One of the sessions I attended at the Women Deliver 2013 Global Conference in Kuala Lumpur, Malaysia at the end of last month dealt with access to universal health care as it affects women's sexual and reproductive health (SRH) and rights.The conversation focussed largely on how countries needed to ensure that universal health care included access to birth control and other sexual and reproductive health services as a human right.This is one area in which T&T isn't actually lagging so badly. Thanks to a network of NGOs and the Government health services, I think birth control and related SRH services, such as screenings for Pap smears, breast exams, and HIV testing and counselling, are widely available, even to the poorest women in the most rural of areas and increasingly to marginalised groups such as sex workers.
This is not the case in many countries where either tradition or government policy or both has restricted access to birth control; many women struggle to control their own fertility and childbearing, and lack access to HIV testing and Aids treatment.We could always improve–for example, by funding the SRH NGOs better. The Family Planning Association does not hesitate to say it has received the same subvention from the Government since 1990, even as the cost of living has gone up and up and up and the TT dollar has gone further and further down.We also have to take a hard look at abortion, which has a vexing legal status and laws against it that are honoured more in the breach than the observance. Far too many women seek illegal abortions and suffer adverse physical or mental consequences as a result, and where safe surgical abortions are available they are too expensive for many women to afford. However the religious bodies in T&T may feel about it, abortion is a real and permanent part of our lives in this country and our Government is being grossly negligent for the sake of political capital in pretending abortion doesn't exist and shouldn't be discussed and treated with in a mature, dignified and secular way.
Another aspect of universal health care that should not be omitted from the world's or T&T's agenda is the adequate provision of mental health services. Mental health has a direct link to sexuality and SRH; adolescents, especially, could benefit from access to mental health services in schools, hand in hand with an efficacious health and family life education curriculum that covers SRH and rights. Too many young people are having sex too young or are forced into sexual activity for us to have a truly healthy adult population.Early sexual activity has possible detrimental physical consequences, including a higher long-term risk of cervical cancer and sexually transmitted infections, including HIV, not to mention teen pregnancy which carries with it a raft of its own problems and dangers.And, psychologically, children forced into sexual activity are subject to a range of potential problems, including depression and anxiety, low self-esteem, and higher propensity for risky behaviour (including risky sexual behaviour).
A T&T Guardian article published only yesterday noted: "there aren't many options in T&T for the treatment of children with psychiatric illnesses." The article, by Taureef Mohammed, has Judy Wilson, CEO and founder of the NGO Rainbow Rescue, noting that "there are a few child psychiatrists (...) but one visit can cost as much as $500."(Pearl Lalla, a social worker at Rainbow Rescue) said the Child Guidance Unit in Barataria is the only government institution that provides psychological help for children.'The first appointment I made was seven years ago and it took me 15 months before the child saw a social worker,' Lalla said. 'Nothing has changed since.'"Mental health is inextricably tied to overall health and healthy relationships.
Had Rehanna Ali been counselled, it's possible she would have left her abuser before it came to beatings, torture and eventually being chopped to death; had her abuser been counselled, it's possible he could have found more appropriate ways to relate to Rehanna rather than beating her, burning her with cigarettes, and eventually chopping her to death.Sadly, there are untold numbers of Rehannas all over this country, in every town and village, right beside the partners who are abusing them.More accessible mental health care–both in terms of cost and availability–would go some way towards mitigating this tragic trend among our population.Good mental health is part of good health and should be embedded in universal health care.