Inter Press Service » Women’s Health http://www.ipsnews.net Journalism and Communication for Global Change Thu, 17 Apr 2014 10:36:32 +0000 en-US hourly 1 http://wordpress.org/?v=3.8.3 Ugandans Fight for the Right to Access Their Own Medical Records http://www.ipsnews.net/2014/03/ugandans-fight-right-access-medical-records/?utm_source=rss&utm_medium=rss&utm_campaign=ugandans-fight-right-access-medical-records http://www.ipsnews.net/2014/03/ugandans-fight-right-access-medical-records/#comments Thu, 27 Mar 2014 13:56:58 +0000 Amy Fallon http://www.ipsnews.net/?p=133255 Dressed in a white dress with black polka dots and pink and red carnations, white knee-high socks and matching patent shoes, Babirye recently celebrated her second birthday.  “She’s doing well, eating well,” Jennifer Musimenta told IPS in Uganda’s local Luganda language as her husband, Michael Mubangizi, acted as a translator.  “But I’m always thinking about […]

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Michael Mubangizi (l) and his wife Jennifer Musimenta (r) with their daughter Babirye. They do not know what happened to Babirye’s twin whose body disappeared after Musimenta gave birth in Uganda’s national referral hospital. Credit: Amy Fallon/IPS

Michael Mubangizi (l) and his wife Jennifer Musimenta (r) with their daughter Babirye. They do not know what happened to Babirye’s twin whose body disappeared after Musimenta gave birth in Uganda’s national referral hospital. Credit: Amy Fallon/IPS

By Amy Fallon
KAMPALA, Mar 27 2014 (IPS)

Dressed in a white dress with black polka dots and pink and red carnations, white knee-high socks and matching patent shoes, Babirye recently celebrated her second birthday. 

“She’s doing well, eating well,” Jennifer Musimenta told IPS in Uganda’s local Luganda language as her husband, Michael Mubangizi, acted as a translator. It is an unwritten policy in Ugandan health facilities that patients were never given access to their own medical records.

“But I’m always thinking about the second child, whether she’s alive or not alive, because I don’t know the truth. I’m always worried.”

The child she’s referring to is Babirye’s sister. In Luganda, Babirye means the first-born of female twins.

Twins are seen as a special blessing among Ugandan families. Mubangizi had a set on his father’s side before his wife gave birth to two girls on Mar. 14, 2012, at Mulago Hospital.

The couple did not know they were expecting twins until Musimenta delivered at Mulago, which is Uganda’s national referral hospital and the country’s largest health facility based in the capital, Kampala.

But within minutes of Musimenta giving birth to the second child, whom they named Nakato, which means second female twin in Luganda, they were told she had died.

The pair were then denied access to their baby’s body. Despite pleading for her own medical records, Musimenta was refused a copy of these too.

“We looked for that dead body for three days,” Mubangizi, who immediately reported the case to the police, told IPS.

“We checked in the mortuary, in the maternity ward, everywhere in the hospital. There was no dead child,” the 30-year-old mechanic said.

Three long days later, the couple were handed the body of a dead baby.

“It was very fresh, as if it had been delivered at that moment,” said Mubangizi. “We said that is not our baby.”

A DNA test, which the desperate pair resorted to, revealed the child was not theirs. And now they don’t know for sure if their daughter is alive or dead.

Nakibuuka Noor Musisi, the programme manager for strategic litigation at advocacy group Centre for Health, Human Rights and Development (CEHURD), said that cases of missing and stolen babies were shockingly all too common in Ugandan hospitals.

“There’s so many cases of mothers who have gone to hospitals [to give birth], especially this particular hospital, and their babies are not given to them,” she told IPS.

“These cases are just reported by the media but their parents don’t take them up [with the courts] because maybe they don’t know where to go.”

She added that it was an unwritten policy in health facilities that patients were never given access to their own medical records in this East African nation.

Grieving, and seeking the truth about their daughter, Mubangizi and  Musimenta, with backing from CEHURD, sued the executive director of Mulago Hospital and the Ugandan attorney general in July 2013.

“When we were faced with this particular case we were forced to go to court to show that actually this is a problem that is happening in the country,” Musisi explained.

The couple argued their constitutional rights had been violated through being denied the access to their medical records, the opportunity to nurture and bring up their child and in the hospital taking her away without permission.

All of this has been coupled with the daily mental anguish and agony they have endured, and are continuing to endure, through not having access to her or her body.

On Wednesday, Mar. 26 the High Court of Uganda ordered Mulago Hospital to furnish the couple with outstanding medical documents, a registry of children delivered on the same day as Babirye and her sister, a list of health workers then on duty and a copy of the DNA test.

Musisi said the ruling set a significant precedent for the rights of Ugandan patients to access their medical records.

“The constitution says that everyone shall have the right to access information, which is in the hands of the state as long as it does not put the state or the security of the state at risk,” she said.

Wednesday’s ruling also has implications for Uganda’s stunningly high maternal morality rate – 438 deaths per 100,000 live births, one of the world’s highest.

“Imagine if you’re a mother who has had a caesarean section and no [medical record] is given to you. As soon as you’re discharged from the hospital, you get home and probably you have a [complication],” said Musisi, speaking at the high court.

“That would mean that you have to go back to that particular health facility. What happens if the facility is very far from your home? These are the reasons we see mothers die.”

The case puts the spotlight on the reason why so many Ugandan women are terrified to give birth in hospitals.

“I won’t go back to deliver in that hospital because what happened two years ago could happen again,” said Musimenta.

Mulago Hospital, however, has showed interest in an out of court settlement with Musimenta and Mubangizi. Mulago’s legal team declined to comment.

But what Musimenta and Mubangizi ultimately want is the truth about their daughter.

“I’m always thinking about what happened to her. I don’t know whether she was kidnapped,” said Mubangizi.

“There are some people overseas who can’t conceive and they give money to the nurses [to buy the babies].”

According to local reports babies are allegedly stolen from hospitals but there are also claims that some health workers have been mixing up babies, with parents been given the wrong newborns or dead bodies.

The couple say they’ll use the settlement from the hospital towards getting closure. They are unable to afford the services of an investigator to probe the details of their missing child.

“When someone has twins it’s an honorary thing in our tradition, we do dancing and singing to welcome the twins,” said Mubangizi.

“So we’ll go to our village and have a traditional ceremony. If the baby is alive, she will reveal herself.”

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A Call for Universal Access to Safe, Legal Abortion http://www.ipsnews.net/2014/03/call-universal-access-safe-legal-abortion/?utm_source=rss&utm_medium=rss&utm_campaign=call-universal-access-safe-legal-abortion http://www.ipsnews.net/2014/03/call-universal-access-safe-legal-abortion/#comments Wed, 26 Mar 2014 22:48:18 +0000 Michelle Tullo http://www.ipsnews.net/?p=133248 Lawmakers and civil society leaders from over 30 countries are calling for universal access to safe, legal abortion. The declaration, released in Washington on Wednesday, comes in the context of a 20-year review by the United Nations of the 1994 International Conference on Population and Development (ICPD) in Cairo. That landmark conference called for safe access […]

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Women march against the Dominican Republic's anti-abortion law in 2009. Credit: Elizabeth Eames Roebling/IPS

Women march against the Dominican Republic's anti-abortion law in 2009. Credit: Elizabeth Eames Roebling/IPS

By Michelle Tullo
WASHINGTON, Mar 26 2014 (IPS)

Lawmakers and civil society leaders from over 30 countries are calling for universal access to safe, legal abortion.

The declaration, released in Washington on Wednesday, comes in the context of a 20-year review by the United Nations of the 1994 International Conference on Population and Development (ICPD) in Cairo. That landmark conference called for safe access to abortions in countries where the procedure was legal, while Wednesday’s declaration calls for the decriminalisation of abortion in all countries.“What we know now is that law changes social attitudes.” -- Nepali MP Arzu Rana Deuba

The declaration also anticipates the post-2015 development agenda. Advocates are calling to expand the discussion on women’s health to include abortion rights when determining the next round of global development goals, following the expiration of the Millenium Development Goals (MDGs).

“True gender equality cannot be achieved without access to safe, legal abortion,” it says. “In the last two decades, roughly 1 million women and girls have died and more than 100 million have suffered injuries – many of them lifelong – due to complications from unsafe abortion.”

One of the MDGs, number five, does aim to reduce by three-quarters the maternal mortality ratio and to achieve universal access to reproductive health. However, it does not include access to safe abortions in its definition of access to reproductive health.

Advocates are now planning to formally offer these recommendations at a 20-year anniversary summit of the original ICPD. That event will take place in Addis Ababa next month.

“Looking ahead to ICPD+20 and the review of the Millennium Development Goals, the one goal they would not take was reproductive and sexual health for all,” Nafis Sadik, the special advisor to the executive director of UNAIDS and the former executive director of the United Nations Population Fund, told IPS.

The new declaration targets not just the international development agenda but also U.S. policymakers.

Four-decade-old legislation here has restricted foreign assistance programmes from funding abortion-related procedures. Critics say the result is a disconnect between the work done by USAID, the country’s main foreign assistance arm, and the women’s health services offered.

“Regarding the problem of U.S. policy – it’s not just the financial support, but the moral leadership,” Sadik says. “It makes a big difference if the U.S. becomes restrictive in areas of support, if they restrict funding for any NGO that provides abortion.”

Cost-effective and feasible

The Airlie Declaration was composed following a two-day conference near Washington. It was written by representatives from over 30 countries, including health ministers, members of parliament, and medical leaders as well as advocates from the United Nations lawmakers and civil society.

“Our goal is to bring this message forward and build a broader coalition,” Elizabeth Maguire, the president of Ipas, an international NGO dedicated to ending preventable deaths and disabilities from unsafe abortions, told IPS. “Every participant is committed to pursuing action.”

Maguire led the recent conference as convenor.

One such participant is John Paul Bagala, president of the Federation of African Medical Students’ Associations. Bagala works in a hospital in northern Uganda that treated 480 women from cases of unsafe abortions in 2011-12 and another 500 in 2012-13.

According to Bagala, providing access to safe abortion is cost-effective. Treating injuries resulting from an illegal abortion in Uganda can cost more than 100 dollars, he says, while the cost of a safe abortion would be less than 10 dollars.

“As a medical student in Africa, we are taking a stand to disseminate the declaration in our respective institutions,” Bagala told IPS.

“To drive [out] stigma from our health workers when they are still in the training system, to ensure that the women, when they come for service, get the best service they need in terms of safety and quality. We are driving towards integrating the aspects of this declaration in terms of reproductive health rights into the curriculum of training health workers in Africa.”

Ipas’s Maguire likewise emphasises that providing universal access to reproductive health care is not just critical but “feasible.” In the case of Nepal, for instance, decriminalising abortion greatly increased women’s health and maternal mortality ratio.

“Nepal is one of the few countries that will be meeting MDG 5, and what the experts say is that it’s increased access to family planning, emergency obstetric care, and increased access to emergency abortion care,” Arzu Rana Deuba, a member of the Nepali Parliament, told IPS.

Deuba recounted the story of a young girl in Nepal who was jailed for 12 years after she was raped and unsuccessfully attempted an illegal abortion. The girl’s story gained international attention, and Nepal eventually decriminalised abortion in 2002.

“It’s a story of hope,” said Deuba. “After 2004, we had 1,500 skilled providers and 75 hospitals doing medical abortion services. As of 2014, 500,000 women have access to safe abortions, and that’s quite a lot for we are not a big country.”

She says Nepal’s success comes not just in the growth of medical services but in the country’s changing cultural attitudes toward abortion.

“What we know now is that law changes social attitudes,” Deuba said.

“I work at the community level and workers tell me there is no more stigma, that abortion is seen as part of women’s rights, that women are more vocal about abortion … it’s seen as part of the continuum of care. Now women don’t have to die anymore and there is a feeling of confidence and security among women.”

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Women Seek Stand-Alone Goal for Gender in Post-2015 Agenda http://www.ipsnews.net/2014/03/women-seek-stand-alone-goal-gender-post-2015-agenda/?utm_source=rss&utm_medium=rss&utm_campaign=women-seek-stand-alone-goal-gender-post-2015-agenda http://www.ipsnews.net/2014/03/women-seek-stand-alone-goal-gender-post-2015-agenda/#comments Mon, 24 Mar 2014 23:10:58 +0000 Thalif Deen http://www.ipsnews.net/?p=133186 The 45-member U.N. Commission on the Status of Women (CSW) concluded its annual 10-day session Saturday with several key pronouncements, including on reproductive health, women’s rights, sexual violence, female genital mutilation (FGM) and the role of women in implementing the Millennium Development Goals (MDGs). The heaviest round of applause came when the Commission specifically called […]

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Brazilian women have been making headway in traditionally male-dominated areas. Construction workers in Rio de Janeiro. Credit: Fabiana Frayssinet/IPS

Brazilian women have been making headway in traditionally male-dominated areas. Construction workers in Rio de Janeiro. Credit: Fabiana Frayssinet/IPS

By Thalif Deen
UNITED NATIONS, Mar 24 2014 (IPS)

The 45-member U.N. Commission on the Status of Women (CSW) concluded its annual 10-day session Saturday with several key pronouncements, including on reproductive health, women’s rights, sexual violence, female genital mutilation (FGM) and the role of women in implementing the Millennium Development Goals (MDGs).

The heaviest round of applause came when the Commission specifically called for a “stand-alone goal” on gender equality – a longstanding demand by women’s groups and non-governmental organisations (NGOs) – in the U.N.’s post-2015 development agenda.

Still, the primary inter-governmental policy-making body on gender empowerment did not weigh in on a key proposal being kicked around in the corridors of the world body: a proposal for a woman to be the next U.N. secretary-general (SG), come January 2017.

"A Striking Gap"

Ambassador Anwarul K. Chowdhury, a former U.N. under-secretary-general who is credited with initiating the conceptual and political breakthrough resulting in the adoption of U.N. Security Council resolution 1325 on women and peace and security, told IPS the annual CSW session is the largest annual gathering with special focus on issues which impact on women, and thereby humanity as a whole.

"It attracts hundreds of government and civil society participants representing their nations and organisations. After the very late night consensus adoption, the agreed conclusions of its 58th session, which focused on the post-2015 development agenda, show a striking gap in firmly establishing the linkage between peace and development in the document," he said.

