Sexual and Reproductive Health and Rights

Mauritius

There is a dramatic and widening gap in both prevalence and incidence of HIV between general and key populations, especially injecting drug users – though data is comparably sparse to that of countries neighbouring Mauritius.

Infant mortality rates are relatively low and have been gradually but steadily decreasing over time. Maternal mortality follows this declining trend from 1990 until 2002 when that trend reversed, and as of the most recent measure in 2015, hovered around 1996 levels at 53. There are increasing numbers of teenage pregnancies, and hospitals are dealing with complications arising from0 unsafe abortions.

Source:
World Databank (2017) Maternal mortality ratio (modelled estimate, per 100,000 live births) https://data.worldbank.org/indicator/SH.STA.MMRT Accessed 01.03.2018

Mauritius has a well-developed health system, though government expenditure on health has rarely reached 10% of total government expenditure since 1995, falling short of the 15% pledged in the 2001 Abuja Declaration. Mauritians have access to free antiretroviral therapy and free general health care. Primary Health Care services are within three kilometres of residents and a wide range of Primary Health Care services are provided.

Given comparatively strong health indicators in areas of common focus in southern Africa, the Mauritian government is concentrating on key populations in view of evidence that concerted interventions in this direction will reduce HIV incidence substantially overall.

Source:
World Databank (2017) Health expenditure, public (% of government expenditure) https://data.worldbank.org/indicator/SH.XPD.PUBL.GX.ZS Accessed 01.03.2018
UNDP, Millennium Development Goals www.mu.undp.org/content/mauritius_and_seychelles/en/home/mdgoverview/overview/mdg5 Accessed 25.04.2015

There exists a two year service gap between the legal minimum age for sexual consent (16) and access to sexual health services without parental consent (18). Furthermore, access to sex education is unavailable in government schools and only taught in some private schools. These structural circumstances surround rising rates of teenage pregnancy, complications resulting from unsafe abortion, and the use of ‘natural’ (incl. thermo-sympto) non-barrier methods of contraception that do not protect against sexually transmitted infections, HIV/AIDS, or offer the reliability of modern methods.

Despite an evidence-based decision to focus on Injecting Drug Users as a key population, progress is hampered by limitations within interventions. Furthermore, persistent stigma and discrimination at treatment centres and in wider society is found to discourage attendance and keep drug injecting activity underground. Injecting Drug Users are liable to harassment by police using the Dangerous Drugs Act if found in possession of syringes and needles. This is not conducive to reducing the alarmingly high rate of non-sterile needles shared amongst Injecting Drug Users. These factors undermine interventions for harm reduction and treatment among Injecting Drug Users.

Abortion was made legal under restrictive conditions and enacted in 2013 but, reportedly, the new legislation had yet to be applied substantively. Although the amendment to the criminal code allows doctors a degree of discretion in carrying out a greater number of abortions, it falls far short of abortion by choice and, under the penal code, any person procuring an abortion or supplying the means to procure an abortion outside of the criteria of eligibility is subject to imprisonment for up to ten years. Further legal reform is purportedly unlikely to occur in the medium term with religious opposition and abortion remaining a contentious subject despite the recent changes in legislation and the government expressing particular concern over maternal mortality and morbidity resulting from unsafe abortion.

There are contradictions and limitations with regard to sexual and reproductive health legislation, policy and practice. For example, there exists no specific or overt law that makes marital rape a crime, but Mauritius otherwise possesses a strong body of human rights-oriented legislation which supports its strategies and programmes.

HIV Act of 2007 overrides legislation which is contrary to the ethos and purpose of the country’s HIV/AIDS policies and strategies but, reportedly,  IDUs continue to be harassed by police and charged under the Dangerous Drugs Act if found in possession of syringes and needles.

Protection of Human Rights Act 1998 is supported by the existence of a Human Rights Commission to ensure better protection of human rights guaranteed by the Constitution of Mauritius and to conduct investigation into complaints against members of the police force.

‘National Action Plan to Combat Domestic Violence’ implemented between 2007 and 2011 by the Ministry of Gender Equality, Child Development and Welfare

Equal Opportunities Act 2012 supports the existing Employment Rights Act by overtly outlawing discrimination of people living with HIV.

Legal AID (amendment) Act 2012 improves access of people to the courts and in particular people living with HIV who had experienced discrimination

Criminal Code (Amendment) Bill 2012 legalises abortion in specific instances but, reportedly from informants, has been applied only to a limited extent.

National Multi-Sectoral HIV and AIDS Strategic Framework 2013-2016 included a specific focus on youth (15-24 year olds), but on the basis of concern about the threat to public health inherent in particular health indicators amongst designated key populations. No subsequent replacement framework was found to be in place as of April 2018.

African Charter on Human and Peoples’ Rights (also known as the Banjul Charter)
Ratified 1992/06/19

United Nations Convention on the Rights of the Child (UNCRC)
Acceded 1990/09/02

Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)
Acceded 1984/08/08

Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa Ratified 2004/10/26

African Charter on Democracy, Elections and Governance
Signed 2007/12/14

Data

Indicator Outcome
Maternal mortality ratio (out of 100,000) 53 (2015)
Infant mortality rate (per 1000 live births) (deaths in the first year of life) 12 (2016)
Child mortality rate (per 1000 live births, in the first five years) 14 (2016)
Proportion of Births Attended by Skilled Birth Attendants 99.8% (2014)
Antenatal care coverage (at least one visit) 100% (2014)
Total fertility rate 1.4 (2017)
Adolescent birth rate (births per 1000 girls aged 15-19) 28.3 (2015)
Contraceptive prevalence rate (% of women aged 15 to 49 years reporting that they use any modern method of contraception 39% (2017)
Unmet need for modern contraception (% of women currently married or in union of reproductive age (aged 15-49) 49% (2017)
HIV prevalence among population aged 15 - 24 years (%) 0.15 (2015)
HIV positive pregnant women receiving antiretroviral drugs to reduce the risk of mother-to-child transmission 96% (2014)
Sources