere. The SIGI results in the region are divided into two extremes concerning discrimination against the girl child. All countries in Eastern Europe and in Central Asia show little to no evidence of son bias (they score respectively 13% and 6% in the missing women indicator, compared to 6% for the global average). However, countries in the Caucasus show high levels of discrimination (65%).
The missing women phenomenon is a concern in Azerbaijan, Armenia and Georgia, where the sex ratios are unbalanced compared to the natural sex ratio and an estimated 170 000 young women are missing.
Unbalanced sex ratios are a persistent problem in Azerbaijan but Armenia and Georgia have made progress (Box 4.7).
Discriminatory social institutions foster bias towards sons and undervaluing of daughters, and this contributes to the missing women phenomenon. In Armenia for example, 54% of the population declare that if a family were to have one child, they would prefer to have a boy, compared with 10% who would prefer a girl and 35% for whom it does not matter.

Key policy recommendations

Adopt integrated and multi-entry-point strategies to help shift son-biased social norms and protect the fundamental rights of girls (Box 4.6).

Take effective legal measures to increase women’s agency and ensure that men and women have equal access to the economic and political spheres. This means granting women and men the same legal status, rights and responsibilities in the family and society, particularly in areas such as marriage, inheritance, dowries, heading the household and parental authority.
Provide social protection to the most vulnerable, particularly the elderly, to relieve families from the burden of their traditional role as a socioeconomic buffer against health, employment and age hazards. In Georgia, for example, the introduction and consolidation of a social protection system since 2005 has gradually reduced sons’ responsibilities towards their parents.
Fight adverse gender stereotypes and encourage the valuing of girls and women through media campaigns. For example, public awareness campaigns and advocacy efforts are among the key actions of Armenia’s State Programme 2015-17 on Preventing Sex-Selective Abortions.

Box 4.6. International and regional standards concerning the rights of the girl child

States have an obligation to eliminate discriminatory practices leading to the phenomenon of missing women.

The concept of missing women was first introduced by Amartya Sen in the late 1980s. He hypothesised that over 100 million women were missing due to excess female mortality resulting from inequality and neglect (Sen, 1990[7]). Commitment to addressing preferential treatment of sons over daughters within the region is widespread.

The “right to life” is guaranteed to every individual under several international treaties, including the Universal Declaration of Human Rights (Art. 3, 1948) and the International Covenant on Civil and Political Rights (Art. 6, 1966).
The Convention on the Rights of the Child (1989, ratified or accessed by all 12 countries) recognises that “every child has the inherent right to life” and calls on States Parties to “ensure to the maximum extent possible the survival and development of the child” (Art. 6).
The CEDAW (1979), ratified or accessed by all 12 countries, requires States Parties to “modify the social and cultural patterns of conduct of men and women, with a view to achieving the elimination of […] practices which are based on the idea of the inferiority or the superiority of either of the sexes” (Art. 5).
The Programme of Action adopted during the International Conference on Population and Development (Cairo Conference, 1994, attended by all 12 countries) enjoins “leaders at all levels of the society [to] speak out and act forcefully against patterns of gender discrimination within the family, based on preference for sons” (Action 4.17).
The Council of Europe passed Resolution 1829 (2011) condemning sex-selective abortion and calling on member states (including Azerbaijan, Armenia, Georgia, Moldova and Ukraine) to prohibit prenatal sex selection.
Georgia, Moldova and Ukraine have also signed or ratified the Oviedo Convention (1997) of the Council of Europe, which prohibits sex selection except for medical reasons.

In-depth analysis of missing women

The SIGI results demonstrate a split in the region concerning discrimination against girls in the household. On the one hand, all nine countries in Eastern Europe and Central Asia show little or no evidence of missing women (they score 13% and 6% respectively in this indicator, compared to 6% at the global level). The natural sex ratio among children ages 0-4 is around 105 males/100 females (WHO, 2011[8]) and is not expected to rise above 106 in the absence of sex-selective abortions, female infanticide or preferential treatment of sons over daughters. It is slightly above what would be naturally expected in Ukraine (106.3), Moldova (106.7) and Uzbekistan (107.1). However, the historic evolution of the sex ratio in these countries does not suggest recurrent discrimination against girls that would translate into missing women. On the other hand, three of the world’s eight countries16 with the highest levels of discrimination in the missing women indicator are found in the Caucasus: in Azerbaijan (93%), Armenia (76%), and Georgia (27%), fewer girls than expected are being born.

