FPATT – Connecting the Intersections
As the longest-serving NGO in Trinidad and Tobago, the Family Planning Association of Trinidad and Tobago (FPATT) has been uniquely placed to have a long and comprehensive view of the state of sexual and reproductive health in the nation. Since its birth over 60 years ago, the FPATT has steadily increased not just its clientele, but its scope of work. Our dynamism, flexibility and grasp of what is relevant has enabled us to grow into so many diverse areas of service and activism – from traditional family planning contraceptive services, to HIV services, cutting edge and accessible cervical, breast and prostate cancer screening; pap smears, or visual inspection with acetic acid (VIA), clinical breast examinations, digital rectal examinations; as well as advocacy and support on LGBTI issues, gender, children’s rights, reducing HIV discrimination and more recently, providing services and support to migrants and refugees.
Our long-sighted vision has also allowed us to see the many ways in which sexual and reproductive health deficits intersect with so many other issues of inequity, undermining, not just universal health coverage, but broad-based rights and true development.
The many issues that FPATT engages with exposes these deep linkages. For example, in our work on domestic violence, we understand that it is intimately interwoven with enduring patterns of patriarchy, male dominance, discrimination and vulnerability. So too, are the struggles confronting the LGBTI community, child marriage and abuse.
We see clearly how our work is essentially, all about rights.
We are living in a very individualistic and uncertain world that has lost its compass. Community and family used to operate like a prefect for what are some core values, like respect and dignity, but no more. Moreover, we have often failed to replace them with evergreen principles that could ground what is necessary for peaceful human existence. For me, the missing link is human rights.
The FPATT has therefore, silently, moved forward its own understanding of its role. Today, we cannot describe ourselves as only providing sexual and reproductive services, as was the case 60 years ago. Rather, we have had to embrace the fundamental notions of human rights. This is no accident, nor any trivial experiment. It is a necessity.
We have understood too that these deep issues of inequity are overlaid with problems of poverty and marginalization, whether we focus on HIV and access to services,
[1] The FPATT was established in Trinidad and Tobago in 1956.
or teenage pregnancy. As the SDGs note, human rights is certainly the key to genuine development and there must be access for all.
As a society, we need to connect these dots. Social development is not insular, but multi-faceted and complex. We must treat with the several aspects of every problem.
In preparing this Report, I was struck by the wide, multi-tasked and extensive reach and impact that the FPATT continues to have, by simply appreciating this truth.
Our theme this year – Sexual and Reproductive Health Rights – An Essential Element to Universal Health Coverage, affirms that reproductive capacity and sexuality are as much part of us as our ability to walk, talk and think. The rights to dignity, personhood, liberty and privacy encompass these vital aspects of our being and are key to unlocking the full understanding of a right to health, both physical and mental health. Sexual and reproductive health rights are indeed, integral to the right to health. and are not to be placed in a vacuum. They are also interconnected to other, perhaps better-known rights, such as the right to education, non-discrimination and equality, LGBTIQ rights, the right to choice in terms of gender equality, the right to work, the right to life (involving choices for mothers with health issues re abortion).
Consequently, where, as often we do, we fail to protect sexual and reproductive health rights, it reflects a failure to protect other fundamental rights (equality, liberty, health), as well as catalysing other key human rights violations, such as the right to work, to education and even life. It is a vicious cycle.
As we contemplate once more, our purpose. I want to once again encourage us to broaden our notion of sexual and reproductive health rights, within this broader rights spectrum and renew our focus to become champions of rights in of themselves, not just sexual and reproductive health rights. Our advocacy at the FPATT therefore, should, in my view, be centred on this vision of rights.
This is the story of the teenage girl from a poor family who is denied appropriate information on sex, is denied sex education in schools, is then ‘criminally’ engaged in sexual intercourse unprotected, unable to negotiate safe sex, becomes pregnant, then unlawfully drops out of school, has poor health care, discovers she is HIV positive and then transmits it to her baby (because the drugs were not available), after which she has afterbirth complications and a sick baby with weak life chances, perpetuating the cycle of poverty. This is FPATT’s story. This is also our story.
