INTRODUCTION
MANY inhabitants within our world have been researching a wide range of social phenomena that directly affect human’s existence. The fact is there are voluminous reproductive health issues that influence human population, and the quality of life that people enjoy. Those issues if not understood and carefully monitored may have catastrophic consequences on man’s future existence. Hence, those issues will continue to be of fundamental challenge to technocrats. In this paper, the author will critically examine reproductive health issues and their implications on the populace.
The Caribbean territory is not unique in the number of health related issues that the peoples continue to grapple. Nevertheless, the region’s dilemma is in the peculiarity in the rate of some of the diseases. The commonalities in some of the cases and the continuous rise in complexities of others are puzzling medical practitioners and researchers within the territory. Those facts are the reasons behind the author’s decision to provide information to the Jamaican populace.
The reproductive health issues that will be presented in this paper are infertility, prostate cancer, Chlamydia, teenage pregnancy, sexual abuse, abortion, STDs/STIs and cervical cancer.
In order to make for a comprehensive analytical understanding of the subject matter, the author will define the following terminologies; as follows:
(i) Health – a state of complete physical, mental and social well being of an individual, and not merely the absence of diseases or infirmity;
(ii) Reproduction - the process of creating a new baby by way of fertilization;
(iii) Fertilization – the fusion of a female’s egg and a male’s sperm;
(iv) Reproductive Health – “addresses human sexuality and reproductive processes, functions and system at all stages of life and implies that people are able to have responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so” (WHO).
REPRODUCTIVE HEALTH SITUATIONS (in Jamaica)
Abortion
The Reproductive Health Service Delivery Guidelines (1999) posits that complications arising from unsafe abortions remain one of the leading causes of maternal mortality in Jamaica. The Report revealed that in 1997, 1.5 percent of Jamaican women have had at least one abortion.
Abortion continues to be prima facie that is illegal in Jamaica with few exceptions. These are; one, to save the woman’s life and, two; to protect the woman’s mental health. Ironically, this must be determined by two (2) or more consulting medical practitioners. Who should be the one to determine a woman’s reproductive rights? Rights! Moreover, where is the woman’s freedom if medical practitioners are needed to determine the woman’s rights?
Sexual Abuse
Statistics revealed that some 27 percent of female adolescents between the age cohort of 15 and 19 years have reported that they have experienced forced sexual intercourse from older men – (PAHO, WTO, MOH et al). The Ministry of Health Report et al (2000) revealed that pedophiles are on the rise since the past four (4) years. Those facts indicate a social reality that is worrying, and shows a psychological dilemma that the society faces.
Because innocent victims often times become passive and withdrawn, such a situation must be address with urgency. As all societies must proper the innocent, young, the old, and those who are unable to protect themselves which is why this issue is of fundamental concern to all technocrats and peoples within our society. In addition, this social experience results in the fear of men that undoubted affect women’s reproductive health.
Sexual abuse directly affects one of the two (2) individuals within the relationship and so this traumatic experience in and of itself speaks to a social and psychological problem to which individuals within the society will need to live with for the rest of their lives, and so this issue must be address with acute urgency. In addition, the age of the persons involved (female adolescents between the age cohorts of 15 through 19 years) speaks to a social ill that will in the future produce other social issues in the society.
A Jamaican Feminist Watchdog group, Women’s media Watch, posits that 20 percent of all Jamaican women between the ages of 15 and 55 have been assaulted by a man.
This social experience speaks primarily to the social and psychological state of many females who are the nurturers of children, and by extension adds credence to some of the social evils that presently are befalling our society.
Furthermore, another group, the Women’s Crisis Centre, Victims of Violent Crime for 1989, posited that rape, domestic violence and incest stood at 2,226 and the figure for 1999 was an alarming 6,680. Meaning in ten years (between 1989 and 1999), the number of sexual abuses committed against women rose by 200.8 percent. This is totally unacceptable and cannot go unabated within our society. Otherwise, we should not expect a balance society with health children, happy homes, and unity between the sexes.
Cervical Cancer
As it relates to cervical cancer, approximately 500,000 cases are reported that are new in our world yearly. PAHO Report (2000) has indicated that this disease is the second leading cause of cancer in women. Many studies have, now, indicated that this may be as a result of some of the contraceptives available and widely used by women. Nevertheless, the choice is ours.
