A government decree in Armenia that bars pregnant women who are not residents of Yerevan from receiving free childbirth services in the capital is causing discontent in outlying regions.

In a bid to boost population numbers, the state covers the costs for childbirth services in Armenia. Seeking better facilities and medical personnel, pregnant women from the regions often travel to Yerevan to give birth. In 2012, 64 percent of the 70,648 women registered for state-provided childbirth assistance gave birth in Yerevan, according to the National Statistical Service.

The May 1 decree issued by the Ministry of Health was designed to encourage improvements at hospitals in the country’s 10 regions. Under the measure, women will only be able to obtain state-paid birthing services at hospitals in regions where they have an official address.

Health Minister Derenik Dumanian, the author of the decree, maintains that budgetary funds to improve care at public hospitals in regions will be forthcoming. The government currently pays 135,000 drams (329 dollars) per delivery in Yerevan hospitals, and 97,000 drams (236 dollars) at facilities in rural locations.

“One-third of the pregnant women from the regions come to Yerevan to give birth; hence, the money designated for rural hospitals is transferred to hospitals in Yerevan, leading to reduced financial resources in the regions, as well as an outflow of professionals from rural communities to Yerevan,” Dumanian told EurasiaNet.org.

Despite government assurances, some pregnant women from rural areas remain wary about the decree. Thirty-three-year-old Gohar Minasian, an expectant mother living in Abovian, 16 kilometers outside of Yerevan, fears the consequences of giving birth in her local hospital.

In 2011, she noted, an Abovian anesthesiologist’s mistake led to the death of a pregnant woman from heart failure. “If this had been in the capital, under the supervision of skilled professionals, both the mother and the child would have survived,” Minasian claimed, without providing supporting details.

Under the decree, pregnant women from the regions will still be able to receive free medical care in Yerevan in emergency situations. The health ministry’s chief obstetrician-gynecologist, Razmik Abrahamian, insists that pregnant women in most of Armenia’s regions already have access to adequate care.

“If a few years ago we did not have rural maternity hospitals with modern facilities and it was understandable why they had to come to Yerevan, now six out of the 10 regions have fully equipped hospitals, but people keep coming to the capital out of habit,” Abrahamian said.

“The new decree will make them at least familiarise themselves with the facilities and conditions available at their new local hospitals, and only then make a decision.”

Independent MP Edmon Marukian, who strongly opposes the decree, argues that it could end up fueling corruption.

“If there are exceptions [made to the decree] for high-risk births and [women] will be sent to deliver in Yerevan, it is quite possible that women with a normal or no-risk pregnancy might bribe someone into getting permission to give birth in Yerevan,” reasoned Marukian, who represents the northern region of Lori.

“Or a pregnant woman from a rural community might be in Yerevan and need to give birth, but a hospital might check her in only in exchange for money.”

Abrahamian dismissed corruption concerns, promising close supervision of the decree’s implementation. All hospitals have a ministry hotline number by which they can report attempted bribery, he added. “Let them call and everyone will be punished.”

Based on infant mortality statistics alone, the regions might appear a better choice to give birth than a hospital in Yerevan. In 2011, the latest year for which data is available, the capital recorded 118 infant deaths, the highest level in the country. But Abrahamian maintained that 70 percent of those deaths were of children born to women from the regions, where, he claimed, public knowledge of prenatal care is spotty.

Nationwide over the past decade, the number of infant deaths has declined steadily. From 2006-2012, the number of infant deaths per 1,000 live births dropped by half to 12. The maternal mortality rate also has fallen to a just a handful, compared with as many as 35 per year a decade ago.

Senior regional hospital staffers say public perceptions of medical care in the regions still lag behind the statistical evidence. For example, in Artashat, a town 29 kilometres southeast from Yerevan, the birthrate at the local hospital has fallen by 50 percent since 2008, when the state began paying for childbirth services.

“Our conditions are good, too, the medical personnel are highly professional, but we cannot compete with the hospitals in the capital equipped with the newest facilities,” said Dr. Zemfira Navasardian, head of the Artashat hospital’s obstetrics and gynecology department.

Obstetricians who earlier moved to Yerevan for work may now be tempted to return home, hospital executives said, but that process requires time. In the meantime, some Armenian women are not willing to wait. Barred from state-funded childbirth in Yerevan, Minasian, a kindergarten teacher, is saving to pay for the services herself.

*Editor’s note: Gayane Abrahamyan is a reporter for ArmeniaNow.com in Yerevan.

This story originally appeared on EurasiaNet.org.

Increasingly the issue of domestic violence in Armenia is a topic for public discussion. Yet greater attention to the issue isn’t yet translating into an expansion of programmes to alleviate suffering and address policy shortcomings.

