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Guyana | Situation Analysis of Children and Women

Guyana

Situation Analysis of Children and Women

2016

Guyana | Situation Analysis of Children and Women

Published by United Nations Children’s Fund, Guyana 72 Brickdam, Georgetown Guyana.

Guyana | Situation Analysis of Children and Women

Acronyms 5 Acknowledgements 8 Foreword 9 Executive Summary 10 Part I: Introduction to the SitAn Document 17

Chapter 1: Introduction 18 1.1) Methodology 20

Part II: Country’s Context 23 Chapter 2. Guyana’s Socio-Economic Situation 24

2.1) Demographics 25 2.2) Migration 29 2.3) Economy 30 2.4) Poverty 33 2.5) Disaster Risk Management 37

Chapter 3: Systems for Children 39 3.1) Educational System 39 3.2) Health System 40 3.3) Child Protection System 42 Child/Juvenile Justice 42 3.4) Budget Allocation 43 3.5) General Legislation for Children 46

Part III: The early years: a healthy start (from conception to 5 years) 49 Chapter 4: The Right to Health 51

4.1) Maternal Mortality 51 4.2) Child Mortality 51 4.3) Main causes related to maternal and child mortality 54 A) Obstetric Risks and Inadequate Health Care 56 Antenatal Care 57 Delivery 59 Post Natal care 62 B) Diseases and Infections 63 Diarrhoea 63 Acute Respiratory Infection (ARI) 65 Malaria 65 C) Nutrition 67 D) Access to Immunization 75 E) Access to Proper Water and Sanitation 77 4.4) Bottlenecks and Barriers 80

Chapter 5: Preventing maternal to child HIV transmission 84 5.1) Bottlenecks and Determinants 86

Chapter 6: Birth Registration 89 6.1) Main causes related to low birth registration 91 6.2) Bottlenecks and Determinants 91

Chapter 7: The Right to Education: Early Childhood Education 93 7.1) Early Child Development Index 96 7.2) Main Causes relate to low ECE enrolment 98 7.3) Bottlenecks and Determinants 99

Table of Contents

Guyana | Situation Analysis of Children and Women

Part IV: The formative years: Childhood (from 6 to 11 years) 101 Chapter 8: The Right to Education 103

8.1) Primary Education 103 A) Bottlenecks and Determinants in Primary Education 109 8.2) Children with Special Needs 110 A) Bottlenecks and Determinants related to education for children with special needs 110

Chapter 9: The Right to be Protected 112 9.1 Corporal Punishment 112 A) Causes related to corporal punishment 113 B) Bottlenecks and Determinants 114 9.2 Child Involved in Economic Activities and Household chores 115

Part V: The emergent years: Adolescents (from 12 to 17 years) 117 Chapter 10: The Right to Education: Secondary Education 119

10.1) Enrolment Numbers 119 10.2) Gender Parity at Secondary Education 120 10.3) School Attendance, Out of school children and School Dropouts 121 A) Causes for school absence and dropouts 126 B) Bottlenecks and Determinants of school dropouts 126 10.4) Quality of Secondary Education 129

Chapter 11: Teenage Pregnancy 133 11.1) Causes and Bottlenecks related to Teenage Pregnancy 133

Chapter 12: Adolescents and HIV/AIDS 138 12.1) Causes, Bottlenecks and Barriers related to HIV/AIDS among Adolescents 139

Chapter 13: The Right to be protected 143 13.1) Domestic Violence 143 Causes, bottlenecks and determinants of domestic violence 144 13.2) Sexual, psychological and physical abuse 146 Causes, bottlenecks and determinants of abuse against children 147 Children in Need of Alternative Care 149 13.3) Child Trafficking and Child Labour 150 Child Trafficking 150 Causes and bottlenecks related to child trafficking 151 Child Labour 152 Causes and Bottlenecks on Child Labour 157 13.4) Adolescent’s Behavioural Health 157 13.5) Children in Contact with the Law and Juvenile Justice 158 Causes and bottlenecks related to children in contact with the law 160 13.6) Participation in Decision Making 161

Part VI: Conclusions and Recommendations 163 Conclusions 164 Recommendations 169 Annex 1: International Conventions ratified by Guyana 173 Annex 2: Child Budget Methodology 174 Annex 3: The Sustainable Development Goals 178 Annex 4: Equity and Equality in the scope of the Situation Analysis. 179 Bibliography 180

Guyana | Situation Analysis of Children and Women

Acronyms

Acronym Definition ACTO Amazonian Cooperation Treaty Organization AIDS Acquired Immune Deficiency Syndrome ANC Antenatal Care ARI Acute Respiratory Infection ART Antiretroviral Therapy ARV Antiretroviral BBSS Biological and Behavioral Surveillance Survey CARICOM Caribbean Community CDC Center for Diseases Control CEDAW Convention on the Elimination of All Forms of Discrimination against

Women CHW Community Health Worker CPA Childcare and Protection Agency CRC Convention on the Rights of the Child CSEC Caribbean Secondary Education Certificate Examination CSO Crime and Social Observatory DESA United Nations Department of Economic and Social Affairs DHS Demographic Health Survey DNA Deoxyribonucleic acid ECD Early Childhood Development ECDI Early Childhood Development Index ECE Early Childhood Education ESL English as Second Language ESP Education Strategic Plan EVM Effective Vaccine Management GARPR Guyana AIDS Response Progress Report GBV Gender Based Violence GDP Growth Domestic Product GGMC Guyana Geology and Mines Commission GII Gender Inequality Index GPHC Georgetown Public Hospital Corporation GRO General Register Office HDI Human Development Index HFLE Health and Family Life Education HIV Human Immunodeficiency Virus HPV Human Papilloma Virus IDB International Development Bank IGME United Nations Inter-agency Group for Child Mortality Estimation IMCI Integrated Management of Childhood Illnesses IMR Infant Mortality Rate IPV Inactivated polio vaccine

Guyana | Situation Analysis of Children and Women

Acronym Definition ISAGS Instituto Sul-Americano de Governo de Saúde (South American

Institute for Government Health) ITN Insecticide treated net LBW Low Birth Weight LGBT Lesbian, gay, bisexual and transgender MAF MDG Acceleration Framework MCYS Ministry of Culture, Youth and Sport MDD Minimum dietary diversity MDG Millennium Development Goals MICS Multi Indicator Cluster Survey MLHSSS Ministry of Labour, Human Services & Social Security MMR Maternal Mortality Rate MoPH Ministry of Public Health MOPS Ministry Public Security MPI Male partner involvement MSM Men who have sex with men NAR Net Attendance Ratio NCD National Commission on Disability NER Net Enrolment Rate NGSE National Grade Six Examinations NOC New Opportunity Corps NPHRL National Public Health Reference Laboratory OHCHR Office of the United Nations High Commissioner for Human Rights ORS Oral rehydration salts PAHO Pan American Health Organization PCR Polymerase chain reaction PHC Primary Health Care PMTCT Prevention of Mother-to-Child Transmission PNC Prenatal Care PNM Post-neonatal mortality PPP People’s Progressive Party PRSP Poverty Reduction Strategy Paper PSSD Probation and Social Services Department PSSO Probation and Social Services Officer RCC Rights of the Child Commission RHA Regional Health Authority RHF Recommended home fluid SDG Sustainable Development Goals SDPS Secondary Departments of Primary Schools SEN Special Education Needs SHN School health and nutrition SIDS Small Island Developing States SRH Sexual and Reproductive Health TVET Technical Vocational Skills Program TVPA Trafficking Victims Protection Act UCLA University of California Los Angeles UNASUR Union of South American Nations UNDP United Nations Development Programme

Guyana | Situation Analysis of Children and Women

Acronym Definition UNESCO United Nations Educational, Scientific and Cultural Organization UNFPA United Nations Population Fund UNICEF United Nations Children's Fund UNODC United Nations Office on Drugs and Crime UNV United Nations Volunteers USAID United States Agency for International Development USD United States Dollars VSO Volunteers Service Overseas WASH Water and Sanitation WHO World Health Organization

Guyana | Situation Analysis of Children and Women

Acknowledgement

The Guyana Situation Analysis of Children and Women was carried out in 2015/2016 by the Government of Guyana, through the Ministry of Social Protection, with support from a number of partners. Technical support was provided by the United Nations Children’s Fund (UNICEF). It is important to acknowledge the technical support provided during this SitAn process by UNICEF staff from the Regional Office for Latin America and the Caribbean, in Panama and the Guyana and Suriname Country Office.

The collaboration of multiple Government Ministries and Departments in Guyana is also deeply appreciated. Furthermore the invaluable assistance of consultants on this project is noted. The decisive role in the review of the reports by the members of the Technical Committees as well as the overall management of the SitAn by the steering committee is also noteworthy. It is expected that this SitAn will pave the way for the systematic monitoring of the situation of children and women living in Guyana.

Guyana | Situation Analysis of Children and Women

Foreword

Children are at the heart of everything we do, and the issues that affect them shape our priorities. This 2016 Situation Analysis of Children and Women in Guyana (SitAn) will inform planning, programming and decision making for the benefit of children in all 10 Regions of Guyana.

We are pleased with the partnership between Government of Guyana, through the Ministry of Social Protection, and UNICEF, which has contributed to the completion of this document.

Making use of the most recent available data and analysis on children in Guyana from both national and international sources, this SitAn reveals a compelling story about the issues that impact children’s lives and wellbeing in the areas of health, education and protection among others, and allows us to effectively focus resources on programmes which respond to their needs and make a difference for them.

One of the distinctive characteristics of this situation analysis is that it adopts a life cycle approach, with connections to the achievement of the Sustainable Development Goals (SDGs). By making the whole child the centre of the analysis, it provides a holistic and integrated approach that connects and reinforces policy and support measures in a coherent manner.

The process also utilised an equity-based approach. For the purpose of this analysis, equity means that all children have an equal opportunity to survive, be protected, develop, participate, and reach their full potential, without discrimination, bias, or favouritism.

This SitAn will be extremely important in informing UNICEF’s Programme of Cooperation with the Government of Guyana for 2017-2021, which has three priority areas; Safety and justice; Life long learning; and Social inclusion and child rights monitoring. This will support the Government in the development and implementation of National Strategic Plans and Programmes, with a view to advancing the realization of the rights of children with emphasis on equity, and on reaching the most vulnerable children and their families.

_______________________ _____________________ Hon. Volda Lawrence Marianne Flach Minister of Social Protection UNICEF Representative, Guyana Guyana and Suriname

Guyana | Situation Analysis of Children and Women

Executive Summary

The 2016 Guyana Situation Analysis of Children and Women (SitAn) is a cooperation between the Government of Guyana and UNICEF, and it has as its main objective to support the new Government in the development and implementation of National Strategic Development Plans and Programmes so as to advance the realization of the rights and development of Guyanese children, with a strong equity focus on the most vulnerable children and their families.

The SitAn document adopts a life cycle approach, with connections to the SDGs. In this line, the document is divided into three main parts: Early Child Development (ECD), comprising children from conception to 5 years of age; childhood, children from 6 to 11 years; and adolescents, boys and girls between 12 and 17 years of age.

Worldwide, inequalities are reflected in many different dimensions. In Guyana, the main dimensions of inequalities used in the analysis were (i) geographical, subdivided into Coastal and Hinterland regions, rural and urban, and among the 10 administrative regions; (ii) gender; (iii) poverty; and (iv) household ethnicity. Whenever possible, these characteristics were used to show the differences in the realization of rights in the child population in the country, and were used to frame the analysis of the situation of children. In reality, despite the fact that the dimensions are analysed separately in the document, they usually overlap within the same social group, and that can either serve to magnify inequalities and inequities, or concentrate privileges.

Socio-Economic context

Guyana is considered to be a medium human development country. In UNDP’s Human Development Report of 2014 (UNDP, 2014), the country’s value for HDI was 0.638, ranking Guyana in position 121 among 187 countries. Despite the fact that the latest value shows and improvement of 0.87% when compared to the value in 2000, the country has been stagnated in the same ranking position since 2008. In terms of Gender Inequality Index (GII), Guyana is in position 113 (among the 187 countries), with value 0.524.

Among the almost 759 thousand inhabitants of the country, children represent 36% of the population. The majority of the population (89%) lives in the coastland region,

which represents 7.5% of the country’s landmass. The remaining 11% of the population lives in the Hinterland region, responsible for 92.5% of the country’s landmass; a region that is characterized by dense forestlands and mountain ranges and marked also by a series of hills and rivers, contributing to the region’s low-density population and difficulty of access.

One important characteristic of the population is the elevated number of Guyanese nationals living abroad. It is estimated that around 422 thousand Guyanese live in other countries. On one hand, the influx of remittances is an important factor for the country’s economy and represents an informal safety net for many families. On the other hand, high emigration is influenced by lack of internal economic opportunities, indicating failures in the job market. On the economic side, this brain drain creates losses around 8% of the country’s GDP. On the social side, emigration breaks families and forces children to live far from one or both parents.

Guyana is considered an upper middle-income country. Despite its good GDP performance, in taking into consideration the GDP per capita, Guyana is the third poorest country in the Western Hemisphere, after Haiti and Nicaragua. Unemployment is high, and it is particularly concerning for the young population, which represents more than 60% of Guyana’s population. Since 2002, youth unemployment has been consistently higher than 30% and is currently estimated to be about 40%.

Guyana’s latest official poverty measurement was done in 2006, prior to the economic crisis that hit the world in 2008. According to that measure, 36.1% of the population in the country was living in poverty, including 18.6% that were living in extreme poverty. Poverty is higher in the interior of the country, and for those families living in the rural areas (including rural in the coast). Poverty in Guyana has a child’s face. Similar to previous measurements, the poverty number from 2006 shows that younger age cohorts have a significantly higher poverty headcount than older ones. 33.7% of young people aged 16-25 lived in poverty in 2006. Almost half of all children aged 16 and below were poor (47.5%) in 2006.

Guyana is susceptible to a variety of hazards including flooding, landslides, drought, fires, and severe weather systems, among others. Between 1990 and 2014, floods were the main natural disaster that happened in the

Guyana | Situation Analysis of Children and Women

country and primarily responsible for deaths. Flooding is common in the coastal areas and in the interior of the country. In the coastal area, an extensive sea defence system of sea walls and dams is the main defence against inundation of the coastal plain due to heavy rainfall, overtopping of the river networks, and breaches in the conservancies or seawall. In the interior, heavy rains and the abundance of rivers create the conditions for constant increases in the water levels. Natural disasters create an extra stress on public finances and significant impact on homes, businesses and human life. In this sense, almost 94% of the negative impact in the country’s economy resulted from past floods.

The country has a body of legislation that protects the rights of children, women and other vulnerable populations. Some of the legislation is considered to be updated and in line with international standards. Nevertheless, the implementation of the legislation was identified as one of the major bottlenecks in the country for the three main sectors related to children (health, education and child protection).

The early years: a healthy start (from conception to 5 years)

Maternal mortality estimates for 2015 stand at 229/100,000 live births, a number that has not shown significant progress since the year 2000 (210/100,000). Child mortality numbers have shown small reductions since the year 2000, but that also does not indicate major changes in the situation. Neonatal mortality continues to be the major component of Under-5 mortality in the country.

Maternal and Child mortalities share similar causes: (i) congenital factors; (ii) elevated obstetric risks reinforced by low levels of prenatal care, delivery and postnatal care; (iii) the incidence of diseases and infections such as respiratory infections, malaria and diarrhoea; and (iv) the poor nutritional status of mothers – high incidence of anaemia – and children – high incidence of stunting – all, were the identified as immediate causes. These are influenced by the following underlying causes: inadequate health care, lack of full immunization, the unhealthy situation of household environment in relation to water and sanitation, and by household food insecurity. Poverty, social norms, regional disparities and gender norms were identified as the structural causes. All these causes are exacerbated for some specific populations such as mothers-to-be and children under the age of 5 living in the Hinterland, in the rural areas, living in poor families, and from Amerindian families. These do not have access to good quality health services, and, consequently, higher

chances of mortality or in the development of cognitive and/or physical impairment.

These causes are supported by a series of bottlenecks and barriers. In terms of enabling environment, the country presents opportunities for the improvement of the coordination among the different actors involved in the health of mothers and children. Stakeholders identified issues related to the management of the system, including lack of communication among the health facilities in the regions and the central management in the capital. On the supply side, the availability of essential commodities and the access to adequately staffed services are both contributing factors to the current situation. Qualitative information shows that not all regions have the adequate number of trained health workers and community health workers. One of the direct factors that hinders access is the country’s geography, that negatively impacts the propensity of families to search for help, but also in health – and educational – professionals to work in the most remote places.

On the demand side, despite being free, difficulty of access creates some implicit financial barriers to some groups. There are also social and cultural practices and beliefs that influence the personal decision of some mothers to access the obstetric services provided by the government. In some areas of the country, cultural barriers are considered as one of the major obstacles impeding women from getting adequate and timely care. Cultural practices also influence the use of home remedies, and the elevated number of home-births that happen in the interior of the country.

HIV prevalence among pregnant women in 2014 was 1.9%, the same as 2013, consolidating an upward trend since 2010. The HIV Prevention of Mother-to- Child Transmission (PMTCT) program is available countrywide. HIV testing of all pregnant women is a requirement during prenatal care. In 2014, 94.4% of the pregnant women accessed PMTCT services and were tested for HIV. Among those identified as HIV positive, 97% of them had received ART in 2014. There were 37 new cases of HIV reported among children (ages 0 to 19) in 2014, number that represents a reduction when compared to 2010, but an increase when compared to 2013 (32 new cases). Most of the new cases among children are found between 15 and 19 year old boys and girls. The fact that almost 25% of the new cases of HIV in the child population in 2014 had happened between the ages of 1 and 14 demands extra attention on prenatal procedures, delivery and postnatal care of mothers and children. These cases represent the failures in the system, i.e., the cases that were not identified, monitored

Guyana | Situation Analysis of Children and Women

and/or properly threated during pregnancy, delivery and the initial months of life of the child.

The efficiency of the PMTCT programme in Guyana is affected by the same bottlenecks related to maternal and child health: shortage of essential commodities, difficulty of access to health facilities, financial constraints, and social and cultural practices and beliefs. Deficiencies in the prenatal care, delivery and postnatal care affect not only the detection of the virus in mothers and babies, but also in the follow up that identified patients should have. Interviewees mentioned that it is known that some pregnant women would perform the rapid testing, and even with a positive result, would not come back for further testing, for getting advice and/or for collecting their ARV medication. Knowledge on mother-to-child HIV transmission is also low in the country (53% among women, and 35% among men), increasing the risk of HIV transmission among those babies born to women who did not have proper prenatal care.

Birth Registration still has room for improvement. 11.3% of the births in Guyana are not registered, with no differences between boys and girls. The number of unregistered births is 3 times higher in Region 1 than the average for the country. Similarly, a child living in the interior of the country (Hinterland), has twice the chance of not having a birth certificate in comparison to a child living in the urban areas (19% and 9.5%, respectively). Two other factors that increase the chances of a child not having a birth certificate are poverty and ethnicity. Areas with high incidence of babies delivered at home also present an elevated number of babies not being registered.

Qualitative assessment done in Guyana indicates two immediate causes and two underlying causes that influence the low levels of birth registration for some groups and some regions. In terms of immediate causes, on one hand, while knowledge of the importance of having children registered is important; on the other hand, parents and caregivers have to have the means to register their children. Both immediate causes are influenced by the cultural aspects and by the efficiency of the system. Poverty, social norms and regional disparities will work as structural causes for the low registration of some populations.

The 2014 Early Child Development Index (ECDI) identified that around 86% of children aged 36-59 months in Guyana are developmentally on track in terms of physical growth, literacy and numeracy skills, socio- emotional development and readiness to learn, with few differences based on socio-economic characteristics

and Regions. For example, children (i) from Amerindian families; (ii) from the poorest families; and (iii) living in the interior of the country have the smallest ECDI (73.2%, 78% and 78.5%, respectively). In terms of regions, children living in Regions 1, 7, 8 and 9 are far beyond the average for the country. The results also show the importance of children to attend ECE institutions: the ECDI for children attending ECE was 91.4% in comparison to 76.5% of those children not enrolled in early childhood education programmes.

Early childhood education can be divided into two segments: Day Care Centres and Play Groups for children between the ages of 0 and 3 years old, these under the responsibility of the Ministry of Social Protection; and Nursery schools for children between 3 years and 6 months, and 5 years of age who did not start primary education, which are under the responsibility of the Ministry of Education. Data for day care centres is not available. In 2014, on average, 61% of the children aged 36-59 months in Guyana were attending nursery school (59.0% of the girls and 63.0% of the boys. Attendance of ECE programmes varies by area, wealth quintile and ethnicity. Rural and interior parts of the country are the ones with lower attendance. Similarly, despite the fact that public nursery schools are available, the poorer the family, the smaller are the chances that the child is going to attend these programmes. In terms of ethnicity, only four in each ten Amerindian children were attending nursery schools in 2014. Regarding regional disparities, Regions 5, 4, 10 and 6 present the highest attendance rates in the country. Meanwhile, in Region 1, only one child out of five is attending nursery school.

Access to formal ECE services is affected by the direct cost involved in enrolling children in day-care centres (the free public ones are few) and indirect cost associated to transport these children to and from school. Evidence also points to the fact that lack of parental knowledge on the importance of starting formal education at early ages, and the difficulty of access to young children, especially in the most remote areas, as immediate causes.

The formative years: Childhood (from 6 to 11 years)

Primary education is mandatory in Guyana, covering children between the ages of 6 and 11. Due to delays in analysing the 2012 Census, the country does not have available an official net enrolment rate (NER) for children in primary education. The lack of official rates does not allow for a proper discussion on the efficiency of the system. In the school year 2011/2012, 94,843 boys and girls were enrolled in the six grades of primary

Guyana | Situation Analysis of Children and Women

education, 49% of them were girls. The vast majority of pupils (93%) were enrolled in free public government schools. On average, 85% of the children attending the first class of primary school in 2014 attended preschool in the previous year, an increase when compared to 2006 when only 65% of the children had attended preschool. Among those enrolled at school, 97% of them were attending the classes regularly. Also, around 96% of the children who start grade 1 in the past reached grade 6 (last grade of primary education in Guyana), showing an improvement when compared to 2006, when 71% of the children reached grade 6.

While access to primary education is important, access to quality education is fundamental for the sustainable development of the country. Using the National Grade Six Assessment as proxy of quality of the primary education, grades between 2009 and 2013 for students from the Hinterland and Coastal areas have improved for Mathematics, English and Science. Nonetheless, the gap in grades between students has increased. For example, while the gap in Mathematics between Hinterland and Coastal areas students was 15 percentage points in 2009, in 2013 that difference was enlarged to 24 percentage points. This indicates that instead of having the inequality reduced, it has in fact increased.

The causes and bottlenecks that influence the difference in quality between the two regions are driven by lack of qualified teachers and poor infrastructure found in the hinterland region. Moreover, most of the students in the Hinterland do not have access to early childhood education, only starting their formal educational career at ages 6 or 7, in comparison to some students in the coast that will start at age 3 or younger. The SitAn also identified that language – some students are raised in their native language that is different from the official English language that is taught in school – and implicit financial barriers will also contribute to the low quality of school achievement of some students.

Guyana does not have an account of how many children with special needs there are in the country, or how many are in need of formal education. Small-scale surveys have identified that 15% of all persons with special needs have never attended school, and the proportion increases to 42% among those children younger than 16 years of age. The country has a limited number of institutions that provide special education, and access to them is difficult due to their location – most are in Georgetown – and due the associated cost related to transport children to and from the schools. There are also social and cultural practices and beliefs that hamper a more inclusive education in Guyana. For some parents, the fact that

they have a child who requires special attention is seen as a burden and considered to be shameful. Adding to that, bullying is normal, with children presenting negative attitudes towards those who need special education.

Therefore, inclusive education and training of teachers for its provision remain severely limited, particularly for children with sensory, cognitive, and/or mental impairments, which leads to the majority of children with disabilities staying at home, resulting in isolation, stigmatization and compromised access to employment opportunities and social services. The reality is that children with disabilities have difficulties in accessing not only schools, but also health services, employment and even social and recreational opportunities. The country’s infrastructures are not accessible for children and adults with motor impairments; and even in the country’s capital, sidewalks, buildings and roads are not completely accessible.

In Guyana, corporal punishment is still legal – with the exception of the courts and the juvenile justice system, where it has been repealed from the laws. In 2014, 70% of children were identified as suffering some sort of corporal punishment. Boys are more likely to receive violent discipline than girls. Violent discipline is widespread in society, and it is independent of the household’ socio- economic characteristics, and the region where the child lives.

Immediate causes of corporal punishment are the excessive use of alcohol and drugs, family conflict, and lack of parents’ knowledge on other forms of discipline. As underlying causes are the fact that the legal system allows for that practice, the lack of parenting skills, and the cycle of abuse that still happens in some families, i.e., the feeling that if the parent suffered corporal punishment when he/she was a child, they can use it to discipline their child today.

The emergent years: Adolescents (from 12 to 17 years)

There were 82 thousand boys and girls enrolled in private and public secondary schools in the country for the school year 2011/2012. Similar to primary education, an official secondary net enrolment rate (NER) is not available, jeopardizing any analysis of the efficiency of the system. There were two main problems seen related to secondary education in Guyana. First, while students might be enrolled at school, their attendance is not guaranteed. Second, the quality of the education that students receive is not homogeneous.

Guyana | Situation Analysis of Children and Women

Boys and girls are dropping out of school – or not attending – (i) due to the country’s economic situation that pushes some of them to start working without the necessary qualification and in low skills – and consequently low pay – jobs; (ii) due to the fact that some do not see the benefits of continuing their academic studies – quality of education, including appropriateness of the curriculum; and (iii) specially in the case of girls, due to teenage pregnancy.

Quality of secondary education has the same problems as primary education. Not all the schools have qualified teachers – in some cases, parents have to pay for private tutors in more specialized subjects; and the learning infrastructure is not the same – while in some schools in the coastal area students have access to education through technology, in others, especially those in the interior and in the rural areas, schools do not have electricity or proper sanitation. As a consequence, the difference in CSEC scores between Hinterland and Coastal areas has not improved between 2008 and 2013.

Teenage pregnancy is still a problem in the country. About 15% of the girls between ages 15 and 19 in Guyana had begun child bearing, with different rates depending on the area that the girl lives, her poverty status, and her ethnicity. For example, one in every five Amerindian girls between ages of 15 and 19 was a mother at the time of the survey, and one in every four girls who lived in poor households in Guyana have started childbearing, in comparison to 1 in every 10 girls living in richer households.

Teenage pregnancy has been associated with three factors: (i) early sexual debut, on average, 5% of the women had their first sexual relationship before the age of 15. That rate is much higher for women in poor families (12.5%), women living in the interior of the country (10%), and for those who are Amerindians (11%). It is important to mention that it is not known if early sexual debut is associated with consensual sex or forced. (ii) Low levels of use of contraceptives. Around 13% of sexually active adolescents (young women aged 15-19 years) mentioned using contraceptives in their sexual relationships. (iii) Early marriages are not a common practice in the country; nonetheless, among girls between 15 and 19 years of age, 13.3% of them were married or in union (cohabiting) in 2014. All these factors are also associated with individual behaviour, i.e., with the boy and the girls’ knowledge on how to practice safe sex, their use of alcohol and drugs, and their level of empowerment in society.

Elevated rates of teenage pregnancy indicate that

adolescents are in risk of contracting HIV and/or other sexual transmitted diseases. Following Haiti, Guyana at that time had the second highest incidence of HIV/ AIDS in the Caribbean, and AIDS was considered the second leading cause of death in the country. Knowledge is one of the most important components in avoiding HIV transmission. Less than half of the adolescent population between 15 and 19 years of age (47.7% for women, and 33.2% for men) have comprehensive knowledge on HIV and AIDS. Small comprehensive knowledge on HIV, high levels of unprotected sex and elevated levels of sexual violence against adolescent girls create extra risks for teenage boys and girls.

Boys and girls in Guyana are exposed to elevated levels of sexual, psychological and physical abuse at home and in their communities, as well as child trafficking and child labour. Gender based violence contributes to the aggravated situation of violence against children. Neglect is the main type of abuse suffered by children, followed by sexual abuse.

A mix of social norms and social and cultural practices have been identified as the main factors that influence violence against children and women. In this sense, using a sociological perspective, gender-based violence, different forms of abuse, and attitudes toward them, could be subdivided into two sets of causes: those at the individual level and those at the social level. For the individual, violence is largely driven by factors related to gender inequality, childhood experiences and the enactment of harmful forms of masculinity. Abuse and violence against women and children are related to the power control that men try to exercise over the women, which is also extended to the children. While legislation to prevent abuse and punish perpetrators exists, the consensus among stakeholders in the country is that the implementation of the different legal norms is still lagging behind. Impunity is seen as a major bottleneck in the system, caused by victims and witnesses that are afraid of reporting abuses – sometimes due to personal or financial connection to the perpetrator.

Child trafficking and child labour are considered two major issues in Guyana. They are interrelated and usually reinforce each other. Among all the cases of human trafficking identified between 2013 and 2015 (totalling 170 cases), 50% of them involved children. 91% of the cases have women as survivors.

Around 18% of the children in the country were involved in child labour. The number is much higher when boys and girls involved in economic activities are taken into consideration: around 35% of adolescents between 15

Guyana | Situation Analysis of Children and Women

and 17 years of age were working in 2014. Both child trafficking and child labour are triggered by the economic situation in which families live. There are also social norms that influence the propensity of families to allow adolescents to work, i.e., work is seen as character building and it should be emphasized from early ages.

Stakeholders in Guyana believe that the situation of children in contact with the law is worse today than it was in the past. There are two institutions that formally work with children in contact with the law. Out of the 831 children and adolescents admitted into the Juvenile Holding Centre between 2011 and 2014, 70% were boys. Most of the boys were admitted accused of theft (break, enter and larceny). For girls, wandering was the main cause of admission. In September 2015, 84 children and adolescents were residents in the New Opportunity Corps (NOC), 55% of them boys.

Poverty is identified as the major cause that influences children to break the law. Adding to that, alcohol and drug consumption, and the influence of peers are also factors that add to the problem. Some stakeholders mentioned the fact that elevated cases of wandering is an indication that the relationship between adolescents and parents is broken. While there are calls to remove wandering from the statute books, many see it as a precursor to committing various crimes, and for some families, it becomes a solution to fix a problem that parents do not know how to solve.

Conclusions

Despite improvements in the socio-economic situation, inequity is a major factor in Guyana, i.e., boys and girls do not have access to the same quality of education, health and child protection due to structural problems described in this document. The country’s averages hinder serious differences, and create different vulnerable groups that demand special attention.

The Situation Analysis points to different groups of vulnerable children and women in Guyana. These vulnerabilities are created and/or emphasized by the four dimensions of inequality utilized throughout the report: geographical, gender, household economic status, and ethnicity. The first group of vulnerable children and women are those who live in the Hinterland. As shown, for almost all indicators used to describe the situation of children, those living in the hinterland are in a worse off situation than those in the coastal areas.

The second group of vulnerable children and women are the Amerindians. Historically they live in the interior of

Guyana (hinterland) and share the same problems as other ethnicities that inhabit those areas; nonetheless, if the Amerindians are analysed isolated from other groups, maybe with the exception of nutrition, they do present the worst indicators among all the population in Guyana. A third group identified as vulnerable are those children with disabilities and special needs. The lack of data on this population is worrisome, and signals that the country does not properly address their needs. Without knowing how many boys and girls have special needs, it is not possible to know if they have access to school and health facilities, and if they have their rights realized.

Children living in single-parents households, especially those headed by women were identified as a fourth group of vulnerable children. Recent information on the correct number of households’ arrangements like these is not known, and available data does not present that disaggregation; however, different interviewees have mentioned that these types of families are common in Guyana. These family arrangements are driven by the harsh economic situation that pushes parents – mainly men – to search for jobs abroad and/or in the most remote areas of the country (mining and logging). In single-parent households, when a mother – of father – is not home, children are affected in different ways. One direct danger for children is that in being alone, they are susceptible to being abused by older children and/or adults. Besides, as mentioned, the lack of a male figure at home was identified as correlated to school dropouts, and to behavioural problems, especially with boys.

The fifth group represents a stand-alone group, but it was also identified as the major cause of all other vulnerabilities: poverty. Not all poor families are going to have their children out-of-school, or will have cases of domestic violence. However, statistically, poor families in Guyana have higher chances of living in a worse-off situation. Children living in poor families have smaller chances of having access to computers and books; they are more susceptible to domestic violence and other types of abuses; they have higher chances of being stunted and have higher chances of being out of school; among other problems.

Despite the fact that the SitAn identified five main vulnerable groups, these are not insulated, i.e., children in one group might also be exposed to the situation described in a second or third group. For example, a child who lives in a female-headed single-parent household might also live in the hinterland, and in a poor family. One point that all these vulnerable groups have in common is that they are exacerbated by the poverty status of the family. Poverty is at the core of most, if not all, the

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problems that affect children and adolescents.

The situation of children and women in Guyana is influenced by different immediate, underlying and structural causes, which are then reinforced by many bottlenecks that prevent boys and girls from fully accessing their rights. The importance of identifying the causes and bottlenecks is related to helping government and different stakeholders to construct public policies that target the most vulnerable populations based on an assessment of the reasons that influence that situation. The SitAn document acted as the first stage in this process: it identified broad bottlenecks that explain the situation. The second stage would be to intensify the analysis, so for each problem acknowledged in the document a thorough map of causes, bottlenecks and determinants can be constructed.

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Part I:

Introduction to the SitAn Document

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Chapter 1: Introduction The 2016 Situation Analysis of Children and Women (SitAn) document is the result of a cooperation process between UNICEF and the Government of Guyana. The process of developing the SitAn was informed by three very important facts: firstly, the 2015 general elections that resulted in a new Government from an opposition coalition; secondly, the end of the period where the Millennium Development Goals (MDGs) set the agenda of international cooperation; and thirdly, the approval of the Sustainable Development Goals (SDGs) and, consequently, the appearance of a new framework for international development and cooperation among countries. Despite the fact that during the time the SitAn was being developed the indicators for monitoring the SDGs were still being debated by the international community, the 2016 Guyana SitAn was developed taken the SDGs and its targets in context. In this sense, the SitAn is not a SDG document, but it carries their principles and ideas, and it will further support the government to reporting against them.

Within this context, the 2016 SitAn has as its main objective to support the new Government in the development and implementation of National Strategic Development Plans and Programmes so as to advance the realization of the rights of development of Guyanese children with a strong equity focus on the most vulnerable children and their families.

One of the distinctive characteristics of this situation analysis is that it adopts a life cycle approach, with some connections to the SDGs. This is a whole-child oriented approach by making the child the centre of analysis, instead of the social sectors and the services. This approach avoids compartmentalizing the rights of children, and provides a holistic and integrated methodology that connects and reinforces the various policy support measures in a coherent manner1. The idea behind the document is quite simple: the realization of one right often depends, wholly or in part, upon the realization of others. For instance, realization of the right to health may depend, in certain circumstances, on realization of the right to water and sanitation, education and information. Hence, it is impossible to disassociate the problems, and try to improve the current situation of children if not by a coordinated approach.

Still, even though all children have the same rights, at any time, everywhere, children have different needs during different stages of their lives. Hence, certain rights may have more relevance or urgency at one age over the other. For example, while the needs for early childhood are mainly relate to health and nutrition, children at primary schools age are mostly concerned with education and access to information. Adolescents face additional needs and challenges with respect to reproductive health and protection from violence and abuse. Hence, the life cycle approach acknowledges the heterogeneity within the children’s needs during the first 17 years of their lives.

For this report, three main life stages are considered: Early Child Development (ECD), comprising children from conception to 5 years of age2; childhood, children from 6 to 11 years; and adolescents, boys and girls between 12 and 17 years of age. These age groups were selected based on the available data for the country. For instance, primary education in Guyana should cover ages 6 to 11, so, despite UNICEF considers ECD to cover up to the age of 8, to comply with available data, ECD was limited to ages 0 to 5, and childhood to ages 6 to 11. Similarly with adolescents: despite the fact that the United Nations defines adolescence as the period between 10 and 19 years of age, the SitAn has limited that group to those ages where boys and girls should be in secondary education, moving into tertiary education, i.e., between 12 and 17. The reader must have in mind that groups – and the problems children face – are not narrowly defined, and a sharp separation between the different stages is not real.

While the advantage of using the life cycle approach is undeniable, one of the disadvantages is that some topics were deliberately placed in one life cycle group. For example, domestic violence was presented and analysed in the part related to adolescents, but it is clear that this violence also affects children younger than 12 years of age. Similar situation with child trafficking that is also placed in the adolescent part, but violates the rights of children of all ages. Those divisions do not jeopardize the overall objective of the document and frequently the text of the document tries to do the links among the different parts, chapters and sections.

1 http://www.unicef.org/adolescence/index_73650.html 2 UNICEF considers ECD as the period between 0 and 8 years of life; nonetheless, different literature will consider that period as being between 0 and 5 years. In order to facilitate the analysis – and specially due to how data is disaggregated – in this situation analysis ECD will be considered as 0 to 5, having in mind that the longer the care with the early stages of the child, bigger are the returns in the future.

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The SitAn process also followed an equity-based approach. For the purpose of this situation analysis, equity means that all children have an equal opportunity to survive, be protected, develop, participate and reach their full potential, without discrimination, bias, or favouritism. This definition is consistent with the Convention on the Rights of the Child (CRC), which guarantees the fundamental rights of every child, regardless of gender, race, religious beliefs, income, physical attributes, geographical location, or other status. Inequities (lack of equity) generally arise when certain population groups are unfairly deprived of basic resources that are available to other groups (UNICEF, Sept 2010).

For an equity-based situation analysis, inequalities have to be mapped; i.e., the differences between groups have to be identified. Once this process happens, inequities can be flagged so they can be addressed in coherent public policies. For more on the difference between inequity and inequality, please refer to Annex 4.

The reduction of inequalities was recognized as one of the major pillars of the Sustainable Development Goals (SDGs). Among the different targets related to this Goal, the empowerment of the most vulnerable populations; the actions to ensure equal opportunities; the promotion of social, economic and political inclusion independently of age, sex, disability, race, ethnicity, origin, religion and other statuses; and the elimination of discriminatory laws, policies and practices are the ones that directly impact on the realization of the rights of the children in Guyana, and are the ones that guide much of the debate raised by this Situation Analysis3.

Worldwide, inequalities are reflected in many different dimensions. In Guyana, the main dimensions of inequalities used in the analysis are presented in Table 1. Whenever possible, these characteristics were used to show the differences in the realization of rights in the child population in Guyana, and were used to frame the analysis of the situation of children in the country. In reality, despite the fact that the dimensions are analysed separated in the document, they usually overlap within the same social group, and that can either serve to magnify inequalities and inequities, or concentrate privileges.

Table 1: Inequality Dimensions, Guyana

Dimension Identified Characteristics

Geographical

Three geographical subdivisions were identified as presenting the major inequalities: First, the difference between:

• Coastal • Hinterland Region

Second, the difference between • Rural • Urban

Third, the difference among the 10 administrative regions.

