SEXUAL AND REPRODUCTIVE HEALTH VULNERABILITY

IN SOUTH AMERICA

Krystle Hinkson-Goodwin

Geographic Information Systems

Fall 2014

• 1/3 of all pregnancies worldwide are unplanned

• Its estimated that 25% of the global population lives in countries with highly restrictive abortion laws, including in South America

• Women in these countries are still prosecuted for having an illegal abortion, and abortion is oftentimes prohibited even in cases of rape, incest or when the pregnancy endangers the life of the woman

• Restrictive legislation on abortion violates a woman's agency and human rights based on the UN International Conference on Population and Development in Cairo, the Fourth World Conference on Women in Beijing and the Universal Declaration of Human Rights

Background

• Population of 756,000

• The only English-speaking country in the South

American continent

• A former British territory which gained

independence in 1966

• Divided into 10 administrative regions

• Multiracial population with Indo-Guyanese

representing 43.45%, Afro-Guyanese

accounting for 30.20%, Amerindians

representing, 9.16% people of “mixed

heritage”

• Georgetown, the capital, comprises 20.7% of

the total population

• The sole country in South America with legal

abortions

• One of the highest rates of HIV/AIDS, maternal

and infant mortality rates in the region

Abstract

According to the 2013 United States census, the global population reached approximately 7 billion and half of that population encompassed women (3.52 billion). The aim of this project was to visually and geographically explore the reproductive rights of women in South America. By collecting multiple statistics and indicators, including criminalization of abortion and the accessibility to contraception for women, the countries of South America were thematic mapped. Finally, a vulnerability map was created, by ranking the maternal and infant mortality rates, unmet need for family planning, and legal status of abortion, to assess the susceptibility of women within the region.

Introduction

South America hosts many of the world’s most comprehensively restrictive abortion legislations resulting in women facing tremendous hurdles to exercise their reproductive rights. Across the continent, millions of abortions are performed

annually in unsafe conditions leading to the death of thousands of women die as a result. Guyana is the lone English-speaking country in South America and the only nation where abortions are legal; while the country of Chile is the only South American nation-state providing no exceptions or extenuating circumstances for an abortion. Most other countries within the region grant exceptions however it is generally only in the case of saving the pregnant woman’s life. A report released by the Guttmacher Institute indicated, many of the women who are disproportionately affected by this are poor or rural, which leads them to often resort to seeking abortions with “inadequately trained practitioners who employ unsafe techniques or attempt to self-induce abortion using dangerous methods.” There are countless barriers that women in South America face just to keep their agency, however most of them are fear of legal repercussions, social stigma and excessive costs for obtaining safe abortions. This project seeks to show the varying levels of vulnerability of the reproductive healthy for women in South America.

This project also explore state of women’s sexual and reproductive health in the country of Guyana, an outlier in the region.

Data Synopsis

Data and Statistics were compiled from the following sources:

Administrative Boundaries, Regional Districts, Roads and Health facilities

Diva-Gishttp://www.diva-gis.org/gdata

Center for International Earth Science Information Network (CIESIN) http://dx.doi.org/10.7927/H4ST7MRB

Google Mapshttps://www.google.com/maps

Open Street Mapwww.openstreetmap.org/

GADM database of Global Administrative Areashttp://www.gadm.org/country

Sexual and Reproductive Statistics:

World Bank Data Portaldata.worldbank.org/

UN Data Portaldata.un.org/

Methodology & Analysis

The genesis of this spatial analysis project emerged from a curiosity to explore the cross-section and inter-linkages between reproductive rights and mortality rates. The project initiated with researching the necessary data for the below indicators which would be used for analysis. Collected indicators were procured from the United Nations Development Program site, the World Bank and the World Health Organization. These indicators were then compiled into a csv file on excel to be used as an attribute table the South American countries and Guyana shapefile boundaries downloaded on Diva-Gis. Once the shapefiles were ArcMap, I joined my csv to the files based on country names. Upon reviewing all of the compiled indicators when sorted from high to low it became clear, even before mapping, that what was anticipated as a success for women’s rights and what was hoped to be a reduced mortality rate due to the legality of abortion in Guyana the complete opposite was true. Guyana was shown to have the second highest rates of maternal mortality in South America, this led to my element of spatial analysis, which will be discussed later.