In 2012, Armenia set a grim record for domestic violence when six women, ranging in age from 21 to 50 years old, died over the course of six months in incidents involving their husbands or fathers-in-law. Collectively, the six dead women left behind 12 children.

No official registry of domestic-violence attacks exists in Armenia. But a 2008 survey of 1,000 Armenian women by Amnesty International found that more than three out of 10 had suffered from physical abuse, and 66 percent from psychological abuse.

The outcry over the recent deaths prompted activists to believe that the government would start making state funds available for the protection and treatment of victims of domestic violence. But on Jan. 21, the government blocked passage of what would have been the country’s first domestic-violence law, saying that revisions should be made to existing legislation, or to the bill itself.

In the absence of government funding, non-governmental organisations (NGOs) are struggling to meet needs.

“There are many cases, and only NGO efforts do not suffice,” commented Susanna Vardanian, director of the Women’s Rights Center, a Yerevan-based NGO, which is a backer of the stalled draft law.

At present, three private domestic-violence shelters (two in Yerevan and one in the nearby region of Armavir), along with several NGO-run hotlines are all that exist for female domestic violence victims. Over the past two years, the Women’s Rights Centre, which runs two hotlines, four regional crisis centres and one shelter, has received some 2,557 calls from women seeking help, according to Vardanian.

At a facility run by the charitable foundation Lighthouse in the village of Ptghunts, the 55 women residents are mostly unemployed, and either pregnant or raising children. The shelter provides basic job training, as well as psychological counselling.

For decades, domestic violence was a topic that not only battered women, but also officials and law-enforcement authorities shied away from acknowledging or discussing. But now, that has begun to change, with people starting to be held accountable for abusive actions.

For example, Haykanush Mikayelian received a 10-month sentence in 2012 for her role in the abuse of her 23-year-old daughter-in-law, Mariam Gevorgian, over a prolonged period starting in 2009. According to testimony at the trial, Mikayelian burned Gevorgian’s body with an iron and a cigarette lighter, beat her regularly and kept her locked indoors under key.

Although police officers are arguably now more aware of the domestic-violence problem than several years ago, they are often left flummoxed by the lack of state-run shelters and legal mechanisms to prevent ongoing abuse of a woman by a husband or relative.

“As soon as it comes to taking actual steps, we seem to be faced with the same resistance,” remarked Lara Aharomian, director of the Women’s Resource Centre, another Yerevan-based NGO active in addressing domestic violence.

The draft domestic-violence law that the government rejected earlier in January would have tried to strengthen official measures to protect victims by introducing restraining orders and expanding the number of shelters, among other measures.

Activists believe that the six fatal domestic-violence cases in 2012 might have been prevented if Armenia had had a law outlining responses to the abuse, and, correspondingly, providing state assistance for shelters.

“(T)he law proposes the creation of a number of facilities, [and the] training of police, which are preventive measures,” said Anna Nikoghosian, a project manager for the non-governmental organisation A Society Without Violence. If shelters had existed near the homes of the six murdered women, all of whom lived outside of Yerevan, “some . . . might be alive today.”

“There are many badly in need of support, but it is impossible to house all of them in only three shelters,” agreed Lighthouse Director Naira Muradian.

Lala Ghazarian, head of the Ministry of Labour and Social Welfare’s Department for Family, Women and Childcare Issues, stressed that the domestic-violence bill isn’t gone for good. “It just needs some changes” to bring it into line with existing criminal law, she said. “We are all well aware that we need a law, shelter, trained policemen, functional tools, but it implies extensive work to change legislation, and it will be done.”

Some government members have said that parliament, now controlled by the Republican Party of Armenia, could pass a domestic-violence law by 2014 or 2015, once ongoing amendments to the criminal code are complete.

Meanwhile, as the topic’s stigma fades away, many ordinary Armenians affirm openly that they are eager to find solutions. In the village of Burastan, 30 kilometers outside of Yerevan, women in 2006 told EurasiaNet.org that questions about domestic violence “destroy traditional Armenian families”. Seven years later, they admitted that abuse is an issue that “has to be addressed”.

“Our children have been growing up in an atmosphere of beatings and fights,” commented 67-year-old Karine Galstian, a mother of four. “Only now we realise how wrong it is to keep silent, because we should at least teach our daughters that the husband has to respect his wife, should not beat her, should not humiliate her in front of the children.”

In the absence of further government measures against domestic violence, such realisations could make a critical difference.

Editor’s note: Gayane Abrahamyan is a reporter for ArmeniaNow.com in Yerevan.

This story was originally published by EurasiaNet.org.