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By: Rashauna Adams-Matthew, Environmental Social Safeguard and Gender Officer, Ministry of Health, Wellness, Social Transformation and the Environment
(Special Acknowledgement to Chief Medical Officer (CMO), Dr. Rhonda Sealey-Thomas, Superintendent of Public Health Nurses (SPHN) Ms. Almarie Roberts Coates, Barbudan Nurses, Ms. Caryl Jones and Ms Jenita Cuffy and Chair of the Cervical Cancer Task Force as well as Lead on the HPV Implementation Project, Dr. Cherie Tulloch for their technical guidance and contribution to this article)
2023 marks the year when the Government of Antigua and Barbuda’s mandate for gender equality and women’s empowerment and its vision for the optimal health and well-being of the residents of Antigua and Barbuda joined ranks under the same Ministry. At a time when the nuances of gender and women’s issues are being treated as cross-cutting for all sectors internationally, the assignment of the Directorate of Gender Affairs (DOGA) under the Ministry of Health provides a unique opportunity to examine the efficacy of public health services on the lives of women in commemoration of International Women’s Day 2023.
The public health space in Antigua and Barbuda is a sector largely used by
women. Of the roughly 49% of Antiguans and Barbudans who depend solely on public health services, women, particularly in low-income or vulnerable households have predominately taken advantage of the ever-expanding services in the sector. In addition to the availability of tertiary care at the Sir Lester Bird Medical Centre (SLBMC), many of which are free of
cost for residents, the existence of primary and secondary care in the community clinics includes maternal, adolescent, and child health services, reproductive health services, and the treatment and monitoring of sexually transmitted infections and diseases (STI/STD) including HIV2, allowing women to easily access healthcare services which are specific to their needs. For example, 100% of women in Antigua and Barbuda can access, free of cost, a range of contraceptive options at the community clinics and the Antigua and Barbuda Planned Parenthood Association (APPA), including condoms, combined oral contraceptive pills, contraceptive injections, and the Intrauterine device or coil (IUD). Another example is the Ministry of Health’s Cervical Screening Project which launched in September 2022 through collaboration with the Pan-American Health Organisation (PAHO) and Basic Health International (BHI). This project was ideal for demonstrating women’s response to new and innovative methods in healthcare. The project was based on the World Health Organisation’s (WHO) policy for the elimination of cervical cancer through vaccination, screening, early detection, and the treatment of precancerous lesions.
The project screened nearly 1,600 women for the Human Papilloma Virus (HPV) in four (4) months, exceeding its target of 1,500 women in six (6) months. The traditional method of cytology testing was replaced with the innovative and high-performance PCR HPV testing which proved more sensitive for detecting HPV in a shorter period. The delivery of screening at the local community clinics ensured that most women from vulnerable households were able to access HPV testing and where necessary, receive treatment for precancerous lesions. This feat is not to be underestimated due to the high rates of cervical cancer in the twin island state. According to the Chair of the Cervical Cancer Task Force and Lead on the HPV Implementation Project, Dr. Cherie Tulloch, cervical cancer is the most common gynecological cancer being treated at the Sir Lester Bird Medical Centre (SLBMC) Oncology Department and Antigua and Barbuda is reported to have one of the highest rates of cervical cancer in the Eastern Caribbean region.7 Only 13% of women seeking treatment at SLBMC were Stage One, meaning that over 80% of women were in advanced stages when seeking treatment for this preventable cancer.
The approach for essentially universal healthcare not only benefits women but also the Ministry of Health. With most women able to access maternal health services throughout their pregnancy thus allowing medical professionals to identify and treat early complications, Antigua has been able to consistently reduce its maternal and infant mortality rate yearly, resulting in maternal mortality of less than 70 per 100,000 live births, and achieving a target under the Sustainable Development Goals (SDG) for ensuring healthy lives and promoting well-being. In addition, universal access to sexual and reproductive healthcare services and the resulting increase in women accessing early maternal care has contributed to Antigua and Barbuda’s certification as one of eight (8) Caribbean territories and states to eliminate mother-to-child transmission of HIV and Syphilis10 and has maintained this certification as of 2022. Initiatives such as free access to contraceptives at community clinics may also be considered a contributory factor to the decreasing rates of adolescent fertility in the twin island state, which has seen a 36.8% decrease between 2000 and 2022.11 In addition, Antigua and Barbuda stands as the first country to undergo comprehensive training for the elimination of cervical cancer through the WHO’s HPV Manual. In addition to international recognition, these programs serve as a smart investment for the government. The programs can reduce incidences of financial catastrophic and medical impoverishment among vulnerable households as well as reduce health and social government expenditure on catastrophic health incidents as well as social welfare programs caused by unwanted and unplanned pregnancies or reproductive health emergencies which the government may be forced to pocket.
