This paper presents and discusses the findings of a desk review on the state of migration and sexual and reproductive health (SRH) of the populations in migrant-sending countries, including Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. In addition, it considers the qualitative data on the access of Central Asian internal and external migrants to antenatal and perinatal care, family planning services, and contraception, including condoms, safe abortion (legal in all countries under consideration), treatment of sexually transmitted infections,
and HIV infection prevention, diagnosis and treatment based on in-depth interviews with experts mobilized both in origin and destination countries. Case studies of relevant migrants' life situations are depicted. Evidence shows that access by migrants to SRH and HIV-related services is constrained compared to the permanent population. Generally, the public health services are inaccessible, unacceptable, and unaffordable to mobile populations, which, in addition, have a low awareness of opportunities to receive them and underestimate their
significance.
In the era of the COVID-19 pandemic, the access of migrants to SRH care has become even worse, as they are still legally considered outsiders by all public health systems, while a significant decrease in their quality of life makes it unaffordable to seek private health care for almost all of them. The COVID-19 pandemic has become a significant impediment to developing and implementing programs aimed at improving access to HIV-related services for migrants under the recommendations of the Technical Workshop on HIV and Migration in Central Asia and the Russian Federation, conducted with the support of the United Nations Population Fund in Astana, Kazakhstan in February 2018.
The enrolment of most migrants from Central Asian countries into public SRH care and HIV services is either not ensured almost at all in any of the three host countries or provided to a limited extent in the Russian Federation for migrants from EAEU member countries. As a whole, migrants have low levels of legal entitlements to public health services. Policies of healthcare funding and budget discipline requirements in migrants receiving countries make the procurements of medicines and contraceptives, including condoms and lubricants in the numbers sufficient to meet the needs of the underserved populations impossible and distributing of health products among anonymous consumers with irregular migrants among them not legal. Other specific barriers to accessing essential SRH services and products for migrants include linking health care to a residence permit and registration; xenophobia, stigma, and dual discrimination
against key populations at higher risk of HIV acquisition and transmission; the requirement to deport migrants with HIV from Russia; overpricing of essential services, medicines, and preventive measures; a lack of migrants' awareness of rights to SRH care, including HIV-related services, at all stages of migration; and a lack of involvement and cooperation with migrant communities in addressing emerging issues.
The needs of internal migrants, who comprise a significant proportion of the present urban population in Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan, as well as international migrants coming from the Central Asian countries to the host countries of Russia, Kazakhstan, and Turkey, cannot be ignored in developing policies and strategies to achieve the Sustainable Development Goals. However, these populations, who are intrinsically vulnerable to SRH disorders and HIV transmission and acquisition, are still left behind.