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Sexual and reproductive health and rights in women of Malta
– Reported, February 03, 2012
The UN Millennium Development Goals, which range from promoting gender equality and empowering women, to halting the spread of HIV/AIDS and eradicating poverty, cannot be achieved if sexual and reproductive health and rights are not addressed.
Indeed, such rights embrace human rights, already recognised in national laws, international human rights documents, and other consensus documents. Yet, Malta still awaits a national sexual and reproductive health policy, although this has been on Government’s agenda for many years!
Regulating reproduction is a matter of the most private choice and the most public interest. Studies suggest that access to quality basic education reduces poverty, and empowers women and girls to make their own choices.
For example, contraception, abortion, childbirth and the new reproductive technologies all pose issues about women’s control over their bodies, with abortion campaigns the most politically prominent. Control over one’s body is perhaps the central feminist credo. Safe reproductive control has been central to the improvement of women’s health in Western countries, where women are enabled to have fewer babies, at safer intervals and safer ages. Such control is also central to other choices, such as paid work and participation in public politics.
However, neither the technology nor the choice is problem-free. The relative hazards and benefits of contraceptive drugs and devices, over-intervention in childbirth, in vitro fertilisation, and similar treatments for infertility, have rarely been fully assessed. The recipients are rarely fully informed, and choice has not always been extended or placed unambiguously with women.
There is extensive debate among feminist scholars about reproductive technologies, often seen as a new form of medical interference with women’s bodies, and a product of the male reality that buttresses male power over women. Indeed, technological conception transfers reproductive control from women to (mostly male) physicians.
It is physically and emotionally harmful to women, and reinforces the importance of the social construct of motherhood, which has historically been an important justification for limiting women’s opportunities in the public sphere. Moreover, the increasing medicalisation of reproduction threatens women’s role in procreation, and also carries with it the potential for eugenic uses.
Taboos vs quality education
Political and religious impediments to access the necessary range of reproductive options present one of the most serious health problems facing women (and men) in Malta today. For example, the 2001/2002 WHO international report suggests that comparative data on the incidence of sexual intercourse, mean age and use of contraception for groups of young people in Malta aged 11, 13 and 15 are unavailable.
Admittedly, the survey questions on sexual health proved problematic. For example, the questionnaire was modified, 11-year-olds and other young people in ‘special’ schools were excluded from the study, and in some schools participation in the study was not allowed!
Although the national minimum curriculum for secondary schools includes education on sex, sexuality and health, data which draw on the responses of school-aged children suggest that sex information is sporadic and largely given informally by parents or friends.
Malta’s first national health interview survey in 2003 suggests that the mean and median age for the first sexual intercourse is 21.3 years and 20 years respectively. Seventy-one per cent of survey participants contend that they had not had more than one sexual partner in the previous 12 months.
Young people and contraception
Data which draw on the Genito-Urinary (GU) Clinic Report of 2004 indicate that casual sex among young people has increased from 28 per cent in 2000 to 42 per cent in 2004. Carabot (2004) suggests that despite the high rate of casual sex, the use of condoms remains poor. He argues that 63 per cent of patients visiting the GU clinic indulged in unprotected sex, and only 25 per cent of young women use any form of consistent contraception, the most popular being the oral contraceptive pill (OCP) in 85 per cent of cases.
In parallel, respondents in Malta’s first national health interview survey were asked whether they had used contraceptives to avoid getting pregnant, or as protection to avoid infections. Responses suggest that while 34 per cent never used contraceptives, only seven per cent used contraceptives regularly: 13 per cent used contraceptives sometimes, five per cent rarely used contraceptives, 10 per cent used contraceptives frequently, 15.4 per cent had not been sexually active; there was no information and/or question was not applicable to 16 per cent of interviewees.
Comparative data drawn on the European Parliament report 1999-2004 suggest that the average EU rate of modern methods of contraceptive use is around 65 per cent: the highest rate at 75 per cent in Germany, Finland, the UK and the Netherlands, and the lowest at 53 per cent in Austria and Greece.
