Women’s health in Turkmenistan: ‘Silence strips us of agency. This must change’ | Global development

Turkmenistan has two faces. The first is the one we see in state media: a pretty dancer, a caring mother, a sister or daughter in a beautiful traditional dress. She may be dancing, cooking or decorating an event with her presence.

The second is closer to reality: women and girls who have nowhere to go when they meet domestic violence, have no recourse to contraception and family planning services, and face sexual harassment – a few examples on a long list of unmet needs.

Access to information is severely curtailed. The state owns or controls all media and the internet is aggressively censored and restricted.

As founder and editor of Saglyk.org, the only website with credible public health information in the Turkmen language, my colleagues and I have been calling for nuanced and informed conversations by educating the public and advocating for science-based best practices in public health in Turkmenistan.

Saglyk’s comprehensive content on sexual and reproductive health is our most read. There is a great demand for this information, especially among women and girls. Turkmen schools don’t teach it. Families don’t discuss it. The media does not publish stories about it. The public space to discuss this basic aspect of being human is nonexistent.

Government agencies sustain this confusion by not providing science-based information to the public and failing to provide any public health data. This leads to women and girls in Turkmenistan having poor health outcomes. It also strips them of their agency. This needs to change.

According to Unicef, Turkmenistan has the highest mortality rate among under-fives in central Asia. According to the latest UN population fund figures only 50{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} of Turkmen women who are married or in a relationship are using a modern form of contraception. And across all women aged 15-49, 8{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} have an unmet need for contraception.

In Turkmenistan, nearly 60{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} of women cannot make independent decisions on fundamental issues such as healthcare, contraception and consenting to sex. The government promotes the pro-natalist messages of eight-child families, reinforcing the idea of women’s primary role as subservient wives and mothers.

The first national report on domestic violence against women, published by UNFPA in August 2022, found that 58{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} of women aged 15-49 believe that violating the restrictions and obligations imposed by a spouse is sufficient reason for a husband to beat his wife. The most common form of spousal control is preventing women from leaving the house without permission. The second most common is banning women from working or studying outside the home. According to the study, 41{6f90f2fe98827f97fd05e0011472e53c8890931f9d0d5714295052b72b9b5161} of women have encountered at least one type of controlling behaviour from their husband or partner in their lives.

Patriarchal culture, harmful traditions, government inaction and absence of public education and communication drive awareness of reproductive and sexual health underground. The public in Turkmenistan see abortion as something deeply immoral so women prefer to keep silent. This also applies to the endemic domestic violence in the country. Women and girls are taught that it is a private matter that should not be discussed in public but heroically endured in silence.

Many government orders are communicated by word of mouth, without legal status. This creates room for corruption, misinterpretation and speculation, not only in public health but in all areas of economic and social life.

The restrictive law on abortion in Turkmenistan undermines the rights, dignity and health of half the population, denying them access to essential reproductive healthcare. In 2015, the government passed a law restricting abortion to only up to five weeks. Before 2015, women in Turkmenistan were allowed to access abortion care up to 12 weeks.

The abortion law further entrenches health inequality: women with resources can overcome the restriction and have an abortion but women with lower financial and social status cannot afford to bypass these restrictions and have no network to do so.

Research shows that restricting access to abortion drives it underground and makes it unsafe. The law was adopted without any public discussion on the medical, moral, legal and economic consequences, and was only made public in 2022. Our calls for constructive engagement with the Ministry of Health have been met with silence.

Saglyk has created a safe space to anonymously share stories of domestic violence, abuse and harassment. Our Bilim app helps women and girls track their periods and learn about their health and rights (Bilim means both period and knowledge).

But these efforts are not enough to bring structural changes to our society, so in the past two years we have been increasingly engaging with international organisations. We are asking organisations that grant or lend money to the country to hold the government accountable on its international commitments to gender equality and the way they are implemented in practice.

This way, we can ensure that tomorrow we do not wake up to a new law that will further restrict the basic rights of Turkmen women and girls to dignity and equality.