"The mainstream discussions in this context have always been highlighting the point that MDGs lacked the energy of women's equal participation at all decision making levels and the overall and essential link between peace and development. So, in UN's work on the new set of development goals need to overcome this inadequacy. Somehow this still remains in the outcome of CSW-58.

"Adoption of the landmark U.N. Security Council resolution 1325 boosted the essential value of women's participation. Its focus relates to each of the issues on every agenda of the U.N. There is a need for holistic thinking and not to compartmentalise development, peace, environment in the context of women's equality and empowerment," Ambassador Chowdhury said.

"It is necessary that women's role in peace and security is considered as an essential element in post-2015 development agenda."
“I did not hear it, but it’s a good question to raise given that a major section of the CSW’s ‘Agreed Conclusions’ were on ensuring women’s participation and leadership at all levels and strengthening accountability,” Mavic Cabrera-Balleza, international coordinator at the Global Network of Women Peacebuilders (GNWP), told IPS.

She said that in pre-CSW conversations, she heard the names of two possible candidates from Europe – whose turn it is to field candidates on the basis of geographical rotation – but both were men.

“The question is: Is the United Nations ready for a woman SG?” she asked.

Dr. Abigail E. Ruane, PeaceWomen Programme Manager at the Women’s International League for Peace and Freedom (WILPF), told IPS the biggest thing at the CSW session was support for a gender equality goal in the post-2015 development agenda and the integration of gender throughout the proposed sustainable development goals (SDGs).

She said the recognition of the link between conflict and development was also important because it is not one that is usually recognised.

Asked about the proposal for a woman SG, she said: “I didn’t hear any discussion of a woman SG in the sessions I participated in.”

Harriette Williams Bright, advocacy director of Femmes Africa Solidarite (FAS), also told IPS the various civil society and CSW sessions she attended did not bring up the discussion of a woman as the next SG.

Still, she said the commitment of the CSW to a stand-alone goal on gender equality is welcomed and “we are hopeful that member states will honour this commitment in the post-2015 development framework and allocate the resources and political will needed for concrete progress in the lives of women, particularly in situations of conflict.”

Antonia Kirkland, legal advisor at Equality Now, told IPS her organisation was heartened that U.N. member states were able to reach consensus endorsing the idea that gender equality, the empowerment of women and the human rights of women and girls must be addressed in any post-2015 development framework following the expiration of MDGs in 2015.

“Throughout the process there has been broad agreement that freedom from violence against women and girls and the elimination of child marriage and FGM must be achieved,” she said.

“Equality Now believes sex discriminatory laws, including those that actually promote violence against women and girls, should be repealed as soon as possible to really change harmful practices and social norms,” Kirkland added.

Cabrera-Balleza of GNWP said the call for a stand-alone goal on gender equality; women’s empowerment and human rights of women and girls; the elimination of FGM and honour crimes, child, early and forced marriages; protection of women and girls from violence; the protection of women human rights defenders; the integration of a gender perspective in environmental and climate change policies and humanitarian response to natural disasters; “are all reasons to celebrate.”

She regretted the CSW conclusions did not make a link between peace, development and the post-2015 agenda.

The earlier drafts of the Agreed Conclusions were much stronger in terms of defining this intersection, she noted.

“I hate to think delegates see peace and development and gender equality and women’s empowerment as disconnected issues or that peace is an easy bargaining chip. …that there is no text on the intersection of peace, security and development defies logic,” she said. “How can we have development without peace and how can we have peace without development?”

Cabrera-Balleza pointed out that “even as we hold governments accountable to respond to this gap, we need to have a serious dialogue among ourselves too as civil society actors – across issues, across different thematic agendas.”

Dr. Ruane of WILPF told IPS that despite longstanding commitments to strengthen financing to move words to action, including through arms reduction, such as included both in the plan of action at the Earth Summit in Rio (1992) and the Beijing women’s conference (1995), “governments gave in to pressure to weaken commitments and ended up reiterating only support for voluntary innovative financing mechanisms, as appropriate.”

In a statement released Monday, Development Alternatives with Women for a New Era (DAWN) said that while the MDGs resulted in a reduction of poverty in some respects, the goals furthest from being achieved are those focused on women and girls – particularly on achieving gender equality and improving maternal health.

Executive Director of U.N. Women Phumzile Mlambo-Ngcuka said the agreement represents a milestone toward a transformative global development agenda that puts the empowerment of women and girls at its centre.

She said member states have stressed that while the MDGs have advanced progress in many areas, they remain unfinished business as long as gender inequality persists.

As the Commission rightly points out, she said, funding in support of gender equality and women’s empowerment remains inadequate.

Investments in women and girls will have to be significantly stepped up. As member states underline, this will have a multiplier effect on sustained economic growth, she declared.

At the conclusion of the session, CSW Chair Ambassador Libran Cabactulan of the Philippines said “it is critical, important and urgent to appreciate every tree in the forest, and have an agreement on how big, how tall or how fat each tree.

“At the same time, we need to be mindful of the entire forest,” she added, pointing out that “the absence of peace and security in the discourse on post-2015 agenda does not make a whole forest.”

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Teen Pregnancy Rising in Zimbabwe http://www.ipsnews.net/2014/03/teen-pregnancy-rising-zimbabwe/?utm_source=rss&utm_medium=rss&utm_campaign=teen-pregnancy-rising-zimbabwe http://www.ipsnews.net/2014/03/teen-pregnancy-rising-zimbabwe/#comments Fri, 14 Mar 2014 09:30:13 +0000 Thandeka Moyo http://www.ipsnews.net/?p=132850 She is only 17, but each morning is a reminder of her losses in life. As Pretty Nyathi* forces herself out of bed, feeds her baby, bundles him on her back and rushes to the market to buy vegetables to sell on the streets of Bulawayo, Zimbabwe she wishes her life were different. “There is […]

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Zimbabwe has seen a significant increase in the number of teen mothers in recent years. Credit: Jeffrey Moyo/IPS

Zimbabwe has seen a significant increase in the number of teen mothers in recent years. Credit: Jeffrey Moyo/IPS

By Thandeka Moyo
BULAWAYO, Mar 14 2014 (IPS)

She is only 17, but each morning is a reminder of her losses in life. As Pretty Nyathi* forces herself out of bed, feeds her baby, bundles him on her back and rushes to the market to buy vegetables to sell on the streets of Bulawayo, Zimbabwe she wishes her life were different.

“There is nothing fancy about being a teen mother,” she told IPS. “I wish I could reverse the hands of time and go back to school and be like any other girl.”

Five years ago her mother died and Nyathi went to live with her grandmother, who runs a shebeen (informal bar) in Tsholotsho, 116 kms north-east of Bulawayo, Zimbabwe’s second-largest city.

At age 14, she was raped by a shebeen client. “I tried reaching out to my grandmother but she would threaten to throw me out,” she said.

Soon the grandmother forced the girl into prostitution with clients. “I have lost count of the men I slept with and I did not use protection,” said Nyathi.

In 2012 she ran away to Bulawayo, where she lived in the streets and survived through commercial sex. Two months later she found herself pregnant and was told at the clinic that she was HIV positive. A pastor took her to a shelter, and Nyathi started antiretroviral (ARV) treatment at Mpilo hospital.

“By the grace of the Lord, my baby is HIV negative,” said Nyathi.

She lives with a relative but struggles to follow the ARV treatment and have “a balanced diet that would help me live longer and at least see my daughter go to school.”

Nyathi is one example of the trend of rising teen pregnancies in Zimbabwe.

In 2011, the fertility rate among teenage girls aged 15-19 was 112 births per 1,000 girls, compared to 99 births per 1,000 girls in 2006, according to the Zimbabwe Demographic and Health Survey (ZDHS).

“That is a significant increase,” Stewart Muchapera, communications analyst with the United Nations Population Fund (UNFPA) in Zimbabwe, told IPS.

Girls living in the rural areas, like Nyathi, are twice as much affected by teenage pregnancies, at a rate of 144 births per 1,000 girls, compared to 70 births per 1,000 urban girls.

Risky pregnancies

“Puberty is a time of rapid biological change and this stage of development needs to be well managed for young people to pass through it safely,” said Muchapera.

Among the many causes of teenage pregnancy, he mentions the lack of adequate, accurate information on puberty, which leaves young people dependent on uninformed peer sources or unguided internet searches.

Some cultural or religious norms such as child marriage and social issues like intergenerational sex, sexual coercion and transactional sex also contribute to teenage pregnancy, he said.

The ZDHS reports that nine out of ten sexually active women aged 15 to 19 are in some form of a marriage, and that for two out of three girls who first had sex before age 15, sex was forced against their will.

In addition, the political and economic crisis of the last decade has brought widespread poverty and disruption of health and education services. Girls engage in risky transactional sex as a means to food, clothes, school and security.

Simanga Nkomo, a midwife in Bulawayo, told IPS that every year she assists younger mothers, some aged 14 and even younger.

“The increase is worrisome, as most of these teenagers are uninformed about maternal health and they risk succumbing to maternal mortality,” she said.

The risk of maternal death is twice as high for girls aged 15 to 19 than for women in their 20s, and five times higher for girls aged 10 to 14 years.

Sipho Ncube* is another teen mother from Bulawayo. She had good grades in her last year of high school but quit studying when she fell pregnant and gave birth to a baby boy, now seven months old.

“It started as a fling and one thing led to another until I discovered I was pregnant. I had knowledge of contraceptives but for some reason I did not use any,” she told IPS.

Ncube and her baby are HIV negative.  But it could easily have been otherwise: national seroprevalence is nearly 15 percent among adults aged 15-49.

Some 120,000 young Zimbabweans aged 15-19 contracted HIV in 2012, and 63.000 of these were girls, estimates the United Nations Children’s Fund.

Ncube’s parents, who work in South Africa, visit three times a year and send a little money. She looks after her siblings, aged 13 and seven, in a two-room rented house in Mpopoma, a high-density suburb. The baby’s father is working in Victoria Falls and helps financially whenever he can.

“I regret everything but I have to live with the silly choices I made,”  Ncube told IPS. “I wish to go back to school and be able to fend for the baby.”

* Names withheld to protect privacy

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Legislators Seek Rightful Place at U.N. Talkfests http://www.ipsnews.net/2014/03/legislators-seek-rightful-place-u-n-talkfests/?utm_source=rss&utm_medium=rss&utm_campaign=legislators-seek-rightful-place-u-n-talkfests http://www.ipsnews.net/2014/03/legislators-seek-rightful-place-u-n-talkfests/#comments Wed, 12 Mar 2014 20:12:34 +0000 Thalif Deen http://www.ipsnews.net/?p=132760 When the United Nations hosts one of its mega conferences – whether on population, human rights, food security or sustainable development – there is always a demand for full and active participation of often-marginalised groups, including women, civil society, indigenous peoples and youth. But some of the world’s parliamentarians – who help implement most of […]

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Secretary-General Ban Ki-moon (centre) arrives with Babatunde Osotimehin (left), Executive Director of the UN Population Fund (UNFPA), for the opening of the 46th session of the Commission on Population and Development, Apr. 22-26, 2013. Credit: UN Photo/Eskinder Debebe

Secretary-General Ban Ki-moon (centre) arrives with Babatunde Osotimehin (left), Executive Director of the UN Population Fund (UNFPA), for the opening of the 46th session of the Commission on Population and Development, Apr. 22-26, 2013. Credit: UN Photo/Eskinder Debebe

By Thalif Deen
UNITED NATIONS, Mar 12 2014 (IPS)

When the United Nations hosts one of its mega conferences – whether on population, human rights, food security or sustainable development – there is always a demand for full and active participation of often-marginalised groups, including women, civil society, indigenous peoples and youth.

But some of the world’s parliamentarians – who help implement most of the U.N.’s programmes of action through national legislation – are also battling to find their rightful place at international conferences.

This is not a shortcoming of the United Nations, say legislators, but the fault of governments that refuse to acknowledge the importance of parliamentarians in official delegations.

When the annual U.N. Commission on Population and Development (CPD) takes place in New York next month, the Asian Forum of Parliamentarians on Population and Development (AFPPD) wants all governments in the Asia-Pacific region to include “at least one parliamentarian committed to progressive population and development policy in their country’s official delegation.”

John Hyde, deputy director of AFPPD, told IPS parliamentarians are directly elected and connected to their communities.

“They can see first-hand the benefit of rights-based, evidence-based policies in improving the life of their constituents,” he said.

And they bring this relevance and commitment to their nations’ delegations, he said.

The Programme of Action (PoA) adopted at the landmark 1994 International Conference on Population and Development (ICPD) – which will be discussed at the CPD Apr. 7-11 – stressed the importance of parliamentarians, civil society and youth being involved in official delegations to the United Nations.

Confirming this, Purnima Mane, president and chief executive officer of Pathfinder International, told IPS “it is incredibly important we involve parliamentarians in development work, empowering them to appreciate and raise issues of population and development with their constituents, and gaining their support to champion global development in national policies, programmes, and budgets.”

In many countries, she pointed out, parliamentarians are already engaged in the process of monitoring their national progress on the ICPD PoA, and building political will and an enabling policy environment, and garnering needed resources for doing so.

Their example needs to be followed more vigorously around the world and inclusion of parliamentarians in national delegations is one way of recognising their role, said Mane, a former U.N. assistant secretary-general and deputy executive director of the U.N. Population Fund (UNFPA).

Hyde told IPS over a third of the Asia-Pacific nations included members of parliaments (MPs) in their delegations to the sixth Asia and Pacific Population Conference held in the Thai capital of Bangkok last year.

The Pacific nations demonstrated the value of well-prepared, engaged MPs, with Cook Islands delegate leader, health minister and AFPPD member Nandi Glassie presenting the majority outcome position on behalf of all the Pacific and a solid majority of Asian nations.

Source: ICPD Beyond 2014 Global Report

Source: ICPD Beyond 2014 Global Report

While many nations will not reveal their full delegation until just before April, many parliamentarians who contributed to APPC should be in their nations’ delegations at the CPD in New York, “hopefully with other parliamentarians embedded in delegations from the other regions of the world”, he added.

Hyde said parliamentarians from across Asia and the Pacific gathered in Chiang Mai, Thailand last month to help craft the official oral statement on priority issues that AFPPD will present during the CPD in New York.

Asked whether the CPD will also focus on the successes and failures of ICPD, Mane told IPS, “While it is difficult to predict what particular issues will see the most attention at the Commission this year, we hope for a continued focus on human rights and individual dignity, the realisation of which is a driver for all areas of development.”