Armenia, Azerbaijan and Georgia have an alarming number of missing women. It is estimated that 170 000 women in the three countries are missing in the age group 0-19 as a result of preference for sons (UNFPA, 2012[9]). There are 108 boys per 100 girls aged 0–4 in Georgia, 113 boys per 100 girls in Armenia, and 115 boys per 100 girls in Azerbaijan. The sex ratio in Azerbaijan is the second highest in the world after the People’s Republic of China. This trend started in the mid-1990s, after the collapse of the Soviet Union (Figure 4.4).

Figure 4.4. Sex ratios for ages 0-4 in selected countries

The situation in the Caucasus reflects the low value given to daughters compared to sons. As neighbouring countries, Armenia, Azerbaijan and Georgia share some social norms, including a bias in favour of having sons. In Armenia for example, 54% of the population declare that if a family were to have just one child, they would prefer to have a boy, compared with 10% who would prefer a girl and 35% for whom it does not matter. In Azerbaijan and Georgia, 27% and 46% of the population, respectively, would prefer a boy (CRRC, 2010[10]). The preference for sons is rooted in traditional stereotypes regarding men’s and women’s roles in the society. Sons are viewed as a lifelong economic resource, and they bear primary responsibility for taking care of their elderly parents. They are also associated with higher social prestige and perpetuation of the ancestral line and family name. In contrast, daughters are seen as a liability who, once married, will contribute instead to their in-laws’ families. They are also perceived as less capable than sons of supporting themselves and their families (World Bank, 2015[11]).

Box 4.7. Legislation and awareness raising to rebalance the sex ratio in Armenia

With 114 boys for every 100 girls in 2015, Armenia had one of the highest sex imbalance levels in the world, surpassed only by China (116) and Azerbaijan (116). In the early 2000s, the sex ratio at birth was as high as 118 boys per 100 girls, and the ratio for the fourth child in a family with three daughters was 177. Yet by mid-2017, Armenia’s sex ratio had fallen to 111 boys for every 100 girls. This indicates that the various studies, programmes and legislative measures undertaken since 2011 to understand and address the reasons behind sex-selective abortions are starting to yield positive results.

Several studies conducted by the UNFPA since 2011 on the prevalence of and reasons for sex-selective abortions in Armenia have allowed governmental and development actors to formulate evidence-based policies and programmes to tackle the issue. Prevention of sex-selective abortions was included in the Gender Policy Strategic Programme 2011-15 and the State Programme 2015-17 on Preventing Sex-Selective Abortions and its action plan.

In 2014, Misoprostol, a drug commonly used to terminate non-desired pregnancies, was added to the list of prescription drugs, and in 2016, sex-selective abortions were outlawed. In parallel, several organisations conducted large-scale activities to raise awareness on the harmful consequences of prenatal sex selection; to train health care, social and educational service providers on preventing sex-selective abortions; and to change harmful stereotypical attitudes towards girls and women. Activities included training sessions, public events, printing of leaflets and posters, and the broadcast of messages and videos on mass media (social networks, radio and TV channels).

Sources: European Union and International Center for Human Development (2016), “Monitoring Public Policy and Programmes to Prevent Gender-Biased Sex Selection and Sex-Selective Abortions in the Republic of Armenia, https://ichd.org/?laid=1&laid=1&com=module&module=static&id=1179 (accessed 7 March 2019); Financial Times (2017), “ ‘Our community loves boys more.’ Armenia’s missing girls”, https://www.ft.com/content/a4ecb4a2-713f-11e7-93ff-99f383b09ff9 (accessed 7 March 2019).

The cultural preference for sons exists elsewhere, but it translates into skewed sex ratios only in the Caucasus. Discriminatory social norms favouring sons over daughters are found in many countries. For example, 37% of the population in Kazakhstan, Kyrgyzstan and Uzbekistan think a university education is more important for a boy than for a girl, compared to 24% of the population in Armenia, Azerbaijan and Georgia (Inglehart et al., 2014[12]). Yet skewed sex ratios are observed in the latter three Eurasian countries only. This is the result of intertwined factors:

