Sacha Saad
Introduction
According to the World Health Organization (WHO) in 2006, the working definition of sexual and reproductive health (SRHR) is not only limited to relevant diseases or the lack thereof. It takes on a more comprehensive approach with respect to one’s sexuality and reproductive system. Hence, SRHR is a human right that every person should enjoy. For instance, one should be able to freely marry whoever they want and reproduce as much as they please or not at all, make decisions pertinent to their families without being coerced, and have access to educational sources and healthcare services under the umbrella of equality and freedom of opinion.
For decades now, SRHR has been weaponized socially, economically, and politically by people in power to further impoverish the vulnerable. Not granting people their SRHR not only harms them physically by putting their health at risk but also stands in their way of attaining bodily autonomy which will in turn affect their and their families’ futures and well-being. The abovementioned healthcare services should not be a matter of controversy as they are now across different countries around the world.
Particularly in developing countries, the lack of SRHR is more prominently seen through unplanned gestations, unsafe abortions due to its illegality, and numerous cases of maternal and fetal deaths or disabilities. Moreover, the very reason women are the most vulnerable in this equation is that their bodies are the very first to house the fetus before they become the primary caregivers once the child is brought into this world.
This review will therefore start by presenting the history of SRHR globally and will delve into the state of SRHR in Lebanon specifically while shedding light on how intertwined it is with gender equality.
SRHR in a Global Context
The world has not just recently been introduced to the concept of SRHR. As early as 1974, the United Nations (UN) World Population Conference gave rise to the World Population Plan of Action. The Plan offered suggestions to countries on how to achieve a balance between economic development and population growth without imposing laws to restrict family planning. Rather, they believed effort should be directed towards more focused population research and the invention of more efficient contraceptive methods.
Twenty years later, the union of 179 countries at the International Conference on Population and Development (ICPD) led to the formation of what was then seen as the progressive Programme of Action. The latter offered a new outlook on the importance of granting people access to all-inclusive reproductive healthcare that varied from providing safe gestation and childbirth services to raising awareness on ways to prevent and treat sexually transmitted infections (STIs). More importantly, it shed light on the essentiality of proper representation of reproductive health as its link to women’s empowerment provides society with the right tools to advance forward.
Since the Programme’s establishment, the UN at the Commission on Population and Development has been annually reviewing the progress attained regarding the SRHR in countries all around the world. Tangible advancements have been recorded, including a drop in avertible maternal mortality by 40% and an 11% decline in female genital mutilation (FGM) in nations with high rates. However, while the trends observed may seem flattering, the goals set by the Programme are still far from reach considering the world’s population has increased, which means more people are at risk even with decreasing rates.
The Sustainable Development Goals (SDGs) also touch upon SRHR. In 2015, the UN founded the 17 SDGs to push nations to join forces and achieve said goals. They range from ending world poverty and caring for the planet to achieving gender equality, peace, and justice globally. Achieving goals 3 (“ensure healthy lives and promote well-being for all at all ages”), 4 (“ensure inclusive and quality education for all and promote lifelong learning”), and 5 (“achieve gender equality and empower all women and girls”) goes hand in hand with people’s access to SRHR, because pregnancy and STI related deaths hinder well-being, sexual and reproductive education are essential knowledge, and gender-based violence is mostly rooted in sexual and reproductive abuse respectively.
SRHR in Lebanon
The Government and its People
So long as patriarchy prevails in our societies, SRHR will remain a taboo topic. Hamdanieh et al. (2019) conducted a study to assess the knowledge of 491 unmarried women across Lebanon between the ages of 17 and 55 years old about sexual and reproductive health. The participants were asked to answer questions about topics such as STIs, premarital genetic tests done by couples, menstruation, contraception, vitamins required during pregnancy, and sexual intercourse during the honeymoon phase.
These women were reported to be the most knowledgeable about pregnancy (88%), followed by premarital genetic tests (55.4%), menstruation (35.6%), post-marital sexual intercourse (34.6%), STIs (17.1%), and vitamins essential during pregnancy (15.3%). These low findings do not come as a surprise, since primary caretakers and educational institutions do not teach the youth such essential information, merely reducing SRHR to women’s role of bearing children.
