The Improvement of Mother and Child Health Services programme is a joint effort by the United Nations children’s agency UNICEF, the European Union and the Uzbek health ministry.
Four years after the programme began, Uzbek hospitals continue to carry out forcible sterilisations of women, a practice that activists say UNICEF and the EU need to address.
Some months after Zulkhumor, a 28-year-old from Navoi region in western Uzbekistan, gave birth to her second child by Caesarean section, she discovered she had been given a hysterectomy.
"There are secret instructions that women who’ve had two children should have their fallopian tubes tied or their uterus removed during labour, to prevent them having any more children,” she said. “Friends of mine have fallen victim to the same medical procedures as me – it’s common practice in Navoi and other towns.”
Tashkent-based lawyer Laylo Hamidova said many women have tried to sue doctors for illegal sterilisation, but the courts refuse to hear such cases.
In Uzbekistan, she said, "It is extremely difficult to prove that a woman’s health has been harmed by forcible sterilisation. Medical staff also cite an unofficial policy of reducing the birth rate.”
A doctor at a maternity hospital in the capital Tashkent confirmed that there was an annual plan for cutting the birth rate.
"It’s Russian roulette,” he said. “If a doctor decides to tie your [fallopian] tubes, he’ll do so, but if he decides to show pity, he won’t.”
The origin of these instructions remains unclear, but many doctors cite an order issued by President Islam Karimov in April 2009 which called for voluntary sterilisation.
"This is about voluntary consent from a woman who does not want any more children. But what we’re seeing is a different practice where women are sterilised without any advance warning,” the Tashkent doctor said.
An NGO worker engaged in maternal and child health said many women in Uzbekistan were unaware of contraceptive measures.
"In our society, these are taboo subjects,” he explained. “So instead of educating the public, the government taking the simple path of reducing the birth rate by force."
Phase 1 of the maternal and child programme ran from 2008 to 2011 and focused on state healthcare provision.
The Uzbek authorities say 17,000 healthcare staff received training in the course of the programme.
Independent experts on the ground, however, say medical provision for mothers and children remains poor, and the government’s international partners appear either to be taken in by its claims, or to be ignoring the facts.
The infant mortality rate remains high at over 21 per 1,000 births, according to unofficial estimates.
An activist with the Life for Mothers NGO was shocked to learn that the UNICEF/EU project had been deemed a success.
"Huge numbers of children are dying in hospital because obstetricians and gynaecologists lack the requisite skills,” she said. “The main cause of infant mortality is respiratory diseases. To tidy up these unsightly statistics, the authorities conceal child mortality data.”
Infant and maternal mortality is higher in rural areas where medical services are poorer.
"There are rural health centres that don’t have a gynaecologist,” the activist said. “Many women don’t come for check-ups at all during pregnancy, and as a result there are more children born with pathological problems.”