“At Pathfinder, we were encouraged by, and applaud, the focus on young people and women’s empowerment found in UNFPA’s most recent review, ‘ICPD Beyond 2014 Global Report’,” she added.

Mane said she is also encouraged to see the reference to sustainability.

Without the engagement of all, including women and young people, as well as realisation of their sexual and reproductive health and rights, sustainable development will be hard to achieve in its truest sense, she said.

The upcoming session will likely touch on the successes and failures of the achievements of the ICPD agenda in the context of identifying key lessons learned “that will carry us forward for greater success in the coming decades.”

These will clearly differ by countries but the major focus needs to be on what is going to be done going forward to accelerate the momentum towards progress, Mane said.

Given that the upcoming session will certainly be shaped by the context of this year and the international focus on the Millennium Development Goals (MDGs) and what comes next, “I believe it is crucial the right to sexual and reproductive health for all people shines through as we discuss the path forward and the post-2015 global development agenda.”

She said progress has certainly been made and momentum is growing through ‘Every Woman Every Child’ and many other efforts by several bilateral partners like the U.S. Agency for International Development (USAID), national governments, philanthropic foundations, civil society and the private sector.

She said they are all working better through joint platforms, but many countries are still very much behind on equitable progress toward the MDG5 targets relating to the improvement of maternal health.

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Pakistani Women Hit Hurdles in Medical Profession http://www.ipsnews.net/2014/03/keeping-pakistani-women-medical-students-track/?utm_source=rss&utm_medium=rss&utm_campaign=keeping-pakistani-women-medical-students-track http://www.ipsnews.net/2014/03/keeping-pakistani-women-medical-students-track/#comments Sat, 08 Mar 2014 09:28:25 +0000 Beena Sarwar http://www.ipsnews.net/?p=132549 On one of her many visits to Pakistan recently, Sarah Peck, director of the US-Pakistan Women’s Council, spent some time talking to young women medical students in Pakistan. She was struck by their passion and commitment — and by the hurdles they face. The US-Pakistan Women’s Council is working with expatriate Pakistani doctors to find […]

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Many women in Pakistan qualify to become doctors, and then do not practice. Credit: Fahim Siddiqi/IPS.

Many women in Pakistan qualify to become doctors, and then do not practice. Credit: Fahim Siddiqi/IPS.

By Beena Sarwar
BOSTON, United States, Mar 8 2014 (IPS)

On one of her many visits to Pakistan recently, Sarah Peck, director of the US-Pakistan Women’s Council, spent some time talking to young women medical students in Pakistan. She was struck by their passion and commitment — and by the hurdles they face.

Left to right, medical student Saima Firdous, Dr Jamila Khalil, Sarah Peck, Dr Khalil Khatri Credit: Beena Sarwar

Left to right, medical student Saima Firdous, Dr Jamila Khalil, Sarah Peck, Dr Khalil Khatri Credit: Beena Sarwar

The US-Pakistan Women’s Council is working with expatriate Pakistani doctors to find ways to encourage women qualifying as doctors in Pakistan to practice medicine.

Women outnumber male students in medical colleges across Pakistan, forming up to 85 percent of the student body in private universities and 65 percent in the public sector.

But only about half of them end up working as doctors. There are no nationwide figures for this estimate, but the Pakistan Medical and Dental Council’s records show the discrepancy between the number of women medical students and women doctors in Pakistan.

Less than half the 138,789 doctors registered with this nationwide body are women, 62,315. For specialists, the numbers are even lower – of the total 29,914 specialists registered with PMDC, only 8,056 are women.

The pattern is also visible in doctors from Pakistan coming to the United States.

“When doctor couples come here, the husband starts to work, the wife takes care of the family,” says Dr Jamila Khalil, president of APPNE, the New England chapter of APPNA, the Association of Physicians of Pakistani Descent of North America.

“I grew up here, I was already a dentist by the time I got married,” she told IPS. A Pashtun from Pakistan’s northwest region bordering Afghanistan, she is a dentist and mother of two teens.

“It was very hard,” she added, her New England twang evident in her pronunciation of the last word, ‘haahd’.

The hurdles women doctors face in Pakistan and how to support them came under discussion at a lunch meeting that Sarah Peck attended recently in Somerville, Massachusetts convened by APPNE.

The US-Pakistan Women’s Council has powerful political connections. It was launched in September 2012 by Secretary of State Hillary Clinton, flanked by two of Pakistan’s most powerful and glamorous women, the then Foreign Minister Hina Rabbani Khar and Ambassador Sherry Rehman.

The initiative, housed at the American University, is a public-private partnership between the State Department and American University, in collaboration with the Organisation of Pakistani Entrepreneurs (OPEN). Its mission is to promote education, employment, and entrepreneurship.

The Council’s aim to promote people-to-people relations between the U.S. and Pakistan represents a major shift in Washington’s foreign policy towards Pakistan since the Obama administration took over.

Previous U.S. governments focused on transactional ties with Pakistan’s powerful military establishment, pursuing short-term strategic agendas with long-term disastrous consequences.

One of the organisers, Dr Khalil Khatri, a dermatologist and former president of APPNE, was also present at the APPNA winter session in Karachi last December where Peck met women medical students.

At the Karachi meeting women medical students had identified many different factors behind the difficulties they face in practicing medicine.

There are social pressures and lack of support, with mothers, mothers-in-law, and husbands often not wanting women to work. Families may help young couples with household matters and childcare but they also pressure them to conform to traditional gender roles.

Then, those who don’t go into ob-gyn or pediatrics have to deal with male patients, frowned upon in that highly gender segregated society – although the women medical students at the Karachi meeting said they had no issues seeing male patients.

What was hard, they said, is the harassment they face, like finding the locks broken on their changing room doors, making it difficult for them to strip and scrub down. Male peers and supervisors don’t take this seriously. In fact, those who complain face further problems.

Transport issues and security concerns, especially for those working late night shifts, are also daunting.

“One way to tackle the security and transport problem would be to arrange shuttles for women medical students especially after hours,” suggested Dr Nasar Quraishi, a pathologist visiting from New Jersey.

One of Dr Khatri’s nieces in Karachi recently started working as a doctor there. “When she has to work late nights, her parents are constantly worried. Two of my other nieces are in medical school there, but they also have every intention of practicing.”

Saima Firdous, 32, a medical student from Pakistan who finished her post-doc at Harvard University last year and is a board member of APPNE, says there is a need for “more women-only medical colleges in Pakistan, so that more people allow girls to study medicine.”

“Coming from a conservative, rural family, I found it really hard,” she told IPS. “Our culture doesn’t allow girls to live or travel alone. I’ve had to fight a lot.”

Her brother didn’t want her to attend the co-ed medical school in their city, Rawalpindi, but he also didn’t want her to go to the only women’s medical college in Pakistan, in Lahore, where she would have to live in a hostel.

“It was my three older sisters, who themselves have never been to school, who stood by me and supported me,” said Firdous, who for two years conducted a television show on the state-run Pakistan Television aiming to educate rural dwellers about basic health issues.

She received a major blow when the man she was in love with and about to marry, a U.S.-qualified physician who had encouraged her in her studies, told her that she could finish medical school, but he didn’t want her working as a doctor.

“I refused,” she said. “I hadn’t studied all those years to sit at home.”

Traveling alone to the United States, where she initially stayed with family friends, was another hurdle. “When I’m done, in another two or three years, I want to return to Pakistan and work, motivate other girls,” added Firdous.

“Women doctors are already respected role models in Pakistan, in all fields. Women have a loud voice in media and society in general,” said Dr Naheed Usmani, a paediatric oncologist from Pakistan who lives and works in the Boston area, and has also worked in Pakistan for several years.

The Council should train women doctors from the Pakistani diaspora to mentor and help students problem-solve, she told Peck.

The Council could also use its network to identify and train mentors based in Pakistan.

In the long term, there is a need to “increase motivation among women medical students and support them to not give up,”  Dr Khatri told IPS. “Secondly, educate society to develop a system where medical students are enabled to carry on their work after graduating.”

The Council’s partnership with U.S. doctors of Pakistani origin provides no quick-fix solutions to these myriad problems, but it is a step in the right direction.

Erum Sattar, a law student from Karachi and president of the Harvard Pakistan Student Group who was present at the lunch, said that the Pakistani students at Harvard would help in any way, perhaps by facilitating video conferencing for mentors and connecting people.

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Dangerous Combo: Violence in Pregnancy and HIV in South Africa http://www.ipsnews.net/2014/03/dangerous-combo-violence-pregnancy-hiv-south-africa/?utm_source=rss&utm_medium=rss&utm_campaign=dangerous-combo-violence-pregnancy-hiv-south-africa http://www.ipsnews.net/2014/03/dangerous-combo-violence-pregnancy-hiv-south-africa/#comments Fri, 07 Mar 2014 08:20:13 +0000 Alisa Hatfield http://www.ipsnews.net/?p=132528 When Phumzile Khoza* came to the central Johannesburg antenatal clinic on a chilly day in August 2013, she was feeling on edge. Not about the medical procedures – she already had two children – but about talking to the nurse. This was her third pregnancy living with HIV, but the first with a new partner […]

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By Alisa Hatfield
JOHANNESBURG, Mar 7 2014 (IPS)

When Phumzile Khoza* came to the central Johannesburg antenatal clinic on a chilly day in August 2013, she was feeling on edge. Not about the medical procedures – she already had two children – but about talking to the nurse.

One in four South African women experience intimate partner violence during pregnancy. Credit: Alisa Hatfield

One in four South African women experience intimate partner violence during pregnancy. Credit: Alisa Hatfield

This was her third pregnancy living with HIV, but the first with a new partner from whom she had been hiding her status for the past two years.

This pregnancy had been rocky from the start. Khoza had been trying to convince her partner to join her for HIV testing, but he refused. Without couples’ counseling, Khoza was afraid to disclose, and it was becoming harder to take and hide her daily medication of antiretrovirals (ARV).

Khoza’s partner was now regularly slapping her, punching her stomach, and kicking her during arguments.  Khoza feared it would get worse if he learned she was HIV-positive.

Although she wanted help, Khoza imagined the nurses would not have time to talk through her complex situation. Plus, she had seen how angry the nurses became with women who defaulted on ARV treatment.

Looking back on that antenatal visit, Khoza reflected: “I was stressing about the way I lived my life, stressing about my past, stressing about my pregnancy. And I had no one.”

Shocking figures

Khoza’s story is increasingly common. An estimated one in four South African women experience intimate partner violence in the 12 months leading up to childbirth.

Violence in pregnancy is associated with pregnancy loss, miscarriage and neonatal death, higher rates of postpartum depression and poor health gains for infants.

In a systematic review of the literature, Dr Simukai Shamu, a Medical Research Council expert on violence, found that prevalence of violence among pregnant women in Africa is among the highest reported globally, and that a major risk factor for violence is HIV infection.

“Because most studies are cross-sectional, it’s difficult to tell whether violence was a result of demands or changes in life due to pregnancy, or if the pregnancy was the outcome of violence,” Shamu told IPS.

Since early 2013, a team from Wits Reproductive Health and HIV Institute (Wits RHI) has been interviewing women living with violence in Johannesburg.

Lead researcher Nataly Woollett said that many women described pregnancy as a time of greater violence.

Fast Facts about HIV in South Africa

• 18% HIV prevalence among people aged 15-49
• 150,000 women newly infected in 2012
• 14,000 new infections among children in 2012
• 3 million women live with HIV

Source: UNAIDS 2013

“Partly because they had to disclose their HIV status and partly because men use the woman’s antenatal visit –where testing is virtually mandatory – as a proxy for their own HIV status, so they are curious about the results,” she told IPS.

At the same clinic, IPS met Martha Ramphele*, who described the rapid escalation of violence that landed her in hospital while six-months pregnant: “He started telling me that I’m a fool and stupid. And then he strangled me and let his cousin beat me up.”

Ramphele reported the incident to the police, but later withdrew the charges to protect her safety and financial security. She suspected her HIV disclosure led to physical abuse, but she couldn’t be sure.

No one can say precisely what triggers violence, but often the blend of stress associated with pregnancy, the shifting power and control dynamics, coupled with a new HIV diagnosis, are enough to heighten conflict.

The nurses’ response

Violence in pregnancy impacts negatively on the health of HIV positive women.

Sister Marieta Booysen, a senior nurse with the Aurum Institute, a research organisation in Johannesburg, explained that pregnant women in violent relationships are the most likely to quit treatment: “When you tell a patient she is HIV-positive but she is scared to disclose to her partner, it is that very same patient who will default on her medication later.”

The Wits RHI team found that most antenatal nurses interviewed recognised that violence hurts adherence to ARV treatment but few know how to deal with the issue.

The poor health care response can partly be attributed to the lack of training but it may also reflect the fact that many nurses suffer violence at home and are afraid to respond.

Dr Nicola Christofides, an expert on both violence and HIV based at Wits University, explained that “nurses who experience violence in their own lives […] are either very sensitive to the issue of violence in their patients’ lives and very receptive, or the opposite, where they are actually in denial and shut down.”

Antenatal nurses want training to respond to violence, the WITS RHI project found.

IPS talked to Khoza at the antenatal clinic five months after she had first met a Wits RHI nurse of the Safe & Sound project, which identifies violence in pregnancy and provides one-on-one counseling and referrals in three antenatal clinics in Johannesburg.

The nurse referred Khoza to the nearest hospital offering psychological care and counseling.  “It is nice to talk about the difficult things if you have someone who understands the situation and gives you clues,” Khoza said.

Khoza had never spoken about the violence in her life until the antenatal visits. A few months later, she separated from the abusive partner and is finding ways to support her children.

“I still have stress but I don’t put that in my heart. I just tell myself everything is going to work out all right even though it is difficult,” Khoza said.

* Name changed to protect her safety.

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India Fights a Tougher TB http://www.ipsnews.net/2014/03/india-fights-tougher-tb/?utm_source=rss&utm_medium=rss&utm_campaign=india-fights-tougher-tb http://www.ipsnews.net/2014/03/india-fights-tougher-tb/#comments Wed, 05 Mar 2014 09:24:29 +0000 Bijoyeta Das http://www.ipsnews.net/?p=132442 For years Joba Hemron, 50, prayed that her cough would go away. She was diagnosed with Tuberculosis (TB) in 2011. She was put on a Directly Observed Treatment Short-course (DOTS), provided free at a public health clinic in Bongaigaon district in Assam. But soon she began missing too many doses. “My sons work in the […]

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A MDR-TB patient at a Médecins Sans Frontières clinic in Manipur in north-eastern India. Credit: Bijoyeta Das/IPS.