Economic and social hardship following the collapse of the Soviet Union may have forced some Eurasian families to reduce the number of children they had, or reinforced the desire for sons to compensate for the disappearance of social safety nets.
Fertility rates have been declining: while Eurasian women had on average 2.5 children in 1990, they have fewer than 2 today (World Bank, n.d.[13]). As a result, parents have fewer opportunities to have a son, and they may adapt their fertility decisions accordingly (World Bank, 2015[14]). For instance, parents in Armenia who have three daughters are five times more likely to have another child than parents who have three sons.
Increased and cheaper access to technologies to determine the sex of unborn foetuses and to have sex-selective abortions has allowed people to terminate pregnancies rather than give birth to girls. The larger unbalances in sex ratios for second and third children suggest that sex-selective abortions have been used as a means to not have daughters (World Bank, 2015[11]). In Georgia for example, the sex ratio is balanced among first-born children (105) but rises to 117 for the third birth (National Statistics Office of Georgia, 2015[15]).
The phenomenon is amplified by high male mortality. Infant and under-five mortality rates are higher among boys than girls, as is normally expected; this indicates the absence of post-natal discrimination against girls.

Reproductive autonomy

Key messages

Abortion on demand is legal in all 12 countries of Eurasia, one of the world’s regions where women’s reproductive autonomy rights are most secure in cases of non-desired pregnancy.
But many women still face barriers to obtaining safe abortions. Despite the fact that all Eurasian women live under liberal abortion laws, many continue to face barriers to obtaining safe and affordable procedures. Access to abortion is often complicated by the difficulty of finding providers willing to perform it, especially in rural areas, and by the legal and social stigma the procedure carries.
Abortion rates are falling with the advent of modern contraception. While induced abortion has traditionally been used to regulate fertility, abortion rates have been falling as modern contraception methods become more available.
But access to modern contraception remains challenging, especially for low-income categories. Some 11% of women in the region lack access to family planning services, in line with the world average of 12%. Women living in the Caucasus (14%) or in Central Asia (15%) are more likely to have an unmet need for family planning than women living in Eastern Europe (6%). In addition, 10% of women rely on traditional contraceptive methods such as withdrawal or abstinence, up to 30% in Azerbaijan, compared to 6% at the world level.
Ukraine is the best performer in this dimension. Although all countries protect women’s reproductive autonomy, Ukraine has the lowest proportion of women who cannot meet their need for family planning (5%). Therefore, it scores 2% in the reproductive autonomy indicator.

Key policy recommendations

Ensure that the right to abortion is guaranteed in practice and that all women can access safe and legal abortion, especially poor women and women living in rural and remote areas.
Ensure that all women have affordable and secure access to high-quality and culturally accepted family planning methods, through a dedicated national budget line for the procurement of contraceptive commodities. For example, Mongolia has been allocating funds for family planning commodities in the national health budget since 2009.
Improve knowledge of modern contraceptive methods, and women’s rights in this regard, for both men and women. Kazakhstan, for instance, has committed to conducting awareness-raising measures and to expanding access to contraception, reproductive health, family planning and counselling services under the Concept on Family and Gender Policy for 2030. Ukraine also offers a good-practice example (Box 4.9).

Box 4.8. International and regional standards concerning women’s reproductive autonomy

Women’s sexual and reproductive health and rights are enshrined in several international and regional treaties.

The CEDAW (1979), signed or ratified by all 12 countries, calls on States Parties to ensure, on a basis of equality of men and women, “the same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights” (Art. 16).
The International Conference on Population and Development (Cairo Conference) brought together 194 governments in 1994. They recognised that “ensuring women’s ability to control their own fertility [is a] cornerstone of population and development-related programmes”.
The Beijing Declaration and Platform for Action (1995) reaffirms that the rights of women “include their right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health” (Art. 96).
More recently, the necessity to ensure universal access to “sexual and reproductive health-care services” (SDG Target 3.7) and to “sexual and reproductive health and reproductive rights” (SDG Target 5.6) has been integrated to the SDG framework.

In-depth analysis of reproductive autonomy

Women’s reproductive health outcomes have improved in recent decades. The Beijing Platform for Action and Millennium Development Goal 5 (“Improve maternal health”) triggered greater attention to women’s reproductive health needs. Increased availability of family planning services in the region has reduced maternal mortality due to healthier spacing of births, fewer pregnancies and unsafe abortions (UNFPA, 2014[16]). Shifting social norms have also given women greater decision-making authority over their own health. In Armenia, 26% of women did not have a say in decisions regarding their own health care in 2000; this dropped to 4% in 2016 (DHS, n.d.[3]). The maternal mortality ratio in the region has been more than halved, from 63 deaths per 100 000 births in 1990 to 28 in 2015 (World Bank, n.d.[13]). Teenage pregnancy has also decreased. While there were 44 births per 1 000 adolescent girls in 1990, there were 27 in 2016 (World Bank, n.d.[13]).

