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1REGULATORY LEGAL BASES OF MEDICAL AND SOCIO-HYGIENIC MEASURES AIMED AT MAINTAINING REPRODUCTIVE HEALTH IN THE REPUBLIC OF
UZBEKISTAN
1Mamatqulov Bakhromjon Mamatqulovich, 2To'rayev Baxodir Sherali o'g'li, 3Ochilova Gulsora Shamsitdinovna, 4Tolipova Gulhayo Komiljon qizi
1MD, Professor, School of Public Health, Tashkent medical academy
2PhD candidate, School of Public Health, Tashkent medical academy 3Assistant, department of therapy Uzbekistan State University of Physical Education and
Sports
4PhD candidate, School of Public Health, Tashkent medical academy https://doi.org/10.5281/zenodo.10223099
Abstract. The demographic crisis observed in many western countries of the world encourages the study of factors that negatively affect population growth. In addition to many social factors, medical factors also affect the population, including the existence of a regulatory legal framework aimed at maintaining reproductive health. This article analyzes the regulatory and legal basis of measures aimed at maintaining reproductive health in the Republic of Uzbekistan from the time of independence until now.
Keywords: Republic of Uzbekistan, reproductive, reproductive health, regulatory and legal measures.
The urgency of the problem. According to the World Health Organization, infertility occurs in 10-15% of families. As a result of the conducted research, it was found that the infertility rate can reach up to 30% in the countries of South Asia, North Africa, Central and Eastern Europe, and Central Asia. Infertility in families is caused by men in 50% of cases, along with women.
In our republic, a number of scientific studies aimed at studying male infertility have been carried out, and they are mainly clinically approached, with more emphasis on treatment measures. Including the treatment of male infertility in hot climate regions using assisted reproductive technologies (Asadov H.D. 2009), the impact of sexually transmitted diseases on the male reproductive system (Vaisov I.A. 2006), complex diagnosis and treatment of male sexual health disorders (Mahmudov A.T. 2016). -y.) methods have been studied.
Studies examining male reproductive health care in developed countries have also found gaps [41]. Also, studies conducted abroad show that men suffering from infertility seek medical examination twice as often as women [42, 43]. Studying the volume of medical care provided to men with problems with reproductive health requires, first of all, an analysis of the regulatory and legal framework.
Purpose of the study: to study and analyze the regulatory and legal basis of measures aimed at protecting men's reproductive health in our republic.
Materials and methods.
E-mail addresses https://lex.uz/, http://www.minzdrav.uz/ were taken as the object of research. The subject of the study is the regulatory legal documents developed in our Republic on the maintenance of reproductive health of children, adolescents, women and men. Out of 100 found
by searching for the key word "reproductive" among the "current" regulatory legal documents in the "word or sentence in the text" section of the electronic address database https://lex.uz/ and http://www.minzdrav.uz/ the contents of more than 100 documents were familiarized with, and about 40 regulatory and legal documents directly related to human reproductive health were thoroughly studied and analyzed.
Results.
In our republic, intensive reforms in the field of health care began in 1998. One of the first normative-legal documents aimed at strengthening reproductive health was the State Program of the Cabinet of Ministers in 1998 to ensure the interests of the family. According to this state program, women of reproductive age, mainly in the ecologically disadvantaged regions of the Aral Bay, were scheduled to undergo dispensary examination [0]. Also, in the 1999 state program, great attention was paid to strengthening women's reproductive health, and it was indicated that measures should be taken to detect tuberculosis early among women and adolescents of reproductive age [2]. In 2001, on the basis of the Decision "On the State Program "Mother and Child", great work was carried out aimed at protecting the health of mothers and children. "Establishment of the Republican Educational and Methodological Center for the Reproductive Health of Girls and Adolescent Girls on the basis of the Department of Obstetrics and Gynecology of the Tashkent Medical Training Institute and its branches in the regions", "upgrading the qualifications of pediatric gynecologists and obstetrician-gynecologists on current issues of maintaining the reproductive health of girls and adolescent girls" As a result of the work, it was envisaged to maintain the reproductive health of girls and teenage girls, to prepare them for safe motherhood [3]. In the same year, great attention was paid to the purchase of necessary drugs and medical equipment for the maintenance of women's reproductive health [4]. However, the conducted analyzes showed that the measures taken are still insufficient. As a result, the work of providing the population with the necessary modern medical preparations and tools to improve women's reproductive health has been strengthened, and steps have been taken to activate the work of attracting benevolence and sponsorship support in addition to the State budget funds [5].
