“Sir, to tell you the truth, things rough so till sometimes me feel like me want to give up”

“Yes people will cuss and say why we mek wi self reach in this situation but when yu reach a stage where you have to struggle to make ends meet, things happen”

“Is years me a look work and get turn down so many times. Sometimes me get so desperate a sell mi have to sell mi body”

“When you reach a stage where when you contact the fathers of your children for maintenance money and they tell you that you have to have sex with them it’s hard.”

TheIn every region of the world, impoverished, poorly educated and rural girls are more likely to become pregnant than their wealthier, more urban, and more educated counterparts. Girls from marginalised groups, and those who have limited or no access to sexual and reproductive health are also at greater risk. For more than four decades, the National Family Planning Board (NFPB) has played a critical role in Jamaica’s development. Since 1967, the Government of Jamaica (GOJ) has recognised the importance of family planning in achieving a balance between population growth and development and in improving the health and well-being of women, children and men.Jamaica’s latest Reproductive Health Survey (RHS), which was published in 2008 reported an almost 50 per cent reduction in fertility rate over three decades; a 40 per cent reduction in unmet contraceptive needs and a 40 per cent reduction in unplanned pregnancies over the last two decades.There are still however important sexual and reproductive health challenges as reflected in the reports of falling but still high rates of unplanned pregnancies (over 40 per cent) and falling but high rates of pregnancies among adolescent girls (18 per cent of all live births in Jamaica are to adolescents). Almost half of all sexually active females, 15-24 years old, said they were coerced into having sex the first time they ever had sex. In this regard, the RHS has highlighted the vulnerability of young girls to forced sex and exploitation by older men. Despite Jamaica’s success in addressing the HIV epidemic, HIV continues to be a significant feature among the Jamaican population and has the potential to substantially impede the social and economic development of the country and contribute to the poverty gap. Globally, the HIV epidemic is also closely tied to poverty and related development issues, high levels of unemployment, and low educational attainment. Moreover, the epidemic may threaten economic productivity because the majority of cases occur in the reproductive and working age groups. With the feminisation of the epidemic more and more women have become infected. For women and girls, poverty may increase vulnerability to HIV infection and force them to exchange unprotected sex for food, money, school fees or other basic needs.Control over financial resources and power is fundamental to one’s capacity to access and use health information, make informed decisions about one’s health and fertility, and to negotiate and insist on safe sex practices. Conversely, when women or men are unable to make critical decisions about their reproductive and sexual health, there are high social and economic costs for them, their families, communities, and country. In 2013, with a commitment to greater cost efficiencies and sustainability the Government of Jamaica ratified the integration of components of the former National HIV/STI Programme — specifically, Prevention, Enabling Environment & Human Rights, Support to Treatment and Care – into the Family and Population Planning Programmes of the National Family Planning Board. With the integration the NFPB has the power to collaborate with and support programmes and initiatives implemented by various ministries, departments and agencies (MDAs) and disseminate and promote information on the specific Sexual and Reproductive Health (SRH) areas which fall under its expanded mandate. These specific areas are:• Improving contraceptive choice and safety.• Reducing STIs (including HIV) and reproductive tract infections.• Promoting healthy sexuality including adolescent sexual health, and• Reducing harmful practices in an environment where human rights are respected and protected.According to the NFPB’s Executive Director, Dr Denise Chevannes-Vogel, “the work of the NFPB is critical to advancing sexual and reproductive health and rights, including increasing access to voluntary family planning services. Especially in the era of the Sustainable Development Goals, optimal sexual and reproductive health can positively influence population dynamics and advance a number of sustainable development priorities, including those related to health, gender equality, food, water and energy security and environmental sustainability”.In respect of family planning, a number of issues continue to dog the integrated SRH/HIV response. Central to these is the issue of unmet need for family planning.Although unmet need for family planning among females in the reproductive age cohort 15-49 years has continued to trend downward, high rates of unmet need persist in some parishes. The Western region had the highest percentage of unmet need (8.7 per cent) when compared with other regions among females 15-49 years. Notably, the parish of St James had an unmet need of 13.6 per cent among this age group (2008, RHS). According to the World Health Organization’s (WHO) Report entitled “Violence Against Women — Health Consequences”, “violence against women may result in unwanted pregnancy, either through rape or by affecting a woman’s ability to negotiate contraceptive use. For example, some women may be afraid to raise the issue of contraceptive use with their sexual partners for fear of being beaten or abandoned. Adolescents who are abused, or who have been abused as children, are much less likely to develop a sense of self-esteem and belonging than those who have not experienced abuse. They are more likely to neglect themselves and engage in risky behaviours such as early or unprotected sexual intercourse. A growing number of studies suggest that girls who are sexually abused during childhood are at much greater risk of unwanted pregnancy during adolescence”. The above-mentioned WHO Report also states that “as with unwanted pregnancy, women are vulnerable to contracting sexually transmitted diseases (STDs) because they are unable to negotiate protection. Women with STDs have a higher risk of complications during pregnancy, including sepsis, spontaneous abortion and premature birth. Some STDs increase a woman’s vulnerability to the HIV virus, as well. Violent sexual assault may also increase their risks because resulting tears to delicate vaginal tissue allow the virus easier entry into the bloodstream. With HIV/AIDS, the consequences are usually fatal for the woman, and possibly for her children as well”. It is important to note that violence against women is not only a possible risk factor for HIV, but can occur as a consequence of disclosure of HIV-positive status (1). So what does all of the above mean to all poverty-stricken young mothers with many children? The board chairperson of the NFPB, Dr Sandra Knight, in response to the article on the plight the women faced, shared one of the strategies being used by the NFPB. She noted that the NFPB has changed its method of sex education counselling by reaching out to men. “In the past, the method was to try to reach out to women, to try to empower the women to make the right choices and decisions, but we notice that we were not seeing much change in the data. What we found was that even though the women were being educated, their decisions were still being influenced by men, who were most often the holders of power in the households”.Dr Chevannes-Vogel adds that “empowerment of women and universal access to sexual and reproductive health services are imperatives in their own right, and key factors which affect population dynamics. Ensuring that everyone can enjoy the right to ‘decide freely and responsibly the number, spacing and timing of their children is vital for the health and well-being of the women, and for overall sustainable development. When women and couples have the means to determine the number of their children, families tend to be smaller, or the size that they can best provide for. This improves their chances of breaking the poverty cycle, and by helping people to manage their fertility, addresses population dynamics and offers opportunities to advance all three dimensions of sustainable development — social, economic and environmental”.Sexual reproductive health (SRH) must not be taken for granted. Meeting the SRH needs of the nation will require substantial investments by government agencies, the private sector and civil society partners, and a commitment on the part of all Jamaicans to actively participate in planning for the future. As the NFPB enters into this new phase of SRH integration, its role is to act as a coordinating body; provide leadership and advocacy; provide capacity building and technical assistance, and provide health demographics. With decreased international support, as a result of Jamaica’s World Bank classification as an upper middle-income country the NFPB will continue to solicit the support of policymakers, planners and the wider community, as we work to ensure all Jamaicans enjoy optimum health in an environment where their sexual and reproductive rights are respected, protected and fulfilled.

