The Wages of Impoverishment

In the Dominican Republic, Health Sector Reform (HSR) became an important public issue at the beginning of the ‘90s. During this time, the negative effects of the ‘80s crisis were still being felt on economic growth and income distribution. Poor households had increased from 47.3 per cent in 1884, to 57.3 per cent in 1989. In 1996, 56 per cent of households lived under poverty conditions and 19 per cent under the extreme poverty line.

Over the past eight years, several HSR proposals have been designed. We had the Project for Modernization of the Health System (1993), the National Health Commission (1995) and in 1997, control of the HSR process moved from the State Secretary of Public Health and Social relief (SESPAS) to the Executive Commission for Health Sector Reform (CERSS).

The role of gender as an important indicator of inequality and disadvantage is clearly seen in the widespread gaps and pitfalls of the current HSR policies in the Dominican Republic. Extension of access to health services is a big challenge requiring significant change in the structure of the budget.

Maternal mortality is one of the most important causes of mortality and morbidity in adult women and is estimated at 229 per 100,000 live births. The main causes of maternal mortality are abortion, toxemia, hemorrhage, and sepsis and in the capital city, AIDS.

Use of medical services in case of illness, accident or pregnancy is quite low. Twenty five percent of the population use self-medication; 25.3 per cent do not use any kind of services; 7 per cent engage in other consultation (not medial) and 41.8 per cent seek medical consultation.

In the CERSS projects and the SESPAS proposal, the emphasis on a basic package of services for the poorest is clear. However, these proposals face an inherent difficulty: how to select the poorest in a country where about 75 per cent of the population lives under poverty and extreme poverty conditions.

In addition, the Dominican Republic has significant numbers of households headed by women and sub-families within households, with sub-heads, that are not usually counted as families. These sub-heads are usually working single mothers living in their parents’ homes or with other families.

The access of women and girls to household resources for spending on their health in rural and urban areas is less than that of men and boys. Dominican women also face a number of cultural barriers when seeking health care. Males are usually the dominant partners in relationships.

Women suffer from low self-esteem and have little control over their bodies and sexuality. Men do not like their wives to be seen by male gynecologists and often complain if their wives stay away from home “too long.” There are cases where mothers give their own names for their daughter’s pregnancy test to avoid violence in the home and public shame.

While the National Institute of Social Security (IDSS) is carrying out its own reform processes, their proposal does not include domestic and agricultural workers, and working adolescent mothers.

In the Dominican Republic, the government provides 14.4 per cent of the national expenditure on health, families have to cough up 75.9 per cent and 7.9 per cent comes form other sources.

On the whole, the Dominican Republic faces an important challenge with regard to gender equity and its health policies. HSR policies and projects present gaps, between their principles of equity and their contents in terms of strategies and activities. They reproduce the mythical images of men and women. Men as workers in the public sphere and women as mothers and health care providers in households and communities.

Poverty, the labor market and weak social policies are directly related to gender, defining new faces of vulnerability and disadvantage in access to health services. Dinys Luciano Ferdinand is a psychologist, gender specialist and advocate for women’s health issues in the Dominican Republic, Latin America and the Caribbean.

Poor pay and prejudice

In Jamaica, the Jamaica Household Workers Association has also been lobbying government to implement improved working conditions and wages. The rate for pay moved to $500 - $800 per week in 1996, although the Household Workers Association had argues for an increase ranging form J$500 - $1,200 per week.

In Barbados, the Women in Development (WID) Inc. has been trying to form an association in order to help education and training for women in this sector and for better employment conditions. Legislation relating to pay for domestic workers dates back to 1965, giving workers the princely sum of Bds. $1.50 per hour.

In Trinidad and Tobago, it is now $7.00 per hour, with the new Minimum Wages Act passed in 1998. In St. Lucia, basic pay ranges form EC$250 to $500 per month.

Rules are not realities

Although the law in most Caribbean territories specifies that domestic employees should receive equal benefits under the National Insurance schemes, the reality is that employers often violate these rights. Provision for redress in most territories is poorly implemented because of the untenable situation in which domestic employees find themselves.

The plight of these workers is further exacerbated by the fact that many are migrants from other Caribbean territories. Many women in this position are forced to accept exploitative work conditions in order to survive because they do not possess the requisite work permits allowing them to seek redress.

Despite government policies encouraging equal opportunities in employment, the vast majority of domestic workers experience gender segregation or sex typing in the labor force. Their reality is one of perpetual inequality in terms of conditions of work.

The challenge remains for a transformation of this thinking and for the implementation and enactment of legislation and educational programs to stop this blatant exploitation of domestic workers.