PREFACE

The problems related to the Reproductive Health currently deserve special attention in Armenia and are identified as priority areas for Public Health intervention. In summer of 1997, the Ministry of Health of Armenia, with support of the World Health Organization (WHO), the United Nation’s Population Fund (UNFPA), and the United Nation’s Children Fund (UNICEF), conducted the first nation-wide population-based Reproductive Health Survey among women, as part of the Armenian National Program on Reproductive Health. As an outcome, the government authorities, non-governmental organizations and international agencies were provided with representative data on the situation surrounding Reproductive Health, in particularly with respect to Family Planning, Induced Abortion and Maternal Health.

However, an aspect of Reproductive Health that has remained largely neglected in Armenia is the sexual and reproductive health of men. There is also the concern over the large number of sexually transmitted diseases (STDs) in both females and males, which if left untreated, can lead to serious health problems and infertility. In fact, several hospital-based research studies comment on the high prevalence of reproductive tract infections and infertility in Armenia. Evaluation of the pattern of infertility revealed that in a significant proportion of the cases infertility in Armenian women is attributed to reproductive tract infection and unsafe abortion. The epidemiological survey of 4349 currently married women of reproductive age, which was conducted in 1989-1990 in city of Yerevan, revealed a primary infertility rate of 3.2% and the secondary infertility rate of 21.4%.

As it was recognised by the WHO, both involuntary infertility and STDs are world-wide social and public health problems that require urgent attention by agencies concerned with reproductive health. Their priorities are based on serious impact not only on the sexual and reproductive Health, but also on the mental health and social well being of couples. The WHO estimated that each year some 333 million people world-wide become infected with STDs. It is commonly known that infertility and STDs may trigger family conflicts and divorce. Some of the STDs, including AIDS carry a high morbidity and or mortality. World-wide epidemiological evidence suggests that approximately 8 percent of all couples experience some form of infertility problem during their lives.

The report that follows is the outcome of two nation-wide surveys on reproductive health of men and women in Armenia, that have been carried out under the framework of the National Program on Reproductive Health, established by the Ministry of Health.  These surveys have been designed and implemented by the Armenian Family Health Association in collaboration with the Republican Center on Perinatology, Obstetrics and Gynecology. The United Methodist Committee on Relief, Armenia Office (UMCOR) has kindly provided financial and technical assistance for project implementation.

By applying social science research methods researchers involved in these surveys have obtained scientifically sound, policy-relevant information on sexual and reproductive health situation in Armenia. The surveys were focusing on the priority aspects of the RH, such as sexual behavior, family planning, abortion, maternal health, and childhood survival. The special reference was made to the social, cultural, service- related and other factors that associated with the STDs and Infertility in both genders. The information and views provided in this report lead to an invitation for governmental authorities, non-governmental organizations and international agencies to develop and implement reproductive health oriented projects that will benefit both genders, focusing on the prevention, education and health care delivery.

The enthusiastic and committed efforts of the team of consultants, researchers, interviewers, drivers, computer specialists and the editors made this report possible. The authors express their special gratitude to the following individuals, supported implementation of this survey:   

Dr. Terry Wollen, head of mission, UMCOR, Armenia office, for organizational assistance and editing of the report.

Dr. Robert Mac-Pherson, Assistant Director Center for Health Service Research of the American University of Armenia, volunteered his assistance in identifying the ideal sample size.

Dr. Montiel Rosenthal (USA), family physician and sister of charity volunteered her editing assistance.

Dr. Jasmen Harutiunyan, Researcher at the Armenian Family Health Association (AFHA), provided assistance in verification and checking the questionnaires.

Ms. Anna Harutiunyan, executive director of the AFHA for organizational assistance and technical support.

Ms. Judy Wollen, program officer, UMCOR, Armenia Office, for organizational assistance and technical support.

Ms. Anaheet Kazanchyan, program adviser of the UMCOR, Armenia Office organizational assistance and technical support.

Dr. Karen Melikyan, physician of the Republican Centre on Perinatology, Obstetrics and Gynaecology, for organizational assistance and technical support.

Dr. Vahan Gulchasyan, secretary of the management office of the National Program on Reproductive Health, Republican Centre on Perinatology, Obstetrics and Gynaecology, for organizational assistance and technical support.

Ms. Susanna Igityan (AFHA), consultant on programming and medical statistics for consultancy in development of computer program, data processing and analysis.

Ms. Mary Garibyan (AFHA), consultant on programming, data entry and cleaning for consultancy in development of computer programs, data entry and cleaning 

The female interviewers for this study are Gajane Aleksanyan, Zarui Aleksanyan, Svetlana Antonyan, Liana Galstyan, Anna Grigoryan, Lusine Harutiunyan, Arshaluis Kirakosyan, Asmik Kochoyan, Lusvard Musikyan and Magda Stepanyan. The male interviewers: Rubik Abrahamyan, Sergey Antonyan, Armen Babayan, Korioun Karagoulyan, Pavel Mazmanyan, Egishe Hovhannesyan, Mikayel Matevosyan, Tigran Nersisyan, Arshak Djerjeryan, Armen Blboulyan. This team selected and carefully recorded the responses of 2800 Armenian women and men from all 11 regions of Armenia. We are grateful also to team of the computer operators of the Armenian Family Health Association for data entry into the computer database.

Special thanks to the staff-members of the regional maternity hospitals and the rural health facilities, and to the team of residents of the Republican Centre on Perinatology, Obstetrics and Gynaecology for their invaluable assistance in implementation of the field works. To all Armenian women and men who lent their candid voices in the interest of improving of family health and welfare in Armenia thank you indeed.