
































Microsoft Word - Henry.docx


 

 
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

 

 

 
 
 
 
 
 
Family Planning in the Republic of 
Tajikistan: A narrative review 
from Soviet times to 2017 

 
Ellison Henry1*, Zarrina H. 
Juraqulova2 

 
1Maternal and Child Health Department, 
Gillings School of Public Health, 
University of North Carolina at Chapel 
Hill, Chapel Hill, North Carolina, USA; 
2Economics Department, Denison 
University, Granville, Ohio, USA 
 
*Corresponding author email: 
ebhenry2@live.unc.edu 
 

 
Vol. 9, No. 1 (2020)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2020.404   |   http://cajgh.pitt.edu 



 
 
HENRY 
 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.404 | http://cajgh.pitt.edu 

 
 

Abstract 

Introduction: Tajikistan’s dramatic shift from a high to a low fertility society has taken place over a little more than two decades. 
While some fertility beliefs remained the same throughout the rapid economic and political transitions of Tajikistan, other beliefs 
may have changed to respond to the financial realities of the newly independent and Central Asian republic, such as having fewer 
children. The objective of this review was to describe and analyze the state of family planning in the Republic of Tajikistan from 
Soviet period (1929-1991) until 2017. 
Methods: The review is based on materials obtained from various sources including Google Scholar and PubMed, relevant to 
family planning in Tajikistan, including government policies, open-access nationally representative data, journal articles, and 
program reports, identified through a selective search of Google Scholar and PubMed databases, and the grey literature.   
Conclusion: This narrative review presents the history of family planning in Tajikistan, outlines an understanding of the health 
system context as it relates to family planning, and analyzes the latest national family planning policy (2017). The authors suggest 
further research is required to (a) understand the beliefs and practices related to family planning; and (b) define strategies to address 
the issue of unmet need of family planning services.   

Keywords: Tajikistan; Family planning; Fertility; Family size; Soviet; Women  

 
Family Planning in the Republic of 
Tajikistan: A narrative review from 
Soviet times to 2017 

 
Ellison Henry1*, Zarrina H. 
Juraqulova2 

 

1Maternal and Child Health Department, 
Gillings School of Public Health, University of 
North Carolina at Chapel Hill, Chapel Hill, 
North Carolina, USA; 
2Economics Department, Denison University, 
Granville, Ohio, USA 
 
*Corresponding author email: 
ebhenry2@live.unc.edu 
 

Research 

During the Tajik Soviet Socialist Republic’s 
(Tajik SSR) membership within the Soviet Union 
(USSR) from 1929-1991, pro-natalist policies were in 
place. USSR aimed to expand the population of member 
republics to meet economic targets defined in five-year 
plans. In that period, it was possible to support high 
fertility rates with financial and other resources provided 
by the centralized government in Moscow. Cheap 
housing, free education and health care, free plots of land 
for members of communal and state farms, and the low 
costs of essential food stuffs all made it possible for most 
families to afford the economic costs of many children 
without too much hardship.1 The Tajik SSR, along with 
today’s Central Asian republics, had the highest fertility 
rates within the USSR. According to census data, the 
Tajik SSR experienced the highest average annual rates 
of population growth between 1959-1970, 1970-79, and 
1979-1989.2 

The Soviet health system was designed to 
provide uniform quality of services across member 
republics; however, there were large variations in the 



 
 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.404 | http://cajgh.pitt.edu 

 
 

number of health workers and the range and quality of 
services provided. For example, in 1987, Georgia (5.7) 
had more than two times the number of physicians per 
1,000 population in comparison to Tajikistan (2.7). Per 
international agreements, the government supported 
family planning service provision and utilization, though 
in practice, it was not promoted.3-6 After legalization in 
1955, abortion was the primary method of fertility 
control throughout the USSR.3,5,7 The Ministry of Public 
Health published abortion statistics in 1988, the first such 
publication in nearly 60 years. This report confirmed the 
use of abortion as the primary method of contraception 
and reported wide use of traditional methods of 
contraception (i.e. withdraw, rhythm) among those who 
used any method. In 1988 there were nearly 5.8 million 
abortions in the USSR.3 Shortages of modern 
contraceptives coupled with an easily accessible network 
of abortion clinics and lack of access to family planning 
education were primary contributors to low utilization of 
modern methods.3-5  

In 1989, as a response to people’s growing 
concerns about abortion safety, the Soviet Family Health 
Association was created. This NGO focused its efforts on 
family planning initiatives. Further, in 1990 the 
government created the Committee on Problems of 
Women, Family and Maternal and Child Health Care.5 

