Introduction and scope of the issue
Maldives has a total population of 407,660 (out of which about 15% are foreign citizens), distributed in 187 administrative islands. The youth cohort (15-29 years) comprise of 31.5 % of the population. While Male’, the capital island, has a population of roughly 38 percent of the total population, about 62 percent live in the islands of the Atolls. Maldives ranks at 105 out of the 188 countries in the UNDP Human Development Index.
The 2017 State of World Population report, ‘’Worlds Apart: Reproductive Rights and Health in an Age of Inequality” identifies several forms of inequalities. As mentioned in the report, “whether a woman is able to exercise her reproductive rights depends in part on whether she lives in a city or rural area, how much education she has and whether she is affluent or poor.” The Maldives is no exception. But some of the challenges Maldives face are unique. This paper focuses on inequalities faced by the people of Maldives as described by those involved at various levels of providing sexual and reproductive health (SRH) services.
The constitution of Maldives ensures right to good standard of healthcare for the people. A few acts and their respective regulations ensure adequate standards of healthcare for the population. Under the Act on Human Rights (2006), the right to health encompasses, among other things, the right of access to health facilities, goods and services on a nondiscriminatory basis, especially for vulnerable or marginalized groups; and the provision of essential drugs and equitable distribution of all health facilities, goods and services.
The Public Health Act (2012), the Health Services Act (2015) and the Health Professionals Act (2015) ensure good standard of healthcare for the population, protection from hazardous agents for health by prevention, and by providing appropriate care of a reasonable quality. The Gender Equality Act (2016) mandates government to provide SRH information and services to all.
The government’s policy of providing free health services to all, though its “Unlimited Aasandha” scheme, ensures health services are provided free of charge to all citizens of the country. This includes services that are available in the country and those which are provided by referring the patient to Aasandha empaneled hospitals abroad.
The Health Master Plan 2016-2025 outlines promotion of safe sexual and reproductive health behaviours and practices among adolescents and young adults as one of its strategic inputs. In the National Reproductive Health Strategy 2014-2018, the government recognizes that reproductive health is a crucial component of the general health.
Sexual and reproductive health (SRH) services and the commodities used in family planning are distributed through the SRH programme for married couples. This programme is run by public hospitals and health centers and some private agencies through their collaboration with the Health Protection Agency (HPA) and UNFPA.
All government hospitals and health centers provide health services including SRH services and family planning services for free. A few nongovernmental organizations like Society for Health Education (SHE), Journey and Open Hand and some clinics provide various combinations of the SRH services for free either through their Aasandha empanelment or through their collaboration with HPA and UNFPA.
Except for the long term methods, the family planning commodities available in the islands’ health centers are not too different from those available in the atoll hospitals. Implants and Intra-uterine devices can only be provided in the atoll hospitals as specialists are employed there. Family planning commodities are dispatched to the island health centersfrom the atoll hospitals, based on the requests sent to the hospital. The family planning commodities are provided free of charge to married couples including foreigners working in the islands.
The government has also established the services of a pharmacy on every island. While condoms are available in these pharmacies for sale, only those in the regional hospitals keep other family planning commodities, and their stock is also limited.
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