Infertility
According to the Reproductive Health Survey on Jamaica (2000) sponsored by the National Family Planning Board (February 1999), the total fertility rate in 1975 was 4.5 percent. This figure represents an average and not an absolute number per woman of childbearing years.
In 1989, the fertility rate fell to 2.9 percent followed by a further reduction in 1993 by 0.1 percent, and then an increased of 0.2 percent (to 3.0 percent) in 1997. This trend indicates a lowering of the fertility rate over a ten-year period.
It should be pointed out that the Age Specific Fertility Rate (ASFR) revealed that the age cohort with the highest fertility rate was 20-24 years.
Many research are now postulating that some of the reasons for the reduced fertility are due to the lowered sperm count in men because of the following:
i. stress
ii. hot climate
iii. jobs selected by men
iv. smoking
v. poor diet
Teenage Pregnancy
The Reproductive Health Survey on Jamaica (for 1997) showed that the age cohort of 15 -19 has the second highest level of fertility to the age cohort 20-24. The former age cohort represents children who are of school years. The Ministry of Health has been advocating for the provision of reproductive health services to adolescents but many are objecting to this but the reality if not address in significant more unplanned children in a society with increasingly less resources to cater for needs of the present population.
The Reproductive Health Survey data revealed that the ASFR in all age cohorts was higher in rural areas than in other urban centres or even in the Kingston Metropolitan area.
Given that reproductive health speaks to the actual well being of the individual and not the absence of infirmities, the high fertility within this age group must be an emotional, social and financial concern to the society members.
Prostate Cancer
A research done by the University of Yaoundé, Cameroon, department of Urology cited that high-grade prostate intra-epithelial neoplasia (HGPIN), a premalignant lesion, is found in 0.7 – 20 percent of all biopsies and was high for African descendants compared to caucasian men.
The researcher pointed out that the highest incidence of prostate cancer reported was in Jamaican men (304\100,000). While, the highest reported mortality from this disease occurs in people of African descent from the Caribbean islands of St. Vincent and Bermuda.
Figure 1
AIDS
Based on figure 1; according to the Ministry of Health (MOH), the HIV/AIDS rate doubled in 2000 in comparison to 1998. That fact previously mentioned is alarming as it speaks to the human social experiences and the social realities that will follow. That is families with children, mothers and even fathers.
The MOH Report (2001) showed that 4 percent point of the population was living with HIV\AIDS virus. The statistics revealed that the fatality rate for those individuals living with the virus was 61.6 percent points. Figure 1 above clearly shows the extent of the AIDS/HIV epidemic on the various age cohorts of Jamaicans over the last nineteen years.
Figure 1 revealed that more men that women have contracted the HIV/AIDS virus. Generally, with boys lacking men as positive role models, any further increase in the death rate of men will further compound the present social ills of this society. Hence, this social epidemic will destroy this beautiful country known as Jamaica.
Since 1999, the infection rate for women stood at 40 percent per year compared of 60 percent for the men.
Table 1
AIDS ABSOLUTE VALUE PERCENT
Total No. of reported cases 511
Children < 10 years 40 7.8
Homo/Bisexual 22 4.7
Total AIDS Deaths 322 11 Deaths weekly
New Cases reported as deaths 30 34.3
Crack users 32 6.8
Sex with prostitutes 83 17.6
STD/STI 335 71.1
NEW CASES:
15 – 24 YEARS 30 5.8
25 – 29 YEARS 60 11.7
30 – 34 YEARS 76 14.8
JUNE 2002
The Jamaican society had it first battle with the AIDS/HIV virus as early as 1982 – (Family Health International). Further, the adult HIV prevalence rate is 1.2 (USAIDS, Statistics, 2001). At the beginning of 2001, approximately, 950 Jamaicans died from the AIDS virus. However, at the end of 2001, 14,000 children under 15 years had contracted the disease. It should be noted that 61 percent of the reported cases of people to have been infected since 1982 were heterosexual individuals.
Other STDs/STIs:
Gonorrhoea
Gonorrhoea is a sexually transmitted disease. As such, the bacteria affect both men and women and may lead to sterility. If gonorrhoea is left untreated, it can develop into an inflammation of the sexual organs in women and an inflammation of the epididymis in men.
In females, the long-term consequence of the disease (gonorrhoea) is closure of the Fallopian tubes. If this happens, the passage of the fertilized egg into the uterus is made difficult and the risk of sterility and ‘impregnancy’ increases.