Cabinet of Ministers 07.05.2002 in order to further improve the medical culture of the population, strengthen women's health, create conditions for the birth and upbringing of children, and create a healthy environment and peace of mind in the family. Adopted decision No. 242 "On measures to increase medical culture in the family, strengthen women's health, birth of a healthy generation and implementation of priorities for its upbringing". This decision focuses on issues such as improving the quality of medical services for pregnant women and children, increasing the knowledge and medical culture of young people on reproductive health issues, and the importance of preventing early marriages between relatives and observing the optimal interval between births. According to this decision, to examine all teenage girls by a gynecologist, to provide women with contraceptives in order to prevent unwanted pregnancy, as well as to further develop the state system for the early detection of congenital and hereditary pathologies in babies and pregnant women, to build new screening centers and to upgrade existing ones. strengthening works have started [6].
In mountainous, desert and hard-to-reach districts, as well as in districts where special attention and priority actions are required, mobile medical-advisory brigades of health authorities provide women with medical care based on a special program. inspection works have been started. Medical-demographic research of reproductive health of women of childbearing age has started in
different districts. Starting from the 2002-2003 academic year, it is planned to increase the knowledge of students of higher educational institutions on the issues of reproductive health and the formation of a healthy family based on the introduction of medical training courses for students in the third year of teaching in the higher educational institutions of the republic on the issues of reproductive health, healthy family formation and medical culture. In order to increase the knowledge and responsibility of men for the reproductive health of family members, from 20022005, it was decided to organize work on improving the medical knowledge and culture of cadets of secondary and higher educational institutions serving in the army and police in the issues of reproductive health, maintaining a healthy lifestyle and forming a healthy family. . 4-hour courses on the basics of reproductive health and medical culture have been introduced at the institutes for the retraining of teaching staff and their professional development. Regular national and regional scientific-practical conferences and seminars on reproductive health and healthy family formation for medical workers have started. In order to prepare and carry out television programs and radio broadcasts on the issues of reproductive health and the formation of a healthy family, permanent working special creative groups have been established at the company "Uzteleradio" and television and radio companies in the regions of the republic, and reproductive health, increasing the medical culture of the family, giving birth to healthy children and their preparation and broadcasting of special educational TV shows and radio broadcasts on current issues of education have begun. Work on the development and publication of booklets, sets of questions and answers, series of recommendations in the form of souvenirs, posters and other visual information materials for teenagers, young people and parents on issues of reproductive health, healthy family formation and leading a healthy lifestyle has been intensified. The establishment of educational and clinical units of the Republican Center for Reproductive Health and their equipping with medical equipment was determined [6].
In the following years, great attention was paid to strengthening women's reproductive health. According to the 2003 investment program, 120 million was allocated to the healthcare system. 40 million from US dollars. USD (30%) is directed to strengthening women's reproductive health is a clear example of this [3].
As a result of the development of international health relations, additional grants were allocated by the government of the Federal Republic of Germany, and the government decided that these funds should be directed to the protection of women's reproductive health along with the fight against tuberculosis [8].
Despite the implementation of a number of activities aimed at strengthening reproductive health, at the beginning of the second decade of independence, it became clear that there is still a lot of work to be done. According to the report "On the activities of the human rights representative (ombudsman) of the Supreme Assembly in 2002", on the basis of the research conducted in the Jizzakh region, attention was paid to the quality of medical services in some institutions providing medical care to pregnant women, the level of their provision of necessary equipment and medicines. it was found that further strengthening is necessary, some institutions are in need of major repairs, and some are even in a state of emergency. Difficulties in providing almost all institutions providing medical care to pregnant women with equipment, laboratory, diagnosis and other special equipment, hard and soft inventory, state bodies and health authorities, citizens' self-management bodies, women's organizations should be further improved necessity, it was determined that the mass media should pay more attention to the coverage of the issues of
educating the young generation in the spirit of gender equality, to the topics of ensuring reproductive rights [9].
The Resolution of the Cabinet of Ministers of the Republic of Uzbekistan "On the State Program of the Year of Health" stipulates the implementation of activities aimed at protecting motherhood and childhood, strengthening maternal and child health, and improving reproductive health. Due to the insufficient knowledge of the population about reproductive health, recommendations on strengthening reproductive health through mass media began to be given more [10].
In order to prevent diseases that develop as a result of iodine deficiency, the provision of preventive measures to provide iodine-preserving drugs to women and children of reproductive age has been established by law at the level of state policy, which has initiated great work aimed at maintaining the health of women, especially women of reproductive age [11].
On the basis of the scientific-research institute of obstetrics and gynecology, as well as the treatment base and women's reproductive health centers, the Republican specialized scientific and practical medical center of obstetrics and gynecology was established. did [12].
