Every human being has the right to make decisions about their sexual and reproductive health, including the ability to reproduce and the freedom to decide how, when and how often. Access to truthful information, complemented with the contraceptive method of choice, which must be safe, effective and inexpensive, is vital for a person to have ideal sexual and reproductive health. Likewise, it is important for them to have the necessary information to protect themselves from sexually transmitted infection. When making decisions regarding whether or not to have children, women must have access to the necessary services that allow them to have a healthy pregnancy, a safe delivery and a healthy baby.
Family planning is a human right and therefore must be available to all who wish to exercise it. Sadly this right is not available to everyone in the Caribbean, especially those living in vulnerable conditions. Obstacles such as the quality and availability of supplies and services, together with socioeconomic limitations, are part of a persistent problem that must be urgently overcome.
More than 220 million women in developing countries who do not want to become pregnant lack access to effective contraception and voluntary planning information and services. Around 80 million women have been recorded to have had an unwanted pregnancy and at least one in four have had a life-threatening abortion. Family planning reduces unwanted pregnancy rates, and in turn, the need for unsafe abortion, which accounts for 13% of global maternal mortality.
The regional unmet need for family planning is estimated at 16.3 per cent (2015) with substantive disparities among countries and, within countries, among age groups. The unmet need in The Bahamas is estimated at 5.6 per cent and Jamaica at 5.8 per cent, while in Trinidad and Tobago it is estimated at 19 per cent and Anguilla at 18.8 per cent. The unmet need in Guyana is 61.9 per cent among persons aged 15-19 compared to 21.4 per cent among persons aged 29-35, and 59.7 per cent vs 20.3 per cent in Suriname. In most countries, the contraceptive method mix offered is very limited, especially of long acting reversible methods. Moreover, the COVID-19 pandemic has further exposed the weaknesses of the supply chains and logistics management information systems, contributing to low availability, and often stock outs, of modern contraceptives at the last mile, which often contributes to the low demand for and use of modern contraceptive methods among all age groups.
Directly related to family planning is the unacceptable high adolescent birth rates in the Caribbean with 69 per cent of the countries having an adolescent birth rate above 40 births per 1,000 girls aged 15-19, above the estimated global average for middle income countries (37.2), and with huge disparities among socio-economic and ethnic groups. The ratio between the top and bottom wealth quintiles is estimated to be fourteen in Jamaica; the adolescent birth rate of those with the lowest educational level is ninety-seven times those with a higher educational level in Suriname; and in Guyana, it is highest among women living in households with an Amerindian household head and lowest among women living in households with an African-descendant household head (148 vs 59). Despite the aspirational and progressive 2014 Integrated Strategic Framework for the reduction of Adolescent Pregnancy in the Caribbean agreed on by CARICOM member states, adolescents in the Caribbean still face legal, societal, policy and health system-related barriers that limit their access to quality integrated sexual and reproductive health services and information. Most of the Caribbean countries and territories require adolescents below the age of 16 or 18 to obtain parental consent. Also, in many countries the minimum age for marriage falls below the age of 18, recommended by the Committee on the Rights of the Child. Child marriage and early unions vary across the Caribbean, from below 10 per cent in Jamaica to as high as 33.5 per cent in Belize and 36 per cent in Suriname, with girls from the poorest wealth quintiles more likely to be married or in union. Conservative attitudes towards sex in the region give rise to discrimination, stigma and silence around the topic of adolescent sexuality, resulting in resistance towards comprehensive sexuality education, including through the Health and Family Life Education curriculum, and access to sexual and reproductive health services. Other identified underlying causes include inadequate reproductive health commodity security, early/forced sexual debut, sexual grooming, incest and age-disparate sex.
That is why the United Nations Population Fund, UNFPA, works in partnership with a wide number of strategic partners to achieve the goal of universal access to sexual and reproductive health rights, including family planning.
Advocacy for investment in youth and for the recognition of adolescents and young people as subjects of rights is the opportunity available to achieve a new balance of policies related to adolescents and young people in the region.
UNFPA has concentrated its efforts on raising awareness and actions related to the problem of adolescent pregnancy, developing programs that allow adolescents and young people to control their sexual and reproductive life, through comprehensive sexual education, advocating for a comprehensive and rights-based approach, which requires the urgent commitment of governments to ensure the conditions that favor the enjoyment and free exercise of the rights of girls and adolescents.
UNFPA is contributing to global commitments that translate into significantly improving the capacities of each person to have children when they choose to have them, not by chance, transforming lives, communities and countries, putting reproductive health within the reach of all people.
