Blerta*, a Prishtina native, decided to go to the gynecologist for the first time when she was 24 years old. She was sexually active and wanted to know more about reproductive health and ways to prevent pregnancy.
During her short visit to the Health Center in the center of Prishtina, the doctor suggested contraceptive pills, which she started taking immediately.
In the four months that she regularly took the pills, neither the doctor nor the pharmacists provided her with information about contraceptives, how they work or their possible side effects. Because of this silence, she was surprised when she started to feel side effects. “I was moody every day,” said Blerta. It was only after doing some research on the internet that she realized many women experience similar symptoms.
Laura*, from Ferizaj, had a similar experience when her doctor prescribed oral contraceptives for hormonal problems.
Similar to Blerta, Laura didn’t know much about contraceptives until her first visit to the gynecologist. She asked questions, but the doctor didn’t provide much information.
Many women and girls in Kosovo do not have access to accurate and detailed information about contraception or sexual health in general. This directly affects their health and well-being.
Contraception plays a central role in gender justice. When women and girls have the autonomy to make their own decisions about their bodies, especially when it comes to avoiding unwanted pregnancies, it paves the way for their inclusion in society, education and the workforce.
Insufficient and inaccurate information
According to the World Health Organization (WHO), access to contraceptives and information about contraceptives is essential for people’s health. Even Kosovo’s Law on Reproductive Health mentions the right to have access to information about sexual health.
One way to ensure this access to information is to integrate sex education into school curricula.
Blerta said that during her schooling she did not learn about reproductive health or ways to prevent pregnancy.
Obstetrician-gynecologist at the University Clinical Center of Kosovo, Berat Krasniqi, said that the lack of information about oral contraceptives is a systemic issue that should involve many institutions, starting with primary schools.
However, despite many discussions on the matter, Kosovo still does not have sexual education as a separate subject. Aspects of sexual and reproductive education are included in different subjects in Kosovo’s education system, but there is no comprehensive approach that covers sexual education beyond the biological elements.
At the end of 2022, the Ombudsman released a report addressing the institutions responsible for providing Kosovars with access to information and services about sexual and reproductive health and contraception.
The report includes the results of conversations with civil society organizations that work in the field of sexual and reproductive rights and focus groups with women from all over Kosovo as well as meetings with authorities, policy makers, law enforcement and local authorities responsible for providing health services in the field of sexual and reproductive health, the report concludes
The report concludes that implementing sexual education in schools is one of the most important steps that the Ministry of Education, Science and Technology (MEST) should undertake. The report states “MEST must ensure that age-appropriate comprehensive sex education is offered as a regular subject for all children and teenagers in Kosovo’s schools.”
The report also emphasizes the importance of dealing with topics such as anatomy, sexual physiology, interpersonal relationships, sexually transmitted infections, sexuality, sexual diversity and gender-based violence.
In Kosovo, access to information is limited and women have to rely on online resources or conversations with their social circle to gather information. Blerta said that she had only heard about contraceptive pills from conversations with other women but never from a health professional.
This leaves women unprepared and uninformed about their reproductive and sexual rights.
Inadequate communication
The lack of information not only restricts access to contraception but also leads to the accidental misuse of contraceptives.
At the age of 26, Urata*, from Gjakova, decided to purchase an emergency contraceptive, often referred to as Plan B or morning-after contraception, after sexual intercourse, as she was concerned about the possibility of becoming pregnant. Due to her limited knowledge about contraception, she only asked for “anti-pregnancy” pills at the pharmacy. The pharmacist gave her normal oral contraceptives that are used longterm to protect against unwanted pregnancies rather than emergency contraceptives, which are taken to prevent pregnancy up to 72 hours after unprotected sex.
“I didn’t know and took them for three days in a row, one at a time. Then I realized that I didn’t even know how to ask for the right contraceptives. If you need emergency contraceptives, then you have to ask for the right ones from the pharmacist,” said Urata.
According to the Ombudsman’s report, 37% of women and girls interviewed said that health professionals did not inform them about contraceptives.
Leonida Molliqaj, director of the Center for Information, Criticism and Action, thinks that the lack of doctor-patient communication poses challenges when it comes to accessing contraceptives. According to her, in Kosovo, contraceptives are not widely used due to stigma.
The Ombudsman’s report also states that not enough is being done in this regard. “Information is mainly provided when there are requests from women or girls, but there is no initiative from health personnel to provide information regarding the importance of contraception and the proper and safe use of contraceptive methods.”
In 2022, the WHO compiled new competency standards for health workers around family planning and abortion. These standards emphasize that health workers should have strong communication skills in addition to professional knowledge so that they are equipped to actively listen to patients and convey information effectively.
Still a stigma
Besides the absence of sexual education in school and the lack of information provided by doctors and pharmacists, sexual health in Kosovo continues to be the subject of stigma. This is why the three women interviewed for this article asked to not be identified.
This stigma is evident in schools when someone tries to ask questions about sex education and is met with ridicule, or when teachers skip sex education sections in the curriculum entirely. Even health service providers contribute to the stigma. This prevents many from seeking advice or accessing sexual and reproductive health services.
When Urata wanted to buy emergency contraceptives, she was embarrassed that her local pharmacist would recognize her and went to a pharmacy far from her home. The WHO states that how people perceive health care is influenced by the behaviors of health workers, who must be effective, non-judgmental and put the patient first.
The taboo surrounding sexual health is considered a factor in the low number of routine gynecologist visits. This lack of check-ups can put the health of girls and women at risk due to delays in the diagnosis of serious diseases. The 2022 Ombudsman report also found that women and girls of all ages are not sufficiently informed about the importance of gynecological consultations and visits.
Molliqaj said that sexual and reproductive health “is only discussed when it comes to birth, in the context of motherhood.” Molliqaj believes that in Kosovo there is a need to reconsider the way that discussions about sex, contraception, gender, sexuality and reproductive and sexual health take place and that everyone should be included in these conversations.
“The primary responsibility lies with the Ministry of Health and the Ministry of Education. We have not seen any awareness campaigns from these institutions regarding reproductive health, let alone contraception,” she said.
The 2022 Ombudsman report also calls for the training for doctors, nurses and midwives in providing adequate information about contraceptives. It also calls for the elimination of prejudices and providing family planning counseling to patients, so that they can choose to use contraceptives in an informed and independent way.
Molliqaj believes that education on sexual and reproductive health would inform young people about their health, well-being and dignity. The current lack of information is leaving many girls and women without access to proper information and healthcare.
Feature Image: Atdhe Mulla / K2.0.
* The names Blerta, Laura and Urata are pseudonyms to respect the privacy of the women interviewed.