In addition to the great positive progress achieved in strengthening the reproductive health of the population, protecting the health of mothers and children, improving the birth and upbringing of a healthy generation, there are serious shortcomings in this important direction of work in the institutions of the maternal and child protection system (medical assistance to pregnant women institutions, perinatal and screening centers, women's reproductive health center, etc.), to pay great attention to the issue of staffing, to increase the knowledge and medical culture of families in matters of reproductive health, maternal and child health protection, especially in rural areas demanded to strengthen their work in connection with preventive and explanatory work [13]. As a result, in 2010-2016, the Non-Governmental International Charitable Fund "For a Healthy Generation" began implementing measures to provide pregnant women living in rural areas with special complexes of general strengthening polyvitamins, including folic acid [14]. At the same time, taking into account the introduction and consumption of food products enriched with micronutrients, measures have been taken to ensure the strengthening of the population's health [15].
Work on reproductive health, motherhood and childhood protection was consistently continued, loans and financial assistance were received in cooperation with foreign countries to provide them with the necessary tools for providing medical care [16]. The main focus was on improving the health of mothers and children [17].
Proposals on the need to develop a law on the protection of reproductive health of citizens in our republic began in 2012 [18].
In order to effectively carry out work on the protection of reproductive health, along with medical institutions, the commission for working with women and girls of the citizens' assembly was assigned the task of assisting in the measures being taken in this regard [19]. It was also determined that the persons responsible for youth policy, social development, and spiritual and educational affairs of the local executive authority should create the necessary conditions for the implementation of work related to this field [21].
Special attention was also paid to issues of training personnel with appropriate knowledge and skills to carry out large-scale work aimed at strengthening women's reproductive health and preventing early and unwanted pregnancy [20].
In order to increase the responsibility of treatment and prevention institutions and to establish public control over the ongoing work, it was introduced that the heads of rural medical centers, heads of family and multidisciplinary polyclinics provide information on the work being carried out in the system of primary medical and sanitary care provided to the population at the meetings of the neighborhood citizens' assembly. During the hearing and discussion of reports on the activities of treatment and prevention institutions, special attention was paid to the indicators of reproductive health of the population and existing problems in this direction [35].
In order to strengthen the reproductive health of the population, conducting in-depth medical examinations among women, girls, children and adolescents of childbearing age, conducting perinatal and neonatal screening of pregnant women, 350,000 pregnant women living in rural areas of the republic were provided with a complex of poly vitamins for free [36]. In our republic, the population over 18 years of age undergoes a preventive examination once a year, the volume of additional examinations is determined depending on the detected (suspected) disease. Girls and women aged 15-49 years undergo an in-depth medical examination once a year [38]. Nowadays, women's month is held twice a year, and women undergo an in-depth medical examination.
In order to increase the knowledge of the population in this regard, the graduates of general secondary and secondary special vocational education institutions in biology will be given knowledge on strengthening reproductive health. Also, in the science of family psychology, young people are introduced to the basics of reproductive behavior [22].
During the reforms carried out in recent years, the tasks of the institutions providing primary medical care to the population were further clarified, and in this they should carry out educational work on the protection of reproductive health, ensuring safe motherhood, preventing unexpected pregnancy, contraception, ethics, psychology, social and other aspects of family life. it is established that [23].
Sanitary norms and regulations have been developed in order to ensure optimal working conditions for women and girls under 18 years of age in carrying out work related to lifting and transporting heavy loads, and to prevent reproductive function and health disorders. In it, the standards of loads that girls and women can carry are defined [37].
The work carried out was effective, but over time, it was assessed that the activities related to the protection of reproductive health of women and girls were not sufficiently organized. The scientific and practical research center "Family" was established and one of its main tasks was to study the issues of reproductive health and demographic development of the family, to increase its well-being and peace of mind, and to develop methodological recommendations for their solution. "Women's consulting rooms" were established in family polyclinics and rural medical centers, and obstetrics-gynecology and socio-legal assistance to their residents was started in accordance with the legislation on protection of mothers and children and reproductive health. Also, the family center together with the Ministry of Health started to identify persons with diseases, including diseases related to reproductive health, in troubled and needy families and to provide them with targeted medical assistance. "Kizlarjon" group was established in educational institutions, and trainings on family and marriage, reproductive health issues, among other knowledge, began to be held for girls [24]. Among the defined tasks of specialists working with women, there is improvement of reproductive health of families and improvement of medical culture [26].