This is the predicament, as reported in a recent newspaper article, in which many women living in poverty find themselves. The families of these women are usually found in inner-city communities, and may have up to eight children in each household. In many cases the head of the household is the single mother.

The

State of World Population 2013, published by the United Nations Population Fund (UNFPA), highlights the main challenges of adolescent pregnancy and its serious impact on girls’ education, health and long-term employment opportunities. The report also shows what can be done to curb this trend and protect girls’ human rights and well-being.

In every region of the world, impoverished, poorly educated and rural girls are more likely to become pregnant than their wealthier, more urban, and more educated counterparts. Girls from marginalised groups, and those who have limited or no access to sexual and reproductive health are also at greater risk.

For more than four decades, the National Family Planning Board (NFPB) has played a critical role in Jamaica’s development. Since 1967, the Government of Jamaica (GOJ) has recognised the importance of family planning in achieving a balance between population growth and development and in improving the health and well-being of women, children and men.

Jamaica’s latest Reproductive Health Survey (RHS), which was published in 2008 reported an almost 50 per cent reduction in fertility rate over three decades; a 40 per cent reduction in unmet contraceptive needs and a 40 per cent reduction in unplanned pregnancies over the last two decades.

There are still however important sexual and reproductive health challenges as reflected in the reports of falling but still high rates of unplanned pregnancies (over 40 per cent) and falling but high rates of pregnancies among adolescent girls (18 per cent of all live births in Jamaica are to adolescents). Almost half of all sexually active females, 15-24 years old, said they were coerced into having sex the first time they ever had sex.

In this regard, the RHS has highlighted the vulnerability of young girls to forced sex and exploitation by older men.

Despite Jamaica’s success in addressing the HIV epidemic, HIV continues to be a significant feature among the Jamaican population and has the potential to substantially impede the social and economic development of the country and contribute to the poverty gap. Globally, the HIV epidemic is also closely tied to poverty and related development issues, high levels of unemployment, and low educational attainment. Moreover, the epidemic may threaten economic productivity because the majority of cases occur in the reproductive and working age groups.

With the feminisation of the epidemic more and more women have become infected. For women and girls, poverty may increase vulnerability to HIV infection and force them to exchange unprotected sex for food, money, school fees or other basic needs.

Control over financial resources and power is fundamental to one’s capacity to access and use health information, make informed decisions about one’s health and fertility, and to negotiate and insist on safe sex practices. Conversely, when women or men are unable to make critical decisions about their reproductive and sexual health, there are high social and economic costs for them, their families, communities, and country.