Eurasian legal frameworks protect women’s reproductive autonomy. In all 12 countries, women can legally obtain an abortion (within a 12-week gestational limit in most cases, and at a later stage of the pregnancy under specific circumstances). The Soviet legacy made the region one of the most protective of women’s rights in this aspect: in 1920, the Soviet Union became the world’s first territory to legalise induced abortion. All Eurasian countries were either part of the Soviet Union (11 countries) or within its sphere of influence (Mongolia), and the right to abortion has been safeguarded. Some countries have reformed their abortion laws since the collapse of the Soviet Union in 1991, but none has introduced restrictions. As a result, all countries in the region are in line with international standards concerning women’s reproductive autonomy (Box 4.8).

Box 4.9. A co-ordinated approach to promote modern contraceptive use in Ukraine

The use of contraceptives worldwide has significantly increased in the past decades, from 55% of in-union women in 1990 to 63% in 2010. In Ukraine, this rate has increased only marginally, from 66.6% to 67%. Poor knowledge and misconceptions about modern contraception are a major barrier to modern contraceptive use in Ukraine.

To increase positive attitudes and expand the use of modern contraceptives, the JSI Research & Training Institute developed a communications strategy for all stakeholders wishing to change social norms around family planning.

Government and development actors thus adopted a co-ordinated and national approach to increase knowledge and use of family planning and shift mistrustful attitudes. The “Healthy Women of Ukraine” campaign ran from 2011-16 and reached 7.8 million Ukrainians, among whom 25 000 participated in education sessions.

Sources: Alkema et al. (2013), “National, regional, and global rates and trends in contraceptive prevalence and unmet need for family planning between 1990 and 2015: a systematic and comprehensive analysis”, https://doi.org/10.1016/S0140-6736(12)62204-1 (accessed 7 March 2019); Podolskyi et al. (2018), “Contraceptive experience and perception, a survey among Ukrainian women”, https://doi.org/10.1186/s12905-018-0651-8 (accessed 7 March 2019); Compass (n.d.), “Healthy Women of Ukraine Program”, https://www.thecompassforsbc.org/project-examples/healthy-women-ukraine-program (accessed 7 March 2019).

But many women still face barriers to obtaining safe abortions. Despite the fact that all Eurasian women live under liberal abortion laws, many continue to face barriers to obtaining safe and affordable procedures. In some countries, women have to overcome legal barriers to obtain an abortion. This may involve a mandatory waiting period, even when it is not medically required (e.g. Armenia, Georgia), or a requirement for parental consent when the woman is a minor (e.g. Kazakhstan, Ukraine). In practice, access to abortion is often complicated by the difficulty of finding providers willing to perform it, especially in rural areas (ASTRA Network, 2014[17]). The right of medical practitioners to put forward a conscience clause can compound this difficulty. Other barriers include the cost of the procedure and the social stigma it carries (ASTRA Network, 2014[17]). Across eight countries,17 47% of the population think that having an abortion can never be justifiable, and this rises to 68% in Georgia (Inglehart et al., 2014[12]).

Abortion rates have fallen as access to contraception improves. In the 1990s, modern contraception was of poor quality and in short supply in the region, and many families resorted to abortion to prevent an unplanned birth (World Bank, 2015[11]). In 1990, the annual rate of induced abortion was an estimated 86 per 1 000 women of reproductive age (15-44), compared to 35 per 1 000 women at the world level. In 2014, this had fallen to about 18 abortions per 1 000 women in the region (UNICEF, 2015[18]). The steep fall in abortion rates has paralleled the steady increase in availability and use of family planning methods. In Central Asia, there were 73 unintended pregnancies per 1 000 women in 1990-94; this fell to 53 by 2010-14 (Singh et al., 2017[19]). The trend is similar for Eastern Europe and the Caucasus. Sources of contraceptives have also diversified. In Armenia, for example, 88% of women obtained information or supplies of contraception from public sources in 2000, while in 2016, 65% of women used private medical sources (DHS, n.d.[3]).