According to the order of the Ministry of Health of the Republic of Uzbekistan on further improvement of the work carried out in connection with strengthening the reproductive health of the population, covering the population with patronage services and preventive examinations, women of childbearing age undergo an in-depth medical examination once a year. Young families are patronized twice a year, in which the situation of women is studied. During the in-depth medical examination, adolescents are examined by a neurologist, neurologist, ophthalmologist, otorhinolaryngologist, surgeon, dentist, endocrinologist and gynecologist [39].
Adolescent boys and men at the age of conscription undergo an in-depth medical examination by a military medical commission. However, the military medical commission does not carry out examinations aimed at identifying changes in the reproductive system [40].
Among the functional tasks of the Deputy Prime Minister of the Republic of Uzbekistan, the head of the complex of education, health care, physical education and sports issues and the department of information and analysis of education, health care, physical education and sports issues, further strengthening the reproductive health of the population, promoting the principles of healthy lifestyle and physical activity Implementation of work such as implementation and implementation is also included [25].
In the development of our republic until 2030, the general use of sexual and reproductive health care services, including family planning and extending the marriageable age for girls under the age of eighteen, as well as the consideration of reproductive health care issues in national strategies and programs [ 27].
Today, with the help of assisted reproductive technologies, many families are lucky to have children. However, in the first quarter of independence, despite the fact that a lot of work was done in the field of health care, the use of assisted reproductive technologies during this period was not legally regulated [28]. Taking this into account, the Law "On Protection of Reproductive Health of Citizens" was developed, and the main directions of state policy in the field of protection of reproductive health of citizens, preventive measures for protection of reproductive health, and the legal basis of issues related to assisted reproductive technologies were shown [29] .
Article 12 of the Law of the Republic of Uzbekistan "On Protection of Reproductive Health of Citizens" is dedicated to protection of reproductive health of men. It states that men's reproductive health care includes: obtaining reliable and complete information about their own reproductive health, infertility treatments, and contraception; ensuring access to services in the field of reproductive health care; treatment of infertility using new medical, including assisted reproductive technologies, as well as less invasive (less traumatic) interventions; to receive confidential medical advice and services for reproductive health issues [29]. Also, this Law stipulates that preventive measures include mandatory preventive medical examinations (initial and periodic) of citizens in order to identify and treat disorders in the field of reproductive health, publicizing educational programs and scientific programs on the protection of reproductive health of citizens through mass media. placed.
According to our legislation, women and men have equal opportunities to exercise their rights in the field of health care, including the provision of qualified medical services, access to convenient medical services, family planning and protection of reproductive health, strengthening reproductive health in the field of medical education, direct and indirect discrimination based on gender. the adoption of initiatives aimed at prevention is guaranteed by the state [30].
Under the Cabinet of Ministers of the Republic of Uzbekistan, the Council for Strengthening the Reproductive Health of the Population, Protecting the Health of Mothers and Children has been established, and the Council is responsible for the implementation of programs and measures adopted on the strengthening of the reproductive health of the population, the protection of the health of mothers and children in each region, district (city). and ensuring their unconditional fulfillment by the authorities, as well as forming a healthy family together with the population, especially young people, medical and educational institutions, self-governing bodies of citizens and the Committee of Women and Girls of Uzbekistan, mass media, strengthening the reproductive health of adolescents, especially adolescent girls , was tasked with carrying out the main tasks of organizing and carrying out extensive promotion and explanatory work on the protection of mother and child health. The establishment of the Center for Assisted Reproductive Technologies under the Republican Center for Scientific and Practical Medicine of Obstetrics and Gynecology will greatly help to solve problems in this field. The main tasks of the Assisted Reproductive Technologies Center are to provide high-quality specialized medical care to the population on a paid basis, to eliminate infertility, to apply the methods of assisted reproductive technologies based on accepted clinical protocols and standards, and to implement the most advanced diagnostic and treatment standards that meet modern and international requirements. in this direction, effective cooperation with medical institutions in foreign countries is established [31].
The work aimed at maintaining reproductive health is supported by the research institute "Makhalla va oila" and social workers [32, 33].
In order to increase the knowledge of the population about reproductive health and improve the medical services provided to them, within the framework of the "Digital Uzbekistan - 2030" Strategy, it is planned to post information on the rights of women to reproductive health, information and education, and the use of reproductive health services on the Government portal and official website of the Republic of Uzbekistan [34].
Summary. As a result of the studied legal documents, the following conclusions can be reached. In our republic, great attention is paid to the maintenance of women's reproductive health and providing them with medical assistance, and this is reflected in the regulatory and legal documents. Measures aimed at maintaining men's reproductive health remain out of focus in regulatory legal documents.
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