Sexual health services shouldn’t be viewed as a luxury, or as something only accessible to those with enough cash to spare after paying their monthly bills.
For many people, wherever they are in the world, sex is an important and rewarding human need; a means of expressing their feelings for another person, or an integral part of their relationship.
For sex to be truly enjoyable, it needs to be a safe, comfortable experience with low risk of unwanted consequences. Suitable contraception should never be so far out of the normal price range so as to be unattainable for ordinary men and women.
In order for any society to truly flourish, citizens need to have full control and autonomy over their own bodies.
This of course encompasses the vastly important area of sexual health, a factor which ultimately determines so many of the choices we make as human beings.
Speaking as a woman, I know how lucky I have been to have had access to a variety of contraceptive methods; allowing me to pursue education, training and an enjoyable career before making the life changing decision to have children. Many women across the world are not so fortunate.
According to statistics given by the Global Library Of Women’s Medicine (GLOWM), 600,000 women die every year from pregnancy-related causes, with 75,000 dying following unsafe abortions. At least 200,000 of these maternal deaths can be attributable to the failure or unavailability of contraceptive services.
Adequate family planning services bring numerous health and socioeconomic benefits for both women and children, allowing mothers to participate fully in society while reducing the risk of infant mortality.
In the country of Venezuela, citizens are seeing first-hand the dismaying reality of life without accessible contraception; an issue which starkly illustrates the catastrophic collapse of the Venezuelan healthcare system.
For Venezuelans, safe sex is indeed a ‘luxury’ few can afford, leading to escalating numbers of sexually transmitted diseases (STIs), unwanted pregnancies, teenage pregnancies and serious pregnancy-related health risks.
There are currently far more people trying to buy goods in Venezuelan stores than there are goods on the shelves, with the price of a variety of products doubling, on average, every 26 days as reported by the BBC.
This economic crisis has led to shortages in a variety of products people in more fortunate circumstances would never think of as being precious, including medicine, food and contraception.
Oral contraceptives, IUDs and condoms were once freely available at public hospitals or through government programs. However, these handouts have been largely suspended due to huge government cuts.
Estimates given by The Venezuelan Pharmaceutical Federation – as reported in the British Medical Journal – suggest the stock of contraceptives in Venezuela has plummeted by 90 per cent from 2015 to 2018. This shortage has caused prices to skyrocket.
In 2016, the price for a three-pack condoms on the black market skyrocketed to 1687.88 Venezuelan bolívar ($169). This staggering figure is due to hyperinflation, with the country’s economy having shrunk by one third between the years 2013 and 2018.
Just one month’s supply of contraceptive pills will use up a quarter of a minimum wage worker’s monthly salary, while a single condom can require half their monthly wage. Scarcity means black market prices can be even steeper.
With contraception being way out of the average person’s budget, many are forced to use unreliable techniques such as the withdrawal ‘pull out’ method or the rhythm method. Abortions are illegal unless a woman’s life is at risk, and so many are ending their unwanted pregnancies by themselves.
As reported by the BBC, many women have even felt desperate enough to opt for permanent sterilisation; with waiting lists of up to 500 women for so-called ‘sterilisation days’.
Since 2014, over four million people have fled Venezuela for neighbouring countries, with the most predominant country being Colombia. By the end of 2019, this number is expected to hit five million.
One of the biggest drivers of migration from Venezuela to Colombia is the access to healthcare Venezuelans are unable to receive in their own home country.
Unfortunately, the overwhelmed Colombian healthcare system is struggling with the influx of migrants, with the government unable to provide enough support. NGOs are therefore helping to plug some of the gaps.
Reproductive care is one such area which represents a significant gap, placing a huge burden on an already overburdened Colombian healthcare system. Many pregnant women are among those fleeing, hoping to have their babies delivered outside of Venezuela’s broken healthcare system.
In a bid to address this pressing issue, Save The Children have established a sexual reproductive health unit in Maicao, located near one of the two main border crossings into Colombia.
The unit – which is part of Save The Children’s Emergency Health Unit – provides antenatal and postnatal care, as well as vital counselling services.
Since the clinic opened on April 3, 2019, staff at Save the Children’s Emergency Health Unit (EHU) have cared for at least 800 pregnant women, including at least 122 pregnant girls. The youngest girl treated was just 14 years old.
Staff at the unit have reported worryingly high numbers of STIs amongst patients, including cases of syphilis and HIV. However, there is little the unit can do to treat those with HIV other than give them the test.
UNILAD spoke with Jenn Gardella from Save the Children, who is currently serving as the humanitarian communications manager for the emergency response to the Venezuela migration crisis in Colombia.
Jenn told UNILAD:
The political, economic turmoil that’s been going on in Venezuela for a number of years, has led to this emergency both inside the country.
Now, these last few years especially, it’s turned into a regional crisis, with the increased migration and outflows because of the levels of desperation inside Venezuela for the most basic things.
