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Barriers to contraception in Jamaica: “teenage girls denied contraceptives” (!!!) » Family Planning

Barriers to contraception in Jamaica: “teenage girls denied contraceptives” (!!!)

November 6th, 2008 by jliebner@stanford.edu Leave a reply »

One of the more obvious barriers to contraceptive use among adolescents is the physical difficulty in obtaining contraception.  From my previous posts, we’ve learned that a good percentage of adolescents (both girls and boys) are educated in the various methods of contraception. As we’ve discussed before, a significant number of sexually active minors are having sex without using contraception, although contraception for women under 25 has increased to 67.3% at first intercourse in 2002.  Major reasons for not using contraception include not expecting to have sex (52.5% for females, 37.1% for males), not knowing any methods (9.5% for females, 30.5% ofr males), and not being able to get a method (12% for both).  Indeed, sexually active girls report finding it difficult to obtain these methods from health care providers, and as a result, are having unwanted pregnancies and contracting HIV (1).

A November 2007 article in the Jamaica Gleaner News, reports that health-service providers in most of the public health centers are refusing to give contraceptives to adolescent girls.  One reoccurring theme is morality and personal convictions: often health-service providers believe that girls are too young to be having sex and feel uncomfortable providing contraceptives to minors.  A study presented at the Caribbean Child Research conference in October reveals that health-service providers are refusing to supply contraceptive to girls because they believe they are too young, yet they provide boys with the same service (2).  This is also true of USAID funded programs designed to promote healthy adolescent lifestyles, such as JA-STYLE, Jamaica’s Solution to Youth Lifestyle and Empowerment.  The USAID Evaluation of Adolescent Reproductive Health Activity 2000-2007 reports that the intended focus on adolescent reproductive heath, particularly the availability of contraception, has been significantly reduced given staff ambivalence and reluctance to make condoms available to minors.  In fact, at JA-STYLE program sites, emphasis has shifted more to counseling than ensuring access to clinical services and prevention methods; condoms are not made easily available and are even restricted until youth receive counseling (3).

This has to do with the problems of abstinence-only approaches.  The USAID strategic objective is to increase the age of sexual debut, and thus designs program activities that encourage abstinence among youth that are not sexually active (3).  However, as Margarette Macaulay, chairman of the Jamaica Coalition on the Rights of the Child, eloquently states, “We all have to accept that underage girls and boys are engaging in sexual contact, and if they are, despite what everyone can do to try to convince them to abstain, we still have to protect them because they are vulnerable” (2).

What is particularly disturbing is that legislation designed to protect children appears to be denying them protection and access to contraception.  The Child Care and Protection Act, a piece of legislation designed to protect children from abuse at the hands of adults, may actually be part of the reason why health-service providers are hesitant to provide contraception to minors.  Health service providers report that they fear being prosecuted for failing to report a suspected case of abuse.  If they provide contraception to a minor, they in a sense could be facilitating the abuse of a minor by enabling forced sexual encounters.   However, recent policy also requires public-health service providers to provide minors with contraceptives in cases where they would begin or continue to have sex without it and allows health professionals to give contraceptives to minors without the knowledge or consent of parents (2).

From what I gather, forced and coercive sex definitely appears to be a problem in Jamaica, particularly targeted at young and vulnerable girls.  However, I believe that it is the responsibility of a doctor to report any cases of inferred abuse and provide medical care – which includes providing safe means of having sex if it is occurring.  It is not the role of the doctor to legislate or punish rape, but to report it if it is occurring.  By denying patients access to contraception, a doctor is not preventing it from occurring, but rather making it even more unsafe for the victim.

So while contraceptive education is promoted and contraceptives are available (in the sense, that yes, they do exist in the country), access to methods, and by association, use of such methods appear limited for adolescent girls due to the opinions and actions of health service providers.  However, the Ministry of Health is working on legislation to address the issues and reproductive health and adolescent groups, like Youth.now and JA-STYLE, are working to improve interpersonal relations of health service providers and create more youth-friendly services in order to bridge this gap.  Other efforts include making contraception available in non-health care settings.

(1) CDC, 2003. Highlights from the Jamaica Reproductive Health Survey, 2002–2000

(2) Gareth Manning, “Teenage girls being denied contraceptives.” The Jamaica Gleaner. November 5, 2007.  Accessed November 6, 2007.

(3) USAID. USAID Evaluation of the Jamaica Adolescent Reproductive Health Activity 2000-2007. December 2007.

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2 comments

  1. Maggie Chen says:

    Your last sentence really caught me–I think that non-health care settings could be a big part of the solution in distributing contraception to those who desire it. It seems like getting birth control methods to girls in health care settings is currently a sticky topic in Jamaica, and it could be a huge barrier to try to generate a different attitude among health care practitioners about the acceptability of younger girls using contraception. Skipping over this method of distribution could be important. When you said ‘non-health care settings,’ I immediately thought of school clinics, or a mobile clinic that could have after school hours. Do you think this might be feasible in Jamaica, i.e. is school attendance high enough and would the school system be open to incorporating health services?

  2. Max Romano says:

    Thanks for the great info. I don’t understand how providers can be simplistic as to think that the presence or absence of contraception is the limiting factor in a young person’s decision to have sex, and I think the solutions that you point to are on the mark. Although I think a doctor’s job includes a responsibility to provide protection (i.e. contraceptives) to their patients, other channels of delivery may be quite helpful. Getting contraceptives into girls’ and boys’ hands is only the first step, however. Contraceptives will neither cause nor prevent forced and coercive sex, but they do provide some protection to the users. And it appears difficult to hope that USAID will move beyond the abstinence vs. contraceptive debate to address the underlying gender hierarchies that lead to coercive sex.

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