Researchers have been cautious in interpreting 
data from the USSR due to possible lack of completeness 
and questions of validity and reliability.3,7 Available data 
on contraceptive method mix is largely based on 
behaviors of women in Moscow. Surveys conducted 
between the 1960s-1980s report a consistent trend of 
preference for traditional methods– withdraw and 
rhythm– followed by condoms.3 Researchers used 1990 
survey data to estimate fertility rates and contraceptive 
prevalence rates across member republics. According to 
these estimates, the Tajik SSR’s high fertility rate was 
paired with the lowest contraceptive prevalence rate; 
only three percent of married couples reported using any 
method of contraception.7 The purpose of this narrative 

review of the literature is to describe and analyze the state 
of family planning in the Republic of Tajikistan from 
Soviet time until 2017. This review is the first to 
synthesize family planning literature from academic and 
non-academic sources within the context of Tajikistan 
using the most updated nationally representative survey, 
the 2017 Demographic and Health Surveys (DHS).  

 

Methods 

A narrative review of English articles was 
conducted using two databases (Google Scholar and 
PubMed), grey literature and reference lists of key 
articles. All search results were reviewed and included if 
they addressed the key outcome of family planning 
within the context of Tajikistan. Secondary searches were 
conducted to include articles addressing fertility and/or 
family planning in the USSR and Central Asia. Articles 
were included if data presented were disaggregated to 
republic-level statistics. 

“Grey literature” refers to publications outside 
of academia and peer-reviewed journals that are 
disseminated by governments and organizations. The 
authors searched grey literature to identify relevant 
government policies and reports from nonprofits and 
donor agencies. These documents were included if 
directly pertaining to family planning in Tajikistan.  

The authors conducted a search for open-access 
nationally representative data. After identifying several 
such surveys (i.e. MICS, TLSS, DHS), the authors chose 
to include the 2012 and 2017 DHS as primary data 
sources for this review. The DHS were chosen because 
they provided the most thorough and updated data on 
family planning. The literature as it relates to family 
planning in Tajikistan is centered on other primary 
outcome measures, using family planning as a dependent 
variable.8-10 The authors offer this review as a 
contribution to the family planning literature, as a starting 
point to understanding the current status of family 



 
HENRY 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.404 | http://cajgh.pitt.edu 

 
 

planning in Tajikistan and how the country’s related 
public health efforts have developed since independence.  

By focusing on English-language publications 
with a focus on Tajikistan, it is possible that the authors 
missed seminal publications that otherwise met the 
inclusion criteria but were published in Russian language 
or focused on other Central Asian Republics. The authors 
chose to limit their scope within these broader language 
and geographical parameters.  

 

Discussion 

Women, Marriage and Fertility  

Tajikistan is officially a secular state; however, 
since independence there has been a resurgence of some 
traditional Islamic (Tajik) values that define a woman’s 
main role in the private sphere (i.e. in the home). The 
government has publicly promoted the traditional 
interpretation of the role of women in Tajik society.11,12 
As Roche notes, “...post-Soviet domestic gender politics 
have focused primarily on women in their role as 
glorified mothers. Along with a revival of Islam since 
independence, motherhood has been reinforced as a 
sacred status by both the government and the Islamic 
opposition, albeit in different ways.”13 The effect this 
may have on women’s roles in Tajik society has not been 
thoroughly studied.14,15 

There are rather significant generational 
differences among women in Tajik society. For example, 
today’s young women navigate a space that is somewhere 
between progressive (i.e. Soviet) and traditional (i.e. 
Tajik). Soviet policy and propaganda promoted gender 
equality and the participation of women in the public 
sphere. The authors note certain aspects of Soviet life 
may have reinforced traditional gender roles, particularly 
regarding women’s reproductive lives (i.e. mother 
awards and birth incentives). The traditional patriarchal 
influences of Tajik culture promote the role of women as 

mothers and homemakers, i.e. as a central figure in the 
private sphere.14,15 

The empowerment of women has broad 
implications for improving health outcomes and vice 
versa. The ability to control fertility is associated with a 
woman’s status in the home and her sense of self-worth. 
Both the 2012 and 2017 DHS examined the degree of 
women’s empowerment among married Tajik women 
and its relationship with family planning decisions. Both 
DHS reported that contraceptive use was “…positively 
associated with women’s participation in household 
decision-making.” The surveys asked women about three 
types of decisions: those related to their own health care, 
major household purchases, and visits to their family or 
relatives.16,17 Using the 2012 DHS, Juraqulova and Henry 
(2020) examined the impact of decision-making abilities 
on women’s contraceptive behavior. The authors found 
that the probability of using birth control was higher for 
a woman who reported having voice in household 
decisions and the financial means to get medical help, 
compared with women who do not have both or either of 
these choices.18  