Before mapping the indicators, there was some troubleshooting that took place as several of the numerical values in my attributes table wouldn’t load. Therefore, I manually entered in the data for those fields using the editing tool as well as created risk rankings for each of the indicators for the vulnerability scale which would take into account the rankings of all prior indicators. For the vulnerability scale the previous rankings were added together to create a new risk numerical value.

VulnerabilityIndicators

Unmet need for contraception (% of married women ages 15-49)

Unmet need for contraception is the percentage of fertile, married

women of reproductive age who do not want to become pregnant

and are not using contraception.

Maternal mortality ratio (modeled estimate, per 100,000 live

births)

Maternal mortality ratio is the number of women who die from

pregnancy-related causes while pregnant or within 42 days of

pregnancy termination per 100,000 live births. The data are

estimated with a regression model using information on the

proportion of maternal deaths among non-AIDS deaths in women

ages 15-49, fertility, birth attendants, and GDP.

Mortality rate, infant (per 1,000 live births)

Infant mortality rate is the number of infants dying before

reaching one year of age, per 1,000 live births in a given year.

Criminalization of Abortion

Once the attribute table was completed, the continent of South

America was thematically mapped according to the indicators, with

the exception of infant mortality rates.

To include an element of spatial analysis, a separate more

comprehensive shapefile was downloaded from GADM which

included regional boundaries. This shapefile as well as one for roads

taken from Diva-Gis was then loaded into ArcMap. A new csv was

then created with information for the main clinics and hospitals in

Guyana. Clinics and hospitals were not listed on the Health Ministry

or National Government website for Guyana consequently I had to

individually comb through dozens of entries on Open Street Map and

Google Maps as there was no comprehensive list of healthcare

facilities (with official name and location).

A list of hospitals, clinics, their corresponding latitudinal/longitudinal

coordinates and district regions was then input into an excel csv and

another join was made to the Guyana shapefile. I then added a

population density raster into the table of contents and attempted to

convert it to a polygon using conversion tools however an error

appeared continuously thus forcing me to re-download the

population density for Guyana as an ascii, convert it to raster and then

convert the raster to a polygon. Once that was completed I went to

layer properties to map according to dot density.

When the population dot density was displayed on the Guyana shapefile, all

hospitals and clinics were mapped using the xy function and measured the

distance between coordinates and roads. This latter step proved to be

unnecessary because it is visually apparent that all of the mapped health facilities

are located near roads, which lends proof to the fact that Guyana’s high rates and

risks are not due to the population being unable to access their health facilities

but rather there is most likely a infrastructural component that is playing a lead

role here.

Results

The results of this project show that much of South America is at a relatively mid

to lower mid- range of mortality rates, which validates evidence that situation is

improving within the region however more still needs to be done. Women in

Bolivia and Guyana were shown to be most susceptible to sexual and

reproductive risk factors and the legalization of abortion does not necessarily

mean countries will have a lower maternal mortality rate or risks. As seen with

the case of Guyana, the mortality and vulnerability rates for women are not due

to inaccessibility to health facilities but rather a larger systemic problem. Several

main components should be considered for playing a lead role in this anomaly,

they include the country’s highly decentralized health care system, unavailability

of integrated health information system, the limited use of health information to

support governmental decision making, limited and dilapidated infrastructural

facilities, “difficult terrain and sparsely populated hinterland making delivery and

monitoring of health services difficult, insufficient human resources for health

and absence of a Human Resource Strategic Plan”.

Resources

1. Human Rights Watch., “International Human Rights Law and Abortion in Latin America”

2. Guttmacher Institute., “Facts on Abortion in Latin America And the Caribbean: In Brief”

3. RH Reality Check. “In Latin America and the Caribbean, Unmet Need for Contraception and Unsafe Abortion Are Widespread”

4. Ibid.

5. World Health Organization., “Country Cooperation Strategy: Guyana At a Glance”