A MDR-TB patient at a Médecins Sans Frontières clinic in Manipur in north-eastern India. Credit: Bijoyeta Das/IPS.

By Bijoyeta Das
NEW DELHI, Mar 5 2014 (IPS)

For years Joba Hemron, 50, prayed that her cough would go away. She was diagnosed with Tuberculosis (TB) in 2011. She was put on a Directly Observed Treatment Short-course (DOTS), provided free at a public health clinic in Bongaigaon district in Assam.

But soon she began missing too many doses. “My sons work in the fields, I was too weak to go on my own to get the pills,” she says. She went to a private clinic, hoping to collect all the medicines at once. That was expensive, which meant she could again not complete the course."Each time the patient moves from one doctor to another, physicians tinker around with the drug combination, further worsening the drug resistance."

Three years and five doctors later, she kept losing weight. “I took medicines whenever convenient but I was only getting worse.” Her family sold a goat and with the money traveled to the state’s capital, Guwahati.

She was diagnosed with multi-drug resistant TB (MDR-TB). “I don’t know what this means, no one explains anything. Will I get well?” she asks. Her frail body shakes as cough rakes her lungs.

For many like Hemron, lack of proper diagnosis and interrupted dosages are increasing their resistance to available drugs. Drug resistance is human-made – an iatrogenic disease resulting from mismanagement of TB, experts say.

Drug resistant TB can occur as a primary infection or develop during a patient’s treatment. India accounted for the greatest increase in MDR-TB in 2012 with an estimated 64,000 new cases.

India provides free TB treatment through the Revised National Tuberculosis Control Programme (RNTCP), which reaches 1.5 million patients. TB remains the deadliest infectious disease in the country with two deaths every three minutes. India has more than a quarter of TB cases globally.

Ramanan Laxminarayan, vice-president of the Public Health Foundation of India says the national TB programme is “stuck in the 1990s.” It is yet to rope in all available tools and involve the private sector.

“Every case of MDR-TB can be 20 times more expensive to treat than a sensitive strain and cause much greater inconvenience, pain and suffering for the patient,” he adds.

Despite regular adherence to medicines, some patients are becoming resistant to frontline drugs. In Mumbai, doctors at Hinduja Hospital said they had identified patients who are “totally drug resistant,”and did not respond to any available drugs. The Indian government rejected the claim.

According to the World Health Organisation (WHO), about 450,000 people contracted DR-TB in 2012. About half of them are in India, China and Russia. An estimated four-fifths of DR-TB cases are still undetected. There were 170,000 MDR-TB deaths globally in 2012.

Madhukar Pai, associate director at McGill International TB Centrea research organisation situated at the McGill University Health Centre in Montreal, Canada, explains that neither public nor private healthcare providers offer quality TB care. He says there are many instances of wrong drug regimens, low quality drugs, scarce monitoring of treatment adherence, patient movement between providers, adding single new drugs to already failing regimens, and inadequate use of drug-susceptibility testing. All this results in MDR and extensively drug resistant (XDR) TB.

MDR-TB treatment is expensive, the treatment often lasts up to two years, with increased risks. Access to the two new MDR-TB drugs— bedaquiline and delamanid, remains limited. They are available in India only through compassionate use mechanisms.

Most patients in India go the private sector but some abandon treatment because of high costs. By the time patients end up in public hospitals they infect many, and also develop severe forms of drug resistance, Pai says.

“In the private sector, irrational TB prescriptions are so common – doctors make up their own drug combinations. This is disastrous. And each time the patient moves from one doctor to another, physicians tinker around with the drug combination, further worsening the drug resistance,” he says.

About 10 percent of drugs in India are estimated by some doctors to be fake, which can muddle up treatment. Testing for drug-resistance is limited in the public sector. “Empiric treatment is used,” Pai says, not treatment that is tailored to a patient’s drug susceptibility profile. This results in selection of drug resistant strains.

The solution isn’t “merely technological”, says Mike Frick of the Treatment Action Group, a research and policy think thank based in the U.S.

New diagnostic machines like GeneXpert may uncover more cases of drug resistance but “it cannot solve the health system’s failure to link patients to the highest level of care that is their right,” says Frick. India fails to provide psycho-social and economic support for patients.

Globally, funding for research into TB has fallen. Governments have slashed budgets; Pfizer and AstraZeneca have abandoned anti-invectives research – increasing the wait for better drugs, diagnostics and vaccines. “It decreases our chances of replacing toxic drugs in the current MDR-TB regimen with newer, safer drugs that are easier for patients to tolerate,” Frick tells IPS.

In 2013, there were numerous reports of drug stock-outs in India, which the government denied. Many patients had to stop treatment; others were turned away from clinics. When treatment is incomplete, it creates an opportunity for drug-resistance to develop.

“The cruel irony is that even as Indian generic manufacturers continued to produce many of the TB drugs that people in other countries depend on, the Indian government couldn’t guarantee TB drug availability to its own people,” Frick adds.

TB is an opportunistic disease and HIV positive patients are more susceptible. Daniel, who asked only his first name be used, is a HIV positive patient. Six months ago he was diagnosed with MDR-TB. “The medicines are so hard, drain me of all strength,” he says.

He is forced to go to public hospital because of the exorbitant costs of medicines. “But there are long waits and everyone comes to know about you. It only adds to the existing stigma.”

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Q&A: The Face of the Future is an Adolescent Girl http://www.ipsnews.net/2014/02/qa-face-future-adolescent-girl/?utm_source=rss&utm_medium=rss&utm_campaign=qa-face-future-adolescent-girl http://www.ipsnews.net/2014/02/qa-face-future-adolescent-girl/#comments Fri, 28 Feb 2014 19:02:41 +0000 Nqabomzi Bikitsha http://www.ipsnews.net/?p=132302 Nqabomzi Bikitsha interviews KATE GILMORE, deputy executive director of the United Nations Population Fund (UNFPA).

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Kate Gilmore, deputy executive director of the United Nations Population Fund, says we have failed to protect our girls from early marriage, from gender-based violence and from early pregnancies. Courtesy: Livia Maurizi/UNFPA

Kate Gilmore, deputy executive director of the United Nations Population Fund, says we have failed to protect our girls from early marriage, from gender-based violence and from early pregnancies. Courtesy: Livia Maurizi/UNFPA

By Nqabomzi Bikitsha
JOHANNESBURG, Feb 28 2014 (IPS)

“The future is today aged 10 and it’s an adolescent girl,” Kate Gilmore, deputy executive director of the United Nations Population Fund (UNFPA), said in an interview with IPS in Johannesburg.

Gilmore discussed the impact on African youth of the last two decades of action on sexual and reproductive health and equal access to education for girls, which are assessed in the International Conference on Population and Development (ICPD) Beyond 2014 Global Report.

The report was released on Feb. 12, the anniversary of the 1994 ICPD, where 176 countries agreed on a 20-year Programme of Action, also known as the Cairo Consensus. This is a good opportunity to assess the gains and challenges of the ICPD, said Gilmore.

Q: What has the global community achieved for young people in the last 20 years?

A: One of the really groundbreaking outcomes of the ICPD was the commitment to sexual and reproductive health, making it a human rights project and not a population control project, not a project about controlling women’s fertility but a project about empowering women to be in charge of their bodies. It was a really cool shift that created transformation in public policy.

The past 20 years has also seen 1,2 billion people lifted out of poverty, a 42 percent decline in maternal mortality, and 90 percent of children passing through primary school.

Q: What economic gains have been made in Africa?

A: We have not made much economic gains in terms of addressing disparities.The gap between the rich and poor has gotten bigger within countries and between countries.

The data we were able to examine, covering the period between 2000 and 2008, just before the most recent economic crisis, showed the world had experienced and benefited from economic growth. But 50 percent of the economic growth went to less than five percent of the world’s population and economic growth gave no benefit to ten percent of the world’s population, who are the poorest.

UNFPA is calling on Member States to commit to legislative and policy reform that says there is no place for inequality, discrimination and marginalisation in our society.

Q: HIV prevalence in adolescent girls has not decreased in the past 20 years. Has the ICPD failed adolescent girls in this regard?

A: Yes, but this is a shared failure, because states also have a responsibility. We have failed to protect our girls from early marriage, from gender based violence and from early pregnancies. Governments need to realise that, unless we change the trajectory of adolescent girls on their journey to adulthood, there will be no development that is more sustainable, inclusive and resilient.

When you change the trajectory of the adolescent girl, everything changes in a community. Looking at all the data from the past 20 years, we can see clearly that what happens to the adolescent girl in the next 15 years, that is what will make or break the future.

Q: How do we invest in young people?

A: By engaging with governments and saying, let us have a look at your national strategies and priorities, let us give you access to the best technical wisdom. We also look into the best way to get the best benefit from having a healthy young population: changing health systems, improving education systems, creating spaces for young people to hone their entrepreneurial skills in new sectors.

Q: How has Africa addressed adolescent sexual and reproductive health?

A: Through deliberations of the African Union, we have seen increasing attention to sexual and reproductive health and rights. However, I do believe it has not always been identified as a young person’s issues. But, as governments have become sophisticated in the analysis of demographic realities, it has become clearer that when we talk about maternal mortality, HIV and AIDS, unsafe abortion, early marriage, fistula, and female genital mutilation, we are talking about young people.

Q: Why is it important to address the youth bulge in Africa?

A: Africa is a young person’s continent. The median age in most countries is 30 years and in Africa it is 20 years. If you want to make the youth cohort the fuel for driving economic prosperity, social stability and good governance, give them access to education and keep them healthy.

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Growing Inequality Mars 20 Years of Women’s Progress http://www.ipsnews.net/2014/02/growing-inequality-mars-20-years-womens-progress/?utm_source=rss&utm_medium=rss&utm_campaign=growing-inequality-mars-20-years-womens-progress http://www.ipsnews.net/2014/02/growing-inequality-mars-20-years-womens-progress/#comments Fri, 14 Feb 2014 22:34:31 +0000 Jonathan Rozen http://www.ipsnews.net/?p=131649 As the world moves closer to the 2015 end mark of the Millennium Development Goals (MDGs), a new U.N. report illuminates how far global society has come, but also how far it still must travel to achieve its objectives. The report tracks the last two decades of progress on issues such as universal access to […]

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Sex education is expelled from Egyptian schools. Credit: Victoria Hazou/IPS

Sex education is expelled from Egyptian schools. Credit: Victoria Hazou/IPS

By Jonathan Rozen
UNITED NATIONS, Feb 14 2014 (IPS)

As the world moves closer to the 2015 end mark of the Millennium Development Goals (MDGs), a new U.N. report illuminates how far global society has come, but also how far it still must travel to achieve its objectives.

The report tracks the last two decades of progress on issues such as universal access to family planning, sexual and reproductive health services and reproductive rights, and equal access to education for girls."This report gives us the leverage to take things to the next level, where women, girls and young people will be central to the next development agenda.” -- Dr. Babatunde Osotimehin

“We must work with governments to address issues of inequality, which is I think the greatest determinate in terms of the MDGs,” Dr. Babatunde Osotimehin, executive director of the United Nations Population Fund (UNFPA), told IPS.

“We expect that as we move into the post-2015 conversation, the evidence we have today will ensure that member states will see that if they are going to make progress…we must put people at the centre of development.”

Since 1994, the year of the landmark International Conference on Population and Development (ICPD) in Cairo when 179 governments committed to a 20-year Programme of Action to deliver human rights-based development, UNFPA has identified significant achievements with regard to women’s rights and effective family planning, but also a dramatic increase in inequality.

Maternal mortality has dropped by almost 50 percent and more women than ever before have access to both contraception and family planning mechanisms, supporting a decrease in child mortality. Furthermore, women are increasingly accessing education, participating in the work force and engaged in the political process.

Nevertheless, a gross disparity remains between the developed and developing worlds. In a press conference, Dr.  Osotimehin indicated that while the global average likelihood of a woman dying in childbirth is one in 1,300, this increases to one in 39 when evaluating developing nations specifically.

The report also notes that 53 percent of the world’s income gains have gone to the top one percent of the global population, and that none of these gains have gone to the bottom 10 percent.

It focuses on root factors of these problems and the central influences on women and girls’ ability to make choices about their lives. Child marriage and education are two main factors in this respect.

Source: UNFPA

Source: UNFPA

“It is important to underscore the fact that once girls don’t go to school, once they are married too early and once they have children as children, they cannot be equal to men, and they cannot have the same political and economic power as men,” explained Dr. Babatunde.

The effect of these factors is not limited to the success of the individual. They are also important for the development of nations as a whole.

“Education and access to health, if they are properly planned, allow people to live longer, and add value to the development of the country,” Dr. Osotimehin told IPS.

UNFPA does not work alone on these issues. Other organisations also collect information and cooperate to address problems associated with population and development.

“The report is very important for us because it both reflects what we have done and suggests a way forward that we like to think we have helped to inform,” Suzanne Petroni, senior director of gender, population and development at the International Centre for Research on Women (ICRW), an organisation which works to identify the contributions and barriers facing women across the world, told IPS.

In 2000, all U.N. member states at the time signed on to the MDGs, all of which are directly addressed in the second ICPD report. They are to be succeeded by the SDGs – the Sustainable Development Goals.

The 1994 Programme of Action was not limited to women’s rights. It also sought to address the individual, social and economic impact of urbanisation and migration, as well as support sustainable development and address environmental issues associated with population changes.

“Ensuring that we have a monitoring mechanism for the implementation of what governments have committed to…that is actually the most important thing going forward,” Dr. Osotimehin stressed to IPS. “We now need to make the commitments count on the ground.”

A key theme in the report is that in areas like South Asia and Sub-Saharan Africa, where 90 percent of the world’s youth are located, there is a massive opportunity for societies to capitalise on their resources and accelerate their development.

But governments must invest in their populations through education, healthcare, access to entrepreneurial opportunities and political participation.

“Civil society, the media, young people and women’s groups can actually work to, in a very positive way, see what [governments] are doing right, and point out where things are not going well…we are seeing that happen around the world,” said Dr. Osotimehin.

“This report gives us the leverage to take things to the next level, where women, girls and young people will be central to the next development agenda.”

