A tale of two regions: reproductive health in the Caribbean and the Gulf

Arab Studies Quarterly (ASQ), Summer, 2005 by David Achanfuo Yeboah

INTRODUCTION

REPRODUCTIVE HEALTH CONTINUES TO constitute an important area in the fields of demography and medicine. Reproductive health has evolved from involving contraceptive use, family planning, abortion and related fields to include the attendance of births by skilled health professionals, safe delivery of babies, encouraging women to exercise their right to choose and the practice of healthy life styles during pregnancy and gestation. An integral component of reproductive health today is the integration of HIV/AIDS services and programs in family planning and other reproductive health activities. Today, reproductive health is not only a major health issue, but also a means to sustainable development as well as a human right (UNFPA, 2005).

Many international meetings of demographic and health professionals continue to discuss and investigate improvements in reproductive health. International Planned Parenthood Federation (IPPF) (2004, p. 2) noted that documents formulated at several international meetings--e.g. the 1994 International Conference on Population and Development (ICPD) in Cairo, the 1995 Fourth World Conference on Women in Beijing--reflect a global consensus on women's right to sexual and reproductive health.

Reproductive health is the basis of a society's existence and provides useful insights into a society's ability to replace itself and future population growth. Future population growth has major implications for planning for all sectors but more so health, education, employment, housing and related areas of socio-economic development.

Reproductive health is also emerging as a useful indicator of development. Following advances in medicine (preventative, diagnostic, therapeutic and prognosis), Infant and maternal mortality have both declined in almost every country. So much so that countries with high infant and maternal mortality rates are considered undeveloped and vice versa. Needless to say that reproductive health is closely associated with sexual health, an important global health issue in this age of HIV/AIDS, Hepatitis B & C, etc.

The importance of reproductive health can also be gauged from the number of private agencies and international organizations contributing to and providing services in reproductive health. Many international organizations including IPPF, Population Services International (PSI), the Population Council, United Nations Population Fund (UNFPA), World Health Organization and other arms of the United Nations contribute millions of US dollars annually to support reproductive health activities. These organizations provide direct financial assistance to many countries in Africa, the Caribbean, Asia and the South Pacific for reproductive health activities.

Indeed, UNFPA (2005, p.1) adds that "investments in reproductive health save and improve lives, slow the spread of HIV/AIDS and encourage gender equality. These in turn help to stabilize population growth...."

It is therefore becoming increasingly imperative for demographers, epidemiologists and various other health specialists to take active interest in and investigate patterns and trends in reproductive health and, hence, the rational behind this study.

The purpose of this article is to examine reproductive health in the Caribbean and the Gulf, identifying patterns, trends, similarities and contradictions, with a view to throwing more light on the subject.

DATA AND METHODOLOGY

The data used in this study have been obtained from diverse sources including published statistical data from relevant international organizations as well as unpublished material at the websites of those organizations (UN, UNFPA, IPPF etc). Some information was also obtained from the Ministries of Health/Health Authorities in some of the countries selected.

The methodology is an epidemiological analysis of the data obtained for the various countries in the study. Six countries were randomly selected for each of the Caribbean and Gulf Regions and reproductive health data were obtained and analyzed for each of the selected countries. The selected Caribbean countries were Cuba, Dominican Republic, Haiti, Jamaica, Puerto Rico and Trinidad and Tobago. Iran, Jordan, Kuwait, Syria, the United Arab Emirates (UAE) and Yemen were selected for the Gulf Region.

RESULTS

The findings of the study are presented under broad headings of contraceptive use and unintended pregnancy, total fertility and adolescent fertility, births attended by skilled health professionals, maternal mortality and health expenditure.

Fertility

Table 1 shows total fertility and adolescent fertility rates for the study countries for the 22-year period from 1980 to 2002. It is evident that both Regions have experienced declines in fertility, consistent with the situation elsewhere (see Yeboah, 2001). The declines have been more massive in the Islamic Gulf than in the Christian Caribbean. Gulf countries such as Jordan, Kuwait and Syria recorded larger declines, while the Caribbean countries only managed to marginally reduce the already low total fertility rate. Sight should not be lost of the fact that not all Gulf countries recorded sizeable declines in fertility and that, in Yemen, there was only a slight decline from 7.9 children per woman to 6.4 during the study period (Table 1).