Article By Jovan Tobas of the Trinidad Express
There are two T&Ts. Here's one example: today the average number of children born to a Trini woman over her lifetime is 1.7. This tells the story of increasing self-determination. Men and women know more about managing their fertility and they have access to the family planning products and services to do so.
But cast your mind to the 2005 Tarouba episode in which then Prime Minister, Patrick Manning, came face-to-face with families in a squatter settlement. Many of them had low incomes and large broods. Their condition is repeated throughout the country. Our low fertility rate doesn't convey just how many individuals still have more children than they either would like or can manage.
There are other indicators that several people throughout the region aren't yet under the umbrella of protective information, behaviour and services. Rates of early sexual initiation and child sexual abuse remain high. HIV-related knowledge is moderate to low. Teen pregnancy is prevalent. People continue to have a great number of high risk sexual encounters. Condom-use is merely moderate. And for the Caribbean as a whole the unmet family planning need is a high 20 per cent.
Geeta Sethi, Director of the United Nations Population Fund (UNFPA) Sub-regional Office for the Caribbean, says that there is an increasing understanding of how and why people are left off the development train.
"There are layers and layers of who we leave out," she explained. "Sometimes it's linked to religion, ethnicity, socio-economics, class, education and, surprisingly here, even age." She noted that there has been a shift in the global approach to targets surrounding HIV and family planning. Governments, development agencies and other stakeholders now aim for Universal Access.
"That means each and every person is included. Health and rights should be for everybody," Sethi said, "irrespective of who they are."
The 1994 United Nations International Conference on Population and Development (ICPD) was underpinned by belief in the inherent worth of each person. At that meeting, 179 countries including our own agreed to a 20 year Plan of Action meant to improve the lives of people by putting their concerns at the centre of development. It includes the promotion of human rights, sexual and reproductive health and rights and gender equality; supporting family planning; and eliminating violence against women. "ICPD Beyond 2014" is a programme through which countries will reaffirm these commitments and review their progress.
Tammy Yates, UNFPA's Assistant Representative in T&T, noted that the local situation is a mixed bag of successes and challenges, persistent issues and new concerns. Trinidad and Tobago adopted a national population policy in 1996. In recent years the Population Programme Unit of the Ministry of Health completed a nationwide training programme for nurses to improve the quality of reproductive healthcare. To varying degrees HIV/AIDS is on the national agenda.
But the dynamics of HIV transmission have shifted since the 1990s. There is a rise in the number of older people contracting the virus over the last five years and HIV rates are consistently as much as five times higher in adolescent girls than in boys between ages 15 and 19. Yates added that there continues to be a two year gap between the ages at which young people can legally consent to sex (16) and access sexual and reproductive health services such as family planning and HIV testing (18).
Yet a third challenge is our rationalisation of forms of sexual orientation, gender identity and sexual behaviour that many deem taboo.
"We have not reached the stage where we are open to the issue of sexual orientation. We are a society that still pushes things under the carpet to a certain extent. When we look at equality before the law or equality in terms of treatment in accessing health services, we have not reached that stage. That is one driver of the health issues faced by communities like men who have sex with men (MSM) and sex workers," Yates said.
Sethi noted that the time countries take to come to terms with the inclusion of sexual and other minorities differs widely. An important factor is the willingness of the affected communities to speak out.
"You also have to have strong partners that are open about the fact that they support these communities. People continue to advocate on these issues at the highest levels of the global agenda. National programmes driven by partners and advocates need to connect to that," she explained. "A lot of times people feel everything is okay as long as it's hidden. This happened in the early years of the AIDS response. Very articulate, strong people from the community had to stand up and say 'This is who I am and I deserve to be treated like everybody else'."
Even after 19 years of working in HIV and reproductive health with agencies including UNAIDs and in places ranging from Bangkok to Bangladesh, the petite Sethi isn't jaded about politicians and their sincerity in signing on to international commitments.
"I might be naïve but I think that governments genuinely believe in these values. I don't think you make these commitments lightly. I don't think you say before the community of nations that you are going to do something and intend not to do it. But you go back home and you're not sure how. There might be contradictory laws or you mightn't have the capacity to engage your citizenry, so what happens is that you don't do it."
That said, the pair is optimistic about what they call "innovative approaches" being undertaken by our Ministry of Gender, Youth and Child Development. They hinted at projects that offer young people information as well as a sense of self. Work is planned to engage parents and communities before starting a curriculum delivered through the mass media.
Yates noted that there is a growing appreciation in T&T about the drivers behind certain types of behaviour.
"There are issues of vulnerability, power imbalance, violence, lack of education and lack of access that impact people's experiences," she said. "There is a growing empathy as well as an understanding of what we need to address if we want the positive outcomes."
Almost two decades on, there isn't any part of the ICPD agenda that the women consider a done deal. Despite strong advocacy in the past, contraception is up for debate in the United States and domestic violence is on the rise here in T&T.
"It is always going to be a struggle and even after you've covered some ground you've got to keep fighting. There are those with a different point of view and that's all right," Sethi said with a smile. "But those who believe have to advocate."
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