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Thursday, December 5, 2013
- In the last decade, several countries in the Latin America and Caribbean (LAC) region have had the opportunity to experience economic growth and establish redistributive fiscal policies aimed at reducing poverty, reducing inequality and improving the coverage and quality of health, education and social protection services.
And yet significant gaps exist in the area of reproductive health and rights, both between countries and as a whole, when it comes to some of the key objectives of the Cairo Programme of Action.
Let us take one of the basic indicators of reproductive health, the maternal mortality ratio. The decline overall in the region is not enough to guarantee the achievement of the target set for 2015.
The average maternal mortality rate in LAC is 80 maternal deaths per 100,000 live births, according to estimates by WHO, UNFPA, UNICEF and World Bank, 2011. Moreover, there are significant inequities between countries.
For example, the estimated maternal mortality rate in Uruguay was 29 deaths per 100,000 live births in 2010, while it was 120 in Guatemala; Haiti exhibits the highest ratio in the region, with 350 maternal deaths per 100,000 live births.
A significant proportion of maternal deaths are caused by unsafe abortions, which represent a serious public health concern in the region.
In 2008, the annual rate of unsafe abortion estimated for the region was 31 abortions per 1,000 women aged 15-44. In 2008, 12 percent of all maternal deaths in Latin America and the Caribbean (1,100 in total) were due to unsafe abortions, according to the World Health Organisation.
Abortion is only legal in six countries, and together, these countries account for less than five percent of the region’s women aged 15-44. (Guttmacher Institute, 2012).
In addition to the discrepancies noted in regard to maternal mortality and access to safe abortion between countries, there are also intra-country disparities.
For example, while the total fertility rate has reduced considerably, in Bolivia (DHS, 2008), the total fertility rate of women with no education was 6.1 compared to 1.9 for women with higher education, and the urban-rural difference is 2.8 to 4.9, respectively; in Panama, maternal mortality is five times higher among indigenous women.
What is even more tragic is that Latin America and the Caribbean has the second highest rate of adolescent pregnancy in the world, with approximately 70 live births per 1,000 women aged 15-19. On an average, 38 percent of women in the region become pregnant before they reach the age of 20 and nearly 20 percent of live births in the region are by adolescent mothers.
The conclusion is clear: universal access to reproductive health is still far from being a reality in the LAC region.
Looking specifically at the seven components of the programme of action, the LAC countries have achieved much higher rates of contraceptive prevalence than Africa or Asia as a whole.
For example, in 2012, the average contraceptive prevalence rate (CPR) among married women in Africa was only 26 percent and 47 percent in Asia (excluding China); in Latin America and the Caribbean it was as high as 67 percent of married women [Population Reference Bureau].
As I said before, the LAC countries have brought down their collective maternal mortality rate to 80 deaths per 100,000 live births – a striking improvement over the Sub-Saharan African average of 500 per 100,000 live births and the South Asian average of 220 per 100,000 live births (UNICEF, 2010).
However, in other key areas of the Programme such as expression of and protection for sexual and reproductive rights including access to safe abortion, post-abortion care, and expression of gender identity or sexual orientation, the LAC region continues to be challenged.
The reasons for the progress in this region were mentioned earlier – development as a whole, higher rates of education and access to contraception have helped considerably.
Let us not forget however, that the lack of progress in ensuring reproductive rights and access to safe abortion in particular comes from the fact that a large number of LAC countries stated formal reservations to many of the rights components in the Programme of Action, including concern over abortion, a national belief and/or laws asserting a need to protect life from the moment of conception, and concern over alternate expressions of family beyond that of formal marriage between a man and a woman.
In contrast, while several other countries in other regions expressed similar reservations (notably many Islamic and Catholic countries), only one African and one Asian country (Djibouti and Philippines) presented formal reservations to this effect. These reservations have continued to hamper progress in these areas and produced the situation we see today in this region.
Purnima Mane, PhD, is President and Chief Executive Officer of Pathfinder International, a global leader in sexual and reproductive health.