The position of women

and demographic processes in the countries in transition

by Wanda Nowicka

Seminar: Female Empowerment and Demographic Processes:

Moving Beyond Cairo

Lund, Sweden, April 21-24 1997

Countries of Central and Eastern Europe and Asia

Countries in Central and Eastern Europe and Asia named by international bodies as countries in transition or countries with economies in transition have gained this label as a recognition of the existence of the third category of countries which do not belong to the developed and developing countries. Those countries share the common experience of a communist totalitarian regime past. Presently, after the fall of communism they are undergoing more or less dramatic changes of political economic systems and social environment.

This region embraces the countries of Central and Eastern Europe and Asia, including those established after the fall of the Soviet Union. These countries could be subdivided into:

- Countries Central and Eastern Europe (CCEE) (Albania, Bulgaria, Czech Republic, Hungary, Poland, Romania, Slovakia),

- Republics of former Yugoslavia (Bosnia and Hercegovina, Croatia, Macedonia, Slovenia, Serbia)

- Commonwealth of Independent States (CIS) (Armenia, Azerbaijan, Belarus, Georgia, Republic of Moldova, Russian Federation, Ukraine),

- Central Asian Republics (Kazakhstan, Kyrgystan, Tajikistan, Turkmenistan, Uzbekistan)

- Baltic States (Estonia, Latvia, Lithuania).

Women of the region

Political and economic situation of the region and the transformation experienced in the late eighties and nineties, has an significant influence on the position of women. Women in Eastern and Central Europe apart from all differences among them share many similarities resulting from common heritage under communist regime.

Elena Kotchkina from the Moscow Center for Gender Studies in her Report⁽¹⁾ on the Legal Status of Women in Russia accurately described processes in Russia which are true to great extent in most countries of the region:

The high level of unemployment among women, segregation in the labour market, the increasing salary gap between women and men, the lack of women present at the decision making level, increasing violence against women, the high levels of maternal and infant mortality, the total absence of a contraceptive industry in Russia, the insufficiency of child welfare benefits, the lack of adequate resources to fund current state programs - this is only part of the long list of women's rights violations.

Each country is undergoing transition in different way. Conditions, cultures, human experiences, economics vary greatly, particularly when you compare Poland or Hungary with the far poorer Central Asian Republics, such as Tajikistan or Kyrgystan. Even within the Russian Federation, conditions and opportunities vary greatly, as when St. Petersburg and Moscow are compared with rural areas of Volgograd or far-east Siberia. Despite these vast differences the general impact of transition in most of these countries brought many similar changes which are perceived as negative ones.

Scope and goals of this paper

Expected length of the article and insufficient existing or available data do not allow to thoroughly analyze the situation of women in all these countries, the focus will be made on Poland as the best known case to the author, and Russia.

The paper is aimed at analyzing the present situation of women and its dynamics in the area of:

education,

political participation,

economy including labour market issues,

health, including reproductive health.

It is intended to demonstrate the impact the present political and economic transformation has made on the position of women in this region: what are the gains, losses and possible threats for the future.

It is also intended to present the main reasons why women can neither fully participate in the process of change nor benefit from the advantages of these processes.

Education

Education is one of the most important indicators of women's empowerment. In the region of Eastern and Central Europe women have been quite well educated. The countries of the region have high literacy rates both for the overall population and for women. Women achieved higher education than in other parts of the world.

However, according to the WHO publication "Investing in Women's Health: Central and Eastern Europe"⁽²⁾ (the publication prepared on a basis of countries' reports) negative signs could be observed resulting from the permanent under-investment of education system. Even though relatively small proportions of the population have the opportunity for higher education, women are well represented at the higher levels of education.

In Poland⁽³⁾ the number of women with high education is constantly growing. Higher education has been completed by 7.7 per cent of people aged 25 and more. Taking into consideration this age group there are 8.7 per cent of people among men, and 6.8 per cent among women. Generally, it might be said that men are in the majority among people who completed academic education. However, this trend is observed only in older age groups - among people aged 65 or more. Among people 65 or more 4.6 per cent of men and 1.4 per cent of women with higher education. In the age-group of 45-64-years old (1988) 9.5 per cent of men and 5.9. per cent of women completed academic education. But in the age-group of 30-44 (1988) there are 9.7 per cent of men and 9.8 per cent of women with higher education. In the youngest age-group 25-29 in 1988 there were 8.0 per cent of men and 9.6 per cent of women.