Figure 4.5. Contraception use among women of reproductive age

But access to modern contraception remains challenging. Across the region, 11% of women still have an unmet need for family planning. This percentage is in line with the global average of 12% but hides sub-regional disparities. In Eastern Europe, 6% of women have an unmet need for family planning, compared to 14% in the Caucasus and 15% in Central Asia. Difficulties in accessing family planning seem to be related to its cost rather than its availability. Across six countries with disaggregated data,18 17% of the poorest women have an unmet need, compared to 12% of the richest, but rural women (15%) are not particularly worse off than urban women (14%) (DHS, n.d.[3]). In six countries of the region,19 access to modern contraception is particularly challenging. Overall, 62% of the region’s married or in-union women of reproductive age use a method of contraception. This compares to the global average of 63%. However, women in Eurasia disproportionately use traditional contraception: 10% rely on traditional methods such as withdrawal or abstinence, compared to 6% at the world level.20 Traditional methods are used by 30% of women in Azerbaijan, 28% in Armenia and around 14% in Georgia, Moldova, Belarus and Ukraine (Figure 4.5) (UNFPA, 2018[21]). In a context characterised by declining fertility rates, investing in modern family planning services has not been a policy priority for many governments because of the belief that family planning negatively affects fertility rates (UNFPA, 2014[16]).

References

[17] ASTRA Network (2014), Status of Sexual and Reproductive Health and Rights in Central and Eastern Europe, http://www.astra.org.pl/pdf/publications/ASTRA_Factsheet_2014.pdf (accessed on 15 March 2019).

[10] CRRC (2010), Caucasus Barometer 2010 regional dataset, The Caucasus Research Resource Centers, https://caucasusbarometer.org/en/ (accessed on 4 February 2019).

[3] DHS (n.d.), Demographic and Health Surveys, https://www.statcompiler.com/en/ (accessed on 15 March 2019).

[12] Inglehart, R. et al. (2014), World Values Survey: Round Six, Country-Pooled Datafile, JD Systems Institute, Madrid, http://www.worldvaluessurvey.org/WVSDocumentationWV6.jsp.

[6] IWPR (2016), FGM Uncovered in Georgia, Institute for War & Peace Reporting, https://iwpr.net/global-voices/fgm-uncovered-georgia (accessed on 4 February 2019).

[15] National Statistics Office of Georgia (2015), Women and Men in Georgia, http://geostat.ge/cms/site_images/_files/english/health/Women%20and%20Men_2015.pdf (accessed on 15 March 2019).

[7] Sen, A. (1990), More Than 100 Million Women Are Missing, , December 20, 1990, New York Review of Books, New York, https://www.nybooks.com/articles/1990/12/20/more-than-100-million-women-are-missing/.

[19] Singh, S. et al. (2017), Abortion Worldwide 2017: Uneven Progress and Unequal Access, Guttmacher Institute, New York.

[5] UNECE (n.d.), UNECE Statistical Database, United Nations Economic Commission for Europe, https://w3.unece.org/PXWeb2015/pxweb/en/STAT/STAT__30-GE__03-WorkAndeconomy (accessed on 15 March 2019).

[21] UNFPA (2018), World Population Dashboard, United Nations Population Fund, https://www.unfpa.org/data/world-population-dashboard (accessed on 4 February 2019).

[2] UNFPA (2017), Economic costs of violence against women in Ukraine, United Nations Population Fund, Kyiv, https://ukraine.unfpa.org/sites/default/files/pub-pdf/Economic%20Costs%20of%20Violence_2017_3.pdf (accessed on 15 March 2019).

[1] UNFPA (2016), “Violence against Women and Girls in Eastern Europe and Central Asia (Factsheet)”, https://eeca.unfpa.org/sites/default/files/pub-pdf/UN_Infographic_violenceEasternEurope_final.pdf.

[4] UNFPA (2015), Combating violence against women and girls in Eastern Europe and Central Asia, United Nations Population Fund, New York, ttps://eeca.unfpa.org/sites/default/files/pub-pdf/21770%20Brief_web.pdf (accessed on 15 March 2019).

[16] UNFPA (2014), The Right to Decide: FamilyPplanning in Eastern Europe and Central Asia, United Nations Population Fund, New York, https://eeca.unfpa.org/sites/default/files/pub-pdf/Family%20Planning%20in%20EECA%20-%2014%20Nov%202012%20-%20English.pdf (accessed on 4 February 2019).

