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

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

Again, cultural and religious factors explain the differences in contraceptive use in the Caribbean and the Gulf. Contraceptive prevalence is interestingly and unexpectedly high in Iran, where strict Islamic laws and cultural practices prevail, albeit various types of contraceptives are becoming increasingly available in the region. In general, contraceptive prevalence is higher in the Caribbean because of the right to choose and the unrestricted use of contraceptives as well as the high development of family planning programs and services, ably supported financially by Caribbean governments and international organizations such as IPPF and UNFPA (Yeboah, 2001). With the emerging trend in which the younger generation is seeking more freedom and becoming less adherent to the Islamic code of conduct, contraceptive use in the Gulf would most likely increase (Ilkkaracan, 2000).

Improvements in medicine, medical practice and service availability (preventative, diagnostic and therapeutic) initially occurring in western societies are now evident also in the Caribbean and the Gulf. A substantial proportion of births in both Regions were attended by skilled health professionals, with the Caribbean recording slightly higher proportions than the Gulf. Both regions also recorded increases in the proportion of births attended by skilled health professionals from 1982 to 1996-98. With the exception of Haiti where the proportion of births attended by skilled health professionals declined and Kuwait where no change occurred, most other countries in the two Regions recorded higher proportions in 1996-98 than in 1982. The decline in the proportions in Haiti is attributable to the political situation in the country and poverty.

During the 1990-97 period, Puerto Rico and Cuba recorded low maternal mortality ratios in the Caribbean (21 and 36 per 100 000 live births respectively) while, in the Gulf, Kuwait and the UAE recorded maternal mortality rates of 20 and 26 per 100 000 respectively. These compare favorably with a UNFPA estimated rate of 400 per 100 000 live births globally in 2000. Indeed, the low maternal mortality ratio recorded for the Caribbean countries and some Gulf countries appear consistent with other studies. For example, UNFPA and the University of Aberdeen (2005) reported that maternal mortality ratios are on average the second lowest in the Caribbean and Latin America and only the developed countries have lower rates.

The increasing proportion of births attended by skilled health professionals has not manifested itself consistently in lower levels of maternal mortality across all the study countries. Other factors, such as good facilities and increasing female education, could have also made a useful contribution. The point is that it would generally appear logical that countries with higher proportions of births attended by skilled health professionals will exhibit lower maternal mortality. Supporting this position, UNFPA and University of Aberdeen (2005: 5) stated that an inverse relationship exists between the proportion of deliveries assisted by a skilled health professional and the mortality ratio in developing countries, and that skilled delivery can protect millions of babies and their mothers (see also WHO, 2005).