Table 1 Higher schools graduates in the years 1980-1994 (by sex)⁽⁴⁾

In Russia⁽⁵⁾ more women are highly educated and have broader educational backgrounds than men. According to the most recent population census (1989), of 1,000 women, 925 had university or secondary education, as compared with 906 men. The share of girls who entered first grade was 50 per cent in 1992. Among children who finished secondary school, the share of girls was 60 per cent in 1992. During 1990-1992, there was a decrease in the number of girls among high school students from 1.4 million to 1.3 million. It is attributed by the UNICEF report to the new emerging job opportunities for women without higher education to get well-paid jobs, as secretaries, saleswomen etc. Women holding doctoral degrees also declined, from 18 per cent in 1980 to 15 per cent in 1992.

However certain symptoms of inequality in education could be observed. It could be best observed and documented on Polish case⁽⁶⁾.

Gender stereotypes

The educational system in many ways perpetuates gender stereotypes, promoting family roles of women as the primary ones. During primary education children become familiar with the place of women and men in the society. Teachers, often completely unaware of this fact, use manuals that perpetuate a patriarchal model of the family and the world. Women and girls are often presented as mothers and housewives in family roles, during housework, while men are presented as professionals or during leisure time. Boys are presented mainly during holidays and interesting activities.

Such patterns and stereotypes promoted in the earliest stage of human development strengthen patriarchal model of the society and are difficult to eradicate.

Inequality of educational opportunities

The Report of NGOs for Beijing quoted above, states that girls and boys experience some inequalities at the high school and university level. Women are not promoted to technical interests and education. There is a well-known case of the intervention of the Polish Feminist Association related to computer classes for boys and housekeeping classes for girls. Girls have fewer possibilities to choose their educational programme at the high school level. Many vocational schools, particularly those addressed to women like tailoring schools have been closed up in recent years as a result of the collapse of textile industry. Some technical schools do not accept girls at all. As a result, more girls than boys attend high schools that do not prepare them for any particular profession.

Women at the university

In the university level women constitute more than half of all students (51,4 per cent in 1991) and graduates of universities. The majority of them, however, study subjects which are low paid in future profession - feminized professions such as teaching, research, medicine. In 1990-1991 women constituted 75.5 per cent of all students of humanities but 17.4 per cent of all students of technical studies.

Such phenomena to different degree exist in other countries of Eastern and Central Europe.

Managerial posts in education

Although women make up the majority of students and graduates and they make 77 per cent of the employed in the field of education, they less often make careers and take top positions in the field of education or research. In 1990-91 women professors constituted 15.1 per cent of all professors⁽⁷⁾. It seems that strong stereotypes hinder the process of equal share among women and men.

Concerns for the future

Moreover, there are signs that educational gains could be threatened by economic transformation in some countries⁽⁸⁾. In Poland⁽⁹⁾ in result of higher costs associated with the education of children it has been observed that in some families investment in the education of a boy than of a girl is perceived as more effective and profitable. By promoting patriarchal stereotypes of a woman's role as mothers and wives, investment in girls' education could be perceived as a loss of resources.

Political participation⁽¹⁰⁾

In the nineties women are seriously underrepresented in power elites and governance systems throughout the region. The process of building new democratic systems and market economies continues without women's participation and without consultation with them on their concerns and priorities. Ruminska-Zimny in referred paper indicates four characteristics of women's status in the process of institutional change: (a) a reduction in political representation; (b) deprivation of economic power; (c) modest representation at the local, municipal and grass-roots levels; and (d) paternalistic tendencies in revision of informal institutions.

A reduction in political representation

The first free elections after the fall of communist regimes resulted in the serious decrease in women's participation in governance and decision-making structures. This was mainly caused by abolition of certain quota mechanisms existing in former systems that guaranteed significant women's participation. Before 1989 proportion of women in national parliaments was 20-40 per cent. Participation of women in parliaments dropped dramatically to single digits with some exceptions.