The shock of political and economic transition 
from being a member of the USSR to an independent 
republic prompted families, especially women of 
reproductive age, to adopt family planning to achieve 
desired family size. In the “new” economy, one 
dependent on household-generated resources to establish 
and maintain a level of well-being, couples who once had 
ten or more children during the Soviet period now have 
four or fewer.16,17 Tajikistan navigated three socio-
economic challenges that contributed to a national 
reduction in family size: civil war (1992-1997); food 
crisis (1995); and drought (2000-2001), which caused 
food shortages. A fourth factor contributing to the 
fertility decline was a temporary labor migration of 
working-aged males.19 Labor migration continues to 
impact marriage and childbearing.20,21  

 



 
 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
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Marriage is a central event in Tajik culture, 
especially in rural areas. It is often the woman’s first 
exposure to sexual activity and the possibility of 
pregnancy.1 As of 2017, about 75% of Tajik women aged 
15-49 reported being currently married.17 Societal 
expectations necessitate newlyweds have a child within 
one year of union. Approximately seven percent of 
teenage girls aged 15-19 in Tajikistan have begun 

childbearing.17 Figure 1 shows that women in every 
oblast report having more children than desired. The 
difference between wanted and actual fertility rates 
suggest an unmet need for family planning services 
throughout the four oblasts and the capital, Dushanbe.16,17 
An unmet need for family planning occurs when women 
are unable to space and/or limit childbearing as they 
desire.22

Data presented from Tajikistan 2017 Demographic and Health Survey, available at https://dhsprogram.com/pubs/pdf/FR341/FR341.pdf 

Figure 1. Wanted and total fertility rates, Tajikistan, 2017

Family Planning  

The Ministry of Health and Social Protection of 
the Population (MoHSPP) prioritizes family planning 
under the umbrella of reproductive health and oversees 
providing family planning guidance to local-level 
implementers (i.e. oblast-level facilities). The Ministry’s 
main objectives, specific to family planning, include: 

1) “Ensuring low-risk pregnancy and safe 
motherhood; and 

2) Reducing complications caused by closely-
spaced pregnancies and pathological conditions among 
women of reproductive age.”23 

The Ministry is responsible for training 
providers, providing “extensive” family planning 
education to all Tajiks, and supplying contraceptives 
throughout the nation. Family planning services are 
provided at regional, district and city reproductive health 
centers at the primary health center level and monitored 
by the National Center on Reproductive Health.23 These 
departments work in conjunction with local city 
authorities to define and deliver health services 
throughout facilities in each oblast.6 

In the Strategic Plan for Reproductive Health 
(2005-2014) the MoHSPP formulated an initiative to 
improve the reproductive health of Tajiks, specifically 
women, by: 

0 1 2 3 4 5

Khatlon

RRS

GBAO

Sughd

Dushanbe

Number of children

Wanted Fertility Rate

Total Fertility Rate



 
HENRY 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.404 | http://cajgh.pitt.edu 

 
 

1) Increasing access to family planning 
services and contraceptives; 

2) Increasing access to antenatal and safe 
delivery services; and 

3) Decreasing mortality and morbidity during 
pregnancy and improving perinatal outcomes.6 

While the objective of the plan was to integrate 
reproductive health services into primary care services, 
the program has yet to be successfully defined and 
implemented. Consequently, measures to increase public 
awareness of the importance of reproductive health and 
to train adequate human resources to meet reproductive 
health needs have not been fully implemented.6 

The most recent reproductive health and family 
planning implementation policy, passed in 2017, 
recommends key interventions to: (a) create an enabling 
environment favorable to reproductive health and family 
planning; (b) adapt the health system to address 
reproductive health challenges; and (c) provide programs 
that meet the needs of adolescents and youth.24 

The distribution of functioning health facilities, 
funding for health services and provision of care is 
uneven across Tajikistan. The overall ratio of health 
worker to population has declined over the last twenty-
five years. Today, there are fewer health professionals 
per capita in Tajikistan than any other country in Central 
Asia. Outmigration of educated and skilled medical 
providers has been a significant contributing factor. 
Health worker shortages are most severe in rural areas. 
This is the result of low salaries, outdated medical 
equipment, poor human resource training, re-training and 
management, and the deteriorating health infrastructure.6 
While the MoHSPP advocates for a ratio of one family 
medicine physician per 1,500 population and one family 
nurse per 750 population across the country, most 
physicians and nurses are concentrated in the capital, 
Dushanbe. Currently, the combined ratio of physicians 
and nurses to population is one of the lowest in the WHO 
European Region.6 

