Executive summary

This scan of sexual and reproductive health in the Atlantic provinces is an overview of information gathered to support implementation of Health Canada's A Report from Consultations on a Framework for Sexual and Reproductive Health. A population health approach to sexual and reproductive health underlies the organization and analysis of the information in the report.

The scan examines epidemiological data on six health problems as well as information on the activities of 52 organizations in the Atlantic provinces working on sexual and reproductive health issues.

What are the Sexual and Reproductive Health Issues?

• Adolescents in the Atlantic provinces have a high level of unprotected sexual activity, placing them at risk for sexually transmitted infections (including HIV), and unintended pregnancies. Unprotected sex can be due to young women's lack of choice and safety in their relationships.

Sexually Transmitted Infections (STIs)

• STIs are less frequent in the Atlantic provinces than in the rest of Canada, except in Nova Scotia, where the rate of chlamydia infections was higher than the national rate (113 per 100,000 population) in 1997.
• Chlamydia and gonorrhea have been increasing steadily in all four Atlantic provinces in recent years.
• Chlamydia infections are reported three to five times more often among women than among men in the Atlantic provinces; young people under 25 are at greatest risk.

Teenage Pregnancies

• Rates of reported teenage pregnancies in the four Atlantic provinces have declined somewhat in the past decade, especially in Newfoundland, and are lower, overall, than in the rest of Canada.
• However, the incidence of teenage pregnancies in Nova Scotia and New Brunswick in 1994 was close to the national rate of 49 per 1,000 population.
• Live births to teenagers is a more accurate measure for estimating adolescent pregnancies, because other pregnancy outcomes (especially abortion) are difficult to track. In 1994, approximately 2,600 teenagers gave birth in the Atlantic provinces.

HIV/AIDS

• Positive test reports for HIV in the Atlantic provinces underestimate actual levels of infection due to the effect of migration: many Atlantic Canadians with HIV are tested elsewhere but return to their home province for treatment and care.
• Men who have sex with men make up the largest proportion of HIV/AIDS cases in the Atlantic provinces, but new HIV infections are declining in this group, except among young men.
• The fastest growing risk category for HIV infection in the Atlantic provinces is heterosexual contact, particularly in Newfoundland and New Brunswick. HIV infection is rising among women and injection drug users in the region.

Aboriginal HIV/AIDS

• According to those who work with Aboriginal people, levels of HIV infection and AIDS are high among the region's Aboriginal people, but there are no statistics to quantify Aboriginal HIV.
• There seems to be a trend for Aboriginal people who test positive for HIV in other parts of the country to return to their reserves in the Atlantic provinces to receive care.
• Frequent unprotected sex signaled by apparently high rates of STIs and teenage pregnancy among Aboriginal youth, together with proportionately large numbers of youth in the Aboriginal population, are early warning signs for the future spread of HIV infection among Aboriginal people in the Atlantic provinces.
• Spread of HIV through heterosexual contact and injection drug use is an even greater problem for Aboriginal people than the population as a whole. Aboriginal women are among those with the highest risk of contracting HIV.

Sexual Violence

• Reported sexual assaults are substantially higher in the Atlantic provinces than in Canada as a whole, although incidence of reported assaults declined between 1992 and 1997. In 1997 there were approximately 3,100 sexual assaults reported to police in the Atlantic provinces.
• Newfoundland has many more reported sexual assaults, proportionately, than the other Atlantic provinces, and 150% more reported sexual assaults than Canada as a whole.
• Only a small fraction of all sexual assaults are reported. Of sexual assaults that are reported, children and youth are the victims in three-quarters of the cases.

The Critical Sexual Health Issues

• The most critical sexual and reproductive health problems are those with irreversible, lifelong consequences, especially for children.

• Underlying most sexual and reproductive health problems are inequities due to poverty, social isolation, lack of education and support, and the marginalization of Aboriginal people and others.

• High levels of unprotected sex among youth in the region pose risks for STIs, unintended pregnancies and exposure to HIV.

• In the Atlantic provinces, the major sexual and reproductive health issues are those affecting children and youth exposed to social and economic risk conditions: sexual assaults, teenage pregnancies and STIs. The latter two are also indicators of risk behaviours that increase exposure to HIV.

• Also critical are sexual health problems affecting adults, particularly women: high overall rates of sexual assaults and the growing spread of HIV through heterosexual contact and injection drug use are serious problems.

What is Being Done About these Issues in the Atlantic Provinces?

Fifty-two organizations across the region were surveyed about their work to address sexual and reproductive health problems; efforts were made to obtain a reasonable selection of major initiatives in sexual and reproductive health promotion and prevention.

Addressing the Critical Issues

• The most critical problems are receiving the greatest attention. The majority of organizations in the scan are dealing with multiple issues, but across these organizations, sexual violence and HIV/AIDS are given high priority.
• Many of the organizations surveyed are working across the life span, but the largest concentration of effort is aimed at youth, and nearly as much at adults. Children and seniors are not overlooked, but they are not the primary targets of most prevention and promotion.
• The critical problems with HIV/AIDS and sexual violence in the region have resulted in highly organized approaches to these issues in some provinces. Multi-faceted, inter-sectoral initiatives have been mounted (particularly in Newfoundland and Nova Scotia) that can be models for action elsewhere.

Population Health Focus on the Issues

• The majority of surveyed organizations are familiar with population health and determinants of health, and explicitly or implicitly apply a population health approach in their work.
• These organizations use a variety of mechanisms to achieve their aims, from providing services and education, to training, capacity building, research and policy development. Most organizations are collaborating within sectors, and some across sectors.
• Population health strategies for sexual and reproductive health range from actions directed at individuals to collective factors; from efforts to enhance personal skills and capacities, to activities to influence families, communities, access to services, societal values and social and economic conditions. Organizations in the scan focus most of their attention on strategies to influence individuals' personal health practices, skills and capacities.

What are the Challenges for Population Health Approaches to Sexual and Reproductive Health in the Atlantic Provinces?

• There is a lack of reliable information about the sexual health status of marginalized groups in the Atlantic provinces, especially Aboriginal people. This key obstacle to implementing population health-based action must be overcome to improve sexual and reproductive health in these groups.

• Most sexual and reproductive health initiatives in the scan are based in cities, even though conditions in rural and remote areas of the Atlantic provinces limit opportunities for optimal sexual and reproductive health. Improving the sexual and reproductive health status of rural Atlantic Canadians is another important population health challenge.

• Most non-governmental sexual and reproductive health organizations exist with difficulty on project funding. An important challenge is to develop options for sustaining and building the population health activities of these organizations.

• Relatively little effort is given currently to "upstream" population health (i.e., focus on starting points in the causal processes determining health status, rather than end points). Adopting an upstream focus is the greatest challenge for implementing a population health approach to sexual and reproductive health. It will require commitment and support at all levels.

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