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CUBA: Sexual and Reproductive Health Requires Cultural Changes

Dalia Acosta

HAVANA, Dec 22 2004 (IPS) - Adriana was just two years old when she asked her mother what “dialectic” meant. Now she is 14 and understands that it roughly means that “the world is in a ceaseless state of movement and change.” But she has new questions.

Adriana’s 40-year-old mother, who has a degree in philosophy, has not always found it easy to answer her daughter’s queries. But she has always tried to respond in a rational, clear manner, and to give straight answers.

A few months ago she found out that Adriana and her boyfriend of two years had started “taking baths together.”

“She asked me if we used condoms, if everything went well, if I was sure,” said Adriana. “Now she herself brings me the condoms.”

“My mother has always told me I can do whatever I want, as long as I don’t hurt myself or anyone else. Ever since I was able to think for myself…she has told me that I have to make up my own mind,” she added.

But Adriana and her mother are far from typical in Cuba. Many parents here prefer not to find out about the sexual lives of their teenage daughters. And if they do learn about what is going on, they tend to go to one extreme or another, either admonishing and punishing them or washing their hands of the whole business.

Something similar can be seen in other countries of Latin America and the Caribbean, according to studies which show that in their families, youngsters do not generally find information and support on dealing with their sexuality, at the same time that adolescents are becoming sexually active at younger and younger ages.

This year, some 150 countries around the world, including Cuba, have held meetings to review the progress made in implementing the action programme adopted at the 1994 International Conference on Population and Development (ICPD) in Cairo.

The need for youngsters to have access to sexual and reproductive health services and information has been a subject of heated debate, said the executive director of the United Nations Population Fund (UNFPA), Thoraya Obaid, from Saudi Arabia.

On Dec. 17, Obaid took part in the workshop “Cuba, Ten Years After Cairo”, during a three-day visit to this Caribbean nation.

“What I have seen in the island nation in terms of sanitary conditions, reproductive and sexual health, as well as education is something I have not observed in any other country I visited in the past,” said Obaid.

She noted that more than 90 percent of children are in school, health care is universal, and the HIV/AIDS rate is low.

Juan Carlos Alfonso, a National Statistics Office (ONE) official who coordinated the meeting, said a number of the goals set in Cairo for 2015 had already been met in Cuba even before the 1994 conference.

The targets assumed by the international community for 2015 include universal health services, education and family planning, life expectancy over 75, and a maternal mortality rate below 75 per 100,000 live births.

According to ONE, Cuba already had a life expectancy of 72.9 years for men and 76.9 for women in 1994, while maternal mortality stood at 42.8 per 100,000 live births, and dropped to 33.9 per 100,000 by 2001.

But even more difficult than preventing maternal deaths is the challenge of getting Cuban women to stop regarding abortion as a birth control method, or to overcome the widespread resistance to using condoms, a reluctance that cuts across gender and sexual orientation lines.

The case of Cuba shows that guaranteeing services, rights and resources is only part of the long road towards full sexual and reproductive health and rights. The challenge now in this country of 11.2 million is to bring about cultural changes that would make it possible to maintain the gains achieved so far and to continue making progress.

Towards that end, UNFPA is supporting a sex education project in high schools that, studies indicate, has helped to push back the age of sexual initiation and to raise awareness on sexually transmitted diseases.

“We have observed a change in the behaviour of the adolescent population, towards more responsible conduct with respect to their health,” Rosaida Ochoa, director of the National Centre for Prevention of Sexually Transmitted Infections and HIV/AIDS, told IPS.

Ochoa said the prevalence of HIV among the 15 to 24 age group has fallen from 0.07 percent two years ago to 0.05 percent today. The rise in the number of cases of HIV/AIDS in Cuba has occurred among adults over 30.

The biggest hurdles to prevention in Cuba, in UNFPA’s view, are the predominant cultural norms, which are based on limited gender stereotypes of sexuality.

Of the four million dollars in aid that UNFPA has earmarked for Cuba for the 2004-2007 period, 3.3 million are to go towards reproductive health projects, and the rest will go into population control and development initiatives.

The projects that have been approved are aimed at bringing the abortion rate down from 33 to 28 per 1,000 teenagers between the ages of 15 and 19, and reducing the birth rate among girls and women in that age group from 50.3 to 42 per 1,000, by 2007.

Abortion is still illegal in most countries of Latin America and the Caribbean. But every year, more than four million abortions – mainly clandestine – are carried out in the region, according to UNFPA.

Worldwide, 20 million clandestine abortions are practised annually, and some 78,000 women die as a result of complications, the U.N. agency adds.

More than meeting specific statistical targets, the Cuban plan is aimed at promoting cultural changes by providing support to initiatives in the sphere of education, promoting gender equality and responsible sexual and reproductive health practices, and reducing violence against women.

But the story of Estrella Gómez and her daughter Lazara demonstrates how much is still to be done in bringing about cultural changes. “If she’s big enough to be with a man, she must know what she’s doing,” Gómez would respond to her friends when they commented on what her daughter was up to.

Today, at age 16, Lazara is six months pregnant, and has undergone several abortions. But although she will be a teenage mother, she is fortunate, because even she herself says she doesn’t know how she avoided contracting a sexually transmitted disease.

“She doesn’t like them,” was Gómez’s simple response, when asked whether her daughter insisted that her partners use condoms.