Contraception and young people: A focus on Zika
'Contraception and Young People: A Focus on Zika' was the focus of this year's World Contraception Day (WCD), observed each year on September 26.
Under the endorsement of the National Family Planning Board - Sexual Health Agency (NFPB-SHA), this year the observance of the day was even more poignant given the potential impact of the Zika epidemic in Jamaica and the role that acceptance and use of contraceptives can have in mitigating conception as well as the sexual transmission of Zika.
This is critical in light of the global evidence on the sequelae of Zika infection - the potential risk of microcephaly in babies born to infected mothers and also a risk of Guillan Barre Syndrome, a paralytic condition, in infected persons.
Focusing on the implications of Zika and the importance of contraception, especially among the sexually active, including young people, the World Contraception Day campaign centred around a vision where every pregnancy is planned through consistent and correct contraceptive use.
WCD's mission since 2007 has been to improve awareness of contraception and to enable young people to make informed choices on their sexual and reproductive health. The vision and mission of WCD are in sync with the NFPB-SHA's own overall vision - that of all Jamaicans enjoying optimum health in an environment where their sexual and reproductive rights are respected, protected and fulfilled.
It is well documented that having sex at an early age increases the risk of becoming pregnant while in school or contracting and passing on a STI, including HIV/AIDS. According to the last Reproductive Health Survey (2008 RHS), the early onset of sexual activity in Jamaica among boys and girls, is 14 and 16 years, respectively.
85 PER CENT OF PREGNANCY UNPLANNED
This is reason enough to heighten the response, as unplanned pregnancy rates are particularly high among sexually active teens. Here in Jamaica and the wider Caribbean, many teens are not using, and may not even know about, contraceptive methods, much less long-acting reversible methods such as the intra-uterine device (IUD) or hormonal implants. According to the 2008 Reproductive Health Survey, 40 per cent of women had a child before they reached the age of 20 years and 85 per cent of these pregnancies were unplanned.
A girl is more likely to experience unwanted pregnancy under circumstances of social exclusion, poverty, marginalization and gender inequality, where she is unable to fully enjoy or exercise her basic human rights, or where access to health care, schooling, information, services and economic opportunities are limited. In the Caribbean, among adolescents who engage in risky sexual behaviours, these actions may stem from social, financial/economic and cultural factors that must be addressed if the adolescent birth rate and sexual risk-taking among adolescents are to be reduced.
It has been said that other influencers that place young people at risk and further underscore the need for them to use a contraceptive to avert pregnancy or the contraction of an STI include:
- Being subjects of coerced sex.
- Peer pressure to engage in sex.
- Powerlessness in negotiating contraceptive use.
- Non-use of contraceptive at first sex.
Strategies that the NFPB-SHA has reportedly implemented as part of its ZIKV campaign to avert adverse fetal outcomes as well as protect the country's young people, and the wider public, are varied.
When contacted, the executive director of the NFPB-SHA, Dr Denise Chevannes, said these have included:
- Ensuring adequate stock levels of contraceptives for distribution islandwide, through the regional health authorities.
- Providing educational material on contraceptives as well as ZIKV to public health facilities, other agencies and individuals.
- Increasing radio, print and television advertising to highlight contraceptive use in pregnancy prevention.
- Face-to-face interventions.
- Training community peer educators and teen mothers.
- Updating the entity's website and social media presence.
The 'Choose 2' (dual-method use of a condom and another contraceptive method to prevent sexual transmission of HIV, sexually transmitted infections and Zika as well as unplanned pregnancies) campaign of the NFPB-SHA seeks to, among other things, bring about awareness of the contraceptive options. The campaign has been ramped up to support the Ministry of Health's national campaign to eliminate the spread of the Zika virus, especially as it relates to its potentially harmful effect on pregnancies.
For decades, the local programme has been supported by key funding partners to address the high incidences of adolescent pregnancy by increasing public awareness of ASRH issues, and providing increased access to SRH commodities for adolescents with a view to addressing prevailing challenges.
NATIONAL INTEGRATED STRATEGIC PLAN
The National Family Planning Board-Sexual Health Agency has further prioritised adolescent sexual and reproductive health, a result of the integration process that unfolded in 2013. It was then that the Cabinet approved the integration of aspects of the former National HIV/STI Programme into the National Family Planning Board and a national integrated strategic plan was developed outlining key activities to fit in sexual reproductive health issues with a concentration on adolescent sexual and reproductive health issues.
Initiatives have included the provision of contraceptives in an age-appropriate way; improved contraceptive commodity security; addressing sexual practices and limited knowledge among adolescents; providing counselling services in outreach settings as well as through the Marge Roper Counselling Service; conducting capacity building and training of peer educators; hosting parenting workshops; garnering evidence for ASRH policy and programme planning in the Reproductive Health Survey; hosting an interactive social media platform on adolescent sexual and reproductive health issues; and implementing a gender-empowerment project to reduce adolescent pregnancy.
The framework of the CARICOM/UNFPA strategy mirrors those of the NFPB-SHA for reducing adolescent pregnancy by 2019 and seeks to:
(i) Improve access to sexual and reproductive health services.
(ii) Improve access to comprehensive sexuality education.
(iii) Social protection and violence prevention of all forms of violence against girls.
(iv) Improve rights-based legal standards in line with the convention on the Rights of the Child and Discrimination against women.
(v) The exchange of knowledge, information and good practices.
The NFPB-SHA is cognisant of the fact that the aligning of the 'Choose 2' and the Zika campaigns has raised levels of consciousness. It is now full time that there is an acceptance of personal responsibility to delay pregnancies in the wake of the debilitating effects of the Zika virus. Improved sexual reproductive health and rights knowledge can help young people make healthy, informed choices about their reproductive lives, and, by extension, better the lives of each and every member of the household.
It is also time to address the issue of adequate and sustainable funding. For decades, the programme in Jamaica has been supported by key funding partners to address the high incidence of adolescent pregnancy by increasing public awareness of adolescent sexual and reproductive health (ASRH) issues, and providing increased access to SRH commodities for adolescents with a view to addressing prevailing challenges.
With Jamaica's classification as an upper-middle-income country by the World Bank and the attendant decline in access to funding of programmes, the issue of sustainable funding is an important consideration, especially given the country's high debt burden and tight fiscal space.