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Sexual Health and Economic Empowerment of Young Women

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Sexual Health and Economic Empowerment of Young Women Working paper 558 Sexual health and economic empowerment of young women and girls in Cuba Exploring the role of social norms Carmen Leon-Himmelstine and Lucia Rost with Fiona Samuels and Maria Stavropoulou July 2019 • This paper brings together evidence on the links between social norms and sexual and reproductive health (SRH), as well as between social norms and women’s economic empowerment (WEE), with a particular focus on Cuba. Social norms intersect with SRH and WEE in multiple ways and can Key messages contribute to the success or failure of interventions targeted at each of those two areas. While some social norms are disabling or discriminatory, others are enabling or more positive. • Social norms related to sexual behaviour can expose women, girls, men and boys to risks and vulnerabilities. Norms that emphasise women’s submissiveness can limit girls’ decision-making about sex, shape fertility choices and influence access to SRH services. • Women tend to do paid work as long as it meets certain conditions – namely, that it: benefits the household; does not threaten the position of men; and does not interfere with the caring and household work that women are expected to provide. • Policies and laws, facility-based interventions, skills training courses, empowerment initiatives and awareness-raising can improve SRH and WEE and could indirectly transform social norms related to SRH and WEE. A holistic approach including sex education at school, provision of childcare services, mass media campaigns and interventions targeting men and boys, is likely to be most effective in shifting social norms around SRH. • The review also suggests a number of areas for further research, including a focus on adolescents and young women, vulnerable and under-researched groups, and gender-based violence. Readers are encouraged to reproduce material for their own publications, as long as they are not being sold commercially. ODI requests due acknowledgement and a copy of the publication. For online use, we ask readers to link to the original resource on the ODI website. The views presented in this paper are those of the author(s) and do not necessarily represent the views of ODI or our partners. This work is licensed under CC BY-NC-ND 4.0. Acknowledgements This report was authored by Carmen Leon-Himmelstine (ODI) and Lucia Rost (independent consultant) with Fiona Samuels (ODI) and Maria Stavropoulou (ODI). We are grateful for all the support provided by Ailynn Torres Santana in the identification of relevant materials largely from within Cuba as well as key informants. Ailynn also acted in a reviewer capacity. We are also grateful for the guidance and support provided by Maxine Molyneux in her suggestion of key materials and themes to explore as well as in her thoughtful reviewing of the report. We also want to thank Elise Andaya (Associate Professor, University at Albany), Heidi Härkönen (post-doctoral researcher, University of Helsinki), Marta Núñez (Universidad de La Habana) and Dayma Echevarría (Centro de Estudios de la Economía Cubana) for help with identifying relevant literature and sharing their insights with us. We also extend thanks to Kathryn O’Neill for editorial support and to Hannah Bass who managed the report’s production. The findings and conclusions contained within are those of the authors and do not necessarily reflect the positions or policies of ODI. 3 Contents Acknowledgements 3 List of boxes, tables and figures 5 Acronyms 7 Executive summary 9 1 Introduction 13 2 The Cuban context 17 2.1 Key indicators 17 2.2 History and religion 18 2.3 Gender dimensions 21 2.4 Marriage, family and living arrangements 23 2.5 Legal and policy environment 23 2.6 Vulnerable groups 25 3 Social norms and sexual and reproductive health 28 3.1 Sexual and reproductive health 28 3.2 How social norms and perceptions are linked to SRH 32 3.3 Programming and interventions 39 4 Social norms and women’s economic empowerment 54 4.1 The Cuban labour context and recent economic reforms 54 4.2 Women’s participation in the labour force: Latin America and Cuba 56 4.3 Adolescents and youth participation in the labour force: Latin America and Cuba 62 4.4 Social norms and women’s economic empowerment in Cuba 68 4.5 Policies and interventions 83 5 Conclusion and recommendations for further research 94 5.1 Summary of findings 94 5.2 Gaps and research questions 96 References 100 Annex 1 Search strategy 112 Annex 2 Cuban policies and laws related to women’s economic empowerment 117 4 List of boxes, tables and figures Boxes Box 1 Quinceañera: celebrating the beginning of womanhood 35 Box 2 Key attributes of social norms interventions 49 Box 3 Perceptions of laws promoting