A/HRC/41/34/Add.1 78. According to the multiple indicator cluster survey of 2014, 27 although one out of three women of reproductive age expressed a desire to space their births or limit the number of children they had, the majority did not use contraception owing to the lack of interest in family planning, a lack of information, or religious and cultural considerations, including opposition from partners, families or communities. Modern contraceptive methods in Kyrgyzstan are not affordable, available, of high quality or physically accessible. There is insufficient information to allow people to make informed decisions regarding their reproductive health, and the capacity of health-care personnel to provide quality familyplanning services is inadequate and their counselling skills are poor. 28 The Special Rapporteur was informed that the supply of contraceptives provided by international development partners had recently stopped. There is an urgent need for Kyrgyzstan to assume its responsibility as the duty bearer in the promotion and protection of sexual and reproductive health rights given the ongoing need for family planning and for quality sexual and reproductive health services. 79. When their sexual and reproductive health needs are not met, women are exposed to a greater risk of abuse and violence, sexually transmitted diseases, including HIV, and unwanted pregnancies. Moreover, research has shown that giving women access to modern methods of contraception in Kyrgyzstan would prevent 113,000 unintended pregnancies, 34,000 unsafe abortions and 60 maternal deaths. 29 80. Following his visits to health-care facilities, the Special Rapporteur was able to confirm that positive efforts had been made to address maternal and infant health issues. Despite the progress made, however, better quality emergency obstetric care is still needed to prevent maternal deaths and to improve conditions for healthy newborn babies. 81. The official data available indicate that the leading causes of maternal deaths are post-partum haemorrhage and septic complications, and that most maternal deaths occur in hospitals at the secondary and tertiary levels. A key factor associated with maternal deaths is the poor quality of Caesarean sections, a procedure that has become more frequent in recent years, to the point that it is now the most common surgical procedure. More emphasis should be made on developing practical skills at all stages of training for medical specialists to effectively improve the delivery of good quality care to pregnant women and newborns. 82. At the community level, the Special Rapporteur was informed about many cases of pregnant women delaying visits to primary care facilities or purposefully concealing health problems before delivery,30 preventing the provision of proper prenatal care. He also heard about the good work carried out by village health committees at the community level and by health-care personnel at primary care facilities, involving regular visits to families to provide information and follow-up on maternal care. Awareness-raising among women about the importance of receiving quality health care and having access to referral services in order to address the right to health for women in Kyrgyzstan is vital. 83. An additional challenge being faced is teenage pregnancy and the adolescent fertility rate, which is high in Kyrgyzstan. Kyrgyzstan holds the second highest adolescent fertility rate in the Eastern Europe and Central Asian region, with the highest number of pregnancies in the provinces of Batken, Jalal-Abad and Talas. The rate is also higher among girls from rural areas, from the lowest wealth quintile and from minority families of Uzbek ethnicity. Most adolescents give birth between 15 and 19 years of age. 27 28 29 30 See Kyrgyzstan, National Statistics Committee, Multiple Indicator Cluster Survey in the Kyrgyz Republic 2014: Final Report (June 2016). Kyrgyzstan, Ministry of Health, Mid-Term Review Report: National Health Reform Program of the Kyrgyz Republic “Den Sooluk” for 2012–2016 (12 June 2016), p. 14. See Family Planning 2020, Kyrgyzstan core indicator summary sheet: 2017–2018 annual progress report. According to the second report on the confidential investigation into maternal deaths in Kyrgyzstan for 2014–2015, more than 40 per cent of women did not cooperate with health-care providers, often pregnant women purposefully concealed health problems and did not visit primary care centres before delivery (see https://kyrgyzstan.unfpa.org/ru/publications (in Russian only)). 15