Mid-level medical professionals typically 
practice in rural areas, carry out preventive and 
diagnostic tasks and perform some administrative duties. 
Nurses train for four years but hold low status within the 
medical community and extremely modest salaries when 
compared with physicians.6 Assumptions could be made 
about which level of medical provider is responsible for 
providing family planning services and reproductive 
health counseling, but specific responsibilities remain 
unclear and are not specified in the national 
Implementation Plan for Family Planning Services 
(2017-2020). 

The majority of Tajikistan’s health expenditures 
come from out-of-pocket payments for services, 
primarily payments for curative care. In 2014 a total of 
US$1.7 billion was spent on curative health care services, 
over half of which came from out-of-pocket payments.25 
It is estimated that by the year 2040, around 40% of all 
funds spent on health will come from out-of-pocket 
payments.26 While the government promotes family 
medicine and preventative programs, government 
(oblast-level, i.e. hukumat) financing gives primary 
attention to hospital services and continues to be 
dominated by input-based budgeting that is based on the 
number of hospital beds and/or personnel rather than on 
health objectives, quality of care and outcomes.6,27  

The United Nations Population Fund (UNFPA) 
has been the largest donor of reproductive health and 
family planning services in Tajikistan. In total, 40% of 
all integrated sexual and reproductive health programs in 
2016 were financed by UNFPA; other NGOs were 
responsible for 54% of the financing. The Tajik 
government financed less than 5% of integrated 
reproductive health programs (Figure 2, right side).28 
Figure 2 (left side) shows 2016 data, which reported 
about US$130,000 (11%) of the total integrated sexual 
and reproductive health service funding was set aside to 
finance family planning initiatives. UNFPA funded 67% 
of the family planning-specific programs in 2016.  



 
 

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This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

This journal is published by the University Library System of the University of Pittsburgh as part  
of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.404 | http://cajgh.pitt.edu 

 
 

Data presented from UNFPA, available at https://www.unfpa.org/data/transparency-portal/unfpa-tajikistan 

Figure 2. Family planning program funding, Tajikistan, 2016

The 2017-2020 national policy on family 
planning includes the MoHSPP’s estimate of the total 
funding needed for family planning and proposal for how 
those funds will be allocated. However, the plan does not 
designate the source(s) of funds nor indicate how the 
projected program costs were calculated. Figure 3 shows 
the distribution of funds by action area; in total these 
efforts are estimated to cost about US$1.9 million.24 
Around US$1.6 million will be spent on interventions, 
the remaining funds are allocated to purchase 
contraceptives required to meet the target contraceptive 
prevalence rate increase of 1.5% per year for each of the 
plan’s years (2017-2020). The source for these 
contraceptive methods and a plan for distribution and use 
were not identified. Within the US$1.6 million for 
programs, about US$110,000 is slated for provider 
education. US$964,000 is allotted to “increase access to 
family planning services and methods”. This increase 
will be achieved through additional provider training and 
a bit of service monitoring in selected facilities.24 There 
is no mention of efforts to train additional providers, 
retain those graduating from medical education programs 
or to extend family planning services more equitably 
across the country.  

According to the 2012 and 2017 DHS’, most 
Tajik women received family planning information via a 
home visit by a health worker or a facility-based 
provider. Women in Khatlon (16.1%) were less likely to 
be visited in the home than women in other regions in 
2012. However, in 2017 home visits by health workers 
increased for women in Khatlon by 11.2%, perhaps a 
consequence of USAID’s Feed the Future program 
activities that promote home health visits. Women in 
Dushanbe experienced the greatest percentage increase 
of home visits, from 18.6% in 2012 to 32.1% in 2017.16,17 

It is unclear how women in both Khatlon Oblast 
and Regions of Republican Subordination receive 
reproductive health information if they lack access to a 
home health visitor or a facility-based provider. Fifty 
three percent of women had not received any messaging 
from radio, TV or print media (i.e. newspaper, 
magazine).17 Many women may be subject to myths 
about family planning and reproductive health and are 
unaware of useful family planning information.  