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Prosecution of Forced Sterilisations in Peru Still Possible http://www.ipsnews.net/2014/02/prosecution-forced-sterilisations-case-peru-still-possible/?utm_source=rss&utm_medium=rss&utm_campaign=prosecution-forced-sterilisations-case-peru-still-possible http://www.ipsnews.net/2014/02/prosecution-forced-sterilisations-case-peru-still-possible/#comments Mon, 03 Feb 2014 22:27:23 +0000 Milagros Salazar http://www.ipsnews.net/?p=131135 Shelving the case of the forced sterilisations of more than 2,000 women in Peru during the Alberto Fujimori regime was a surprise move by the prosecutor in charge. What happened? An IPS investigation found that legal avenues to pursue justice have not been exhausted. On Jan. 24, prosecutor Marco Guzmán announced an end to the […]

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Alfonso Ramos (left) shows a newspaper reporting the death of his sister Celia in Piura due to forced sterilisation. Micaela Flores (centre) and Sabina Huillca are sterilisation victims from Cusco. All three have been waiting for justice for 17 years. Credit: Milagros Salazar/IPS

Alfonso Ramos (left) shows a newspaper reporting the death of his sister Celia in Piura due to forced sterilisation. Micaela Flores (centre) and Sabina Huillca are sterilisation victims from Cusco. All three have been waiting for justice for 17 years. Credit: Milagros Salazar/IPS

By Milagros Salazar
LIMA, Feb 3 2014 (IPS)

Shelving the case of the forced sterilisations of more than 2,000 women in Peru during the Alberto Fujimori regime was a surprise move by the prosecutor in charge. What happened? An IPS investigation found that legal avenues to pursue justice have not been exhausted.

On Jan. 24, prosecutor Marco Guzmán announced an end to the investigation of forced sterilisations carried out in Peru between 1996 and 2000. He said he would not pursue criminal charges against Fujimori (1990-2000), three former health ministers and other officials accused of being responsible for the crime."The doors were padlocked. They carried me off on a stretcher, tied my feet and cut me.” -- Micaela Flores

“They took us in trucks. We got in quite innocently and contentedly. But then we heard screams and I ran… The doors were padlocked. They carried me off on a stretcher, tied my feet and cut me,” Micaela Flores, then a mother of seven from Anta province in the southern region of Cusco, told IPS.

On that occasion about 30 women went to the health centre, duped by a campaign offering general check-ups, she said.

Guzmán has decided to prosecute only health personnel in the northern department of Cajamarca. The sterilisations were part of the Voluntary Surgical Contraception Programme (AQV – Anticoncepción Quirúrgica Voluntaria), created by Fujimori and his government to bring about a drastic reduction in the birth rate in the poorest parts of the country, especially among rural Quechua-speaking women.

Guzmán, as head of the second supraprovincial prosecutor’s office, took over the case in July 2013 after the investigation was reopened in November 2012.

There are currently 142 volumes of evidence in this longstanding case. In May 2009 the prosecution shelved the probe into the former ministers and other officials for the first time, in spite of repeated urging for its completion from the inter-American human rights system.

In 2003, the Peruvian state signed a friendly settlement agreement before the Inter-American Commission on Human Rights (IACHR) in the case of Mamérita Mestanza, who died in 1998 as a result of a poorly performed tubal ligation procedure done without her consent.

The government promised to pay an indemnity to her family and investigate and bring to trial the government officials who devised and implemented the forced sterilisation campaign.

After years of delays and foot-dragging, human rights organisations had their hopes raised when Guzmán showed interest in investigating Fujimori’s command responsibility for the generalised, systematic practice of sterilisations.

In late November the prosecutor said there were “indications of the alleged participation of Alberto Fujimori in the crimes,” and expanded the investigation into the cases of Mestanza and others.

Rossy Salazar, a lawyer with the women’s rights organisation DEMUS who is representing the victims, told IPS that this statement by the prosecutor appears on page 60277 of the file as part of a report on the case addressed to Víctor Cubas, the prosecutor who coordinates all human rights cases.

In an interview with IPS, Guzmán acknowledged having said “there were indications that Fujimori had participated.” At that point he had interviewed over 500 victims, mainly in the northwestern department of Piura and in Cusco, he said, although in his latest 131-page decision he states he only interviewed around one hundred.

Guzmán was also in possession of evidence that the programme had targets, incentives, and even sanctions for personnel who did not fulfill sterilisation quotas, according to documents obtained by government agencies that investigated the facts of the case.

DEMUS invoked these official documents in an appeal against the prosecutor’s decision to shelve the case, which it presented Jan. 28 before the Office of the Public Prosecutor.

The appeal refers to four letters from the former health minister, Marino Costa, to Fujimori in 1997. In one document the minister reports to the president on the increased numbers of AQV operations performed and says “by the end of 1997 our total production should be fairly close to the target.”

IPS asked Guzmán: “After determining in November that there were indications of Fujimori’s participation, why did you absolve him from responsibility so soon afterwards?”

“In order to examine him I had to interrogate him. I went to interrogate Fujimori and he answered some questions, but not others. For some he invoked the right to silence. Then his defence lawyer gave me a number of documents. This was important because Fujimori had never been questioned about this case before,” he said.

Fujimori’s interrogation on Jan. 15 in the Barbadillo prison, where he is serving a 25-year sentence for human rights abuses, lasted less than three hours. One week later, Guzmán closed the case against the ex-president.

“Was your interview with Fujimori decisive for determining whether he participated in the crimes?” persisted IPS.

“It was taken into consideration, but it was not decisive. The decisive thing is the legal package I have to apply… There is no legal support for imputing guilt,” Guzmán said.

The prosecutor argued that Peruvian law does not provide for the crime of forced sterilisation, and therefore there is no legal support. In his decision he said the victims’ complaints would not be classed as crimes against humanity, which refer to generalised or systematic attacks on a civilian population and have no statute of limitation.

In international terms, the Rome Statute, which established the International Criminal Court, does recognise the crime of forced sterilisation. The statute entered into force in Peru in July 2002, after the sterilisations were carried out and denunciations were initiated, but “the international community has regarded forced sterilisation as a crime since the early 1990s,” Salazar said.

In its appeal, DEMUS argues that the prosecutor’s decision “should not halt the criminal investigation.” It is “only the first step in the search for truth” and does not end the evidence collection phase. DEMUS asks for a higher level prosecutor to bring charges so that the case can continue. Another means of re-opening the case would be for another victim to bring a new complaint.

DEMUS also plans to bring the case to the attention of the IACHR in March.

On Jan. 31, an article by Guzmán was published in the newspaper El Comercio, saying that “the only way Fujimori could be held responsible is by demonstrating command responsibility, and according to the Constitutional Court the requirements for this are not fulfilled, because there is no rigid vertical structure involved, and doctors cannot be obliged to operate against their will.”

“They are isolated cases,” he told IPS.

According to the Health ministry, 346,219 sterilisations were performed on females and 24,535 on males between 1993 and 2000, 55.2 percent of them in the period 1996-1997 alone. During that period an average of 262 tubal ligations were carried out a day.

More than 2,000 persons were documented to have been deceived or threatened into undergoing sterilisation. Women in Cusco were among the worst affected, because on average nearly five operations a day were performed there, according to Health ministry figures and the testimony of victims.

Sabina Hillca, from Huayapacha in the Cusco region, told IPS that she set out for the health centre in Anta when she was due to give birth to her daughter, Soledad, but the birth happened on the way.

The nurses told her she should stay to be “cleansed” and avoid infection. The next day she woke up crying, with sharp pain, an incision close to her navel, and tied to the bed. Afterwards she fled to her village, cleaned the wound with soap and water, removed the stitches as best as she could, and went to her mother for herbal treatments.

“Now I have cancer because dry blood collected in my ovaries,” she said, showing the dark scar on her abdomen.

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HIV On a Dangerous Threshold in Sri Lanka http://www.ipsnews.net/2014/02/hiv-dangerous-threshhold-sri-lanka/?utm_source=rss&utm_medium=rss&utm_campaign=hiv-dangerous-threshhold-sri-lanka http://www.ipsnews.net/2014/02/hiv-dangerous-threshhold-sri-lanka/#comments Sun, 02 Feb 2014 07:45:24 +0000 Amantha Perera http://www.ipsnews.net/?p=131089 Four thousand HIV infections in a population of 20 million should not be a difficult figure to manage. But experts in Sri Lanka say social customs and strict laws are hindering them from carrying out prevention and awareness campaigns among high-risk groups. Despite impressively low national infection rates, there are signs that the spread of […]

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Lack of awareness among youth on risks of HIV infections needs to be addressed quickly to stem the disease from spreading, the National HIV Strategic Plan Sri Lanka 2013–2017 has warned. Credit: Amantha Perera/IPS.

Lack of awareness among youth on risks of HIV infections needs to be addressed quickly to stem the disease from spreading, the National HIV Strategic Plan Sri Lanka 2013–2017 has warned. Credit: Amantha Perera/IPS.

By Amantha Perera
COLOMBO, Feb 2 2014 (IPS)

Four thousand HIV infections in a population of 20 million should not be a difficult figure to manage. But experts in Sri Lanka say social customs and strict laws are hindering them from carrying out prevention and awareness campaigns among high-risk groups.

Despite impressively low national infection rates, there are signs that the spread of HIV – which can lead to AIDS – has increased among these groups, most of which face ostracism, they say.

Sri Lanka, an Indian Ocean island nation, is considered a low HIV prevalence country, according to official statistics. Going by the latest data of the National AIDS Prevention Programme, there are little over 1,800 HIV infected in the country, of which the majority is male, at 1,080.For Sri Lanka’s high-risk groups, time is ticking away.

Even if undetected cases were to be factored in, the overall case load is estimated to be around 4,000, Susantha Liyanage, director of the programme, told IPS.

Liyanage, however, warned that these low figures could be hiding a much more explosive and complex situation – the risk of an epidemic within high-risk groups. “There is a very real chance that there are higher infection rates among high risk groups. We are already seeing such a trend,” he told IPS.

A similar warning came in the Sri Lanka National HIV Strategic Plan 2013-2017 released last year. “Certain socio-economic and behavioural factors noticed in the country may ignite an epidemic in the future,” it said.

Among the risk groups identified in the plan were men who have sex with men, youth aged between 15 and 25, intravenous drug users and the offspring of HIV positive parents.

Experts say while HIV awareness has grown in Sri Lanka, fighting the spread of the disease within high-risk groups is being stymied by legal and social strictures.

“Under Sri Lankan law, homosexuality and drug use are criminal offences, making it extremely difficult to work openly with these groups,” Milinda Rajapaksha, working director at National Youth Services Council, told IPS.

Liyanage said the situation is similar for commercial sex workers, identified as yet another high-risk group.

“With all of these groups we have to be discreet and use intermediary organisations to conduct awareness and prevention programmes,” he said.

Of the known infections, 80 percent are due to unprotected sexual activity and 4.4 percent due to parent to child transmission.

Liyanage said despite the presence of a free island-wide prenatal care service carried out by the Ministry of Health, HIV screening of pregnant mothers was still very poor.

The National HIV Strategic Plan said in 2011 only three percent of all pregnant women had been tested for HIV, even though over 95 percent of pregnancies in the country had access to prenatal care.

Another astonishing detail is, of the known infections, 20 percent is in the age group of 15 to 25. A little over five years back, this age group made up less than six percent of known infections.

Liyanage said the increase in infections among the youth was a grave concern. “It indicates that awareness programmes are not effective among the youth.”

Last November a new intra-ministerial committee was formed, with Liyanage at its head, to draft new recommendations to slow down the spread of the disease among youth.

Sri Lanka also lacks sex education at the secondary school level.

Rajapaksha from the National Youth Council said lack of awareness was becoming a serious problem as more and more youth became sexually active. The official said Sri Lanka’s health policy was yet to recognise youth as a special category, making it difficult to target health risks within the group.

A new National Youth Policy scheduled for release in February recommends that this anomaly be rectified.

Rajapaksha said homosexual men were particularly at risk since social conventions stigmatised them severely. He said in urban areas, especially in the Western Province, activists and groups were helping gay groups but such work was extremely difficult in rural areas.

“On top of this there is hardly any chance of conducting large-scale public awareness campaigns aimed at these groups – the public backlash will be too much,” he said.

Asela, a gay man who works with homosexual groups, said all meetings conducted by his group were limited to a very closed group and there were hardly any public programmes.

“If you are in the network, help is readily available. But we do not carry out any programmes aimed at the general public whereby gay men or women unknown to us can reach us,” he said.

According to research, there are between 30,000 and 40,000 men having sex with men in Sri Lanka. HIV infections within the group have shown a steady increase in the last five years. In 2009, a year after surveillance of the group began, infections were 0.48 percent of overall cases. The rate was 0.9 percent in 2011 and it is currently 12.3 percent.

The group also showed a high number of sexual partners and at least a quarter indicated they had sexual liaisons with women as well.

For Sri Lanka’s high-risk groups, time is ticking away.

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Kenya’s Journey Towards Zero New HIV Infections Falters http://www.ipsnews.net/2014/01/kenyas-journey-towards-zero-new-hiv-infections-falters/?utm_source=rss&utm_medium=rss&utm_campaign=kenyas-journey-towards-zero-new-hiv-infections-falters http://www.ipsnews.net/2014/01/kenyas-journey-towards-zero-new-hiv-infections-falters/#comments Wed, 29 Jan 2014 06:54:35 +0000 Miriam Gathigah http://www.ipsnews.net/?p=130909 In early January 2008, during the violence that rocked Kenya after disputed general elections, a man knocked at Lucia Wakonyo’s gate at Mathare Valley, in the sprawling Mathare slum.  “He was calling out for my neighbour and I told him my neighbour was not in. He pleaded to give him refuge,” Wakonyo told IPS. When […]

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During shortages of antiretrovirals due to strikes by health staff, Lucia Wakonyo resorted to self-medication. Credit: Miriam Gathigah/IPS

During shortages of antiretrovirals due to strikes by health staff, Lucia Wakonyo resorted to self-medication. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, Jan 29 2014 (IPS)

In early January 2008, during the violence that rocked Kenya after disputed general elections, a man knocked at Lucia Wakonyo’s gate at Mathare Valley, in the sprawling Mathare slum. 

“He was calling out for my neighbour and I told him my neighbour was not in. He pleaded to give him refuge,” Wakonyo told IPS.