Gender Not for all indicators, but very important in some:

• Male • Female

Household socio- economic status

Quintiles identified in MICS, especially the comparison between the first (representing the richest population) and the last quintile (representing the poorest population).

3 Targets 10.1, 10.2 and 10.3 of the Sustainable Development Goals.

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Dimension Identified Characteristics

Ethnicity

The ethnicity of the household head identified in the MICS was used as a proxy of the ethnicity of mothers and/or children. In this sense, the following groups were used in the equity analysis:

• East Indian • African • Amerindian • Mixed Race

The analysis has showed that among the four ethnic backgrounds, the Amerindian population is the one with worst off indicators.

The SitAn document is divided into six parts. The first part has the introduction to the document and its methodology. The second part presents the country context. It summarizes important socio-economic aspects that influence the realization of child rights, and it describes some of the systems that are directly related to the development of policies and provision of services for boys and girls. Part III debates Early Childhood development, including topics related to health of the mother and child, water and sanitation, education and child protection. Part IV concentrates on the formative years – between 6 and 11 years old. It mainly focuses on education, but also starts the debate on child protection. Part V presents the situation of adolescents in different aspects related to health, education and child protection. Part VI has the conclusions and recommendations.

Different boxes are presented throughout the document. Their main objective is to complement the text with information, to flag some SDGs, to present some of the stories that were heard during the data collection process, and to make aloud the opinions of adolescents and other stakeholders who were part of the process. The proper Situation Analysis tries, as much as possible, to involve different stakeholders, including children and mothers. The 2016 Guyana SitAn did that, and to use their full extension of thoughts, some were transcribed in the boxes.

1.1) Methodology

The SitAn used, as its main methodological support the Guidance on Conducting a Situation Analysis of Children’s and Women’s Rights – Taking a rights-based, equity-focused approach to Situation Analysis (UNICEF, Dec 2012), as well as insights from the UNICEF Global Assessment on Situation Analysis of Children’s and Women’s Rights (UNICEF, June 2012), among other key documents developed by UNICEF in the past years.

The following were the main methodological choices used during the SitAn process:

1. Desk Review of key documents from research, studies, publications, governmental plans, and other materials that are identified as important for the work to be conducted. The objective was to first conduct a mapping of the problems related to children and their possible causes, the assessment of availability of data, the input for questions to be used during the interviews and focus groups, and the identification of causalities that could explain the situation and the bottlenecks. The list of documents used in this Situation Analysis is presented at the end of the document.

2. Quantitative Data Review of national and international surveys, demographic and health surveys, census, and income and expenditure survey, among others, as well as administrative records from health, education and child protection sectors. The objective was to identify trends in the indicators, and to map the disparities presented in the country, trying to link with possible sources of inequalities.

In 2014 UNICEF Guyana in partnership with the Bureau of Statistics conducted a Multiple Indicator Cluster Survey (MICS). The SitAn extensively used the MICS’ results as the main data source.

3. Interviews with key stakeholders, including UN Staff, governmental officials, representatives of NGOs, civil society and adolescents, among others. The objective was to explore the problems identified in the literature

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review, to map the main problems related to children, and to determine their possible causes and bottlenecks. Also, the interviews were used to capture different perspectives that were not found – or were not evident enough – in the literature review.

4. Focus Groups / Group interviews with stakeholders in the country, including representatives of indigenous populations, civil organizations, NGOs, mothers and/or adolescents groups. The objective was to go beyond the formal interviews (described in item 3) and to capture the interaction between those that were participating in the discussion.

5. Field Observation: Some of the interviews and focus groups happened during work visits to Region 1, 4 and 6. The visits were used to observe the environment where children lived, and also used as an opportunity to generate human-interest stories that are presented in the boxes.

The overall process of developing the Situation Analysis followed UNICEF’s three steps in conducting a situation analysis (Figure 1).

Figure 1: UNICEF’ suggested steps to conduct a Situation Analysis

The process of identifying the major causes of child rights shortfall (step 2) overlapped with the process of assessing the main shortfalls and inequities (step 1). Causal analysis was the major tool used in step 2. The causal analysis is based on three levels: (i) immediate causes, i.e., events or circumstances that can, by themselves, produce an effect; (ii) underlying causes, which are conditions that by themselves will not produce an effect, but must be present for the effect to occur; and (iii) the structural causes that are the factors or events that are further back in the chain but deeply influence the effect – they are social relations, socio-economic situations and social norms that influence all other causes4.

Once the causes are recognized, bottlenecks and barriers, i.e., specific issues and/or situations that are preventing children to access their rights, are identified and framed within the determinant framework also adopted by UNICEF to help in identifying bottlenecks in the realization of children’s rights (Figure 2).

4 For more on causal analysis please refer to (UNICEF Regional Office for Latin America and the Caribbean, 2006), (UNICEF, Dec 2012)

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Figure 2: Key determinants for barriers and bottlenecks

Source: UNICEF Guidance on Situation Analysis (UNICEF, Dec 2012)

The text for each of the chapters is deliberately divided into two sections: (i) the description of the situation, i.e., a narrative on how the situation of children and women is for the country and for the different inequality dimensions, and (ii) an analysis of causes and possible bottlenecks/barriers related to the described problem.

The validation process (step 3) happened in two presentations that took place in Georgetown in April of 2016. In the presentation were invited representatives of all the stakeholders groups that were part of the process.

Guyana | Situation Analysis of Children and Women

Part II:

Country’s Context

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Chapter 2. Guyana’s Socio-Economic Situation Guyana lies in the north part of South America, and it is bordered by the Atlantic Ocean to the north, Brazil to the south and southwest, Suriname to the east and Venezuela to the west (Figure 3). With 215,000 square kilometres (83,000 sq. mi), Guyana is the third-smallest country on mainland South America after Uruguay and Suriname. The fact that around 80% of the territory is covered by rainforest creates a distinction that is going to be further explored in this report: the difference between the interior area of the country (i.e. the Hinterland Region) and its Coastal area. Much of the inequalities described in this report are based on these two regions.

Figure 3: Guyana geographical location

Source: Google maps

Due to its coastal vulnerability, Guyana is also considered a Small Island Developing State (SIDS), and it is a member of the Alliance of Small Island States. In common with other SIDS, Guyana also faces special disadvantages associated with small size, insularity, remoteness and susceptibility to natural disasters. These factors render the economies of these states very vulnerable to forces outside their control – a condition that sometimes threatens their economic viability (Smirnov, April 2014).

Out of 18 human rights treaties, Guyana has ratified 11 of them, including the Convention on the Rights of the Child (CRC), the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), and the Convention on the Rights of Persons with Disabilities (Please refer to Annex 1 for a complete list of human rights conventions ratified by the country).

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2.1) Demographics

According to the latest census (Bureau of Statistics Guyana, June 2014), the population of Guyana in 2012 was 747,884 inhabitants, slightly smaller than the 2002 population (751,223 people). The largest age group is the one between ages of 15 and 19 (Figure 4). Children ages 0 to 195 represent around 36% of the country’s population (Table 2).

Figure 4: Population pyramid, % of the population, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Table 2: Population estimation by age groups, Guyana, 2012

Boys Boys % Total Pop Girls Girls % Total

Pop Total % Total

Pop 0-4 37,864 10.2% 33,910 9.0% 71,774 9.6% 5-9 38,345 10.3% 33,703 9.0% 72,048 9.6%

10-14 38,350 10.3% 36,454 9.7% 74,804 10.0% 15-19 42,796 11.5% 40,258 10.7% 83,054 11.1% 20-24 32,380 8.7% 32,539 8.7% 64,919 8.7%

Child Population 157,355 42.2% 144,325 38.5% 301,680 40.3% Adolescent

Population (10-19) 81,146 21.8% 76,712 20.4% 157,858 21.1%

Youth Population (15- 24)

75,176 20.2% 72,797 19.4% 147,973 19.8%

Adult Population (18+)

214,274 57.5% 229,898 61.3% 444,171 59.4%

5 According to the Convention on the Rights of the Child, a “child” is a person below the age of 18. Due to data constraints, some of the indicators will include the population under the age of 19 as being part of the child population.

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Boys Boys % Total Pop Girls Girls % Total

Pop Total % Total

Pop

Total Population 372,547 100.0% 375,337 100.0% 747,884 100.0%

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)6

Among the child population, 55.3% of the children live with both parents, 27.7 live with their mothers, 10% do not live with their parents, and 4% live with their fathers only (Figure 5).

Figure 5: Children’s living arrangements, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

In terms of gender, at country level, females slightly outnumbered males (Figure 4), with some variations in terms of regions (Table 3). According to the 2014 MICS, 66% of the household heads were male, and the remaining 34% were female7. Women’s role in Guyana’s decision-making processes is on the rise; women represent 61% of the work force, 31% of judges, 75% of magistrates, 31% of parliamentarians, and 29% of government ministers (PAHO, 2012). Despite this progress, as it is going to be discussed in this Situation Analysis, women are still lagging behind men in realizing their rights – and they are still the ones who are subject of different types of abuse, and the most vulnerable in terms of trafficking.

6 Until December 2015 the country’s Bureau of Statistics did not release the final analysis of the 2012 Census. Some numbers for the situation analysis are calculated based on percentages presented in diverse surveys (including the 2014 MICS and 2009 DHS). 7 This number does not account for the number of single households headed by women and by men.

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Table 3: Male/Female percept distribution at country and region levels, Guyana, 2012

Region Name Male Female Region 1 Barima-Waini 52.5 47.5 Region 2 Pomeroon-Supenaam 50.4 49.6 Region 3 Essequibo Islands-West Demerara 49.9 50.1 Region 4 Demerara-Mahaica 48.9 51.1 Region 5 Mahaica-Berbice 49.8 50.2 Region 6 East Berbice-Corentyne 50.2 49.8 Region 7 Cuyuni-Mazaruni 52.8 47.2 Region 8 Potaro-Siparuni 54.1 45.9 Region 9 Upper Takutu-Upper Essequibo 51.3 48.7 Region 10 Upper Demerara-Berbice 49.6 50.4 Coastal 49.5 50.5 Hinterland 52.4 47.6 Guyana 49.8 50.2

Source: 2012 Census (Bureau of Statistics Guyana, June 2014)

There are 10 administrative regions (Table 3) in the country that are located in two meso regions: Coastland and Hinterland regions. The Coastal plain, which include the capital city, represents the smallest physical geographic area of Guyana, but at the same time comprise the higher percentage of the population (89.1%). The heavy concentration of population is due to the fact that the majority of the commercial activities in the country are carried out in the Coastland regions.

The Hinterland region comprises more than two-thirds of the land area. Despite the fact that its population continues to grow, it only represents 10.9% of the total population (Figure 6). The region is characterized by dense forestlands and mountain ranges and marked also by series of hills and rivers, contributing to the region’s low-density population.

Figure 6: Characteristics of Coastland and Hinterland Regions, Guyana

Source: (Bureau of Statistics Guyana, June 2014)

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Table 4: Summary of Guyana’s Administrative Regions, Area, Population and Region, 2012

# Administrative Region Area km2 Population Population per km2 Region Urban / Rural

1 Barima-Waini 20,339 26,941 1.32 Hinterland Rural

2 Pomeroon-Supenaam 6,195 46,810 7.56 Coastland Urban

3 Essequibo Islands-West Demerara

3,755 107,416 28.61 Coastland Rural

4 Demerara-Mahaica 2,232 313,429 140.43 Coastland Urban

5 Mahaica-Berbice 4,190 49,723 11.87 Coastland Rural

6 East Berbice-Corentyne 36,234 109,431 3.02 Coastland Urban

7 Cuyuni-Mazaruni 47,213 20,280 0.43 Hinterland Rural

8 Potaro-Siparuni 20,051 10,190 0.51 Hinterland Rural

9 Upper Takutu-Upper Essequibo

57,750 24,212 0.42 Hinterland Rural

10 Upper Demerara- Berbice

17,040 39,452 2.32 Coastland Urban

Guyana 214,999 747,884 3.48

Source: 2012 Census (Bureau of Statistics Guyana, June 2014)

Guyana is essentially a rural country. 73.6% of the population lived in rural areas in 2012, an increase when compared to 2002 (Figure 7). At the same time, according to the 2014 MICS, almost three-quarters of households (72%) were found in rural areas and just over a quarter are found in the urban areas. Four out of ten administrative regions are considered to have urban townships and cities (Table 4). There are more women living in the cities than men (around 100 thousand women in comparison to 92 thousand men). About two-thirds (61.7%) of the urban population is clustered in Georgetown, the capital city of Guyana and its suburbs. As a matter of fact, Region 4, where the capital city Georgetown is located, is the most densely populated, with 42% of the population.

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Figure 7: Urban and Rural Population, Guyana, 2012

Source: 2012 Census (Bureau of Statistics Guyana, June 2014)

The present population of Guyana is racially and ethnically heterogeneous, with ethnic groups originating from India, Africa, Europe, and China, as well as indigenous or aboriginal peoples. Despite their diverse ethnic backgrounds, these groups share two common languages: English and Creole.

There are nine indigenous tribes residing in Guyana: the Wai, Machushi, Patamona, Arawak, Carib, Wapishana, Arecuna, Akawaio, and Warrau. The 2006 Amerindian Act (Government of Guyana, March 2006) protects indigenous peoples’ rights and sets forth benefits, including land titling, intellectual property rights, environmental protection and mining and forestry. The act also empowers the village councils to establish rules for their communities and set fines within the legal confines of the law.

Despite being a multicultural country, evidence points to discrimination against some groups. The UN Committee on the Rights of the Child expressed concerned at the prevalence of discrimination against Amerindian children, and children with disabilities. Furthermore, the Committee was showed concerned about discrimination against children on the basis of sexual orientation and/or gender identity (UN Committee on the Rights of the Child, 2013).

In terms of religion, data from a 2002 census on religious affiliation indicates that approximately 57% of the population is Christian, 28% are Hindu and 7% are Muslims. An estimated 4% of the population does not profess any religion.

2.2) Migration

According to the United Nations, the country had a little bit more than 11 thousand legal migrants in 2013 (United Nations, DESA-Population Division and UNICEF, 2014), mainly from Suriname, Brazil and Venezuela (Table 5). This number might hinder a significant population that moves to and around the country attracted by the mining and logging operations, especially near the borders of Venezuela and Brazil. Qualitative data shows that the number of citizens from these two countries is seen as elevated by many Guyanese.

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Table 5: Stock of legal migrants by top five countries, Guyana, 2013

Country of origin Total Suriname 4,662 Brazil 2,166 Venezuela (Bolivarian Republic of) 2,132 United States of America 1,273 China 1,166 Total 11,399

Source: United Nations Population Division (United Nations, DESA-Population Division and UNICEF, 2014)

A significant number of Guyanese professionals and skilled personnel migrate to Europe, North America, and other Caribbean countries (PAHO, 2012). Data from the United Nations Population Division shows that in 2013 (United Nations, DESA-Population Division and UNICEF, 2014), more than 422 thousand Guyanese lived abroad, most of them in the United States and Canada (Table 6). The high levels of emigration in Guyana are related to difficulties in finding employment, and the inability of local economies to absorb young graduates. One clear consequence of the elevated number of people living abroad is the brain drain that happens in the country. Those who are qualified by the educational system in Guyana do not see immediate opportunities in the country and are forced to move abroad to continue their education, and/or to use the skills that they learned.

Table 6: Total number of Guyanese living abroad, top 5 countries, Guyana, 2013

Country of destination Total United States of America 281,371 Canada 101,004 United Kingdom of Great Britain and Northern Ireland 21,073 Suriname 11,530 Venezuela (Bolivarian Republic of) 7,401 Total 422,379

Source: United Nations Population Division (United Nations, DESA-Population Division and UNICEF, 2014)

Around 6% of the children 0 to 17 have at least one parent living abroad. Fathers being abroad are more common than mothers. The highest percentages of children with at least one parent living abroad are in Region 10 (13%), in urban areas (9%), among children in the richest households (10%), and among those living in households with an African (9%) or mixed race (8%) household head (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).

Apart from the social loss that the country has – children living far from their parents – from an economic perspective, this brain drain produces gaps in knowledge and skill that are not easily replaced. The Caribbean Development Bank reports that Guyana’s emigration has produced a loss of 7.8% of the country’s GDP (Caribbean Development Bank, 2015). Estimates from the World Bank show that around 80% of those who were born in Guyana and had graduated at university level live abroad, mostly in the United States (The World Bank, 2008).

2.3) Economy

Guyana is considered an upper middle-income country. Guyana’s GDP has been stabilized after the fall in 2006, with a performance better than the average for the region (Figure 8). Real GDP growth slowed in 2014 (3.8%) reflecting the softening in global commodity prices including gold and bauxite.

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Figure 8: GDP Growth, Guyana and Latin America & Caribbean, 2000-2014

Source: (The World Bank, 2015)

Despite its good GDP performance, in taking into consideration the GDP per capita, Guyana is the third poorest country in the Western Hemisphere, after Haiti and Nicaragua. The country’s GDP per capita reached around US$ 4,000 in 2014, a number that is one and a half times smaller than the average for the Latin America and Caribbean region in 2014 (Figure 9). According to the World Bank8, real GDP growth is projected to fluctuate within the range of 3% to 5% during 2015-2018. Economic activities will be driven by continued investments in primary industries. Potential offshore and hydro-energy projects may also attract foreign investment and further boost growth. Inflation is expected to remain relatively subdued. Nonetheless, volatile commodity prices represent a significant risk.

Figure 9: GDP Per capita, comparison Guyana and Latin America & Caribbean, 2000-2014

Source: (The World Bank, 2015)

8 http://www.worldbank.org/en/country/guyana/overview Accessed on December 11, 2015.

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The service sector, including banking and construction, is responsible for about 59% of the GDP in 2014. Other main economic activities in Guyana are agriculture (production of rice and Demerara sugar), bauxite mining, gold mining, timber, shrimp fishing and other minerals (Figure 10). In May 2015 Exxon Mobil announced Guyana’s first significant oil find9, creating a possible new source of resources for the country.

There is a concern by the UN Committee on the Rights of the Child that the fact that the economy is heavily dependent on extractive and timber industries might generate violations of children’s rights (UN Committee on the Rights of the Child, 2013). The Committee is especially concerned at the impact of these businesses on the living conditions of children and their families in the regions directly affected, on the health hazards and environmental degradation arising therefrom as well as on issues related to child protection such as child abuse, child labour, and child trafficking, among others.

Figure 10: GDP Composition, Guyana, 2014

Source: (Bureau of Statistics, 2014)

Unemployment has remained high. With youth making up more than 60% of Guyana’s population, the youth unemployment issue is of particular importance. Since 2002, youth unemployment has been consistently higher than 30% and is currently estimated to be about 40% (Caribbean Development Bank, 2015). As mentioned, unemployment is one of the causes for high levels of emigration to other countries. Chronic problems related to the labour market include a shortage of skilled labour – as mentioned before the country has a process of brain drain due to the migration of qualified labour to other countries – and a deficient infrastructure.

Remittances are a very important component of the country’s economy, making it comparable to direct foreign investments in the country. In 2005, remittances represented about 25% of the country’s GDP (The World Bank, 2008). Around US$ 438 million in remittances entered the country in 2014, representing 16% of the country’s GDP (Maldonado, R., Hayem, M., 2015). In 2013, direct foreign investment represented less than 7% of the GDP.

On a positive side, remittances are used by many families as a constant source of income, and are considered by many as a safety net for many families; consequently, it is an important factor to reduce poverty and inequalities. Remittances allow poor recipient households to increase their savings, spend more on consumer durables and human capital, and improve children’s health and educational outcomes (The World Bank, 2008).

On a negative side, as evaluated by the World Bank (The World Bank, 2008), remittances not always reach the poorest segments of the country; instead, they reach the better-off households. In this line, government cannot see the inflow of remittances as a substitution to programmes to alleviate and fight poverty among the most vulnerable populations. On the contrary, the large inflow of remittances indicates that (i) wages in the country are not enough to provide for the wellbeing of families; and (ii) poverty is considerable in the country and policies to reduce it are not

9 http://news.exxonmobil.com/press-release/exxonmobil-announces-significant-oil-discovery-offshore-guyana Accessed on October 14, 2015.

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being efficient. In both cases, families have to depend on external money to improve their situation.

2.4) Poverty

Box: Measuring Poverty in Guyana

The poverty line is obtained by specifying a consumption bundle considered adequate for basic consumption needs and then by estimating the costs of these basic needs. In other words, the poverty line defines the level of consumption (on income) needed for a household to escape poverty. Absolute poverty lines were defined from the consumption data in order to be able to distinguish the poor from the non-poor and to quantify the level of poverty.

For those who are considered poor, two poverty lines were used to measure the extent of their poverty as extreme or moderate poverty. The extreme poverty line is based on the normative food basket (2400 calories per male adult) provided by the Caribbean Food and Nutrition Institute. Total calorie intake is identical to the food basket used in 1992 and 1999, allowing for the comparability of the poverty rates derived. The average cost of the food basket across the ten regions for 2006 was G$7,550 per month per male adult (approximately US$1.25 per day).

Moderate poverty lines were constructed to include an allowance for non-food items. This allowance was estimated by observing the share of total consumption devoted to food and non-food items of the 40% poorest households. The average moderate poverty line across regions for 2006 was G$10,494 per month per male (or US$1.75 per day).

Source: (Government of Guyana, July 2011)

Figure 11: Poverty Rates, Guyana, 1992-2006

Source: 2011-2015 Poverty Reduction Strategy Paper - PRSP (Government of Guyana, July 2011)

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The 2006 measurements confirmed that poverty and extreme poverty were stronger in the interior areas of the country (Table 7), and were uneven if regions were taken into consideration (Table 8).

Table 7: Poverty rates for different areas, Guyana, 2006

Moderate Poverty Extreme Poverty National 36.1 18.6 Urban Coastal 18.7 7.3 Rural Coastal 37 17.1 Rural Interior 73.5 54

Source: 2011-2015 Poverty Reduction Strategy Paper (Government of Guyana, July 2011)

Out of all poor people in the country, most of them were living in areas categorized as rural coastal, followed by urban areas and rural interior (Figure 12). Due to the population distribution in the country, most of the poor people would be living in Region 4, nonetheless, in percentage terms; poverty is massive in Regions 8, 1 and 9, where more than 70% of the population living in those areas were considered poor (Table 8).

Figure 12: Distribution of poor population by areas, Guyana, 2006

Source: 2011-2015 Poverty Reduction Strategy Paper - PRSP (Government of Guyana, July 2011)

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Table 8: Poverty distribution by Regions, Guyana, 2006

Regions % of population living in poverty

National share of the poor population

(%) Barima-Waini 80.06 3.18 Pomeroon- Supenaam 51.94 6.25 Essequibo Island West Demerara

40.09 14.08 Demerara- Mahaica 24.56 42.43 Mahaica- Berbice 42.58 6.11 East Berbice Corentyne 28.45 15.76 Cuyuni Mazaruni 61.42 2.48 Potaro- Siparuni 94.28 1.48 Upper Takatu Upper Essequibo 74.38 2.96 Upper Demerara Berbice 39.36 5.26 National 36.1 100

Source: 2011-2015 Poverty Reduction Strategy Paper - PRSP (Government of Guyana, July 2011)

One challenge in calculating poverty in Guyana is to find a measurement that can encompass different cultures and lifestyles that are present in the country. As emphasized in the 2011-2015 Poverty Reduction Strategy Paper (PRSP) (Government of Guyana, July 2011), due to the Amerindians’ lifestyle characteristics, this group is particularly prone to measurement error when using the same consumption basket to calculate poverty lines, and that expenditure patterns for this group may be quite different from those of other ethnicities.

As mentioned in the 2015 World Development Report (The World Bank, 2015), children living in poverty experience greater levels of environmental and psychosocial stressors than their higher-income counterparts and that stress and adversity in the first years of life can permanently constrict the development of physical and mental capacities throughout adulthood. Furthermore, children from disadvantaged families are less likely to receive consistent support and guidance

from responsive caregivers. They are also likely to have had less opportunity to develop the critical skills—including skills in controlling their impulses, understanding the perspectives of other people, and focusing attention—that are important for engaging effectively with teachers and other children, paying attention in class, completing assignments, and behaving appropriately.

The Sustainable Development Goals (SDGs) advance on the Millennium Development Goals call to end poverty. This time the SDGs on its Target 1.2 openly indicates that poverty must be reduced among women and children. Poverty in Guyana has a child’s face. Similar to previous measurements, the poverty number from 2006 shows that younger age cohorts have a significantly higher poverty headcount than older ones. 33.7% of young people aged 16- 25 lived in poverty in 2006. Almost half of all children aged 16 and below were poor (47.5%) in 2006. Data on child poverty was not disaggregated for different ethnicities, regions and/or areas of the country.

The 2014 Multiple Indicator Cluster Survey (MICS) did not calculate poverty rates for the country, but used a quintile wealth index to differentiate wealth across households, from poorest to richest10. Data from MICS 2014 has confirmed

10 The wealth index is a composite indicator of wealth. To construct the wealth index, principal components analysis is performed by using

The Voice of Adolescents:

Who are the poor people in Guyana? Are there many poor people in the Guyana?

“The people living in poverty - no homes, can’t afford to take care of their children; children being forced to drop out of school and being required to work in the mining industry to help make ends meet.”

“ Poverty exists all over Guyana”

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two main disparities in Guyana: the difference between rural and urban, and the difference between coastal and interior regions. While 13% of the population living in the urban areas could be considered poor, the number is raised to 22.5% in the rural areas. As a matter of fact, almost 44% of the population in rural areas would be living in the two smaller wealth quintiles, in comparison to 30% in the urban areas (Figure 13). That difference is higher when coastal and interior regions are compared: 62% of the population in the interior areas of Guyana were considered to be living in poverty in 2014, in comparison to 12.8% in the coastal areas (Figure 14).

Figure 13: Percentage distribution of the household population by wealth index quintiles, according to area of residence (Rural and Urban), Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 14: Percentage distribution of the household population by wealth index quintiles, according to area of residence (Interior and Coastal Areas), Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

information on the ownership of consumer goods, dwelling characteristics, water and sanitation, and other characteristics that are related to the household’s wealth, to generate weights (factor scores) for each of the items used. First, initial factor scores are calculated for the total sample. Then, separate factor scores are calculated for households in urban and rural areas. Finally, the urban and rural factor scores are regressed on the initial factor scores to obtain the combined, final factor scores for the total sample. This is carried out to minimize the urban bias in the wealth index values.

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2.5) Disaster Risk Management

According to the Emergency Response Preparedness Plan (Ministry of Social Protection and UNICEF in Guyana, Oct 2015), Guyana is susceptible to a variety of hazards including flooding, landslides, drought, fires, and severe weather systems, among others. Between 1990 and 2014, floods were the main natural disaster that happened in the country (Figure 15) and the main responsible for deaths (Figure 16).

Guyana is abundant in water, but, at the same time, drainage throughout most of the country is poor and river flow sluggish. Swamps and areas of periodic flooding are found in all but the mountainous regions, and all new land projects require extensive drainage networks before they are suitable for housing and agricultural use (Ministry of Social Protection and UNICEF in Guyana, Oct 2015). Flooding is common in the coastal areas and in the interior of the country. In the coastal area, an extensive sea defense system of sea walls and dams is the main defense against inundation of the coastal plain due to heavy rainfall, overtopping of the river networks, and breaches in the conservancies or seawall. In the interior, heavy rains and the abundance of rivers create the conditions to constant increases in the water levels.

Figure 15: Frequency of reported natural disasters, 1990-2014, Guyana

Source: Prevention Web (Prevention Web, 2015)

Figure 16: % of total deaths related to natural disasters by type of disaster, 1990-2014, Guyana

Source: Prevention Web (Prevention Web, 2015)

Natural disasters create and extra stress to public finances and significant impact on homes, businesses and human life. In this sense, almost 94% of the negative impact in the country’s economy was resulted from past floods (Figure 17). For example, in 2005, severe floods resulted in the loss of economic activity and damage to buildings, crops and other national assets totaling approximately 59.49% of 2004 GDP. This economic impact put considerable pressure

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on government expenditure, necessitating the redistribution of resources away from development endeavors to meet emergency response and recovery needs. Additionally, approximately 34 persons died, essential services (schooling, transportation and safe water distribution) and basic economic activity (primarily agricultural production) were disrupted, and thousands were displaced from their homes for months.

Figure 17: % of total natural disaster economic impact, 1990-2014

Source: Prevention Web (Prevention Web, 2015)

Apart from regular localized cases of flooding, Guyana’s other main disaster threats are droughts and fires. Homes in Guyana have traditionally been constructed with wood and situated closely together, providing the conditions for large urban fires. The country is also prone to severe forest fires, especially in the dry seasons and during El Nino conditions.

The extent of the vulnerability of communities to Guyana’s disaster risks is determined by a number of social, economic, cultural, political, and environmental factors. Groups particularly vulnerable to disasters include children, pregnant women, the elderly, the differently-abled, single parents (especially mothers), farmers (crops and livestock), the homeless, and the poor (Ministry of Social Protection and UNICEF in Guyana, Oct 2015).

After the floods in 2005 Guyana has intensified its institutional response to disasters. The country has solidified its commitment to addressing its vulnerabilities and decreasing its disaster risk. This was first officially highlighted in the 2007 Declaration of Turkeyen, which recognized the need to strengthen the capacity of signing members to prevent and respond to disasters through international cooperation and policy development and implementation. This commitment also resulted in the consideration of disaster risk in development strategies, including the National Competitiveness and Low Carbon Development Strategies, and sector plans and programmes including the draft National Health Sector Plan, the Hinterland Water Strategy, and the joint International Development Bank (IDB)/ Government of Guyana (GoG) Water and Sanitation Initiative. The country is also a member of the Caribbean Disaster Emergency Management Agency, the apex disaster risk management body in the Caribbean, and it works to ensure its disaster management policies and strategies align with those adopted at a regional level.

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Chapter 3: Systems for Children

3.1) Educational System

Guyana’s education system through its school curricula, funding, standards and other policies are set by the central government and implemented through the Ministry of Education and eleven education departments. Ten of these education departments correspond with the administrative and geographical regions of the country, while the capital, Georgetown, is treated as a separate education department. The Principal Education Officer (Georgetown) and Regional Education Officers are responsible for monitoring and supervising all educational activities within their respective regional education departments (Ministry of Education, 2015c).

The educational system is composed of Nursery, Primary Education and Secondary Education. Despite the fact that the government of Guyana considers children between the ages of 0 and 8 to be in Early Childhood Education (ECE), for the purposes of this Situation Analysis, ECE is going to encompass those children who did not start Primary Education. Day Care Centres and Play Groups are not considered to be part of the formal educational system (the MoE is not responsible for it), but they contribute to the cognitive and physical development of the child (Figure 18). Children enter primary school at age six and should start secondary from the age of 12. At the end of the primary education cycle, students are requested to do a placement exam. Those who perform well are placed in the school of their choice, which general speaking is a Senior Secondary school. Secondary schools are further subdivided depending on the grades achieved namely list A, B, C and D schools. The children with the lowest grades are placed in the secondary departments of the primary schools referred to as Primary Tops (Figure 19).

Figure 18: Summary of Educational System in Guyana

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Figure 19: Detailed Educational System in Guyana

School is mandatory for children between the ages of 6 and 16 years of age (covering primary and secondary educations). Private and public schools are available in the country. There are no tuition fees for public Nursery, Primary and Secondary schools; nonetheless, as it is going to be discussed later, families still have to afford for some indirect costs such as transportation, specialized books and food.

National budgetary allocations determine the level of expenditure in each education district. The amount is disbursed to the ten Regional Democratic Councils, which run the affairs at regional level and which in turn disburses funds to the regional education departments. The funds for the Georgetown Education Department are disbursed through the Central Ministry of Education (Ministry of Education, 2015c).

The 2014-2018 Education Sector Plan frames the educational sector in Guyana (Ministry of Education, 2014). According to the plan, the priority for the 5 years is to increase the learning achievements at all levels of education and for all sub-groups, and to decrease the differences in learning outcomes between sub-groups, especially between students in coastal and hinterland schools.

For Early Childhood Education (still under the supervision of the Ministry of Education), the country has developed an action plan that sets the targets between 2014 and 2018 (Ministry of Education, 2014b). The targets cover important areas in terms of guaranteeing access, improve monitoring and evaluation processes, increase the participation of parents, and improve quality of teaching.

3.2) Health System

In Guyana, the Ministry of Public Health (MoPH) is responsible for setting national policy, regulation, and standards; for building and initial furbishing of facilities; and for initial financing of 100% of the employment of doctors, nurses, and Medex’s11 (Government of Guyana, 2014). At regional level, the Regional Health Authority (RHA) has the autonomy to assess, plan and implement health services and manage the facilities for a defined population in a defined geographic area, including day-to-day management of the facilities and employment of all other staff working in the health sector (ISAGS and UNASUR, June 2014). The country’s main framework for health is the Health Vision 2020 (Ministry of Public Health, Dec 2013) that sets the strategy and overall planning for the health sector. The document has as one of its priority areas to focus on the reduction of maternal and child mortalities, and the improvement of health for adolescents.

11 A Medex is a medical extension worker with prescription and diagnostic rights.

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There are five levels of health care in Guyana as depicted in Figure 20. Each provides a specific spectrum of services to patients. The system prescribes that referrals should go from one level to the next level and that counter referral should take place accompanied by the necessary information on diagnosis and treatment.

Figure 20: Guyana Health Structure and number of facilities

Source: (ISAGS and UNASUR, June 2014)

Although the Hinterland population has numerous facilities compared to the small proportion of the total population, these guarantee only local access to limited health services. For access to a broader range of diagnostic and treatment services individuals of the Hinterland will need to overcome large distances and travel frequently over rivers, by road and sometimes by air (ISAGS and UNASUR, June 2014).

Budgetary flows and lines of responsibility have been agreed on between the Ministry of Finance, the Ministry of Local Government and Regional Development, the Ministry of Public Health, and the Regional Democratic Councils (PAHO, 2012). The right to healthcare free of charge is guaranteed in the country’s constitution.

Maternal health care services – as well as other primary health consultations – are provided free of cost in public facilities. Overall, in 2014 there were 364 antenatal care sites, along with 43 regular delivery sites in the 10 regions of Guyana. Occasionally, deliveries also occur at home or in the community. The only referral institution for high- risk pregnancy and emergency cases is Georgetown Public Hospital Corporation (GPHC) (Government of Guyana, 2014).

Maternal and Child Health services are provided by a multi-disciplinary team as part of the Ministry of Public Health’s Family Health Programme, in hospitals, health departments and health posts and in homes through the introduction of Integrated Management of Childhood Illnesses (IMCI) and Community-Integrated Management of Childhood Illnesses and Community Health Workers (CHWs). The CHWs are front-line workers, mainly situated in the hinterland regions where the indigenous population live.

According to analysis from the Pan American Health Organization (PAHO), the country’s health system performance and health outcomes have improved over the years, but challenges remain, especially related to data management and quality of care. Formal data needed for monitoring and evaluating health system performance at the regional level are limited, and information flows among central, regional, and facility levels are fragmented and not fully integrated. In addition, data from the private sector are not systematically collected, analysed, and integrated. With respect to quality of care, while protocols and guidelines exist, and training is conducted, inadequate monitoring and enforcement of standards and loss of trained health human resources present barriers to sustained improvement (PAHO, 2012).

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3.3) Child Protection System

Different actors contribute the the child protection system in Guyana12. The Ministry of Social Protection (MoSP) – through the Childcare and Protection Agency (CPA) (agency created by law and linked to the Ministry) – has central role in terms of child protection. The CPA functions as the oversight and management body for the protection of children in Guyana and has the power to implement policies and decisions in relation to the laws governing children, monitoring of child care facilities, intervene in cases where a child is abused or neglected and to protect vulnerable children (Ministry of Social Protection and UNICEF Guyana, June 2014). Another important stakeholders is the Probation and Family Welfare Department (under the Ministry of Social Protection), which is largely responsible for prevention services through access to social protection mechanisms, and reintegration and rehabilitation of children in contact with the law. Further, the Labour Department also in the MoSP is responsible for issues on child labour. Note that the MoSP is also responsible for some amount of social protection programmes and as such, play as critical role in the other sectors. Therefore, in order to fulfil its mandate the CPA must work with other government and non- government institutions such as the Ministry of Education and Ministry of Public Health – a discussion on the agency capacity is done in Chapter 13.

The Ministries of Education and Public Health are two other key ministries with significant child protection responsibilities. Besides being responsible for the New Opportunity Corps – next subsection – the Ministry of Education has Welfare Officers placed regionally to provide support to the students and parents. Further the Ministry of Education has responsibility for the provision of prevention and response services to all children, in cooperation with other agencies such as the Guyana Police Force and the Ministry of Public Health. The Ministry of Public Health plays a critical role in services such as those related to school health (e.g. school screening for visual and hearing impairments, personal hygiene and enviornmental health care and drug education), nutrition and HIV/AIDS preventions; and in monitoring of health standards of facilities – including treatment services for survivors of abuse. The Ministry of Public Health also interacts with the Department of Citizenship to guarantee birth registration to the children born in the country.

The current staff, financial capacity and management of the system are seen as insufficient to guarantee the rights of the children in terms of protection against abuse and violence. For instance, the country has less than 100 social workers – some of them working at schools as welfare officers –, and, based on the review of the national budget (section 3.4), the allocations for the sector are not as significant as health and education. Moreover, unlikely to those two sectors, the child protection system is still highly centralised.

Outside the government, the Rights of the Child Commission (RCC) is a non-governmental and non-partisan organization that is the primary agent for holding the government and people of Guyana accountable to child rights. Besides, different NGOs and international organizations such as UNICEF are present in the country to support national capacity to achieve results for children and realize their rights.

The Juvenile Branch is the unit within the Guyana’s Police to deal with all matters that concern juveniles – where they are the perpetrators as well as victims. They handle cases involving different types of abuse such as rape, neglect and abuse. The Juvenile Branch is response for the investigation and police part of the case. The support to victims, including counselling, is done by the Childcare and Protection Agency.

The country has about 100 Social workers - minus school welfare officers, a number that is considered by many stakeholders as insufficient to cover the whole territory. Also, based on the review of the national budget (next subsection) the allocations for the sector are not as significant as those for health and education. Moreover, unlike those sectors, the system is still highly centralised.

Child/Juvenile Justice

Child/juvenile justice in Guyana includes different Ministries and branches of government: the CPA, the Ministry of Public Health, the Ministry Public Security (MOPS), the representative for the police, the judiciary, the Ministry of

12 A child protection system may be described as a set of laws, policies, regulations and services, capacities, monitoring, and oversight needed across all social sectors – especially social welfare, education, health, security, and justice – to prevent and respond to protection related risks (UNICEF, 2010).

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Social Protection (MoSP) and the Department of Culture, Youth and Sports, among others.