economic empowerment across different generations of respondents 84 Tables Table 1 Definitions 16 Table 2 Cuba’s key indicators 17 Table 3 FMC public welfare records 22 Table 4 Laws and policies on gender equality in Cuba 24 Table 5 HIV and STIs in Cuba 28 Table 6 Contraception in Cuba 29 Table 7 Fertility rates in Cuba 31 Table 8 Expectations of femininity, sexual behaviour, and risks and vulnerabilities in LAC 33 Table 9 Expectations of masculinity, sexual behaviour, and risks and vulnerabilities in LAC 33 Table 10 Policies related to adolescent SRH in Cuba 40 Table 11 Delivery and postnatal care in Cuba 47 Table 12 Latin America and the Caribbean (24 countries*): key indicators of the national labour market for annual and quarterly periods, by gender (2007 and 2012–2017) (%) 57 Table 13 Labour force, employed and unemployment rates, 2012–2017 59 Table 14 Females employed by sector of economic activity, 2017 60 Table 15 Females employed in each economic activity and monthly income*, 2017 61 Table 16 Employed population according to occupational category and sex, 2017 62 Table 17 Latin America (16 countries*): key indicators of the labour market by age group, January to September 2016 and 2017 (%) 63 5 Table 18 Workers classified by age, working category and sex, 2013–2017 (thousands) 64 Table 19 Occupations of youths aged 15–29 years in 2012 (%) 67 Table 20 Cuban policies and laws on women’s economic empowerment 85 Figures Figure 1 Estimated number of abortion and menstrual regulation procedures per 1,000 women aged 12–49, Cuba, 1968–2002 30 Figure 2 The Cuban health pyramid 41 Figure 3 Timeline of response to HIV/AIDS in Cuba 44 Figure 4 Improving adolescent access to and use of contraception through adolescent-friendly services: theory of change 45 Figure 5 Ecological model for an enabling environment for shaping adolescent SRH 52 Figure 6 Latin America: gender monthly wage gap, by sub-region, 2005–2015 (%) 58 Figure 7 Job advertisement of a famous paladar in Havana 67 6 Acronyms ANAP Asociación Nacional de Agricultores Pequeños (Cuban National Association of Small Farmers) CPA Cooperativas de Producción Agropecuaria (Agricultural Production Cooperatives) ART anti-retroviral therapy ARV anti-retroviral CCRD Centro Cristiano de Reflexión y Dialogo (Christian Reflection and Dialogue Centre) CCS Cooperativas de Crédito y Servicios (Credit and Services Cooperatives) CCT conditional cash transfer CDA Center for Democracy in the Americas CEDAW Committee on the Elimination of Discrimination against Women CEM Centro de Estudios de la Mujer (Center for Women’s Studies) CENESEX Centro Nacional de Educación Sexual (National Center for Sex Education) CEPAL Comisión Económica para América Latina y el Caribe (Economic Commission for Latin America and the Caribbean) CEPDE Centro de Estudios de Población y Desarrollo (Center for Population and Development Studies) CESJ Centro de Estudios de la Juventud (Centre of the Studies of Youth) CNPITS/VIH/SIDA Centro Nacional de Prevención de las ITS-VIH/SIDA (National STI/HIV/AIDS Prevention Centre) CPA Cooperativas de Producción Agropecuarias (Cooperatives of Agricultural Production) CUC Cuban convertible peso CUP Cuban peso ELA Empowerment and Livelihood for Adolescents EMTCT Elimination of Mother-to-Child Transmission ENIG Encuesta Nacional Sobre Igualdad de Género (National Survey of Gender Equality) ENSAP Escuela Nacional de Salud Pública (National School of Public Health) FEU Federación Estudiantil Universitaria (University Student Federation) FMC Federación de Mujeres Cubanas (Federation of Cuban Women) GAC Global Affairs Canada GDI Gender Development Index GDP gross domestic product GER gross enrolment ratio GII Gender Inequality Index GNI gross national income GrOW Growth and Economic Opportunities for Women GSHS Global School-Based Student Health Survey HBV Hepatitis B HDI Human Development Index HIV human immunodeficiency virus ICRT Instituto Cubano the Radio y Television (Cuban Institute of Radio and Television) 7 ICT information and communications technology IEIT Instituto de Estudios e Investigaciones del Trabajo (Instituto for Labour Research) INSTEC Instituto Superior de Ciencia y Tecnología (Higher Institute of Science and Technology) IUD intrauterine devices ILO International Labour Organization IVF in vitro fertilisation IPS Inter Press Service LAC Latin America and the Caribbean LGBTQ lesbian, gay, bisexual, transgender and queer LMICs low- and middle-income countries MICS Multiple Indicator Cluster Survey MINSAP Ministerio de Salud Pública (Ministry of Public Health) NEET not in education, employment or training NGO non-governmental organisation NASC Cooperativas de Creditos y Servicios (Non-agricultural and Services Cooperatives) NSS non-state sector ODA official development assistance ONAT Oficina Nacional de Administración Tributaria
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