There is a low burden of disease but trend-indicating health statistics are weakened by ambiguities around actual numbers of people living with HIV. Government officials attribute this to individuals seeking treatment in the late stages of AIDS, treatment defaulting, and a lack of funding and human resources to generate comprehensive information on the scale and nature of the HIV epidemic. There is very low maternal mortality aided by complete coverage of skilled birth attendants, low and declining overall fertility, and a low burden of disease overall.
Healthcare infrastructure and accessSevere economic challenges facing the country have precipitated a state of foreign donor led systemic and crisis management interventions to address HIV and AIDS, and sexual and reproductive health (SRH) challenges. These foreign donors provide only limited funds directly to the government; the bulk is allocated to, and managed by, non-governmental organisations. The donor influence on health provision in Zimbabwe is deepened by the limited domestic investment in health which stood at 8.5% of government expenditure in 2015 (falling well short of the 15% pledged in the 2001 Abuja Declaration). The right of access to basic health care, including SRH and for chronic conditions, is enshrined in the 2013 Constitution of Zimbabwe, but a sub-clause explicitly makes realisation of these rights conditional on resources available. Future research that identifies why Primary Health Care and antiretroviral treatment programmes have particularly poor coverage in rural areas may therefore have advocacy and policy implications. Furthermore, the reach of the Prevention of Mother to Child Transmission programme is limited, and there is little evidence of systematic interventions in key populations.
Sources: World Databank (2015) Health expenditure, public (% of government expenditure) https://data.worldbank.org/indicator/SH.XPD.PUBL.GX.ZS Accessed 23.02.2018
There exists a three year gap between the minimum legal age for sexual consent (15 years) and minimum legal age to access sexual health services without parental consent (18 years). Health workers who offer sexual health services to minors could face punishment. This may contribute to the proportionately high and steady trend in adolescent birth rate against a backdrop of relatively low and declining overall fertility. In an effort to lower the high rate of teenage pregnancy, family life and sex education programmes have been integrated into the school curricula. Despite this, there are an increasing number of women under 24 years old seeking care due to complications from ‘back street’ abortions suggesting unwanted teenage pregnancy persists but may increasingly be under-represented by adolescent birth rates. A change in the country’s education regulations in 2002, allows girls to return to school following childbirth, but a minority of girls actually do due to societal stigma related to early motherhood.
Source: Ministry of Foreign Affairs (2013) Millennium Development Goals Status Report: Assessing Seychelles Progress toward the Millennium Development Goals
Criminalisation, stigma and discrimination limits access to sexual and reproductive health services for men who have sex with men, injecting drug users, and female sex workers. This is due to a fear of exposure and retribution, and a denial of services by healthcare workers.
Both men who have sex with men and injecting drug users report significant employment of female sex workers. This behaviour is therefore seen to risk moving the concentrated HIV epidemic seen in Seychelles currently, to a wider population epidemic. Some efforts have been made to sensitise female sex workers to HIV prevention.
Seychelles experiences a high rate of abortion, most of which are unsafe and conducted in non-medical environments. The vast majority of all unsafe abortions are accessed by young women under the age of 20 years. It is possible that the two-year disparity between the age of sexual consent and access to sexual and reproductive health services (without parental consent) could be a variable in the rate of abortion. Abortions have been legal since 1994 on restrictive grounds, but there are bureaucratic barriers to access. Recently, government officials report that more approved abortions are occurring through an informal agreement between the judiciary and health ministry circumvents, to some degree, the legal and bureaucratic barriers.
Legal constraints affecting key populations’ access to sexual and reproductive health and women’s access to abortion by choice stand out amidst Seychelles broader body of human rights-oriented and gender sensitive legislation, health policies and programmes, and commitment to sexual and reproductive health generally, conditions of employment, and HIV and AIDS in the workplace.
The Termination of Pregnancy Act of 1994 allows for termination up to twelve weeks gestational age on health grounds and the regulations restrict adolescents’ and adults’ use of this option. However, government officials reported that more approved abortions are occurring through an informal agreement between the judiciary and health ministry
Dangerous Drugs Act (amended in 2014) continues to prevent the institution of a needle exchange programme and drug replacement therapies for injecting drug users
The National AIDS Act 2013 reconstituted the National AIDS Council in the same year, making it a statutory body and giving it more power, credibility and resources to coordinate, communicate, monitor and evaluate national programmes
National AIDS Trust Fund is made up of government provided funds to which both state and non-state actors can apply for funding for their programmes and projects
National HIV/AIDS Strategic Plan for 2018-2022 focuses on key populations thought to be at higher risk of HIV exposure, with a particular emphasis on injecting drug users.
The Family Violence (Protection of Victims) Act 2000 gave the Family Tribunal, established in 1998 under the Children Act, power as a paralegal entity to address the issue of gender-based violence and other forms of family violence
National Policy for the Prevention and Control of HIV & AIDS and other STIs 2011 provides for access to appropriate and quality care for people living with HIV, and furthermore states that special focus will also be placed on ensuring that all seropositive people’s sexual and reproductive health and rights shall be upheld
African Charter on Human and Peoples’ Rights (also known as the Banjul Charter)
United Nations Convention on the Rights of the Child (commonly abbreviated as the CRC, CROC, or UNCRC)
Convention on the Elimination of All Forms of Discrimination against Women
Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa
African Charter on Democracy, Elections and Governance