Female political representation varies according to the country. It is highest in Slovakia with 18 per cent of seats and lowest in Azerbaijan where only 2 per cent of members of the national parliament are female. Overall, women in the CIS countries, with the possible exception of Kazakhstan and Uzbekistan, as well as women in the countries of former Yugoslavia, except Slovenia, are the biggest losers. Women in most other countries of Eastern Europe, except for Albania and Romania, as well as women in the Baltic states, except Lithuania, have higher levels of political representation reaching 10 per cent and over.

Low participation of women in parliaments unables forming inter-parliamentary coalitions. Such coalition, however, does exist in the Polish Parliament where participation of women equals 13 per cent in result of 1993 elections.

Participation of women in various national committees and bodies is uneven and limited mainly to 'soft' committees in social areas rather than those where resources are allocated, such as budget and finance committees, in the area of technology, foreign policy or defence are formulated.

Female participation in executive power structures is extremely low. Although some individual women hold or have held high level positions in new governments in some countries such as Bulgaria, Poland or Lithuania. At present there is no female head of state or government in the region. Typically there is one or no women ministers and the number of women holding senior positions in the civil services is limited. Women's losses in government posts are, however, less severe than losses of seats in national assemblies as the number of these posts in the past was very limited. Between 1980 and 1994 the number of female members of the Lithuanian Parliament decreased from 125 to 10 and the number of women ministers from one to zero⁽¹¹⁾.

There is another dimension of this issue. In the former regimes important decisions were taken at top party level, outside the parliaments, and only very few women reached positions within these inner circles of power. Therefore, although many more women were present in various bodies, their real impact on decision-making process was not that big. Representation in new democratic systems, on the other hand, gives more real influence on the process of decision-making, but women do not actively participate in it. In many countries of the region many women were active participants of dissident movements that led to democracy, particularly in Poland. It is ironic to some extent that female Solidarity members worked hard for freedom and democracy mainly behind the scene when most male Solidarity leaders were in prison. After the political change very few women could play significant roles in public life in new democratic society⁽¹²⁾.

Even in feminized sectors of labour where women constitute the majority of the work force, such as medicine and education, they are seriously underrepresented in positions of leadership⁽¹³⁾

Deprivation of economic power

Deprivation of economic power, as expressed by low numbers of women at managerial and executive levels in the economy, has been largely inherited. Women, as directors of enterprises or heads of national or local banks were traditionally few under the former regime despite the generally high levels of education. It can be only partly attributed to the profile of female education, focused little on technical or engineering skills, which probably accounts for the low share of women in managerial positions in manufacturing and particularly in energy, mining and metallurgy. The high number of women with diplomas in economics did not resulted in many women in top positions in the field of economy such as banking. It appears that women comprise not more than 2 per cent of the workers in the administrative and managerial sectors in many Central and Eastern European and the CIS countries⁽¹⁴⁾

Data on decision-making positions in national economies desegregated by gender is very scarce and hardly comparable owing to the vague definition of such positions. Incomplete data does not give evidence, however, that women's position in the economy has altered under the transition process and accurate evaluation and inter-country comparison are impossible.

The general impression is that an uneven start into the transition period means that women have little or no influence on the process of redistribution of wealth and economic resources which is now under way in all countries in the region. This process includes privatization of state assets as well as the introduction of new pay regulations and a new tax system. Women's absence from the decision-making positions in this process could have far-reaching implications for their access to resources, economic power and consequently politics.

Modest representation at the local, municipal and grass-roots levels

Women's political losses can be also seen at the local level. The proportion of women elected to local office was lower than in the past. In Poland, for example, women's representation at local level declined from 20.7 per cent (1984) to 11 per cent in 1990. The extent of changes in women's representation at local level across the countries cannot be evaluated due the lack of data and their incomparability. Figures for some countries indicate that women's participation in local bodies may vary significantly by country. In Belarus women's share is 47 per cent, in Armenia - 36 per cent and in Bulgaria - 20 per cent⁽¹⁵⁾.

