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Sexual and Reproductive Rights for Contraception in Bolivia, Colombia and Uruguay in the Framework of Human Rights*

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Sexual and Reproductive Rights for Contraception in Bolivia, Colombia and Uruguay in the Framework of Human Rights* Pan American Journal Review of Public Health Sexual and reproductive rights for contraception in Bolivia, Colombia and Uruguay in the framework of human rights* Kathya Lorena Cordova-Pozo,1 Graciela Cordova-Pozo,2 Ana Monza,3 Gabriela Píriz,3 Diva Moreno-Lopez4 and Ivan Cardenas4 Suggested citation (original article): Cordova-Pozo KL,Cordova-Pozo G,Monza A, Píriz G,Moreno-LopezD, Cardenas I. Derechos sexuales y reproductivos para la anticoncepción en Bolivia, Colombia y Uruguay en el marco de los derechos humanos. Rev Panam Salud Publica. 2017;41: e140. doi: 10.26633/RPSP.2017.140 ABSTRACT Objective. Compare World Health Organization (WHO) guidelines for contraception in a human rights framework with the existing regulatory frameworks of Bolivia, Colombia, and Uruguay and evaluate which aspects of those regulations need to be developed. Methods. A systematic analysis was based on the WHO analytical framework “Ensuring human rights in the provision of contraceptive information and services: Guidance and recom- mendations” to determine whether the legislation of Bolivia, Colombia, and Uruguay contain general references to the population, specific referen ces to adolescents, or do not refer to the topic. To this end, 36 documents related to contraception were analyzed: 9 from Bolivia, 15 from Colombia, and 12 from Uruguay. Results. It was confirmed that each country’s legislation complies with several WHO recom- mendations. The three countries have strengths in nondiscrimination and in opportunity for informed decision-making, and have weaknesses in accessibility, quality, and accountability. Acceptability is a strength in Colombia and Bolivia, and confidentiality is a strength in Bolivia and Uruguay. Colombia has weaknesses in avai lability, confidentiality, and participation. Conclusions. Comparison of national legislation with WHO guidance helps to see the strengths and weaknesses of national regulatory frameworks and to see opportu nities to improve regulations. Keywords Contraception; legislation; health legislation; Bolivia; Colombia; Uruguay; adolescent; human rights. Sexual and reproductive health (defined as 11-19 year olds). Actions Colombia, 13% of adolescent girls are (SRH) is a critical issue for adolescents during this stage can have conse- married, and 20% girls under the age of quences for the rest of their lives, such 18 have already carried a pregnancy to 1 South Group, Cochabamba, Bolivia. Send corre- as adolescent motherhood, and sexu- term (1). In Uruguay, the number of spondence to: Kathya Lorena Cordova-Pozo. ally transmitted infections (STIs), in- births in adolescent mothers is 16.4%; Email: [email protected] 2 Hospital Seton, Cochabamba, Bolivia. cluding human immunodeficiency only 3.6% of mothers are in a favorable 3 Administración de los Servicios de Salud del virus (HIV). The adolescent population economic environment and 22.4% are Estado (ASSE), Montevideo, Uruguay. 4 Ministerio de Salud y Protección Social, Bogotá, is 22% in Bolivia, 18.4% in Colombia mothers are in unfavorable economic Colombia. and 15.3% in Uruguay. In Bolivia and environments (2). * Non-official English translation revised by the authors. In case of discrepancy between the two versions, the Spanish original shall prevail. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited. No modifications or commercial use of this article are permitted. In any reproduction of this article there should not be any suggestion that PAHO or this article endorse any specific organization or products. The use of the PAHO logo is not permitted. This notice should be preserved along with the article’s original URL. Rev Panam Salud Publica 41, 2017 1 Review Cordova-Pozoetal.•Sexualandreproductiverightsforcontraception With regards to HIV, 31.5% of the were collected and reviewed; nine from cultural diversity (16). Raising aware- study population in Bolivia and 26% in Bolivia, 15 from Colombia and 12 from ness of adolescent health and training in Colombia know about HIV, 8.9% in the Uruguay (Annex 1). The analysis was differentiated services are also promoted urban area and 17.6% in rural areas. The multidisciplinary and per country; con- (17). Colombia’s sexuality policy is artic- prevalence of HIV in the population ducted, by a Bolivian political economist ulated within national and international aged 15-24 years is 0.3% in Bolivia and and a medical doctor; by a Colombian norms on sexuality and SRHR (11), 0.5% in both Colombia and Uruguay (1). adolescent technical leader and a special- which helps