Initiatives in health sectors not specific to women but for which women tremendously benefit must not be ignored. Antigua and Barbuda now has two (2) resident psychiatrists as well as immediate access to other psychiatrists within the Eastern Caribbean. The country has also appointed psychiatric nurses in the community clinics which has helped reduce the burden on the island’s sole public mental facility. This has allowed increased access to mental health services in general and for women. According to the Superintendent of Public Health Nurses (SPHN), Ms. Almarie Roberts-Coates, the increased access to mental health services have not only been ideal for the early detection or onset of mental and emotional challenges but particularly among women, has opened conversations on postpartum depression, a
condition often misunderstood, as well as conversations on the impact of self-care and self-love on women’s health. Women have not only served as the major beneficiaries of the public health sector but are also agents of change in the sector. While the initial image of healthcare is often a man in a white coat with a stethoscope around his neck, the ‘motor’ of the sector is a woman in white attire and orthopedic shoes, consistently interacting with patients, monitoring vitals and providing 24/7 bedside care to the residents of the sole public hospital. This was particularly evident during the height of the coronavirus disease 2019 (COVID-19) pandemic where nurses provided 24-hour primary care in the face of increased exposure, no vaccines, and limited treatment for an obscure virus in this area of the world. According to Nurse Almarie Roberts-Coates, the COVID-19 pandemic publicly displayed not only the importance of nurses but their resilience in undertaking the role of health provider, therapist, activist, and supervisor for the thousands of persons infected and affected while maintaining their other healthcare duties.
Over the past ten (10) years, women have even begun to dominate as the persons in the “white coat with the stethoscope” as well as adjudicating figures in the sector. Based on data from Antigua and Barbuda’s Medical Association, most licensed medical practitioners in Antigua, particularly those who live and work continuously on the island, are women.16 The Chief Medical Officer (CMO), Deputy CMO, and Permanent Secretary of the Ministry of Health, key personnel in the development and push of public health policies are women, signaling that higher educational attainment at the tertiary level by women is now translating into equal access to economic opportunities and decision-making positions.
The public health sector has certainly made significant strides in women’s health and leadership; however, the work is far from over, particularly when maintaining momentous achievements. CMO, Dr. Rhonda Sealey-Thomas who also chairs PAHO’s regional validation committee responsible for the validation and revalidation of countries of the EMTCT of HIV and Syphilis, noted that the Ministry of Health’s priorities over the next five years will be the updating of its National Strategic Health Plan (NSHP) which expired in 2019, and the physical improvement of healthcare facilities.Whereas the NSHP previously included limited reference to sexual and reproductive health services, an updated plan will include a greater focus on these services, particularly in light of Antigua’s elimination of mother-to-child HIV and Syphilis transmission and the island’s intention to maintain this certification. From the NSHP will emerge other critical policies including updated policies on NCD, HIV/AIDS reduction as well as Mental Health Access, and an improved system of monitoring and evaluation to track the success of the policies.
The improvement of healthcare facilities will include the building of modern purpose-built facilities and the continued introduction of technologies, particularly in community clinics. One such immediate facility is the Fiennes Institute19, a plan no doubt welcomed by the women working and residing in the current facility.
2023 has been a critical year for the future of Antigua and Barbuda. The recent election and the newly appointed government mean the establishment of new priorities, some policies, and plans for the continued development of the country. This reflection on the impact of public health services on the lives of women demonstrates the importance of mainstreaming gender in public health policy. This means ensuring that the needs of women and men are identified and accurately reflected in public health policies and service options, considering intersectional factors of poverty, income, disability, location, and other indicators of vulnerability. Current initiatives show that women will access healthcare services once such initiatives are, accessible, affordable, and appropriate to their specific needs. As such, the Women of Antigua and Barbuda wait eagerly for the next level of public healthcare.