Paternalistic tendencies in revision of informal institutions

In result of last changes together with the establishment of right-wing parties, the patriarchal model of the society has been re-evaluated in the countries of the region despite all existing cultural differences. The renaissance of these tendencies indicates that communist countries did not review gender roles in reality, both at family and political levels. The patriarchal trends have been justified on traditionalist, demographic and emotional grounds. Traditionalistic arguments, based on a return to women's predestination, have been developed and promoted by the extreme right-wing political parties and supported, in some countries, by growing fundamentalist movements or religions. It could be best observed in the Polish context. Demographic arguments recall the decrease of birth rate and threaten the extinction of the nation. Finally, bringing women home was interpreted as freeing them from "forced" labour under communism.

Some reasons for the decline in participation of women

- communist systems did not introduced real gender equality mechanisms, promotion of women had mainly economic grounds, did not lead to full participation in decision-making, distribution of resources, did not change gender stereotypes. Therefore, many of women's gains under communism were so easy to be taken away or limited.

- weakness or lack of authentic grassroots women's movement that was unable to defend women achieved rights and promote gender equality in accordance with international standards.

- psychological barriers (unwillingness to get involved more actively in politics resulting from disillusion over the political experience of the past, lack of self-confidence, fear of being associated with the former regime through picking up on feminist issues, priority given to family issues, fears to oppose patriarchal model).

Women in the economy

The burden of the transition to market economy weighs more heavily on women than on men, particularly because of the decline of social and public services and the financial situation of families, as growing unemployment and inflation⁽¹⁶⁾.

The feminization of poverty has been observed as a very important indicator⁽¹⁷⁾ of this process.

Women at labour market

Women's position on the labour market in the countries of Central and Eastern Europe, the CIS and the Baltic States deteriorated under the transition process. In many countries the female participation rate remained high, often between 70 and 80 per cent, in other countries a considerable decline of this rate has taken place owing to high rates of women's unemployment. (cf. Table 2)

In Poland, for example, since 1985 the female participation rate decreased from 78 to 57 per cent (1994)⁽¹⁸⁾. Women in most countries in the region also maintained their share in the labor force at between 45 and 50 per cent. In some countries, such as Russian Federation, Ukraine and Belarus even a slight tendency towards an increase in the women's share was reported⁽¹⁹⁾. In Russia 84 per cent participate in labour force⁽²⁰⁾.

Being employed for many women meant not always choice but necessity: on the family level, there has been need for two incomes to compensate somehow for the rapidly falling wages and salaries.

Women, however, seem less successful than men in competing for jobs in market environment. There are easier fired and find job with greater difficulty, particularly in growing private sector. Employed women continue to be paid less than their male counterparts. The following trends were recognized by Ruminska-Zimny: (a) a rise of female unemployment; (b) slow integration into private sector activities; (c) sectoral segregation of women's jobs; (d) persistent wage gap.

A rise of female unemployment

Since 1989 unemployment became an integral element of economic restructurization and privatization processes in all countries of Central and Eastern Europe, the CIS and the Baltic States. Levels of female unemployment are uneven across the region and not easy to compare across countries. Among countries for which there are data, the lowest proportion of the female labour force out of work, between 0.8 and 4.1 per cent, is reported in Belarus, the Russian Federation, Ukraine and the Czech Republic. In countries of Central and Eastern Europe these numbers vary between 8.5 and 18.5 per cent and rise to 47 per cent in Macedonia.

Since 1990 in most countries of the region unemployment affected women to greater extent than men. It means that costs of economic transformation are bore more by women then men. All countries in the region, except for Hungary, Lithuania and Slovenia, have a male-female gap in unemployment, as measured in terms of men's unemployment.

This gap is the largest in Russian Federation, Kyrgystan, Belarus and Armenia. In Russia in September 1992 nearly 1 million people were unemployed, of which 71 per cent were women. This is an average that masks regional and local concentrations as high as 89 per cent, for instance, in the Nenets region. This is expected to increase with mass layoffs in many industries⁽²¹⁾. The Ukrainians, where women constitute two-thirds of all unemployed, call this phenomenon "unemployment with a female face"⁽²²⁾.The male-female unemployment gap is also considerable in the Czech Republic and Romania.