Consider too when an undocumented person is HIV positive, but is not tested or treated and transmits to others, likely as a sex worker. The ability of such persons to contribute to the economy is compromised and the state now has to pay more for the long term negative impacts. It is estimated, for example, that teenage pregnancy costs the state 2.43 % of GDP.
[2] UN Sustainable Development Goals.
Access – a core component of Universality
The concept of universal health coverage is grounded in the notion that health is a right and importantly, acknowledges that there are structural obstacles to every person enjoying this basic right. It invokes a duty on the state to remove those obstacles. FPATT has recognized this from the start. We see the barriers to rights when schools, or hospitals, or health centres in rural areas do not function as they should if at all. At times, such geographical barriers sometimes manifest in disproportionate ethnic or class stratification, further violating the rights construct. It is something that should always be challenged.
Rights are funny things. They do not discriminate on the basis of who we proclaim are deserving. They exist for each and every person. It is for this reason that recently, we called on the Ministry of Health to reverse its decision not to offer Pre-exposure Prophylaxis (PrEP)HIV drugs for our population[3]. It is also why we started our mobile health clinics going to every nook and cranny of the country. Access to health, including sexual and reproductive health, has been a constant theme of ours for over 60 years. We view this as a core component of universality.
I am proud to report to you, as President of this distinguished organization, on some of this extensive work. However, at the core, my Report is really about re-emphasising the philosophy and essence of the FPATT, underscoring our genuine commitment to equal rights for all.
Special Interest Groups and Integrating Themes
In my last Report, I asked that we pay particular attention to 3 groups (1) Youth – especially girls; (2) Refugees & Migrants – which I view as an emerging issue re sexual and reproductive health rights; and (3) Sexual and reproductive rights of persons living with disabilities, including those with psycho-social disabilities We resolved to prioritise CSE and HIV services while underscoring interlocking themes of access and rights.
This year I want to add another issue to the potpourri. It is now very clear that mental health is an important and prevalent issue in Trinidad and Tobago. Suicide is on the increase. Mental health presents itself squarely in the sexual and reproductive health portfolio and needs to be confronted in the several areas in which we work.
I am pleased to report that we have achieved and surpassed many of the goals we set for ourselves – measureable by the outcome indicators and targets that we established. In my Report, I will allude to these identifiable objectives and themes.
Migrants and Refugees – UNHCR Partnership and Work
We witnessed significant strides in our goal of universal coverage in terms of one special interest group, migrants and refugees, in fact surpassing our targets. Our work has involved both advocacy on what is an important national issue and direct services.
[3] https://www.looptt.com/content/family-planning-wants-citizens-have-access-hiv-drug.
Perhaps most remarkable, was the United Nations High Commissioner For Refugees (UNHCR)’S faith in our organization, selecting us as the sexual and reproductive health and child health service provider for refugees in Trinidad and Tobago, often lifesaving services. This includes Paediatric Services for Venezuelan migrant children over the age of five years. In 2019, for example, we served 1377 such clients.[4] This enabled us to make a meaningful input not only re advocacy to this important issue, but in tangible ways. Other international agencies turned to the FPATT to provide services, such as the United Nations Population Fund (UNFPA), which Provided Dignity & Emergency health response kits; Funding for training of bi-lingual community- based health volunteers and Self Defence training for migrants vulnerable to sexual violence. Similarly, UNICEF partnered with us to provide Nutritional screenings and Paediatric services for Venezuelan migrants under the age of five (5).
The issue of an ever increasing migrant/ refugee population, including children who are not entitled to go to schools or hospitals, continues to present often unique problems. It requires effective advocacy and direct intervention. In May 2019, the FPATT partnered with the Faculty of law, UWI, to host a historic hearing on the subject of Migrants and Refugees at the IACHR.
The rights dimensions of this issue are broad, involving rights to health, asylum and dignity, as we informed at the IACHR hearing. The sudden migrant/ refugee inflow has resulted in such women being sexualized and stereotyped as sex workers and loose women. In some cases, women are trafficked or forced into sex work. At our clinics, we are seeing repeated problems of rape and sexual abuse, including in relation to migrant children.