By contrast, at 31 per cent, the average rate of contraceptive use in accession countries is much lower than the EU average: the highest is recorded in the Czech Republic, Slovakia, Hungary and Slovenia at 47 per cent, and the lowest in Romania and Lithuania at 13.5 per cent.
Furthermore, data in Malta’s first national health interview survey 2003 indicate that the method/s most frequently used 12 months prior were: withdrawal – 14 per cent, condom – 13.3 per cent, safe period – 12 per cent, contraceptive pill – 2 per cent, coil – 0.4 per cent, cap/diaphragm – 0.05 per cent, spermicides – 0.02 per cent, other – 3.5 per cent. Interestingly, 55 per cent of survey respondents provided no information, or the question was not applicable to their sexual behaviour.
Unwanted pregnancies and abortion
Abortion should not be promoted as a family planning method. It is completely banned in Malta and is punishable at law under section 241-243A of the Criminal Code. A related concern is that not only women, but men too must bear responsibility for preventing unwanted pregnancies.
Carabot (2004) contends that few young women seem to worry about unplanned pregnancies. Indeed, data which draw on Malta’s 2004 national obstetric information system suggest that an increased rate of adolescent pregnancies runs parallel to the trend in unprotected sex that is in turn compounded by the lack of quality sexuality education and specific sexual and reproductive health counselling and services.
For example, in 2004, 18 per cent of all deliveries occurred to lone mothers, six per cent of whom were in the 15-19 age bracket: five deliveries were to mothers under 15. The percentage rose to 21 per cent in the first quarter of 2005: six per cent of deliveries were to mothers aged 15-19 but none to under-15s during this time.
Women and poverty
The Millennium Development goals raise public awareness about the feminisation of poverty, which is intrinsically linked with female-headed households, as a vulnerable and residualised group.
For example, Malta’s 2003 Household Budgetary Survey shows that 76 per cent of single-parent households are headed by women: 47 per cent are aged under 20, and 44 per cent live below the poverty line and depend on social assistance.
AIDS
Carabot (2004) reports that most AIDS cases seen in Malta since 1985 were homo/bisexual men. He adds that while casual sex among these persons is high, the use of condoms is low. In the meantime, there were 10 notified cases of AIDS and seven deaths in Malta between 2000 and 2004.
Time for action
Nothing just happens; it has to be planned. Indeed, Malta’s key challenge to sexual and reproductive health and rights is its tradition of involving religious, conservative views in its national reproductive health agenda. However, there is just no excuse!
Young people have a right to information and prevention, and outreach services need to target ‘high-risk’ groups, among whom are non-school attendees, girls attending existing services for pregnancy testing and contraception, children of teenage parents, young people living in high risk areas, and young people in care.
Good access to all forms of contraception would reduce unwanted pregnancies and sexually transmitted diseases. Malta needs to emphasis condoms, as the proven best-practice preventive method for HIV/AIDS (European Policy Framework, 2004). Reproductive control is central to women’s health and autonomy, and where services are inadequate, costs in health, life and personal freedom are enormous.
Malta is bound to draw up a Development Aid Policy by 2007, and it urgently needs to understand the state of sexual and reproductive health and rights, and best practices for effective implementation of reproductive health policies.
For example, Malta lacks reliable data on sexual behaviour and harmonised reproductive health indicators. Key data on the true prevalence of all STIs, including HIV, are unknown (Carabot, 2004). Malta is still unsure of the prevalence of and correlation between HIV cases and drug users. Rarely has it been emphasised that Malta still awaits a clear and separate sexual and reproductive health policy, which hangs in the pipeline. Sexual violence has a devastating impact on the sexuality and the reproductive health of women and teenage girls, yet the Domestic Violence Act has, for years too, hung in the pipeline.
It is high time for action. The UN Millennium Goals form a blueprint agreed to by all world countries with a target date of 2015. Sexual and reproductive health and rights in Malta are still engulfed in silence and taboo. The key now is to address the issue with urgency and sustained action. Whether this opportunity will be used to the full remains to be seen.
Credits: Dr Frances Camilleri-Cassar Times of Malta
More Information at: http://www.timesofmalta.com/articles/view/20051127/opinion/sexual-and-reproductive-health-and-rights-in-malta.70736
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