The existing male-female gap in unemployment is probably wider than illustrated due to the tendency to underestimate female unemployment rates. One of the reasons for such underestimation is the reliance on the employment offices data which omit those not recorded, most of whom are women.

The great majority of women are not prepared to handle the growing insecurity and necessity to look for and change jobs often. Under communism most people stayed at one job for many years. Women are under strong pressure to meet the higher standards demanded at the workplace, both in the private and in state sectors, as well as to cope with increased responsibilities as wives and mothers resulting from the shrinking social infrastructure. At the same time, it is difficult to find a new job as a result of discrimination against women practised by employers who choose men rather than women, except perhaps in some feminized industries and low-paid positions. Women with good qualifications are compelled to take jobs that do not correspond to their qualifications. Few (re)training programmes are available. Women with children and women over 40 are often the first to be fired⁽²³⁾. Job advertisements indicating expected sex of candidates are not forbidden as in most developed countries.

Slow integration into private sector activities

Although, the adequate data is not available with this respect, it has been observed that less women than men are trying to look for new opportunities in the private sector. The proportion of women working in the private sector as employees is smaller than that for men in countries with better data with this respect⁽²⁴⁾. Women's chances depend largely on their education. There are a number of success stories of women entrepreneurs throughout the region but the majority, particularly those younger, with better education are living in big urban centers⁽²⁵⁾. For the majority of women in transition countries, however, in particular those less educated, older and living in rural areas or small towns , integration into the private sector is more difficult and the number of new jobs is limited. Similarly in most countries self-employed women often run small shops, work as street vendors, do repairs or offer social and personal services. These women face severe obstacles as they lack business skills and knowledge, a supportive infrastructure and access to credit. Also as employees in the private sector women tend to find jobs in small or medium-sized firms including home-based enterprises, often operating within the grey economy with low job security and highly unregulated labour conditions. One of the main reasons why private employers hire men rather than women is women are less available to work longer hours and are perceived as expensive workers due to associated social benefits as well as the lack of many technical skills⁽²⁶⁾.

Sectoral segregation of women's jobs

The sectoral employment pattern has not changed over the last few years. As in the past, female employment is concentrated in the service sector and in light industries. Industries such as textiles and food processing, trade, supply services, education, health, social protection, culture are highly feminized in all countries across the region.

In many countries, particularly in Poland, Romania, Moldova, Ukraine and most other CIS countries women also constitute an important part of the labour force in agriculture. Many women working in agriculture are unpaid family workers.

Persistent wage gap

In all former planned economies the male-female gap in levels of wages and salaries is a legacy of the past. Despite the lack of formal discrimination women were paid less than men typically by 20-25 per cent in professional category with an even greater discrepancy for unskilled workers. Indirect discrimination of women with respect to income has been a result of the fact that sectors with high proportions of women called "feminized professions" tended to be less paid⁽²⁷⁾. It could be particularly observed in such categories like education, health and social services. The gender gap is still present in all countries in transition. It seems the lowest in Ukraine and Slovenia and the widest in the Russian Federation.

The lack of data makes it impossible to evaluate whether the gender gap increased or decreased during the transition. In some countries there is evidence that the male-female gap in wages and salaries has increased. In Latvia, for example, it has been estimated that in early 1994 women's wages and salaries constituted 77 per cent of the average wages of men while in 1992 women's wages were estimated at 81 per cent of those of men⁽²⁸⁾. In Ukraine, on the other hand, it is estimated that there has been a small increase in female relative salaries in industry , particularly in light industry.

Women's attitudes towards work

Other aspects affecting male-female income differentials result from lack of change in relations within families - lack of partnership model that could be a result of women entering labour force. In result of this working women return home from their jobs to face their 'second job', with little help from men in child care and housework. It appears that women often are not as committed to the labour force as men; they frequently see themselves as secondary earners who often leave the labour force for extended periods of time to raise children. It should be noted, however, that it applies much less to professional married women. Moreover, due to breaks in employment, many women are not able to develop or to maintain their skills on the job⁽²⁹⁾.

