A Resolution for 2014: Eliminating Health Care Inequality

by Alexander Sanger

As we ease into 2014, many of us are continuing to make good on New Year’s resolutions to better ourselves and appreciate the good in our lives in an increasingly unpredictable world.

I have the fortune to experience this hope and inspiration each time I walk through the doors of the International Planned Parenthood Federation/Western Hemisphere Region offices. From lawyers to doctors to human rights advocates, my colleagues are remarkable. They work hard and long hours, often spending weeks away from their families to lend their expertise and passion to ensuring the most rural and marginalized communities in Latin America and the Caribbean — one of the most unequal regions in the world — have a voice and a choice.

Recently, I had the opportunity to chat with Jessie Clyde, our Youth Program Officer, about her work. Given the recent news about the decline of the Argentinian economy and the murder of Miss Venezuela, protecting the health and rights of the region’s 106 million youth is one of the most crucial and impactful investments we can make. I hope you enjoy her guest post on how inequality impacts sexual and reproductive health:

Flip through a guide book on Latin America and you’ll read about steak houses in Argentina, powdery white beaches in Mexico and eco-friendly resorts in the jungles of Costa Rica. Read the news and you’ll learn about Brazil hosting the next World Cup, the growth of Mexico’s middle class, and Venezuela’s obsession with plastic surgery.

Compared to other regions of the world, Latin America seems to be doing well at first glance. Health indicators show progress: maternal and child mortality numbers have dropped, contraceptive use is up and abortion was even legalized in Mexico City in 2011. But as a public health professional in the region with a focus on the sexual and reproductive health of adolescents, I’m not so quick to celebrate these victories: My fieldwork has taught me that national averages often tell a very different story than the reality found on the ground.

All it takes is a quick detour from the urban capitals and glossy tourist havens to see the large number of people in the region who still desperately need quality health services. On a recent trip to Venezuela, it took only a few minutes to leave the sparkling city behind and find ourselves in the slums of the surrounding hills. On these steep streets, I encountered a pregnant 15 year-old girl who didn’t have the information or access to services to prevent unintended pregnancies. A short boat ride away from the famous turquoise waters of the Belize cayes, young people speak to me about high levels of violence, HIV and adolescent pregnancies. And in Argentina, I have spoken with undocumented immigrants in public hospitals who struggle to get their basic health care needs met because of discrimination.

A recent study by the Guttmacher Institute backs up my observation that while the region as a whole is doing well, there are still pockets of extreme poverty that leave women unable to access basic services. The report begins by telling us the good news. Approximately seven out of 10 married Mexican women of childbearing age currently use a contraceptive method (a level similar to the United States), family size has declined from about six children in the 1970s to just over two, and maternal mortality has fallen significantly.

However, despite these impressive achievements, large disparities by population subgroups remain. The services, supplies and human resources that allow women in wealthier urban areas to plan their families are not always available to all. Poorer states such as Chiapas, Guerrero and Oaxaca still have large populations living in homes with no indoor plumbing or electricity, let alone access to sexual and reproductive health care. Not surprisingly, the indicators in those regions aren’t quite as rosy. For example, abortions in Mexico City are safe and accordingly, just 0.5 percent of these procedures were associated with mild complications in 2009. However, of the abortions obtained by poor rural women, 45 percent led to complications. This figure is even more striking when you consider the fact that nearly half of Mexico’s population lives in poverty.

The first step in closing these gaps is to have the data that proves they exist. The Guttmacher study is a great step forward, but comparable data for other countries in the region is largely unavailable, leaving health professionals without the quantitative data needed to shift policies and budgets.

Latin America is a diverse region that spans the peaks of the Andes to the tributaries of the Amazon to the Panama Canal. That is a diversity that we should continue to celebrate. However, when it comes to access to health care and sexual and reproductive health indicators, we want to see fewer differences across those mountains, rivers and canals.


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