At the same time, it teaches us that the problems of gender inequity and discrimination are deeply entrenched in our society and repeats itself easily in various configurations.
Youth and Children – Especially Girls
Turning to the youth. The right of young persons/children to have information and treatment to secure their well-being and dignity is enshrined in CEDAW and strongly endorsed by FPATT. The needs and rights of young people are of critical concern for advocates in the Caribbean sub-region. Yet, legislative barriers and myopic policies prevent them from enjoying, and being protected by, the full slate of their sexual and reproductive health rights.
[4] 198 unique clients in during the period October – December 2018
We have been in the forefront of the struggle to annihilate child marriages and raise the age of marriage and age of consent to 18 years, now the age limit for a child.[5] This legislative change is deservedly applauded. Yet, we recognise the dangers, in law and policy, that are not sufficiently broad in its appreciation of the relevant social needs and conflicting rights interests. For the past 3 years I have been warning about the gaps in our law and policy, that neglect to make clear that the age of consent of a child is not to be tied to the right of children and young people to receive comprehensive sex education or access to sexual and reproductive health services where needed.
The recent amendments to laws impacting children have created a further conflict since they now make provision for mandatory reporting requirements. Where young people present for sexual and reproductive health services, the law emphasises, not the care and attention that they need, but a desire to criminalise such persons, since care providers and medical personnel are required to report instances of suspected sexual activity of minors, those below 18. The conundrum is immediately obvious, given the high sexual activity of our young people. This should not be the focus of our law and while it is surely aimed at sexual predators, its wide brush negatively impacts youth and children in general. Moreover, while the law may not specifically preclude such services, it creates what we call a “chilling effect” on their human rights.
Indeed, the need to ensure that the youth receive adequate and appropriate sexual and reproductive health services and information, remains one of FPATT’s greatest challenges, despite its clear need.
Harmful Legislative Framework – Conflicts with Child Marriage Laws
We must surely be aware of the paradigm: high rates of unprotected sexual activity and teenage / child pregnancies. Our restrictive and outdated laws and policies are helping to catalyse the teenage and child pregnancy phenomenon in the Commonwealth Caribbean. They are poor examples of social engineering and are disconnected with the reality of sexuality, sexual and reproductive attitudes and practices in the region.
You know the statistics: Approximately 20% of women in the Caribbean have had at least one child by the age of 19, with a considerable percentage of adolescent girls even giving birth before the age of 15. Overall, we make our sexual debut at young ages, especially our girls. A comprehensive study on adolescent health in the Caribbean
[5] The Act, No. 8 of 2017 is an Act to amend the Marriage Act, Chap.45:01, the Muslim Marriage and Divorce Act, Chap. 45:2, the Hindu Marriage Act, Chap. 45:3, the Orisa Marriage Act, Chap.45:4 and the Matrimonial Proceedings and Property Act, Chap.45:51, which raises the legal age of marriage to 18 years, outlawing child marriage.
[6] The adolescent birth rate (per 1,000 women aged 15-19) in the Caribbean varies considerably across the countries, ranging from 26 in Turks & Caicos (lowest) to 97 in Guyana (highest). Overall, while all countries could be classified as middle – or high-income countries (World Bank, 2012) they have higher adolescent birth rates than in the developed countries (24) and many have even higher rates than less developed countries (53). With the exception of Turks & Caicos, the adolescent birth rate is also higher than the birth rate in the general population, demonstrating that a proportionally high number of adolescent girls have been pregnant at least once by the age of 19.
among nearly 16,000 adolescents of nine countries in the region concluded that 34.1% (22.2% male; 51.9% female) have had sexual intercourse before the age of 19. Of those adolescents responding positively, 63.4% (40.3% male; 78% female) had their sexual debut before the age of 12. Often, first intercourse is forced, which highlights the underlying issue of gender-based sexual violence and strategies for prevention and response. Further, the younger the age of the child, the more susceptible she is to forced sexual intercourse.
Even if intercourse is not forced, our youth, in particular, our girls (and increasingly our boys) are engaging in sexual activities because of vulnerabilities born out of gender inequality and disempowerment. They are unable to negotiate NO SEX or Safe sex, with condoms. Further, they are denied access to contraception e.g.
