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

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

Contraceptive use and risk of pregnancy

The percentage of females aged 15-49 years using any form of contraception is shown in table 2. It is evident from the table that contraceptive prevalence among married women 15-49 years old was higher for the Caribbean countries than the Gulf countries, albeit the proportion was higher in the Islamic Iran than many Christian Caribbean countries. The lowest contraceptive prevalence was 21% and the highest was 78%, recorded in Yemen and Puerto Rico respectively.

Another finding was that, with the exception of Haiti, the countries which provided information on the risk of unintended pregnancy recorded low proportions. In Haiti, 48% of married women aged 15-49 years were at risk of unintended pregnancy during 1990-98, compared to 13% in the Dominican Republic and 22% in Jordan.

BIRTHS ATTENDED BY SKILLED HEALTH PROFESSIONALS AND MATERNAL MORTALITY

Births attended by skilled health professionals and maternal mortality ratios for the study countries during the study period are presented in table 3. For those countries which provided information for 1982 and 1996-98, such as Haiti, Jamaica in the Caribbean and Syria and the UAE in the Gulf, a higher proportion or births attended by skill health staff was recorded in 1996-98 than in 1982. With the exception of Haiti where the proportion actually declined from 34% to 25%, all the other Caribbean countries in the study recorded higher proportions during 1996-98 than in 1982. The pattern was by and large the same for the Gulf countries. While Kuwait recorded no change (98% for both 1982 and 1996-98), Syria (43% in 1982 and 77% in 1996-98) and the UAE (94% in 1982 and 99% in 1996-98) made some progress. Haiti recorded the lowest proportion of 25% both for the Caribbean and for all the study countries and Yemen recorded the lowest proportion for the Gulf countries (43%). Table 3 shows further that 5 of the 6 Caribbean countries recorded 92% or higher proportion of births attended by skilled health professionals, compared to only 3 Gulf countries during the same period. Cuba and Puerto Rico (99% each), Trinidad and Tobago (98%), and Dominican Republic (96%) recorded some of the highest proportions of births attended by skilled health professionals in the Caribbean. The UAE (99%), Kuwait (98%) and Jordan (97%) recorded the highest proportions of births attended by skilled health professionals in the Gulf (Table 3).

With regards to maternal mortality ratio, the results were mixed for both Regions. In the Caribbean, Puerto Rico and Cuba recorded comparatively lower ratios of 21 and 36 per 100 000 live births, while Haiti recorded the highest ratio of 910 per 100 000 live births in the Caribbean. In the Gulf, Kuwait and the UAE recorded lower ratios of 20 and 25 per 100 000 population respectively, compared to 1400 per 100 000 population for Yemen.

HEALTH EXPENDITURE

The study found that total expenditure on health as a percentage of GDP increased slightly for most of the study countries. With the exception of Syria and the UAE in the Gulf and Trinidad and Tobago in the Caribbean where a slight decrease was recorded, all the other 9 countries in the study increased the total expenditure on health as a percentage of GDP during the 1997-2001 period. For example, total expenditure on health as a percentage of GDP increased from 6.6 to 7.2, 5.8 to 6.1, 5.9 to 6.3 and 3.8 to 4.5 in Cuba, Dominican Republic, Iran and Yemen respectively.