Dominican Republic

Overview

Although reproductive health services have improved in quality and accessibility in the past few decades, further progress is now deterred by the chilling effect of harmful U.S. policies, including the Mexico City Policy, and a lack of political will on the part of the Dominican government. While the effects of the Mexico City Policy are nuanced, it is clear that the policy has stifled free speech and intensified an already unfavorable political climate. The capability of the Dominican Republic to meet the needs of its people is further complicated by political instability and extreme poverty in bordering Haiti, whose impoverished conditions continue to exacerbate the island-wide crisis of the bateyes. Moreover, one of the largest funders of family planning assistance to the Dominican Republic, the United States Agency for International Development (USAID), is scheduled to end its program in 2007. Lacking governmental commitment to reproductive health and burdened by the chilling effect of U.S. policies, the Dominican Republic could be left unprepared.

The State of Reproductive Health in the Dominican Republic

The Dominican Republic lies in the central Caribbean, occupying the eastern two-thirds of the island of Hispaniola, with Haiti occupying the rest of the island. The country is in the middle stages of its demographic transition; 53 percent of the population is young (under age 25). Roughly 30 percent of the population lives below the national poverty line, and conditions of poverty are gravely exacerbated in the bateyes, where the average worker earns eight to ten pesos a day (about US$0.25). Bateyes are former sugar plantations worked by Haitians who were encouraged to enter the Dominican Republic as a source of cheap labor. The workers were exploited on a large scale by both the Dominican and Haitian governments, and conditions deteriorated further under the “anti-Haitianism” regimes of Dominican leaders Rafael Trujillo and Joaquín Balaguer. Since the collapse of the sugar plantations over the past two decades, the majority of bateyes in the country have become settlements of extreme poverty populated by Dominicans, Haitians, and Haitian-Dominicans. Most of the bateyes lack essential health care services, access to nutrition, basic sanitation and hygiene and job opportunities. The rates of HIV transmission are highest in the bateyes at 14 percent, compared to the national average of 1.1 percent.

Contraceptive use is complicated in the Dominican Republic by embedded Catholic ideologies, dominant machismo and poverty. Although country-wide contraceptive prevalence is almost 70 percent according to the United Nations, 46 percent is due to sterilization, which is not a viable option for most young people. The Catholic Church and the government urge young people to delay sex and/or to remain faithful to a single partner. Such messages, while important as part of a broader sexual and reproductive health communications strategy, fail to emphasize the importance of contraceptives and condoms in preventing pregnancy and disease. Instead, condoms are associated with infidelity and sexually transmitted infections (STIs) and are only promoted to women as an HIV/AIDS preventative—an ineffective strategy because machismo prevents women from negotiating condom use for anything other than birth control. Similarly, the use of oral contraceptives is also stigmatized as a sign of a woman’s infidelity. Dominican men commonly deny paternity and the needs of pregnant women are often ignored. The government has generally failed to respond to the cultural and social dynamics that influence contraceptive use in the country. The reproductive health needs of the large youth population have gone largely neglected.

In 2001 the Dominican government passed a Social Security Health Law that guaranteed access to most sexual and reproductive health services; however, the law has not been implemented. Reproductive health supplies are now included in the national budget, yet this has not translated into full allocation of the funds. As such, state distribution of reproductive health supplies is unsystematic and thus the private sector is heavily relied upon to fill the gap for both supplies and services.

According to the Penal Code of 1948, which is based on the French Napoleonic Code of 1832, abortion is illegal under all conditions in the Dominican Republic. Although the law does not expressly permit abortion to save the life of the woman, the general principles of criminal legislation allow abortions to be performed for this reason on the grounds of necessity. Despite its illegality, the procedure remains common and dangerous. A 1990 survey estimates that the annual rate of abortion is 47 per 1,000 women aged 15-44, of which 9.8 per 1,000 are hospitalized each year for treatment of complications from induced abortion. Two women are currently in jail for abortion, though typically in cases that are judicially tried, the woman has died from the procedure. Due to cultural norms and strong Catholic influences, there is no viable movement for the legalization of abortion. However, many women’s groups have proposed a revision of the penal code to depenalize abortion on the grounds of incest, rape and congenital abnormalities. Still, efforts to depenalize abortion, even only to modify the extreme abortion prohibitions, have largely failed due to a lack of resources and political inhibitions, both of which have been greatly exacerbated by the United States’ imposition of the Mexico City Policy (also called the Global Gag Rule).