Publication site : SciELO
Authors : Wilza Villela, Redy Wilson Lima, Cláudia Fernandes de Brito
Date of publication : 2018
Type of publication : Scientific paper
Cape Verde is an archipelago on the west coast of Africa. In the last years the country has registered a rapid development and increase in its population. Fifty five per cent of resident Cape Verdeans fall into the age range of 15 to 49 years old with 20% between 15 to 24. So, an important part of the population is adolescent, young people and is in reproductive age. After the independence, in 1975, a concerted effort was made to organize a health system that could tackle the high rates of maternal mortality. One of the first measures taken was the creation of the Infant/Maternal Family Planning Vaccination Program (PMI/PF/PAV). In 2001, following the International Conference on Population and Development Programme of Action the PMI/ PF/PAV was widened to reach teenagers, young people and adult men. Its name was switched to the National Program for Reproductive Health, PNSR. Reproductive Health Centers (RHC), for teenagers and young people were created , thematic programs on sexual and reproductive health (SRH) were incorporated as educational activities in the Youth Centers and sexual education was included in the scholar curriculum.
In 2007 an evaluation of the PNSR showed the difficulties of implementing the RHC. Moral postures adopted by the professionals, doubts in relation to confidentiality and the fear of the girls being seen in these services were identified. Other studies confirmed the lack of qualified human resources to deal with the issues arising from SRH with teenagers and young people, the low turnout of men attending these services and the infrequent use of the Youth Centers. Also, aspects of the organization and the functioning of the health system were referred to as obstacles to the performance of the PNSR. The health care system was centered on the hospital, and primary health care and the health promotion activities in the communities need to be improved. Socio-cultural characteristics in the country were noted as another barriers for the PNSR success . In Cape Verdean society, strict moral standards co-exist with contemporary and globalized lifestyles. The mix of concepts and practices related to sexuality, reproduction, and women autonomy produces ambiguity and contradiction in the way to think about SRH and the PNSR operationalization.
The Cape Verdean context
Since 2008 Cape Verde has been considered a country with an average income. In 2015 the country was ranked as 122 amongst 188 countries in the Human Development Index.
In 2015 the country was ranked as 122 amongst 188 countries in the Human Development Index
However, Cape Vert faces a lot of structural problems, as the need to import food, and the scarcity of drinking water and natural energy sources. The availability of job vacancies has not been enough to absorb the increase in the population and the subsequent demand for employment. In 2011, 49.9% of the people between the ages of 15 and 25 were not in gainful employment nor were they studying. Urban violence, youth gangs, sexual commerce and the use of substances all permeated the lives of Cape Verdeans. The distance and the diversity amongst the islands difficults the access of the population to the health services. General hospitals are only available on two islands; small hospitals are located on the islands more densely populated.
Health centers (HCs), health clinics and primary care units are scattered around the islands owing to the concentration of the inhabitants
Health centers (HCs), health clinics and primary care units are scattered around the islands owing to the concentration of the inhabitants. Just the HCS has doctors and nurses. The health services are provided on a co-participatory basis. Ante-natal care, the provision of contraception guidelines and the supply of condoms are provided for free. Services such as cervical smear tests and the application of injectable contraceptives require the payment of a small fee. A non-governmental organization connected to the International Planned Parenthood Federation also supplies services covering SRH on five islands.
According to the Demographic Inquiry into Reproductive Health in 2015, the prevalence in the use of contraceptives was 43.9% amongst women as a whole. The fall in the fertility rate from 2.9 children per woman in 2005 to 2.3 in 2015 suggests an expansion in this practice. The fall in the number of children being born was noted amongst all age groups including those under the age of 19. However the number of pregnancies amongst young people is considerably high. In 2013, 20% of those who were pregnant and received ante-natal care were aged 19 or under. Data for 2010 showed that 26.2% of young people between the ages of 15 to 19 and 0.5% that were under the age of 15, had previously become pregnant at some point in their lives. The law permits the abortion up to the twelfth gestational week. The consent of the family is needed in the case of girls under the age of 18.
60% of abortions that take place in the country, occur outside of the official health system
However, it is estimated that 60% of abortions that take place in the country, occur outside of the official health system. Difficult to meet the requirement on the gestational period, no family consent, the payment of the fee and the lack of a health care service on the island where the pregnant woman lives and accounts of poor treatment for the services personel respond to the clandestine abortions. The standard that sets out an interruption in studies during pregnancies is referred to an important reason to abortion among teenagers. In spite of not having accurate data on the extent of abortions,their very occurrence is one of the alleged reasons for looking to improve the PNSR. The prevalence rate of HIV/AIDs in Cape Verde is 0.8% in the general population, 7.9% amongst sex workers, 3.9% amongst drug users and 15% amongst homosexual men.
The detection rate amongst women is greater than amongst men, due to the tests conducted during ante-natal care. This may also be related to socio-cultural barriers to homosexuals and sexual exchanges between men. There is not much integration between prevention and care measures aimed at the population that is most affected and measures for the population as a whole. The HCs do not provide services to sex workers, drug users and homosexuals and there not sufficient resources to meet the demands for SRH guidance. The PNSR just sets out general measures that aim to encourage the use of contraceptives. Observational studies and face to face interviews have shown that there is a reluctance in the use of this input. However studies conducted on populations have referred to its use by 65% of the people involved on an occasional basis, last year. The perception that AIDs is a disease that affects “other people” namely: migrants, residents of poor boroughs and those who are “promiscuous”, has also been noted in studies . This type of mistake coupled with gender inequality, brings specific risks for women who correspond to 57.3% of new cases of the infection in the country.
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