to achieve common objec- The prevalence of modern methods of ized professional of the Ministry of tives in other laws (Primary Health Care, contraception is 33.7% in Bolivia, 72.7% Health and Social Protection; and by a the Ten-year Public Health Plan 2012- in Colombia and 74.8% in Uruguay; con- Uruguayan psychologist and a gynecolo- 2021, the General System of Social Secu- doms being the least popular method: gist from the SRH area of the​​ public rity in Health (GSSS, Law 100/93). This 4% in Bolivia, 7% in Colombia, and 30.8% system. regulates the Plan of Basic12Attention in Uruguay (1). These statistics are simi- and STI/HIV and unwanted pregnancy lar throughout South American coun- RESULTS prevention programs through informa- tries, with differences between regions, tion, education, communication and use rural-urban areas, and socio-economic The results are presented in numerical of the male condom, guaranteeing the contexts, since South America has high order under the WHO’s analytical frame- free access of adolescents to contracep- levels of inequality that hinder social in- work, entitled “Human Rights Respect tive services (18-21). Uruguay focuses on clusion and sustainable growth (3). when providing contraceptive informa- creating contraceptive and fertility treat- The Montevideo Consensus urges tion and services: guidance and recom- ment protocols for the population (13). Governments to change their legislation mendations” (WHO, 2014) (Table 1)a1. in order promote of sexual and reproduc- 2) Availability of contraceptive tive health and rights (SRHR) (4). This 1) Discrimination in the provision information and services [2.1] Consensus is a strategic framework for of contraceptive information and advancing the Program of Action of the services [1.1-1.2] Bolivia provides yearly a planning for International Conference on Population provision and storage based on a pro- and Development in Cairo in 1994 and The three countries have regulations to grammatic goal for each health facility the Latin American and Caribbean Con- ensure access to contraceptive information and is added at the municipal, local, de- sensus on Population and Development and services without discrimination [1.1]. partmental, and national levels (8) to adopted in Mexico in 1993. In Bolivia all healthy adolescents are eligi- strengthen the National Single Supply The aim of this manuscript is to com- ble for any contraceptive method after System and the Medicines Logistics Ad- pare the recommendations of the World guidance and counseling, and the guide- ministration Subsystem and Inputs, Health Organization (WHO) (5) to pro- lines recommend designing of friendly es- which ensure the provision of materials, vide contraceptive information and ser- tablishments that take care of regional and medicines and contraception (16). No vices with the normative framework of cultural particularities to favor the access specific regulations were found for Col- Bolivia, Colombia and Uruguay, evaluat- and use of contraceptives by multiple us- ombia. Uruguay has regulations for pur- ing contraceptive legislation and high- ers, including adolescents (8,9). Colombia chases that revise, consolidate and lighting the aspects necessary to develop guarantees SRHR, freedom of violence, estimate needs annually, based on the and achieve respect for human rights. equality, autonomy and without discrimi- previous consumption coordinated by nation due to sex, age, ethnicity, sexual ori- the SRH departments, ensuring access METHODS entation, gender identity, disability, and quality of care (22, 23). religion or victims of armed conflict (10,11). A systematic analysis and evaluation Colombia detects and addresses risk fac- 3) Accessibility of contraceptives was carried out based on the analytical tors, promotes protective factors for ado- information and services [3.1-3.10] framework, circumscribed in the WHO lescents (12). Uruguay recommends the document ¨Respect of human rights when universalization of primary care in sexual The three countries meet 4/10 sub-rec- providing contraceptive information and and reproductive health (SRH) with inte- ommendations but there is a lack of im- services: guidance and recommendations¨ grality, quality, opportunity, and commit- proved access for displaced populations (2014) (Table 1). The legislation of Bolivia, ment of human resources and adequate and those living in crisis [3.4]. There is Colombia and Uruguay were reviewed to information systems, guaranteeing univer- also a lack of mobile services for those see if they contain general references to sal access to contraception (13,14). facing geographical barriers [3.8]. the population, specific references for ad- All three countries support laws and The three countries have regulations olescents, or no reference to these
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