Need for Parental Consent for Health Care, Contraception
The legislative and policy barriers to adolescents accessing sexual and reproductive health education and services, especially contraception, is a major obstacle. Parental consent may be required which cause young people to go underground, or services may be prohibited altogether. However, several countries do not specify an age for access to medical services. However, it is instructive that where the law is silent, the age of consent for sex has in practice served as a guide as to what is appropriate, even if not specifically referenced in law.
These laws do not correspond with the Caribbean reality of early initiation of sexual activity among adolescents or even the age of consent for sexual intercourse in some cases. These barriers, along with the stigma attached to young girls engaging in sexual activity, also put adolescents at an increased risk of contracting HIV or other sexually transmitted diseases, unintended pregnancy and unsafe abortions.
Women and Girls Disenfranchised
Where the law is silent, there is technically, no legal barrier to sexual and reproductive health services and there is room for flexibility. We once again call for adoption of the court driven Gillick principle, to import tests of reasonableness and mature understanding of the child in assessing whether a school could provide sex education to children. That test is still relevant today. Gillick competency and Fraser guidelines refer to a legal case which looked specifically at whether doctors should be able to give contraceptive advice or treatment to under 16-year-olds without parental consent.[7]
I also once again call for clarification on the question of consent in terms of access to the provision of these services, since the new age of consent has been counter-productive in this regard, de facto outlawing the ability to administer FPATT services – sexual and reproductive rights. This is ironic – since raising the age of consent was
[7] (Gillick v West Norfolk, 1984). In the judgment delivered by Mr Justice Woolf: “…whether or not a child is capable of giving the necessary consent will depend on the child’s maturity and understanding and the nature of the consent required. The child must be capable of making a reasonable assessment of the advantages and disadvantages of the treatment proposed, so the consent, if given, can be properly and fairly described as true consent.”
aimed at more protection for young persons – more social services and the like, and was not intended to be a punitive policy. The inconsistency negatively impacts the work of FPATT and its mission to democratise sexual and reproductive health rights and aid development.
I reiterate that there is no legal basis for uniformity between the age of consent for sex and the age of consent for children to have access to sexual health services and education. That is based on a false premise. The provision of sexual and reproductive health services, information and education are meant to provide protection to youth, especially where it is most needed – to vulnerable children who are disempowered and at risk, long before the age of 16 or 18.
The new reporting requirements, placed on care providers to ‘report’ suspected sexual activity in minors demonise and criminalise our youth without offering real solutions.
Need to Deflect the Current Heavy Legislative Focus on Criminalisation
The focus on criminalisation of sexual and reproductive health and related issues has an adverse impact, encouraging negative practices instead of inculcating positive social norms/ practices and human rights. Similarly, sexual orientation is criminalised; Abortion is criminalised; and Sex workers are criminalised. All of the above lead to poorer sexual and reproductive health and less rights.
Forcing doctors and other service providers to be morality policemen is also not an optimum strategy. There is no morality in placing the lives of young girls at risk.
The Right to Information and Sex Education as Key Components of Sexual Rights
Sadly, sex still remains a relatively taboo subject too often comprehensive sex education (CSE) is not provided and/or educators are not supported to teach it effectively. We made some headway in our pilot school project, supported by the International Planned Parenthood Federation (IPPF), FPATT’s parent body. Private secondary schools in Trinidad and Tobago were targeted under as 12-month pilot project. The project aimed to equip young people with the knowledge and the skills to enable them to better understand the responsibilities and risks associated with their Sexual and Reproductive Health.
This enables us to reach young people with sexuality education before they become sexually active. Further, providing teachers with the relevant information specifically tailored to build their capacity, will contribute to their effective engagement with young people and the provision of age-appropriate information to support more responsible and informed decisions about sexual and reproductive health and overall wellbeing. The project included:
a) Documentation of local experiences, in relation to comprehensive sexuality education, in the private secondary school setting; curriculum development;
b) a workshop with teachers and youth to advance CSE within private secondary A total of 36 persons were trained (16 teachers, 20 youth).
c) Established a WhatsApp group for workshop participants to network and support each other.
d) Hosted a public event that focused on youth and CSE.
e) Produced a short video highlighting CSE as a taboo topic.
f) Produced two social media videos using popular local characters to highlight the importance of CSE in schools.