According to the country’s legislation, the age of criminal responsibility is 10 and at age 17 a child can be tried as an adult. The national juvenile justice system provides for both custodial and protective forms of guardianship or custody for children in contact with the law. A juvenile who has been apprehended by the Police is kept in the police precinct separate from the adults prior to being taken before a Magistrate – where available, such as in Georgetown, the child is kept in a separated facility; when that is not possible youth are reportedly kept in a separate room in the police facility. It is the policy that juveniles who are arrested are brought before the courts at the earliest date or released into the custody of their parents or guardian, who enter into a recognizance until the hearing of the case. The Court would determine sentencing of the child following a probation report. The Court system allows for child matters to be separately addressed and/or in camera hearings to be conducted (Ministry of Social Protection and UNICEF Guyana, June 2014).

Pre-sentence procedures are conducted when the child first comes into contact with the law and is held at the holding facility or at a police station as the matter is investigated. Based on the outcome of the investigation an officer of the Probation and Social Services Department (PSSD)/Ministry of Labour, Human Services & Social Security (MLHSSS) is requested to prepare a probation report. Two options may be determined by the court, that the child be placed on probation or be put in detention. Should the child be placed on Probation, s/he falls under the supervision of a Probation and Social Services Officer (PSSO) whereas, if the child is placed in detention, the child is sent to New Opportunity Corps (NOC) and falls under the guardianship of the Ministry of Culture, Youth and Sport (MCYS) (Ministry of Social Protection and UNICEF Guyana, June 2014). Hence, there are two major institutions that host children in contact with the law: the Juvenile Holding Centre and the New Opportunity Corps (NOC) (Figure 21)13.

Figure 21: Institutions related to children in contact with the law, Guyana

The Juvenile Holding Centre should be used for the reception, care and custody of Juveniles awaiting their court appearance; Juveniles who have been committed by the courts but not escorted to the New Opportunity Corps; and Juveniles who have completed the period of their sentence and awaiting rehabilitation to their families or to the community. Meanwhile, the New Opportunity Corps (NOC) is the only juvenile correctional facility in the country. It serves to provide social rehabilitation of juveniles (males and females) between the ages 10 and 17.

3.4) Budget Allocation

The total national budget estimated for 2015 was G$163.7 billion, around US$810 million, an increase of 12% when compared to the revised 2014 budget (Government of Guyana, 2015). The expenses in the country’s national budget are divided into two categories: those conducted by the central government, and those expenses carried by the regional governments. Figure 22 depicts the monetary allocation for 2015 for those Ministries more related to children.

13 The number of children in contact with the law and the discussion on the topic is presented in chapter 13.

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Figure 22: Government Expenses divided by selected Ministries, Guyana, 2015

Source: (Government of Guyana, 2015)

Despite the fact that Guyana does not have a budgetary system that allows for monitoring social services to children, nor to monitor how services targeting boys and girls are being delivered at subnational levels (UN Committee on the Rights of the Child, 2013), using the 2015 Budget estimations it is possible to make a rough calculation that around 35% of the 2015 budget is related to expenses that could influence the situation of children14. Among those expenses, 46% of them were allocated for projects related to education (Figure 23), which are implemented by national and regional governments.

Figure 23: Categorization of expenses directly related to children, Guyana, 2015

Source: (Government of Guyana, 2015)

Considering all the values allocated for the educational sector in Guyana, around 36% is destined to “education delivery”, followed by expenses in “post-secondary education” and “secondary education” (Figure 24). Allocations for secondary, primary and nursery schools correspond to 14%, 11% and 7% of the national budget for education, respectively.

Figure 24: National Budgetary Allocation for Education, Guyana, 2015

14 The methodology identifies those areas related to children and adds their budgetary allocation. Please refer to Annex 2 for a more detailed description of the methodology used to calculate this number, the sub-projects that were used to estimate this number, and the limitations of the estimation.

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Source: (Government of Guyana, 2015)

OBS: Data includes all the expenses for the Ministry of Education (budget lines 40 and 41). Data does not include the values to be implemented by regional governments.

The second highest allocation for children is health. The biggest allocation happens in regional and clinical services managed by the national government (48% of the national budget) – this value does not consider those funds allocated directly to the regions for their own expense with health. The second highest expense is Georgetown Public Hospital, which consumes 24% of the national budget. It is important to mention that only 2% of the national budget is allocated for disability and rehabilitation projects, and around 1% to family healthcare. As it is going to be discussed through this report, both areas were considered to be vulnerable in terms of policies for children and women.

Figure 25: National Budgetary Allocation for Health, Guyana, 2015

Source: (Government of Guyana, 2015)

OBS: Data includes all the expenses for the Georgetown Public Hospital Corporation, Ministry of Health and Ministry of Public Health (budget lines 46, 47 and 43). Data does not include the values to be implemented by

regional governments.

Around 16% of the budget dedicated to children is allocated to child protection services, a value that does not correspond to the importance of this topic to the stakeholders in the country. As it is going to be discussed later in this document, child protection – involving child abuse, domestic violence, corporal punishment, child trafficking and child labour, among other topics – is considered to be one of the child related areas in Guyana where many child rights are being violated, and where massive investments in capacity building for prevention and support must be done.

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Almost 89% of the budget related to child protection goes to “Social Services” (Figure 26), which is defined in the 2015 budget as follows: to work in partnership with all Guyanese toward the empowerment of individuals and families through the elimination of poverty and inter-personal violence.” Less than 5% of the budget allocated for child protection goes to “child care and protection”15.

Figure 26: National Budgetary Allocation for Child Protection, Guyana, 2015

Source: (Government of Guyana, 2015)

OBS: Data includes all the expenses for the Ministry of Labour, Human Services and Social Sec.; and Ministry of Social Protection (budget lines 48, and 49). Data does not include the values to be implemented by regional

governments.

3.5) General Legislation for Children

Despite the fact that the provisions for child rights are guaranteed in different articles of the Country’s constitution, assessment from the Ministry of Social Protection (Ministry of Social Protection and UNICEF Guyana, June 2014) reports that the country has no consolidated law that embraces all topics related to children, rather legislation of relevance to children can be found in a number of Acts such as:

• The Status of Children Act No. 19 of 2009 • The Childcare and Protection Agency Act No. 2 of 2009 • The Protection of Children Act No. 17 of 2009 • The Criminal Law Offences Act No. 16 of 2005 • The Adoption of Children Act No. 18 of 2009 • The Prevention of Crimes (Amendment) Act No. 11 of 2008 • The Occupational Safety and Health Act No. 32 of 1997 • The Sexual Offence Act No. 7 of 2010 • The Marriage Act 2005 • The Amerindian Act 2006 • The Persons with Disabilities Act 2010 • Childcare & Development Services Act 2011 • Custody, Contact, Guardianship & Maintenance Act 2011 • Training Schools Act

15 Childcare and protection is defined in the budget document as: To prevent, reduce and alleviate abuse and neglect of children by effective interventions, procedures and programmes.

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• Juvenile Offenders Act • Employment of Young Persons Act • Probation of Offenders Act • Education Act • Registration of Births and Deaths Act, 1973

Similar situation happens in terms of public policies. Public policies exist for health, education and social welfare, but the country lacks a coordination policy that is able to connect all the policies under the umbrella of child rights. The lack of one public policy translates into lack of coordination in the system. The CPA does not have the autonomy, the capacity and the means to coordinate all the actions related to children. Similar situation faces the Rights of the Child Commission. Despite the fact that its mandate clearly defines the promotion of programmes, policies and other actions aimed at the wellbeing of the child, the RCC does not have the internal capacity to coordinate the system, nor it is its mandate to coordinate government’s actions related to children.

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Part III:

The early years: a healthy start (from conception to 5 years)

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The early years of life are crucial not only for individual health and physical development, but also for cognitive and social-emotional development. Events in the first few years of life are formative and play a vital role in building human capital, breaking the cycle of poverty, promoting economic productivity, and eliminating social disparities and inequities. Early Childhood Development (ECD) refers to a comprehensive approach to policies and programmes that should include attention to health, nutrition, education, and water and environmental sanitation in homes and communities (UNICEF, 2002).

Evidence suggests that investing in the initial years of the child brings the optimum return in terms of socio-economic benefits. For instance, for every $1 invested in the physical and cognitive development of babies and toddlers, there is a $7 return, mainly from cost savings in the future (UNICEF, 2001). For every dollar spent on immunization, studies show savings of US$6.30 in direct medical costs, and US$ 18 in indirect medical costs – losses due to missed work, death and disabilities (Zhou, et al., 2003). Besides, investments in ECD increase the chances of performing well at school, improve child’s attention, increase the child’s capacity to be resilient, and increase his/her ability to cope with stress and difficult situations (The World Bank, 2015).

The concept of investment in ECD should be seen as systemic, and it involves the areas of health, education and child and social protection. A proper environment for the development of the child should guarantee proper (i) care of the mother and the baby; (ii) access of quality water and sanitation; (iii) access to institutions that are safe and parents who are knowledgeable to help developing the initial cognitive aspects of the child; (iv) nutrition to the mother and child; and (v) registration at birth; all combined to an overall scheme where the rights of the child can be fully realized, independently of his/her socio-economic status, ethnicity or place of living.

In order to address this dynamic system, this part has four chapters that should be seen as interconnected. Chapter 4 deals with the health of the mother and the child, focusing on the main causes and determinants of maternal and child mortalities. Chapter 5 starts the discussion on HIV, presenting what is the situation in terms of prevention of mother- to-child transmission. Chapter 6 describes the situation in terms of birth registration. Chapter 7 depicts the situation of Early Childhood Education (ECE).

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Chapter 4: The Right to Health This chapter explores the connections between maternal and child health. It starts presenting the numbers related to maternal and child mortality, and then explores the main causes and bottlenecks associated with them. The reduction of Maternal and Child mortalities, and the improvements in health and decline of diseases that have to be associated with them, are the core of the third SDG Goal (Ensure healthy lives and promote well-being for all at all ages).

4.1) Maternal Mortality

A healthy start for a child’s life has to take into consideration the care that the mother receives during pregnancy, delivery and post-delivery. Maternal mortality and child mortality are interconnected. Babies whose mothers have died during childbirth have a much greater chance of dying in their first year than those whose mothers remain alive.

Guyana has identified the health of its mothers – present and potential – as the most crucial area to be addressed within the MDG Acceleration Framework (MAF) (Government of Guyana, 2014). According to the most recent estimates, Maternal Mortality in Guyana for 2015 was 229/100,000 live births, a number that has been showing signs of decrease in the past 5 years, but still higher than the 2000 value (Figure 27).

Figure 27: Maternal Mortality Ratio estimation, Guyana, 2000-2015

Source: (WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division, 2015)

4.2) Child Mortality

Based on the 2014 MICS data, the infant mortality rate (IMR) is 32 per 1,000 live births, showing a small reduction

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when compared to 2000. Under-five mortality (U5MR) has also been reduced over the years, reaching 39/1,000 live births in 2015 (Figure 28), compared to 47/1,000 in 2000 (Figure 28).

Figure 28: Trends in Mortality Rates, Guyana, 2000-2015

Source: Estimates generated by the UN Inter-agency Group for Child Mortality Estimation (IGME) in 2015, available at http://data.unicef.org

Most of the deaths related to children younger than 5 years (around 59% of them) occur in the neonatal period, i.e., between birth and the first month of life (Table 9). There are some differences in the probability of dying among children up to age five years based on certain background characteristics, such as place of residence, mother’s education, and ethnicity (Table 10).

Table 9: Early childhood mortality rates, per 1,000 live births, Guyana, 2014

Mortality Rate Definition Value (/1000 live births) Neonatal mortality (NN):

Probability of dying within the first month of life 23

Post-neonatal mortality (PNM):

Difference between infant and neonatal mortality rates

Infant mortality: Probability of dying between birth and the first birthday

Child mortality: Probability of dying between the first and the fifth birthdays

Under-five mortality: The probability of dying between birth and the fifth birthday

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

In looking at the data (Table 10), the difference between coastal and interior areas has to be seen carefully. At first sight, U5MR was 41/1000 for coastal areas, and 33/1000 for the interior (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015), generating a discrepancy with other socio-economic indicators that would suggest that the situation in the interior was worse than the situation in the coast. Nevertheless, in disaggregating the data by urban and rural coastal, the rural part is responsible for the majority of the child mortality deaths. Another important observation to be further investigated is the fact that in the interior areas of Guyana, the post-neonatal deaths are

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higher than the neonatal deaths. In other words, children are surviving birth, but are dying before completing their first birthday. The same situation is seen mainly with the Amerindian population. While in general the U5MR for this group is below the country’s average, most of the child deaths for the Amerindians will occur after the first month of life16.

Table 10: Early Childhood mortality rates, per 1,000 live births, by different geographical areas, Guyana, 2014

Neonatal mortality rate

Post-neonatal mortality rate

Infant mortality rate

Child mortality rate

Under-five mortality rate

Guyana 23 9 32 8 39

Area Urban 6 1 7 4 11 Rural 28 11 39 9 48

Coastal 27 8 35 6 41 Urban Coastal 7 0 7 0 7

Rural Coastal 34 10 45 9 53 Interior 7 13 20 13 33 Ethnicity East Indian 43 5 48 6 55 African 15 9 24 4 29 Amerindian 3 15 18 12 30 Mixed Race 15 9 24 4 29

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

There is no difference in terms of neonatal mortality between the poorest 40% population, and the richest 60%. Nonetheless, mother’s education level appears to play a major role in limiting childhood mortality. All the indicators of childhood mortality are much higher among children whose mothers only have primary education compared to those whose mothers have secondary or higher education (Figure 29). For example, neonatal mortality, infant mortality and under-five mortality rates among children with mothers with primary education are over three times higher than those with mothers with secondary or higher education.

16 Despite all the methodological robustness of the method, disaggregated mortality estimations are subjected to large confidence intervals and conclusions must be taken cautiously.

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Figure 29: Early Childhood mortality rates by mother’s education, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

4.3) Main causes related to maternal and child mortality

Figure 30 summarizes different causes that combined could be associated with maternal and child deaths in Guyana. These causes are then arranged in a causal tree in Figure 31, where the immediate, underlying and structural causes are then identified.

Figure 30: Group of possible causes for maternal and child deaths

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Figure 31: Causality Analysis for Maternal and Child Mortalities in Guyana

Source: based on (UNICEF, 2009)

In terms of maternal mortality, these causes could be divided into two groups: first, those that are directly related to obstetric complications during pregnancy. Around 73% of the maternal deaths in 2012 were direct maternal deaths17, i.e., those resulting from obstetric difficulties of the pregnant state (pregnancy, delivery, and postpartum), interventions, omissions, incorrect treatment, or a chain of events resulting from any of these (Government of Guyana, 2014).

The second group is related to indirect obstetric deaths that occur due to either previously existing conditions or from complications arising in pregnancy, which are not related to direct obstetric causes but may be aggravated by the physiological effects of pregnancy. These include such conditions as HIV and AIDS, malaria, anaemia and cardiovascular diseases (UNICEF, 2009). Indirect causes were responsible for 27% of the deaths in 2012 (Figure 32).

Figure 32: Direct and Indirect number of maternal deaths, 2010-2012

Source: 2014 MDG Report (Government of Guyana, 2014)

17 Estimates available for 2015 do not allow for this disaggregation.

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Both direct and indirect causes could be seen under two lenses. First, in terms of services, many deaths could be avoided if quality services for pregnant women were available. In reality, taking congenital factors outside the equation, most of the deaths could have been avoided if appropriate care of pregnant women, attention at birth and care post-partum and in the initial stages of life of the new-born were available for all pregnant women in the country. Moreover, the fact that 59% of the under five mortality deaths happens in the first month after delivery indicates that the poor quality of prenatal, delivery and postnatal care is also connected to high levels of neonatal mortality in the country. For instance, neonatal sepsis, congenital anomalies, birth asphyxia and prematurity could all be reduced with appropriate access to quality maternal health services (antenatal and delivery care, including a clean delivery environment).

Second, some of the causes are directly and/or indirectly associated to personal characteristics of the mother, i.e., to their nutritional status; their health situation; to the quality of the environment of where they live (including access to proper water and sanitation); and to the access to government supplies, among others. These are influenced by the structural and underlying causes depicted in Figure 31, but also directly influence the chances of morbidity (immediate causes).

For child mortality, when looking at the direct causes of death between birth and 12 months (Figure 33), respiratory infections, nutrition and other factors that are independent – but maybe consequence – of the ANC, delivery and PNC periods start showing up as important immediate and underlying causes of child mortality. In this sense, the same service and personal characteristics lenses that were seen related to maternal mortality also apply to child mortality. Similar socio and economic structural conditions that will negatively impact in the chances of mothers to die during delivery and postnatal periods will influence the child’s propensity of dying before the age of five. The next subsections explore the different causes in more details.

Figure 33: Leading causes of infant mortality, Guyana, 2005-2008

Source: (PAHO, 2012)

A) Obstetric Risks and Inadequate Health Care

While obstetric risks are considered to be immediate causes of Maternal and Child mortalities, these risks are caused by inadequate access to good quality health care, especially prenatal care, delivery and post natal care.

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Antenatal Care

The antenatal period is essential to prevent complications during pregnancy and at births, to prevent HIV transmission from the mother to the child, and to monitor the health and nutritional status of the mother and the baby. Antenatal care is available in Guyana at different levels of the health care system. Although differences still exist between the coastal and hinterland regions in Guyana, the national antenatal coverage rate has been above 90% since the year 2000 (Government of Guyana, 2014). According to the 2014 MICS, nine in ten mothers (91%) received antenatal care more than once and a vast majority of these had at least four visits (87%).

As other indicators, antenatal care oscillates depending on the region where the mother lives, her economic status, and her ethnicity. As depicted in Figure 34, in two out of the ten regions, 9% of the pregnant women did not have any prenatal care. On Region 1, only 67% of the women had the recommended four or more antenatal care visits.

Figure 34: Percentage of pregnant women without any prenatal care, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Also, as shown in Figure 35, those mothers who live in the interior part of the country have three more times the chance of not having access to prenatal care than those women who live in the coastal part of Guyana. Almost 4% of the poor women did not have access to prenatal care in comparison to the women in the richest quintile, and almost 6% of the Amerindian women did not see a doctor before delivering their babies. In reality, only 77% of the Amerindian women had four or more prenatal visits, in comparison to 90% of the East Indian mothers.

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Figure 35: % of women with no prenatal care by different characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Table 11 shows a much stronger disparity that affects the most vulnerable populations, the percentage of mothers who attend antenatal care provided by a skilled provider. Common with the other indicators, those mothers in the interior of the country, in the poorest households and from the Amerindian families are not seen by medical doctors, nurse/ midwifes, single midwifes or Medex – all considered to be skilled providers – at the same rate as other populations.

Table 11: Access to prenatal care, Guyana, 2014

% antenatal care provided by skilled

provider

% antenatal care provided by non skilled

provider

% with no prenatal care

Urban 98.1 0.7 1.1 Rural 88.4 8.8 2.8 Coastal 97.2 1.2 1.7 Urban Coastal 98.7 0.8 0.6 Rural Coastal 96.6 1.4 2 Interior 66.7 28.1 5.3

Poorest 75.7 20.5 3.9 Second 94.9 2.2 3 Middle 96.8 0.9 2.3 Fourth 98.9 0.5 0.6 Richest 99.1 0.5 0.4

East Indian 97.3 1.4 1.3 African 98.5 0.1 1.3 Amerindian 58.5 35.5 5.9

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% antenatal care provided by skilled

provider

% antenatal care provided by non skilled

provider

% with no prenatal care

Mixed Race 91.3 5.3 3.3

Country 90.8 6.9 2.4

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

While rates of prenatal care are high, access at the correct period of pregnancy – first trimester – is not being achieved. Almost 45% of the pregnant women have their first doctor visit after the initial three months of pregnancy (Figure 36), opening a window for problems to occur during pregnancy.

Figure 36: Time of first antenatal care visit, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Delivery

Overall, skilled personnel delivered almost 92% of births that occurred in the two years preceding the 2014 MICS survey. Historically, that number was around 80% in the year 2000, and has been higher than 90% since 2005 (Government of Guyana, 2014).

Despite the elevated proportion of births being delivered by skilled health personnel, the Government of Guyana admits that addressing insufficient obstetric and gynaecological capacity in the public health sector remains a bottleneck - for instance, in 2011, only six obstetricians were present in the entire public health system in Guyana (Government of Guyana, 2014). Besides, in 4 out of the 10 regions in the country, the presence of skilled health professionals during birth have values below the national average of 92.4% (Figure 37). The presence of skilled birth attendants is low for those populations living in the interior of the country, those from the poorest families, and those mothers coming from an Amerindian background.

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Figure 37: Percentage of births delivered by skilled providers, Regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 38: Percentage of births delivered by skilled providers, socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Most of the assistance at delivery is provided by nurses/midwives, followed by doctors (Figure 39).

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Figure 39: Person assisting at delivery (%), Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Regarding place of delivery, in Guyana, in the two years preceding the 2014 MICS, 93% of births were delivered in a health facility – 79% of deliveries occurred in public sector facilities and 14% in private sector facilities. 6% of the births happened at home. As with the other indicators, deliveries at home are higher in Regions 1 (15.2% of the births) and 7 and 8 (31.6% of the births). Deliveries at home are quite high in the interior area of the country (around 25%), and among the Amerindian mothers (34% of the deliveries). In terms of wealth, while no birth among the mothers in the richest families happened at home, almost 19% of the births in the poorest populations happened at their residence (Figure 40).

As it is going to be discussed later in this chapter, delivery at home are influenced by cultural factors, but also by the distance that mothers have to travel to access health facilities, the lack of access to these facilities (mothers have to travel by boat or in poor road conditions), and, consequently, by the direct and indirect costs that are associated with the delivery.

Figure 40: Percentage of births that happened at home, socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

In 2011, the Georgetown Public Hospital Corporation (GPHC), which is the national referral hospital for obstetric cases, accounted for 41% of all deliveries nationally, with a total of 5,497 live births. Due to the high number of

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deliveries, most of the maternal deaths also occurred in the same hospital – around 74% of the maternal deaths in 2011, and 59% in 2012.

Despite the elevated number of births that take place in health facilities, the statistics do not take into account the standard of care available at the delivery facilities. As reported by the Ministry of Public Health, all high-risk and emergency cases have to be referred to GPHC due to the lack of adequate resources at regional level institutions. An assessment carried out by the Ministry of Public Health in collaboration with UNFPA established for the first time the national baseline data on availability, use, and quality of emergency obstetric and new-born care (EmONC) services as recommended by the WHO, UNICEF, and UNFPA. The report suggested that the number of facilities providing EmONC in Guyana is inadequate and that this is compounded by issues regarding competence and skills of health personnel, and provision of equipment, which undermine the quality of emergency care provided nationwide (Government of Guyana, 2014).

Post Natal care

Postnatal care usually involves 3 visits to the doctor within six weeks of delivery. Increased emphasis on the importance of post-natal care, recommending that all women and new-borns receive a health check within two days of delivery. Post-natal care visits (PNC) refer to a separate visit by any health provider to check on the health of the new-born and provide preventive care services. PNC visits do not include health checks following birth while in facility or at home.

Despite the fact that health checks following birth were conducted for nearly all deliveries taking place in health facilities in Guyana (93% of the babies and 92% of the mothers receive a health check after delivery), the level of postnatal care (PNC) visits for children and mothers is quite low: on average 52% of the babies did not have a postnatal care visit following their birth, and most likely they saw a health provider once it was time for their first vaccine. For the mothers, the situation is actually worse: almost 68% of the mothers who delivered in health institutions did not come back for a follow up visit with a health provider.

On the contrary of other health indicators, as depicted in Figure 41, there is no much oscillation in terms of postnatal visit when socio-economic characteristics are taken into consideration. Four regions are above the national average in terms of babies not coming back for postnatal visits, and three of them have rates higher than 65%: Regions 10, 3 and 6 (Figure 42).

Figure 41: Percentage of babies with no postnatal visit, socio-economic characteristics, Guyana, 2015

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

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Figure 42: Percentage of babies with no postnatal visit, regions, Guyana, 2015

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

B) Diseases and Infections

Diseases and infections can directly and indirectly contribute to the death of mothers-to-be and children before the age of five. The main diseases and infections identified in Guyana are related to diarrhoea, acute respiratory infections (ARI) and malaria. HIV is also a major disease that jeopardizes the health of children and mothers. HIV related to prenatal and delivery is discussed in chapter 5.

Diarrhoea

Diarrhoea is a leading cause of death among children under five worldwide, and it also relates to child and maternal deaths in Guyana. Most diarrhoea-related deaths in children are due to dehydration from loss of large quantities of water and electrolytes from the body in liquid stools. Management of diarrhoea – either through oral rehydration salts (ORS) or a recommended home fluid (RHF) – can prevent many of these deaths.

On average, 8% of the mothers interviewed for the MICS survey mentioned that children between 0 and 60 months had episodes of diarrhoea in the two weeks preceding the interview18, a number that does not show much improvement if compared to 2006, when around 9% of the mothers have reported their children presenting diarrhoea (Bureau of Statistics and UNICEF Guyana, 2008). The 2014 rate varies considerably depending on the area where the child lives, the poverty status of the family and his/her ethnicity. For instance, children living in the interior of the country have three times more chance of having diarrhoea than those living in urban areas. Similarly, 21% of the children living in Amerindian communities had diarrhoea (Figure 43). Episodes of diarrhoea are also more frequent in Regions 7, 8 and 9 (Figure 44).

18 As warned by the MICS report: These results are not measures of true prevalence, and should not be used as such, but rather the period- prevalence of those illnesses over a two-week time window (Bureau of Statistics, Ministry of Health and UNICEF Guyana, April 2015).

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Figure 43: Percentage of children who in the last two weeks had an episode of diarrhoea, by area and socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 44: Percentage of children who in the last two weeks had an episode of diarrhoea, by region, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Cases of diarrhoea are directly related to access to proper water and sanitation, and to hygienic habits in the family. As explored previously, access to improved sources of drinking water and improved sanitation are smaller for those families living in the interior of the country, for the poorest families, and the Amerindians: the same three characteristics that surround those families whose children under 5 present the higher episodes of diarrhoea. According to the 2014 MICS results, 61% of the mothers who reported their children had diarrhoea looked for advice from a health facility. Number can be low since mothers might not see the need to look for medical advice as the condition might happens

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frequently, and, consequently, be considered normal. Overall, 43% of children with diarrhoea during the two weeks prior to the survey received ORS: 27% received fluids from ORS packets and 25% from pre-packaged ORS fluids. Children in interior areas (52%) are more likely to have received ORS than those in coastal areas (36%). Treatment with ORS was similar regardless of sex of the child and socio-economic status of the household (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).

Acute Respiratory Infection (ARI)

Globally acute respiratory infection (ARI) is one of the leading causes of death in children under five. In Guyana, 31% of the children dying below the age of 1 are related to respiratory infections, and 5% were identified as ARI (Figure 33 on page 40). Among different acute respiratory diseases, pneumonia is the most serious for young children. Identification of cases of pneumonia and other respiratory infections are limited since suspected cases might not be real cases. In the two weeks preceding the 2014 MICS survey, 2.2% of children between 0 and 59 months were identified as having symptoms related to ARI19. Suspected cases of ARI were four times higher in the interior of the country (4.1% of the children) then the urban areas (0.8%). Also, children in the poorest quintiles have three times more chance of having symptoms of ARI than those children in the richest quintiles (3.3% and 0.7%, respectively). In terms of ethnicity, 4.5% of the children living in Amerindian families presented ARI symptoms, the highest number among all ethnicities identified in the country.

Eighty-four per cent (84%) of children aged 0-59 months with symptoms of ARI were taken to a qualified provider. The great majority of these children were taken to a public health facility (77%), while much smaller proportions were taken to a private health facility (12%) or a community health provider (10%). Overall, 31% of children with ARI symptoms were given antibiotics (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).

ARIs are caused by viruses and bacteria, which are almost impossible to avoid. Nonetheless, certain risk factors increase the chances of young children to develop the infection. Poor water and sanitation in the households, and the lack of hygiene at home can increase the chances that children are affected by respiratory infections. Also, the fact that some children are not fully vaccinated can weakness the immune system, increasing the chances that common respiratory infections can develop into more severe diseases. The nutritional status of the child (subject to be explored later) also determines the chances of developing a more serious respiratory infection: malnourished children have higher chances of developing serious ARI (Cunha, 2000).

All these factors are somehow present in Guyana. Those children living in poor families, in the interior of the country, and/or coming from Amerindian families have higher chances to be susceptible to stronger infections and, consequently, have their health affected to the point where they are in danger of dying.

Malaria

In Guyana, the coastal areas are considered to be malaria-free, while the interior is considered to be a high-risk malaria area, affecting mainly the indigenous and mining populations. According to the World Malaria Report (WHO, 2014), the number of cases in Guyana has increased between 2000 and 2013 (Figure 45). As a matter of fact, among all the countries in the Americas, Guyana and Venezuela were the only two that registered an increase in incidence in the period. The country has registered 31,478 presumed and confirmed cases of malaria in 2013.

19 According to the MICS report: A child was considered to have had an episode of ARI if the mother or caretaker reported that the child had, over the specified period, an illness with a cough with rapid or difficult breathing, and whose symptoms were perceived to be due to a problem in the chest or a problem in both the chest and a blocked nose. While this approach is reasonable in the context of a MICS survey, these basically simple case definitions must be kept in mind when interpreting the results, as well as the potential for reporting and recall biases. (Bureau of Statistics, Ministry of Health and UNICEF Guyana, April 2015)

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Figure 45: Number of presumed and confirmed malaria cases, Guyana, 2000-2013

Source: (WHO, 2014)

In terms of prevention, the 2014 MICS results indicate that 5% of households have at least one insecticide treated net (ITN), a decrease of 20 percentage points when compared to 2009 – the 2009 DHS had indicated that 25.6% of the households had at least one ITN (Ministry of Health, Bureau of Statistics and USAID, Oct 2010). Other important indicators also show decline in use of ITNs; for instance the percentage of children under age of 5 who slept under and ITN in the previous night was reduced from 32% in 200620, to 24% in 200921, and finally to 7.4% in 201422; and the percentage of pregnant women who had slept under an ITN was reduced from 32% to 7% between 2009 and 201423. These declines need to be further investigated. One possible reason for the decline in the use of ITNs might be the impression that as malaria cases have been reduced, the use of ITNs was not necessary anymore. In fact, the pick of use of ITNs coincide with the low number of malaria cases reported in the country (Figure 45), giving the impression that malaria was under control. After that, as fewer people were sleeping under ITNs, cases have increased reaching a new peak in 2013 when.

The 2014 MICS results also indicate that 30% of households in the interior areas have at least one ITN and 16% have at least one ITN for every two household members. Availability of ITNs at the household level is most prevalent in Regions 1, 7, 8 and 9, with more than one-half of households with at least one ITN (53%), and just over one-quarter of households with at least one ITN for every two persons (27%). The high percentages of ITN availability in the poorest households and households with an Amerindian household head are indicative of the concentration of these households in the high-risk interior areas.

Similar to ARI, identification of malaria is not straight forward, and many times it is confused with fever. Around 14% of children 0 to 3 years of age had episodes of fever during the two weeks preceding the 2014 MICS survey. Advice was sought from a health facility or a qualified health care provider for 71% of children with fever. In high-risk interior areas, advice or treatment was sought from a health facility or provider for 81% of children with fever, a much higher figure than that in coastal areas (66%), possibly reflecting the risk of malaria in case of fever. In interior areas, advice or treatment was sought from a community health provider for a large percentage of children (21%), after public health facilities (78%).

Children living in the poorest households and those whose mother have only primary education are more likely to

20 2006 MICS 21 2009 DHS 22 2014 MICS 23 Numbers for 2006 were not available.

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seek advice or treatment than those in wealthier households and those whose mother have secondary or higher education.

Overall, 12% of children with a fever in the previous two weeks had blood taken from a finger or heel for testing. As expected, the proportion of children tested for malaria is higher in interior areas (23%) than in coastal areas (6%), and in the rural areas (13%) than in the urban areas (8%). Nearly one-third of children in the high-risk Regions 1, 7, 8 and 9 were tested for malaria (31%), a much higher figure compared to other regions. It is noteworthy, however, that one in ten children with a fever in Region 4 were tested for malaria.

Malaria is not the only mosquito transmitted disease that can affect children in the country. Due to the constant migration that happens in the borders of the country, vector-transmitted diseases that are present in other territory are easily carried to Guyana. Also, the country is vulnerable to a range of natural and human-caused disasters that can be exacerbated by climate change. These factors contribute to increases in vector-borne diseases that are endemic in some areas of the country. For instance, dengue fever has been on the increase. There were 1,468 cases recorded in 2010, up from 258 in 2006; there was one recorded death in the period, due to dengue haemorrhagic fever (PAHO, 2012). Additionally, the most recent threat in terms of vector-borne diseases is the Zika virus. The outbreak that took place in Brazil in 2015 has reached Guyana, with some cases of the diseases officially confirmed early 201624.

C) Nutrition

The nutritional status of pregnant women and children is an immediate cause of maternal and child deaths, and also aggravates the health status indirectly contributing to the precarious health status of some mothers and children. Inadequate nutrition before birth and in the first years of life can seriously interfere with brain development and lead to neurological and behavioural disorders (UNICEF, 2002). Even when nutrition is not directly responsible for deaths, a deficient nutritional status negatively influences other diseases, aggravating the physical and cognitive condition of boys and girls.

Guyana has met the MDG target of halving the proportion of people suffering from hunger (Government of Guyana, 2014), nonetheless, a considerable percentage of children still suffer nutritional problems in the country. The challenge now is to reach the new targets set by the Sustainable Development Goals, which claims for ensuring access to safe, nutritious and sufficient food (SDG Target 2.1) and to end all forms of malnutrition, including stunting, while addressing the needs of adolescent girls, pregnant and lactating women (SDG Target 2.2). In order to reach those targets, the government has been revising the 2002 Food Based dietary Guidelines, focusing on reducing the impact of iron deficiency anaemia, emphasizing the importance of breastfeeding, and addressing the emerging treat of non- communicable diseases, among others.

Around 9% of children under age of five in Guyana are moderately or severely underweight and 2% are classified as severely underweight (definitions in the box below). 12% of the children are stunted (too short for their age), and 3.4% are severely stunted. 6.4% are considered to be wasted, or too thin for their height, being 1.7% considered severely wasted. 5.3% of children are considered to be overweight for their age (Table 12).

24 Source: http://www.who.int/csr/don/20-january-2016-zika-guyana-barbados-ecuador/en/ Accessed on January 25, 2016.

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BOX: Nutrition measures

Weight-for-age (underweight) is a measure of both acute and chronic malnutrition. Children whose weight- for-age is more than two standard deviations below the median of the reference population are considered moderately or severely underweight while those whose weight-for-age is more than three standard deviations below the median are classified as severely underweight.

Height-for-age (stunted) is a measure of linear growth. Children whose height-for-age is more than two standard deviations below the median of the reference population are considered short for their age and are classified as moderately or severely stunted. Children whose height-for-age is more than three standard deviations below the median are classified as severely stunted. Stunting is a reflection of chronic malnutrition as a result of failure to receive adequate nutrition over a long period and recurrent or chronic illness.

Weight-for-height (wasted) can be used to assess wasting and overweight status. Children whose weight- for-height is more than two standard deviations below the median of the reference population are classified as moderately or severely wasted, while those who fall more than three standard deviations below the median are classified as severely wasted. Wasting is usually the result of a recent nutritional deficiency. The indicator of wasting may exhibit significant seasonal shifts associated with changes in the availability of food or disease prevalence.

Table 12: Percentage of children under age 5 by nutritional status, Guyana, 2014

Moderately Severely Underweight 8.5 2.2

Stunted 12 3.4

Wasted 6.4 1.7 Overweight 5.3 -

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Stunting should be seen as a major concern for the country. A child who is stunted often appears to be normally proportioned but is actually shorter than normal for his/her age. Stunting starts before birth and is caused by poor maternal nutrition, poor feeding practices, poor food quality and frequent infections that can slow down growth. Stunting is not reversible after a certain age; hence, to have an impact on stunting levels, nutrition interventions need to be targeted to women during pregnancy and to children from birth to 18 months of age.

At short term, stunting increases the chances of death among children between the ages of 0 and 5; and decreases his/ her cognitive, motor and language developments. At long term, stunting is related to obesity, low school performance and low learning capacity, and, consequently, low work skills and productivity (Stewart, CP; et al , 2013).

As depicted in Table 13, compared to other regions, greater proportions of children in Regions 7 & 8 and 9 are found to be moderately or severely underweight (12%) and moderately or severely stunted (27-28%). Regions 7 & 8 also have the highest proportions of children who are severely underweight, with 5%, as well as severely stunted, with 11%. In contrast, the percentage wasted is highest in Regions 3 and 6 (9%). While the differences are relatively small for underweight and wasting prevalence between the areas of residence for both urban-rural and interior-coastal disaggregation, as it relates to stunting, children in interior areas (20%) are twice as likely as those in coastal areas (10%).

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Box: Feeding Programmes

Guyana has a National School Feeding Programme that seeks to address the issues of nutrition and stunting, specifically in the hinterland region. The National School Feeding Programme supplies biscuits and fruit drinks (for Region 9 it also supplies Peanut butter and cassava bread), and targets all Nursery and Primary Level Schools (up to Grade 2). As of April of 2016, more than 45,000 boys and girls were beneficiaries of the programme. In 2016 government has also started a pilot community based school feeding (hot meal programme) with selected Nursery and Primary schools within the Buxton/Friendship and Enmore communities.

Table 13: Nutritional status by Region, Guyana, 2015

Region Underweight Stunted Wasted Overweight Barima-Waini 6.2 18.4 3.3 7.1 Pomeroon-Supenaam 4.3 15.2 3.6 8.6 Essequibo Islands-West Demerara

9.3 11.8 8.7 5.5

Demerara-Mahaica 7.8 9.4 5.8 5.4 Mahaica Berbice 9.4 11.3 6.2 3.8 East Berbice-Corentyne 10.1 8.4 9.1 4.2 Cuyuni-Mazaruni & Potaro- Siparuni

11.6 28 5.3 7.3

Upper Takutu-Upper Essequibo

11.6 26.6 6.5 4.1

Upper Demerara-Berbice 5.8 9.5 4.2 3.4

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Household wealth is clearly associated with the nutritional status of children relative to underweight, stunting, and wasting: as household wealth and mother’s education increase, the likelihood of the children to be moderately or severely underweight, stunted, and wasted decreases. As depicted in Figure 46, those children living in poor families and those living in the interior of the country have double the chances of being stunted than the national average. Besides, one in every four Amerindian children could be considered as suffering of stunting. A higher percentage of children aged 0-5 months are severely undernourished according to all three indices in comparison with older children.

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Figure 46: % of children moderately stunted by socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

The nutritional status of children and women are determined by immediate, underlying and structural causes that involve, among others: (i) Low Birth Weight; (ii) inadequate dietary intake – which should start from breastfeeding; (iii) constant diseases that weakness the children; and (iv) household food insecurity – determined by the economic conditions that family has, among others (Figure 47).