When Wakonyo opened the gate, “he threw me to the ground and raped me,” she said. Two months later, she discovered she was pregnant and infected with HIV. Wakonyo never attended an antenatal clinic and delivered an HIV positive baby with a traditional birth attendant.“They get tested for HIV but they do not go back for the results." -- Reproductive health expert Dr Joachim Osur

Her next pregnancy was very different. In 2012, Wakonyo delivered an HIV negative baby, after attending antenatal care and being put on prevention of mother-to-child transmission treatment (PMTCT).

Wakonyo and her baby benefitted from Kenya’s successful drive to extend PMTCT, which nearly halved new infections among children between 2009 and 2011.

But, worryingly, the drive is losing impetus. PMTCT coverage fell by 20 percent in 2011-2012, says the Progress Report 2013 of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

“Five out of 10 pregnant women living with HIV do not receive antiretroviral medicines to prevent mother-to-child transmission,” Rangaiyan Gurumurthy, UNAIDS Senior Strategic Information Advisor in Nairobi, told IPS.

Gurumurthy explained that this figure excludes the 11 percent of HIV positive pregnant women on a regimen of a single dose of Nevirapine, which is not as effective as combination drug therapies.

The result is an estimated 13,000 children newly infected with HIV in 2012. Kenya’s seroprevalence rate is six percent and in moderate decline, according to UNAIDS.

Experts agree on the main reason behind the reduction in PMTCP – disruptions in the health services.

In December 2011, doctors went on strike to pressure the government to put more money into health care. In March 2012, nurses staged a two-week long strike, and five months later doctors again went on strike for nearly three weeks. More strikes took place in 2013.

During the strikes, Wakonyo resorted to self-medication, taking any antiretrovirals that she could find as well as traditional medicines, although aware this could lead to resistance to ARVs.

“Indeed, PMTCT uptake may have reduced but only during the strikes of doctors and nurses, as well as due to test kits stockouts,” said Dr. Simon Mueke, acting senior director of Medical Services at the Ministry of Health. “But overall, PMTCT uptake has been on the rise.”

George Omondi, from the local advocacy group Women Fighting AIDS in Kenya (WOFAK), agrees. “The PMTCT programme has been so successful that the country has shifted from P to E. We no longer talk about prevention of mother to child transmission but elimination – eMTCT,” he told IPS.

Moving forward

UNAIDS points out that Kenya is taking steps to strengthen PMTCT, such as providing free maternity services, scaling up its Mentor Mother programme nationwide and boosting support for exclusive breastfeeding among HIV positive nursing mothers.

Reproductive health expert Dr. Joachim Osur observes that “you cannot improve PMTCT coverage if maternal health services are not improved. Nationwide, only about 41 percent of women deliver in hospital.”

In Nyanza and Western provinces, he added, only a quarter of women deliver under the care of trained health attendants. “When a woman delivers at home, she cannot access the full PMTCT treatment,” he explained.

Another problem is getting all pregnant women tested for HIV. Out of the estimated 1.5 million pregnancies that occur every year in Kenya, between 87,000 and 100,000 test HIV positive

“Not every woman at antenatal care accepts to be tested for HIV. The reasons for avoiding the HIV test are multiple but stigma remains key,” Osur said. “Unfortunately, health workers cannot force the test on women, it is their right to accept or refuse.”

Some pregnant women visit the clinic only once. “They get tested for HIV but they do not go back for the results,” said Osur.

In spite of these challenges, WOFAK’s Omondi remains optimistic that a reduction of HIV transmission among breastfeeding mothers to less than five percent and a 90 percent reduction in mother to child HIV transmission rates by 2015 is a realistic goal.

“The waiver of maternity fees in all public hospitals since June [2013] will have a positive effect on maternal health in general,” he said. “But there is need for community awareness around HIV. Many women stay away from PMTCT services for fear of stigmatisation.”

AIDS experts remain concerned over the continued unrest in the health sector and have urged the government and health professionals to settle outstanding issues over remuneration, and thus ensure that doctors and nurses are at hand when needed and that fewer babies are born with the virus.

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More Women Weigh Risks and Rewards of At-Home Birthing http://www.ipsnews.net/2014/01/women-weigh-risks-rewards-home-birthing/?utm_source=rss&utm_medium=rss&utm_campaign=women-weigh-risks-rewards-home-birthing http://www.ipsnews.net/2014/01/women-weigh-risks-rewards-home-birthing/#comments Mon, 27 Jan 2014 03:45:20 +0000 Lorraine Farquharson http://www.ipsnews.net/?p=130789 It was a long and hard 10 hours of labour. “Don’t give up,” Carolina Pinheiro recalls her doula urging, as she provided both physical and emotional support. Pinheiro says she chose at-home birthing with midwife assistance because she wanted a safe environment, plus the gentle care the method provides, which included exercise stretches, a foot […]

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Midwives assume the role of the doctor and replaces the more clinical hospital setting with holistic and homeopathic methods. Credit: Bigstock

Midwives assume the role of the doctor and replaces the more clinical hospital setting with holistic and homeopathic methods. Credit: Bigstock

By Lorraine Farquharson
NEW YORK, Jan 27 2014 (IPS)

It was a long and hard 10 hours of labour.

“Don’t give up,” Carolina Pinheiro recalls her doula urging, as she provided both physical and emotional support.“If you feel safer in a hospital then do that, but there should not be an assumption that hospitals are safer than home. " -- Carolina Pinheiro

Pinheiro says she chose at-home birthing with midwife assistance because she wanted a safe environment, plus the gentle care the method provides, which included exercise stretches, a foot massage and aromatherapy.

Since Pinheiro could not sit up to eat during the 10 hours, yet still needed strength to push, the doula squeezed “fresh green [kale and fruit] juice” for her and constantly brought jugs of water.

“A doula is recommended if a mother chooses the at-home [birth], because she comes to your house and guides you through until the time is right for the midwife to come,” Pinheiro tells IPS.

Pinheiro’s baby was positioned feet-down, and it took three hours to turn him around. “Usually, pushing should last two to three hours,” she says.

“If I was in a hospital they would not allow me to push so long and suggest a C-section. I didn’t want that,” she adds. “My doula and I agreed to invite the midwife over only when the time felt right.”

In Pinheiro’s view, the midwife assumes the role of the doctor and replaces the more clinical hospital setting with holistic and homeopathic methods. “So there is no medication during pushing. She just guided me holistically in the positions that I could try,” Pinheiro says.

Even as women in the United States spend 98 billion dollars a year on hospitalisation for pregnancy and childbirth, the country’s maternal mortality rate has doubled in the past 25 years, to around 15 deaths per 100,000 births. Currently, the U.S. ranks 50th in the world in terms of maternal mortality, among the bottom of the most developed countries.

“My midwife took care of me through my entire pregnancy and was there by my side all along, so I knew I would feel safer,” said Pinheiro. She said that having the midwife carry out the delivery at home also made her feel more private. “If you are in a safe environment, you will be fine.”

Sandra Londino, a licensed midwife who runs a private practice in Ithaca, New York, says more than 90 percent of births with obstetricians occur in hospitals. For the most part, the use of modern technology proved effective in the early detection of complications and providing faster solutions, but there are drawbacks as well.

Londino says that when women ask questions about the birth and delivery, they are too often “brushed off” or they are not told the truth.

“Many just agree to an epidural [spinal anesthesia] or a quick C-section just because the doctor says so,” she adds. “Perhaps it is due to money and power, because we don’t see physiological births any more. There are hardly normal births in this country.”

Many women who first chose midwifery for pre-natal and birthing assistance are now opting for at-home birthing with therapeutic guidance from a doula, a phenomenon that grew 41 percent from 2004 to 2010, according to Londino.

Saraswathi Vedam, chair of Home Birth at the American College of Nurse-Midwives, says that this method is increasingly within the mainstream.

“One can always change their mind and go to the hospital,” Vedam says. “Women just enjoy the comfort and continuing care from someone who they feel a more personal relationship with, such as a midwife.”

Results of a survey show that expectant mothers chose an at-home birth in order to avoid unnecessary interventions and to have more control over her birthing decisions. Some said they trust in natural birth as a normal healthy process and did not want any separation from their newborn.

Others said that since they underwent a healthy pregnancy, having the baby at home would make them feel safer by decreasing the possibility of contracting an infection or being coaxed into a Caesarean.

Still, the American College of Obstetricians and Gynecologists argues that home births are unsafe and does not support them.

“It’s important to remember that home births don’t always go well, so as physicians, we have an obligation to provide families with information about risks, benefits, limitations and advantages,” said Richard N. Waldman, the group’s president.

Insurance companies have decided to follow ACOG’s advice by refusing to reimburse clients for at-home births. Londino says she doesn’t understand the logic from a financial perspective.

“Hospital births, without intervention or complication, cost roughly 9,500 dollars, which an insurance company is willing to pay,” she says. “Yet an at-home birth performed by a midwife, whose invoice includes regular pre-natal visits, all necessary tools and delivery, is only 3,500 dollars – which is refused reimbursement.”

Retired hospital midwife Ellen Cohen, who wrote a book about the effectiveness of pre-natal care in order to deliver safe babies without modern technology, says bearing a child is a vulnerable time in women’s lives where they try to do the best for themselves and their newborns.

“If one looks at childbirth as a pathological incident as opposed to something natural, then they will use a machine to help them feel safe – even something like the electrical fetal [heartbeat] monitoring,” Cohen added.

This method is not for everyone though, Pinheiro cautioned. “If you feel safer in a hospital then do that, but there should not be an assumption that hospitals are safer than home. One responds better when they are in their own environment. For me, it was a remarkable experience.”

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Impoverished Cambodians For Sale http://www.ipsnews.net/2014/01/impoverished-cambodians-sale/?utm_source=rss&utm_medium=rss&utm_campaign=impoverished-cambodians-sale http://www.ipsnews.net/2014/01/impoverished-cambodians-sale/#comments Fri, 24 Jan 2014 03:25:17 +0000 Michelle Tolson http://www.ipsnews.net/?p=130642 Many Cambodian women arrive in South Korea or China for marriage, only to find themselves being chosen as mistresses, say labour rights activists. While young Cambodian men, who travel to Thailand to work on fishing boats, often fall prey to drug abuse. Loss of land, debt, poor pay and high prices of petrol and electricity […]

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Many Cambodians see dubious hope across the Poipet border crossing to Thailand. Credit: Michelle Tolson/IPS.

Many Cambodians see dubious hope across the Poipet border crossing to Thailand. Credit: Michelle Tolson/IPS.

By Michelle Tolson
PHNOM PENH, Jan 24 2014 (IPS)

Many Cambodian women arrive in South Korea or China for marriage, only to find themselves being chosen as mistresses, say labour rights activists. While young Cambodian men, who travel to Thailand to work on fishing boats, often fall prey to drug abuse.

Loss of land, debt, poor pay and high prices of petrol and electricity are pushing youths from poverty-stricken Cambodia to foreign lands – sometimes with disastrous consequences.

Miserable working conditions in the garment sector have only worsened the labour trafficking scenario.Despite these problems, repatriated workers often leave Cambodia again.

Tola Moeun, head of the Community Legal Education Centre (CLEC), said rural farmers comprise 80 percent of Cambodia’s population, but they are increasingly in debt due to high-interest loans. As a result, youth leave home in search of work.

He also cited the example of Cambodia’s garment industry, saying the prospect of being a garment worker is so terrible that often women will do anything to escape this fate.

“Women garment workers often choose to go to South Korea to escape the situation,” Tola told IPS.

CLEC has received several calls from families whose daughters were experiencing troubled “marriages” to Chinese and South Korean men that turned out to be sham marriages.

Tola said families accept money from marriage brokers without understanding the situation. The truth emerges when the women arrive in South Korea, only to be lined up in a room for the “husband” to choose from.

“I went to South Korea in 2011. It was explained to me that South Korean wives are not worried about sex workers because the husband takes a mistress. So he chooses a Cambodian girl to ‘marry’,” he said.

“In China, there is a shortage of women in the countryside. The man wants a wife to work for him without pay, so she becomes not only a labour slave but also a sex slave,” Tola said.

He concedes, however, that all international marriages are not shams.

A 24-year-old woman in Phnom Penh told IPS she knew of many successful relationships through marriage brokers. But she contacted IPS when a 30-year-old woman was being aggressively pursued by a marriage broker after she changed her mind about an offer. The broker backed off when CLEC was mentioned.

“A lot of Cambodian girls marry South Korean men. These are real relationships. Really poor people do this. Sometimes the girls come back and are able to build a house for the family and improve their lives.”

Young Cambodian men travel to Thailand to work in the construction sector, on fishing boats or in fish processing factories. This takes place either formally, using a broker for visas, or illegally.

“In case of illegal offers, the recruiter will call and say, ‘Do you want a job?’ The person will then cross the border at night, not using checkpoints, hiding in the back of a truck, lying head to toe with other people and covered with supplies that are being transported,” said Tola.

Brahm Press of the Raks Thai Foundation, an organisation that assists migrant workers, said most problems occur due to work contracts at the Cambodian end.

“As of July 2013, around 8,000 Cambodians were registered in Bangkok – 5,000 men and the rest women – and they were probably all in construction. I have heard that after deductions for recruitment agencies and housing, they come away with less than the 300 baht [10 dollars] a day minimum wage,” Press told IPS.

He said problems usually occur due to misunderstandings about work arrangements and fees or when passports are withheld to ensure that workers pay their recruitment debt.

Recently 13 young Cambodians – 11 men and two women aged between 15 and 23 – entered Thailand with the help of brokers to whom they paid 500 dollars each, said Si Ngoun, the father of one of the youths.

“They were promised a good job with a good salary of 300 baht per day.”

For two months they worked at a rubber band factory, a metal smith factory and, lastly, in the construction sector, which is where their troubles began.

“We were paid very little, about 120 baht [four dollars] per day. We didn’t want to work any more because we were too hungry,” 20-year-old Si Pesith, one of the workers, told IPS.

Tola said the workers asked for food and protested but the employer had them jailed as illegal workers. Usually detention lasts six to nine months, but Cambodian Ambassador You Ay intervened and they were sent home within a week.

IPS spoke with Pesith after he was repatriated. “If we compare work in Thailand with that in Cambodia, it is not much different,” he said.

Thai fishing boats have been flagged by the U.S. State Department Trafficking in Persons (TIP) Report as potential labour trafficking scams for Cambodian migrants.

Press said conditions on fishing boats are notoriously difficult to monitor. Work there has been linked to drug use as labourers try to get through work shifts that can last up to 20 hours.

“When migrants, first Burmese and then Cambodians, were prominently replacing Thais on the boats, amphetamines were becoming the rage,” he said.