In 1993, the Ministry of Health data revealed that the prevalence of this disease in Jamaica is 464 per 100,000.
Syphilis
Syphilis is a sexually transmitted disease that may also be transmitted through blood transfusion. This bacterium is caused by Treponema pallidum.
According to the Statistical Institute of Jamaica, the rate of syphilis infections in Jamaica stood at 27.2 percent (702 cases), compared to 22.3 percent in 2000 (586 cases).
Hepatitis B
From the World Health Organization (WHO) website, an article written by Dr. Gebre established that individuals who are infected with this virus may transmit the disease by the sharing of toothbrushes or razor blades.
Furthermore, Hepatitis B is a serious disease that kills approximately thirty (30) Jamaican yearly and about one (1) million peoples worldwide (Eulalee Thompson, 2000). Continuing, she stated that, “about one-third to one-half of adults infected with HBV may show yellow jaundice or discolouration of the white of the eye.”
Chlamydia
This is a sexually transmitted disease. This bacterium may affect urethra, cervix, or the eyes. This disease in women often times results in sterility, pregnancy complications or may even influence the delivery of the infants.
Chlamydia infections affect some 162 million peoples, with approximately 97 million new cases being detected yearly – (WHO, 2000).
If Chlamydia is left untreated in an infected person, it will cause reproductive damage and infertility.
Family Planning
The Social and Economic Survey of 1997 and 1993 have clearly shown that fertility rate has been drastically reduced over the past forty years. In the 1960s, the fertility rate for women of childbearing ages was approximately 6.2 children per woman. In the 1975, the rate fell to 4.5 children per woman. It should be pointed out that the National Family Planning Board was commissioned in 1974 and so some may argue that this is shear coincidence, and does not explain the reduction in fertility rate.
Further, the fertility rates per woman continue to fall thereafter. Even though the fertility rates may not be ascribed in its entirety to the Board, one cannot discount that institution for its invaluable contribution in assisting to lower the rates post 1974.
The National Family Planning objectives and mission statement have fundamental changed the landscape of some of the cultural myths, malpractices, and has equally awaken the social consciousness of policy makers and the society at large.
The Board’s functions and responsibilities range from male responsibility to female responsibility in reproduction. Other functions that are within the Board’s mandate are as follows:
i. contraception and sterilization
ii. counseling
iii. improve the quality of life of the family
iv. wider access to health care for the citizenry of the country
v. eliminate and significantly reduce maternal deaths
vi. increase the knowledge base of the citizenry of particular geographical locality of the reproductive functions of the body and their reproductive rights
vii. best practices for infant care
Figure 2
In 1997, the Reproductive Health Survey revealed that of women between the ages cohorts of 15 through 49 years, 62 percent of them had used some form of contraceptive. The Survey showed that contraceptive prevalence for women in Jamaica rose from 62 percent to 66 percent over the four-year period from 1993 to 1997. Within the social reality of the high HIV/AIDS prevalence rate in Jamaica, a 66 percent contraceptive prevalence rate is catastrophic.
The research indicated that the pills and the condoms were the most frequently use contraceptive preferred by women. In general, oral contraceptives (21 percent) were the post prevalent method reported by women in union, followed by the condom (17 percent) and female sterilization stood at 12 percent. Young men reported that the condom (61 percent) as the most prevalent method of contraception, followed by oral contraceptive (12 percent), sterilization (8 percent) and injectables (4 percent). Again, with the high HIV/AIDS prevalence rate the primary method of contraceptive cannot be pills as a more reliable method of protection from STIs is a secondary method such as the condom.
A startling finding report was that among women who were in unions, the use of secondary method together with the primary method of contraception increased from 5 percent of users in 1993 to 12 percent in 1997. Less that, 1 percent of the female population used a secondary method of contraception other than the condom.
Figure 3
Figure 3 above clearly adds a profound explanation of the severity of the problem of adolescent pregnancy in Jamaica. Note that the 31.2 percent and 58.8 percent of males and females used contraception the first time. The number of males who had used a contraceptive the last time increased to 68.0 percent in comparison to 52.6 percent of females.
In Jamaica, the rate of contraceptive usage is significantly low despite the fact that HIV/AIDS have been increasing. In addition, given the fact that more heterosexual individual having contracted the virus in comparison to homosexual individuals, why is the rate of secondary method of contraceptive so low in this age cohort?