We've written recently on the difficult times facing sexual health services in the UK. In some parts of the world, inadequate sexual and reproductive health services already put many people at risk from late diagnoses, to dangerous illegal procedures. The first in our new series on sexual health around the world, by Dr Verity Sullivan, takes a look at Argentinian provision and presents a strong case to protect what we've got.
2016 has been a rough year for sexual health and contraceptive services in the UK. Demand for care is higher than ever, particularly from the under 16s, the LGBT community and victims of sexual assault and FGM. But despite this, a £200 million public health budget cut has meant clinic closures and reduced access to vital sexual health care for the most vulnerable.
The Family Planning Association’s 2015 report Unprotected Nation predicts costs of up to £259 billion over the next 10 years due to unintended pregnancies and sexually transmitted infections (STIs) based on a 10% cut in funding. Ladies in particular are getting a raw deal, with reduced access to contraception promising a rise unwanted pregnancy and abortion rates.
However, our specialty continues to strive for improvement and to provide free, top-notch care to those who need it. And I had a very stark reminder of how fantastic our NHS is when it comes to keeping women in the UK STI and baby-free, when I spent several months working as a doctor in Buenos Aires, Argentina this year.
Argentina is a beautiful country, but a torrid political and economic history, alongside a strong Catholic mindset, has left its most vulnerable needing more. The complicated business of being female is even more challenging on Argentine terrain, with ‘machismo’ (a strong sense of male entitlement) meaning that sexism is rife. This stretches from catcalling in the street through to unacceptable rates of gender-based violence: femicide in Argentina is a huge problem where it is estimated that a woman is killed every 30 hours.
This ‘boys are better’ attitude also seeps into the health system, where women are openly judged or even turned away when attending for sexual health care (apparently tests are unnecessary ‘unless you sleep around.’ *scream*). Whilst attitudes are actively changing, progress remains slow and I was repeatedly thankful for the non-judgemental care i’ve been fortunate to receive as a female living in the UK and for the support groups available to victims of sexual violence.
Within South America, Argentina’s public health system is relatively advanced. It boasts a decent standard of contraceptive health care, particularly since the government introduced free contraception in 2003. But problems still exist, with long delays, demands for ‘spousal permission’ (needing the thumbs up from your other half to get treatment) and even outright refusal of care (due to a doctor’s personal or religious beliefs) all affecting women’s access.
Contraceptive options are limited, with the oral contraceptive pill and intrauterine device (IUD) available for free. Colleagues were stunned to hear of the huge, up-to-date selection of contraceptives provided, for free, here in the UK and made me appreciate the incredible choice women in the UK are afforded.
Abortion is illegal in Argentina, permitted only in extreme circumstances. Despite this, a report from the Argentine Ministry of Health in 2007 estimated that approximately 500,000 illegal abortions take place in Argentina every year. Safety of the procedure varies wildly (depending on what you can afford), with thousands hospitalised annually with complications.
In the UK, Public Health England reports 186, 824 abortions were performed in England and Wales in 2015, with a rate of 2 per 1,000 in the under-16s. 38% were to women who had already had one or more abortions, highlighting the dire need for mandatory sex education in schools and adequately funded contraceptive services. With a 10% cut to sexual health and contraceptive services in the UK, the FPA predicts total public spending costs of up to £57 billion due to unintended pregnancies.
Alongside the opportunity to get to know an incredible country, meet some fabulous people (and try some fabulous wine), my Argentine experience was a stark reminder of how hard our predecessors have fought for the sexual and contraceptive rights of women in the UK. And of the severe ramifications of their removal. If you believe we should keep hold of these rights, please take the time and contact your local MP.
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