“First there was Ya-Ma (horse drug), which was milder than the current Ya-Ba, but no less addictive. During the last decade there were anecdotal reports, first of migrants on fishing boats voluntarily taking Ya-Ma, then stories of captains putting Ya-Ba in the drinking water.” Press, however, said such stories had become less frequent.

Eliot Albers, executive director of the International Network of People who Use Drugs (INPUD), said criminalisation of drug use makes it harder to assist users, especially migrants.

“Poverty and labour abuse worsen people’s relationship with drugs. They suffer from labour abuse and drugs help them get through the day,” Albers told IPS.

Migrant workers lack union representation, making them especially vulnerable to abuse. If they are formal workers, the process of migration is expensive (up to 700 dollars each), requiring a recruiter and debt. If they are informal, it is cheaper. But they risk detention and deportation by Thai police if they complain about the working conditions.

Despite these problems, repatriated workers often leave Cambodia again.

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Seasonal Migration Frustrates Ethiopia’s Family Planning http://www.ipsnews.net/2014/01/seasonal-migration-frustrates-ethiopias-family-planning/?utm_source=rss&utm_medium=rss&utm_campaign=seasonal-migration-frustrates-ethiopias-family-planning http://www.ipsnews.net/2014/01/seasonal-migration-frustrates-ethiopias-family-planning/#comments Mon, 20 Jan 2014 10:34:19 +0000 Miriam Gathigah http://www.ipsnews.net/?p=130434 Yohamin Kesete, 32, and her six children live in Dollo Ado, a pastoralist community in Ethiopia’s drought-stricken Somali Region. But this is not where you will always find them. Kesete says that as temperatures soar and the rains become even more rare, her family is often forced to leave the area in search of water […]

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Women and children take a break from the scorching sun in Ethiopia's arid Somali Region. Because of the nomadic life of the community it has been difficult to provide family planning services. Credit: Miriam Gathigah/IPS

Women and children take a break from the scorching sun in Ethiopia's arid Somali Region. Because of the nomadic life of the community it has been difficult to provide family planning services. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
DOLLO ADO, Ethiopia, Jan 20 2014 (IPS)

Yohamin Kesete, 32, and her six children live in Dollo Ado, a pastoralist community in Ethiopia’s drought-stricken Somali Region. But this is not where you will always find them.

Kesete says that as temperatures soar and the rains become even more rare, her family is often forced to leave the area in search of water and pasture.

“We have to survive, so we move to other regions. This is a hardship area. There are times when I have had to move while heavily pregnant because it gets too dry and there is nothing to eat. We cannot stay in Dollo Ado just so that we can deliver in hospital, we will die of starvation,” she tells IPS.“Without access to family planning, women in pastoralist communities … will continue to give birth until their wombs run dry.” modern midwife Feven Alazar.

Her village lies some 980 km away from the capital, Addis Ababa, and because of the nomadic life of the community here it has been difficult for the government and community-based NGOs to provide family planning services.

“Even though I can barely feed my current children, I am worried that I will have six more children before I am 40 years old,” Kesete says.

Family planning has been recognised and implemented as an important part of global development, particularly for the role it plays in reducing maternal mortality and improving maternal health.

But Ethiopia’s Demographic and Health Survey shows that the unmet need for contraceptives in this Horn of Africa nation now stands at 25.3 percent. In addition, for every 100,000 live births, 676 women die, which increased marginally from 673 deaths in 2005.

“Seasonal migration among pastoralist communities continues to frustrate efforts to ensure that these communities not only access family planning but that they also have more family planning choices,” Feven Alazar, a modern midwife who works for Ethiopia’s ministry of health, tells IPS.

“Among pastoralist communities maternal deaths are much higher. Not only is contraceptive prevalence low but women deliver at home, which often leads to complications. By the time they are rushed to a health facility, it is usually too late to save either the baby or the mother,” she says.

Alazar points out that when pastoralists move from an area in search of water, the local health extension officers – who provide women with access to family planning at household level – move too.

“Just like the community, the health extension officers move out of the arid areas when it is too dry. They have to survive,” she explains.

As a result, she says, a significant number of women in Ethiopia’s arid and semi-arid areas are yet to enjoy full access to contraceptives.

“The more family planning choices there are, the higher the chances that even more women will be using contraceptives because they switch and find a method that works for them,” Alazar explains.

Although central and southwestern Ethiopia have higher contraceptive prevalence rates – as high as 56.3 percent in the capital Addis Ababa – the same cannot be said of the pastoralist communities in eastern and southern Ethiopia. Here you will find some of the lowest contraceptive prevalence rates in the country.

“There are many Somali refugees in Dollo Ado, which has a population of about 500,000 people. In the Kobe refugee camp there is a population of about 127,000 people and Bokolmanyo [another refugee camp in Dollo Ado] has a population of about 130,000. Here, contraceptive prevalence is less than eight percent. Yet family planning is key towards reducing maternal deaths,” Mekuria Altaseb from the Family Guidance Association of Ethiopia, a local NGO, tells IPS.

Altaseb acknowledges that the government is working towards resettling pastoralists living in arid areas to regions with better climatic conditions, but says that “not enough is being done to cushion pastoralists from climate change.”

“While a region like Dollo Ado is very dry, there are two major rivers here. River Dawa is on the border between Kenya and Ethiopia, while River Ganale cuts across Dollo Ado. Innovations should be put in place to help the pastoralists easily access the water and use it not just for livestock, but also for agriculture so they will not have to keep moving,” she says.

Altaseb says that Ethiopia has increased contraceptive prevalence from just 15 percent in 2005 to 29 percent in 2011 in an effort to bring maternal mortality down to 267 by 2015. But statistics by organisations like the United Nations Population Fund show that Ethiopia, along with six other countries, including Nigeria and the Democratic Republic of Congo, still account for about half of all maternal deaths globally.

“Without access to family planning, women in pastoralist communities … will continue to give birth until their wombs run dry,” modern midwife Alazar explains.

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The Virtual Doctor Will See You Now http://www.ipsnews.net/2014/01/virtual-doctor-will-see-now/?utm_source=rss&utm_medium=rss&utm_campaign=virtual-doctor-will-see-now http://www.ipsnews.net/2014/01/virtual-doctor-will-see-now/#comments Thu, 09 Jan 2014 11:09:07 +0000 Amy Fallon http://www.ipsnews.net/?p=130006 There are thousands of miles between Chanyanya Rural Health Clinic, a basic medical centre in Zambia’s rural Kafue District with no resident doctors despite being the main centre for nearly 12,000 people, and the New York University (NYU) Teaching Hospital, one of the world’s most prestigious medical schools. The two are worlds apart, not only […]

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By Amy Fallon
CHILANGA, Zambia, Jan 9 2014 (IPS)

There are thousands of miles between Chanyanya Rural Health Clinic, a basic medical centre in Zambia’s rural Kafue District with no resident doctors despite being the main centre for nearly 12,000 people, and the New York University (NYU) Teaching Hospital, one of the world’s most prestigious medical schools.

Mercy Nalwamba, the clinical officer general of Makeni clinic in Chilanga District. Credit: Amy Fallon/IPS

Mercy Nalwamba, the clinical officer general of Makeni clinic in Chilanga District. Credit: Amy Fallon/IPS

The two are worlds apart, not only when it comes to geography.

Yet when Florence* broke out in a strange rash two weeks after she began taking ARVs for HIV in 2011, the clinic, about 90 minutes from the capital Lusaka, was able to connect to a NYU infectious diseases expert on the other side of the world with just a few clicks of a computer mouse.

Through the Virtual Doctor Project (VDP), a telemedicine initiative being pioneered in Zambia linking rural clinics across the southern African country with volunteer doctors around the globe using the local broadband network, Florence was prescribed the correct medication.

Her rash had been “all over the body”, recalled Kebby Mulongo, the clinical officer who first saw her.

“It was just about two days in between [when] the doctor [in New York] was able to get back to me. The expert in New York knew what the problem was ASAP,” Mulongo, 30, told IPS.

“And that’s what I was happy about, because after that I kept on treating the patient in the ward. Within a week or so the patient improved instead of me sending the patient to the hospital.”

A smiling Mulongo added: “Medicine is about consultation. If we can consult at the click of a button like that, it’s better for us.”

The VDP, now running live in six Zambian sites, use eHealth Opinion software to submit patient files electronically. Clinical officers, trained to screen patients before they see a doctor, access this using Fizzbook laptops. The dust-proof, splash-proof, robust laptops can be easily transported and a battery backup means they can withstand Zambia’s power cuts.

The software allows the clinical officers to build a patient file which is compressed and sent to one of the VDP’s medical experts in Zambia, the UK, U.S., India, Pakistan, China, Nigeria, New Zealand or Malaysia. The file includes the patient’s basic details, medical history, prescription and the specific questions the Zambian clinical officers need answered.

All clinical officers are given a basic Samsung HD camera with which they can take photos of X-rays. These can be uploaded to the computer and included in the patient file along with lab reports. The “virtual doctor” then reviews the information they’ve received and offers diagnostic and treatment advice with another click of a button.

Operational in Zambia for six months, the VDP, set up by an eponymous charity, are due to go live at three more sites this month. They hope to have at least 12 sites live by the end of the year. They’re also looking at expanding into Tanzania in the near future, along with other African countries.

Just before Christmas four new clinical officers were trained in Zambia’s new Chilanga District.

“Effectively it’s a platform for you to be able to talk to somebody else about a patient that maybe you’re not too sure on. The idea is not to take any responsibility for ownership away from you,” project co-ordinator Heather Ashcroft told the trainees.

“You still are and you remain the first port of call, you have the final say on how you diagnose or treat a patient. The idea behind the system is that you get a bit of a sounding board.”

Mercy Nalwamba, 22, was one of two female clinical officers who attended the Dec. 23 training session. A recent graduate of Chianama College of health sciences, she is now the clinical officer general of Makeni clinic in Chilanga District and sees about 50 patients daily, the majority of them suffering from respiratory tract infection, diarrhoea and malaria.

Nalwamba said having access to the VDP experts at Makeni would mean the clinic would have to make less referrals to other centres further away for nonemergency cases, the project’s main aim. But she told IPS, “I can’t wait to hear their opinions and new ideas. It will enhance my work, I’ll gain more experience and knowledge.

“I think there will be less work and we’ll be getting more information on how to go about (treating) chronically ill patients, how to manage them and when we’re referring them we can at least make the patients a little bit stable.”

Ashcroft says the Memorandum of Understanding (MOU) signed with Zambia’s Ministry of Health (MoH) states that VDP will provide the equipment, training and software for free for the first 12 months, giving the system time to “bed in and have a positive impact on the clinic’s referral rates”. The government is supporting them in motivating and encouraging health staff to use it.

“Following this, we will continue to support the clinical officers, however, a small surcharge will be made to ensure that the system can be upgraded and maintained in the health centres,” Ashcroft told IPS. “All equipment, and licenses for donations is provided by charitable donations, so our aim is to equip the clinics with everything they need for the service to become a self-sustaining, yet integral part of the day-to-day running of the health centres.” The charity is one of the increasing number of NGOs accepting Bitcoin donations.

Andrew Phiri from the MoH is confident the government will be able to support VDP after its first year, stressing it’s a much-needed project.

“We’ve got a lot of people living in rural areas, they have to walk long distances (to clinics). We don’t have a lot of ambulances. You find that our health facilities are not closely linked, they are huge distances apart,” Phiri told IPS.

“Through consultation you are going to give the best quality of care that the patient requires. It will be a very good outcome because, really, in medicine you need to consult, you cannot work alone.”

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Breast Is Best, But Not in Swaziland http://www.ipsnews.net/2014/01/breast-best-swaziland/?utm_source=rss&utm_medium=rss&utm_campaign=breast-best-swaziland http://www.ipsnews.net/2014/01/breast-best-swaziland/#comments Tue, 07 Jan 2014 11:33:24 +0000 Mantoe Phakathi http://www.ipsnews.net/?p=129922 Smiling as she breastfeeds her six-week-old baby boy, Lindiwe Dlamini, 38, is optimistic about his future. Dlamini, who is HIV-positive, is determined that her baby will not be infected. The mother of three – who conceived her first two children when she was HIV-negative – was on antiretroviral therapy (ART) when she delivered a healthy […]

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Lindiwe Dlamini nurses her six-week-old baby boy. Credit: Mantoe Phakathi/IPS

Lindiwe Dlamini nurses her six-week-old baby boy. Credit: Mantoe Phakathi/IPS

By Mantoe Phakathi
MBABANE, Jan 7 2014 (IPS)

Smiling as she breastfeeds her six-week-old baby boy, Lindiwe Dlamini, 38, is optimistic about his future.

Dlamini, who is HIV-positive, is determined that her baby will not be infected. The mother of three – who conceived her first two children when she was HIV-negative – was on antiretroviral therapy (ART) when she delivered a healthy boy in November.

Now she is feeding him on breast milk and nothing else for six months – advice she received during antenatal care. She knows mother’s milk is more nutritious and carries antibodies.

“Breastfeeding is the most affordable method for me because I’m unemployed, but I wasn’t so sure considering my status,” Dlamini told IPS.

FAST FACTS

• WHO recommends exclusive breastfeeding for the first six months

• Breastfeeding should begin within one hour of birth

• Breastfeeding should be "on demand", as often as the child wants day and night

• Bottles or pacifiers should be avoided

• At six months, complementary solid foods, such as mashed fruits and vegetables, should be introduced

Source: WHO

Half of all new episodes of HIV transmission to children occur during breastfeeding if mothers are not on ART, says the Joint United Nations Programme on AIDS (UNAIDS).

Alarmingly, although Swaziland recorded a 38-percent decline in new HIV infections among children between 2009-2012, seven out of 10 mothers here do not receive antiretroviral medicines during breastfeeding to prevent infecting their babies, says the 2013 UNAIDS Progress Report.

Swaziland has one of the highest HIV infection rates in the world, at 26 percent of people aged 15 to 49.

A domestic worker who had to quit her job after falling pregnant, Dlamini relies on the income from her partner, a construction worker. Buying formula milk would strain the family budget. A 900-gramme tin costs 130 emangaleni (about 13 dollars) and lasts a month.

Dlamini breastfed her first two babies without any problem, but faced a dilemma with the third, or so she thought: “The worst thing that could happen to me is to infect my baby with HIV.”