At our clinics, currently, we serve a yearly average of 1400 young males and females, ages 24 and younger. Services received include Pap smears, contraceptives, HIV tests, other sexually transmitted infection screening (Gonorrhoea, Chlamydia) and counselling, but there is more need here which must be harnessed.
HIV Services
Sexually Transmitted Infections (STDs) and HIV rates increasing
The UN Global Commission on HIV in New York reports an alarming increase in HIV in youth, especially girls and women generally. This must be highlighted, as well as continuing advocacy for the most vulnerable groups, who also include some invisible people, such as prisoners.
With regard to our continued call for access to Pre-Exposure Prophylaxis, (PrEP) drugs, we reiterate our earlier call for the Ministry of Health to revisit its current policy NOT to introduce PrEP in Trinidad and Tobago. We are not called upon to be morality police, according to our own image and likeness. The notion that we should give HIV medicines only to eh deserving is based on a false premise. Should we similarly deny diabetic drugs to those sufferers because we suspect that their lifestyle contributed to their ailment?
The Minister of Health’s suggestion that the introduction of PrEP will encourage promiscuity and high-risk behaviour is based on a false premise and a reflection of the social stigma and discrimination that still exists around HIV, rather than as a useful tool to prevent HIV. We already know that such stigma fuels rather than prevents the spread of HIV and is counterproductive as well as discriminatory. could negatively impact the work of the National AIDS program. [8] Clinical trials and acceptability studies throughout the world demonstrate high effectiveness of PrEP in preventing sexual transmission of HIV in different populations; as well as a high degree of acceptance among potential users, especially if prophylaxis is subsidized or affordable. There are therefore key public health and pragmatic rationales for such treatment. To protect the society at large, it is important that we provide full and equal access to HIV services. We should not be pennywise and pound foolish.
It is critical to the achievement of universal health coverage – one of the key health targets of the Sustainable Development Goals, and vital that the citizens of Trinidad
[8] THE AIDS Coordinating Committee whose vision is “A future without new HIV infections, reduced AIDS related deaths and no stigma or discrimination associated with living with HIV.”
and Tobago can access the medicines they need, when and where they need them. FPATT therefore calls for full access to comprehensive PrEP services for those for whom it is appropriate and desired, along with support for medication adherence for those using PrEP.
The World Health Organisation (WHO) has recommended PrEP for ‘at-risk’ groups, who are statistically likely to face exposure to HIV, due to the prevalence of HIV among groups which include men who have sex with men, female sex workers, transgender women, and people in serodiscordant relationships (where one person has HIV and the other does not).[9] Several governments in the Caribbean Region have recognized the importance of PrEP as a prevention tool and have already included PrEP as part of their HIV prevention strategy. In 2018 both the Bahamas and Barbados introduced PrEP through the public health system. Jamaica and Guyana plan to do so.
The Family Planning Association of Trinidad and Tobago stands ready to partner with the National AIDS Coordinating Committee and the Ministry of Health to conduct a pilot program for PrEP, given that the population for whom this is intended are already accessing services through its clinics.
In fact, our work on HIV increased during the period and included potent partnerships with, e.g. the following:
(a) the FAMILY HEALTH INTERNATIONAL (LINKAGES PROJECT) FHI360
– To Identify HIV positive persons among the most at risk populations and transitioning them into treatment and care services;
(b) the CARIBBEAN VULNERABLE COMMUNITIES COALITION (CVC)
– To identify HIV clients who were lost in the system and follow up with them with an emphasis on key populations and getting them back into the treatment and care through peer navigation; and
(c ) the AIDS HEALTHCARE FOUNDATION
The following initiatives were concluded:
(i) Funding for HIV Screening & Treatment Services;
(ii) Sexual and Reproductive Health Community Based Activities; and
(iii) International Condom Day Events – Arima – This activity enabled FPATT to integrate safe sex messages and distribute condoms during a carnival parade through the streets of Arima, the second main borough in Trinidad, where there is no activity carried out on what is traditionally referred to as Fantastic Friday. This received welcomed support from the burgesses of Arima and the Mayor invited FPATT to make this a major event on the Carnival Calendar; and
(iv) International Women’s Day Event – Queen’s Park Savannah
LGBTI Rights
During the reporting period, we have witnessed dramatic strides on the LGBTI issue before the courts. Jason Jones succeeded in the High Court with the criminal prohibition of sodomy being declared discriminatory and a violation of the right to privacy. The CCJ also ruled in favour of cross-dressing victims that had been criminalised in Guyana. Yet, there is much more work to do to change the paradigm of discrimination and disadvantage that continues to reside in this country.
