By Nyala Thompson Grunwald
It is legally recognised that every person has a right to proper healthcare, a right to proper sexual and reproductive healthcare. SRHR is wholly intricate to social relations within a community. The sexual and reproductive health granted to – yes, why is it ‘granted’ in the first place? – a person will differ according to the norms, roles, conventions thrown onto that person’s body and gender – unfortunately usually conflated. Needless to say, a person’s sexual and reproductive health should only differ according to their needs. And if a person is underage and is not in proper possession of the facts, then that person needs to be informed. No matter the age and circumstances of a person, access to information, awareness of SRHR and its relevant services is fundamental.
Due to the infrastructures that sustain our societies today – capitalism, religion, patriarchy, colonialism….to name a small few – our realities, and our realities when engaging with our health and the healthcare we respectively need, are shaped in a certain way. Independent of our health, our realities and bodies are folded into certain narratives and imaginations. And the different sexual and reproductive healthcare available to people is a crucial part of that. The WHO “estimates that poor reproductive health accounts for up to 18% of the global burden of disease and 32% for the total burden of disease for women in reproductive age.” (UNFPA, 2017) This statistic concerns a female (the study does not specify whether the statistics designate assigned female at birth, female-identifying, female-presenting…) demographic. Unfortunately, as that study by the UNFPA Caribbean puts it: “Health status in a population is strongly correlated to the economy of jurisdiction”, in this case relevant to women in the Caribbean.(ibid) The study further states that “the reality that poverty adversely affects the availability and accessibility of basic sexual and reproductive health services and commodities.” (ibid)
Those quotes are interesting, as the first states that, because women are usually – borrowing from the study here – socio-economically dependent on the men in their lives, their health relies on that jurisdiction. The second states that economic and financial considerations are essential barriers to healthcare.
There are several layers to that; one is the aforementioned projection of social relations onto people’s bodies, here indicating an unequal power dynamic in relations between women and men in the Caribbean. Another layer is the grounds that healthcare in itself – put simply – is tied to relations of labour, and structured within a global economy based on a racial and patriarchal ideology of the accumulation of wealth for the few. Therefore the healthcare systems of respective societies are formed from a provider-client/consumer capitalist relationship, with significant issues in the overall welfare of either party. Material and social realities in poverty and in sex and gender relations become detrimental to the implentation of and access to healthcare, and to SRHR.
What are the policies and programmes currently in place regarding SRHR in the Caribbean?
Policies and programmes that dynamically inform and assist regarding SRHR in the Caribbean are focused in education and health establishments and organisations. (UFNPA 2017, FPA 2018). The treaties and conventions that mandate these programmes are drawn from a framework for international human rights – the majority of which were ratified in the middle – late 20th century and early 2000s. (Geneva Foundation for Medical Research 2015). Disregarding the who came up with this, who signed this, in what context were these drawn up, these documents are overarching laws regarding the safety of all persons in every respect – including and oft especially healthcare.
How is this reflected in the Caribbean region today? The UNFPA Caribbean study reports that, whilst maternal mortality rates are extremely low, the contraction of illnesses that potentially endanger SRHR have not decreased, and adolescence pregnancies have risen in certain areas, whereby the study summarises that “Existing data indicate a decrease in unmet need for family planning in some countries and persistent levels in others”. (UFNPA 2017) And these unmet needs draw on misinformation, lack of accessibility conditional to geographic, social and economic factors. Significantly, the study points out that:
“even though the CARICOM integrated strategic framework to reduce adolescent pregnancy in the Caribbean addresses comprehensive sexuality education, sexual violence, sexual and reproductive health, and knowledge management; cultural and legal barriers, as well as institutional weaknesses obstruct its implementation in all countries.”(ibid)
Cultural and legal barriers is a diplomatic overview of the power imbalance and violence (in all its forms) of binarily gendered relations that are detrimental to every person’s mental, physical, sexual and reproductive health. The above statement is damning, and raises several questions: is the framework that CARICOM has implemented enough? Are the systems set up by respective Caribbean institutions and organisations enough? Does the above quoted statement reflect sufficient legislation, policies and care that is effective to addressing ever need of every person’s SRHR in the Caribbean?
Now I do not have an answer to those questions, I am only contributing to a necessary discussion about SRHR in the Caribbean. It would seem that the one of the more significant issues here is lack of education and information to those persons that are underage, and, being the most vulnerable at that age, need the proper information so to achieve full awareness of their sexual reproductive health, and carry that awareness with the possibility of constantly informing themself and accessing new information throughout their life. But those strategies exist, in school, in organisations, in medical establishments, are they enough? Are these strategies providing spaces for gender-responsive, sex-positive (or at least open) conversations?
A person will receive some form of sex education (at school, ‘the talk’ – oh my gosh people, The Talk, that’s a discussion starter on its own). The forms which that takes and the bias with which it is taught can make the difference between an awareness that supports, and an awareness that endangers an underage and not underage person’s body and life.
Recently, Feminitt Caribbean launched the start of The Right Way project. Through training and educational resources, this initiative seeks to push for the communal application(that’s French) of the National Sexual and Reproductive Health policy in Trinidad and Tobago. Thus this project aims to provide a safe space for conversations about any person’s SRHR at a local level. We are all aware of the extent to and depths of which Trinidad and Tobago, indeed the wider Caribbean, are cultures of community – why not start pushing for more all-encompassing/comprehensive healthcare relations (t)here?
References
CAMPO Charlotte, ‘The International Human Rights Framework and Sexual and Reproductive Rights’, Training Course in Sexual and Reproductive Research, Geneva Foundation for Medical Education and Research 2015,
FPATT, ‘To Not Teach Comprehensive Sexuality Education in School is Unpardonable’, 06/12/2018, http://www.ttfpa.org/to-not-teach-comprehensive-sexuality-education-in-school-is-unpardonable/
UNFPA Caribbean, ‘Sexual and Reproductive Health Thetic Brief’, 02/09/2017, https://caribbean.unfpa.org/en/news/sexual-reproductive-health-thematic-brief
Nyala Thompson Grunwald (she/her) is a Franco-Trinbagonian panist and artivist. Currently a postgraduate student based in London, Nyala’s research thus far focuses on decoloniality and afrodiaspora in race, music, gender and culture.