Reproductive health in Jamaica

Paul Andrew Bourne


MANY inhabitants within our world have been researching a wide range of social phenomena that impact on humans' existence in society for some time now. Due to the fact that, there are voluminous reproductive health issues that do directly impact on the human population and by extension on the quality of life they enjoy, and the fact that the implications of such situations can be catastrophic, in addition to the fact that those issues will continue to be of fundamental challenge to technocrats for some time to come, the author will critically examine those issues and their implications so as understand their role on reproduction.

The Caribbean territory is not unique in the number of health related issues that the peoples continue to grapple with. But the region's dilemma is in the peculiarity in the rate of some of the diseases. In addition to, there appear to be some increasing commonalities in the cases. The continuous rise in complexities of a number of the cases is now puzzling medical practitioners and researchers within the territory. Some of the phenomena of reproductive health issues that will be studied are as follows: aids, infertility, prostate cancer, chlamydia, teenage pregnancy, sexual abuse, abortion, STDs/STIs and cervical cancer. As such, the territory for study is Jamaica.


In order to make for a comprehensive analytical study 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 the human sexuality and reproductive processes, functions and system at all stages of life and implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduction 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 abortion remain one of the leading causes of maternal mortality in Jamaica. The Report revealed that in 1997, 1.5 percent of the Jamaican women have had at least one abortion.
Abortion continues to be prima facie illegal in Jamaica with the exceptions allowed to save the woman's life or to protest the woman's physical or mental health. Irony is this must be determined by two (2) or more medical practitioners. Hence, who is the one that determines a woman's reproductive rights? And, where is woman's freedom?

Furthermore, approximately 43 percent of all Jamaican women who are currently between the age cohort of 15 and 24 have had at least one pregnancy by age 19 (STATIN). This, therefore, shows the extent and complexities of the situation of abortion. As well as the physical, the sociological and psychological issues that young mothers and by extension society are having to face.

Sexual Abuse
Statistics revealed that some 27 percent of female adolescents' population of the age cohort 15-19 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 worried problems, and show a psychological dilemma that our society faces. Because the innocent victims often times become passive and withdrawn, such a situation must be address with urgency. The fear of men later in the lives of the females wills undoubted affect their reproductive health. Therefore because the issue of sexual abuse directly affects one of the two (2) individuals within the relationship in addition to the fact of the age of the persons, as such the issue is of concern.

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.

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 while the figure for 1999 was an alarming 6,680. So in ten years (between 1989 and 1999) the number of sexual abuses committed against women rose by 200.8 percent which is totally unacceptable and cannot go unabated within our society for such longer.

Cervical Cancer
Approximately 500,000 more new cases of cervical cancer are reported and diagnosed in our world yearly. PAHO Report (2000) has indicated that this disease is the second most 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.



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. The rate fell to 2.9 percent in 1989, 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, on using the Age Specific Fertility Rate (ASFR), the data showed that the age cohort with the highest fertility rate was the 20-24. This was followed by the age cohorts 25-29, 15-19 then the 30-34.

Many research are now postulating that some of the reasons for the reduced fertility due to the lower sperm count in men are associated to 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 third highest level of fertility. The Ministry of Health has been advocating for the provision of reproductive health services being provided for adolescents. This they argue is indicating a worrying trend as it relates to the fertility within that age cohort.

The Reproductive Health Survey data revealed that the ASFR in all age cohorts was higher in rural areas, followed by other urban and then Kingston Metropolitan area. According to the ASFR statistics, the dilemma as it relates to fertility in adolescent youth is of concern to all within Jamaica

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 of emotional, social and financial concerns to the society generally.

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 occurs about a decade in African decent compared to white men.
The researcher pointed out that the highest incidence of prostate cancer so far has been reported 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.

AIDS
Figure 1
According to the Ministry of Health, the HIV/AIDS rate was doubled in 2000 compared to 1998. The average length of lifespan with HIV or infected AIDS cases was thirteen days. The MOH report for 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.