Our friends in the LGBTI community tell us that they are grateful for the safe space that we have created in our clinics and Living Room. Indeed, the LGBTI community is the second highest category of services in our portfolio. We publicly renew our commitment to equal rights and the end of discrimination for the LGBTI community, through advocacy and the provision of accessible, equitable service provision. This is also part of our goal to universal health coverage.
SERVICE OUTCOMES –M OUTCOME 3 – SERVE PEOPLE
Our clinical services continue to grow in scope as well as increase access, despite financial challenges in a weak economic climate. The following provides some statistics:
2017-2019
FPATT serviced 19,943 unique clients delivering 287,453 services.
# Migrant Clients – 1575 (October 2018/2019)
# Children – 97 (October – December 2019)
Total # Contraceptive Services – 33,589
Total # Abortion Related Services – 117
Total # HIV and AIDS Services – 34,568
Total STI/RTI – 24,851
Total Gynaecology services – 84,204
Total Obstetric services – 2271
Total Urology services – 4646
Total subfertility services – 40
Specialized SRH Services (e.g. GBV) – 21,086
SRH Other – 12,233
Non SRH Medical – 69,848
15 Community Based Health Volunteers were trained to work in five earmarked communities (Chaguanas/Waterloo, Maloney, Arima, Sangre Grande, Barrackpore/Debe) in FPATT’s Outreach Programme.
Better National, Regional and International Linkages
The partnerships that we need to develop are not limited to the national framework. We aim to have more strategic alliances with our CARICOM neighbours, enhancing regional advocacy – finding the commonalities. The CARICOM framework on teenage pregnancies assumes this and is a useful platform, but there needs to be a broader agenda.
These linkages give us an opportunity to shape the global agenda and of course, also to strengthen our own institution and dare I say, our resolve.
We also continued our partnerships with the Ministry Of Social Development And Family Services, which gave us its annual government subvention; and the Tobago House of Assembly, with which we signed a Memorandum of Understanding for the scale up of sexual and reproductive health services in Tobago.
INSTITUTIONAL DEVELOPMENT, GOVERNANCE, FINANCE AND ENTREQPRENEURSHIP
A Year of Change – International linkages
Given the enormous amount of work that has been achieved in the Reporting period, you may be surprised to learn that for the last year and a half, we have been forced to deal with governance issues at the international level. IN many ways this was a year of change and even disruption. Governance adjustments at the international level, with our parent body, the IPPF, took up a fair measure of time. Yet, as these international relationships transitioned, other new, strong international liaisons were being formed, enhancing our capacity to provide service to our community.
These were necessary but time consuming. Happily, they were concluded in December 2019 and our parent body IPPF, has emerged stronger and more fit for purpose.
Currently, the International Planned Parenthood Federation (IPPF) provides the following:
(i) Unrestricted funding for programming & technical support service;
(ii) Funding for transitioning FPATT into a social enterprise;
(iii) Funding for FPATT’s Insurance Paramedical Examination;
(iv) Incubator Programme (FPATT Sustainability/ Social Enterprise Project); and
(v) Funding for Comprehensive Sexuality Education Project
Private Partnerships
Our goal of universal access has been significantly enhanced by the private sector partnerships and entrepreneuship objectives we have embraced. They include:
The SCOTIABANK FOUNDATION
- Provision of five hundred (500) Cervical Cancer Screening Services to underserved women in ninety-five communities Trinidad and Tobago
- 20% of all women screened received an unsatisfactory/abnormal result (i.e. 99 women)
- 9% of the beneficiaries were youth (under the age of 25)
The NATIONAL LOTTERIES CONTROL BOARD
- Provision of eight hundred (800) Cervical Cancer Screening Services to underserved women in ninety-five communities Trinidad and Tobago
- 16% of all women screened received an unsatisfactory/abnormal result (i.e. 128 women).
