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April 13, 2007
MVA training
In order to ensure services for displaced women to end a pregnancy safely, there must be skilled doctors and adequate equipment to perform the procedures.

After the fall of the Soviet Union, Eastern Europe’s new republics struggled with nation building and, during that process, tensions erupted in a disputed territory called Abkhazia.

Abkhazia is recognized by the United Nations and other international organizations as an autonomous region of Georgia. But in the early 1990s, a Russian-backed Abkhaz separatist movement declared Abkhazia’s independence, sparking an Abkhaz-Georgian armed conflict.

Caught between warring factions, many Georgians, ethnic Abkhaz and others fled the region, which is located on the eastern shore of the Black Sea and also shares its northern border with Russia. A 1995 Human Rights Watch report estimated that up to 200,000 people were displaced by fighting, and many have yet to return home after further flareups of violence.

Among those who have been unable to go back to their homes are internally displaced women who are now living in a deserted Communist-era hotel near the Tbilisi Sea in Georgia. Along with their material belongings and their homes, they left behind their rights and access to health services, including those related to sexual and reproductive health.

In November 2006 and March 2007, Ipas funded two programs to help improve the quality of abortion care for all Georgians, including the internally displaced. HERA XXI, a nongovernmental organization founded in 1997 and a member of the International Planned Parenthood Federation since 2000, conducted the November session to educate displaced women about abortion and related reproductive-health issues. In spring 2007, a training was held to increase health-care providers and obstetrician-gynecologists’ knowledge of abortion services.

In Georgia, abortion services are legal until the 12th week of pregnancy in a wide variety of circumstances. After the 12th week, pregnancy termination is allowed in state-licensed hospitals or clinics in a number of cases that are particularly relevant to the lives of displaced women: pregnancy after rape, homelessness or living in a hostel, refugee status or unemployment of the woman or her husband.
Along with the November workshop, two consulting doctors from the Sharashidze Medical Centre tested new health information tools on abortion, including posters and leaflets, with a group of 20 displaced women from Abhazia. The posters detailed the manual vacuum aspiration (MVA) method, a safe and cost-efficient method of pregnancy termination.

In addition to asking displaced women how they’d like to receive information about safe abortion care, the workshop also provided the participants with concrete information about where they could seek a safe abortion. While Georgia has a high rate of legal abortions, many continue to be performed in less than optimal circumstances — without anesthesia or using dilatation and curettage, a method associated with higher complications than MVA. A 2004 report, “Abortion and Contraception in Georgia and Kazakhstan,” suggested that while an estimated two-thirds of married women surveyed in Georgia had had abortions and many more viewed abortion as an acceptable pregnancy option, there were still concerns that abortion can be risky in some settings.

In the area near the hotel where displaced women live there were two health centers certified to provide abortion services. One clinic provided discounts to displaced women, who could pay 15 lari (almost US$9) rather than the standard fee of 25 lari; but that clinic had temporarily halted offering abortion services as part of health-system restructuring. The other operational center charged 60 lari, with no help for displaced women. (However, internally displaced women can get some financial assistance for safe abortion care from the Abkhaz exile government.)

In addition to certified health centers, in order for displaced women to end a pregnancy safely, there must also be skilled doctors and adequate equipment to perform the procedures. To increase the availability of services, Ipas supported the March training to educate a dozen doctors from throughout Georgia, including one health professional from the disputed region.

Ipas’s recent work with HERA XXI and its partner, the Georgian Obstetricians Gynaecologists Association (GOGA) builds on efforts that began in 2004. In that year, Ipas initiated work with the National Abortion Federation to conduct MVA training in Tbilisi and Ipas took the lead in establishing training and commercial distribution of MVA in the region.

Following this series of workshops, now displaced women may talk openly over the clothesline, content with at least one positive change in their internally displaced lives.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258