Figure 47: UNICEF’s conceptual framework for nutrition

Source: Based on (UNICEF, 1998)

(i) Low Birth Weight (LBW). Weight at birth is a good indicator not only of a mother’s health and nutritional status but also the new-born’s chances for survival, growth, long-term health and psychosocial development. Low birth weight (defined as less than 2,500 grams) carries a range of grave health risks for children. Babies who were undernourished

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in the womb face a greatly increased risk of dying during their early days, months and years. Those who survive may have impaired immune function and increased risk of disease; they are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life. Children born with low birth weight also risk a lower IQ and cognitive disabilities, affecting their performance in school and their job opportunities as adults (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).

On average, according to the 2014 MICS, 14% of the infants who were weighted after birth were born with low weight, a number that is smaller than 2006 figures – recorded as 19% by the 2006 MICS (Bureau of Statistics and UNICEF Guyana, 2008) –, but slightly higher than the rate collected by the DHS survey in 2009 (13.2%). In 2014, low birth weight does not oscillate much in terms of economic status – for instance, LBW for those children born in poor families was 15.4% in comparison to 11.2% in the richer families; and ethnicity – LBW for Amerindian children was 16.4% in comparison to 14% in the East Indian populations. The same holds true when the region where the child is born is taken into consideration: the highest incidence of LBW happens in Region 9 with 18% of the children being born with this condition, and the lowest incidence happens in Region 2 and 10, with 11.2% of the children being born with less than 2,500 grams.

While the low oscillation seems to indicate some structural problems in the country related to poverty and social norms interfering with access to food and quality of health, underreporting might also interfere with the numbers, indicating possible issues related to measurement and quality of data. Proper measurement of weight at birth is an issue that should be taken into consideration when LBW is analysed. According to MICS, while only 6% of the births in Guyana were not weighted at birth, that average hinders some important regional and socio-economic disparities. In Region 1, almost 20% of the boys and girls who were born did not have their weight measured, and for those children born in the interior of the country the number reaches 11.4% of the births. For those boys and girls born in poor families, 10% were not weighted when they were born. The number for those born in Amerindian families is much higher: 16%. All these numbers point to the fact that the numbers related to LBW might actually be higher than the ones registered, especially among the most vulnerable socio-economic situations.

The main direct causes of low birth weight are primarily connected with the mother’s poor health and nutrition. In this sense, three factors have most impact: the mother’s poor nutritional status before conception, short stature (due mostly to under nutrition and infections during her childhood), and poor nutrition during pregnancy.

(ii) Inadequate dietary intake. Proper feeding of infants and young children can increase their chances of survival; it can also promote optimal growth and development, especially in the critical window from birth to two years of age. For the 0 to 5 age group, proper feeding includes breastfeeding and, later, proper access to balanced and nutritional meals. Exclusive breastfeeding for the first six months of life and sustained breastfeeding up to two years of age protect children from infection, provides an ideal source of nutrients, and is economical and safe. However, many mothers don’t start to breastfeed early enough, do not breastfeed exclusively for the recommended six months or stop breastfeeding too soon (UNICEF, 2013a). UNICEF and WHO recommend that infants be breastfed within one hour of birth, breastfeed exclusively for the first six months of life and continue to be breastfed up to two years of age and beyond (WHO, 2003).

On average, 89% of the children born in Guyana between 2012 and 2014 were breastfed (Figure 48). Among the children who were breastfed, only 23% of the children between 0 and 5 months of age were exclusively breastfed – for infants aged 0-5 months, exclusive breastfeeding is considered as age-appropriate feeding.

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Figure 48: Percentage of children who were ever breastfed by socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Another component that influences malnutrition is related to proper feeding of children and adults through diverse feeding. According to the 2014 MICS, 65% of the children between 6 and 23 months of age had received the minimum dietary diversity (67% among boys and 64% among girls)25. The minimum dietary diversity (MDD) will vary depending on (i) the region – Region 9 has the smaller number of boys and girls with proper MDD (40%), in comparison to Region 2 (83%); (ii) the area where the children live – children in the interior have 60% of MDD compared to 71% in urban areas; (iii) mother’s education – 38% of the children from non-educated mothers will have a minimum dietary diversity in comparison to 87% from mothers who have higher education; (iv) the poverty status – 55% of children from the poorest families will have the minimum diet in comparison to 77% of the children living in the richest families; and (v) the household ethnicity – 54% of the children from Amerindian families will have the minimum dietary diversity in comparison to 66% of other ethnicities.

Iodine Deficiency Disorders (IDD) is the world’s leading cause of preventable mental retardation and impaired psychomotor development in young children. In its most extreme form, iodine deficiency causes cretinism. It also increases the risks of stillbirth and miscarriage in pregnant women. Among those households in which salt was tested in 2014, in almost 52% of them salt was not iodized. Use of iodized salt was lowest in Region 9 (3%) and highest in Regions 3 and 7 & 8 (27% in each case). There are no notable urban-rural and coastal-interior differences in terms of iodized salt consumption. The richest households are twice as likely as the poorest households to consume iodized salt (26% and 13%, respectively) (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).

Inadequate food intake also results in high levels of anaemia in the population. Although there are other causes, anaemia is most often a reflection of micronutrient deficiencies. Micronutrient deficiencies pose a serious public health problem in developing countries such as Guyana (Ministry of Public Health and the Pan American Health Organization, Dec 2013). Even subclinical deficiencies of these micronutrients can impair health as well as intellectual development of individuals. Hence, there is a wider impact of micronutrient deficiency on a nation’s economy, as communities and entire countries become trapped in a cycle of poor health, poor education, poor productivity and persistent poverty.

25 According to the MICS, minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables.

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Anaemia is a direct and indirect cause of maternal mortality. In general, 41% of the pregnant women surveyed in 2014 were considered anaemic (Table 14). The high levels in the coastal and in urban areas might be associated with the life style and the eating habits that women have in these areas.

Table 14: % Anaemia among pregnant women, Guyana, 2012

Area Normal Anemic Urban 59.1 40.9 Coastal rural 54.9 45.1 Hinterland 65.9 34.1 All 58.7 41.3

Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)

Anaemia during pregnancy can also be avoided by the intake of vitamins and supplements. In 2012, iron supplements were being used by 54.6% of antenatal women. When asked the main reasons for not being taking iron, the majority of pregnant women answered that they did not think it was necessary (17%). 16% of the interviewed women mentioned they did not start since they did not get it at the clinic yet. It is not known if the lack of access was due to lack of interest in getting the supplements, lack of knowledge that they would benefit from it, or lack of supplies to be distributed to those that needed it. All health facilities provide free supplements to pregnant women. However, pregnant women in hinterland areas appear to utilise the free supplements received while those from coastal rural and urban areas have a tendency to purchase the supplements, such as Feroglobin/Pre-natal supplements at a pharmacy (Figure 49).

Figure 49: Source of Iron Supplements for pregnant women taking Iron Supplements, Guyana, 2012

Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)

In terms of children, 24% of boys and girl between 0 and 5 years-old were considered anaemic in 2014. Despite the fact that the gap between the urban, coastal rural and hinterland are not so distant from the country’s average (Table 15); the hinterland is the area that presents the higher levels of anaemia among children. It is important to flag the difference between children and pregnant women in terms of anaemia prevalence in the hinterland. As depicted in Table 14, pregnant women in the hinterland presented the smaller levels of anaemia.

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Table 15: % Anaemia among children 0 to 5 years of age, Guyana, 2012

Area Normal Anemic Urban 78.2 21.8 Coastal rural 74.1 25.9 Hinterland 73.4 26.6 All 76.0 24.0

Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)

The difference in anaemia levels between children and mothers-to-be could be explained by the fact that lower percentages of children are taking extra iron in the hinterlands than in the other two areas (urban and coastal rural) (Figure 50). One of the possible causes for that is the financial barrier that families might have in accessing iron supplements. 90% of the families that provide supplements for their children had to buy them in pharmacies (Ministry of Public Health and the Pan American Health Organization, Dec 2013).

Figure 50: Percentage of Children 0-5 taking extra iron, by selected area, Guyana, 2012

Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)

Despite the fact that for the three groups investigated in the 2012 Anaemia Survey, anaemia is smaller than 1997 (Figure 51), the rate of reduction between children and pregnant women is quite different. While the reduction for children between 0 and 5 was 50% and for the primary school group was 62%, for pregnant women anaemia was reduced by 21%. This difference indicates that changes in the prenatal scheme in the country are necessary in order for the proper nutrition of mothers and new-born babies to be fulfilled.

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Figure 51: Percentage of selected population with anaemia, Guyana, 1997 and 2012

Source: (Ministry of Public Health and the Pan American Health Organization, Dec 2013)

In terms of eating habits, survey conducted in 2013 (Ministry of Public Health and the Pan American Health Organization, Dec 2013) showed that the group of foods which young children were consuming most frequently was Foods Made with Flour (85.7%), which included bread and roti. Chicken was eaten frequently by 67.6%, Egg by 43.3% and Fish by 42.7%. Green leafy vegetables such as spinach and pak choi were consumed frequently by 33.1%. 27.2% of the children between 0 and 5 years old were having Beans, Peas and Lentils frequently and 20.0% had nuts at least three times per week.

Box: Eating habits at the indigenous communities

In terms of Nutrition, many Indigenous Communities have their own staple diet. They would eat fish, which is rich in protein, cassava bread and fruits from their farms. Hence the Hinterland communities have a pretty healthy diet as against persons living in the Coastal Regions. However, many young children lack calcium in their diet, as much emphasis is not placed on milk because it is expensive. Thus, many children are prone to fractures because of the lack of calcium.

D) Access to Immunization

Most common vaccine-preventable diseases remain under control in Guyana (PAHO, 2012); nonetheless, around 22% of children aged 24-35 months were not fully vaccinated against vaccine preventable childhood disease in the country. This percentage varies across background characteristics except for the sex of the child, where approximately the same proportion was vaccinated. Children from the urban areas and those on the coast are more likely than their rural and interior counterparts to be fully vaccinated. It is noteworthy that the likelihood of children in the coastal areas to be fully vaccinated is 29 percentage points greater than those in the interior areas, with 85% and 56% respectively. In terms of regions, less than 50% of the boys and girls in Regions 1 and 5 were fully vaccinated (Figure 52). According to PAHO, these facts indicate the need to scale up efforts to reach these populations and improve the quality of vaccination services overall, including recording and monitoring systems (PAHO, 2012).

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Figure 52: % of children aged 24-35 months fully vaccinated, by Region, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Amerindian children are less likely to be vaccinated than other ethnic backgrounds (Figure 53). Almost half of the children from the Amerindian communities were not vaccinated fully, creating a constant risk of outbreaks. One fact to be further explored is that the percentage of children fully vaccinated is higher in those families in the mid-quintiles than poor and richer families (Figure 53).

Figure 53: % of children aged 24-35 months fully vaccinated, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

In terms of other vaccines, Guyana incorporated rotavirus and pneumococcal vaccines into its immunization schedule in April 2010 and January 2011 (PAHO, 2012). Similarly, the country has introduced the human papillomavirus (HPV) vaccine in late 2011, targeting 11-year-old girls. It is estimated that every year 161 women are diagnosed with cervical cancer and 71 die from the disease in Guyana. Cervical cancer ranks as the 2nd most frequent cancer among women

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in Guyana and the 1st most frequent cancer among women between 15 and 44 years of age (ICO Information Centre on HPV and Cancer, Dec 2015). The HPV vaccine was supposed to help diminishing those rates; nonetheless, according to the interviews for this Situation Analysis, the HPV vaccine was not fully introduced.

E) Access to Proper Water and Sanitation

Goal 6 of the Sustainable Development Goals focuses on ensuring availability and sustainable management of water and sanitation for all, with special attention to the needs of the most vulnerable populations, including girls and women. Precarious water and sanitation – WASH (including garbage management) are one of the main contributors to under-five, infant and maternal mortalities worldwide. Inadequate access to and use of safe drinking water, sanitary facilities and unhealthy hygiene behaviours are likely to contribute to high rates of infectious and waterborne diseases and stunting adversely impacting on the mortality of children and mothers, nutrition, school achievement, learning outcomes and future employability for boys and girls. It has been estimated that 50% of malnutrition is attributable to improper water, sanitation and hygiene (Fewtrell L. et al, 2007). Different types of diarrhoea, measles and even pneumonia could easily be avoided if families, mothers and children had access to clean, safe water and appropriate sanitation facilities at home and in the health facilities where babies are delivered. Hand washing with soap is one of the most effective and inexpensive ways to prevent pneumonia, as it reduces the risk of lower acute respiratory infections by 25% (Global Public-Private Partnership for Handwashing with Soap, 2008).

Overall, 94% of the population in Guyana use an improved source of drinking water – 99% in urban areas, 93% in rural areas, 98% in coastal areas and 71% in interior areas (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). Among the regions, the situation in Region 9 (Upper Takutu-Upper Essequibo) is considerably worse than in other regions; only 42% of the population in this region get its drinking water from an improved source. Access to improved source of water is also dependent on the family’s wealth (Figure 56). Around 21% of the poor population in Guyana does not have access to any source of improved water.

Figure 54: Access to improved source of drinking water, regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

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Figure 55: Access to water by wealth quintile, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Among those households with improved access to water, almost half of them use bottled water (47%) as source of water for cooking and/or drinking (Figure 56).

Figure 56: Source of improved water, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

The quality of the water in some regions of the country is a problem that affects the health of children. Gold mining, which is one of the main drivers of Guyana’s economy, mainly occurs in the hinterland regions through public- private partnerships. Studies in the gold mining areas of Region 1 in 2006 showed that all water samples contained mercury above the WHO drinking water quality guideline of 1 mg/l, and sediment samples showed levels of mercury that exceeded the Canadian Environmental Quality Guidelines of 0.486 ppm. About one-third of all fish caught had mercury levels higher than those recommended by the United States Environmental Protection Agency of 0.5 ppm, and results from a survey of the human environment showed a significant level of mercury contamination in the northwest area of the country (PAHO, 2012).

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In terms of sanitation, overall, 95% of the population are living in households using improved sanitation facilities : 98% in urban areas, 94% in rural areas, 97% in coastal areas and 86% in interior areas. The main difference being the greater use of pit latrine with slab in rural and interior areas compared to urban and coastal areas, where the use of flush toilets with piped sewer system or septic tank is more common (Bureau of Statistics, Ministry of Health and UNICEF Guyana, April 2015).

Although 85% of the poorest households use improved sanitation facilities – 69.3% not shared and 15.4% shared (Figure 57) – the type of improved sanitation facilities is strongly correlated with wealth, the poorest households primarily using pit latrine with slab (60%), while the richest households have flush toilets with a piped sewer system or septic tank (100%). Open defecation is practiced for less than 1% of the population in Guyana, but its practice is higher among those living in Regions 7 and 8 (11% of the population). The 2014 MICS also shows a decline in the percentage of children ages 0 and 2 whose last stools were disposed of safely. The 2014 rate was 43% in comparison to 72% from 2006 (2006 MICS) and 77% in 2009 (2009 DHS).

Figure 57: Access to sanitation by wealth quintile, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

A proper household environment for children would combine the use of improved drinking water sources and improved sanitation facilities by household; 83% of the people in Guyana would be living in households that match the two characteristics. That number is much smaller for people living in the interior of the country (54.7% had access to both), for the poorest population (57.7%), and for the Amerindian population (39%) (Figure 58).

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Figure 58: Percentage of people living in houses with improved drinking water sources and improved sanitation, socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Sanitation and water availability should be complemented with good hygiene habits. Hand washing spaces were observed in 75% of the households. In 9% of households the MICS data collector could not indicate a specific place where people would usually wash their hands, and the remaining 16% did not give permission to see the place used for hand washing.

As it is going to be presented next, challenges still exist with regard to the quality of water, sanitation and hygiene, as reflected in the high rates of diarrhoea in children aged 1–5 years old in Region 3 (24.6%) and Region 4 (30.8%); other regions report rates between 2.4% and 7.5%. The fact that in 47% of the houses that have access to improved water use bottle water for cooking is a signal that piped water might not reach the desired quality in a large part of the country.

4.4) Bottlenecks and Barriers

As depicted in the previous sub-sections, access to quality ANC, delivery and postnatal care; access to immunization; access to water and sanitation; cases of diarrhoea, ARI and malaria; and the nutritional status of mothers, boys and girls are going to vary by region, socio-economic status and ethnicity. These inequalities are sustained by different bottlenecks and barriers that work together reinforcing the current situation, affecting not only the health of the mothers, but also the health of children and future adolescents. In order to facilitate the analysis, these bottlenecks are framed within the 10 determinants used by UNICEF (Figure 2 on page 5).

In terms of enabling environment, the country’s main policy framework for health is the Health Vision 2020 (Ministry of Public Health, Dec 2013) that sets the strategy and overall planning for the health sector. The document has as one of its priority areas to focus on the reduction of maternal and child mortalities, and the improvement of health for adolescents. As depicted in section 3.2, Child and maternal health are delivered through a referral system with five levels, from basic care (health posts that cover the entire country) up to two National Referral Hospital (both in the coastal area). As mentioned before, analysis from the Pan American Health Organization (PAHO, 2012) shows that the country’s health system performance and health outcomes have improved over the years, but challenges remain, especially related to data management and quality of care. Formal data needed for monitoring and evaluating health system performance at the regional level are limited, and information flows among central, regional, and facility levels are fragmented and not fully integrated. In addition, data from the private sector are not systematically collected,

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analysed, and integrated to national statistics. Lack of data translates into problems with planning and management of resources. As a matter of fact, inadequate coordination and collaboration at sectorial and inter-sectorial levels and unclear definition of roles and responsibilities between central and regional authorities were identified as major bottlenecks to reduce maternal mortality in the country (Government of Guyana, 2014).

The management and the coordination of the health system might not directly influence the parents’ decision to search for a health facility, but both influence how the system works and how it addresses the needs of the population in general. The Government of Guyana (Government of Guyana, 2014) has identified bottlenecks and barriers in how management, supervisory, and monitoring tools are used in the health system. According to the 2014 assessment, protocols and guidelines are not adequately disseminated and used; consequently, administrative processes are not enforced. Also, communication and coordination between health facilities were considered to be inadequate, with weak feedback mechanisms, and poor documentation. These, coupled with lack of accountability for physicians as well as for staff at all levels of health care, translate into insufficient systems to prevent the recurrence of errors and spurious referrals. The lack of some materials, medicines, rapid HIV testing kits, vaccines and other supplies were identified as gaps in managerial capacity, including problems with procurement and stock management.

In terms of vaccines, as mentioned, a relatively large group of children are not fully vaccinated in the country. A common issue that hinders the full access to vaccines in many countries is related to problems in the management of the vaccines supply chain. Assessment conducted by the Pan American Health Organization and World Health Organization on Effective Vaccine Management (EVM) (Pan American Health Organization and World Health Organization, July 2014) showed that overall, the country’s management of the vaccine supply chain has reported high scores related to vaccine arrival procedures; capacity to store the vaccines at decentralized levels; building infrastructure; equipment availability; preventive maintenance of cold chain equipment, and stock management; among others. Nonetheless, the assessment also indicated two major challenges related to (i) keeping the ideal temperature for the vaccines – in some facilities there were oscillations in temperature that could jeopardize the quality of the vaccines; and (ii) improving the distribution of freeze-sensitive vaccines. In this sense, while there are still some challenges in management, the reasons why some groups of children do not access the vaccines is not solely on the government responsibility to provide the vaccines, and should be further investigated. Probably, difficulties of access and hidden financial costs – discussed in the paragraphs below – might influence the parents’ propensity to vaccinate their children.

On the supply side, the availability of essential commodities and the access to adequately staffed services are both contributing factors to the current situation. Qualitative information shows that not all regions have the adequate number of trained health workers and community health workers. In this line, according to the assessment done by PAHO (PAHO, 2012), the low availability of qualified and skilled personnel is a major challenge for Guyana’s public health system. More than 90% of the specialist medical staff in the public sector in 2012 was foreign nationals. Vacancies ranged between 25% and 50% for most categories of workers, and in rural areas, specialties such

Box: Access to health in Region 1

Some economists believe that people are moved by incentives, i.e., people are motivated by different factors that influence their decision of performing an action. That type of analysis could be used to understand the decision of a woman to access or not a health facility in some of the most remote areas of Guyana. The following is part of an interview and summarizes the situation that a woman would face and that will determine her incentives to access health care in Region 1:

Region one is very vast area and health facilities are twenty miles apart. Most of the areas are swamps and riverain. So for a mother to leave her home to go to a health post where a community health worker is stationed would be difficult, time consuming and costly. The problem is compounded where that health worker is not equipped to do a delivery or do a referral. For a health worker to reach some communities, the difficulty is the same. In many instances, the health worker has to pay for the boat and the fuel since the government does not have the money. A cost is attached to each visit and most times it is an expense that the community health worker will have to bear.

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as pharmacy, laboratory technology, radiography, and environmental health had even higher vacancy rates. The health sector in the hinterland has difficulty in attracting and retaining skilled staff due to low wages, challenging working conditions, limited opportunities for training, inadequate career development systems, and the absence of a comprehensive human resources development plan. Most of the staff from outside the hinterland does not see the incentive to stay in the region. Residency in the hinterland goes together with unfavourable influences of other social determinants such as poverty, lower educational levels, lack of job opportunities, and health risks arising from environmental factors such as malaria, for example (ISAGS and UNASUR, June 2014).

Guyana’s geography poses further obstacles to mothers and children’s access to health care in hinterland regions (see box below). Mountainous and riverine villages are sparsely populated. Besides, the conditions of roads to these villages are usually extremely challenging, for some populations, the only access to government facilities – health, school and police – is done by boat or by 4 by 4 trucks being driven in non-paved roads. The 2014 MDG Acceleration Framework (Government of Guyana, 2014) noted that relatively few specialist and facilities serve fairly large geographic areas with very challenging terrains. Besides, the weather in some areas might be brutal, with heavy rains and gusty winds.

The difficulty of access and lack of adequate facilities also impacts on the referral system to emergency cases. Access to obstetric emergency care is limited to Georgetown. If a woman living in one of the most remote areas of the country needs surgery to deliver the baby, she has to be flown to the capital. The issue is that, depending on her geographical location; this woman has to be transported in a regular car to the airport, wait for the plane to arrive (Medi-Evac), has to fly to the capital, and has to be seen by an obstetrician. Between the identification of the need for the surgery, and the surgery starts, more than 4 hours might easily pass by, decreasing the changes that the mother and the baby have to survive.

The difficulties of access in the interior areas of the country are going to influence not only the low levels of prenatal care, delivery and postnatal care, but also the propensity that mothers are going to have to transport their children to be vaccinated or to visit a health facility. As identified by different stakeholders in the hinterland, most visits to the doctors will only happen if the mother identifies an eminent threat to the life of the child. Cases of fever or diarrhoea will be most of the time ignored and considered as normal. Sometimes, due to lack of access to medicines, and/or cultural practices and beliefs, home-based medicines are going to be used instead of pharmaceutical drugs.

On the demand side, despite the fact that access to ANC, delivery, PNC and all the primary health scheme are free of charge, and community health workers are available to provide the support for the families, the overall access to the health facilities in the interior regions of the country is difficult and expensive, creating a financial barrier to some families.

Financial barriers are not exclusive in the interior of Guyana, but also quite evident in the coastal and urban areas. The country does not have a measure of how many people live in poverty in the urban areas (intra-city poverty), but it is clear that cities such as Georgetown have pockets of poverty. In this sense, families might live in the cities, and not have the same geographical difficulties in accessing public services such as health facilities, but their economic situation influences on their decision of accessing those institutions. Pregnant women have to pay for transportation, and, if they work, a day in the doctor represents a day without payment. Financial barriers also influence the food intake of families in the country, as well as their propensity to provide vitamins and supplements to the children. Those with more money have access to better quality food and have access to all the vitamins that children and pregnant women might need.

Poverty is a serious determinant to all the issues that influence child and maternal deaths in Guyana. It is clear that those pregnant women and children from richer families have higher chances to access good quality health, live in households with improved water and sanitation, have access to proper food, and, consequently, have better chances of having the appropriate physical and cognitive development between the ages of 0 and 5.

There are also social and cultural practices and beliefs that influence the personal decision of some mothers to access the obstetric services provided by the government. Cultural barriers were highlighted in the MDG Acceleration Framework as one of the major obstacles impeding women from getting adequate and timely care. These are compounded by the fact that women (i) do not always know about the potential consequences of not seeking early antenatal care; (ii) are denied access to information; and/or (iii) do not have the ability to seek services even if they

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are aware these are needed; all resulting in late enrolment. According to the 2009 Demographic and Health Survey – DHS (Ministry of Health, Bureau of Statistics and USAID, Oct 2010), women’s use of antenatal, delivery, and postnatal care services from health professionals vary by level of empowerment. In societies where health care is widespread, women’s empowerment may not affect their access to reproductive health services; in other societies, however, as it is the case of Guyana, increased empowerment of women is likely to increase their ability to seek out and use health services to better meet their own reproductive health goals, including the goal of safe motherhood. Data from 2009 DHS show that mothers who participate in one to four household decisions have better access to maternal health services than mothers who participate in no household decisions. If cultural barriers continue to hinder women’s acceptance of maternal health care services, any planned intervention will not have the desired effects since it would not reach the target population (Government of Guyana, 2014).

Cultural practices were also identified as a bottleneck that influences the health seeking behaviour related to young children. Anecdotal evidence shows that some parents prefer to offer new-borns their home remedies instead of taking their babies to the hospitals. In the same line, qualitative reports mention that some communities have the belief that fever is a component of the child’s development, and only seek for help when the health situation of the child is unstable.

Some cases of babies being delivered at home are also influenced by cultural practices (and by social norms). Qualitative information shows that while mothers from indigenous communities might do some prenatal visits, there are also an elevated number that would decline to deliver in the hospital, and would opt for delivering their babies at home, even when some risk is detected. Home deliveries in Guyana are relatively low. As mentioned, data from the 2014 MICS shows that on average, 6% of the births would happen at home, with considerable differences among regions, ethnicity and socio-economic status. These disparities should be further investigated in order for a plan that takes into consideration intercultural health services that allow women choice and quality services according to cultural preference to be developed. While the large number of home deliveries for the Amerindian population (34.1%) could indicate social and cultural aspects that guide their decision, the elevated number of home deliveries for the poor population (19%) indicates that financial aspects might also influence in the decision to deliver at home.

Home deliveries are connected to two types of underreporting. First, babies delivered at home have a higher chance of not being registered and not having a birth certificate. Second, in a worst case scenario when the mother or the baby dies, there is also a high chance that their death is not notified to the authorities.

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Chapter 5: Preventing maternal to child HIV transmission The HIV Prevention of Mother-to-Child Transmission (PMTCT) program is available countrywide (PAHO, 2012). HIV testing of all pregnant women is a requirement during prenatal care. In 2014, 94.4% of the pregnant women accessed PMTCT services and were tested for HIV. Despite elevated, the number represents a decrease when compared to other years (Figure 59). According to the government, the main cause for that reduction was the shortages of test kits at some regional sites during 2014 (Government of Guyana, 2015b)26.

Figure 59: % of women who performed volunteering HIV testing during pregnancy, 2010-2014

Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).

Despite being the same as 2013 (1.9%), HIV prevalence among pregnant women in 2014 consolidates an upward trend since 2010 (Figure 60). This increase should be further investigated. It is not known if it represents an actual increase in the number of women being infected, or the number is due to better detection of cases. For instance, the number of sites that provide PMTCT services has doubled since 2006, from 92 sites to 188 in 2014, indicating that more women are having access to testing, and, consequently, more cases are being detected.

Figure 60: Prevalence of HIV in ANC population, Guyana, 2010-2014

Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).

26 For a discussion on general cases of HIV, please refer to chapter 12

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All HIV-positive pregnant women are offered antiretroviral treatment (ART) as part of the PMTCT programme. The number of HIV care and treatment sites increased from 8 in 2005 to 19 by the end of 2010, and the number of voluntary counselling and testing sites increased from 27 to 75 over the same period (PAHO, 2012). According to data from the Ministry of Public Health, 97% of the HIV positive pregnant women had received ART in 2014 (Government of Guyana, 2015b). In the same year, 2.6% (5/193) of babies born to HIV-positive mothers were infected with HIV, a slightly increase when compared to 2.1% (4/191) in 2013.

There were 37 new cases of HIV reported among children (ages 0 to 19) in 2014, number that represents a reduction when compared to 2010, but an increase when compared to 2013 (Figure 61). Most of the new cases among children are found between 15 and 19 year old boys and girls (Figure 62).

Figure 61: New HIV cases registered for children (ages 0 to 19), Guyana, 2010-2014

Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).

Figure 62: Distribution of new HIV cases for the children population, Guyana, 2010-2014

Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).

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The fact that almost 25% of the new cases of HIV in the child population in 2014 had happened between the ages of 1 and 14 (Figure 62) demands extra attention on prenatal procedures, delivery and postnatal care of mothers and children. These cases represent the failures in the system, i.e., the cases that were not identified, monitored and/or properly threated during pregnancy, delivery and the initial months of life of the child.

5.1) Bottlenecks and Determinants

The efficiency of the PMTCT programme in Guyana is affected by the same bottlenecks explored in the sections related to maternal and child health: shortage of essential commodities, difficulty of access to health facilities, financial constraints, and social and cultural practices and beliefs. Deficiencies in the prenatal care, delivery and postnatal care affect not only the detection of the virus in mothers and babies, but also in the follow up that identified patients should have. Interviewees mentioned that it is known that some pregnant women would perform the rapid testing, and even with a positive result, would not come back for further testing, for getting advice and/or for collecting their ARV medication.

Regarding the enabling environment, access to quality data remains a challenge, and as such impacts on research, policy development, and budgetary allocations to support service delivery in un-served/underserved populations. Poor and/or limited supervision was another factor that contributed to poor quality data and affects quality assurance of data too (UNICEF Guyana, June 2015). On the supply side, there were also reports of limited human resources and shortages of HIV testing in some regions.

On the demand side, knowledge on HIV and how it is transmitted is an important tool to prevent mother to child transmission during pregnancy. Overall, 92% of women and 84% of men know that HIV can be transmitted from mother to child. However, only 53% of women and 35% men know all three ways of mother-to-child transmission (during pregnancy, delivery and by breast-feeding) (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). Besides, male partner involvement (MPI) in counselling and testing at ANC and PMTCT services is especially low in the country; for example data from Regions 1, 7 and 9 shows that MPI stranded at 8.9% in 2011; 10.4% in 2012; and 9.20% for 2013 and 2014 (UNICEF Guyana, June 2015). These results indicate the need to bring fathers to the prenatal consultations, and the need to strength the HIV information being communicated to mothers. Knowledge on mother-to-child transmission is low for all regions and socio-economic characteristics (Table 16). On the contrary of other indicators, even if wealth is taken into consideration knowledge on mother-to-child transmission does not vary much between rich and poor families.

Table 16: % of women and men with knowledge on mother-to-child HIV transmission by socio-economic characteristics and region, Guyana, 2014

Women Men Total 52.5 34.6 Region Region 1 34.9 33.7 Region 2 54.4 62 Region 3 42.5 29.9 Region 4 54.9 29 Region 5 48.8 27.5 Region 6 63.4 44.5 Regions 7 & 8 58.6 41.7 Region 9 42.6 51 Region 10 42.1 40.7

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Women Men Urban 50 32.2 Rural 53.4 35.5 Coastal 53.3 33.4 Urban Coastal 51.4 30.1 Rural Coastal 54.1 34.5 Interior 46.4 43.4 Poorest 53.2 39.7 Second 55.6 36.7 Middle 55.1 34.1 Fourth 47.7 29.2 Richest 51.7 32.9 East Indian 54.7 35.9 African 51.5 33.3 Amerindian 46.3 38.1 Mixed Race 50.9 31.5

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Knowledge on HIV is also acquired through HIV counselling during prenatal care. The numbers on HIV counselling collected by the 2014 MICS survey show a different picture from the numbers reported by the Government of Guyana. Among women who had given birth within the two years preceding the 2014 MICS survey, 67% had received HIV counselling during antenatal care and 85% were tested for HIV during antenatal care and received the results (Figure 63). Around 64% of the women in the country had received the “complete care” related to HIV (received HIV counselling, were offered an HIV test, accepted and received the results).

Figure 63: HIV counselling and testing during antenatal care, averages, Guyana, 2014

Received antenatal care from a health care professional for last pregnancy

Received HIV c o u n s e l l i n g d u r i n g antenatal care

Were offered an HIV test and were tested for HIV during antenatal care

Were offered an HIV test and were tested for HIV during antenatal care, and received the results

Received HIV counselling, were offered an HIV test, accepted and received the results

85.0 66.7 85.5 84.8 63.8

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Less than half of the pregnant women in Amerindian households and in the interior of the country had received the complete HIV package during prenatal care (Figure 64). Much of this could be associated with the difficulties in accessing prenatal care. It is also worrisome that less than 30% of pregnant women in Region 1 had access to the complete preventive care in terms of HIV (Figure 65). Other regions with low access were Regions 7, 8 and 9.

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Figure 64: % of pregnant women who had received HIV counselling, were offered an HIV test, accepted and received the results by socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 65: % of pregnant women who had received HIV counselling, were offered an HIV test, accepted and received the results by Regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

The 2014 MICS numbers show that while HIV prevention might be part of the prenatal care that takes place in the country, its efficiency is not fully achieved. The fact that some women were not informed about HIV during their pregnancy or do not remember having information on HIV, plus the low knowledge on HIV and the low rate of mothers-to-be receiving the complete HIV package shows that despite the extended coverage, the content and the reach of the PMTCT should be further evaluated and possibly improved. The PNC, delivery and PNC periods are opportunities for HIV to be detected, and children to be prevented to contracting it. If this window is not used, and HIV is transmitted from mothers to children without being detected, chances are high that the children will only find out being HIV positive when they are adolescents or young adults.

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Chapter 6: Birth Registration According to UNICEF, the birth registration is more than an administrative record of the existence of a child. It is the foundation for safeguarding many of the child’s civil, political, economic, social and cultural rights. Article 7 of the Convention on the Rights of the Child specifies that every child have the right to be registered at birth without any discrimination. Birth registration is central to ensuring that children are counted and have quality access to basic services such as health, social security and education. Knowing the age of a child is central to protecting them from child labour, being arrested and treated as adults in the justice system, forcible conscription in armed forces, child marriage, trafficking and sexual exploitation. A birth certificate as proof of birth can support the traceability of unaccompanied and separated children and promote safe migration. In effect, birth registration is their ‘passport to protection.’ Universal birth registration is one of the most powerful instruments to ensuring equity over a broad scope of services and interventions for children , and its importance is recognize when Target 16.9 of the SDGs mentions that governments must provide legal identity for all, including birth registration.

In Guyana, the law provides for registration of children within 12 months of birth. There is a nominal fee of G$ 30. While the General Register Office (GRO) is responsible for recording births, deaths and marriages, and issuing relevant certificates, the Ministry of Public Health also has some amount of responsibility for the registration of births through their community health workers who also need to register births.

Registration centres are available in all 10 regions of the country. For children born out of marriage, the name of the father is not stated except at the joint request of the mother and of the person who acknowledges being the father. In that case, both are required to sign the required form.

Since 2013, Guyana has in place a bedside registration, i.e., birth registration is done at the institution where the birth took place. However, qualitative assessment in the hinterlands shows that few are the children who were registered at the hospital, and who have a birth certificate.

As a matter of fact, according to the 2014 MICS survey, 11.3% of the births in Guyana are not registered, with any differences between boys and girls. The number of unregistered births is 3 times higher in Region 1 than the average for the country (Figure 66). Similarly, a child living in the interior of the country (Hinterland), have twice the chance of not having a birth certificate in comparison to a child living in the urban areas (19% and 9.5%, respectively) (Figure 67). Two other factors that increase the chances of a child not having a birth certificate are poverty, and ethnicity.

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Figure 66: Percentage of unregistered births by Regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 67: Percentage of unregistered births by Socio-Economic Status, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

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6.1) Main causes related to low birth registration

Qualitative assessment done in Guyana indicates two immediate causes and two underlying causes that influence the low levels of birth registration for some groups and some regions. In terms of immediate causes, on one hand, while knowledge on the importance of having the children registered is important; on the other hand, parents and caregivers have to have the means to register their children. Both immediate causes are influenced by the cultural aspects and by the efficiency of the system (Figure 68).

Figure 68: Causal Tree on low levels of birth registration

6.2) Bottlenecks and Determinants

On the demand side, rooted in social and cultural practices, the lack of adequate knowledge of how to register a child’s birth is one major bottleneck to the fulfilment of a child’s right to identity. Data show that only 16% of mothers or caretakers of unregistered children report knowing how to register a child’s birth (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). Also connected to the social practices is the lack of knowledge among parents and caregivers on the importance in having a birth certificate (side box). While some children might be registered after birth, they do not have the official birth certificate document, and many parents of young children do not see that as a problem.

Anchored on the enabling environment and supply side are two bottlenecks for the system: the lack of coordination among the different stakeholders involved in the process of birth registration, and the inefficiency of the registration system. The registration system is almost totally manual and highly centralized, resulting in delays due to loss of application and original documents, errors, invalidity of certificates, multiple applications for one child and increased transaction costs (Ministry of Social Protection and UNICEF Guyana, June 2014). There is also the deficiency of effective methods to track and accurately assess the status of applications is process from their entry to completion. As reported by the Rights of the Child Commission (Rights of the Child Commission and UNICEF, Oct 2011), there are cases of unprepared and unskilled staff working with birth registration, resulting in errors in the process.

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For instance, some birth certificates are not being stamped by government officials, making the document invalid. In the same line, as appointed by the 2014 MICS, gaps in registration could be a result of people reporting partial/incomplete registration as not being registered. Until 2015, the partial/incomplete registration would occur when, based on information from the child’s mother, the father of the child was expected to present himself to affix his signature to the form acknowledging being the father. This practice has changed in 2015, and it is expected that the number of partial/ incomplete registrations to be reduced in the coming years. From 2015 on, birth registration forms pending fathers’ signature are going to be processed and birth certificates will be issued by the GRO after a specific length of time has elapsed. The process allows for the name of the child’s father to be added to the birth certificate at a later stage.

Box: Birth Certificate

In focus groups with indigenous mothers in Region 1 we asked if their children had a birth certificate. None of the children, young or old, had a birth certificate. They had their vaccination cards, but not the birth certificates.

When we asked if the mothers had a birth certificate, the answer was the same: no. Asked why they (mothers and children) did not have a birth certificate, they asked us back: why do we need a birth certificate?

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Chapter 7: The Right to Education: Early Childhood Education Target 4.2 of the Sustainable Development Goals (SDGs), emphasizes the importance of investing in Early Childhood Education when mentions that by 2030, countries should ensure that all girls and boys have access to quality early childhood development, care and pre-primary education so that they are ready for primary education.