Erosion of the state supported social infrastructure

Since 1989 the state-supported infrastructure in education, health and child-care has been seriously curtailed in all countries of the region, except the Czech Republic, Slovakia and Hungary. Few countries made direct cuts in social welfare, and the reduction in social benefits is often hidden and characterized by decreasing quality of services, restricted access to free services or simply shortages of supplies. The lack of many basic and still formally free treatment, drugs and medical services in many countries of Eastern Europe, the CIS and the Baltic States. In Modova, for example, in 1994 it was estimated that 60 per cent of the nation's medical equipment is non-functional due to the lack of spare parts, and patients in hospitals are expected to bring their own syringes, medications and bed linen⁽³⁰⁾. The costs of the social security coverage have been increasingly transferred from the state to households and added to by the process of partial commercialization of some services, such as child-care and/or education and health care.

Though women have been affected by all these changes the most serious losses occurred in the area of child-support benefits and child-care infrastructure. Real value has been quickly falling in most countries in the region. In Russia allowances for children below 18 months old decreased from 14.2 per cent to 1.5 per cent of the average wage between January 1992 and September 1993⁽³¹⁾. At the same time the state supported system of child-care facilities including creches and kindergartens has been affected by the lack of funding and many of them have been closed. In Poland over the years 1989-1993 the number of creches and kindergartens fell down over 20 per cent⁽³²⁾. In Russia in 35 regions, 2 to 8 per cent of pre-school children's institutions were closed, primary for lack of funding.

The erosion of family benefits and the child-care infrastructure have significantly increased women's functions as caregivers and thus their workload within family.

Changes in quality and style of life

Economic transformation resulted in many changes in people's lives. People under communism were used to social and economic security. Most people had jobs, usually not well paid but sufficient for modest living. Many could afford summer or/and winter holidays for the whole family. People, in general, did not make spectacular careers, but they had permanent jobs (usually the same for a long time if not for ever). They had a sense of relative security and stability.

When transformation came many people, particularly older ones, could not easily adjust to new style of life: often losing or changing jobs, closing work places, competition in labour market, need of constant education and retraining, poor chances for sufficient retirement. New life conditions contribute certainly to deterioration of health.

Women's health

Since 1989 , all societies in the countries of Eastern Europe , the CIS and the Baltic States experienced a rapid deterioration in all health indicators. A number of studies concluded that changes in mortality rates, life expectancy and fertility rates show patterns not seen even under wartime conditions⁽³³⁾.

In 1990, average life expectancy for women in the CIS was 6 years less than the average for women in the EU. The difference for women in CCEE was 5 years. In some countries life expectancy dropped from 76.3 years in 1990 to 75.86 in 1991. The figure for Poland decreased from 75.6 to 75.4 in 1991, and that for St. Petersburg dropped from 74.3 to 74.0 in 1992. The health gap between the CCEE and CIS and the rest of the European region widened in all respects between 1981 and 1990 and the new data for 1991/1992 show even greater difference as the economic crisis deepens.

The problems include high levels of maternal mortality, a large number of abortions per woman in her life time and per live birth, poor availability of information and services for family planning, high suicide rates and a lack of community-based mental health services and drugs to treat serious illnesses. Teenage pregnancy, which has a serious impact on education of young women, has also increased. Maternal mortality is still unacceptably high. The highest maternal mortality rates are found in the Central Asia Republics and in Romania. Maternal mortality in Romania and Albania fell dramatically after the legalization of abortion in 1989. Nevertheless, abortion remains a major cause of maternal mortality in both countries. As a result of absence of an affordable supply of contraceptives, abortion is a main method of family planning and one of the leading causes of maternal mortality. The abortion rates are among the highest in the world⁽³⁴⁾. Two main causes of overall women's mortality in the region are cardiovascular disease and cancer.

This deterioration of health can certainly be attributed to the hardships of everyday life, loss of security and deterioration of healthcare services. Most of the countries experience a lack of screening services and prevention services for female diseases such as: breast and cervical cancers. As a result, cancers, particularly breast cancer, often reach an advanced stage before being detected.

Healthcare systems in most countries demand general reforming. Many health services are lacking or of not good quality.