In 2013, with a commitment to greater cost efficiencies and sustainability the Government of Jamaica ratified the integration of components of the former National HIV/STI Programme — specifically, Prevention, Enabling Environment & Human Rights, Support to Treatment and Care – into the Family and Population Planning Programmes of the National Family Planning Board.

With the integration the NFPB has the power to collaborate with and support programmes and initiatives implemented by various ministries, departments and agencies (MDAs) and disseminate and promote information on the specific Sexual and Reproductive Health (SRH) areas which fall under its expanded mandate. These specific areas are:

• Improving contraceptive choice and safety.

• Reducing STIs (including HIV) and reproductive tract infections.

• Promoting healthy sexuality including adolescent sexual health, and

• Reducing harmful practices in an environment where human rights are respected and protected.

According to the NFPB’s Executive Director, Dr Denise Chevannes-Vogel, “the work of the NFPB is critical to advancing sexual and reproductive health and rights, including increasing access to voluntary family planning services. Especially in the era of the Sustainable Development Goals, optimal sexual and reproductive health can positively influence population dynamics and advance a number of sustainable development priorities, including those related to health, gender equality, food, water and energy security and environmental sustainability”.

In respect of family planning, a number of issues continue to dog the integrated SRH/HIV response. Central to these is the issue of unmet need for family planning.

Although unmet need for family planning among females in the reproductive age cohort 15-49 years has continued to trend downward, high rates of unmet need persist in some parishes. The Western region had the highest percentage of unmet need (8.7 per cent) when compared with other regions among females 15-49 years. Notably, the parish of St James had an unmet need of 13.6 per cent among this age group (2008, RHS).

According to the World Health Organization’s (WHO) Report entitled “Violence Against Women — Health Consequences”, “violence against women may result in unwanted pregnancy, either through rape or by affecting a woman’s ability to negotiate contraceptive use. For example, some women may be afraid to raise the issue of contraceptive use with their sexual partners for fear of being beaten or abandoned.

Adolescents who are abused, or who have been abused as children, are much less likely to develop a sense of self-esteem and belonging than those who have not experienced abuse. They are more likely to neglect themselves and engage in risky behaviours such as early or unprotected sexual intercourse. A growing number of studies suggest that girls who are sexually abused during childhood are at much greater risk of unwanted pregnancy during adolescence”.

The above-mentioned WHO Report also states that “as with unwanted pregnancy, women are vulnerable to contracting sexually transmitted diseases (STDs) because they are unable to negotiate protection. Women with STDs have a higher risk of complications during pregnancy, including sepsis, spontaneous abortion and premature birth. Some STDs increase a woman’s vulnerability to the HIV virus, as well. Violent sexual assault may also increase their risks because resulting tears to delicate vaginal tissue allow the virus easier entry into the bloodstream. With HIV/AIDS, the consequences are usually fatal for the woman, and possibly for her children as well”.

It is important to note that violence against women is not only a possible risk factor for HIV, but can occur as a consequence of disclosure of HIV-positive status (1).

So what does all of the above mean to all poverty-stricken young mothers with many children? The board chairperson of the NFPB, Dr Sandra Knight, in response to the article on the plight the women faced, shared one of the strategies being used by the NFPB. She noted that the NFPB has changed its method of sex education counselling by reaching out to men. “In the past, the method was to try to reach out to women, to try to empower the women to make the right choices and decisions, but we notice that we were not seeing much change in the data. What we found was that even though the women were being educated, their decisions were still being influenced by men, who were most often the holders of power in the households”.

Dr Chevannes-Vogel adds that “empowerment of women and universal access to sexual and reproductive health services are imperatives in their own right, and key factors which affect population dynamics. Ensuring that everyone can enjoy the right to ‘decide freely and responsibly the number, spacing and timing of their children is vital for the health and well-being of the women, and for overall sustainable development. When women and couples have the means to determine the number of their children, families tend to be smaller, or the size that they can best provide for. This improves their chances of breaking the poverty cycle, and by helping people to manage their fertility, addresses population dynamics and offers opportunities to advance all three dimensions of sustainable development — social, economic and environmental”.

Sexual reproductive health (SRH) must not be taken for granted. Meeting the SRH needs of the nation will require substantial investments by government agencies, the private sector and civil society partners, and a commitment on the part of all Jamaicans to actively participate in planning for the future.

As the NFPB enters into this new phase of SRH integration, its role is to act as a coordinating body; provide leadership and advocacy; provide capacity building and technical assistance, and provide health demographics.

With decreased international support, as a result of Jamaica’s World Bank classification as an upper middle-income country the NFPB will continue to solicit the support of policymakers, planners and the wider community, as we work to ensure all Jamaicans enjoy optimum health in an environment where their sexual and reproductive rights are respected, protected and fulfilled.

Leo O’Reggio is the communications officer for the National Family Planning Board.