The 2017 DHS reported about 71% of currently 
married women were not using any method of 
contraception (modern or traditional) as compared with 
72% reported in the 2012 DHS. The top three reasons 



 
 
HENRY 
 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
This journal is published by the University Library System of the University of Pittsburgh as part  

of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.404 | http://cajgh.pitt.edu 

 
 

Data from the Ministry of Health and Social Protection of the Population, available in print 
Figure 3. Distribution of funds by priority action area, Costed Implementation Plan for Family Planning, 2017-2020

women reported discontinuation of use were wanting to 
become pregnant (32.6%), side effects/health concerns 
(26.3%) and infrequent sex/husband away (17.7%). 
Eighteen percent of women using any method of 
contraception reported using the intrauterine device 
(IUD), and a marginal percentage used pills, male 
condoms, injectables or traditional methods. In total, 
20% of women want to stop having children while 11% 
want another child in two or more years.17 This suggests 
that 33% of married women in Tajikistan need access to 
long acting contraceptive methods (i.e. implant or 
sterilization) to achieve fertility goals.  

The DHS identified an association between 
decision-making power and unmet need for family 
planning. The use of any method of contraception and 
any modern method both steadily increased with the 
number of household decisions women participated in 
(i.e. those related to their own health care, major 
household purchases, and visits to their family or 
relatives). Tajik women who reported not participating in 
household decisions had the highest unmet need (25%), 
while those who participated in all three measured 

decisions had lower unmet need (21%) according to 2012 
DHS. However, these numbers changed in 2017 – unmet 
need was higher among women who participated in all 
three decisions (34.6%) compared to women not taking 
part in any decisions (23.7%).17 

In the Costed Implementation Plan for Family 
Planning (2017-2020), the MoHSPP identified unmet 
need of family planning as a specific area of public health 
concern. The government proposed a target of 1.5% 
annual increase in the contraceptive prevalence rate 
(CPR) as a pathway to reducing unmet need.24 However, 
the plan does not provide the details of how CPR will be 
increased; it does indicate that “to reach this goal a 
number of key interventions were developed making use 
of the…expertise of national experts and technical 
assistance partners”.24 

 

Conclusion 

In 2014, with support from USAID, 
EngenderHealth’s RESPOND project used DHS data to 

26.30%

57.10%

4.10%
0.30%

15.80%
Delay early childbearing and
promote health birth spacing

Increase acceess to quality family
planning services

Integrate family planning services
into PHCs

Enhance community support for
delaying marriage

Purchase additional contraceptives



 
 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

This journal is published by the University Library System of the University of Pittsburgh as part  
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Central Asian Journal of Global Health 

Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.404 | http://cajgh.pitt.edu 

 
 

work with the MoHSPP and other national stakeholders 
to project fertility and contraceptive prevalence trends in 
Tajikistan until 2020. RESPOND published a report 
specifying the inputs (i.e. finances, contraceptive 
methods) necessary to achieve two outcomes of interest: 
(1) maintain current CPR among married women of 
reproductive age through 2020; and (2) reduce the current 
unmet need by 2020 by providing a more balanced 
method mix. An estimate of US$1.3 million was given to 
meet the first outcome, and an additional US$450,000 to 
achieve the second outcome. The source of funds and 
other recommended inputs were not identified.29 

The RESPOND activity and most recent 
national implementation strategy are encouraging steps 
towards providing the reproductive healthcare services 
that Tajik women seek to achieve fertility goals. The 
2017-2020 Costed Implementation Plan for Family 
Planning suggests reproductive health is a core 
component of the political agenda of the Tajik 
government.  

This narrative review has collected relevant 
information about family planning in Tajikistan, from 
Soviet time until 2017. Data has been provided to show 
that women experience an unmet need for family 
planning and access to these services is insufficient for 
women to achieve desired fertility. Research is needed to 
provide an understanding of the family planning beliefs 
and practices of key populations. For example the beliefs 
and practices of women in Khatlon Oblast, an important 
location because both DHS surveys reported Khatlon’s 
unmet need and fertility rates as the highest in Tajikistan, 
coupled with early marriages and low contraceptive 
method uptake.16,17 Further research is crucial to develop 
an in-depth understanding of women and provider 
experiences utilizing and providing family planning 
services. This information is necessary to inform 
strategies to address unmet need and inequitable access 
to quality services across the country. Reproductive 
health and family planning relate to all aspects of 

population health and must be maintained as pillars of 
Tajikistan’s future health policies and reforms. 

 

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HENRY 

 
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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 
 

Central Asian Journal of Global Health 
Volume 9, No. 1 (2020) | ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2020.404 | http://cajgh.pitt.edu 

 
 

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