I have already mentioned the partnerships with UNHRC< PAHO< UNICEF etc.
Entrepreneurship
We have also stepped up our efforts to build entrepreneurship, including with effective private sector partnerships.
We recognise the financial straits of Government and international donors and this compels us to find more creative and effective ways to harness resources from the state, not simply relying on the subvention, albeit appreciated. Both the state and ourselves have an important focus on the under-served and these shared goals can work to our advantage in enhancing our resource capabilities.
Phoenix Park Gas Processors Ltd (PPGPL)
We partnered with PPGL for the provision of services to their staff and the Phoenix Park community. We also worked on the HEALTHLINK Social Enterprise Project (1 employee = 1 community worker)
FINANCIAL AND OTHER CHALLENGES
FPATT continues to rely on funding from Government, local and international donors to sustain its services. Our prices are highly subsidized as we seek to achieve our social mission of ensuring that men, women and young people particularly in poor, marginalized and underserved communities have access to these critical services. Consequently, revenues generated from service delivery fall below targets.
- IPPF’S Core grant has declined
- Donor funding is becoming more and more restrictive and no longer covers operational costs making it more difficult to sustain.
- The economic downtown in Trinidad and Tobago continues to impact on the Government’s ability to sustain its subvention allocations.
- Importantly, more money is still needed for our target of a new mobile clinic to concretise the ACCESS to services that I emphasized and for our other important work.
FPATT continues to appeal to the private sector and government to increase their levels of support, particularly as it relates to the critical national contribution the Association is making towards the sustainable development of Trinidad and Tobago.
Resource Development and Deficits
Issues around resource development are also challenging, whether in the Staff or financial and other resources. We have also not done enough to increase and sustain our Membership. FPATT, as it transitions into a social enterprise, has taken steps to expand and diversify its service offerings. However, the dearth of medical and clinical staff is stymieing this growth potential.
FPATT’s mobile unit was purchased in 2001 and has serviced over 50 communities in Trinidad and Tobago. Due to wear and tear and its age (19 yrs) it requires routine servicing and replacement parts to be operational. Due to funding constraints, maintenance of the mobile was limited to funding availability and/or the good will of PTSC who serviced the mobile at no cost and in its spare time. The unavailability of the mobile has created gaps in the delivery of sexual and reproductive health services to underserved and marginalized populations.
Other worthy mentions in terms of resources include:
1 Transitioned from Navision to Netsuite Accounting Software which is directly linked to the Association’s data management system – Open EMR which allowed for seamless upload of financial and statistical information into the broader reporting systems namely DHIS2 and Prism;
- Creation of Service Statistics Team for the monitoring and evaluating the Association’s reach and performance.
Strengthen Informed Advocacy
Advocacy, and our status as a champion of rights, continues to be key to our mission.
Our partnerships have also been important in our advocacy goals. I have already mentioned the UWI IACHR hearing. We have also teamed up with PAHO/WHO to provide training in a WHO Clinical Handbook – Health care for Women subjected to Intimate Partner Violence or Sexual Violence. I reiterate that we must strengthen our advocacy to persuade the region’s decision-makers to:
- step up political will and investment for advancing gender equality and women’s empowerment, the rights and empowerment of adolescents and youth, and sexual and reproductive health and rights for all;
- guarantee the rights of all people to make free and informed decisions about their sexual and reproductive lives, including with regard to their sexual orientation and gender identity, and the call to end discrimination and violence based on sexual orientation and gender identity;
- guarantee universal access to sexual and reproductive health services that are youth-friendly, and to eliminate violence against women and girls and ensure critical services for all victims and survivors of gender-based violence;
- investment for advancing the right to health, recognising that sexual and reproductive rights for all are part of that agenda and its current inherent inequities, both in terms of access to rights and the scope of the right; and
- Join with other CSOs and endorse the demands on the state to end domestic violence.