[9] UNFPA (2012), Sex Imbalances at Birth, United Nations Population Fund, Bangkok, https://www.unfpa.org/sites/default/files/pub-pdf/Sex%20Imbalances%20at%20Birth.%20PDF%20UNFPA%20APRO%20publication%202012.pdf (accessed on 15 March 2019).

[18] UNICEF (2015), Transformative Monitoring for Enhanced Equity 2016 Database, UNICEF Regional Office for CEE/CIS, http://www.transmonee.org/ (accessed on 4 February 2019).

[20] WHO (2018), Family planning/Contraception, World Health Organization, https://www.who.int/news-room/fact-sheets/detail/family-planning-contraception (accessed on 25 April 2019).

[8] WHO (2011), Preventing gender-biased sex selection, World Health Organisation, Geneva, http://www.who.int/reproductive-health (accessed on 15 March 2019).

[14] World Bank (2015), Missing girls in Armenia: Causes, consequences and policy options to address skewed sex ratios at birth, Poverty Global Pratice, ECA regional team, World Bank Group, http://www.worldbank.org/content/dam/Worldbank/Highlights%20&%20Features/eca/armenia/presentation-missing-girls-armenia.pdf (accessed on 4 February 2019).

[11] World Bank (2015), Missing Women in the South Caucasus: Local Perceptions and Proposed Solutions, World Bank Group, Washington, http://documents.worldbank.org/curated/en/539891468281380371/pdf/94705-REVISED-WP-PUBLIC-Box393246B-Missing-women-Dudwick-July-22-final-clean-English-Version-Nov-6-2015.pdf.

[13] World Bank (n.d.), World Development Indicators (WDI), World Bank Group, Washington, https://datacatalog.worldbank.org/dataset/world-development-indicators (accessed on 15 March 2019).

Notes

← 1. RPI scores for Turkmenistan and Uzbekistan cannot be computed because of a lack of information on the prevalence and acceptance of violence against women.

← 2. Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, Ukraine and Uzbekistan.

← 3. Armenia, Belarus, Kazakhstan, Turkmenistan and Uzbekistan.

← 4. Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine and Uzbekistan.

← 5. Law on Prevention of Domestic Violence, Art. 13.

← 6. Law concerning the Prevention of Domestic Violence, Art. 13, 15 and 19.

← 7. Belarus, Georgia, Kazakhstan, Kyrgyzstan, Mongolia, Tajikistan and Turkmenistan.

← 8. Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova and Tajikistan.

← 9. Armenia, Azerbaijan, Belarus, Kazakhstan, Kyrgyzstan, Tajikistan, Ukraine and Uzbekistan.

← 10. Law No. 2012-XII of the Republic of Uzbekistan On Enactment of the Criminal Code of the Republic of Uzbekistan, Art. 118.

← 11. Azerbaijan, Georgia, Kyrgyzstan, Moldova, Mongolia and Ukraine.

← 12. For more details and sources, please refer to the SIGI 2019 country profiles available at www.genderindex.org.

← 13. Armenia, Azerbaijan, Kyrgyzstan, Moldova, Tajikistan and Ukraine.

← 14. Law 763-IIc Amending the Criminal Code of Georgia, Art 1.

← 15. And more precisely on the “proportion of girls and women aged 15-49 years who have undergone female genital mutilation/cutting, by age” (SDG Target 5.3.2).

← 16. At the global level, alarming sex ratios are found in Georgia, Hong Kong (China), Chinese Taipei, India, Viet Nam, Armenia, Azerbaijan and the People’s Republic of China (in ascending order of the sex ratio among 0-4 year olds).

← 17. Proportion of the population who think that having an abortion can never be justifiable, by country: Azerbaijan (51%), Armenia (57%), Belarus (30%), Georgia (68%), Kazakhstan (40%), Kyrgyzstan (55%), Ukraine (33%) and Uzbekistan (51%) (Inglehart et al., 2014).

← 18. Armenia, Azerbaijan, Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan.

← 19. Armenia, Azerbaijan, Belarus, Georgia, Moldova and Ukraine.

← 20. These figures are computed using data from UNFPA (2018) assuming the rate of traditional contraception use is equal to the difference between the rate of total contraception use and the rate of modern contraception use.

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