As reported by Global News, maternal death rates in Venezuela soared by over 65 per cent between 2015 and 2016.
It’s therefore little wonder such large influxes of mothers – many of whom are barely more than children themselves – choose to go to such desperate measures.
Over one quarter of the the pregnant women who have made the crossing to Colombia are teenage girls, a demographic prone to serious complications such as anaemia, high blood pressure and premature labour. The perils when making the crossing itself can also be grave.
Girls as young as 14 years old have made the dangerous journey from Venezuela to Colombia, entering trough through informal border crossings known as ‘Trochas’ where they are at the mercy of criminal gangs and armed groups.
Jenn told UNILAD:
I think there seven border point, seven points where there are migration people and they have to show some kind of document even when there’s a passport or any sort of identification card.
But there are three hundred or more – probably more – informal border points which are called […] that are just completely unregulated, and under the control of either armed groups – like the armed groups that are present in Colombia or Venezuela – and criminal gangs.
They will receive more vulnerable people, such as pregnant women, and there is lots of exposure to, you know, the risks of physical harm, sexual abuse, exploitation, human trafficking. Of robbery and theft.
Like pretty much any informal border crossing in anywhere in the world, right, there is a price to pay. And if you don’t pay the price then you either don’t cross or something happens to you.
So it can be a very harrowing journey through for some of these people. But even when they cross, even when they’re in Colombia, that doesn’t mean they’re not exposed to these risks.
Once they make it through the crossings, expectant mothers can expect further perils. Without friends or family to turn to, they will often be forced to sleep out on the streets. Without required documentation, they will be unable to access healthcare at all.
In Colombia, childbirth is classed as an emergency, meaning they will be afforded medical treatment during the birth. However, this treatment does not encompass pre-natal or post-natal care, and such women won’t be checked on afterwards.
The horror many of these patients will have faced during their journey means the sexual health unit places an emphasis on mental health; providing psycho-social support for women who have endured terrible acts of violence and abuse.
Jenn told UNILAD:
Many, many women who come to us tell us of their experiences either in Venezuela, during the crossing here, or being kind of very vulnerable and living in the streets without any resources in Colombia and have been severely sexually assaulted.
So that psychosocial support services for women is a key part of what we’re responding to in this unit, because the entire journey is extremely risk-laden.
UNILAD also spoke with Diana Pulido, a healthcare manager at the unit, who explained how research into the state of the Venezuelan healthcare system is currently forbidden by the government.
Diana explained how, with very little data currently being released by the Venezuelan government, it’s difficult to compare what maternal and reproductive healthcare was like before and after the financial crash, however anecdotal evidence paints a grim picture.
Dirty, contaminated hospital where is no food and where women are expected to bring their own gloves, tools and medicines for birthing procedures. Regular blackouts which happen – terrifyingly – during c-sections.
Dire healthcare conditions paired limited access to contraception will ultimately have grave consequences for both the short and long term, with the health and future prospects of mothers and babies severely compromised.
Diana told UNILAD:
If you don’t have access to family planning you at risk. are at greater risk of mortality. This spacing time between children, their bodies are not recovering. So they are more at risk. […]
In twenty years, in thirty years, we’re going to see the consequences. I think that we need to wait to see. It’s teaching us in a huge way.
It’s too early to understand the implications of what’s going on. But for example, when you’re faced with a choice when you have pretty much no money, when you’re faced with a choice of ‘I can buy a single condom’ or ‘one kilo of rice’, what’s anybody going to buy, you know?
That’s an obvious human choice. I mean, people aren’t going to stop having sex, people aren’t going to stop living their lives and things. So it’s definitely when that’s the choice that you have to make, it’s no wonder that we’re seeing some of the spikes in STIs and the spikes in pregnancies and things like that.
Because family planning, birth control, it’s not an option. Both for lack of available methods as well as what is available, it’s just not what you’re going to pick when you’re hungry. Decisions are bleak, I think.
Going forward, Save the Children is working to establish a mobile sexual and reproductive health unit, providing services in La Guajira, close to Maicao as well as the areas bordering Venezuela.
Over in Venezuela, the situation remains dire. Drugs are so scarce that doctors are often unable to treat patients with STIs, while those with unwanted pregnancies continue to make the sort of dire decisions which should be unimaginable in our modern era of medicine.
Global organisations such as the UN Population Fund have started importing thousands of condoms and hormonal implants to Venezuela, with priority given to the welfare of teenage girls and the promotion of female empowerment.
A condom, no matter how throwaway we might view such objects, represents far more than a contraceptive. It can mean the difference between health and sickness, financial stability or destitution. In the very worst cases, it can mean life or death.
Without adequate family planning and maternal health services, a society such as Venezuela will suffer the consequences for generations.
If you have a story you want to tell send it to UNILAD via [email protected]