When 35-year-old Narine made the journey from her village to Yerevan, she wondered whether she would keep the baby. A mother of two girls, she needed a son. “I have to bear a boy to inherit my husband’s family name. He should have a son by his side,” she would later say.
The trip ended in yet another abortion. She had traveled to Yerevan for an ultrasound to check the sex of the fetus. The results showed the baby would be a girl, and thus she made the difficult choice to end her pregnancy. It was an emotionally taxing decision. Narine would develop depression; a sense of guilt and bouts of crying would haunt her for weeks.
Narine’s story is in no way unique in the former Soviet state, where in the days of communism, abortion was the national and primary method of birth control. The practice continues. For generations, Armenian women have undergone abortions as a form of family planning—controlling the size of their family and, more recently, the sex of their offspring.
“This is not an ‘Armenian’ phenomenon, just an unfortunate legacy of the USSR,” said Dr. Kim Hekimian, who teaches at the public health department of the American University of Armenia, in an interview with the Armenian Weekly.
It is not uncommon for an Armenian woman in her 40s to have numerous abortions. According to a 1995 study conducted at a Yerevan abortion clinic, the median number of abortions for women over 40 was 8. Some have had as many as 25 by the time they’ve reached menopause.
From an economic standpoint, it is expected. The procedure was available at no cost to the patient during the Soviet era. Today, a small price has been tagged on—somewhere around $25. Still, it is affordable, at least enough to compete with the price of a year’s supply of the birth control pill.
Selective abortion also has its socioeconomic motives. Traditionally, when a girl grows up and marries, she leaves her parents’ residence. “The return on the investment, particularly in the rural areas, is low if you have one child and that child is a girl. A male offspring, on the other hand, would bring his wife into the home and take care of the in-laws,” said Hekimian.
Armenian law allows for a woman to have an abortion up to 12 weeks into pregnancy—a period during which the sex of the fetus may not be determined. This suggests that if the determinant of some abortions is the sex of the fetus, those abortions are being conducted illegally.
“The data on births [in Armenia] shows that the sex-at-birth rates are abnormal: [currently] 114 boys to 100 girls,” United Nations Population Fund (UNFPA) Assistant Representative Garik Hayrapetyan told the Armenian Weekly. “The issue exists in Armenia.”
Nature already skews the sex ratio at birth, with 105 males to every 100 females. The abnormal gap between male and female births became noticeable in the 1990’s, coincidentally during a time when ultrasounds became available in the country.
“It is not a secret that selective abortion is a problem in Armenia, and fortunately we have begun speaking about it,” said Marine Margaryan, a social worker and project coordinator for Public Information and Need of Knowledge (PINK Armenia). “But still, for the majority, it is fine to have an abortion based on gender. The stereotypical and biased approach to the role females should have in our society led us to this kind of gender imbalance.”
Reports and warnings
The issue of selective abortion hit Armenia hard in recent months, when a number of reports claimed that Armenia was among the top countries where the practice had reached a worrying proportion. According to the 2011 Gender Gap Report, which was conducted by the World Economic Forum, Armenia has the worse score, after China, in female to male sex ratio at birth. Neighboring Georgia and Azerbaijan showed similar trends.
In October 2011, the Parliamentary Assembly of the Council of Europe (PACE) passed a resolution condemning selective abortion. “There is strong evidence that prenatal sex selection is not limited to Asia. In recent years, a departure from the natural sex ratio at birth has been observed in a number of Council of Europe member states and has reached worrying proportions in Albania, Armenia, and Azerbaijan,” read the resolution, which then called on the three countries to investigate and monitor the situation, and provide support to awareness-raising initiatives.
“It was not only shocking, but also very embarrassing for us,” said Dr. Gohar Panajyan, the mother and child/reproductive health/family planning advisor at the U.S. Agency for International Development’s (USAID) HS-STAR Project. “Anecdotally, we had been made aware of the problem,” she told the Armenian Weekly, but sound scientific data to confirm the widespread stories had been lacking. Now, the issue was staring the country squarely in the eye.
Panajyan believes a long-term strategy needs to be adopted, a solution that takes into account Armenia’s societal and family norms, and aspirations.
Abortions have decreased in Armenia, according to Armenia’s Demographic and Health Survey (ADHS). The 2010 abortion rate in Armenia was 0.8 abortions per woman. That number was 1.8 and 2.6 in 2005 and 2000, respectively. On the other hand, the 2010 fertility rate in Armenia was 1.7 births per woman, which is below the needed level of fertility to replace the current population (that number should be slightly over 2.0). Therefore, the average number of abortions an Armenian woman will have is about half the number of births she will have, according to the report.
Different uses of contraceptives
The current challenge is to promote alternatives to abortions by increasing the availability and accessibility of counseling that provides women and couples with modern family-planning information. Perhaps the task is further complicated by decades of Soviet propaganda against modern contraceptives such as the birth control pill.
Condoms were not produced in sufficient quantity in the Soviet Union, and their quality was poor. “It was the first focus group that I conducted on this issue in 1995. The women would discuss how the only thing condoms were good for was in peeling potatoes. [They would use them] like a latex glove in the kitchen,” said Hekimian. Although their quality has significantly improved, condoms today remain too costly for most Armenian families. Another form of contraceptive, the Intrauterine Device (IUD), was produced and used in the Soviet Union, and continues to be recommended today.
Approximately 27 percent of married women relied on modern methods of contraception in 2010, according to the ADHS data. A slightly higher number, about 28 percent, opted for traditional methods, such as periodic abstinence, withdrawal, and “folk methods.” Although the use of all forms of contraception has decreased since 2000, the use of modern methods has increased from 20-22 percent to 27 percent. Condom use in particular rose from 7 percent in 2000 to 15 percent in 2010.
In January 2010, USAID initiated a one-year maternal and child health (MCH) improvement project in Armenia known as NOVA 2. The project introduced family-planning counseling to 24 healthcare facilities in five regions in southern Armenia. The result was a noticeable decrease in abortions.
Similarly, UNFPA helped create 75 family-planning units in Armenia offering free counseling and modern contraceptives to the public. Panajyan says USAID’s current HS-STAR Project is creating clinical practice guidelines that Armenia’s Ministry of Health will promote, along with counseling, for use by Armenia’s healthcare professionals.
“This is the first time I’m hearing on all stakeholder levels an interest in actually measuring and maybe perhaps giving bonuses to physicians who carry out this counseling effectively. It’s happening at the ministerial level, which I think is really great work,” said Hekimian.
The real trial will be in the funding and enforcement of such initiatives on a national platform.
Panajyan believes it is too early to predict what the future holds, and whether Armenia will have a female deficit.
“Concerned by the problem, UNFPA Armenia supported a survey to understand the reasons behind and the magnitude of the phenomenon,” said Hayrapetyan, adding that the survey results will be available in December 2011.
A mother of three boys, Panajyan says she was overjoyed with her third pregnancy. Her greatest wish was for a healthy child, no matter the sex. “The issue itself—the discriminative approach at birth where each child does not have an equal right to birth and life—should be considered,” she said. “I’m not saying that prohibitive laws should be approved and enforced, but something should be targeted—at least on a societal level—to increase the public’s awareness of the issue.”
“There was a recent tragic case, where a family from a remote region—a father, a pregnant mother, and two daughters—drove to Yerevan for the mother to receive an ultrasound test to find out the sex of the fetus. As the father revealed later, they had decided to get an abortion if it was a girl. But on their way to Yerevan, the family had a car accident, and one of their daughters was killed,” said Hayrapetyan. “That completely changed their lives, and their view on sex selective abortions.”