Help came through a mentor mother, Jabu Mkhaliphi, who works for the NGO Mothers to Mothers. An HIV-positive mother who breastfed her three-year-old daughter, Mkhaliphi allays the fears of pregnant women.

“No mother wants to infect their baby,” Mkhaliphi told IPS. She takes them through her experience and, as a result, most of her clients, like Dlamini, embrace exclusive breastfeeding despite their initial fear.

Yet many women living with HIV are sceptical about breastfeeding in this impoverished southern African country. Only 17 percent of children aged four to five months are exclusively breastfed, says the most recent Demographic Health Survey.

And, with a median duration of mixed breastfeeding of 17 months, there are many chances for HIV infection.

Percy Chipepera, director of the Swaziland Infant Nutrition Action Network (SINAN), links this trend to the discovery, back in the 1990s, that breast milk carries the virus, when HIV positive mothers were discouraged from breastfeeding.

“During this period, a lot of children died of diarrhoea and malnutrition,” said Chipepera.

Some deaths could be attributed to poor hygiene when preparing the feeding bottles, leading to gastrointestinal infections, while many parents could not afford formula milk, which led to malnourishment, he explained.

A glimmer of hope was restored when ART was introduced around 2005. ART lowers the mother’s viral load significantly, making breastfeeding, if done properly and exclusively, quite safe.

Being at body temperature, breast milk will not damage the baby’s delicate mucosa lining up its digestive system. However, hot food can cause microscopic lesions through which the virus could enter.

The good news: if the mother’s viral load is low or undetectable thanks to ART, the chances of transmission are greatly reduced.

The art and science of breastfeeding

Exclusive breastfeeding – giving the baby nothing but breast milk – for six months is recommended by the United Nations Children’s Fund (UNICEF), by SINAN and by the Ministry of Health.

However, exclusive breastfeeding is not that simple for many mothers. Grandmothers and aunties may believe that babies are not satisfied by breast milk alone and must be given supplementary food or ritual herbal teas.

Dr. Florence Naluyinda-Kitabire, an HIV/AIDS specialist with UNICEF, attributes these practices to poor understanding of breastfeeding.

Among the things that mothers should learn, said Naluyinda-Kitabire, is that babies should not be removed from one breast until they have dried it out.

“There is a lot of art and science around breastfeeding,” she said. “We need to educate not only the mothers but their families.”

One common mistake is that mothers remove the infant from the one breast soon after they have finished the liquid milk, leaving the hind milk. Yet the hind milk fills up the baby because it has fat.

“While HIV/AIDS is responsible for the decline in breastfeeding, other issues need to be addressed,” said Naluyinda-Kitabire.

One is the misconception, not only in Swaziland, that exclusive breastfeeding is for HIV-positive mothers. Naluyinda-Kitabire stressed that all babies, irrespective of the mother’s HIV status, should be breastfed because it is good for their health.

On average, exclusive breastfeeding by Swazi mothers lasts only three months, reports the 2010 Swaziland Multi-Indicator Cluster Survey.

Part of the reason is that mothers must return to work after 12 weeks. The International Labour Organisation, through the Maternity Protection Convention, which Swaziland has not yet ratified, calls for a minimum maternity leave of 14 weeks and for workplace support for nursing mothers.

Another deterrent is the aggressive commercial marketing of formula as a good substitute for breast milk. The government is considering a Public Health Bill to limit false claims in formula marketing, and to force manufacturers to explain, on the tin, in the local language, SiSwati, that breast is best.

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Towards a Change of Culture Leading to a Gender-Balanced Approach http://www.ipsnews.net/2013/12/towards-change-culture-leading-gender-balanced-approach/?utm_source=rss&utm_medium=rss&utm_campaign=towards-change-culture-leading-gender-balanced-approach http://www.ipsnews.net/2013/12/towards-change-culture-leading-gender-balanced-approach/#comments Mon, 23 Dec 2013 17:44:13 +0000 Emma Bonino http://www.ipsnews.net/?p=129707 In this column, Emma Bonino, the Italian minister of foreign affairs, writes about progress made in strengthening women’s rights, and the challenges that still lie ahead.

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In this column, Emma Bonino, the Italian minister of foreign affairs, writes about progress made in strengthening women’s rights, and the challenges that still lie ahead.

By Emma Bonino
ROME, Dec 23 2013 (Columnist Service)

The past three years have been very important to scale up the movement to protect the rights and fundamental freedoms of women and girls and, particularly, to eliminate female genital mutilation worldwide.

We saw the political momentum growing and culminating December 2012 with the consensual adoption by the General Assembly of Resolution 67/146 banning female genital mutilation worldwide.

On that occasion all United Nations member states sent a strong political message about their commitment. The resolution calls upon member states to ensure effective implementation of international and regional instruments protecting women’s rights and to take all necessary measures to prohibit female genital mutilation.

The resolution was an important step forward; it is now our responsibility to ensure its effective implementation. The recent UNICEF report reminds us that despite the best efforts towards its abandonment, female genital mutilation still persists.

For this reason, during the General Assembly this year we organised a side event, together with Burkina Faso, UNFPA and UNICEF, to share specific contributions that governments and international institutions have made to the commitments undertaken with the adoption of the resolution.

Genital mutilation is only one of the manifold forms of violence women are still suffering all over the world. Just to mention the example of my own country, over 100 women have been killed in Italy this year, mostly in the context of domestic violence.

To reverse such a terrible trend, we have increased government action against crimes that victimise women. I am also very proud that Italy became the fifth member state of the Council of Europe to ratify the Istanbul Convention for preventing and combating sexual and domestic violence.

The same happened with the ratification of the Arms Trade Treaty, which introduces principles and criteria to oversee the movement of arms and to combat illegal trafficking. Such treaties contain an explicit provision on gender-based violence.

Women are the first victims of such trade. This also goes in the direction of a general change of culture leading to a gender-balanced approach in peace-building processes.

Gender-based violence was also the common denominator underlying the discussion at the high-level meeting during the General Assembly last September of the Equal Futures Partnership, the initiative launched by former U.S. Secretary of State Hillary Rodham Clinton which Italy just joined.

This is a partnership uniting nations firmly committed to closing the gender gap and to sharing experiences so that local practices can be replicated all over the world.

A less blatant but nonetheless harmful form of violence against women is the practice of early and forced marriages. We must take every opportunity to recall the importance of eradicating this practice in one generation’s time span, accelerating change in culture and traditions through a vibrant, ongoing campaign.

For this reason we also call for the inclusion of this target in the post-2015 development agenda.

A very encouraging step was the approval last month by the U.N. General Assembly’s Third Committee of a resolution aimed at achieving a ban, within the next 12 months, on early and forced marriages. This resolution – promoted by Italy and nine other countries – was co-sponsored by 109 countries and was approved by consensus.

Violence against women also encompasses trafficking and slavery. This is a particularly
painful subject for me: it is very sad and frustrating to feel helpless when hundreds of migrants, women and men and children, tragically die off the coasts of Lampedusa (in Sicily). For this reason we are insisting on a common European effort within the framework of the Mediterranean task force led by the European Commission to combat human trafficking.

This leads me to talk about the situation of women in our neighbouring countries in the Southern Mediterranean. In some of these countries the promotion of women’s rights has a long tradition.

In other cases gender issues have been promoted by those autocratic regimes which the Arab Spring swept away, as they became instrumental for them to show their modern face to Western allies while continuing to violate other human rights.

Whatever the reasons for their past promotion, we must continue monitoring to avoid any setback, like attempts to delegitimise the Personal Status Code (adopted in 1956) in Tunisia or to misapply the law imposing sanctions for female mutilation in Egypt.

For this reason we should increase our efforts in initiatives like the one undertaken by the European Union and United Nations, “Spring Forward for Women”, which includes measures to ensure effective access by women to economic and political opportunities in the Southern Mediterranean region.

On the Italian side, I would also like to mention an initiative we successfully launched last February and that we will repeat next year: Women in Diplomacy School. The school aims at giving women specific tools for their empowerment as leaders. It is open to the participation of young women from our neighbouring Mediterranean countries.

The Women in Diplomacy School is part of a wider project that Italy has launched in view of the Expo Milan 2015, the Women and Expo initiative.

Our ambitious goal is to make Expo 2015 in Milan the first “gender Expo” ever, hoping that this will serve as an example for future editions.
(END/COPYRIGHT IPS)

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U.S. Urged to Change Policy on Support to Victims of Sexual Violence http://www.ipsnews.net/2013/12/u-s-urged-change-policy-support-victims-sexual-violence/?utm_source=rss&utm_medium=rss&utm_campaign=u-s-urged-change-policy-support-victims-sexual-violence http://www.ipsnews.net/2013/12/u-s-urged-change-policy-support-victims-sexual-violence/#comments Thu, 12 Dec 2013 20:26:40 +0000 Ramy Srour http://www.ipsnews.net/?p=129519 The U.S. government is being urged to roll back a longstanding policy that has banned foreign aid funding from being used for health care services for victims of sexual violence in conflict situations. A group of leading U.S. and African NGOs gathered here Wednesday to launch a global campaign that, if successful, would provide millions […]

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By Ramy Srour
WASHINGTON , Dec 12 2013 (IPS)

The U.S. government is being urged to roll back a longstanding policy that has banned foreign aid funding from being used for health care services for victims of sexual violence in conflict situations.

A group of leading U.S. and African NGOs gathered here Wednesday to launch a global campaign that, if successful, would provide millions of women and girls in crisis and conflict areas around the world with post-rape access to comprehensive health care.

The Centre for Health and Gender Equity (CHANGE), an advocacy group, was joined by the U.S.-based Human Rights Watch in calling on the administration of President Barack Obama to clarify or repeal four-decade-old legislation, known as the Helms Amendment, that forbids U.S. foreign aid recipients from using this funding to perform abortions “as a method of family planning.”

“The 1973 Helms Amendment is a law that says no funds are allowed for abortions overseas as a matter of family planning – full stop,” Serra Sippel, the president of CHANGE, told IPS. “But when we talk about abortion in the case of rape, that’s not family planning, so the law [actually] doesn’t forbid foreign assistance to pay for these cases.”

At the new campaign’s launch, Sippel said nearly 50 women between the ages of 15 and 49 are raped every hour in the Democratic Republic of the Congo (DRC), “where rape is used as a war weapon.”

Unwanted pregnancies resulting from rapes in conflict situations have become a particularly visible feature of the ongoing violence in the DRC, where people living in the eastern part of the country remain subject to marauding militias in a war that has claimed nearly three million lives. This situation is exacerbated by the ongoing social stigma surrounding rape across many parts of Africa.

“I will tell you about a 20-year-old girl who was raped and who, since abortion in the DRC is illegal, kept the baby, hiding her pregnancy because rape causes so much shame there,” Justine Masika Bihamba, the founder of the Women’s Synergy for Victims of Sexual Violence (SFVS), a network of 35 women’s rights organisations in the DRC, told IPS.

“But when she gave birth, she went with her mom – who didn’t want her to keep the child – and wrapped the baby in flannel and abandoned it along the road.”

When a hunter passed by and found the baby, he called for help.

“But everyone was afraid,” Bihamba continued, “and no one had the courage to come and cover the child. When they brought it to the hospital, they found out that the child was dehydrated and was about to die.”

The story underscores how difficult it can be for rape survivors to move on with their lives. Often, Bihamba said, women try to hide a post-rape pregnancy because evidence of her assault would brand her as “inferior” to other women, perhaps making it difficult later on to find a husband.

Changing the law

The new campaign, “Break the Barriers”, is now set to step up pressure on the Obama administration to support and allow access to safe abortion services for the millions of women and girls who face sexual violence in areas plagued by conflict. Currently, the confusion surrounding the Helms Amendment makes this difficult.

The problem, advocates suggest, is that the law has been interpreted by U.S. government agencies, including the U.S. Agency for International Development (USAID), to include post-rape abortions, despite the fact that the text only refers to family-planning purposes.

(USAID was unable to respond to requests for comment by deadline.)

“President Obama doesn’t actually need congressional action to do this,” CHANGE’s Sippel said. “We are simply asking him to clarify, through an executive order, that the law doesn’t bar funding for abortions in cases of life endangerment.”

Yet others say more drastic change is required.

“We think that the Helms law is just bad law,” Liesl Gerntholtz, the executive director of the women’s rights division at Human Rights Watch, told IPS. “It deprives women of critical services and it really doesn’t advance human rights in any way.”

Gerntholtz says the Helms Amendment should be repealed.

Future roadmap

But the U.S. government has also recently taken a series of measures that recognise sexual violence as a frequent characteristic of conflict. In 2011, the Obama administration issued an executive order, the U.S. National Action Plan on Women, Peace and Security, which sought to “protect women from sexual and gender-based violence and to ensure equal access to relief and recovery assistance.”

Yet advocates point out that women’s security worldwide remains unacceptably weak. Recent U.N. statistics find that the first half of 2013 saw 705 registered cases of sexual violence in the DRC alone, while the World Health Organisation notes that nearly 50,000 women and girls continue to die from unsafe abortions every year.

The Obama administration also recently embraced U.N. Security Council Resolution 2122, adopted in October, which is set to strengthen women’s participation in “all phases of conflict prevention, resolution and recovery,” in addition to ensuring better access to comprehensive reproductive services.

But, activists say, more needs to be done.

“We would like to see the U.S. develop a roadmap and strategies that will enable [reproductive services] to reach the most vulnerable,” Ruth Ojiambo Ochieng, the executive director of the Uganda-based Isis-WICCE, a women’s rights group, told IPS.

But while the newly launched campaign puts a strong emphasis on what the U.S. government could and should do, there are obstacles to what U.S. activism can achieve. Perhaps most importantly, abortion remains illegal in many countries.

In the DRC, for instance, abortion is criminalised by two articles of the country’s criminal code, which punish “women who get an abortion, but also anyone who assists them with the practice,” SFVS’s Bihamba told IPS.

Even if the Helms Amendment were to be repealed or clarified, U.S. and international humanitarian agencies would likely face legal hurdles in the provision of abortion on the ground.

Still, advocates hope that a strong U.S. stance on the issue will send an important signal globally.

“An executive order coming from the [Obama administration] would show the world that the U.S. government is stepping up to recognising that women who have been raped need access to abortion services,” CHANGE’s Sippel told IPS. “Global leadership by the U.S. government can really help push [countries] like the DRC to move forward and change their laws.”

The post U.S. Urged to Change Policy on Support to Victims of Sexual Violence appeared first on Inter Press Service.

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