The government of Guyana recognizes the early childhood development years as birth to age and is in tune with global trends as the Early Childhood Education (ECE) years as the period age 3 to 8. In a broader sense, ECE could be subdivided into Day Care Centres and Play Groups for children between the ages of 0 and 3 years old, and Nursery schools27 for children between 3 years and 6 months, and 5 years of age who did not start primary education. Most of the day care centres are privately owned – the country has two municipal centres in Georgetown; while Nursery institutions are made available free of charge for parents. The Ministry of Social Protection regulates Day Care centres, while the Nursery, primary and secondary schools are under the responsibility of the Ministry of Education.

Government has no data on the number of children in Day Care Centres. In terms of Nursery Schools, according to the latest data available (Ministry of Education, 2012), in the school year 2011-2012, around 26 thousand boys and girls ages 3 and 6 months to 5 were enrolled in nursery schools in the country. Out of that number, 93% of the children were attending public nursery schools. There were 442 public and 58 private institutions offering nursery education in the 2011-2012 academic year.

In 2014, on average, 61% of the children aged 36-59 months in Guyana were attending nursery school (59.0% of the girls and 63.0% of the boys) (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). Attendance of ECE programmes varies by area, wealth quintile and ethnicity (Figure 69). Rural and interior parts of the country are the ones with lower attendance. Similarly, despite the fact that public nursery schools are available, the poorest the family, smaller are the chances that the child is going to attend ECE programmes. In terms of ethnicity, only four in each 10 Amerindian children were attending nursery schools in 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). Regarding regional disparities, Regions 5, 4, 10 and 6 present the highest attendance rates in the country. Meanwhile, in Region 1, only one child out of 5 is attending nursery school (Figure 70).

27 Early childhood education programmes include programmes for children that have organised learning components as opposed to baby- sitting and day-care, which do not typically have organised education and learning components.

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Figure 69: Percentage of children between 3 and 5 years of age who are attending ECE programmes, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 70: Percentage of children between 3 and 5 years of age who are attending ECE programmes by Administrative Region, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Regarding quality, despite the fact that Day Care centres have to follow guidance from the Ministry of Social Protection, there is no monitoring of quality of those institutions. The number of qualified staff and the conditions of the Day Care institutions is practically unknown.

For nursery schools, out of the 1601 teachers at public nursery schools, 65% of them were considered to be qualified, 25% were untrained, and 10% unqualified. Out of all the teachers, 12% of them had a graduation related to early childhood education (Ministry of Education, 2012). The Ministry of Education has pointed out in its Education Strategic Plan (ESP) that in addition to an increase in the proportion of trained teachers, there has been improved monitoring and greater support to schools through 40 Infant Field Officers from all education districts who have been trained to support colleagues in a cluster of schools. The idea is that these Officers should visit schools in the cluster periodically

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to assess their instructional programmes, their internal and external environments and to offer advice as necessary (Ministry of Education, 2015c).

Quality of care at the household environment complements the learning process that happens in educational institutions. Different measures can be used to monitor the quality of care at home. The first one is parent engagement with the child. Interaction with parents is crucial in supporting the development of children’s capacities for learning (The World Bank, 2015), it helps children to build their vocabulary, shapes their behaviour, and learn motor skills.

According to the 2014 MICS survey, for almost nine out of ten (87%) children aged 36-59 months, an adult household member engaged in four or more activities that promoted learning and school readiness during the three days preceding that survey. In the same line, the survey indicates that the father’s involvement in four or more activities was limited (16%), with a mean number of 1.3 activities, compared to that of the mother (55%), with a mean number of 3.4 activities (Figure 71).

Figure 71: Fathers and mothers engagement in activities with children, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Father’s presence in playtime with children does not vary much in terms of area, ethnicity and poverty status. The major differences in time of interaction with children is seen when the regions are taken into consideration (Figure 72). With the exceptions of Regions 2, 9 and 4, all other regions of the country had father engagement in activities smaller than the national average.

Figure 72: Percentage of children with whom biological fathers have engaged in four or more activities by Region, Guyana, 2014

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Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Exposure to books in early years not only provides the child with greater understanding of the nature of print, but may also give the child opportunities to see others reading, such as older siblings doing school work. Research has shown a strong correlation between exposure to books at home and the achievement of higher academic grades for students (Evans, Kelley, & Sikora, 2014), as well as the importance of children from the most disadvantaged home to have access to books to improve their academic scores (Allington, Richard L. et al, 2010).

According to 2014 MICS, 47% of the children below the age of 5 live in households that have 3 or more children’s books, and 24% of the children in households were 10 or more books are available. Access for books is smaller for those children living in the interior of the country, for those children in the poorest families, and living in Amerindian households (Figure 73).

Figure 73: Percentage of children living in households that has for the child 10 or more children’s books, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

7.1) Early Child Development Index

2014 MICS has calculated an Early Child Development Index (ECDI) to help in assessing the developmental status of children in Guyana. The index is based on selected milestones that children are expected to achieve by ages three and four, in four different domains: Physical growth, literacy and numeracy skills, socio-emotional development and readiness to learn. ECDI is calculated as the percentage of children who are developmentally on track in at least three of these four domains. For more information on the methodology please see MICS document.

Around 86% of children aged 36-59 months in Guyana are developmentally on track, with few differences based on socio-economic characteristics and Regions. For example, children (i) from Amerindian families; (ii) from the poorest families; and (iii) living in the interior of the country have the smallest ECDI (73.2%, 78% and 78.5%, respectively) (Figure 74). In terms of regions, children living in Regions 1, 7, 8 and 9 are far beyond the average for the country (Figure 75). The results also show the importance of children to attend ECE institutions: the ECDI for children attending ECE was 91.4% in comparison to 76.5% of those children not enrolled in ECE.

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Figure 74: Early child development index score by socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 75: Early child development index score by regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Among the four domains, children are on track in the physical and learning ones, followed by social-emotional and literacy-numeracy (Figure 76).

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Figure 76: Percentage of children age 36-59 months who are developmentally on track for indicated domains

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

7.2) Main Causes relate to low ECE enrolment

Figure 77 summarizes the main immediate, underlying and structural causes that influence the low access to formal ECE services for some disadvantage groups in Guyana.

Figure 77: Causal Tree for Low Access to Formal ECE Services

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The differences in access and quality of education among regions and socio-economic profiles can be attributed to accessibility difficulties; isolation of settlements; lack of adequate trained personnel and, in some cases, language barrier (Krammer & Crandon, April 2015). Especially for the hinterlands, as mentioned before, accessibility to some communities is very difficult, with no regular bus routes, very poor roads, and, in some extreme cases, boats are the most used mean of transport. The sparse population and the difficulty of access make services delivery a problem. For older children, as it is going to be discussed later in this document, walking from home to and from school is common. For younger children, this is not a choice for parents. Some larger communities might have ECE programmes being offered within the primary school building, for others that does not happen.

7.3) Bottlenecks and Determinants

In terms of bottlenecks, on the parents’ side, a mix of social and cultural practices and the financial situation of the families hinder the access to early childhood education, and it limits the interaction between parents and young children. Stakeholders mentioned that for certain parents, ECE is not recognized as part of the child’s formal education. That helps to explain why 4 in each 10 children between 36 and 59 months are not in ECE institutions.

Despite the availability of tuition free Nursery Schools, access to them is still bounded by the financial capacity of the family. As mentioned, less than 50% of the children between the ages of 3 and 5 in the poor families are enrolled in ECE institutions. That indicates other costs that might be connected to ECE, such as uniforms, meals and transport. Besides, for those more remote areas, as mentioned, the poor access to the government facilities is a major obstacle.

The interaction between parents and young children (in this case younger than 5 years of age) does not happen with most of the families in Guyana. Barriers that prevent parents from engaging more fully with infants and young children include parents’ lack of knowledge about child development, and lack of awareness that verbal interaction with children is important. Parents might be held back by mental models based on traditional beliefs that some practices can be harmful to the child or by a fear of ridicule for violating a social norm against talking to infants (The World Bank, 2015).

Moreover, the harsh economic situation of the country forces parents to spend long hours working and being absent of their houses. In some cases, in searching for better economic opportunities in the interior of the country (mining and logging) and abroad, many parents – especially fathers – do not live with their children. As it is going to be explored later in this Situation Analysis, the father’s absence from home is considered by many stakeholders in Guyana as one of the principal causes of misbehaviour among adolescents, influencing school dropouts and their behaviour in society.

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Part IV:

The formative years: Childhood (from 6 to 11 years)

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During childhood, the dimensions of education and protection of children’s rights take on a greater relevance during development. It is a stage when the physical, intellectual, social and emotional capacities acquired in early childhood are consolidated. Within this idea, chapter 8 deals with primary education and special needs education. The chapter also uses the opportunity to discuss the struggles that children and adults with special needs face in the country.

Chapter 9 starts the debate on violence against children, discussing the use of corporal punishment as a form of discipline. As in the previous chapter, child discipline is not exclusive of the 6 to 11 group. Nonetheless, this is the group that cannot react to this type of violence and, most of the time, will accept it silently. The discussion on child discipline creates a bridge with the next part of the Situation Analysis that covers the adolescent years. In that part the major topics related to child protection are going to be presented and discussed.

Box In one of the visited indigenous communities, ECE services were offered in a multilateral school, where younger children were separated from older ones by the blackboards. Multi-grade teaching is common. The caveat was that the teacher did not speak the local language, so communication between pupils and the instructor was difficult.

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Chapter 8: The Right to Education

8.1) Primary Education

Primary education is mandatory in Guyana, covering children between the ages of 6 and 11. There were 94,843 children enrolled in the six grades of primary education in the 2011/2012 academic year (Ministry of Education, 2012), 49% of them were girls (Figure 79). The vast majority of pupils (93%) were enrolled in free public government schools.

According to the 2014 MICS, on average, 85% of the children attending first class of primary school in 2014 attended preschool in the previous year, an increase when compared to 2006 when only 65% of the children had attended preschool (Bureau of Statistics and UNICEF Guyana, 2008). There is not much variation in terms of preschool attendance between poorest and richest families, and between urban and rural areas. The main difference is seen when the regions are taken into consideration. Among the ten regions, Region 2, followed by Region 1, have the smaller proportion of boys and girls entering primary education with the preschool background (Figure 78).

Figure 78: Percentage of children attending first grade who attended preschool in previous year, by Regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Due to delays in analysing the 2012 Census, the country does not have available an official net enrolment rate (NER) for children at primary education. The lack of official rates does not allow for a proper discussion on the efficiency of the system. Official data from the Ministry of Education shows that in absolute numbers, the number of boys and girls in grades 5 and 6 is bigger than the number of pupils in the initial years of primary education, with not much difference between boys and girls (Figure 79). Total enrolment by regions will follow the demographic distribution for the country, i.e., for those regions with higher populations – Region 4, for example – the total enrolment of children in primary schools is going to be higher than for those regions with smaller populations – Regions 7 and 8.

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Figure 79: Number of boys and girls enrolled in primary education, public and private institutions, Guyana, 2011/2012

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

Numbers from the 2014 Multiple Indicator Cluster Survey show that the Net Attendance Ratio (NAR) for primary education was 97%, with no variation in terms of gender, region, area, wealth quintile and ethnicity. Also, the MICS shows that a group of children is starting primary education at an older age than the recommended 6 years. In 2014, around 10% of children at age six were out of primary education, the majority of them were still attending preschool (and therefore starting primary education older than the recommended age), and a smaller group was out of school.

Around 96% of the children who start grade 1 in the past reached grade 6 (last grade of primary education in Guyana), showing an improvement when compared to 2006, when 71% of the children would reach grade 6 (2006 MICS). As depicted in Figure 80, in 2014, primary school completeness starts showing a tendency that is very clear in secondary education: the fact that more girls are finishing their formal studies than boys.

Figure 80: Percentage of pupils who reach grade 6 by gender, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

One possible reason for the high percentage of children finishing primary education is connected to the automatic promotion policy (Grade Retention policy) implemented by the Ministry of Education in 2011 and revised in 2013. The initial policy allowed for all students to be promoted to the next grade regardless of their performance at the annual assessments. However, the revised policy allows for students to repeat a grade if they score below the overall pass mark set by the school in more than 50% of the subjects (Bureau of Statistics, Ministry of Public Health and UNICEF

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Guyana, April 2015).

The primary completion rate was 109% for 2014, also suggesting that there are children starting their primary education at older age than the recommended. In terms of transition to secondary education, 96% of the children, regardless of sex, who were attending the last grade of primary school in the previous school year, were found to be attending the first grade of secondary school in the school year of the 2014 MICS survey.

While access to primary education is important, guaranteeing quality education for all children in the country is the prerequisite for achieving equity, and for the fully development of individuals and society (UNESCO, 2005). Quality and equitable educations at primary and secondary schools are in the core of the Sustainable Development Goals (Target 4.1). Different measures of quality exist worldwide. In Guyana, the new MoE Strategic Plan tries to emphasize the importance of quality education through a list of outcomes that should be achieved by 2018 (see box below).

Box:

Quality in Education:

The MoE in its 2014 – 2018 strategic plan indicates the following as their outcomes:

Good learning achievements, especially for literacy, mathematics, and science, with an increasing percentage of students scoring at advanced levels;

High levels of internal efficiency (high attendance rates, low repetition rates, low dropout rates, high completion rates for each level of education);

High levels of equity (low differences on enrolment rates, learning scores and internal efficiency rates between sub groups of students).

Some current measures in quality of education at primary level are associated with the academic and professional qualifications of teachers – the assumption being that qualified and trained teachers will help to improve learning (Ministry of Education, 2015c). Around 73% of all the teachers in primary education in Guyana were considered to be trained to be teaching at that level. That national average hides regional inequalities depicted in Figure 81.

Figure 81: % of trained teachers in Primary Public Schools, by Region, Guyana, 2011/2012

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

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Access to education material, in particular textbooks, is seen as an indication of quality so the ratio of students to a book is another indicator with the ideal being one book per student for each subject. In theory, all children should have access to free books for mathematics, English and science. Nonetheless, interviews and focus groups show that the distribution of books for those children in the most remote areas is sometimes a problem, and occasionally children only have access to their books weeks after the educational years has started.

Access to computers, computer programmes and properly equipped laboratories and workshops, is also seen as essential to foster learning. According to information provided by the Ministry of Education, out of the 436 government primary schools (numbers from the 2011-2012 Educational Digest) 83 of them had computer labs, in regions 2, 3, 4, 5, 6, 7, 9, 10 and Georgetown. Therefore, the vast majority of primary schools in the country do not have electricity and, consequently, children at school do not have access to the Internet or any type of multimedia method. As a matter of fact, in using households as proxy of schools that have access to electricity, only 56% of the households in the interior have electricity in comparison to 91% of the households in the coastal areas. Differences are also seen among regions: 25% in Region 9; 27% in Region 1; and 47% in Regions 7 & 8; compared with between 78 and 94% of households in the other regions (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). In the same line, despite the fact that more primary schools have access to water and sanitation today than in 2008 – the estimate from 2008 was 51% of primary schools and the number for 2013 registers 68% of the primary schools with access to water and sanitation (UNICEF, Feb 2015) –, the numbers are still far from ideal, affecting thousands of children.

Another measure of quality of education is the pupil-teacher ratio. In theory, smaller the number of children per teacher, higher is going to be the attention that the teacher can provide to the students, increasing their chances of learning. On average, this ratio was 23 students per teacher in the 2011/2012 academic year, with some differences between private and public institutions (Table 17). Trained teachers also influence the quality of education. According to the Ministry of Education, there were a little bit more than 4 thousand primary schools teachers in Guyana in 2011/12. Out of the total number of teachers, 2,840 or 70% of them were considered trained to be teaching at primary level. The average ratio pupil/trained teacher for both private and public schools was 33.

Table 17: Pupil/Teacher Ratio in private and public primary schools, Guyana, 2011/2012

Public Private Country Pupil Teacher Ratio 24 15 23 Pupil/Trained Teacher Ratio 33 33 33

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

The difference between these four measures of quality of education contributes to the gap between coastal and hinterland in terms of student’s achievements in primary education. Despite the fact that standardize tests are not the best option to measure the outcome of education (Baker, 1988), they provide a quantitative measure that can help decision-makers to identify problems and plan their actions. In Guyana, quality of primary education can be compared over time using the grades of the National Grade Six Examinations (NGSE), the exam that classifies the students based on their scores in math, English, science and social studies.

On the average, student performance on the NGSE has improved between 2009 and 2013 (Figure 82), with some significant improvements in the case of mathematics. Despite this positive trend, in looking at the data with equity lenses, the progress has not been similar in coastal in hinterland areas.

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Figure 82: Percentage of pupils scoring 50% or more on NGSE, 2009 and 2013

Source: National Grade Six Assessment Analysis 2009 and 2013.

It is true that both hinterlands and coastal areas had better grades in 2013 than 2009; nonetheless, the gap between these areas was not reduced, and, in fact, has increased. For instance, in 2009, the difference between the hinterlands and the coastal area for mathematics was 15 percentage points. In 2013, despite the fact that more students in the hinterlands were achieving 50% of the grades when compared to 2009, the gap has increased to 24 percentage points (Figure 83). Similar increase in the gap happened with English (Figure 84) and Science (Figure 85).

Figure 83: Percentage of children achieving 50% or more in Mathematics, Hinterland and Coastal areas, Guyana, 2009 and 2013

Source: National Grade Six Assessment Analysis 2009 and 2013.

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Figure 84: Percentage of children achieving 50% or more in English, Hinterland and Coastal areas, Guyana, 2009 and 2013

Source: National Grade Six Assessment Analysis 2009 and 2013.

Figure 85: Percentage of children scoring 50% or more in Science, Hinterland and Coastal areas, Guyana, 2009 and 2013

Source: National Grade Six Assessment Analysis 2009 and 2013.

One major element that influences the outcomes of education in coastal and interior areas is related to the language barriers that some populations face in the interior of Guyana. Assessment commissioned by UNICEF and conducted with the full participation of the MoE in 2012 show the need to accommodate the traditional local languages to English in a way that students are not penalized for not having learned English at home. At the same time, the assessment shows the concern with the traditional languages in the country so they are not considered to be a second class language, leading to their extinction (UNICEF Guyana, Dec 2012). Qualitative information points to the fact that the country has nine different Amerindian tribes each with their own language. Besides, in the border regions, due to the frequent migrations, Portuguese and Spanish are common languages among the population. It is possible that some

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children will only have a formal contact with English when they start their primary education, creating a difference between them and those boys and girls who are immersed in the country’s official language since they were born. As the teaching aid and tests are written in English, it is expected that students from the coastal and urban areas will outperform the pupils from the hinterlands. Besides, the majority of teachers at all levels are not trained in English as Second Language (ESL) and in cross-cultural instructions (UNICEF Guyana, Dec 2012). Moreover, some teachers – especially those from outside the regions – are not used to the local languages.

The language barriers will influence learning in primary school, and they will also be one of the reasons why some students drop from secondary school. While no study has been conducted, there is reason to speculate that the use of English language in the classrooms and the exclusion of indigenous languages may be a contributing factors to the dropout rates in schools in indigenous communities (UNICEF Guyana, Dec 2012).

Despite improvements in the grades over time, different sectors of the government have expressed concern with the quality of education in the country. For instance, the Ministry of Finance on its Budget Speech called attention that Guyana “cannot ignore the abysmal results for Mathematics and English in this country, where more than half of our students are unable to establish that they have general proficiency in these two foundational subjects” (Minister of Finance, Aug 2015).

A) Bottlenecks and Determinants in Primary Education

As mentioned, the lack of official enrolment rates jeopardizes an assessment of coverage of the system, i.e., it is not known if all children between ages of 6 and 11 are enrolled in primary education, and if they are finishing it. Nonetheless, the difference in quality of education between the hinterland and coastal areas is clear, and summarized in the following excerpt from the Ministry of Education, that also indicates some of the main determinants that reinforce this gap:

“While there has been significant improvement in the physical structures at this level, many primary schools are still in an open classroom system. Some schools in hinterland communities have no access to a source of power and in general it is more difficult to get resources into these schools. Many of the smaller schools are multi grade schools (a teacher teaches two or more grades) and they are mainly located in the hinterland regions and in the remote riverine areas of coastal regions. Unfortunately these are also the areas, which have a lower proportion of trained teachers. Nationally over 70% of primary school teachers are now trained but in the hinterland regions the proportion falls to 51%” (Ministry of Education, 2015c).

On one hand, government has been trying to close the gap between the different regions of the country with policies focusing on the demand side (families) and on the supply side (teachers and schools). For instance, in order to increase enrolment and retention in primary education, in 2008, the Government implemented school feeding, school uniform, and textbook programs targeting nursery and primary schools, which has resulted in improved school attendance among children in the hinterland (PAHO, 2012). At the same time, the School Welfare Unit has developed indicators for characterizing and locating actual and potential exclusion; identified barriers to inclusion; and proposed strategies to remove barriers (Ministry of Education, 2015c).

On the other hand, despite all the efforts, the policies are not being efficient enough to guarantee that the benefits are enough for all children in the country, especially those located in the most remote areas. For example, despite the fact that assistance to parents to buy uniforms for their children are in place, interviews have identified that some parents do not know their children could have access to that benefit. For those parents who access the benefit, the major complaint was that the subsidy is only enough to buy one uniform for each child, and that uniform should last for the whole year. Besides, the assistance does not cover eyeglasses for those children who need it. Parents can apply for extra benefits from the School Welfare Unit, but the process does not seem to be clear, and involves some bureaucratic steps that create another layer of difficulty for some parents.

Another financial barrier for the families is related to the cost of going to school. Families have to afford the child’s transport to school, and, as discussed before, for some children, that involves boat trips and/or walking for more than one hour. The distance and the accessibility to school were identified as a major deterrent in ECE, and they continue

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to be a problem in primary and secondary levels. The difference is that in primary school children are older, and in some areas of the country, it becomes normal for them to walk for more than 1 hour to and from school.

Focusing on the supply side, government has also been trying to address the gaps in primary education through actions to increase the quality and retention of teachers in the most needed areas. Anecdotal evidence points that most of the teachers want to be placed in the coastal schools, where infrastructures at school and in the cities are better. Anecdotal evidence also shows that those teachers who were being brought to the country’s capital for training would try to remain in the city, sometimes abandoning their teaching careers in the interior of the country. In order to avoid that problem, to increase the number of teachers being trained, and to make the process more cost efficient, teachers in the hinterland are being trained through a Distance Education Training Program. Despite not being formally evaluated, stakeholders link the improvement in teacher qualification to this programme.

Government has also institutionalized two formal incentives trying to attract and keep qualified teachers to the interior of the country: (i) the remote area incentive – available to everyone working as a teacher in the Hinterland; and (ii) the hard-line allowance – available for a teacher coming from the Coastland. Both incentives are based on the distance from an urban centre or town. For example, if a teacher in Region 9 is closer to Lethem town, the incentive would be G$5,000 per month (around USD 25); further off would be G$7,000 a month (around USD 34). However, stakeholders mentioned that the incentives still do not compensate for the higher costs and challenges a teacher incurs while living and working in the Hinterland. Some may have to provide for two homes where their families are still dwelling on the Coast.

8.2) Children with Special Needs

Survey from 2013 indicates that most of out of school children that need special education are in the group between 6 and 12 years of age (National Centre for Educational Resources Development, 2013).

Currently, the country has no official information on the number of adults and children with disabilities and/or special needs who live in the territory, and how many of them are enrolled at school. The World Health Organization estimates that 10% of the population in 2013 had some type of disability, a number that would be higher than the 6.3% suggested by the 2002 census (National Centre for Educational Resources Development, 2013). Consequently, it is impossible with today’s information to have any measurement of efficiency of the educational system for that population, and to affirm that the right for education for children with special needs is being realized. Despite this fact, it is consensus among the stakeholders in Guyana that the number of children in special education institutions is far from the reality, and the current structure does not attend all that need.

A) Bottlenecks and Determinants related to education for children with special needs

National policy demands that children with special needs should be placed in the mainstreamed schools. However, due to institutional capacity of the school system – lack of specialized teachers, support staff and infrastructure, few are the special needs students in the regular schools. As a matter of fact, access to educational opportunities is seen as one of the major bottlenecks in the current system. For instance, a 2005 survey commissioned by the National Commission on Disability (NCD) found out that 15% of all persons with special needs have never attended school, and the proportion increases to 42% among those under 16 years of age (National Commission on Disability, UNICEF Guyana and VSO, 2005).

Box: Guyana School Feeding Programme

Guyana currently has a national School Feeding programme that seeks to address the issue of nutrition and specifically in the hinterland regions.

A World Bank Evaluation from the Guyana Community-Based School Feeding Program (The World Bank, June 2013) has identified that the program improved community participation in schools and children’s human development outcomes: enrolment in the schools have increased by 16%; more children were attending school; children who were part of the schools where the program was being implemented grow more than children from other schools; scores have improved; and school participation in classroom activities increased.

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Access is limited due to the location of the schools that provide Special Education Services and due the associated cost related to transport children from and to the schools. The majority of Special Needs schools are located in Region 4, and more specifically in the capital – Georgetown. The long distances that some children have to travel to these schools inhibit their attendance also because of financial constraints. Even when vocational training is available for those older children with special needs, some cannot complete due to the cost of transportation (Ministry of Education, 2015a). Data shows that among those who answered the 2005 survey, 79% of families caring for a person with special needs have experienced financial difficulties. The main reason for that is the attention that is necessary for caring for a persons with disability limiting the main care givers level of engagement in employment, and consequently reducing the overall family income.

There are also social and cultural practices and beliefs that hamper a more inclusive education in Guyana. For some parents, the fact that they have a child who requires special attention is seen as a burden and considered to be shameful. Adding to that, parents do not know their rights and the available support that they could get from different organizations. Other “normal” children also present negative attitudes towards those who need special education. In this line, there are different reports of bullying and aggression against these children. The NCD 2005 survey has shown that 44% of the respondents have experienced negative attitudes or behaviours as a result of their disability. In sum, as mentioned by the UN Committee on the Rights of the Child, societal discrimination against children with disabilities remains widespread (UN Committee on the Rights of the Child, 2013).

On the supply side, few are the institutions that are prepared to receive these children in terms of infrastructure (washrooms, ramps, etc.) and in terms of staff capacity. There are few new teachers being trained to handle children with special needs – most of the teachers who go into training are those who already work with special needs children. The teachers’ training institution offers a module in special education. Across the Regions, with the support from UNICEF training programmes for teaching to the blind/visually impaired and the deaf have begun. Nonetheless, the country still has a massive shortage of specialized teachers and qualified staff. Aggravating the situation is the absence of a career path for designated Special Education Needs (SEN) teachers; promotion is sought through appointment to traditional schools, thus draining the already depleted SEN teaching force (Ministry of Education, 2015a).

Therefore, inclusive education and training of teachers for its provision remain severely limited, particularly for children with sensory, cognitive, and/ or mental impairments, which leads to the majority of children with disabilities staying at home, resulting in isolation, stigmatization and compromised access to employment opportunities and social services (UN Committee on the Rights of the Child, 2013). The reality is that children with disabilities have difficulties in access not only schools, but also health services, employment and even social and recreational opportunities. The country’s infrastructure is not accessible for children and adults with motor impairments; and even in the country’s capital, sidewalks, buildings and roads are not completely accessible.

Sustainable Development Goals (SDGs) Target 4.a: Build and upgrade education facilities that are child, disability and gender sensitive and provide safe, non- violent, inclusive and effective learning environments for all.

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Chapter 9: The Right to be Protected

9.1 Corporal Punishment

While discipline is important in the formation of a child’s behaviour, corporal punishment at school or at home is a violation of a child’s basic human rights, which includes the right to protection against any form of violence and the right to respect for their physical integrity and human dignity. Corporal punishment interferes with the learning process and with children’s cognitive, sensory, and social emotional development . Research has connected corporal punishment to increase in antisocial behaviour in adolescents and to the recurrence of sexual and domestic abuse and violence (Global Initiative to End All corporal Punishment of Children, May 2015). Corporal punishment is a form of physical abuse against children, and it is considered by many as a form of domestic violence.

In Guyana, corporal punishment is still legal – with the exception of the courts and the juvenile justice system, where it has been repealed from the laws. A 2005 study involving nearly 4,000 children aged 3-17 in Guyana found that 81% had been beaten or hit with a belt, cane, whip or other object; children as young as 3 years reported being disciplined by their parents with an object. One third of children described physical punishments leading to injury, including bleeding skin, broken bones and blacking out (Global Initiative to End All Corporal Punishment of Children, 2012).

The use of corporal punishment in Guyana has been slightly reduced over time. In 2006, around 74% of the children between 1 and 14 years of age in Guyana had suffered a form of violent discipline in the month preceding the data collection, which would include psychological aggression and/or physical punishment. In 2014, 70% of children suffered corporal punishment. Boys are more prompt to receive violent discipline than girls. At the same time, violent discipline is independent of the household’ socio-economic characteristics (Figure 86), and the region where the child lives (Figure 87), for instance, while 87% of the children were disciplined through a violent method in Region 9, the same is not true in Region 1, where less than 48% suffered this type of violence. In the same age group, 6.4% of the children had suffered some sort of severe physical punishment .

Figure 86: % of children 1-14 years disciplined through a violent method by socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

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Figure 87: % of children 1-14 years disciplined through a violent method by Regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

A) Causes related to corporal punishment

Despite some differences among regions and socio-economic groups, corporal punishment is so entrenched in the society that it is practiced at almost the same level by all socio-economic groups (Figure 86), independently of poverty, place of residency or ethnicity. There is consensus in the country that the practice is rooted in Guyana’ societal norms, and it is not seen as a form of violence against children; instead, it is considered by many as an effective mechanism of discipline. As a matter of fact, around 50% of respondents of a 2011 survey mentioned that corporal punishment is necessary to bring up children properly (UNICEF Guyana, Nov 2015).

At home, bad behaviour is perceived to be best corrected by whipping and be administered by any parent, older sibling or other adult family member, and this can be exacerbated by the abuse of alcohol and/or other drugs by parents. At schools, the Ministry of Education has been trying to phase out the practice from public schools but there is resistance from different levels of society including parents, teachers and unions. Some teachers defend the idea that without some lashes – especially in the younger groups – there would be chaos in the classrooms (Ministry of Social Protection and UNICEF Guyana, June 2014). Figure 88 depicts the main immediate, underlying and structural causes related to corporal punishment in Guyana.

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Figure 88: Causal Tree related to corporal punishment

B) Bottlenecks and Determinants

Guyana’s legislation related to corporal punishment is confuse and sometimes contradictory, and could be considered as a major bottleneck to end this practice. The Protection of Children Act differentiates between corporal punishment and physical abuse, nonetheless, the identification is not straight forward, and it is subject to assessment by the Child Protection Officers who is called to intervene. As mentioned by interviewees, if a child is exposed to a couple of lashes, and a parent frequently uses this form of discipline, the officers will work with the parent to promote non- violent forms of discipline, without major punishments for fathers and/or mothers. The Act is clear on a child who has been assaulted, that parent will be arrested and charged.

At schools, the current policy, which restricts administering corporal punishment to head teachers and senior teachers with an accompanying “Maintenance of Classroom Discipline Manual”, has proven ineffective (UNICEF Guyana, Nov 2015), and positive forms of discipline are being disseminated in society. Some private schools have banned the practice. In this line, different NGOs and government officials are working with parents and teachers to change behaviour towards non-violent discipline methods.

While some might advocate that violence against young children is connected to the poverty status of the family, the results of the 2014 MICS shown that this argument is not true, since corporal punishment is practiced independently of the family wealth status. In that sense, on the demand side, bottlenecks and barriers that interfere in the current situation are more connected to social norms and cultural practices than any other reason. The fact is that corporal punishment has being practiced generation after generation and it is accepted as a suitable form of discipline.

One of the problems of using corporal punishment as a form of discipline is the message that violence is a suitable method of correcting someone’s attitude and/or behaviour. That message is being sent to children since young ages, creating a self reinforcing situation where later in life the same concept is going to be used generating cases of domestic violence and abuse against children and women. The discipline through violence is one of many “forms of violence” that children face in Guyana. Part V of the situation analysis will describe other forms of violence that are initiated or aggravated by the practice of corporal punishment.

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9.2 Child Involved in Economic Activities and Household chores

In Guyana, around 25% of children aged 5-17 years are engaged in some form of economic activity28. The older the child, higher is the chance that he/she is going to be working for longer hours. Table 18 depicts the percentage of children working in economic activities for three different age groups. The bulk of children involved in economic activities and child considered to be working are between 12 and 17 years of age, which is discussed in chapter 13.3.

Table 18: Percentage of children involved in of economic activities during the week previous to the survey, Guyana, 2014

Age Group % 5 to 111 16.9 12 to 142 31.1 15 to 173 34.9

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

On average, 17% of the children between ages of 5 and 11 are engaged in some form of economic activity for at least one hour (17.6% for girls and 16% for boys). That involvement is higher in Region 9 (69% of the children), in the interior of the country (31% of the children), among the poorest families (29% in comparison to 13% of children in the richest families), and among Amerindian families (35%) (Table 19).

In terms of household chores, on average, almost 57% of the children between 5 and 11 were helping at home (58% among boys and 55% among girls). Table 19 shows that the same characteristics involved in being engaged in economic activities also apply to household chores, i.e., those children in Region 9, from the interior of the country, in the poorest families, and from an Amerindian ethnicity are more susceptible to be involved in household chores. One important factor to mention is that among the children who are helping at home, 57% of them attend school, and 34% did not, indicating that household chores might start when children are young, and therefore, before they start their formal primary education.

Table 19: Percentage of children 5 to 11 years of age involved in economic activity and household chores, by socio-economic characteristics and Regions, Guyana, 2014

Economic activity for at least one hour

Household chores less than 28 hours

Total 16.9 56.5 Boys 16.1 58.2 Girls 17.6 54.9

Region 1 11.7 55.6 Region 2 17.4 52.7 Region 3 12.3 58

28 Economic activity (paid or unpaid) is any work on plot / farm / food garden; looking after animals; helping in family or relative’s business, running own business; producing or selling articles / handicrafts / clothes / food or agricultural products; or any other activity in return for income in cash or in kind. For detailed definitions of child labour please access the 2014 MICS report (Bureau of Statistics, Ministry of Health and UNICEF Guyana, April 2015).

The voice of adolescents:

Is corporal punishment a form of discipline?“The older generation views it as a form of discipline and the younger generations who are aware of their rights now view it as a form of violence. So the view is changing to more non-violent forms of punishment. Young teachers do not administer corporal punishment but sit students down and speak to them and be more of a friend to their student. On account of this some students choose to not listen or show respect to their teachers.”

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Economic activity for at least one hour

Household chores less than 28 hours

Region 4 10.7 53.9 Region 5 9.9 52.8 Region 6 20.4 46 Regions 7 & 8 24.5 70.4 Region 9 69.2 90 Region 10 15.8 61.7

Urban 12.9 48.2 Rural 18.2 59.4 Coastal 13.2 53 Urban Coastal 10.8 45.9 Rural Coastal 14.2 55.6 Interior 30.9 70.2

Poorest 29.1 69.1 Second 12.7 56.5 Middle 13 49.1 Fourth 9.9 55 Richest 13.6 46

East Indian 16 50.8 African 12.3 59.9 Amerindian 34.7 73.5 Mixed Race 13.8 52.1

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Causes, bottlenecks and determinants related to children involved in economic activities and household chores are discussed in chapter 13.3.

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Part V:

The emergent years: Adolescents (from 12 to 17 years)

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Early adolescence marks the onset of puberty and recent brain research reveals that adolescence involves a critical transition for cognitive development. Early adolescence involves experimentation with new ways of behaving, transitioning into a time of risk-taking as well as greater responsibilities. As adolescent boys and girls grow, they begin to develop a greater sense of identity that affects decisions and life choices. At this stage, investment must focus on those adolescents who are most at risk of passing the legacy of poverty and discrimination to the next generation (UNICEF, April 2012).

During adolescence, gender norms and roles tend to consolidate and the developmental paths of girls and boys begin to diverge. Although particular experiences vary by cultural and socio-economic contexts, the onset of puberty can often mark an increase in the mobility of an adolescent boy, while that of a girl is often decreased. She may face limitations in the ability to make decisions affecting her education, work, marriage, and relationships. Discriminatory social and cultural gender norms also negatively affect boys, constraining them to concepts of masculinity that perpetuate discrimination and keep them from realizing their full potential, including in roles as partners and caregivers (UNICEF, April 2012).

This part of the situation analysis has four chapters. Chapter 10 presents the problems related to secondary education, focusing on the stakeholders’ perception that adolescents are dropping out of school before finishing their formal education. Chapter 11 deals with teenage pregnancy. While teenage pregnancy could be seen with “health” eyes, the main concern is the protection aspect of it. Chapter 12 deals with adolescents and HIV. Finally, chapter 13 discusses many aspects relate to child protection, including domestic violence, different types of abuse and children in contact with the law, among others. As it happens in the other parts, some of the problems presented in this part of the Situation Analysis are not exclusive of boys and girls in the adolescent group – child labour, for example – but the decision was to have the discussion in one place so the topic could be analysed with more narrowed eyes.

Also, similar to the other chapters, the discussion starts with a brief description of the problem, and jumps into an analysis of causes and determinants. This analysis is sometimes explicit taking the shape of a subchapter, and in other times it happens within the main text.

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Chapter 10: The Right to Education: Secondary Education

10.1) Enrolment Numbers

Similar to primary education, an official net enrolment rate (NER) is not available, jeopardizing any analysis of the efficiency of the system. The Ministry of Education acknowledges that 82,091 boys and girls were enrolled in private and public secondary schools in the country for the school year 2011/2012 (latest dataset available), most of them in public general secondary schools (Figure 89).

Figure 89: Percentage of students enrolled in public and private institutions, secondary level, Guyana, 2011/2012

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

As mentioned in Chapter 3.1, the Secondary Departments of Primary Schools (SDPS) hosts those students who did not perform well in the National Grade Six Examinations (NGSE), and do not immediately qualify to attend a general secondary school, and/or those students who cannot afford going to secondary schools. In general, 15% of the students attending public secondary schools in Guyana in the 2011/2012 academic-year were in SDPS. The national average hides a significant inequality among the regions (Figure 90).

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Figure 90: Percentage of students in General Secondary Schools and Secondary Department of Primary Schools, by region, Guyana, 2011/2012

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

10.2) Gender Parity at Secondary Education

While the majority of students at primary level were boys, the situation is different in secondary education. Among the children enrolled at secondary level in 2011/2012, 51% of them were girls and 49% were boys. Starting in Form 3, there are more girls than boys enrolled at school, and that difference becomes very clear in Form 5 (Figure 91). Possible causes for more girls than boys in secondary education are related to school dropouts, topic to be discussed later on this chapter.

