I patiently stood in line at the pharmacy, awaiting my turn to purchase my supplements for the month. I overheard an exchange between the pharmacist and a young lady with her toddler clinging to her legs. “How you mean I have to go to a doctor to get the birth control pills? I always get it from this pharmacy. You giving me the money for the doctor’s visit?” she said before walking off, visibly upset. The pharmacist looked on, unable to offer any further assistance to her.
This was in Saint Lucia, in August 2022, roughly two months after Roe vs Wade was overturned in the United States of America. And one month after the Pharmacy Act of 2007 which addressed the dispensary of oral contraceptive pills without a prescription was enforced. As an experienced advocate for the rights of women and girls, my immediate reaction shifted to question what reproductive health and the rights of women and birthing people** would look like in the next few years. I couldn’t help but wonder about many others like her who had difficulty accessing a medical doctor for a prescription for their oral contraceptives. I cringed at the thought of crucial family planning tools being less accessible to those whose resources were already extremely limited and live in remote, rural areas.
Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception. Globally, 48 percent of all pregnancies are unintended and of these, 60% end in abortions. It is estimated that 45 per cent of all abortions are unsafe, accounting for five to thirteen per cent of all maternal deaths recorded. This is according to the State of the World in 2022 report by the United Nations Population Fund (UNFPA). Guttmacher Institute reports that between 2015-2019, 74% of pregnancies in St Lucia were unintended with 55% ending in abortion. Considering that St Lucia’s laws only make provisions for abortion in the case of incest or when the mother’s life is endangered, with prerequisites such as a police report in the case of rape and a compulsory waiting period, coupled with existing abortion stigma, it is near impossible to collect accurate data on the occurrence of abortions.
One can only extrapolate the proportion of abortions that are conducted in an unsafe manner based on the existing conditions. Lest we forget the disposed foetuses found in November 2021, December 2017, August 2014, April 2012. In each case, dialogue and public outrage dissipated as quickly as it emerged, until it happened again. The reproductive health and general wellbeing of our women is at high risk and it is critical that law-makers do all in their power to minimise unintended pregnancies, through increasing access to modern contraception.
Global studies reflect that unintended pregnancies disproportionately affect women of lower socioeconomic status, regardless of development status of the country. A study conducted in Tehran, Iran in 2018 found that unintended pregnancies were more concentrated in poorer women. A 2021 study in six South Asian countries also found that not only were poorer women more likely to have unintended pregnancies, rural women were more likely to have them than urban women. While the St. Lucia Planned Parenthood Association does make provisions for access to an in-house doctor, for those who work long hours, and live outside of the city, there is still difficulty in accessing their services. For them, they need to access childcare, extra financial resources, take time off work, -unfortunately unpaid in many instances, and travel to get to their appointments. In addition, social and gender norms in rural areas tend to be more conservative and patriarchal causing reduced levels of autonomy in health-care decision making, household decision and contraception use. It is critical therefore, to fill the gaps and reduce barriers to access contraceptives.
The State of the World report also found a strong correlation between economic and social development and lower rates of unintended pregnancy. Giving women and birthing people autonomy over their bodies and giving them agency in family planning enables them to make informed decisions and they are empowered to live their lives as they choose. Only then, will we realise steady acceleration in achieving sustainable development goals.
Previous World Contraception Day Ambassador for the Caribbean and medical doctor, Dr Kizanne James shares, “Access to contraception advances human rights. We know that there are numerous benefits of contraception for women and families including being able to space pregnancies – spacing pregnancies by more than 2 years reduces the infant mortality rate by 45% (WHO). It also gives families and women control over how much and if they want to have children at all. Other health benefits include managing acne, anaemia, reducing mood swings or depression related to premenstrual syndrome, decreasing heavy bleeding and cramps during periods, making periods regular, and the list continues.
The World Health Organisation evidences that making contraception freely accessible is good for the country as well, as it allows for greater opportunities for better health outcomes, the empowerment of women, sustainable population growth, and economic development. We must do all we can in the Caribbean to ensure that there are no barriers to contraception access, including educational, financial, or geographic barriers. Different countries use different models of care to provide education, contraception access and screening for the appropriate contraception methods. For example in the United Kingdom, Jamaica, and Trinidad and Tobago patients can visit pharmacists to access certain types of contraception such as “the pill”, other types such as long acting methods can be accessed from a medical doctor. Improving contraception access and education around contraception is an opportunity for healthcare providers, educators, and the government to work together to provide this fundamental healthcare option. If persons would like more information about the different types of contraception and if it would be suitable for them, they can visit the NHSInform.scot or the CDC website.”
Pharmacist Mischa Christie, registered with the Pharmacy Council of Jamaica (PCoJ) commented that the Jamaican pharmacists are able to make recommendations for over the counter contraceptives based on what the patient is looking for such as, side effects, cost, ease of use, hormonal ingredients. If a patient may need more than an over the counter recommendation, they are referred to a general practitioner. For new users, pharmacists are instructed to confirm their age (over 18, otherwise they tend to instruct patients to visit a general practitioner). When asked an opinion on registered St. Lucian pharmacists being allowed to recommend oral contraceptives, Christie responded, “Pharmacists should be able to recommend something as simple as over the counter oral contraceptives. We are more than capable. We aren’t just there to read doctors’ hand-writing and give you what it says, our knowledge of drugs, their function and appropriate dosages encompasses so much more.” Reducing unintended pregnancies on a national scale requires a comprehensive approach with short, medium and long term goals. Increasing access to comprehensive health services, addressing and improving social and systemic oppression and barriers, investing in research and comprehensive sexuality education, are all integral in ensuring women and birthing people have autonomy over their lives. Access to modern contraception, however, is urgent and revisiting existing laws and regulations is critical to ensure that the most vulnerable among us are not left behind.
St Lucia was one of the 179 countries which adopted the Cairo Declaration on Population & Development in 1994. Article 5 addressed reproductive health and family planning and I quote, “We welcome the approach that places family planning in the broader framework of reproductive health care. We urge all national governments to make responsible efforts to resolve their population governments to make responsible efforts to resolve their population issues in a way that respects their own national and cultural identity, values and tradition. We therefore commit ourselves, as elected representatives of the people, to do our utmost to remove all remaining barriers in our countries that inhibit access to family planning services, information and education, as well as to help support the provision of reproductive health and family planning services as widely as possible. We further urge Governments to ensure that all population and development policies and programmes in our countries safeguard internationally recognized human rights.”
We are depending on you lawmakers, to safe-guard our lives, our wellbeing and that of future generations. How this is dealt with now, will have a ripple effect on generations to come. We are confident that you will do the “utmost to remove all remaining barriers in our country that inhibits access to family planning services.”
A note on inclusive language: The author fully acknowledges that the need for access to contraceptives isn’t limited to cis-gender, heterosexual women. In this Op-Ed, the term “women” is used, as well as “birthing people” to include non-binary and trans people.