Particularly public healthcare centers in former Soviet Union experience serious difficulties. In Russia significant cuts in the public health care budget have resulted in a decrease of state-guaranteed health services for women and children. A lack of modern equipment, accessible medicine, and qualified personnel has led to deteriorating health among the population, particularly among women and children. Essential drugs and medicines were covered in 1990 up to 75 per cent but in 1993 only up to 65 per cent. Among 760 essential drugs, more than 350 are imported and therefore very expensive.

A decline in women's reproductive health is corroborated by increases in the number of children born with genetic disorders, which is reported to have increased 22-fold over the past 15 years. Moreover, an analysis of infant mortality by cause of death shows an increase in causes related to the mother's health, such as perinatal mortality and congenital malformations, from 43 per cent of infant deaths in 1981 to 64 per cent in 1991⁽³⁵⁾.

Reproductive health of women is in a poor shape in Poland. Women's morbidity and mortality of reproductive system is high and it is systematically growing. 1994 Report on Demographic Situation of Poland issued by the Government Population Commission anticipates that if the level of health care services does not improve with regard to diagnostics, therapy and prophylactics of cancer, deaths of women resulted from cancer may increase about 40 per cent by the year 2010.

Private clinics are being established in many countries but financial barrier does not allow many people to use these services.

Women's reproductive health and health services

Women's reproductive health in this region is not a priority issue for decision-makers in the region. In result of low fertility rates, reproductive health of women from countries in transition is not a priority for funding by international donors, agencies and organizations.

Most countries experience the significant decrease of birth rate, which has been low before. This demographic situation as well as factors such as unemployment, growing competition in labour market resulted in revitalization of ideologies that threaten the societies with slogans of the extinction of the nation, if women do not have more children. These ideologies often based on religious or/and nationalistic slogans promote 'family values', which in general view a woman in traditional roles of a mother of many children and a housewife. These tendencies can be best observed in Poland and Russia.

In Russia the society is being threatened by some political parties and the media by the vision of dying Russia and the need of saving the nation⁽³⁶⁾. These tendencies resulted in establishment of strong anti-abortion movements, as legal abortion is viewed as main reason of decreasing population growth.

Abortion

Under communism policies promoting motherhood, some CCEE attempted to increase birth rates by making contraception and abortion illegal ( Romania, Albania). Naturally, these policies failed. Instead of achieving their purpose, these policies led to extremely high maternal mortality in some countries. After having abolished such policies, the situation began to improve. For example, the very high abortion-related mortality for Romania in 1990 actually represents a fall from earlier figures and the improvement appears to be continuing. Nevertheless, abortion is still a major cause of maternal death. Decrease of maternal mortality has also been observed in Albania⁽³⁷⁾ after legalizing abortion in 1991.

In most countries of the region abortion was legalized much earlier than in the developed countries. In most countries it has been performed broadly, because family planning was not sufficiently popularized. In Russia and other countries of the Soviet Union, abortion remains the most common and effective means of family planning⁽³⁸⁾. As a result of pro-natalistic tendencies in some countries, attempts have been made to restrict the liberal abortion laws or at least limit access to abortion services.

The most extreme example of such policies is the case of Poland. Abortion was legalized in Poland in 1956 and was legal for almost forty years. Under the pressure of the Roman-Catholic Church, against the will of the majority of society the law was changed in 1993. According to this law, legal abortion was available only when the woman's life and health was threatened, when pregnancy was the result of a crime, or when the foetus was badly deformed.

This law resulted in many negative consequences for women's reproductive health. Two reports on the consequences of the anti-abortion law (1994, 1996) issued by the Federation for Women and Family Planning give the analysis how this law affected women's reproductive health and rights. Its main effects were the following:

¨ The law turned out to be more restrictive in practice than on paper. Many women who were entitled to legal abortion, were often denied their right in their local hospitals,

¨ The law did not stop abortions on social grounds it pushed them to the "underground" - women seeking abortion would find a doctor who performed it illegally or would go abroad. These two phenomena were called „abortion underground" or „abortion tourism",

¨ The law has affected mainly the poorest and the uneducated members of the society. Illegal abortion turned out to be expensive (300$ - 1,000$).