Figure 91: Total number of boys and girls enrolled in secondary education in Guyana, by grade, 2011/2012

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

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10.3) School Attendance, Out of school children and School Dropouts

Different stakeholders in the country agreed that children might be enrolled at school, but guaranteeing their attendance is a different challenge. Secondary Net Attendance Ratio (NAR) for the country29 in 2014 was 84.5%, being 88% for girls and 81% for boys, indicating that among those who are enrolled in school, 15% of them do not go to school (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). Net attendance varies by region (Figure 92); and by area, wealth quintile and ethnicity (Figure 93). Table 20 presents the same disaggregation by gender. Possible causes related to high levels of absence are very similar to those connected to the elevated number of out-of-school children and school dropouts, topics that are explored a little later in the text.

Figure 92: Secondary Net Attendance Ratio by region, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 93: Secondary Net Attendance Ratio by socio-economic status, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

29 MICS did not differentiate between public and private secondary schools, or between general and Secondary Departments of Primary Schools.

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Table 20: Net attendance ratio, boys and girls, by socio-economic characteristics, Guyana, 2014

Boys Girls Total Total 81.0 87.9 84.5 Region Region 1 59.2 71.5 65.4

Region 2 73.2 79.6 77.0 Region 3 82.0 88.3 85.0 Region 4 83.4 90.4 86.9 Region 5 79.8 88.7 84.3 Region 6 77.5 87.4 82.3 Region 7 & 8 68.3 78.6 74.4 Region 9 84.0 83.5 83.7 Region 10 89.6 90.6 90.0

Area Urban 85.2 94.1 89.6 Rural 79.5 85.7 82.6

Coastal 81.6 89.5 85.6 Urban Coastal 82.5 94.3 88.5 Rural Coastal 81.3 87.8 84.5 Interior 77.5 79.1 78.4

Wealth index quintile

Poorest 72.7 76.0 74.3 Second 74.4 88.0 80.6 Middle 80.7 91.0 85.9 Fourth 89.3 91.2 90.3 Richest 92.7 96.1 94.5

Ethnicity of household head

East Indian 76.9 84.8 81.0 African 88.9 96.4 92.2 Amerindian 68.8 77.8 73.6 Mixed Race 80.1 87.5 84.1 Others/Missing/DK 39.0 73.9 63.5

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Out of school children at secondary level is a reality for the country. According to the 2014 MICS, 14.4% of children between 12 and 16 years of age were not attending secondary school. The country average conceals regional (Figure 94) and socio economic inequalities (Figure 95). For instance in Region 2, 22% of boys and girls between the ages of 12 and 16 are out of school – meaning that they are not in primary nor secondary institutions. Similarly, one in each five boys and girls in the same age group in poor families, and living in Amerindian families are also out of secondary school.

The Voice of Adolescents

Why are there more girls than boys in high school?

“Because of poverty. Parents would send their girls to school and have their boys work to earn an income for the family. It is easier for boys to find a job than a girl as some business would hire a small boy over a small girl.”

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Figure 94: Secondary Level Out of School Population by Region, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 95: Secondary Level Out of School Population by Socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

While on average more boys are out of school than girls – 63.7% of the out-of-school population are boys, and 36.3% are girls – when the information is disaggregated at different socio-economic indicators new patterns will appear. For instance, poverty pushes an almost similar number of boys and girls to be out of school. Among those children out of school in the poorest quintile, 46% of them are girls, compared to 10% of girls in the richest quintiles (Figure 96). Similarly in Region 2, 7 and 8, 50% the secondary level out of school population are girls, and in Region 9, more girls are out of school than boys (Figure 97).

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Figure 96: Percentage of secondary level out of school students, by gender and wealth quintile, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 97: Percentage of secondary level out-of-school students by gender and region, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Usually, the secondary out-of-school population has three origins (UNICEF and UNESCO Institute for Statistics, 2011). First, those children who are still in primary level and will start secondary education late. The second group is formed by those children who will never attend school, and the third group by those children who were at school but for different reasons dropped out. The first group is not a concern in Guyana since boys and girls are still at school and are expected to move from primary to secondary education – however, one might say that these are the adolescents who have higher propensity to drop out later. As a matter of fact, among children 12 and 16 years of age, only 1.2% was still in primary school (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015). The second group is also minimum in the country since most of the children are entering the formal education system (2014 MICS data shows that the literacy rate for the country is 98%, and NAR for primary education is almost 97%).

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The third group is the one where the majority of out-of-school children in Guyana are placed, i.e. adolescents enter secondary education but do not finish their formal studies.

Numbers from the Ministry of Education for the school year 2011/2012 present a dropout rate of 7% for that academic year (Ministry of Education, 2012). 2014 MICS analysis shows that at age 14, boys and girls start dropping out of school with higher intensity, reaching a point when at age 16, 35.1% of the boys at that age are going to be out of school (Figure 98).

Figure 98: Percentage of out-of-school children by age and gender, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

School dropouts are not recent phenomena. Data shows that starting in 2007 the school life expectancy at secondary education for boys and girls start to be different (Figure 99). While the indicator for boys has been constant since the early 2000’s, for girls there is a constant improvement along the years. This might be an evidence that policies of incentives might had influenced girls to stay more years in school than boys.

Figure 99: School life expectancy in secondary education, 1999-2012, Guyana

Source: World Bank (http://data.worldbank.org/)

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A) Causes for school absence and dropouts

School absences and school dropouts are rooted in very similar causes. Differently from other countries, the Ministry of Education does not officially monitors and publishes the causes of absence and dropouts. Hence, in order to try to determine these causes in Guyana, a mix of quantitative and qualitative methods were used. These are depicted in Figure 100.

Figure 100: Causal tree for school absence and dropouts in Guyana

B) Bottlenecks and Determinants of school dropouts

The economic situation of the family (financial access) is one of the major causes that influence absence and dropouts; i.e., poverty will directly influence in the child’s propensity to be at school. The financial aspect is connected to many small indirect costs that when added up can significantly impact the household’s budget, especially for families with many children. For instance, as it happens in primary education, there is no public transport to and from school in both urban and interior areas of the country, creating the need for parents to pay for it. The difficulty of access and the cost associated to school access in the interior areas was already mentioned. Despite the fact that the urban areas do not suffer the same difficulties of access of the interior areas of Guyana (unpaved and dark roads, distance villages, access by boats etc.), some distances in the urban centres create a need of transport by car or bus, being translated into extra expenses for some families.

In the same line, while the books for the four basics subjects are available for free, parents have to afford the books for specific subjects, and, in the case of the most remote areas of the country, parents also have to pay for private tutors to teach these subjects since some schools do not have specialized teachers available. Young people that participated in focus groups in Guyana mentioned that the lack of free meals at school also hinder the presence of adolescents at secondary school – the government meal programme only covers ECE and primary level. As parents have to provide lunch or money for food, it was mentioned that some boys and girls feel ashamed for not having that money, and prefer to stay away from school. Also, it was mentioned that it is common that students go to school in the morning, leave in the lunchtime and do not come back in the afternoon.

The financial aspect also pushes the older children to do chores at home such as take care of younger siblings or older relatives at home or in the community. As mentioned in chapter 7, day cares are mostly private owned.

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In a situation where the mother and the father have to work, occasionally the older child has to stay home so the younger child is not alone. As a matter of fact, 2014 MICS shows that 3% of children aged 0-59 months were left in the care of other children, and the same proportion (3%) were left alone. Rural children (6%) were twice as likely to be left with inadequate care as urban children (3%) and interior children (11%) were almost three times as likely as coastal children (4%). Inadequate care was more prevalent among children whose mothers had no education (12%), as opposed to children whose mothers had at least primary education (3-6%), and among children living in the poorest households (10%), as opposed to children living in wealthier households (1-4%). Great regional disparities are observed, with the highest percentage found in Region 9 (21%), followed by Regions 7 & 8 (10%) then by Region 6 (8%). Inadequate care was also most prevalent in children living in households with an Amerindian household head (14%). 2014 MICS did not capture the situation in terms of head of household; nonetheless, according to informants in the country, this situation seems to be more frequent in single parents households headed by women.

Maybe one of the most evident aspects of the influence of the financial situation in dropouts and absences is seen when child labour is taken into consideration. Most of the stakeholders – including adolescents – mentioned that the main cause for boys and girls to be out of school is the need for work, or their inclination to work due to disappointment with the school curriculum. Child labour is discussed later in this section (chapter 13), but the fact that adolescents – mainly boys – are attracted to the labour market before being fully prepared create a vicious cycle that perpetuates poverty in the country: unprepared workers have higher chances to be employed in unstable jobs, have smaller salaries, and are extremely vulnerable to economic oscillation in the country’s economy. Most of the adolescents who work are doing it illegally, at small shops or farms. In some regions, attendance is highly affected during rice harvesting season when boys and girls are going to help their families or make some extra money working in bigger farms. Qualitative assessment done in the country link the low skill jobs with higher levels of frustration, elevated cases of violence against women and high level of suicides.

As mentioned, poverty is not the only factor that drives adolescents to look for jobs. Two other factors also influence that decision. First, rooted on the supply category of determinants, stakeholders mentioned that the quality of secondary education – topic to be explored in section 10.4 – does not match students’ expectations, and consequently the school curriculum is not attractive to a large portion of male students. The main complains mentioned that the curriculum is too academic and not practical enough. Similarly, some pupils – usually those who are older for their grade, who have learning difficulties or whose main language is not English – cannot cope with the curriculum at secondary level, and see as their only option to drop out of school and look for jobs. In order to address this problem, Government of Guyana has trying to revitalize the Technical Vocational Skills Program (TVET) programme.

The second factor that creates an incentive for early insertion of boys in the labour market was mentioned by different stakeholder in Guyana as a mix of social norms and social practices that promotes that boys have to explore the world and be adventurous, while girls have to be protected by their families and be prepared to get married. This type of collective expectation creates an incentive for boys to leave school and start working, while preserves girls at school for longer terms. As a matter of fact, as it is going to be explored later, this determinant also influences how boys behave at home and in society, affecting their propensity to consume alcohol and other drugs, and their involvement with non-legal activities. For girls, this determinant influences in early marriages.

Lack of parenting at home, especially for secondary male students, was seen as one factor that influences them to leave school without finishing their formal education. Stakeholders in Guyana strongly associated the lack of parenting with the father’s absence from home, and in those single parent households. For a single parent, being absent from the house is, in most of the times, not an option, but a coping mechanism to financially sustain the house, especially in places where one job does not guarantee a salary that is enough for ensuring the wellbeing of the family. Lack of parental supervision should not be seen as irresponsibility on the part of the mother or the father, but as a failure of the State and the Social Protection System that does not guarantee safe spaces for children to stay while their mothers are working, and cannot guarantee policies that

The voice of Adolescents If education is free, why can’t some persons afford to come to school? “While education is free, students still need uniforms, pens, pencils, books, textbooks and other school supplies, which their parents cannot afford. Even with uniform vouchers parents still need to pay to sew the uniform.” “The school does not provide lunch and most kids cannot afford to buy lunch, they would go home and return to school after lunchtime. The children who live far cannot go home and therefore most of them don’t eat.”

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complement low salaries and alleviate their vulnerability.

Related to the lack of a male figure at home, one of the causes related to the high number of school dropouts among boys was associated with the small number of male teachers in the system. As depicted in Figure 101, the majority of teachers in primary and secondary schools are women, and according to different stakeholders, boys – especially those coming from single parents households headed by women – do not find a male figure at home or at school, making them less inclined to stay at school.

Figure 101: Teachers by gender, primary and secondary general public schools, Guyana, 2011/2012

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

One factor reported by stakeholders is the undesirable influence of remittances in adolescent’s behaviour and their propensity to stay in school. As seen, remittances are extremely important for the country’s economy and in many instances they work as a safety net for many families in Guyana. Despite its importance, for some people, the fact that adolescents have easy access to money being sent by their parents or relatives abroad create a situation where they do not need to put any effort on their academic career and still receive some money at the end of the month, or whenever they ask for. According to the interviewees, remittances are creating a generation of adolescents and young adults who erroneously believe they do need to invest in a professional career.

For girls, one of the main causes of school absence and dropout is teenage pregnancy. As it is going to be explored later (chapter 11), one in every five women in the country had started childbearing during their adolescence. Causes for teenage pregnancy are also explored in chapter 11, but the consequences of it are related to girls abandoning school and not returning to finish their formal studies. Girls are allowed to stay at school during pregnancy, but after delivering few have the support from their families and/or public authorities to continue their studies.

Despite the fact that violence at school was not considered to be one major factor that influences children to drop out of school, be absent, or as a factor that influences student’s propensity to learn; stakeholders mentioned that some boys and girls are going to verbally attack each other and sometimes get into physical fights. Besides, there are reports of abuse against sexual minorities in school. Some LGBT students reported being harassed by their peers and when they approached their teachers for support, they were punished because of their assumed or actual sexual orientation or gender identity. Further, there have been reported cases where if a child is identified as gay, whether real or perceived, that child is neglected or sometimes verbally abused by the teacher in the presence of other students, with derogatory remarks (Red Thread, AIDS, FACT and SASOD, Feb 2013). As a consequence, some adolescents decide to drop out of school to avoid these types of violation.

Worldwide, quality of education is one of the most important determinants that influence the decision of boys and girls in finishing their formal secondary education and advancing into tertiary level. The quality of education is explored in the next subsection.

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10.4) Quality of Secondary Education

Similar to primary education, guaranteeing quality of secondary education is the major challenge that the country faces. About 68% of the teachers were considered to be qualified to be teaching at secondary school. Regions 7, 8 and 6 present the smaller percentages of qualified teachers in the country (Figure 102). Related to this point is the fact that children in the interior of the country do not have teachers at school to teach the specialized topics. As mentioned before, in some regions, if pupils want to prepare to the specialized CSEC exams they have to hire private tutors. That reality contrasts with the urban areas where specialized teachers are available in public secondary schools.

Figure 102: % of qualified teachers at public secondary schools, by Regions, Guyana

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

Similar to primary education, the government should guarantee access to educational material for all the students at secondary level. Qualitative assessment has shown that while the majority of students in the hinterlands at secondary level have access to the four core subject books – English, Mathematics, Social Studies and Science –, access to specialized books and materials is not equitable since students have to buy those books.

In terms of school infrastructure, access to computers, laboratories and workshops, the situation is the same as primary schools: those students in the hinterland and in the interior of the country are in a worse off situation than those in the coastal/urban areas. The country does not have a measure of how many secondary schools have electricity, and consequently access to computers and Internet. Using MICS 2014 data of access to a computer as proxy, access to modern technologies at schools would be quite low. According to the MICS results, only 54% of boys and girls age 15 to 19 had access to a computer in the month previous to the data collection. Access to a computer varies according to poverty level. Adolescents in the richest families have three times the chance to have access to a computer than those living in poor families (Figure 103). MICS data also shows that only 21% of adolescents in Amerindian families have access to computers. Similarly, access is reduced for those adolescents living in Regions 1, 7, 8 and 9 (15.3% of the adolescents have access to computers), and those children living in the interior of the country (38% have access).

Figure 103: % of children with access to a computer at least once in the previous month, 2014

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Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Access to Internet among the young population is a little better than access to a computer. 56% of boys and girls in Guyana have accessed the Internet at least once in the moth preceding the 2014 MICS survey. The reason for that is that adolescents use their smartphones to connect to the Internet.

Students from the interior of the country have reported that the fact they do not have access to Internet and new technologies at school creates an unfair difference with those students that are enrolled in schools where electricity is available – generally in the urban areas. According to the students, those pupils in the urban areas have better chances of learning than those who live in the hinterlands, and, consequently, have higher chances of getting better jobs in the future.

It was also noticed by the pupils at secondary level, by teachers and by government officials that school infrastructure at all levels needs to be upgraded: bathrooms and classrooms are dirty, chairs and desks are broken and sometimes insufficient for all students, and when it rains – what is quite frequent at some times of the year – water drops from

The voice of adolescents

Do you know students who dropped out of school?

“Yes, there are few from the village that are working. They dropped out of school at an early age, some because the parents are not working regularly or are not supportive.”

“I know a lot of dropouts. They dropped out of school due to teenage pregnancy, financial problems, illness, disability, or the need to support their family by working. Some parents can’t afford to send their kids to school. I have a friend who dropped out of school.”

“Yes. Most of the dropouts are wayward kids and their parents don’t seem to care. They may be putting themselves at risk and the females may become pregnant.”

“Yes, I have a family member who dropped out due to peer pressure; some are delinquent, and they prefer to smoke, drink or use drugs. Most females drop out when they get pregnant.”

“A child coming from a home with five or more siblings the parents cannot afford to purchase school uniforms and other school supplies. Hence parents would usually send the child with the most potential to school and the rest would stay at home or go to work, or follows bad company which leads to the use of drugs and alcohol.”

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holes in the roof. Heat can be unbearable hindering student’s capacity to concentrate. In general classrooms have no air-conditioning, and students have mentioned that where electricity is available, some fans do not work properly, making noises that also disturb students’ concentration.

Despite the fact that the general pupil/teacher ratio for private secondary schools is smaller than the ratio for public secondary schools, the ratio of qualified teachers is actually better in public institutions than private ones (Table 21). That is the result of the investment that the country is doing in training teachers in its entire territory.

Table 21: Pupil/Teacher ratio for secondary level, Guyana, 2011/2012

Public Private Pupil Teacher Ratio 21 14 Pupil/Trained Teacher Ratio 31 49

Source: 2011/2012 Education Digest (Ministry of Education, 2012)

The voice of adolescents

“What would you change at school?” was one of the questions asked for all the students who participated in interviews and focus groups. The following were some of the answers from them:

“There is a library in the school but it is not operating as it should and while there is a computer lab there is not teacher for the subject area.”

“There are no sports facilities such as basketball or football courts.”

“Improve the standard of the facilities available to help the students, and the way in which the school is organized; the quality of resources available to use for example the labs and the access to textbooks. At present the textbooks are supplied by the school but many of the students still don’t have access.”

“There is need for more teachers and should offer more subjects. The school also needs better surroundings; better facilities; it needs to be repaired; and electricity.”

“The quality of teaching in the areas of Mathematics and Social Studies can be improved, there are limited or no teachers for these subjects. The classrooms are not comfortable- they are too small- and the school roof leaks during the rainy season; sometimes students may even have to relocate to other classrooms because of the rain.”

Analogous to primary education, quality of secondary education at coastal and interior areas could be assessed using standardized tests, in this case the results from the 2008 and 2013 Caribbean Secondary Education Certificate Examination (CSEC). The first point that calls attention and demands further investigation by the Ministry of Education is the fact that for boys and girls, independently of where they leave, the scores for mathematics for 2013 are worse than 2008 (Figure 104). Besides, it is worrisome that only 7% of the girls living in the hinterlands have passed in mathematics in 2013.

The second point that also should be flagged is that, despite the improvement of grades in English for boys and girls (Figure 105), the gap in percentage points between the hinterland and coastal areas’ scores in 2008 and 2013 did not change for the girls, and, in fact, increased for the boys. The Ministry of Education (Ministry of Education, 2015c) has identified the differences in qualified teachers as the main reason for this difference. As mentioned before, while this is an important factor, other factors explored in the primary education section and in throughout this chapter shows that lacks of investments in infrastructure, books, and in the curriculum are also part of the system that defines how students are performing in the CSEC exams.

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Figure 104: CSEC Scores in Mathematics, Hinterland and Coastal Areas, Boys and Girls, Guyana, 2008 and 2013

Source: (Ministry of Education, 2015c)

Figure 105: CSEC Scores in English, Hinterland and Coastal Areas, Boys and Girls, Guyana, 2008 and 2013

Source: (Ministry of Education, 2015c)

One eminent consequence of the elevated numbers of adolescents who stop their formal education before finishing the secondary education, in combination with the low quality of education at secondary level, is the lack of work skills that most of the adolescents in Guyana will present. This problem is aggravated when, as described in the initial pages of this SitAn, unemployment rates for the overall population are estimated to be high; creating a situation where few are the opportunities for the young generation, and where even the skilled youth have to accept low-skill jobs to survive. Chapter 13 describes the situation in terms of child labour and it emphasizes some points related to employability of the young population in Guyana.

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Chapter 11: Teenage Pregnancy Adolescent pregnancy is a concern that involves (i) health: worldwide evidence shows that pregnancy among young girls is dangerous for both the mother and the baby (UNICEF, 2011); (ii) education: the 2009 Guyana Demographic and Health Survey (DHS) revealed that early childbearing, particularly among teenagers, has had negative socioeconomic and sociocultural consequences, such as early school dropout (PAHO, 2012); and (iii) child protection: young girls could become pregnant due to lack of empowerment, lack of education and as victims of sexual violence, indicating failures in the protection system, Including the immediate protective environment of the family, school, religious institution and community.

The rates of teenage pregnancy in Guyana did not change between 2007 and 2010: around 20% of the births in the country happened among adolescents (PAHO, 2012). According to the 2014 MICS, adolescent birth rate stands at 74 per 1,000 women – the country’s general fertility rate is about 81/1,000.

About 15% of the girls between ages 15 and 19 in Guyana had begun child bearing, with different rates depending on the area that the girl lives, her poverty status, and her ethnicity (Figure 106). For example, one in every five Amerindian girls between ages of 15 and 19 was a mother at the time of the survey, and one in every four girls who lived in poor houses in Guyana have started childbearing, in comparison to 1 in every 10 girls living in richer households.

Figure 106: Percentage of women between ages 15 and 19 who have begun childbearing, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

11.1) Causes and Bottlenecks related to Teenage Pregnancy

As analysed by UNFPA (June 2014), pregnancies among adolescents have multiple structural causes and bottlenecks. There are social causes, such as poverty, level of education, area of residence, beliefs, tradition and culture, among others, which are correlated to behavioural patterns. The girls most likely to have a live birth before age 18 reside in rural and remote areas, have little or no education, and live in the poorest households (UNFPA, 2013).

In Guyana, teenage pregnancy could be explained by three immediate causes that interconnect among themselves: early sexual debut, unprotected sex and early marriage. Each one of these causes is influenced by underlying and structural causes such as poverty, individual behaviour, beliefs and traditions and by abuse and violence (Figure 107).

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Figure 107: Possible causes of Adolescent Pregnancy

While the official age of sexual consent in Guyana is 16 years old, on average, 5% of the women had their first sexual relationship before the age of 15. That rate is much higher for women in poor families (12.5%), women living in the interior of the country (10%), and for those who are Amerindians (11%) (Figure 108). The situation is disturbing in Region 1, where almost 1 in every 4 women had started their sexual life before the age of 15 (Figure 109). One point that these statistics do not show is if the early sexual debut was consensual or it was forced. In many cases, first intercourse is forced, which highlights the underlying issue of gender-based sexual violence and the need for prevention and response strategies (UNFPA, June 2014). As a matter of fact, 2008/2009 Biological Behavioural Surveillance Survey (BBSS) mentions that almost 24% of the secondary school girls who have started their sexual life were forced by someone to have sex (Red Thread, AIDS, FACT and SASOD, Feb 2013). Connected to this matter are repeated reports of incest in Guyana in the most remote areas, sometimes accepted by cultural traditions, and motivated by the consumption of alcohol and other drugs.

Figure 108: % of girls who had sex before the age of 15, by socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

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Figure 109: % of girls who had sex before the age of 15, by Regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

While violence explains part of the early sexual debut of boys and girls, social norms also influence the adolescent decision to start their sexual life. Peer pressure, lack of dialogue with parents and no guidance at school are seen as three factors that will increase the chances of early sexual debut. Stakeholders mention that unsupervised teenagers, especially those living in single-parents households have higher chances of starting their sexual life below the age of 16, and without any type of parent counseling.

In terms of use of contraceptives (related to unprotected sex) by sexually active adolescents, according to the 2014 MICS, there was no clear pattern between contraception use and age of women. However, 13% of sexually active adolescents (young women aged 15-19 years) mentioned to be using contraceptives in their sexual relationships, a number that is below the country average (34%), and the lowest among all other age groups. Contraception use is highest among women aged 25-34 years (41%). The use of contraceptives is influenced by three factors. First, there are health systems bottlenecks and/or legal procedures (legislation) that limit adolescents’ access to reproductive and sexual health services. In this line, there are situations where adolescents (under the age of majority), who are sexually active, encounter legal barriers to accessing contraception, information and counselling. Girls under the age of 16 do not have access to Sexual and Reproductive Health (SRH) services without parental approval (Government of Guyana, 2014). Second, the lower use of contraceptives is connected to lack of empowerment of girls and older women. Male partners reject the use of any type of protection and girls have to submit to their demands. Lack of empowerment is related to lack of information, and fear of being beaten and abused. Third, qualitative reports also indicate that some religions are still very much against the use of condoms and other contraceptives, with the fear that the incentive of using them would send a message of incentive to young people to have sex. As reported by some stakeholders, part of society in Guyana still believes that the discussion of sexual behaviour is instigating children to have sex, instead of educating them to the possible consequences. When children have sexual questions, the responses they receive from adults are often punitive, rather than educational (Red Thread, AIDS, FACT and SASOD, Feb 2013). This affects not only the propensity of a girl to be pregnant, but also risks her life in contracting HIV and/or other sexual transmitted diseases.

Child/early marriage is not a common practice in Guyana, nonetheless, among girls between 15 and 19 years of age, 13.3% of them were married or in union (cohabiting) at the time of the 2014 MICS survey, a slightly reduction when compared to 14.1% in 2006 (2006 MICS). Early marriage is influenced by different socio-economic characteristics such as poverty and ethnicity (Figure 110). Among those women who were married at the time of the 2014 MICS survey, 4.4% married before the age of 15, and 27% married before the age of 18. Similar to girls, 13.4% of the boys between 15 and 19 years of age were also married in 2014.

Figure 110: Percentage of women ages 15 to 19 years old currently married/in union, by socio-economic

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characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Individual behaviour is influenced by knowledge acquired at school and at home. On the supply side, schools do not offer comprehensive sex education; consequently adolescents often rely on information (frequently inaccurate) from peers about sexuality, pregnancy and contraception (UNFPA, June 2014). Guyana has institutionalized the Health and Family Life Education (HFLE) programme as a tool to address sexuality and other topics that would promote wellbeing, and discuss social development issues during the child’s school learning process. The idea is to mainstream life skills subjects – including sexual education – through the school curriculum, with the objective to reduce cases of teenage pregnancy, bullying, school dropouts, HIV infections and alcohol and drugs consumption. Evaluation of the HFLE programme (Ministry of Education and UNICEF Guyana, Feb 2014) shows that despite the fact that the programme is considered to be extremely relevant, there is no conclusion if it has been effective in achieving its results.

Moreover, the evaluation found the same evidence as the interviews conducted in Guyana at the end of 2015 for this SitAn: the fact that teachers are selective in the topics they teach when the subject is sexual behaviour and sexual education. The main reasons for that selection were identified as (i) lack of training in the topics being taught; and (ii) teachers’ personal views and opinions, influencing their decision on which subjects to teach. For instance, stakeholders mentioned that due to social and cultural taboos, teachers do not feel comfortable talking about sex outside of the biological reproductive subject, and prefer to skip content related to sexual behaviour and sexuality. Interviewees also mentioned cases where teachers would impose their own view on the topic being presented, jeopardizing the objective of the HFLE programme. While teachers might have their own bias on the topic, they do not find any systems in place to explore the internal conflicts between their personal and professional values in order

The Voice of Adolescents: Availability of services for adolescents

“Sometimes the service providers are also to be held accountable. The schools in Guyana do not have sexual reproductive health information, education and training. Nurses at health clinics do not want to give the young girls contraceptives. Lack of acceptance of age appropriate sex education program in school by parents and some teachers also contributes to teenage pregnancy. Sometimes the young women themselves cannot be held accountable, when due to the pressures at home and around they are forced into teenage pregnancy.”

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to effectively deliver the curriculum and address the needs of all their students, including those who are lesbian, gay, bisexual and transgender (LGBT) (Red Thread, AIDS, FACT and SASOD, Feb 2013).

Poverty is seen as a structural cause that influences all the other causes related to teenage pregnancy. Nonetheless, many stakeholders also reported that in more remote regions, and in most extreme cases, poverty is a direct factor that pushes families to try to have their young daughters married, and one way to accomplish that is to have the girl pregnant. In this line, intergenerational sex is also seen as one important factor in the elevated number of girls who get pregnant at early ages. Among the girls between 15 and 24 years of age who had sex in the last 12 months, 12% had intercourse with men 10 or more years older. For the girls between 15 and 17 years of age, 11% of them had sex with men 10 years older than them. Intergenerational sex varies slightly based on the family wealth. While 14% of girls between the age 15 and 24 in the poorest households had sex with older men, the rate for the richest families is 10.4% (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).

The voice of adolescents: Culture and teenage pregnancy

In a focus group with adolescents and young adults, we asked about how culture influences teenage pregnancy. This is the answer of one of the participants:

“Culture has an influence on teenage pregnancy. Within a year or two of high school some parents marry off their girls. In the Indian culture children are married at an early age. When a young person cannot find jobs, culture forces them to start a family. Marriage is a way to cope with poverty where parents arrange for their children to marry someone from abroad so that they can migrate or to arrange a marriage into rich families. There are a lot of arranged marriages in the Indian communities, which also lead to depression and suicide. Children in these circumstances hardly have a say as against those in a much better off position.”

The causes and consequences of elevated numbers of teenage pregnancy are worrisome for all the reasons here discussed. Unprotected sex not only elevates the chances of teenage pregnancy, but also creates a new risk for the youth population: of being infected with HIV and other sexual transmitted diseases. Topic to be further explored in the next chapter.

The Voice of Adolescents:

Is teenage pregnancy common? Do you know any teenage mothers?

“I know of a few cases. In most cases, the partners are usually older and the girls suffer low self-esteem. I am not sure if they wanted to become pregnant or whether it was an accident. In most cases it is unplanned; but the girls ought to have known the consequences of having sex and taken steps to protect themselves. I don’t believe they were empowered enough to encourage the young men to use condoms.”

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Chapter 12: Adolescents and HIV/AIDS HIV/AIDS became a serious concern in the country after 2004. Following Haiti, Guyana at that time had the second highest incidence of HIV/AIDS in the Caribbean, and AIDS was considered the second leading cause of death in the country (Ministry of Social Protection and UNICEF Guyana, June 2014).

The overall prevalence of HIV infection has been on the decline in Guyana. As reported by the 2014 Guyana AIDS Response Progress Report (GARPR), the country’s adult HIV prevalence is estimated to be 1.4%, representing a reduction when compared to 2.4% in 2004. At the end of 2014, a total of 751 new cases of HIV were diagnosed compared with 758 cases reported in 2013, also a reduction when compared to 2009 when 1,176 new cases were reported (Figure 111) (Government of Guyana, 2015b). Despite the reduction represents progress, government and partners should further investigate if it represents a real reduction of people being contaminated or failures in identifying positive cases due to lack of testing.

Figure 111: Number of new HIV and AIDS cases, Guyana, 2001-2014

Source: 2014 Guyana AIDS Response Progress Report (Government of Guyana, 2015b).

Since 2003, more women have being reporting positive HIV cases than men. Moreover, the highest number of reported cases of HIV in 2014 occurred in the 25-49 age group accounting for 61.7% (463/751) of all cases compared with 67.7% in 2013. Region 4 continued to have the highest proportion, of all HIV cases in 2014 with 72.8% of all cases compared with 75.4% in 2013 (Government of Guyana, 2015b). The relatively higher notification of cases in Region 4 can be attributed to the larger population size and the higher concentration of HIV services, including counselling and testing.

The Biological and Behavioural Surveillance Survey (BBSS) 2014 showed a sharp decrease in the HIV prevalence among female sex workers (FSWs), from 26.6% in 2005 to 5.5% in 2014. There was also a marked decrease in prevalence among men who have sex with men (MSM) from 21.2% in 2005 to 4.9% in 2014, and among miners from 6.5% in 2000 to 1% in 2014. Several populations were surveyed for the first time in 2014 with HIV prevalence reported as follows: Loggers 1.3%, male sex workers (MSWs) 5.1%, and trans-genders 8.4% (Government of Guyana, 2015b).

The diagnostic capacity of the treatment and care programme continued to be supported by the National Public

Box: The HFLE Programme

The HFLE targets (i) social and interpersonal skills, such as communication, refusal, assertiveness, and empathy; (ii) cognitive skills, such as decision- making, critical thinking and self-evaluation skills; and (iii) emotional coping skills, such as self-awareness, self-control, and conflict resolution (Ministry of Education, 2015c)

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Health Reference Laboratory (NPHRL), which provides CD4, viral load and DNA polymerase chain reaction (PCR) testing. The laboratories of 5 government hospitals in Regions 2, 3, 6, 7 and 10, also provided CD4 testing. Three of these hospitals are regional hospitals.

During 2014, treatment and care services were delivered through 22 treatment sites. A total of 5,041 HIV patients (55.8% females and 44.2% males) were listed on the register in the care and treatment programme at the end of 2014 with 4,295 (85.2% of the patients) receiving antiretroviral therapy (ART). There were 602 new enrolments during the year, including 17 children. ARV is available for free, but similar to the case of pregnant women who are identified as HIV positive and stop taking the medicine, there are cases where patients do not come back for follow up or for new dosages of ARV. That seems to be common in the interior of the country where due to economic factors migration is high, pushing families to search for better economic opportunities in different places.

Besides, HIV patients also suffer a heavy stigma that influences their willingness to seek for medication and treatment in some regions. For instance, it was reported that in the interior of the country, the HIV specialists coming from the capital schedules monthly consultations for patients, all in the same day. The community already knows that those in the health facility at that day are seeing a doctor due to HIV, increasing stigmatization of those seeking for treatment, and, consequently, also increasing the chances that people would stop treatment.

12.1) Causes, Bottlenecks and Barriers related to HIV/AIDS among Adolescents

For the adolescent and youth adult groups in Guyana, HIV is largely transmitted through unprotected sex, which is influenced by a series of underlying and structural factors depicted in Figure 112.

Figure 112: Causal Tree for HIV and STDs infections among adolescents

As discussed in Chapter 1130, the elevated rates of teenage pregnancy in Guyana is an indication that unprotected sex is common in the country, creating the additional risk for adolescents to be exposed to sexual transmitted diseases,

30 Most of the issues related to adolescent’ sexual behaviour, including early sexual debut, individual behaviour, and use of condoms were discussed in Chapter 11 (Teenage pregnancy).

HIV Key Affected Populations

In Guyana, the following are considered the key affected populations in relation to HIV, i.e., the populations who are more in risk of contracting it:

Men who have sex with men (MSM)

Trans-genders

Sex workers

Miners and Loggers

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including HIV. Adolescents, especially the girls are of great concern.

Sexual risk behaviour is also associated with adolescents having multiple sex partners without using condoms. In this line, the 2014 MICS report mentioned that around 2.4% of the women between 15 and 24 years of age had more than one partner in the last 12 months, in comparison to 15% among men in the same age group. In looking specifically at the group between 15 and 19 years of age, numbers are smaller: 1.6% for girls, and 10% for boys. Around 50% of the youth population between 15 and 24 years old who had more than one sexual partner in the last 12 months had reported using a condom last time they had sex (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015).

One of the most important prerequisites for reducing the rate of HIV infection is accurate knowledge of how HIV is transmitted and strategies for preventing transmission. According to the MICS results, in Guyana, a large majority of the women and men aged 15-49 years have heard of AIDS – 98% and 97%, respectively. However, the percentage of those who know of both main ways of preventing HIV transmission – having only one faithful uninfected partner and using a condom every time – was 75% for women and 74% for men.

Less than half of the adolescent population between 15 and 19 years of age (47.7% for women, and 33.2% for men) have comprehensive knowledge on HIV and AIDS, i.e., they know that (i) consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV; (ii) a healthy-looking person can have HIV, and (iii) are able to reject the two most common local misconceptions about transmission/prevention of HIV in the country. As a matter of fact, among all the age groups in the research, the group between 15 and 19 for both men and women has the smaller rate of comprehensive knowledge.

For the population between 15 and 49 years of age31, comprehensive knowledge on HIV is also small: 55.6% for women and 48.6% for men. Comprehensive knowledge was particularly low among both women and men living in Region 5 (28% and 18%, respectively) as well as those living in households with an Amerindian household head (39% and 34%, respectively). Only in Region 9 the comprehensive knowledge of men age 15 to 49 years old is higher than women. In all other regions, and all other socio-economic characteristics men know less on HIV/AIDS than women (Table 22).

Table 22: % of population between 15 and 49 years of age with Comprehensive Knowledge on HIV by socio- economic characteristics and region, Guyana, 2014

Women Men Country 55.6 48.6 Urban 67.5 64.7 Rural 51.2 42.8 Coastal 56.2 49.0 Urban Coastal 66.9 66.5 Rural Coastal 52.3 42.7

31 2014 MICS results did not present this information for the population between 15 and 19 years of age.

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Women Men Interior 51.5 45.4 Region 1 42.7 35.2 Region 2 64.9 37.2 Region 3 47.8 46.5 Region 4 59.8 55.2 Region 5 27.6 17.9 Region 6 63.3 53.0 Region 7 & 8 39.7 37.8 Region 9 37.4 45.5 Region 10 69.5 49.8

Poorest 40.2 33.9 Second 49.3 38.3 Middle 54.9 52.1 Fourth 61.7 50.3 Richest 67.1 66.0 East Indian 50.4 43.7 African 62.8 55.0 Amerindian 38.9 34.1 Mixed Race 63.6 58.2

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Despite the fact that 81% of the girls between ages of 15 and 19, and 71% of adolescent boys in the same age group know a place to get tested for HIV, the rates for those who were actually tested are much smaller (30.6% and 20% for girls and boys respectively) (Figure 113).

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Figure 113: % of boys and girls ages 15 to 19 with knowledge of a place for HIV testing, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

In terms of legislation and policies (enabling environment), in response to the rising challenge of HIV/AIDS and other health issues, the Ministry of Education (MoE) has been working in cooperation with the Ministry of Public Health in two policies aimed at secondary school students: first, the school health and nutrition (SHN) and HIV/AIDS policy was disseminated in 2009; and second, the Health and Family Life Education (HFLE) programme, which focuses on reducing teenage pregnancy and HIV prevention. As mentioned previously in chapter 11, the HFLE 2013 evaluation revealed that if the intervention is to have greater positive impact, much more work needs to be done in the area of teacher training; learning materials; teacher attitudes towards sensitive topics; parental involvement; whole school approach; and effective referral systems (Ministry of Education and UNICEF Guyana, Feb 2014).

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Chapter 13: The Right to be Protected

Sustainable Development Goal 16: Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive

institutions at all levels

Target 16.2: End abuse, exploitation, trafficking and all forms of violence against and torture of children

The abuses, different forms of violence and violations of rights described in this chapter are all interconnected. The idea to separate the violations into six subsections has as objective to emphasise the issues; nonetheless, the causes, bottlenecks and barriers related to domestic violence, for instance, share common grounds with sexual, psychological and physical abuse, as well as child trafficking and child labour. This chapter also covers mental health – an important issue flagged by different stakeholders in the country; explores the situation of children in contact with the law, and describes how adolescents are participating in decision making at home, school and society in general.

13.1) Domestic Violence

In homes and families, children suffer as witnesses of domestic violence and as victims of child abuse and neglect (UNICEF Regional Office for Latin America and the Caribbean, 2006). Frequently the domestic violence that has women as their main victims is extended to boys and girls of all ages.