The FPATT is in sync with CARICOM and international approaches to sexual and reproductive health rights and with the 2030 Sustainable Development Goals, [10] but more advocacy and leadership at the policy level is required.[11]
Need for disaggregated data
Clearly, my call for increased and more focused advocacy depends on appropriate mechanisms for effective messaging. In this regard, I emphasise that we must double our efforts to produce disaggregated data in the areas which we serve. We have talked about better liaisons with the UWI and this needs to be concretised and formalized. International funding agencies are now more anxious for data and concrete results. This is also key in winning the argument with governments and policy-makers. Recently, at a national Innovation Forum I read out some of the figures for gender inequity in Trinidad and Tobago and was bemused to learn that key stakeholders in the audience did not know and were appalled.
- Do we know how many young people drop out of school, society because of discrimination and stigma, whether HIV, sexual orientation etc.?
[10] The 37th Annual Conference of Caribbean Community Heads of Government held on July 4-6, 2016, issued a communique endorsing the “Every Caribbean Woman, Every Caribbean Child” Initiative. It is the umbrella under which specific elements are identified. Chief among them are: Reduction in the rates of teenage pregnancies, violence against women, children and adolescents, as well as reduction in the rates of cervical cancer and elimination of mother to child transmission of HIV. The Initiative is championed by the First Ladies of the Region. This is indeed recognition of the importance that our region places on the role of women, girls and adolescents in the development process. It is also a commitment to the 2030 Sustainable Development Goals approved by 192 States at the UN General Assembly in September 2015 that highlight empowering of women and girls and the new focus on women, adolescent girls, young people and gender equality in UN High Level Political Declaration on ending the AIDS epidemic adopted by consensus in June 2016.
[11] The CARICOM Integrated Strategic Framework for the Reduction of Adolescent Pregnancy in the Caribbean, approved by COHSOD in 2014, which aims to address the various determinants linked to adolescent pregnancy, some of them legal barriers, also needs our attention in terms of advocacy. It provides a set of expected results with measurable indicators which could be reported upon on a regular basis by the countries in the Caribbean. The goals are: To reduce the number of adolescent pregnancies in each country of the English- and Dutch- speaking Caribbean by at least 20 % within the time-period 2014 –
Our work with NASTAD, using our San Fernando, Youth and Mobile Clinics to conduct data collection exercises for KAPB among local sex workers and MSMs, is notable in this regard.
Conclusion
It is evident that FPATT continues the high quality of health care for which it has been known for over 60 years. Providing privacy, consistency, trained staff and conscientious customer relations continue to benefit families. Care is based on the needs, values and preferences of the clients, with full compassion and empathy.
In the past year we have accentuated our emphasis to a Rights Based approach sexual reproductive health. We recognise and address the many dimensions of this right – gender, HIV discrimination, poverty, stigmatisation, violence, ignorance and misinformation, youth, misguided morality. A key aspect of this right is ACCESS. This is evident in our re-energised focus of bringing services within the reach of low-income people, the marginalised and displaced peoples.
The work to deepen the right to health elevate rights in general, is too important and complex to go it alone. We need critical partners in this noble venture, who share our ideals and commitment.
Thank You to the Staff and Losing Stalwarts
Changes in governance are penetrating even our own local Board. This year we lost 2 devoted stalwarts of the organisation, Grace Talma and Relna Vire. Trinidad and Tobago remains indebted to them for their long years of dedicated service. Their contribution is immeasurable.We will miss them. We hope that the FPATT will continue to attract the kind of community oriented giants like these two – especially from our youth. Your country needs you.
While there will be a formal Vote of Thanks, I want to add my own Thank you to our evergreen, hard-working and inspiring Executive Director, Mrs. Donna Da Costa-Martinez and her staff, for all of their tremendous work. Without them, the FPATT will wither away on the vine and they make the impossible seem easy.
Professor Rose-Marie Belle Antoine
President, Family Planning Association of Trinidad and Tobago
Dean, Faculty of Law, UWI
DPhil (Oxon); LLM (Cambridge); LLB (UWI)
February, 2020.