Moreover, the Ministry of Public Health (MoPH) and Ministry of Education and Higher Education (MEHE) in Lebanon do not adequately raise awareness about SRHR amongst unmarried women of all ages. In addition to access to SRHR information, MoPH should also provide affordable healthcare services to safely practice these rights. According to their official website, MoPH and the United Nations Population Fund (UNFPA) have been collaborating since 1998 to cater to the population’s SRHR needs. The provided services range from screening for reproductive system diseases to appropriately dealing with rape cases for men and women alike. Moreover, pregnant women are offered a limited number of echography and visits, vaccination for newborns, essential reproductive health medications, etc. at affordable costs at public health centers around the country.
Nonetheless, an important reproductive health service that the government does not provide is abortion. The Lebanese law criminalizes abortion unless the pregnancy is killing the bearing woman. This law oppresses women by limiting their access to SRHR amongst other forms of oppression. As previously mentioned, no bodily autonomy means no freedom to make decisions regarding their lives and that of their families.
Impact of the Economic Crisis
The work done by the MoPH may appear to be a good plan on paper, but what matters is that the statistical numbers confirm that the population’s rights are being respected. The latter is especially important considering Lebanon is passing through the worst economic crisis to date in addition to the global pandemic COVID-19 that has immensely limited the healthcare system from providing affordable services to people from all economic statuses. Therefore, the MoPH has initiated the Vital Dye Observatory (VDO) in 2016 with the intention to monitor and assess maternal and child health data for people of all nationalities in Lebanon. Since then, the MoPH has been publishing annual statistical numbers in an online report.
The most recent VDO shows that live births in 2021 have decreased by 6.7% in comparison to 2020 while maternal deaths have spiked by 150%. No data is found concerning other aspects of SRHR besides pregnancy and childbirth such as comparable rates for STIs, cancer in the reproductive system, and abortion. Therefore, it is safe to assume with such unfortunate numbers that any progress achieved regarding the status of SRHR in Lebanon over the years has been overturned since the crisis. The MoPH should prioritize this issue particularly because all drugs and pharmaceuticals including reproductive medications and contraceptive methods are no longer subsidized by the government and have become too costly for most of the population.
Inter and Non-Governmental Interventions
Luckily, the UNFPA’s intervention to meet the people’s SRHR in Lebanon amidst all the chaos has gone beyond a mere advising collaboration. They have been providing all the primary health care centers under the MoPH’s wing and some designated hospitals across Lebanon with lifesaving packages that contain essentials such as contraceptives, delivery kits, reproductive health drugs, and medical equipment (Sexual and reproductive health). In 2020 alone, UNFPA Lebanon assisted over 300,000 people from all governorates through the distribution of those packages. They have also trained midwives and healthcare workers, provided consultations and exams, and raised awareness on SRHR across more than sixty-five municipalities through the work of their implementing partners (organizations such as Abaad, Akkarouna, Makassed…).
Numerous non-governmental organizations (NGOs) have also been working tirelessly to fill the gap. We will be discussing a few starting with Marsa, a sexual health center founded in 2011. They offer STI testing, pap smears, and medical and psychological counseling and treatment (most at subsidized prices) in a confidential and friendly environment. Another prominent NGO is SALAMA, the Lebanese Association for Family Health. Founded in 2008 as the Lebanese branch of the International Planned Parenthood Federation, SALAMA provides clinical services similar to Marsa’s as well as family planning, urology, fertility, pediatric, and safe abortion benefits.
The A Project is also the initiative behind the unconventional but crucial confidential sexual hotline, led by volunteers qualified in sexuality counseling. Lastly, Plan International is a humanitarian association that targets gender equality among children. In Lebanon, their scope of work includes endorsing education and in particular girls’ SRHR knowledge starting at an early age. The efforts of other initiatives do not go unnoticed as their work, even if on a smaller scale, is surely contributing to the advancement of the state of SRHR in Lebanon.
Conclusion
If the state of SRHR in Lebanon was improving in previous years, the economic crisis and COVID-19 pandemic have negated most if not all the progress is done. On a small and feasible scale, educational institutions must include SRHR in their curriculums and not just for high school students who would have already been exposed to such information on the internet (many times inaccurate information too).
The work done by the international community, NGOs, and smaller initiatives has been incredibly important, but it is not enough to sustain SRHR in Lebanon if the government continues to neglect these issues. Lastly, while the numbers published by the MoPH in the VDO include refugees residing in Lebanon, this review did not capture the severity of the situation for these already vulnerable and marginalized populations. It is thus worth delving more into the state of SRHR with respect to refugees in Lebanon in the future.
Today, change may seem so far from our reach, but if we sit back and do nothing it will only grow farther.
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