Between 2011 and 2013, the Crime and Social Observatory (CSO) from the Ministry of Public Security has registered more than 9,200 different types of domestic violence cases in Guyana, with 65% of them involving assault (

Table 23). Between January and October of 2015, 17 women were murdered by their partners32.

Table 23: Domestic Violence cases registered by type, Guyana, 2011-2013

Domestic Violence Reports Cases 2011-2013 % of total cases Assault 5,998 65% Threatening Language 1,486 16% Abusive Language 763 8% Provoking breach of peace 354 4% Threatening behavior 248 3% Other 368 4% Total 9,217 100%

Source: Crime and Social Observatory (CSO), (UNICEF Guyana, Nov 2015)

Despite the fact that the majority of victims are older than 25 years old, there are a significant percentage of children (8%) and young adults (16%) being victims of domestic violence (Figure 114).

32 Source: Guyana Chronicle, Thursday, November 26, 2016.

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Figure 114: Age distribution of victims of domestic violence, 2011-2013

Source: Crime and Social Observatory (CSO), (UNICEF Guyana, Nov 2015)

Causes, bottlenecks and determinants of domestic violence

Domestic violence has a straight connection to gender-based violence (GBV). According to PAHO (PAHO, 2012), gender-based violence is widespread in Guyana and rising among all socioeconomic and ethnic groups, affecting more women than men. Between 2006 and 2007, there was an estimated 50% increase in the total number of GBV victims, 3,600 more than the previous year. The largest increase was recorded in Berbice (Regions 5 and 6), where reported cases rise steeply from approximately 300 in 2006 to 1,890 in 2007, representing a 500% increase. At least one in three Guyanese women has reportedly been a victim of GBV, and Help and Shelter, a nongovernmental organization working in this area, served 324 female clients between January and July of 2008. Of these, 128 were of African descent, 112 of East Indian descent, and 84 from other ethnic groups (PAHO, 2012).

A mix of social norms and social and cultural practices have been identified as the main factors that influence violence against women. In this sense, using a sociological perspective, gender-based violence, and attitudes toward it, could be subdivided into two sets of causes: those at the individual level and those at the social level. For the individual, gender-based violence is largely driven by factors related to gender inequality, childhood experiences and the enactment of harmful forms of masculinity (Fulu, et al., 2013). Violence against women is related to the power control that men try to exercise over the women, which is also extended to the children (UNICEF, 2012).

Overall, 10% of men and women between 15 and 49 years old believes it is justifiable to a husband hit his wife if she goes out without telling him, neglects the children, argues with him, refuses sex with him or if she burns the food (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015), a considerable reduction when compared to 18% in 2006 (Bureau of Statistics and UNICEF Guyana, 2008). Table 24 compares the perspectives of women and men towards violence, and displays how different socio-economic aspects influence in the behaviour. For instance, domestic violence is more acceptable among those in the rural areas than in urban settlements, for both men and women. Also, the poorest the family, highest is the acceptance of wife beating. Another factor that should be taken into consideration is the fact that the highest level of acceptance of wife beating happens in the Amerindian community, one in every four adults believe it is justifiable to hit the wife. High numbers are also present in Regions 9 and 1 (for both women and men), Region 5 (mainly for women), and Region 7/8 for men.

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Table 24: Percentage of women and men (15-49 yeas) who believe a husband is justified in beating his wife, by gender and socio-economic characteristics, Guyana, 2014

Women Men Country 10.2 9.6 Urban 2.8 5.4 Rural 12.9 11.1 Coastal 9.4 8.5 Urban Coastal 2.7 5.4 Rural Coastal 11.9 9.6 Interior 15.6 17.8 Region 1 14.8 25.8 Region 2 20.1 9.1 Region 3 12.8 15.3 Region 4 7.3 7.2 Region 5 20.5 8.6 Region 6 5.7 5.3 Region 7 & 8 16.4 18.1 Region 9 27.4 31.5 Region 10 4.2 7.1

Poorest 19.0 17.8 Second 12.2 9.7 Middle 10.5 8.5 Fourth 6.6 7.7 Richest 5.2 5.4 East Indian 12.9 10.1 African 4.8 5.2 Amerindian 26.6 25.5 Mixed Race 6.1 9.5

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

At the social level, violence and attitudes toward gender are created based on the country’s history, and how other social factors are constructed in society, including how religion and culture shape morals, practices and attitudes (UNFPA, 2009).

In this sense, lack of punishment for those men that perpetrate violence against women (and, as it is going to be explored later, against children) was appointed as one factor that reinforces violent acts in the country. For example, between January and November of 2015, 582 cases of domestic violence were reported in Berbice, from these, 326 reached the court, and only 17 men were convicted33. According to stakeholders, the belief of impunity reinforces violent behaviour among different populations in Guyana. In many cases, the perpetrator is let go when reports are made. Victims refuse to give statements to the police or to the courts, afraid of being stigmatized or being object of

33 In 2014, Berbice had similar numbers: 585 reports of domestic violence and 19 convictions. Source: Stabroek News, November 21, 2015.

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future violence. Poverty also hinders reporting against domestic violence. In many instances, the perpetrator is the only provider for the family, and if he is arrested, mother and children will not the necessary financial means to support themselves.

In terms of legislation, the Sexual Offences Act was passed in May 2010 to strengthen measures for gender based violation prevention, and it makes spousal rape illegal. A National Policy for Domestic Violence is in place, with a special unit established in the Ministry of Labour, Human Services, and Social Security to oversee and monitor its implementation.

13.2) Sexual, psychological and physical abuse

For UNICEF34, there is significant evidence that violence, exploitation and abuse can affect the child’s physical and mental health in the short and longer term, impairing their ability to learn and socialize, and impacting their transition to adulthood with adverse consequences later in life. Violence, exploitation and abuse are often practiced by someone known to the child, including parents, other family members, caretakers, teachers, employers, law enforcement authorities, state and non-state actors and other children. Worldwide, only a small proportion of acts of violence, exploitation and abuse are reported and investigated, and few perpetrators are held accountable.

According to numbers reported by UNICEF (UNICEF Guyana, Nov 2015) and originated from the Childcare and Protection Agency (CPA), housed in the Ministry of Social Protection, the number of children being abused in the country has been reduced between 2011 and 2014 (

Table 25). Children neglect is still the main type of violation suffered by children, followed by physical and sexual abuse.

Table 25: Types of Child Abuse Reported By Gender, 2011, 2013 and 2014

2011 2013 2014 Boys Girls Total Boys Girls Total Boys Girls Total

Physical 350 488 838 277 307 584 279 210 489 Sexual 63 652 715 80 590 670 60 568 628 Verbal 107 200 307 106 141 247 71 94 165 Neglect 860 1,017 1,877 789 863 1,652 675 662 1,337 Abandoned 38 56 94 38 45 83 26 27 53 Total 1,418 2,413 3,831 1,290 1,946 3,236 1,111 1,561 2,672

Source: Childcare and Protection Agency (CPA), (UNICEF Guyana, Nov 2015)

Preliminary information from the CPA indicates that 1,915 cases of abuse were reported between January and September of 2015: 1042 cases of neglect, 492 cases of Sexual Abuse and 381 cases of Physical Abuse. Historically girls are the main subjects of the different forms of abuse. 58% of the cases reported in 2014 were against girls (Figure 115).

34 http://www.unicef.org/protection/57929_57972.html. Accessed on June 1, 2015.

“Our family system is broken, and many times persons who are in abusive relationships do not have that family support, so they remain silent”.

Social Protection Minister Volda Lawrence, Guyana Chronicle, November 26, 2015.

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Figure 115: Gender distribution of child abuse cases, Guyana, 2011, 2013 and 2014

Source: Childcare and Protection Agency (CPA), (UNICEF Guyana, Nov 2015)

Despite the fact that the data does not distinguish between different ethnicities in the country, Amerindian children in Guyana have been reported to experience higher levels of physical and sexual abuse than children from the general population (UNICEF Regional Office for Latin America and the Caribbean, 2006). Besides, anecdotal evidence collected in Guyana points to more cases of violence against children happening in the poorest communities.

Causes, bottlenecks and determinants of abuse against children

The main causes and bottlenecks of child abuse are rooted in social norms and social and cultural practices that are being conducted for years in the country. These are strengthened by lack of implementation of the legislation, weak monitoring of cases, underreporting and impunity.

In terms of social norms and practices, all those social and cultural determinants that influence on violence against women (section 13.1) also help to explain the situation in terms of different abuses suffered by children. Similarly, the issues with corporal punishment (presented in chapter 9) are extended into adolescence.

Sexual exploitation and abuse remain prevalent and socially tolerated, particularly if it involves girls. The cultural and social roots of sexual abuse of females is also illuminated by the fact that many girls believed that sexual harassment is ‘normal’ and is usually instigated by a women’s choice of clothing and behaviour. For example, a large proportion of the children interviewed in Guyana for UNICEF’s study on violence against children believed that girls were often the instigators of sexual abuse as they wore revealing clothing (UNICEF Regional Office for Latin America and the Caribbean, 2006).

Interviewees in the country have mentioned that there is a cycle of abuse where fathers and mothers who presently abuse their children were victims in the past. In this sense, some forms of abuse are actually considered acceptable and transmitted from one generation to another (UNICEF, 2012). The perpetuation of this cycle shows that measures have to be taken to change behavioural aspects of the community. Also related to social norms are the complicity of families, neighbours and society in general in accepting the abuse, and consequently the general silence around violence, abuse and exploitation.

Regarding legislation, on one hand, the country has enacted legislation to strengthen the protection of children from sexual abuse and exploitation, including the Sexual Offence Act of 2010, the 2009 Protection of Children Act and the 2008 Prevention of Crime Act. On the other hand, the consensus among stakeholders in the country is that the

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enforcement of the legislation is a major bottleneck in the system. The legislation is considered to be quite advanced; nevertheless, stakeholders agreed that it is not implemented, as it should. Lack of implementation is related to weak internal systems to enforce the law – few are the cases where police officers are punished for not pursuing a case of abuse – and lack of knowledge among those who should implement the legislation. Besides, government agencies that handle cases of abuse against children do not have sufficient staff to investigate all the cases. The police Juvenile Branch has three officers stated in Georgetown to cover the whole country. Despite the fact that they try as much as possible to cooperate with regional polices, the number is insufficient to properly investigate all those who are accused of committing crimes against children.

As appointed by the UN Committee on the Rights of the Child, the country has lack of data and information on the root causes and extent of sexual exploitation and abuse of children, as well as inadequate monitoring and reporting mechanisms (UN Committee on the Rights of the Child, 2013). Guyana has no electronic distinct or centralized data collection system for cases related to children – most of the systems are decentralized and paper-based. For instance, the Juvenile Branch does not have an online database to monitor cases, and no real-time summary reports of the problems that happen in the country involving children (either as victims or as perpetrators). In order to have access to the data, someone from the branch has to call on the different police divisions and ask them to send in their reports, which are not always on time. As mentioned by stakeholders, the Ministry’s reported numbers are always different from the Juvenile Branch numbers. It was felt that the lapse in data collection was a result of the divisions failing to collect information, file it and reporting it properly. This hampers not only the Juvenile Branch in preparing their annual reports, but also the whole child protection system that does not have accurate and real-time data to plan and manage for results. Consequently, the lack of harmonizing data in child protection issues jeopardizes monitoring their situation, and the development of public policies to specific address some issues.

Underreporting happens due to failures in the protective system of victims and witnesses. Victims and witnesses are afraid of being stigmatized – creating a double burden on them –, afraid of suffering other forms of violence and/or, afraid of not having the necessary support if the perpetrator is sent to jail. Stakeholders’ perception is that impunity is high and, consequently, if victims report their cases, they are going to suffer more. The financial situation is an important component in the victim’s decision to report abuse. When children and women have a financial dependence on the perpetrator, they are going to lose their only financial support if the perpetrator is sent to jail. As widely discussed in Guyana, some cases of abuse are reported to the police, but later they are dropped by the victims or their families in fear that something worse could happen to them. In this line, teachers and health workers might have the ability to identify cases, but there is silence from them since the reporting might actually put them in risk of being threatened by the perpetrators.

Anecdotal reports suggest that the consequences of sexual abuse are often that the child (and sometimes the mother) is forced to leave their home or community and experience extensive dislocation in their lives. However, the perpetrator often remains unpunished and does not receive any rehabilitative services. It is therefore likely that the perpetrator will sexually abuse another young victim in the future (UNICEF Regional Office for Latin America and the Caribbean, 2006).

As mentioned in discussion on domestic violence, impunity is seen as one of the major bottlenecks in relation to prevent abuse against children, influencing adult’s behaviour and hampering the reporting of cases. Anecdotal evidence collected in Guyana shows that the process for arresting and prosecuting someone accused of child abuse is long and bureaucratic. In many cases families do not have a feedback from the police and/or from the courts about how the process is running. According to stakeholders, it is common that perpetrators of physical and sexual abuses try to compensate the victims and their families with money or other goods. In some cases, the police or local leaders suggest the act of compensation.

Assessment conducted by the Ministry of Social Protection and UNICEF (Ministry of Social Protection and UNICEF Guyana, June 2014) shows that children living in the hinterland and in the coastal communities did not feel that police officers or their parents could protect them from abuse. Corruption and poverty were cited as the primary reasons. Children stated that police officers were known to yield to persons with wealth and parents could not protect them since they were either poor or fearful of the police. It therefore means that the rebuilding of public trust in law enforcement officers starting with children at the community level is an important component of child safety.

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Even in cases where the perpetrator is reported, the legal procedures can prevent prosecution35. For example, as reported by UNICEF (UNICEF Regional Office for Latin America and the Caribbean, 2006), in Guyana, children need to be able to give credible evidence and the defence lawyers are often so intimidating that the child becomes upset and confused and the evidence is declared not credible. In this line, according to the country’s legislation, the accused has to be held for 72 hours, in which time the police must bring their case36. As mentioned by many stakeholders, this time is not enough to investigate and build a case when children are involved. Consequently, it is common that those who abuse children are walking away with no punishment. As mentioned by one of the interviewees: “If persons perceive the law to be ineffective in terms of prosecution and enforcement there will always be a negative attitude of the offenders in the commission of these offences. It is therefore necessary to strengthen the investigative process, which will result in a better attitude towards the commission of these offences, in that they would be less likely to commit such acts”.

Children in Need of Alternative Care

Children in need of alternative care could be characterize into three groups: (i) those boys and girls who lost one or two parents; (ii) those children who do not receive acceptable care from their parents due to neglect or other form of abuse; and (iii) children in detention – this last group is discussed in section 13.5. In 2003, there were an estimated number of 22,000 orphans in Guyana, 7 thousand of them due to HIV/AIDS. The estimates for 2010 were 23,000 orphans, 9 thousand due to HIV/AIDS (Greene, 2009). Not all of the cases related to child abuse are referred as cases where the child needs to be taken from their parents.

Assessment commissioned by the Ministry of Social Protection and UNICEF (Ministry of Social Protection and UNICEF Guyana, June 2014) mentions different forms of alternative care in Guyana. Institutional care is the most common form of alternative care provided by the State. Other types of alternative care, such as adoption and foster care (and many other variations of family - and community-based care) are also practiced to some extent. In practice, these forms of care and their many variations constitute a full spectrum of alternative care environments known as the continuum of care. In Guyana, most children outside of parental care live with their extended families in kinship care arrangements. The placement of children in institutions is usually a last resort, and only used when all other placement options have been exhausted

There are 23 children homes in Guyana, three are state owned and 20 are privately owned. Over 800 children were living in these homes at the end of 2012 with 212 of these children in the government managed children homes. According to reports, the CPA is experiencing great difficulties in maintaining the caregiver to child ratio at the residential homes and 2012 saw an even greater escalation of this situation. Pertinent data on residential facilities are not available, thereby making it difficult to ascertain accuracy on age and other needed information. (Ministry of Social Protection and UNICEF Guyana, June 2014).

Guyana does not currently have an alternative care policy - along the process has started. Besides, Guyana is not a party to the Hague Convention on international adoption. In that sense, there are many concerns expressed by the UN Committee on the Rights of the Child in relation to those children who need to be placed in alternative care, among them: (i) there are increasing numbers of children, particularly those from single-parent families, being placed in institutional care; (ii) there are no safeguards and procedures for ensuring that institutional care is genuinely used as a measure of last resort; (iii) the alternative family and community-based options for children deprived of a family environment or children with special protection needs are inadequate in scope and quality; (iv) there are insufficient efforts being made to reunite children in institutional care with their biological families, resulting in many of these children remaining in institutions until the age of 18 years; and (v) the Visiting Committees monitoring the institutions do not adequately ensure the quality of care provided and the protection of children from violence and abuse at such facilities (UN Committee on the Rights of the Child, 2013).

35 In order to fix this problem, Government through NGO-Public partnership and UNICEF have supported one-stop centers to support reporting on abuse. 36 The 72 hours is the longest time a person can remain in police custody, without being charged. However, an extension can be requested. In terms of completing an investigation before requesting legal advice, three months are allotted. If a man is arrested on a report of abuse, the police can either request an extension on his time or release him on bail and have him report to the station the next day or every other day or every week depending on how the investigations are going. A juvenile may not be forth coming with their statement as it takes time, sometimes days. Thus time can be requested in order to acquire that statement.

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13.3) Child Trafficking and Child Labour

Child Trafficking

The Sustainable Development Goals on its Target 5.1 calls for an elimination of all forms of violence against women and girls, including trafficking, sexual and other types of exploitation. Worldwide, trafficking in persons and human trafficking – including child trafficking – has been used as umbrella terms for the act of recruiting, harbouring, transporting, providing, or obtaining a person for the purpose of exploitation such as compelled labour or commercial sex acts. For UNICEF, child trafficking is a violation of their rights; it interferes with their well-being and denies them the opportunity to reach their full potential.

Human trafficking can include, but does not require, movement. People may be considered trafficking victims regardless of whether they were born into a state of servitude, were exploited in their hometown, were transported to the exploitative situation, previously consented to work for a trafficker, or participated in a crime as a direct result of being subjected to trafficking. At the heart of this phenomenon is the traffickers’ goal of exploiting and enslaving their victims and the myriad coercive and deceptive practices they use to do so (US Department of State, July 2015).

Guyana is considered by the US Department of State as a Tier 2 Watch List Country; i.e., it does not fully comply with the United Sates 2000 Trafficking Victims Protection Act’s (TVPA) minimum standards, but is making significant efforts for it. The country is a source and destination for men, women and children subjected to sex trafficking and forced labour.

Worldwide the number of persons and children as victims of human trafficking are difficult to be monitored, and many cases are underreported. The Ministry of Labour, Human Services, and Social Security reported 80 suspected cases, and 179 confirmed victims of human trafficking between 2013 and 2015. 91% of the victims were women (Table 26). Among the victims, 50% were children under the age of 18, with some as

young as 11 and 13 years of age (Table 27).

Table 26: Cases of Human Trafficking, Guyana, 2013-2015

2013 2014 2015 Total # of suspected cases reported 26 26 28 80 # of confirmed victims 52 57 61 170 # Men 8 6 1 15 # Female 44 51 60 155 % Children 68% 45% 41% 50%

Source: Communication received from The Ministry of Labour, Human Services, and Social Security in May of 2016.

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Table 27: Age of victims of trafficking, Guyana, 2013-2015

Age of Victim 2013 2014 2015 Grand Total 11 1 1 13 1 1 3 5 14 4 5 3 12 15 9 5 5 19 16 9 2 5 16 17 4 9 4 17 18 5 3 3 11 Total Children 32 25 24 81 Total Adults 15 31 35 81

Source: Communication received from The Ministry of Labour, Human Services, and Social Security in May of 2016.

Causes and bottlenecks related to child trafficking

Human trafficking in Guyana is partially connected to the extractive industries that move a significant part of the country’s GDP. Although communities can benefit from such industries by using these natural resources for sustainable development; mining, drilling, and quarrying activities often occur in relatively remote areas with minimal infrastructure and limited rule of law, leading to the development of makeshift communities, such as mining “boom towns,” that are vulnerable to crime. There are evidence of sex trafficking near gold mines in Guyana, as well as in the mines near the borders of Brazil, Suriname and Venezuela. In that sense, the 2015 Trafficking in Persons Report mentions that children are particularly vulnerable to sex trafficking and forced labour, mainly due to limited government presence in the interior, and the unethical activities involving some police officers in the country. In the same line, Guyanese nationals are subjected to sex and labour trafficking in Suriname, Jamaica, and other countries in the Caribbean region (US Department of State, July 2015).

Child trafficking is a concerned, but it is not yet seen as being the consequence of organize criminal groups acting in the country. For most of those involved in fighting the problem, it happens through referrals and invitations. Child trafficking is fuelled by a myriad of underlying and structural causes that involve cultural attitudes, disintegration of the family structure, lack of parent’s knowledge on the schemes used by traffickers, lack of work opportunities and lack of adequate law enforcement, legal protection, prosecution or sanction, among other causes. On the background of all these causes is the financial situation of individuals and families: it is common understanding among stakeholders in Guyana that child and adult human trafficking is entrenched and self-enforced by poverty.

Anecdotal evidence points to the fact that economic vulnerable families will support their children to work in small shops and/or bars near the mines in order to increase the household’s income. While some children might start working as vendors, shop owners usually take control of the children and use them to bring costumers to the bar/ shop. In most extreme cases, different stakeholders mentioned cases of mothers who prostitute their daughters since that is the most immediate source of income they might have. While girls are the main victims of trafficking, qualitative information collected in Guyana show that boys are also sent by their families to work in illegal mining areas, logging, or in farms.

Despite efforts from the government in fighting human trafficking – for example, government has a unit to combat this crime, has released its anti-trafficking action plan in June 2014 and it has been implementing the Combating Trafficking of Persons Act of 2005 – Guyana’s response to the problem is still lagging behind. Analysis from the US Department of State (US Department of State, July 2015) mentions that law enforcement efforts remain insufficient, and weak law enforcement efforts have been hindering the process of holding traffickers accountable. The situation is aggravated since government does not have enough law enforcement agents trained and acting to prevent this type of crime. For instance, the Trafficking in Persons Unit – hosted in the Ministry of Social Protection – had in November

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of 2015 two officers to cover the whole country. Besides, police officers and local government officials who work in the most remote areas of the country are not fully capacitated to identify and fight cases of child trafficking, contributing to one of the major bottlenecks: the challenge to identify and prosecute those involved with trafficking.

Stakeholders also mentioned weak cooperation between the different government actors involved in the problem, among them, it was mentioned that the Guyana Geology and Mines Commission (GGMC), institution responsible for regulating the mining sector in the country, sometimes makes a “blind eye” to the problem. As well as the cases of child abuse, underreporting of cases also occurs since people in the community – including teachers and health staff – do not feel empowered for reporting those cases since the results are unknown. If the process is not clear and efficient, people become afraid of possible retaliations from those accused of trafficking.

According to stakeholders, the courts in Guyana are also not fully prepared to conduct and prosecute cases of human trafficking, including those involving children. There were few convictions reported in 2014, and internal assessments have demonstrated that Government’s efforts to investigate, prosecute, and convict traffickers and identify and assist victims remained limited, with few support to local based NGOs that could help to identify and assist victims. Adding to that, there are reports of cases not being prosecuted, and convicted traffickers being released on bail while they wait for their appeal on court (US Department of State, July 2015).

Child Labour

Child trafficking has a straight relationship with child involvement in economic activity and child labour37.

In looking at different socio-economic characteristics, around 56% of children between the ages of 12 and 14 years old were involved in economic activities in the interior areas of the country (Figure 116). Children in the Amerindians communities have a higher probability of working in comparing to other ethnicities. Most of these working children are located in Region 9, where 3 in each 4 boys and girls in this age group are engaged in economic activities (Figure 117).

Figure 116: Percentage of children age 12-14 years involved in economic activities for at least 14 hours a week by socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

37 As described in Chapter 9, economic activity (paid or unpaid) is any work on plot / farm / food garden; looking after animals; helping in family or relative’s business, running own business; producing or selling articles / handicrafts / clothes / food or agricultural products; or any other activity in return for income in cash or in kind. For the age group between 12 and 14 years of age and the group between 15 and 17 years of age, if a child is involved in economic activity for less than 14 and 43 hours in a week (respectively), he/she is not considered to be victim of child labour. If the boy or girl works for more than 14 or 43 hours, respectively, then the situation is characterized as child labour. For detailed definitions of child labour please access the 2014 MICS report (Bureau of Statistics, Ministry of Health and UNICEF Guyana, April 2015).

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Figure 117: Percentage of children age 12-14 years involved in economic activities for at least 14 hours a week by Regions, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Similar to the age group between 12 and 14 years old, the chances of being involved in economic activities for the children in the group between 15 and 17 increase if they are from the Amerindian community, if they live in the

Government Response to Human Trafficking

Guyana is equipped with the Combating of Trafficking in Persons Act No. 2 of 2005, which provides the legal basis for law enforcement actions with regard to trafficking in persons. The introduction of the piece of legislation followed Guyana’s ratification of the United Nations Convention against Transnational Organized Crime (UNTOC) and its supporting instrument, the Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children.

Guyana established a Ministerial Task Force on Trafficking in Persons. The Task Force was established in February 2007 and is an inter-agency body intended to meet monthly to plan, implement, monitor and evaluate national strategies in response to issues relating to trafficking in persons.

From the inception, the Ministerial Task Force has been chaired by the Ministry of Public Security, then Ministry of Home Affairs, and has featured a number of Agencies - both Governmental and Non-Governmental – which are each represented by an individual who is regarded as a Focal Point person to assist in expediting inter- agency cooperation. Initially, the Task Force was comprised of seven Agencies: The then Ministries of Home Affairs; Labour, Human Services and Social Security; Legal Affairs; Foreign Affairs and Amerindian Affairs; along with Help & Shelter and Food for the Poor. Overtime, the composition of the Task Force has expanded to also include the Ministry of Local Government, Ministry of Natural Resources and the Environment, Guyana Geology and Mines Commission.

Source: Communication from the Ministerial Task Force on Trafficking in Persons, received in May of 2016

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interior of the country, and if they are from poor families (Figure 118). There are more boys than girls working on this age group. Region 9 is also where proportionally more children between ages 15 and 17 are engaged in economic activities (Figure 119).

Figure 118: Percentage of children age 15-17 years involved in economic activities for at least 43 hours a week by Socio-economic characteristics, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Figure 119: Percentage of children age 15-17 years involved in economic activities for at least 43 hours a week by Region, Guyana, 2014

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

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Overall, among all children 5 to 17 years of age 18% of them are considered to be engaged in child labour, i.e., they work over the limit stipulated as involved in economic activity. That number is higher than the number estimated by the 2006 MICS when 16.4% of the children were considered to be involved in child labour (Bureau of Statistics and UNICEF Guyana, 2008). In 2014, 13% of children were considered to be working under hazardous conditions. Table 28 depicts the 2014 information disaggregated by different socio-economic characteristics.

Table 28: % of child labour and % of children working under hazardous conditions, Guyana, 2014

% of children engaged in child labour

% Children working under hazardous

conditions Total Country 18.3 12.5 Sex Male 19.7 14.5 Female 17 10.5 Region Region 1 23 15 Region 2 21.5 15 Region 3 16.3 11.3 Region 4 11.2 6.2 Region 5 13.8 10 Region 6 18 9.9 Regions 7 & 8 35.3 30.2 Region 9 70.7 56.6 Region 10 27.8 24.9 Area Urban 14.5 9.5 Rural 19.7 13.6 Coastal 14.2 8.6 Urban Coastal 11.4 6 Rural Coastal 15.3 9.6 Interior 37.1 30.2 School attendance

Yes 18.2 12.1 No 18.9 15.3 Wealth index quintile

Poorest 32 24 Second 15 11.5 Middle 14.8 8.7

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% of children engaged in child labour

% Children working under hazardous

conditions Fourth 12.8 8.6 Richest 11.6 5

Ethnicity East Indian 16 9.4 African 16 10.8 Amerindian 40.9 33.5 Mixed Race 13.1 8.8

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Most of the children involved in child labour are working in the agriculture sector (including farming, forestry and fishing); industry (construction, welding and mining); and services (domestic work, work in bars and restaurants, and street vending). As mentioned, the country also has evidence that some children are involved in economic activities characterized as worst form of child labour, such as commercial sexual exploitation as result of human trafficking (US Department of Labor, 2014)

Despite the fact that household chores cannot be characterized as economic activity, if not managed well they can deviate time from the child time of studying and playing. Around 68% of the children between the ages of 5 and 17 interviewed for the 2014 MICS survey were involved in household chores. The older the child, higher is his/her involvement in household chores. Starting at age 12, more girls are involved in these activities than boys. Other characteristics that also determine household chores are related to where the child lives (interior or coastal areas), the wealth status of the family, and his/her ethnicity (Table 29).

Table 29: Percentage of children by involvement in household chores during the week previous to the Survey, by socio-economic characteristics and age groups, Guyana, 2014

Age groups 5 to 11 12 to 14 15 to 17

Country 56.7 76.6 83.2 Male 58.5 75.5 78.9 Female 54.9 77.8 87.1 Urban 48.2 79.2 86.2 Rural 59.6 75.7 82.0 Coastal 53.1 74.2 82.7 Urban Coastal 45.9 76.4 85.4 Rural Coastal 55.8 73.3 81.6 Interior 70.5 88.2 86.4 Poorest 69.3 87.5 90.9 Second 56.5 79.4 82.6

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Age groups 5 to 11 12 to 14 15 to 17

Middle 49.1 75.4 79.0 Fourth 55.0 65.2 82.4 Richest 46.6 70.4 80.2 East Indian 51.0 62.1 77.3 African 59.9 88.3 85.0 Amerindian 73.9 84.9 92.0 Mixed Race 52.1 77.4 89.3

Source: MICS 2014 (Bureau of Statistics, Ministry of Public Health and UNICEF Guyana, April 2015)

Causes and Bottlenecks on Child Labour

There are two main causes that push children into labour. First, the harsh economic conditions that families face create the necessity for many parents to have their children working to support the household income. That is even worse in single-parents households when only one adult can provide for the wellbeing of the family. Children are seen as being able to contribute to the household income since they are young, and as they grow older, they can have more profitable functions.

The country has no evidence on an efficiency policy that fought child labour in the past years. Much of it is seen as common and acceptable by society.

The second cause related to child labour is the social norm found in Guyana’s society that accepts child labour as normal, and that sees it as “character building” instead of rights violation. This social norm helps to construct what is called in the economic literature as an “intergenerational child labour trap” (Basu, Dec 1998) (Lópes-Calva, 2002), where young boys and girls have to work since their parents were working when they were children.

In terms of enabling environment, the UN Committee on the Rights of the Child has mentioned the need to update the legislation and the current policies to make clear on the internal definition of child labour (UN Committee on the Rights of the Child, 2013). The “Employment of Young Persons and Children Act” (Chapter 99:01) of the Laws of Guyana allow for the implementation of certain conventions of the International Labour Organization that relate to the employment of young persons and children. In this Act, a ‘child’ is defined as “a person under the age of fifteen years” while a ‘young person’ is defined as “a person who has ceased to be a child and who is under the age of sixteen years”. The Act prohibits the employment of a person, under the age of 15 years (child) and a young person, at night and in an industrial undertaking (e.g. mining, transportation and construction), subject to exceptions. The provisions of this Act do not apply to any employment or work in which only members of the same family are employed. In addition, it does not include family and small-scale holdings producing for local consumption and not regularly employing hired workers.

13.4) Adolescent’s Behavioural Health

Suicide is the 7th leading cause of death in Guyana38, with a mortality rate of 44.2 per 100,000 inhabitants, positioning the country as the highest prevalence in the world – the global average is 16/100,000 (WHO, 2014b). Between 2006 and 2008, suicide was the leading cause of mortality among persons between 15 and 24-years old: 22.4% of the deaths that occurred in that group were due to suicide (PAHO, 2012).

No one factor can explain Guyana’s high suicide rate. Newspaper article published in 2015 tries to identify possible

38 Source: World Health Rankings, using data from 2014 WHO. Available at http://www.worldlifeexpectancy.com/country-health-profile/guyana Accessed on January 20, 2016.

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causes for the problem39: Health workers have pointed to the deep poverty in rural areas, the prevalence of alcohol abuse (which is notorious for its contribution to successful suicides) and the ease of access to deadly substances – one of the most frequently used suicide methods in the country is the ingestion of pesticide. As many people are farmers, pesticides are readily available and contribute significantly to the high suicide rate. Some scholars have theorised that exposure to certain herbicides and pesticides used in the country makes farmers more prone to suicidal behaviour. According to the article, mental illness is misunderstood in the country, with symptoms often mistakenly attributed to witchcraft (known locally as obeah). Communities often ostracise sufferers, and on occasion have physically assaulted them, at times with the endorsement of religious leaders, who are highly respected figures.

While the article might deal with immediate and direct causes of suicide, other implicit factors also negatively contribute to this decision. According to adolescents that participated of focus groups, suicide is prevalent in the region they live (and in the country) due to youth’s inability to cope with problems. According to them, children and adolescents do not have a good channel of communication with adults, including parents, relatives and teachers at school. Besides, schools do not have counsellors to help those boys and girls that are experiencing difficult situation. Quoting the words of one adolescent that participated in one focus group:

“Many of the suicides are related to relationship issues. For example, there are girls that cannot share their problem with a parent because they are ashamed. Sometimes it is a cultural influence. There are stories that some girls committed suicide when they were told they had to marry older men – arranged marriage is still a reality in some parts of Guyana. So lack of counselling at school and parental skills all contribute to the high prevalence in suicide in the Region.”

Other factors might also contribute to high prevalence of suicide among the youth population. Among them, the lack of economic perspectives is considered to be very influential in the decision of some youth to take their own life. The fact that jobs are difficult in the country – as mentioned unemployment rate for the youth population is much higher than the country average – influences the present behavioural state of the youth, and creates doubts about the future perspectives in terms of work, family and relationships. Some young people cannot handle the pressure, and suicide becomes the only way out.

While some stakeholders have the position that the number of suicides is not that alarming, and cases are over reported by the media; suicide is part of the adolescents’ reality. For example, the results for the 2010 Global School Survey for Guyana show that 23% of the children between ages 13 and 15 had seriously considered attempting suicide in the 12 months previous to the survey (19% for boys, and 29% for girls) (WHO and CDC, 2010). Besides, the same survey shows that only 37% of the students interviewed to the survey considered that their parents understood their problems and worries (38% for boys and 36% for girls), indicating that there is the need to further investigate and strength the relationship between parents and their children.

13.5) Children in Contact with the Law and Juvenile Justice

Children in contact with the law have become a concern in Guyana. Data for the number of children in contact with the law comes from two different sources: the Juvenile Holding Centre and the New Opportunity Corps40. In 2014, there were 214 boys and girls in the Juvenile Holding Centre, a number that is slightly higher than the previous year (Figure 120).

39 The Guardian Internet Version. Published on June 3, 2015. http://www.theguardian.com/global-development-professionals-network/2015/ jun/03/guyana-mental-illness-witchcraft-and-the-highest-suicide-rate-in-the-world. Accessed on October 12, 2015. 40 Please refer to chapter 3.3 to better understand the juvenile system in Guyana and the relationships among the different institutions that are part of it.

Voice of Adolescents:

Have you ever helped out your family or relatives at a shop?

“Yes, after school or on the weekends either by selling at times when my parents are busy, for no remuneration at all.”

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Figure 120: Number of boys and girls admitted in the Juvenile Holding Centre, 2011-2014

Source: Juvenile Holding Centre, (UNICEF Guyana, Nov 2015)

Out of the 831 children and adolescents admitted in the Juvenile Holding Centre between 2011 and 2014, 70% were boys. Most of the boys were admitted accused of theft (break, enter and larceny). For girls, wandering was the main cause of admission (Table 30).

Table 30: Main alleged crimes committed by boys and girls, Guyana, 2011-2014

Boys Total % of total crimes Girls Total % of total

crimes Break, Enter and Larceny 153 27% 6 2% Wandering 99 17% 164 64% Simple Larceny 89 15% 20 8% Robbery Underarms 38 7% 0 0% Robbery 23 4% 0 0% Murder 7 1% 2 1% Other crimes 167 29% 63 25% Total 576 100% 255 100%

Source: Juvenile Holding Centre, (UNICEF Guyana, Nov 2015)

In September 2015, 84 children and adolescents were residents in the New Opportunity Corps (NOC), 55% of them boys. Among those who were sentenced, 56% were due to wandering and 33% due to crimes related to theft. Further crimes involve assault, and possession of narcotics, among others. Most of the children at NOC are from Region 4 (also reflecting the biggest population in the country), but some expressive numbers are from Regions 3 and 5.

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Causes and bottlenecks related to children in contact with the law

On the demand side, the most probable and recurrent cause that influences children to commit acts against the law is poverty and lack of economic opportunities. The economic situation of some families is a major determinant for some children to steal or commit small non-violent crimes

Social and cultural practices are also determinants that influence the propensity of children to violate the law. First, children grown up in an environment at home and in society where violence is acceptable, for instance, most of the adolescents were beaten when children as a form of being educated (corporal punishment was discussed in chapter 8) and, consequently, the use of force becomes an acceptable way to make a statement. Second, different stakeholders mentioned that adolescents are attracted to the image of violent characters observed in movies, video- clips or portrayed in video games and music, and that negative image influences their behaviour in society. Both cases indicate that the continuous mentoring process that should happen in the relationship between parents and children/adolescents is not happening. For instance, 42% of the children who answered the 2010 Global Health Survey mentioned that their parents, in most of the time, did not know what they were doing in their free time (WHO and CDC, 2010).

As a matter of fact, many stakeholders mentioned that the relationship between parents and children is becoming so problematic that some parents do not know how to handle their children, and the solution found for some is to report boys and girls to the police as they were committing wandering. While there are calls to remove wandering from the statute books, many seen it as a precursor to committing various crimes, and for some families, it becomes a solution to fix a problem that parents do not know how to solve.

Cultural practices also influence in the ingestion of drugs and alcohol, both considered being elements that encourage children to drop out of school, become violent and commit illegal acts. The 2010 Global School Survey (WHO and CDC, 2010) identified that 39% of the boys and girls in Guyana between the ages of 13 and 15 had drank alcohol in the 30 days before the survey. 29% of the students drank so much that they were really drunk one or more times during their life (Table 31). Around 7% of secondary students (11% for boys and 4% for girls) had tried marijuana before (Inter-American Drug Abuse Control Commission, 2015), a number that is considered low by different stakeholders in the country that work with adolescents and young populations.

Table 31: % Alcohol consumption, students between 13 and 15 years of age, Guyana, 2010

Total Boys Girls Percentage of students who drank at least one drink containing alcohol on one or more of the past 30 days

39.2 44.1 34.3

Among students who ever had a drink of alcohol (other than a few sips), the percentage who had their first drink of alcohol before age of 14 years

79.0 80.5 77.1

Percentage of students who drank so much alcohol that they were really drunk one or more times

29.3 34.7 24.5

Source: (WHO and CDC, 2010)

Guyana has no public rehabilitation facilities to provide the relevant care and treatment services to children and adolescent s who are affected by drug and alcohol use. The private resident facilities that do exist have high enrolment costs attached to and some families can ill afford to pay because of their economic circumstance.

According to the stakeholders, impunity and lack of law enforcement create a perception in adolescents that they cannot and do not need to follow the rules, opening spaces for them to commit crimes. When children realize there is little or no form of sanctions for their negative behaviours they will feel empowered to exercise such negative forms of attitude or behaviours against whom they desire. For instance, interviewees had mentioned anecdotal reports of older children threatening teachers, and attacking younger siblings and even their parents and relatives.

On the supply side, assessment conducted by the Ministry of Social Protection and UNICEF (Ministry of Social

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Protection and UNICEF Guyana, June 2014) point to a series of issues to be corrected and improvements that need to be done so children in contact with the law have their rights realized, and have increased their chances of rehabilitation. Some of these issues are related to (i) duplication of services being offered by different government agencies, without proper coordination of efforts, leading to resources not being efficiently distributed; (ii) lack of clear coordination in the overall response and prevention related to children in contact with the law; (iii) nonexistence of public policies targeting the most poor families trying to alleviate the economic situation of vulnerable children and their families; and (iv) development of rehabilitation measures that can effectively reintegrate children in contact with the law in society; among others.

The juvenile system in Guyana (briefly described in chapter 3.3) is not exclusive to children; i.e., there is no separate Judge or Magistrate that attends to Juvenile cases – in some instances, a court is temporarily appointed as a “juvenile court”. The country has no special skills training for officers of Court such as prosecutors, magistrates and judges working with children. The absence of specialized training of court officers on child justice can lead to lack of understanding on how to address child related matters and to manage other court officers such as prosecutors, lawyers and social workers who may not always be sensitive to the child’s needs (Ministry of Social Protection and UNICEF Guyana, June 2014).

Also connected to this point, as mentioned by different stakeholders, is the lack of human and financial resources that have made the Juvenile Branch unable to execute its mandate. As mentioned before, the unit has no internal capacity to investigate all the crimes that are committed against and by children in Guyana, and when it tries to cooperate with regional authorities, lack of communication and increased bureaucracy become a bottleneck.

The assessment also identified problems with the coordination in the juvenile justice system. A well-functioning system requires a clear understanding of the systemic structures and strong interagency coordination. However, this coordination does not work smoothly for children and key stakeholders in this process voiced their concerns over the weaknesses in the system. Children may be delayed for extended periods in holding centres and are sometimes sent to NOC without a probation report or birth certificate. For instance, 32% of the children are sentenced without a probation report. One anecdotal report cites a case where a child was placed before the court on a capital offence and was left for more than three years within the system, which resulted in him facing trial at age 18, the age of an adult. The child was subsequently tried as an adult (Ministry of Social Protection and UNICEF Guyana, June 2014).

13.6) Participation in Decision Making

Child participation is one of the guiding principles of the Convention on the Rights of the Child. The principle affirms that children are full-fledged persons who have the right to express their views in all matters affecting them and requires that those views be heard and given due weight in accordance with the child’s age and maturity. It recognizes the potential of children to enrich decision-making processes, to share perspectives and to participate as citizens and actors of change (UNICEF, 2005).

In practice, according to the UN Committee on the Rights of the Child (UN Committee on the Rights of the Child, 2013), respect for this right remains limited, with no systematic approach in place for the participation of children and young people in local governance. The UN Committee on the Rights of the Child raised that sociocultural attitudes and traditions continue to restrain children from freely expressing their views in schools, courts and within the family. During the process of developing this situation analysis, many children, from different parts of the country, gender, ages, ethnicities and wealth statuses were consulted formally and informally. As expected, they presented many different realities and points of view; nonetheless, all had one point in common: they all mentioned not having any space to participate at school. While school is not the only environment where the child lives, it is the space where he/ she spends 1/3 of his/her day, and it is an environment where learning is the main goal. In theory, the school could be the space where participation should be taught and practiced. “Participation” was such a distant concept that children did not know what the word meant, and the vast majority reacted positively with the chance to have their voices heard by the school management and by the teachers.

While all the students were receptive to the idea of participation at school, at home and in their community; they also

Voice of Adolescents:

“Many of the students upon completing school cannot find proper jobs and they end up turning to prostitution and illegal activities.”

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shared a concerned that some adults might not be prepared to listen to their opinions and take them seriously. Students mentioned that their participation only becomes effective if teachers are ready to listen and respect their opinions.

Children and adolescent mentioned that sometimes they are given a chance to participate at home, but the majority of the decisions lay with the adults. At the same time, participation in community is inexistent. They did not recognize any open spaces where they could interact with their community in order to have their voices heard.

Voice of Adolescents:

“No one has ever asked us what we would like to change about the school. If given the opportunity, we would be glad to share our ideas/views and feelings on the areas for improvement in the school.”

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Part VI:

Conclusions and Recommendations

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Conclusions Guyana has improved some of its socio-economic conditions over the past decades. For instance, (i) the country’s GDP has showing positive trends since 2006, and in particular years it has been higher than the average for the Latin America & Caribbean; (ii) under 5 mortality has been reduced; (iii) antenatal care provided by a skilled professional has improved from 81% in 2006 to 91% in 2014, and similarly, delivery by a skilled health provider increased from 83% to 92% in the same period; (iv) the MDG commitment of halving the proportion of people suffering from hunger was achieved; (v) moderate and severe stunting has been reduced from 18.3% in 2006 to 12% in 2014, and severe stunting from 10% to 3.4% in the same period; (vi) breastfeeding rates have increased from 75% in 2006 to almost 90% in 2014; (vii) rates of acute respiratory infection wend down between 2006 and 2014 for more than 50% (4.7% in 2006 and 2.2% in 2014); (viii) the percentage of children under age 5 left alone or in the care of another younger child was reduced from 11% to 5% between 2006 and 2014; (ix) more children are finishing primary school in 2014 when compared to 2006; and (x) acceptance towards hitting or beating a wife are less prominent now than it was in 2006; among other developments.

Despite all the improvements, inequity is a major factor in Guyana, i.e., boys and girls do not have access to the same quality of education, health and child protection due to structural problems described in this document. The country’s averages hinder serious differences, and create different vulnerable groups that demand special attention. Vulnerability is connected to the risk of deprivation, losing assets, being physically or psychologically hurt, or losing life due to different threats in the environment that surrounds the child and his/her family. The notion of vulnerable populations is common in emergency preparedness analysis; nonetheless, the concept can be adapted to indicate those situations where social and economic changes create a risk for the population. Within this idea, vulnerability is related to a family not having enough financial resources, but it is also connected to not having access to proper public policies that provide the systemic protection that boys and girls should have at different ages in order for them to have their rights realized.

The first group of vulnerable children and women are those who live in the hinterland. As shown, for almost all indicators used to describe the situation of children, those living in the hinterland are in a worse off situation than those in the coastal areas: child mortality rates are higher; not all children are being fully immunized; 1/3 of the births are not registered in some regions of the hinterland; child labour is a reality, and school attendance for primary and secondary education are the lowest of the country; among other issues.

The second group of vulnerable children and women are the Amerindians. Historically they live in the interior of Guyana (hinterland) and share the same problems as other ethnicities that inhabit those areas; nonetheless, if the Amerindians are analysed isolated from other groups, maybe with the exception of nutrition, they do present the worst indicators among all the population in Guyana. For instance, 34% of the births for the Amerindians happen at home; only 54% of the children between 0 and 5 are fully vaccinated; 60% of the Amerindian children do not attend Early Childhood Education programmes; 22% of Amerindian girls between 15 and 19 years of age are mothers; and 1 in every 4 men from the Amerindian ethnicity believes hitting a woman is justifiable; among others.

A third group identified as vulnerable are those children with disabilities and special needs. The lack of data on this population is worrisome, and signals that the country does not properly addresses their needs. Without knowing how many boys and girls have special needs, it is not possible to know if they have access to school and health facilities, and if they have their rights realized.

Children living in single-parents households, especially those headed by women were identified as a fourth

Voice of Adolescents:

Do you have a chance to express yourself at school, or interact with teachers and share ideas?

“There are spelling bee, debating and impromptu speaking competitions at school; I participate in spelling bee most times. The students are rarely given the opportunity to interact with teachers or the HM and share ideas or aid in decision making.”

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group of vulnerable children. Recent information on the correct number of households’ arrangements like these is not known and available data does not present that disaggregation; however, different interviewees have mentioned that these types of families are common in Guyana41. These family arrangements are driven by the harsh economic situation that pushes parents – mainly men – to search for jobs abroad and/or in the most remote areas of the country (mining and logging). In single-parent households, when a mother – of father – is not home, children are affected in different ways. One direct danger for children is that in being alone, they are susceptible to being abused by older children and/or adults. Besides, as mentioned, the lack of a male figure at home was identified as correlated to school dropouts, and to behavioural problems, especially with boys.

The fifth group represents a stand-alone group, but it was also identified as the major cause of all other vulnerabilities: poverty. Not all poor families are going to have their children out-of-school, or will have cases of domestic violence. However, statistically, poor families in Guyana have higher chances of living in a worst-off situation. Children living in poor families have smaller chances of having access to computers and books; they are more susceptible to domestic violence and other types of abuses; they have higher chances of being stunted and have higher chances of being out of school; among other problems.

Despite the fact that the SitAn identified five main vulnerable groups, these are not insulated, i.e., children in one group might also be exposed to the situation described in a second or third group (Figure 121). For example, a child who lives in a female-headed single-parent household might also live in the hinterland, and in a poor family. One point that all these vulnerable groups have in common is that they are exacerbated by the poverty status of the family. Poverty is in the core of most, if not all, the problems that affect children and adolescents.

Figure 121: Vulnerable child populations in Guyana

The situation of children and women in Guyana is influenced by different immediate, underlying and structural causes, which are then reinforced by many bottlenecks that prevent boys and girls to fully access their rights. The importance of identifying the causes and bottlenecks is related to helping government and different stakeholders to construct public policies that target the most vulnerable populations based on an assessment of the reasons that influence that situation. The SitAn document acted as the first stage in this process: it identified broad bottlenecks that explain the situation. The second stage would be to intensify the analysis, so for each problem acknowledged in the document a thorough map of causes, bottlenecks and determinants can be constructed.

41 According to the 2009 DHS (Ministry of Health, Bureau of Statistics and USAID, Oct 2010), 13% of the households in the country were single- person households; nonetheless, the survey did not identify single-person households headed by women.

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Throughout the SitAn document, the bottlenecks were characterised based on the four UNICEF’s determinant categories: enabling environment, supply, demand and quality. Similar to the vulnerability groups, the bottlenecks and determinants are not isolated and they act together to influence the situation of children and women. Using the four determinants categories, the SitAn has found the following:

In terms of enabling environment, Social Norms are extremely influential in the situation of children and women, and they can be used in favour or against the vulnerable groups. Some social norms in Guyana still hinder the full realization of child rights in the country. For example, stakeholders mentioned that society still differentiates between how boys and girls should be raised by their parents: boys should adventure the world, and girls should be protected. This type of norm influences school dropouts, child labour and many of the violent behaviours that boys present in the country.

In general, the country has a set of legislations and policies related to children issues that were considered to be comprehensive and updated – some exceptions were flagged concerning child protection issues. The overall consensus among the stakeholders is that while legislation exists, implementation of the rules is weak and insufficient. Corruption, lack of resources (personnel, infrastructure, etc.) and not enough knowledge were commonly associated with gaps in the implementation of the laws. Besides, impunity was seen as one major bottleneck that influences perpetrators to continuing committing crimes, and victims and witnesses not to report abuses.

One gap also identified by different stakeholders was the management and coordination of policies related to children. The Childcare and Protection Agency (CPA), housed in the Ministry of Social Protection is the specialized agency for child protection in the country; nonetheless, the agency does not cover other aspects related to children and adolescents such as health, education, employability and culture, for example. Coordination among the different areas (health, education and child protection), covering different geographical locus (regions, urban/rural and coastal/ interior) and different stakeholders (NGOs, government, civil society and international organizations) was tried in the past, but different sources in the country mentioned they did not achieve results, and became less frequent in the recent years. Even inside one specific thematic area, child protection, for example, the different actors do not seem to coordinate their actions, and opportunities to improve the situation are lost.

One of the reasons why the SitAn document follows a life-cycle approach is to make clear to stakeholders that the rights of the children cannot be seeing compartmentalized into health, education and child protection. As mentioned in the introduction of this document, children have different demands at different ages, and these correspond to a cross sectorial and systemic approach that demand a strong coordination from different line ministers and their different units.

The analysis of the country budget made on chapter 3.4 mentioned that around 35% of the country expenditure could be connected to expenses related to children, most of them related to education. A child budget analysis is important to evaluate the efficiency of the expenses related to children, and, in using the data, to make adjustments targeting the most vulnerable groups. In this sense, the objective of the analysis presented in this SitAn document is not to evaluate the public expenditure, nor to do any type of judgement, but to show that it is possible to track government expending, and it is feasible to create a monitoring system that could allow civil society to monitor the efficiency of the expenses in the realization of children’s rights. In this sense, the national budget should not be seen as a bottleneck now, since a further analysis is necessary; however, different government officials complained that their offices do not have enough resources (monetary and staff) to fully implement their mandate, contributing to the lack of implementation reported by the stakeholders.

On the supply side category, the two determinants – availability of essential commodities and access to adequately staffed services, facilities and information – were identified as major bottlenecks in Guyana. For those vulnerable children and women living in the interior of the country, access to school, health facilities and police are challenging, and, sometimes, almost impossible. For some populations, the geographical characteristic in the hinterland makes that access only possible by boat or by special cars. As mentioned in the main text of this document, difficulties of access will hinder women’s access to prenatal care, delivery and postnatal care; it will make younger children stay home instead of going to Early Childhood Services; and it will influence mothers not to take their children to health care if their situation is not identified as an emergency. Moreover, it was also identified that those school children in the hinterland do not have access to books, school supplies all the teachers they need so they can compete fairly with those children living in the coastal area, and, consequently, have better chances to advance in their studies and/

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or look for a professional qualification.

Among the three determinants considered in the demand category, only two were identified as important for Guyana. The different ethnicities that pacifically cohabit in Guyana create different social and cultural practices and beliefs that impede a generalization on how they actually influence the realization of child rights. Nonetheless, social and cultural practices are in the root of many violations of child rights. For example, the fact that part of the Indian population in the country arranges the marriages of girls influences school dropouts, adolescent pregnancy, and was considered as one of the causes of high levels of suicides among young populations. Another example comes from the Amerindian community where, the mix of cultural practice and abuse of alcohol and other drugs are identified as causes to incest.

Social practices influence how children behave at school and at home. Rates of alcohol consumption among adolescents and early sexual debut are elevated, and are associated with peer pressure and the need for adolescents to fit-in. Violence against women and children are also rooted in a mix of social and cultural practices and social norms. The fact that corporal punishment is seen as an appropriate educational method sends the message that the use of force and violence is acceptable, and they can be used at any age.

Despite the fact that the government assumes most of the financial costs for services and practices related to education and health, different indirect costs were identified as major barriers to the realization of some rights. Education is free, but families have to afford transportation to school and, as mentioned, in the interior of the country that might indicate boat or special cars. Also in the interior of the country, those families who want to invest in their children’s education have to hire private tutors for subjects that should be taught at school but are not.

The financial cost is alleviated or aggravated by the economic condition of the family. For the wealthy families, the financial costs of some services are not prohibitive, for the poorest ones, some small values might indicate big gaps in their monthly budget. Once more, poverty not only interferes with the propensity of being a vulnerable child, but poverty also aggravates how all the determinants here presented will impact on the child’s life cycle. For a family with monetary resources, distance, difficulty of access to school and private tutors are not as expensive as a family who lives in poverty.

Despite being central to all the problems related to children, poverty has not being measured since 2006. At that time, almost 50% of the children in the country were living in poverty. After 2006, the world was hit by the economic crisis in 2008, and the international markets for those products that Guyana export have not being stable. Chances are that some of those children who lived in poverty in 2006 grown up to still live in poverty today, but at this time, as fathers and mothers.

The country has adopted Poverty Reduction Strategy Papers – the last one covering the years between 2011 and 2015 – as guidance to reduce poverty. The Strategy followed a traditional poverty alleviation approach; i.e., it followed a traditional economic mechanism: alleviating income constraints during childhood would enable parents to buy goods and services that would support child development. The idea is that economic improvements for the family would immediate translate into benefits for the children. That direct link is not always true. For example, evidence has suggested that traditional economic mechanisms – such as cash transfer programmes – cannot be translated in improvements in early childhood development, unless they have specific conditionality’s or mechanisms related to it (The World Bank, 2015).

All the 8 determinants here used to categorize the bottlenecks are influenced by the poverty status of the family, and by the quality of care that is available for the children and women in the country. It is not expected that all children have the same facility to reach school, but at least it would be expected that those children living in the coast would have the same level of quality of education than those living in the hinterland. Unfortunately, that is not the case in Guyana. National exams have shown that for primary and secondary education, scores for those pupils in the hinterland are worse than those in the coast. In fact, the gap between them has increased; indicating that the situation today is worse than it was in the past.

Quality of health in the interior of the country is also worse than in the coastal area. There are no emergency obstetric units in the hinterland – the only one available is in Georgetown, and the most serious cases related to children and adults have to be treated in the capital. Similarly, anecdotal reports also mention those living in the interior of the

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country complain about the quality of the police force, and how that influences in their lack trust in that public authority.

The 2016 Situation Analysis of Children and Women in Guyana covered different aspects that directly and indirectly affect the life of children and women in the country. Nevertheless, the document does not extinguish the analysis of many themes that were raised in the document, nor it covers all the possible characteristics related to the life of the child. The SitAn was based on different readings, data sources and direct qualitative data collection that involved dozens of stakeholders, from different backgrounds, in the country. The documents used for the SitAn are extremely rich, and it is recommended that the reader access them in order to get a more accurate perspective on most of the themes presented in the document – the full list of references is at the end of the document.

Statistically sound and internationally comparable estimates on a range of indicators on children and women, especially on the most disadvantaged, are essential for developing evidence-based policies and programmes, aimed at identify and responding to their needs. UNICEF continues promotes the realisation of children and women’s rights and well-being, which remain at the centre of the post-2015 agenda. In Guyana, as in countries around the world, an understanding of the situation of children is regarded as a fundamental step towards eradicating inequities and enhancing inter-generational equity. It is also essential to inform programmes aimed at strengthening children’s ability to reach their potential as productive, engaged, and capable citizens.

Data generation and management in Guyana have increased with a greater national emphasis on evidence-informed action. Over the last fifteen years, household data, not older than five years, have been always available for decision- making. These include the MICS 2000; Population and Housing Census 2002; MICS 2006; Demographic and Health Survey 2009 and MICS 2014, punctuated by a number of other studies and evaluations. However, there has been an evident lack of harmonization of the disaggregation, collection and reporting of information, making it difficult to conduct trend and other comparative analyses, to help determine real progress across key indicators, over time.

Deliberate steps were taken in the conduct of the most recent MICS (2014) to ensure the level of disaggregation in the MICS mirrored, as much as possible, the Demographic and Household Survey (DHS 2009). A decision was taken to continually advocate for all data in subsequent national surveys to be disaggregated accordingly, to allow for comparisons and aggregation of results. However, there is still some ways to go especially towards establishing a roadmap for harmonisation especially at the sub-national level and ensuring consensus among developmental partners and other stakeholders. In directly supporting the harmonisation of data, especially on women and children, partners are indirectly advocating for the realisation of children’s right to survival, development, protection and participation as is outlined in the Convention of the Rights of the Child (CRC) as well as the inalienable rights of women as articulated in the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW).

Qualitative data for the document complemented the quantitative data available, and it was collected at the end of 2015, few months after the election that legitimately change the government, and elected a new party after 23 years. The new government is an opportunity to evaluate those policies that were being implemented, keeping the ones that were successful, changing those that need to be improved, and designing new programmes that can effectively diminish the inequalities that are present in the country. The new government is going to govern the country at the same time that the Sustainable Development Goals (SDGs) are being shaped.

The SDGs represent a shift in global cooperation, giving voice for the most vulnerable populations, and clearly indicating that inequities have to be reduced, otherwise sustainable development at any level is not achievable. Children, youth and future generations are referenced as central to the Sustainable Development Goals. Children are directly related to 12 of the goals, and indirectly by the other 5 (please see the list of goals in Annex 3). The SDGs call for explicit targets on reducing inequality, ending violence against children and combating child poverty. At the same time, UNICEF emphasizes the importance of “leaving no one behind.” Reaching first the poorest and most disadvantaged children must be reflected in all targets, indicators and national implementation frameworks as they are developed (UNICEF, 2014).

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Recommendations The list of recommendations below reflects past suggestions found in many of the readings, as well as the recommendations made by different stakeholders.

Poverty and Vulnerabilities

• Following SDG Targets 1.1 and 1.242, to develop and implement a methodology to yearly measure poverty and vulnerabilities, capturing the different cultural peculiarities in the country. The method should allow for monitoring poverty at national level, and, at the same time disaggregate poverty for different ages, regions, geographical areas and ethnicities. The method for monitoring poverty should clearly define child poverty, and should adopt a multidimensional measure that complements the monetary method.

• Taking into consideration SDG Target 1.343, to strengthen support to families in situations of vulnerability, in particular single-parent families through systematic, long-term policies and programmes to ensure access to social services and sustainable income opportunities;

Children with special needs and disabilities44

• Conduct a national assessment to identify the number and the situation of children with special needs and disabilities in the country in order to develop public policies to address their needs.

• Undertake long-term awareness-raising programmes in order to combat negative societal attitudes prevailing against children with disabilities;

• Allocate adequate human, technical and financial resources for ensuring the availability of health, rehabilitation services and education for children with special needs, and in doing so prioritize addressing the situation in the hinterland;

• Develop a disability education action plan to specifically identify current inadequacies in resources, and to establish clear objectives with concrete timelines for the implementation of measures to address the educational needs of children with disabilities, incorporating their inclusion in the mainstream education system to the greatest extent possible.

Coordination of policies for children and child budget45

• Establish or designate a specific high-level governmental body for the overall coordination of all activities relevant for the implementation of the CRC, and ensure that it has sufficient authority and adequate human, technical and financial resources to effectively coordinate actions for children’s rights;

• Implement a child budget methodology (a suggested methodology is presented in this Situation Analysis) to track government expenses related to children, guaranteeing an online monitoring tool where civil society can monitor the expenses.

42 SDG Target 1.1: By 2030, eradicate extreme poverty for all people everywhere, currently measured as people living on less than $1.25 a day. SDG Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions. 43 SDG Target 1.3: Implement nationally appropriate social protection systems and measures for all, including floors, and by 2030 achieve substantial coverage of the poor and the vulnerable. 44 elements from (UN Committee on the Rights of the Child, 2013) 45 Using elements from (UN Committee on the Rights of the Child, 2013)

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Education46

• Guarantee equitable resources for education at all levels, including the allocation of adequate human, technical and financial resources for the most vulnerable regions of the country aiming to equalize the current gap in terms of quality;

• Continue to train teachers and staff in the Health and Family Life Education (HFLE) programme, make behaviour counsellors available at all schools of the country, and increase the channels of communication between teachers and students for topics related to social behaviour, sexuality and comportment.

• Emphasize career guidance for students beginning at the last years of primary education, and help students at secondary level to understand careers paths and how their choices in secondary school influence in their professional development in the future.

• Strength alternative curriculums for secondary education, including the development of vocational schools that mix theory with practical application of concepts.

• Work with the Bureau of Statistics to produce and make available data related to education so proper public policies can be developed, and resources better managed.

Health47

• Strengthen the coordination and collaboration mechanisms between the different actors involved in maternal and child health services, including the identification of clear roles and responsibilities among different stakeholders.

• Eliminate the shortage of skilled personnel currently serving within the public health sector, especially in the interior regions of the country, and guarantee training for all the staff in the system.

• Guarantee enough budgetary resources to address the shortage of equipment and supplies, including HIV rapid testing.

• Create effective monitoring and evaluation systems to ensure adherence to the regulatory framework and continuous adjustment to existing programmes based on expected and actual outcomes and results.

• Improve the infrastructure of health facilities in the hinterland including the establishment of additional waiting rooms to host pregnant women waiting for delivery and in the post-delivery period.

• Develop and implement a strategy to overcome cultural barriers that currently discourage women from accessing care in a timely manner during pregnancy, including training staff to be culturally sensitive.

• Assess the immediate and underlying causes of suicide among the youth48 in the country and develop coordinated public policies (health, education and social protection) to address the findings.

Birth registration

• Modernize and update birth registration procedures in Guyana.

• Implement a communication campaign emphasizing the importance of the birth certificate for children.

46 Using elements from (UN Committee on the Rights of the Child, 2013) (Ministry of Education, July 2013) 47 Using elements from (Government of Guyana, 2014). 48 Topic discussed in section 13.4 (adolescent’s behavioral health).

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Human and Child Trafficking49

• Vigorously investigate and prosecute sex and labour trafficking cases and hold convicted traffickers accountable with time in prison that is commensurate with the severity of the crime.

• Revise legislation to increase the time perpetrators are sentenced to jail – today the maximum time of imprisonment is 5 years.

• Develop child-sensitive investigation procedures and court procedures that protect the privacy of children and minimize their re-traumatization.

• In partnership with NGOs, develop and publicize written standard operating procedures to guide and encourage front-line officials—including police, health, immigration, labour, mining, and forestry personnel—to identify and protect victims of forced labour and forced prostitution;

• Train the current police force in methods to investigate and arrest those involved in human trafficking, and capacitate magistrate in judging cases related to human trafficking.

• Use communication strategies to educate the population on identifying and reporting suspect cases of human/ child trafficking.

Child Abuse50

• Strengthen awareness-raising and education programmes including campaigns with the involvement of children in order to educate the population to identify, prevent and report cases of child abuse.

• Strengthen the country’s legal framework and legal enforcement mechanisms at the national and local level, increasing the implementation of the current laws and regulations.

• Develop a long-term societal behaviour change campaign to reduce sexual abuse and its acceptability, especially of girls, as well as to address harmful cultural practices involving child abuse and exploitation.

• Ensure the implementation of programmes and policies for the prevention, recovery and reintegration of child victims of abuse.

Corporal Punishment

• Create appropriate and clear measures to prohibit corporal punishment at home and at schools.

• Strengthen and expand awareness-raising and education programmes and campaigns, promoting positive and alternative forms of discipline and respect for children’s rights.

Children in Contact with the Law51

• Raise the minimum age for criminal responsibility to an internationally acceptable level;

• Provide adequate diversionary options for children as part of wider reforms in the court system in order to ensure that detention is the last resort;

• Allocate adequate human, technical and financial resources for ensuring that children in contact with the law

49 Using elements from (US Department of State, July 2015). 50 Using elements from (UN Committee on the Rights of the Child, 2013) 51 Using elements from (UN Committee on the Rights of the Child, 2013)

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receive free legal advice and representation;

• Establish additional juvenile detention and rehabilitation facilities, particularly in its hinterland region, and ensure regular independent monitoring and inspection of all facilities in which children and youth are placed to ensure that Convention-compliant standards of treatment and care are maintained;

• Make use, if relevant, of the technical assistance tools developed by the United Nations Interagency Panel on Juvenile Justice and its members, including the United Nations Office on Drugs and Crime (UNODC), UNICEF, Office of the United Nations High Commissioner for Human Rights (OHCHR) and non-governmental organizations, and seek technical assistance in the area of juvenile justice from members of the Panel.

Child Participation52

• Train teachers and principals in the importance of child participation at school and society.

• Develop toolkits for public consultations on national policy development to standardize these consultations at a high level of inclusiveness and participation;

• Undertake programmes and awareness-raising activities to promote the meaningful and empowered participation of all children, within the family, community, and schools, including within student council bodies – with particular attention to children in vulnerable situations.

52 Using elements from (UN Committee on the Rights of the Child, 2013)

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Annex 1: International Conventions ratified by Guyana

International Conventions Signature Ratification/ Accession

International Convention on the Elimination of All Forms of Racial Discrimination: 1965 (1969)

1968 1977

International Covenant on Civil and Political Rights: 1966 (1976) 1968 1977 Optional Protocol to the International Covenant on Civil and Political Rights 1966 (1976)

NA 1999

Second Optional Protocol to the International Covenant on Civil and Political Rights, aiming at the abolition of the death penalty: 1989

NA NA

International Covenant on Economic, Social and Cultural Rights: 1966 (1976)

1968 1977

Optional Protocol to the International Covenant on Economic, Social and Cultural Rights: 2008

NA NA

Convention on the Elimination of All Forms of Discrimination against Women: 1979

1980 1980

Optional Protocol to the Convention on the Elimination of All Forms of Discrimination against Women: 1999

NA NA

Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment: 1984 (1987)

1988 1988

Optional Protocol to the Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment: 2002 (2006)

NA NA

Convention on the Rights of the Child: 1990 1990 1991 Optional Protocol to the Convention on the Rights of the Child on the involvement of children in armed conflict: 2000 (2002)

NA 2010

Optional Protocol to the Convention on the Rights of the Child on the sale of children, child prostitution and child pornography: 2000 (2002)

NA 2010

Optional Protocol to the Convention on the Rights of the Child on a communications procedure: 2011 (2014)

NA NA

International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families: 1990

2005 2010

International Convention for the Protection of all Persons from Enforced Disappearance: 2006

NA NA

Convention on the Rights of Persons with Disabilities: 2006 2007 2014 Optional Protocol to the Convention on the Rights of Persons with Disabilities: 2006

NA NA

Source: United Nations Human Rights website (http://indicators.ohchr.org/): accessed on October 5, 2015.

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Annex 2: Child Budget Methodology Two simple methods were developed to calculate how much of the national budget is allocated for programmes and projects that could directly impact on the situation of children. The first (so-called general child budget allocation) included the total budget allocated for those agencies that conduct policies, programmes and projects that will have direct influence on children. The second method (called specific child budget) tried to go into the details of the expenditure of those selected agencies at programme level, excluding those values that were allocated for administrative purposes.

All the values are coming from the Volume 1 of the Estimates of the Public Sector Budget (Government of Guyana, 2015).

General Child Budget Allocation

This method:

• Considers all the allocated values for the agencies

• Keeps the budget of different agencies separate

Table 32 depicts the list of Agencies used for the general allocation. If all the values are taken into consideration, roughly 42% of the expenses of the country were allocated for children.

Table 32: Summary of values used to calculate general child budget allocation, Guyana, 2015

Agencies 2015 Budget Allocation

G$ (,000)

% Total Allocation

41 Ministry of Education 7,874,640 4.8% 40 Ministry of Education 6,624,583 4.0% 46 Georgetown Public Hospital Corporation 4,010,772 2.5% 47 Ministry of Health 6,612,537 4.0% 43 Ministry of Public Health 5,987,592 3.7% 44 Ministry of Culture, Youth and Sport 1,077,471 0.7% 48 Ministry of Labour, Human Services and Social Sec. 5,973,500 3.7% 49 Ministry of Social Protection 4,056,921 2.5% Sum allocated for the Regions 26,527,470 16.2% Total Related to Children 68,745,486 42.0% Other Government expenses 94,906,145 58.0% Total Guyana Budget 163,651,631

Specific Child Budget

This method:

• Excludes those values that were identified as administrative;

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• Excludes those values at regional level that are not related to education and health;

• Divides the allocated budget into four categories: Education; Health; Youth and Culture; and Child Protection

• Add the total values allocated to education and health in the regions into the Health and Education categories

• Combines the allocations of the Ministry of Labour and Ministry of Social Protection into the child protection category.

• Combines the allocations of the Ministry of Health, Ministry of Public Health and Georgetown Public Hospital into the Health category.

Table 33 depicts the subcategories used to calculate the specific child budget. 35% of the total budget was allocated to activities related to children.

Table 33: Summary of values used to calculate the specific child budget, Guyana, 2015

Agency/Sub-programme 2015 Budget Allocation Percentage Education G$ (,000)

414 Training and Development 696,484 415 Education Delivery 4,405,904 402 Training and Development 1,071,681 403 Nursery Education 891,274 404 Primary Education 1,350,512 405 Secondary Education 1,762,682 407 Cultural Preservation and Conservation 232,991 408 Youth 113,643 Regions 15,450,974 Total Education 25,976,145 16%

Health Georgetown Public Hospital Corporation 4,010,772 472 Diseases Control 337,077 473 Primary Health Care Services 542,991 474 Regional and Clinical Services 4,124,024 477 Rehabilitation Services 206,533 432 Disease Control 946,240 433 Family Health Care Services 238,131 434 Regional & Clinical Services 3,859,555 437 Disability and Rehabilitation Services 90,057 Regions 5,973,850 Total Health 20,329,230 12%

Youth and Culture

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Agency/Sub-programme 2015 Budget Allocation Percentage Education G$ (,000)

442 Culture 338,481 443 Youth 359,517 444 Sport 260,681 Total Youth and Culture 958,679 1%

Child Protection 482 Social Services 5,394,934 484 Child Care and Protection 253,080 492 Social Services 3,504,528 494 Child Care and Protection 205,999 Total Child Protection 9,358,541 6% Total Specific Child Budget 56,622,595 35% Total Country Budget 163,651,631

Limitations

Both methods have the same limitations.

First, they average all the expenses as being related to children. For example, both calculations consider all the expenses for the Georgetown Public Hospital Corporation as being connected to children. In reality, that is not true, since adults also use the hospital facilities for many different treatments. The same conscious mistake is practiced with the budget of all other agencies. Another example: the values for education and health for the regions were integrally considered in both methods, when, in reality, some of those values might be allocated to administrative purposes, not directly providing services for children. Similar situation happens to both Social Services values (482 and 492) that cover a much larger public than only children.

Despite the fact that the specific child budget method tries to reduce this error when it excludes those budgetary items that are explicitly related to administration, it fails when it averages all other items.

The second limitation is that the methods do not include other sectors that also influence in the life of the child, such as water and sanitation, and the expenses with security (police, legal affairs, etc.).

These two limitations point to one conclusion, one question and two recommendations in relation to the development of a child budget. The conclusion is that the child budget – i.e., the amount of the national budget destined to children – is much smaller than the 35% calculated by the specific child budget method.

The question is related to the added value of calculating a child budget in the country. While there are clear advantages on tracking those expenses related to children, the decision of monitoring the child budget has to be agreed between government and civil society, and a new monitoring system should be used to monitor year expenses related to children, and to compare different years.

If monitoring of the child budget is considered to be a good input for public policies, the recommendations would

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be. First, government and stakeholders should agree on which items should be monitored by the child budget; i.e., if water and sanitation, for example should be taken into consideration, or not, and if those expenses related to management should also be considered since they result in changes for those services being offered for children.

Second, government has to work on its financial monitoring systems to allow for easy tracking those expenses related to children. With today’s technology, and using the preselected expenses agreed with stakeholders (recommendation 1), a marker should be created in the country’s budgetary system allowing for the monitoring of the budget for children at real time.

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Annex 3: The Sustainable Development Goals The SDGs have 17 Goals listed as follows:

• Goal 1: End poverty in all its forms everywhere

• Goal 2: End hunger, achieve food security and improved nutrition and promote sustainable agriculture

• Goal 3: Ensure healthy lives and promote well-being for all ages

• Goal 4: Ensure inclusive and equitable quality education and promote lifelong learning opportunities for all

• Goal 5: Achieve gender equality and empower all women and girls

• Goal 6: Ensure availability and sustainable management of water and sanitation for all

• Goal 7: Ensure access to affordable, reliable, sustainable and modern energy for all

• Goal 8: Promote inclusive and sustainable economic growth, full and productive employment and decent work for all

• Goal 9: Build resilient infrastructure, promote inclusive and sustainable industrialization and foster innovation

• Goal 10: Reduce inequality within and among countries

• Goal 11: Make cities and human settlements inclusive, safe, resilient and sustainable

• Goal 12: Ensure sustainable consumption and production patterns

• Goal 13: Take urgent action to combat climate change and its impacts

• Goal 14: Conserve and use the oceans, seas and marine resources for sustainable development

• Goal 15: Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably manage forests, combat desertification, and halt and reverse land degradation and halt biodiversity loss

• Goal 16: Promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels

• Goal 17: Strengthen the means of implementation and revitalize the global partnership for sustainable development

For more information on the SDGs please access:

http://www.un.org/sustainabledevelopment/sustainable-development-goals/

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Annex 4: Equity and Equality in the scope of the Situation Analysis. Table 34 depicts the main differences and similarities between a rights-based and equity based approaches used in the situation analysis of children and women. These two approaches do not cancel each other; on the contrary, they are complementary and reinforce the debate over the realization of children’s rights.

Table 34: Human Rights and Equity-based perspectives

Rights-based approach Equity-based approach

Definition: Application of human rights principles in child survival, growth, development and participation. Respect, protect, fulfil

Definition: Application of an equity-focused approach in the realization of child rights Poorest, most marginalized, deprived of opportunities, etc.

Scope: All children have the right to survive, develop and reach full potential regardless of gender, race, religious beliefs, income, physical attributes, geographical location or other status.

Scope: All children have equal opportunity to survive, develop and reach full potential without discrimination, bias or favouritism. Focus is on the most marginalized children.

Guiding principles: Accountability, Universality, indivisibility, and participation. Justice overriding theme

Guiding principles: Equity is distinct from equality. Equality requires all to have same resources, while equity requires all to have equal opportunity to access the same resources. Concept of equity is universal with social justice

Violations of child rights arise when the basic child rights are not realized as per CRC four principles: non-discrimination; best interest of the child; right to survive, grow and develop; and the right to participate/ be heard. Concept of progressive realization of rights.

Inequities arise when certain population groups are unfairly or unjustly deprived of basic resources that are available to other groups.

It is important to emphasize that equity is distinct from equality, and, consequently, inequity (or lack of equity) is also different from inequality (or the lack of equality).

Inequality is characterized by differences among populations, groups or people. These differences can be the result of natural personal characteristics – some individuals might have a higher propensity for studying science than social studies – or can be created by failures in society, causing some to have better opportunities than others. Inequity is related to lack of access to goods and services due to structural problems in the country or territory. Inequity happens when inequalities are being generated and/or aggravated by failures in how socio-economic policies are implemented. For example, the fact that the place where a child is born, its gender, or the actual economic situation of her parents determines the child’s future is an equity issue. Inequities generally arise when certain population groups are unfairly deprived of basic resources that are available to other groups (Bamberger & Segone, 2012).

In sum, equality requires everyone to have the same resources. Equity requires everyone to have same opportunity to access the same resources. The aim of equity-focused policies is not to eliminate all differences so that everyone has the same level of income, health, and education, among others. Rather, the goal is to eliminate the unfair and avoidable circumstances that deprive children of their rights.

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Photo Credits:

United Nations Children’s Fund (UNICEF) Guyana

2016